James Lind and scurvy: the first modern clinical trial

James cute was a scottish doctor in the service of His Majesty’s Navy (Royal Navy), who lived in the first half of the century XVIII. Surely few of you will remember having studied or read it, but it is held as the first person to conduct a clinical trial with “modern” features. Also, like the person who deduced, thanks to said trial, the efficacy of the treatment of ingesting citrus fruits as a method for cure scurvy (1). – What is scurvy? Well it comes from Frenchscorboute», which refers to one of its worst effects: «belly rupture» -. But, is this really true?

A time of navigators and discoveries

since it started the age of “discoveries”a late 15th century, Europeans were exploring and mapping the world like never before. It was also thanks to technological innovations on navigation and nautical. These allowed the development of new vessels and a better knowledge of maritime routes.

…with many problems

However, there was a catch. Well everyone who embarked on a long sea voyage ran the risk of suffering from an ailment: scurvy. First, she would rot his gums. Then she would give him sores all over his body. And, finally, he would end up leaving him bedridden, without strength, to die shortly after.

Worst of all, this disease, known since ancient times (the Egyptians already suffered from it) (2), it seemed that it could not be avoided no way. Well, it was thought that she was associated with the harsh conditions of long sea voyages. For example: poor diet, consumption of “dirty” water, hard work and overcrowding in unsanitary conditions. This disease was by far the worst enemy of any crew that he tried to stay sailing for “too long” (3).

James Lind: a Scottish doctor to figure it out

Born in Edinburgh in 1716, James Lind studied medicine at the Royal College of Surgeons of Edinburgh. In 1739, entered the royal navy as a medical traineewithout even waiting to have obtained their degree.

Lind spent more than 15 years dealing with the effects of this disease. And, almost on the verge of discharge (1746), he was assigned to his last position as doctor of the HMS Salisbury. There, according to his writings, he executed an idea that had been on his mind for a long time…

James Lind vs. scurvy

James Lind chose 12 sick sailors. He divided them into six groups of two individuals each.. He treated each couple differently, but trying to keep all other factors the same for all of them.. To the first, he prescribed drinking cider. He administered dilute sulfuric acid to others. To the third couple, he made them ingest diluted vinegar. He gave sea water to two others. To another of the couples, a purgative mixture. Finally, citrus fruits (oranges and lemons) to the sixth and last couple. And he was observing his evolution.

Only the couple given the fresh citrus improved completely.. Although he also observed a slight improvement in the patients who took the cider. This led Lind to write, after graduating in 1748, his conclusions in a book that would change the course of the history of medicine: A treatise of the Scurvy (1753). In it, he maintained that there was some connection between the cure of the ailment and the consumption of citrus fruits. Although Lind himself did not understand why the consumption of the juice of these fruits, especially when it had been previously cooked/boiled and packaged to increase its durability on long sea voyages, had practically no effect on the patients (all of it had been lost). vitamin) (4).

…or not resolved altogether…

Lind maintained throughout his life, like the vast majority of physicians of his time, that scurvy had a multifactorial origin. The diet, the lack of fresh air and the overcrowding and lack of hygiene. Therefore, despite his own observations, he maintained that it should be treated from different angles. That is could not be cured only by changing the diet.

It was not until almost half a century later when a new generation of doctors returned to value Lind’s texts. Thus, they imposed citrus consumption in the diet of sailors. Although the royal navy he did not fully implement it until well into the 19th century.

Why is what James Lind wrote important?

The importance of Lind’s study lies in the fact that was correct in describing the need to control the variables of the experimentso that all subjects were in similar conditions and so compare “like with like”. By his own account, he chose patients with similar symptoms, kept them in the same place, and fed them a common diet, apart from supplements.

However, the observation of that citrus helpedalleviated or cured scurvy was something known to European sailors and naval doctors since the 15th century. There are travel texts where its use is discussed and its use on long trips is recommended (5).

Furthermore, today we know of doctors who tested “homogeneous” groups of patients with different treatments from the 9th century (6).

The figure of James Lind today

It is not only doubtful that this essay by Lind was the first, but even that it was actually carried out in the way described in his book, since the results have been studied. ship’s logbooks and in them no case of scurvy has been registered. Of course, there are researchers who suggest that the politics of the time consisted of denying and hide any appearance of the diseasesince it was considered a misfortune inherent to poor organization and conditions on board.

So that, we have no way of proving that this first modern clinical trial was conducted in the manner Lind indicates in his writings.. Even if James Lind had made it all up, he hit on the method that would serve to set many subsequent researchers on the path to finding the best and other new treatments for various ailments (7).

Do not miss more interesting articles and Find out what history is.

References and bibliography

References

(1) Dunn, 1997, p. 64–65.

(2) EA Coordinators, 2016.

(3) Barón, 2009, p. 315–332.

(4) Lind, 1753.

(5) Lazcano González, sf

(6) Turner Poveda, 2004.

(7) Bartholomew, 2002, pp. 1–14.

Bibliography

  • Baron, JH, 2009, “Sailors’ scurvy before and after James Lind – a reassessment”, Nutrition Reviews, vol. 67, no. 6, p. 315–332.
  • Bartholomew, M., 2002, «James Lind and scurvy: A revaluation», Journal for Maritime Research, no. 4, p. 1–14.
  • Bown, S., 2003. Scurvy. How a Surgeon, a Mariner, and a Gentleman Solved the Greatest Medical Miracle of the Age of SailThomas Dunne Books–St. Martin’s Press, Alberta.
  • AE Coordinators, 2016, “Scurvy in a Predynastic Egyptian Baby”, Friends of Egyptology (AE)February 1, 2016. Available at https://egiptologia.com/escorbuto-en-un-bebe-del-predinastico-egipcio/ (December 14, 2020).
  • Dunn, P., 1997, “James Lind (1716–94) of Edinburgh and the treatment of scurvy”, Archives of Disease in Childhood: Fetal and Neonatal Edition. United Kingdom: British Medical Journal Publishing Group, vol. 76, no. 1, pp 64–65.
  • Lazcano González, sf, “Agustín Farfán”, Royal Academy of History. Available at http://dbe.rah.es/biografias/17892/agustin-farfan (December 14, 2020).
  • Lind, J. (1753). 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. edinburgh
  • Turner Poveda, E. (ed.), 2004, Al-Rāzī. The virtuous conduct of the philosopherEd. Trotta, Madrid.