Back in the Day: James Lind – the Scotsman considered a medical hero

Housed in an imposing building, the School (usually abbreviated to LSHTM) was founded by a Scot, Sir Patrick Manson (1844-1922) in 1899 and was originally located in the Thameside docklands. The current building dates from 1929 when it was opened by HRH the Prince of Wales, the future Edward VIII who abdicated to become the Duke of Windsor.

Around the building is a frieze on which are carved 23 names of men who made a massive contribution to the fields of hygiene and tropical medicine. The names were chosen by a committee whose deliberations were in secret so we do not know what criteria were used to judge those who were honoured in this way. Suffice to say they are legendary figures in the two fields of medicine which make LSHTM one of the great medical institutions of the world.

One of the 23 is Manson himself, and others on the frieze include the great French chemist and microbiologist Louis Pasteur, the founder of epidemiology Thomas Sydenham, and the discoverer of vaccination Edward Jenner.

Yet of the 23, no fewer than seven of the names belong to Scots, if we accept Joseph Lister as one of us – and he did make most of his discoveries about antiseptics and preventative medicine here in Scotland. The other six are Manson, Sir David Bruce, Sir Ronald Ross – born in India to a Scottish father – Sir John Pringle, Sir William Leishman and Sir James Lind.

Over the next three weeks I will be looking at the contributions these men made to history, in order to show just how disproportionate Scotland’s contribution to medical science has been. We really did lead the world in many aspects of medical science and those names on the LSHTM’s walls are proof of that.

I suspect that the names of Ross and Bruce will be known to those who have an interest in the subject of medicine, but I suspect not too many people will know too much about James Lind, which is a great pity because he is one of the most fascinating characters in Scotland’s medical history and pioneered a scientific technique which is standard across the world today. He also played a huge and largely unrecognised part in ensuring that Napoleon was unable to conquer Britain, as we shall see.

There have been many discussions recently about the benefits and drawbacks that the Act of Union of 1707 brought to Scotland in the 18th century, and it has to be concluded that some people did really well out of the Union, mostly the wealthy and the aristocracy.

What is rarely discussed is just how much Scotland brought to the newly minted United Kingdom. The 18th century Jacobite risings have been used by propagandists for the British state to colour the history of that century as one of English supremacy within the Union, but in the fields of science and industry – as we saw recently with James Watt and William Murdoch – it was Scotland that provided the innovation and invention that drove forward the British Empire.

For as the life and career of James Lind shows, it took a Scot with a questioning and methodical mind to ask the questions and deliver the solutions that helped make one of the great bulwarks of the Empire, the Royal Navy, the ruler of the seas. Indeed, I would contend that Lind made one of the greatest, if not the greatest, contributions to the UK of any Scot in the 18th century.

Lind did not design ships or cannons, but in his own way he gave the Royal Navy a huge advantage in its constant battles across the globe and saved many thousands of lives. It really is no exaggeration to say that the UK owed Lind a massive debt, one that was never repaid.

That situation was summed up in 1896 when an anonymous author published an article entitled Heroes of Medicine: James Lind, which was printed in the medical journal The Practitioner. He wrote: “James Lind has been the means of saving innumerable lives and preventing an incalculable amount of suffering; yet even to the members of his own profession today his name is almost unknown. Of his life even less is known than that of Shakespeare.”

It has probably also been unhelpful to historians researching the life of Lind that he kept no vast archive of notes and that he had a cousin, also James Lind, who was also a doctor and scientist and personal physician to the household of King George III – the two have often been confused in the past, but thanks to a revival of interest in our subject James Lind, we know much more about him nowadays.

JAMES Lind was born in Edinburgh on October 4, 1716, the son of a merchant father, also James, and a mother, Margaret, whose family included doctors and surgeons.

After a broad curriculum education at the High School of Edinburgh, Lind was apprenticed to George Langlands, a surgeon who encouraged him to attend lectures at the Edinburgh Medical School.

On the completion of his apprenticeship, Lind joined the Royal Navy in 1738.

From the outset he had a concern about the health and welfare of sailors, and in particular he was very aware of scurvy, the scourge of sailors the world over.

We now know that this dreadful disease is due to a deficiency of Vitamin C, but back then medicine knew nothing about vitamins and the important role they play in health. Like every other doctor, Lind was baffled as to the cause of scurvy, but he was all too familiar with its often fatal effects, and considered the so-called “cures” to be almost useless. It is important to note, however, that Lind took a holistic approach to the health of sailors, not least because he was convinced – wrongly, as it happens – that scurvy was a result of putrefaction within the body.

