Editing James Lind (section)

===Prevention and cure of scurvy===
{{Main article|Scurvy}}

Scurvy is a disease caused by a [[vitamin C]] deficiency, but in Lind's day, the concept of [[vitamin]]s was unknown. Vitamin C is necessary for healthy [[connective tissue]]. In 1740 the catastrophic result of [[George Anson, 1st Baron Anson|then-Commodore George Anson]]'s [[George Anson's voyage around the world|circumnavigation]] attracted much attention in Europe; out of 1900 men, 1400 died, most of them allegedly from scurvy. According to Lind, scurvy caused more deaths in the British fleets than French and Spanish arms.<ref>Bown, Stephen R. (2003). ''Scurvy: How a Surgeon, a Mariner, and a Gentleman Solved the Greatest Medical Mystery of the Age of Sail''. New York, NY: St. Martin's Press. {{ISBN|0-312-31391-8}}</ref>

Since antiquity in some parts of the world, and since the 17th century in England, it had been known that [[citrus fruit]] had an [[antiscorbutic]] effect. [[John Woodall]] (1570–1643), an English military surgeon of the [[British East India Company]] recommended them<ref>Rogers, Everett M. (1995). ''Diffusion of Innovations''. New York, NY: The Free Press. {{ISBN|0-7432-2209-1}}. Page 7.</ref> but their use did not become widespread.  [[John Fryer (travel writer)|John Fryer]] (1650–1733) too noted in 1698 the value of citrus fruits in curing sailors of scurvy.<ref>{{Cite journal|last=Wujastyk|first=Dominik|date=2005|title=Change and Creativity in Early Modern Indian Medical Thought|journal=Journal of Indian Philosophy|language=en|volume=33|issue=1|page=96|doi=10.1007/s10781-004-9056-0|issn=0022-1791|pmc=2633698|pmid=19194517}}</ref> Although Lind was not the first to suggest citrus as a cure for scurvy, he was the first to study its effect by a systematic [[Controlled experiment|experiment]] in 1747.<ref>Carlisle, Rodney (2004). ''Scientific American Inventions and Discoveries'', John Wiley & Songs, Inc., New Jersey. p. 393. {{ISBN|0-471-24410-4}}.</ref> It was one of the first reported, controlled, clinical experiments in history, particularly because of its use of [[control groups]].<ref name="Baron2009"/>

Lind thought that scurvy was due to [[putrefaction]] of the body that could be helped by [[acid]]s, so he included an acidic dietary supplement in the experiment. This began after two months at sea when the ship was afflicted with scurvy. He divided twelve scorbutic sailors into six groups of two. They all received the same diet, but in addition group one was given a quart of [[cider]] daily, group two twenty-five drops of elixir of [[vitriol]] (sulfuric acid), group three six spoonfuls of [[vinegar]], group four half a pint of seawater, group five two [[orange (fruit)|oranges]] and one [[lemon]], and the last group a spicy paste plus a drink of [[barley water]]. The treatment of group five stopped after six days when they ran out of fruit, but by that time one sailor was fit for duty while the other had almost recovered. Apart from that, only group one showed any effect from its treatment.{{citation needed|date=November 2023}}

