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Physician to the Royal Navy: Dr James Lind and the Scurvy Question

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Physician to the Royal Navy: Dr James Lind and the Scurvy Question Physician to the Royal Navy: Dr James Lind and the Scurvy Question. Portrait of James Lind (1716 - 1794) by Sir George Chalmers (c.1720 – 1791). Clare M. M. Grange. September 2014. © Clare M.M. Grange 2014 Table of Contents Table of Contents……………………………………………………………………………....1 Table of Figures ………………………………………………………………………….........2 Abbreviations…………………………………………………………………………………..2 Dedication and Acknowledgements…………………………………………………………...3 Introduction……………………………………………………………………………………4 Chapter I……………………………………………………………………………………...11 Chapter II……………………………………………………………………………………..25 Chapter III……………………………………………………………………………………40 Chapter IV……………………………………………………………………………………55 Conclusion……………………………………………………………………………………72 Appendix A: Map depicting Haslar and its Environs………………………………………...78 Appendix B: List of the Vitamin C content of various foods………………………………..79 Bibliography………………………………………………………………………………….80 1 Table of Figures Figure I. Graph demonstrating the improving health of the Navy……………………..56 Figure II. Graph comparing Winter Quarter and January 1780-1805………………..…63 Figure III. Photograph of plaque dedicated to James Lind………………………………90 Abbreviations. TNA The National Archives NMM National Maritime Museum 2 Dedication For DT, without whose love and support this dissertation would not have been possible, thank you so very much. To my parents who were most tragically killed many years ago – we were all denied a great deal. Acknowledgements The staff at the Caird Library, National Maritime Museum, Greenwich and the National Meteorological Library and Archive, Exeter deserve acknowledgement for their courtesy and helpfulness. 3 Introduction: Background to the Scurvy Question The popular image of the drunken sailor, riddled with syphilis and scurvy, has long held sway and, in some cases, he has been portrayed as an object of amusement. However, the life of an eighteenth century sailor was no matter for jest. The situation for sailors in Georgian Britain was a hazardous one in which their health was a parlous affair; these men were far more likely to die of disease than any form of traumatic injury. The mortality figures for the Seven Years’ War illustrate this situation demonstrating that approximately 1,500 men died of battle injuries whilst circa 15,000 died from disease.1 The word scurvy evokes images of appalling symptoms such as bleeding gums, suppurating wounds, loss of teeth, neuropathy, fever, horrendous suffering and a dreadful death. Scurvy appears whenever circumstances are such that a diet restricted in ascorbic acid (vitamin C) is the result. This situation occurred in seafarers when they began spending prolonged periods of time at sea in pursuit of exploration, fishing grounds and matters of war, all of which resulted in lack of access to fresh supplies and reliance on salted provisions. The human body is unable to produce its own vitamin C and, as there are various factors to consider including the individual’s bodily store of vitamin C, the time taken to produce scurvy from a vitamin C free diet will vary. On average it would seem symptoms of scurvy would appear in a previously well-nourished individual from about 10 weeks but may take as long as 30 weeks.2 In 1593 scurvy was described by Richard Hawkins as ‘a plague of the seas and a spoyle of mariners.’3 Lord Anson’s voyage around the world (1740-1744) is notorious for the 1Daniel Baugh, ‘The Eighteenth Century Navy as a National Institution 1690-1815) in J.R.Hill (ed.), The Oxford Illustrated History of the Royal Navy (Oxford 2002), pp. 121-2. 2 Roy Porter (ed.), Cambridge Illustrated History of Medicine (Cambridge 1996) p.46. 3Richard Hawkins, The observations of Sir Richard Havvkins Knight, in his voiage into the South Sea. Anno Domini 1593, Early English Books Online p.22. 4 loss of life; 1,051 men died, predominantly from scurvy, out of a complement of 1,955.4 In 1753 James Lind commented: …the scurvy alone, during the last war (War of Jenkins’ Ear 1739 - 1748) proved a more destructive enemy, and cut off more valuable lives, than the united efforts of the French and Spanish arms.5 Sailors faced many other diseases including typhus, otherwise known as gaol or ship fever, and a variety of conditions that came under the general heading of ‘fevers’. Poor ventilation, poor hygiene in combination with overcrowding, as a result of the exuberance of the press gangs, generated conditions which were perfect for the spread of disease. This is illustrated by the fact that in 1755 13,000 men were pressed in six weeks.6 The only health care available was that provided under the contract system whereby sick sailors were placed in private lodgings, the owners of which were paid by the Admiralty, or into civilian hospitals.7 Neither was a satisfactory arrangement; there were increasing levels of sickness, the number of beds was insufficient and the behaviour of the naval personnel could be troublesome and problematic for civilian staff to control. A solution needed to be found even if it was purely for practical reasons and not necessarily compassionate concerns. Eventually, on the 15 September 1744, John Montagu, Earl of Sandwich and First Lord of the Admiralty, was able to persuade the Council of George II that naval hospitals were needed and an order was then 4 Christopher Lloyd and Jack Coulter, Medicine and the Navy 1200-1900, Volume III 1714-1815 (London, 1961) p.296. 