His first position was as a surgeons’ mate on a ship which saw action in the Mediterranean, the Caribbean and the Atlantic off the coast of West Africa. Lind later joined the 50 gun ship HMS Salisbury which was part of the Channel fleet. His captain was George Edgcumbe who would later become chief of the Royal Navy.

It was while serving aboard the Salisbury that Lind carried out the experiment that would make his name, albeit many years later. While the ship was on patrol in the Bay of Biscay in 1747, Lind devised a way of testing to see which of the several “cures” for scurvy was most effective.

He set up six groups of two affected sailors each, and while they all ate the same diet, each duo was given different direct treatments. One group had two pints of cider daily, the second group had drops of sulphuric acid, the third got six spoonfuls of vinegar, the fourth group got a half pint of seawater while the fifth was given two oranges and a lemon and the final group some spices and barley water – all six of these treatments had been tried by naval surgeons but no one had ever systematically examined which was the best.

A frieze beside The London School of Hygiene and Tropical Medicine says James Lind and 23 others contributed to medicine

It had been known for centuries that oranges, lemons and limes gave relief, but now Lind proved they were by far the best cure. Indeed, one of the sailors given the citrus fruit was back on duty before the two week test even ended.

The real genius of Lind was to methodically report this controlled clinical trial – one of the first such experiments in medical history.

He would later write: “The most sudden and visible good effects were perceived from the use of oranges and lemons; one of those who had taken them being at the end of six days fit for duty … The other was the best recovered of any in his condition; and being now deemed pretty well, was appointed nurse to the rest of the sick.”

In 1748, Lind left the Navy and returned to Edinburgh to finish his medical degree at the University. His doctoral thesis was on venereal disease which he had seen plenty of in his naval career.

He went into private practice and married Isabella Dickie. They would have two children, John and James, the former following his father into medicine while the latter would have a successful career in the Royal Navy and be knighted for his bravery.

In 1753, Lind published his masterwork: “A treatise of the scurvy. In three parts. Containing an inquiry into the nature, causes and cure, of that disease. Together with a critical and chronological view of what has been published on the subject.”

In his book that was soon being published internationally, Lind showed that scurvy was killing more Royal Navy sailors than the French and Spanish navies. He also described his experiment and his conclusion that scurvy is a disease of faulty digestion and excretion, exacerbated by environment. He believed there were multiple causes of scurvy, including diet, foul air and lack of exercise.

That is possibly why he did not say he had found a cure, though he did write: “Some new preservative against the scurvy might in this treatise have been recommended; several indeed might have been proposed, and with great show of probability of their success; and their novelty might perhaps have procured them a favourable reception in the world. But these (citrus) fruits have this peculiar advantage above anything that can be proposed for trial, that their experienced virtues have stood the test of nearly 200 years.”

Yet maddeningly, Lind did not go the whole way and claim he had found the cure for scurvy: “What medicine can counteract the continued influence of improper diet, air and confinement, the last of which in particular I now judge to be a principal cause of the great obstinacy and frequent mortality of the scurvy in long voyages at sea.”

Lind was soon appointed chief physician to the new Haslar Hospital in London, and continued with his experiments on scurvy treatments. He wrote: “To what has already been said of the virtues of oranges and lemons I have now to add that in seemingly the most desperate cases the most quick and sensible relief was obtained from lemon juice by which I have relieved many hundred patients.”

He was still hugely concerned with sailors’ health and welfare – he showed the Royal Society his method of distilling fresh water from seawater and was instrumental in recommending a general improvement in the care of sick sailors, particularly their personal hygiene, which the Royal Navy by and large adopted.That recommendation came because of a simple piece of observation – the upper floors of Haslar Hospital were largely free of typhus, another big killer of sailors, because the patients were kept clean while the disease ravaged the lower floors were hygiene was not so good.

It was not until the 1790s that the Admiralty was persuaded to look at Lind’s work again, and after further Lind-style experiments, in 1795 the Navy was ordered to issue lime and lemon juice to all sailors – in a very short time, scurvy was under control, just in time for Trafalgar and the 19th century supremacy of the Royal Navy.

Lind did not live to see his great work finally accomplished because he died at Gosport in 1794. Only in recent decades has the scale of his achievement been truly recognised.