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James Lind's evidence-based medicine

Apropos the BMJ’s remarks on the arrival of evidence-based medicine, I was reminded by Theodore Dalrymple, writing in the April 22, 2006 Spectator, that James Lind, a Royal Navy surgeon, conducted one of the world's first controlled medical trials. The year was 1747, and Lind was trying to cure scurvy, a devastating deficiency of ascorbic acid (Vitamin C).

Scurvy can cause ulcers of the lower legs and feet, bleeding gums, loss of teeth and hair, weakness, depression, hallucinations, blindness, and death. It is believed that in the 18th century the Royal Navy saw more mortalities from scurvy than from battles.

A surgeon of the British East India Company had advocated using citrus fruits to combat scurvy as early as 1600, but his advice fell on deaf ears. Lind was the first to probe the citrus effect with a systematic experiment. His trial proved the efficacy of citrus fruits, and ranks as one of the first experiments in the history of medicine.

Lind ascribed the effect of the citrus fruits to their acid. He had no knowledge of vitamins, which were discovered by British scientist Frederick Gowland Hopkins in the early 20th century. (Hopkins' curious career is described here.)

Lind published his results in 1753, but the lackadaisical attitude of the authorities meant that quite a few years passed before citric fruits became part of the shipboard menu. In 1794 Gilbert Blane, also experimenting, issued lemon juice on board the Suffolk on a two-month-long voyage to India. The ration mixed in the daily grog (Bacardi Limon?) contained the necessary minimum daily intake of ascorbic acid, and no sailor fell ill. The Admiralty took notice.

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