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Case 3: Naval Medicine: The Fight Against Scurvy
Exhibition curator: Katie Sambrook
James Lind. A treatise on the scurvy. Second edition. London: printed
for A. Millar, 1757.
St. Thomas's Historical Collection 28.b.9
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Account of Lind's experiment into the prevention of scurvy, from: James Lind. A treatise on the scurvy. Second edition. London: printed for A. Millar, 1757. [St. Thomas's Historical Collection 28.b.9 ] (click on image to see larger version). |
Scurvy was the most widespread and malignant disease of seamen in the eighteenth
century. Caused by a shortage of vitamin C, it was a direct result of the poor
diet, almost entirely lacking in fruit and vegetables, provided for seamen on
board ship. Initial symptoms included ulcers, swollen gums, the loosening of
teeth and general lassitude; often the disease proved fatal. The search for
means of prevention and cure preoccupied not only naval physicians and surgeons
but also the British government, acutely aware of the need for a fit and healthy
Royal Navy to fight the succession of wars against France.
James Lind, a naval surgeon on board the 60-gun HMS Salisbury, was responsible
for one of the most important medical developments of the eighteenth century.
Observing that the diet supplied to the crew of the Salisbury was dominated
by salt and starch and that one of the characteristics of scurvy sufferers was
an overwhelming craving for fruit and vegetables, he conducted a controlled
clinical trial. He chose twelve scurvy patients and supplied them all with the
usual ship's diet for six days. Two of the twelve also each received two oranges
and one lemon a day each, another two each received a quart of cider a day,
another pair half a pint of sea water a day each and so on. At the end of the
six days the two whose diet had included the fresh fruit were able to return
to duty. Lind now knew that fresh fruit could cure scurvy. As it was not possible
for crews on long voyages to receive regular supplies of fresh fruit, he recommended
the daily provision of preserved lemon juice.
The page on display records Lind's experiment on the Salisbury.
Charles Bisset. A treatise on the scurvy, design'd chiefly for the use of the British Navy. London: printed for R. and J. Dodsley, 1755
St. Thomas's Historical Collection 21.c.10(b)
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| Charles Bisset's proposed diet to prevent scurvy, from: Charles Bisset. A treatise on the scurvy, design'd chiefly for the use of the British Navy. London: printed for R. and J. Dodsley, 1755. [St. Thomas's Historical Collection 21.c.10(b)] (click on image to see larger version). |
Initially Lind's Treatise had little influence; as a former naval surgeon, his status in the medical profession was not high and to many medical authorities his prescription of lemon juice seemed too simple a solution to be true. Other writers continued to propound their own theories as to the best way to combat scurvy, among them Charles Bisset (1717-1791), who, in his treatise of 1755, shown here, recommends a diet of gruel, wine, rice, salt meat and mustard: precisely the type of diet, in fact, likely to produce an outbreak of scurvy, rather than prevent it. Others suggested giving sufferers sea water to drink or, in the absence of any other solution, fell back on that general cure-all of eighteenth century medicine, blood-letting.
Thomas Dickson Reide. A view of the diseases of the Army in Great Britain, America, the West Indies, and on board of King's ships and transports. London: printed for J. Johnson, 1793
Guy's Hospital Physical Society Collection RC971 REI
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| Thomas Dickson Reide's method for treating scurvy, from:Thomas Dickson Reide. A view of the diseases of the Army in Great Britain, America, the West Indies, and on board of King's ships and transports. London: printed for J. Johnson, 1793. [Guy's Hospital Physical Society Collection RC971 REI] |
The American War of Independence saw a high incidence of scurvy among both
the men of the Royal Navy and the troops transported across the Atlantic. Reide,
an army surgeon with the First Regiment of Foot, served in North America and
the Caribbean. As this publication shows, even by the 1790s it was still not
generally accepted that fresh fruit and vegetables were the best weapons against
scurvy. While Reide acknowledges the benefits of a good diet, his principal
methods of treatment were blood-letting, bathing in an infusion of spruce (plentiful
in North America), fomentation with ointments and the administering of various
medicines.
Gilbert Blane. Observations on the diseases incident to seamen. London: printed by Joseph Cooper, 1785
St. Thomas's Historical Collection 28.a.20
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Gilbert Blane. Observations on the diseases incident to seamen. London: printed by Joseph Cooper, 1785. [St. Thomas's Historical Collection 28.a.20] (click on above image for a larger version). |
It was not until 1795, over forty years after Lind had first published his Treatise, that the daily provision of preserved lemon juice, supplemented by regular supplies of fresh fruit and vegetables whenever these were obtainable, was prescribed by the Admiralty for the prevention and cure of scurvy. Instrumental in influencing this decision was the work of naval physician Gilbert Blane (1749-1834). Blane served under Vice-Admiral Rodney as Physician of the Fleet during the American War of Independence. His Observations on the diseases incident to seamen records the conclusions drawn from his years of service and shows him to be a whole-hearted supporter of Lind. Unlike Lind, however, Blane was in due course to attain a position of influence. By 1795 he was himself Commissioner for the Sick and Wounded and was able, through his friendship with Sir Alan Gardner, a member of the Board of the Admiralty, to recommend the daily issue of lemon juice. By the time of Trafalgar this daily prescription was an integral feature of naval life. Nelson was an ardent supporter of the scheme and made strenuous efforts to increase the allowance of lemon juice supplied to the Fleet, as well as its supply of fresh fruit and vegetables.
On display is a table recording the total numbers of sick, wounded and dead in the British fleet serving in America for the month of April 1782. In his commentary Blane points to the low level of disease for that month, attributing it to a variety of factors, including high morale from recent success in battle and the recent arrival of fresh provisions from England. Our copy of this book was given by Blane to the library of St. Thomas's Hospital, where he was a physician.
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