MAN WHO CURED SCURVY

Press, Volume CI, Issue 29844, 9 June 1962, Page 8

MAN WHO CURED SCURVY

Remarkable Achievement Of Scottish Doctor (Specially written for “The Press” by ALASTAIR BORTHWICK] LONDON. rpWO thousand men set out to sail round the world with Commodore Anson in the year 1740. When the voyage ended four years later, all but 200 of them were dead. The disease which killed them was scurvy. The defeat of this disease, the scourge of sailors for centuries, was brought about by an Edinburgh doctor called James Lind, who heard of the Anson disaster and determined to get to the root of it. So well did he succeed and so simple was his cure that in the 200 years since his ideas were put into practice the number of lives he has saved must run into hundreds of thousands. Navies today, and armies, too, still safeguard the health of their men by applying the discoveries of this man.

Scurvy is almost unknown now, but once it was an accepted part of life at sea. This is what Anson had to say about it:— “This disease is surely the most singular and unaccountable of any that affects the human body. Its symptoms are inconstant and innumerable, and its progress and effects extremely irregular: for scarcely any two persons have the same complaints. . . . “However, there are some symptoms which are more general than the rest. . . .

These common appearances are: large discoloured spots dispersed over the whole surface of the body; swelled legs; putrid gums; and, above all. an extraordinary lassitude of the whole body . . . and this lassitude at last degenerates into a proneness to swoon, on the least exertion of strength, or even the least motion. This disease is likewise usually attended with a strange dejection of spirits: and with shiverings, tremblings, and a disposition to be seized with the most dreadful terrors.”

Anson’s list of symptoms does not stop there. In his account of his nightmare voyage he describes many other guises in which scurvy took the lives of his men Often, he says, it produced fevers. pleurisy, jaundice, rheumatic pains, shortness of breath, ulcers, and was so deceptive that men who thought they were on the way to recovery dropped down dead without warning. It was this remarkable assortment of symptoms which had defeated the doctors and the quacks for so long, because with so much to choose from they had come to the conclusion that scurvy was not one disease but many. They talked of land scurvy and sea scurvy, the hot scurvy and the pale scurvy and mouth scurvy, and dozens of others; and for all of these they ascribed different causes and different cures.

reading today. But it was not so easy then. The doctors maintained, furiously contradicting each other, that scurvy was caused by hot air, or cold air, or moist air; by salt rations, bad bread, old cheese and rancid butter; by the immoderate use of tobacco; by ale and gluttony; or by almost any other cause that came into the doctor’s head. The cures were equally various and included bleeding, blistering, purging, wine, cider, Greenland scurvy-grass, green vegetables, sea water, and concoctions such as a broth of snails and crayfish, or asses' milk and the juice of dandelions. Each expert had his own cure; and. since the course of the disease varied so greatly, all were able to delude themselves that they were doing some good. It was upon this scene of ignorance and superstition that Lind entered, determined to begin once more at the beginning. He threw overboard most previous teaching and resolved to believe only what he could see and test for himself.

As he was a naval surgeon, he was able over the years to build up the mass of facts he needed, for in those days there was never any shortage of scurvy victims in the British Navy, or indeed in any other navy. In the end he carried out what is now recognised as the first properly controlled experiment in the history of medicine. Experience suggested a small number of cures which might conceivably work. Unlike the other doctors. Lind did not plump for one of them and then start erecting some fancy theory upon it. He tested them in the modern way. against each other. On May 20. 1747, on board H.M S. Salisbury, he took 12 sailors suffering from scurvy (“Their cases as similar as 1 could have tljem”) and gave them the six most likely cures. All had the same basic diet, but in addition he gave two of them a quart of cider a day. two a thrice-daily dose of elixir vitriol, two a dessert

spoonful of vinegar. He made two drink sea water, two had a daily lemon and a couple of oranges, and the remaining two had a mixture of garlic, mustard seed and a number of other ingredients. Five of the groups showed little improvement, but the condition of the sixth seemed miraculous. Of the two men who had oranges and lemons, one was fit for duty in six days and the other was so well that he was soon nursing the rest. The secret evidently lay in the juice of oranges and lemons. Further experiment confirmed the cure. The case was proved. In 1753 Lind published “A Treatise of the Scurvy," which set out the whole means of preventing and treating the disease. It went into elaborate detail on diet and living conditions, but at the heart of it was his recipe for making concentrated lemon juice and his recommendation that the juice should be made part of the Navy's regular rations. If this were done, he said, scurvy would cease.

It took the Navy more than 40 years to take him seriously, but when it did take him seriously in 1795 the disease became virtually extinct in naval ships within two years. No sooner was each man issued with a daily ounce of lemon juice after his sixth week at sea than scurvy cases simply did not arise. It was recorded that a hospital which handled over 1500 cases a year before Lind’s cure was adopted had only one case a few years later. The cure was almost as remarkable from the defence point of View as it was from the medical, for Lind’s little daily tot of juice actually doubled the effective strength of the Royal Navy. In the days when ships had to put back into port every 10 weeks as scurvy began to strike down their men, other ships had to stand by to take their place. Now duplication was unnecessary. It was officially stated that one man-of-war with lemon juice was worth two men-of-war without.

Lind’s discovery was not the end of the story, thanks to the unfortunate fact that the words “lime juice” were often used where “lemon juice" was meant. Americans call the English "Limeys” to this day for that reason. In fact the Mediterranean lemon was three times as effective as the much cheaper West Indian lime, and the use of lime juice in insufficient doses continued to allow scurvy outbreaks, especially in merchant ships. Also the authorities on land were slower to adopt Lind's ideas than the naval ones, late though the naval authorities were, and disasters continued to strike armies living on a restricted diet. Extraordinary as it seems, as late as 1912 Captain Scott and his party set off for the South Pole with rations which contained neither fruit nor vegetables.

Then work began on isolating the substance in oranges, lemons, and similar fruits which brought about the cure so that it might be produced artificially in a factory. With the disease conquered there

Since we know now that a regular ration of lemon juice would have cured them all, these theories make curious

were no human patients to experiment upon, but it was discovered that guinea pigs could contract scurvy and it then became possible to try out the different fruits and measure their potency. Best of all, it was found, was rose-hip syrup: and almost as good (as Lind himself knew) were black currants. Oranges were only one-quarter as effective as these, but the laboratory experiments nevertheless proved him right; oranges were quite good enough, and unlike the other fruits they were cheap and plentiful. Science has not been able to discover any natural scurvy cure more practical than Lind’s.

But science pressed on towards an artificial cure. Gradually the various elements in the fruits were whittled away, and in the end they were left with ascorbic acid, which we now know contains the vital element, vitamin C. The chemical structure of the vitamin was laid bare in 1933, and soon afterwards it could be turned out in a factory. A truckload of pills manufactured today could have prevented half the scurvy disasters in history.

It is a long story and a tragic one; and the most tragic aspect of it is that the cure was so simple. Men died for centuries, by the hundreds of thousands in the most appalling circumstances: and almost none of it was necessary. Each and every one of them could have been saved, as the great James Lind showed, by a glass of lemon juice.