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Scurvy - The Tale of naval Hippocrates

It is difficult to imagine what needs to be accomplished by a physician to be compared to Hippocrates. In fact, I’d go so far as saying, it’s doubtful that any one doctor could give as much time to the learning, understanding and propagating medicine and it’s facets as Hippocrates. Yet, here is a man who had been called the Hippocrates of Naval medicine - James Lind.

Now we all know that James Lind was the man that figured out that the cure for scurvy was Vitamin C containing foods. But how did this discovery even come about? As it turns out, people before Lind already knew that citrus containing foods lead to curing scurvy. What Lind added to the fight against scurvy was evidence that citrus was curative to scurvy. In essence, Lind performed one of the earliest known epidemiological studies.

So how did he do it? 

Lind actually believed that scurvy was caused by putrefaction if your body and he believed that this putrefaction could be stopped by acids. However, he wasn’t sure which acid was most effective. So, he set up and experiment. 

While on a voyage, he picked twelve sailors who were suffering from scurvy and divided them into six groups of two. Each of the groups got a different acid. Group one was given a quart of cider daily. Groups two got twenty five drops of sulfuric acid. Group three got six spoons of vinegar. Group four got half a pint of sea water. Group five got two oranges and a lemon. And group six got spicy paste and a mix of barley water. 

The patients in group five were only given their medication for three days as they ran out of lemons and oranges. However, the patients of groups five were the most responsive to treatment. This sends as a major mile stone both epidemiology and in medicine.

Lind published his findings in a book called “A treatise on scurvy.” This was initially ignored but as the age of exploration began for the East India Trading company, the need to find a cure increased. Lind’s work began to be recognised for the groundbreaking idea it was. 

But the story of James Lind is not done with the understanding of the disease and it’s cure. There was another, bigger problem - that of logistics. There was no way for the ships to keep fresh produce like lemons and oranges for months on end without spoiling. As a result, even a well stocked ship had naval officers afflicted with scurvy because the produce just got spoilt.

James Lind, now retired, vowed to find a solution - an elegant one at that. Lind discovered that a plant known as water cress was present in abundance and was a good source of vitamin C. So Lind suggested that they grow the plan on board so that they never run out of healthy sources of Vitamin C. And once that was started, there were virtually no cases of scurvy to follow on the high seas. 

The simple story of vitamin C, it’s loss and deficiency, the discovery of a solution, developing that into a cure and implementing it is what the life of any physician should look like. Our life is a never pursuit of solutions.

Author: Narendran Sairam (Facebook)

Sources and citations

Brown, Robert H, et al. “Nutrition.” Harrison's Principles of Internal Medicine, by Larry Jameson et al., 19th ed., vol. 2, McGraw Hill, 2017