Shortly after this experiment, Lind retired from the Navy and practised privately as a physician. In 1753, he published ''A treatise of the scurvy'',<ref name="Lind1753">{{cite book|first =James |last= Lind |title=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 |edition= 1st |url= https://archive.org/details/b30507054 |year=1753|publisher=A. Kincaid and A. Donaldson |place= Edinburgh |via= Internet Archive}}; [https://archive.org/details/treatiseonscurvy00lind (2nd ed., 1757)]; [https://archive.org/stream/treatiseonscurvy1772lind#page/n5/mode/2up (3rd ed. 1772)]</ref> that was mostly ignored. In 1758, he was appointed chief physician of the [[Royal Hospital Haslar|Royal Naval Hospital Haslar]] at [[Gosport]]. When [[James Cook]] went on his first voyage he carried [[wort]] (0.1&nbsp;mg vitamin C per 100&nbsp;g), [[sauerkraut]] (10–15&nbsp;mg per 100&nbsp;g) and a syrup, or "rob", of oranges and lemons (the juice contains 40–60&nbsp;mg of vitamin C per 100&nbsp;g) as antiscorbutics, but only the results of the trials on wort were published. In 1762 Lind's ''Essay on the most effectual means of preserving the health of seamen'' appeared.<ref name="Lind1762">{{cite book|author=James Lind|title=An Essay on the Most Effectual Means of Preserving the Health of Seamen in the Royal Navy: Containing Directions Proper for All Those who Undertake Long Voyages at Sea&nbsp;... |url=https://archive.org/details/b30511410|year=1762|publisher=D. Wilson|pages=[https://archive.org/details/b30511410/page/4 4]–}}</ref> In it he recommended growing salad—i.e. [[watercress]] (43&nbsp;mg vitamin C per 100&nbsp;g)<ref>{{Cite web|url=https://fdc.nal.usda.gov/fdc-app.html#/food-details/170068/nutrients|title = FoodData Central}}</ref>—on wet blankets. This was put into practice, and in the winter of 1775 the British Army in North America was supplied with mustard and cress seeds. However Lind, like most of the medical profession, believed that scurvy came from ill-digested and putrefying food within the body, bad water, excessive work, and living in a damp atmosphere that prevented healthful perspiration. Thus, while he recognised the benefits of citrus fruit (although he weakened the effect by switching to a boiled concentrate or "rob", in which the boiling process destroys vitamin C), he never advocated citrus juice as a single solution. He believed that scurvy had multiple causes which therefore required multiple remedies.<ref>{{Cite journal | doi = 10.1080/21533369.2002.9668317|pmid=20355298| title = James Lind and scurvy: A revaluation| journal = Journal for Maritime Research| volume = 4| pages = 1–14| year = 2002| last1 = Bartholomew | first1 = M. |s2cid=42109340}}</ref>

The medical establishment ashore continued to believe that scurvy was a disease of putrefaction, curable by the administration of elixir of vitriol, infusions of wort and other remedies designed to 'ginger up' the system. It could not account for the effect of citrus fruits and so dismissed the evidence of them as unproven and anecdotal. In the Navy however, experience had convinced many officers and surgeons that citrus juices provided the answer to scurvy, even if the reason was unknown. On the insistence of senior officers, led by Rear Admiral [[Alan Gardner, 1st Baron Gardner|Alan Gardner]] in 1794, lemon juice was issued on board the ''[[HMS Suffolk (1765)|Suffolk]]'' on a twenty-three-week, non-stop voyage to India. The daily ration of two-thirds of an ounce mixed in [[grog]] contained just about the minimum daily intake of 10&nbsp;mg vitamin C. There was no serious outbreak of scurvy. This resulted in widespread demand for lemon juice, backed by the [[Sick and Hurt Board]] whose numbers had recently been augmented by two practical naval surgeons who knew of Lind's experiments with citrus.  The following year, [[the Admiralty]] accepted the Board's recommendation that lemon juice be issued routinely to the whole fleet.<ref name="Vale, Brian 2008, p. 160-75">{{Cite journal | doi = 10.1080/00253359.2008.10657052| title = The Conquest of Scurvy in the Royal Navy 1793–1800: A Challenge to Current Orthodoxy| journal = The Mariner's Mirror| volume = 94| issue = 2| pages = 160–175| year = 2008| last1 = Vale | first1 = B. | s2cid = 162207993}}</ref> Another Scot, [[Archibald Menzies]], brought citrus plants to [[Kealakekua Bay]] in [[Hawaii]] on the [[Vancouver Expedition]], to help the Navy re-supply in the Pacific.<ref name=vancouver>{{cite journal| title=Vancouver in Hawaii |author1=Speakman, Cummins  |author2=Hackler, Rhoda |hdl= 10524/121 |journal=Hawaiian Journal of History |volume=23 |year=1989 |publisher=Hawaiian Historical Society, Honolulu}}</ref>
This was not the end of scurvy in the Navy, as lemon juice was at first in such short supply that it could only be used in home waters under the direction of surgeons, rather than as a preventative. Only after 1800 did the supply increase so that, at the insistence of [[John Jervis, 1st Earl of St Vincent|Admiral Lord St Vincent]], it began to be issued generally.<ref name="Vale, Brian 2008, p. 160-75"/><ref>Macdonald, Janet (2006). ''Feeding Nelson's Navy. The True Story of Food at Sea in the Georgian Era.'' Chatham, London. {{ISBN|1-86176-288-7}}, pp. 154–166.</ref>