5James Lind, A Treatise on 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 1753), p.v. 6Richard Middleton, ‘Naval Administration in the Age of Pitt and Anson’ in Jeremy Black and Philip Woodfine (eds.), The British Navy and the Use of Naval Power in the Eighteenth Century (Leicester,1988), p.110. 7 A.J. Revell, Haslar The Royal Hospital (Gosport, 2000), pp.7-11. 5 issued directing three hospitals to be built.8 Haslar Hospital was the first of these, the others being Plymouth and Chatham. The Haslar foundations were laid in 1746. It was built on a peninsula and is situated at the western side of the entrance to Portsmouth Harbour - please see Appendix A. The hospital was completed in 1761 but the need was such that patients began to be admitted in October 1753.9 Haslar was originally intended to accommodate 1,500 patients but by 1761 it had a capacity of 2,000 and was four times greater in size than the London hospitals of Guy’s and St Thomas’. The final cost was in the order of £100,000 (from an initial estimate of £38,000) which would appear to reflect the scale of the problem and the determination to find a solution.10 An online calculator, Measuring Worth, accessed through the University of Exeter, estimates the cost, in today’s terms, to be equivalent to £5.1 million at the lower end to £13.45 million when the hospital was completed.11 A further illustration of the number of sick entering into Haslar is demonstrated by the recording of 5,045 deaths from 24 August 1755 – 31 March 1765.12 It is difficult to place this figure in context particularly as it does not take into account burials at sea and deaths elsewhere. It is also difficult to estimate the number of men actually in service as there are discrepancies between the number of men voted by Parliament and those apparently on board. Indeed Rodger describes using the numbers voted as ‘an accounting fiction’ and 8 Revell, Haslar The Royal Hospital, pp.7-11. 9 Revell, Haslar The Royal Hospital, pp.7-11 10 N.A.M. Rodger, The Command of the Ocean: A Naval History of Britain 1649-1815 (London ,2005) p.309. 11 Measuring Worth http://www.measuringworth.com/calculators/ppoweruk/ University of Exeter, www.projects.exeter.ac.uk. 12 TNA: ADM 102 /374. ‘List of all the Seamen who have died at the Royal Hospital at Haslar from the 24th August 1755 to the 31st March 1765.’ 6 prefers to use those borne.13 However, it seems the picture is depressing and one that is accompanied by various estimations as to how many skeletons are interred in the grounds of Haslar. Recent archaeological evidence suggests somewhere in the region of 20,000 skeletons may be present, the vast majority of which are thought to be male and from the seafaring fraternity.14 James Lind was appointed Chief Physician of the Royal Hospital, Haslar in 1758 and continued in this post until his retirement in 1783. In 1731 Lind was apprenticed to an Edinburgh surgeon and in 1738 entered the Royal Navy under the command of, the appropriately named, Admiral Haddock. Lind served until 1748 when he returned to Edinburgh and gained his medical degree. Whilst serving on board HMS Salisbury, Lind conducted an experiment (further details of this experiment are in Chapter II) beginning on 20 May 1747, into the prevention and cure of scurvy.15 This is probably the first recorded clinical trial even if the cohort consisted of just twelve subjects. Lind divided them into six groups of two and gave each group a different treatment with one group receiving two oranges and one lemon a day. The treatments continued for six days which was manifestly enough time to produce recovery in the two sailors receiving the citrus fruits. The recovery in one man was so significant that he was sufficiently well to help nurse the others. Lind stated: The consequence was that the most sudden and visible good effects were perceived from the use of oranges and lemons.16 13 Rodger, The Command of the Ocean, pp.636 – 8. 14 P. Roberts, S. Weston, et al ‘The Men of Nelson’s Navy: A Comparative Stable Isotope Dietary Study of Late Eighteenth Century and Early Nineteenth Century Servicemen from Royal Naval Hospital Burial Grounds at Plymouth and Gosport, England.’ American Journal of Physical Anthropology, 148:1-10 (2012).
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