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.

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

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

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.

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.

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.

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.’

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). 15 Lind, Treatise on the Scurvy, 1753, p.191. 16 Lind, Treatise on the Scurvy, 1753, p.193.

Lind wrote a very detailed report of his investigation and findings in his Treatise on the

Scurvy published in 1753 which he dedicated to Lord Anson. Lind went on to treat a great number of scorbutic patients at Haslar and notes that during 1758-1760 he treated 1,146 cases of the disease.17 Lind treated 300 – 400 scorbutic patients a day in Haslar from 1758 – 1763:

…no spot whatever has exhibited more numerous or more distressing cases of

it than Haslar…every morning furnished me with original pictures of the

disease…patients brought from all quarters of the globe.18

Rodger suggests that after the Seven Years’ War scurvy was ‘no longer a serious problem in

British warships’ and believes it has been the subject of some hyperbole.19 It is likely Lind would disagree. Lind describes ‘an almost constant attendance on patients affected with scurvy’ during thirteen years from 1758 to the publication of the 1772 edition of Treatise on the Scurvy.20 In 1780 there was a significant outbreak in the Channel Fleet with 1,457 cases admitted to Haslar.21 In August 1780 there were another 2,400 cases in Admiral Geary’s fleet after a ten week cruise in the Bay of Biscay. There were so many sick they had to be housed in tents erected under the south wall of the hospital. Detailed instructions were issued which included the tents ‘to be formed from booms and sails’; ensuring the encampment was guarded (to prevent desertion); directions as to the care and hygiene of the sick and that:

17 James Lind, An Essay on the most effectual means of preserving the health of seamen, in the Royal Navy…By James Lind… The second edition improved and enlarged (London 1762), p.141. 18 James 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. By James Lind M.D. The third edition, enlarged and improved, (London, 1772), p.iii. 19 Rodger, The Command of the Ocean, p.308. 20 Lind, A Treatise on the Scurvy, 1772, p.iii. 21 Gilbert Blane, Statements of the Comparative Health of the British Navy from the Year 1779 to the Year 1814 with Proposals for its Further Improvement by Sir Gilbert Blane, Bart. F.R.S. Physician to the Prince Regent, Read 20 June 1815. Read June 20, 1815.’ Medico-Chiurgical Transactions, 6 (1815), p.542. 8

…no women to have any communication with them and that no spirituous

liquors are admitted into the encampment.22

John Lind (physician at Haslar and son of James Lind) wrote:

Besides the sick here enumerated many scorbutics were sent on shore from

ships, who were taken care of by their own people, and no account of them

was taken at the hospital. 23

This dissertation will demonstrate there were more cases of scurvy to come.

Lind’s experiment and his findings are at the heart of this dissertation. It must be noted, however, that he was a gifted and dedicated physician whose work and research encompassed much more than scurvy but those aspects are outside the scope of this study. Finally in 1795,

48 years after his experiment, 42 years after the 1753 publication of the Treatise on the

Scurvy and a year after Lind died, the Navy mandated the introduction and supply of lemon juice to its sailors. Why was there such a delay?

It is the aim of this dissertation to examine and analyse the possible reasons for such a hiatus and to provide some original thought to this question. The methodological approach to answering this question will include close analysis of various primary sources which include

Lind’s own writings and those of Gilbert Blane and Thomas Trotter as well as many archival documents. The pursuit of this research has included visits to the Caird Library, National

Maritime Museum, Greenwich; The National Archives, Kew; Historic Library at the Institute of Naval Medicine, Portsmouth; Royal Navy Museum Library, Historic Dockyard,

22 Extract from ‘Letter from Captain Richard Kempenfelt to Vice Admiral George Derby 21st August 1780.’ Cited in Unknown Author ‘H.I.’ ‘Scurvy: An Appendix’ The Naval Review, 3(1956) pp.341-3, 23 Extract from a ‘Letter from Dr John Lind, late physician to Haslar Hospital’ cited in Gilbert Blane, Statements of the Comparative Health of the British Navy, p.552. 9

Portsmouth and the National Meteorological Library and Archive, Exeter. A tour of the grounds of the Royal Hospital Haslar (the buildings are considered too unsafe to enter) added extra depth and feeling to this study. St Mary’s Church, Portchester has also been visited and is where Lind is reputed to be buried; one of the church walls displays a plaque dedicated to him. The Library of the University of Reading has provided some secondary material and the

Internet has also been useful.

The sources will be examined from a quantitative as well as a qualitative aspect but there will not be an elaborate statistical analysis as the records are incomplete. The data will rely on what can be gleaned from the statistics available and will be an indication of trend rather than a definitive account. It will be examined as carefully as possible and considered in relation to the delay in implementing lemon juice.

The primary sources will be considered alongside secondary material which is mixed in its admiration, or otherwise, of Lind and it is intended that by taking a balanced approach to the investigation, a realistic account will be achieved. This should provide an enhanced view of the difficulties facing Lind.

The first chapter of this work will examine the historiography as it relates to scurvy and

James Lind. The second chapter will examine eighteenth century medicine, the prestige, or not, of naval medicine, Lind’s medical education, the clinical trial he conducted and his place and reputation within the medical fraternity. This chapter will place Lind’s findings, recommendations and clinical trial in the medical context of the time. Chapters three and four will form the investigative aspect of this dissertation and attempt to answer the question of why there was such a long delay in the implementation of lemon juice. This is an intriguing conundrum and, apart from an interest in medical history and James Lind as a man and a physician, forms part of the motivation for the selection of this topic. Inevitably, further questions will be raised as the work progresses and the conclusion will form the final chapter.

Chapter One: James Lind in the Historiography

The story of the conquest of scurvy, and of James Lind’s role in that quest, has attracted much attention and been described by one academic as a ‘well-trodden path.’24 The historiography resulting from that path is quite extensive but, to continue the analogy, although it is a path that may have been trodden many times progress along it is not linear and does not follow neat steps of advancement; it is a much more complex journey.

This chapter is able to address just a small amount of the available historiography, but will illustrate the difference in opinion and approach to this subject revealing a dichotomy of feeling about Lind. As a broad generalisation, the medical authors, perhaps not surprisingly, find Lind has been neglected and are very much in praise of his achievements. Others such as

Bartholomew and Wootton are far more critical and believe Lind and his work on scurvy have been given undue credit.

James Lind is relatively unknown and seemingly not as famous as three of his eighteenth century contemporaries: Sir Edward Jenner (1749-1823), Sir John Pringle (1707-1782) and

Sir Gilbert Blane (1749 – 1834). Lind was not knighted and his lack of recognition features prominently in the literature available. This lack of recognition is intriguing particularly in view of Lind’s achievements. He was a Fellow of the Royal College of Physicians of

Edinburgh, a Fellow of the Royal Medical Societies of Paris and Copenhagen and his various writings were translated into French, German, Italian and Dutch.25 In spite of these accomplishments Lind remained obscure for a considerable period of time. He has gradually become more recognised and his achievements considered and appreciated – mainly within

24 Personal communication 10th May 2013. 25 The Medical Register for the Year 1783. (London 1783) Eighteenth Century Collections Online, Print Editions ; Louis H. Roddis, James Lind Founder of Nautical Medicine (London, 1951), pp.157-163.

medical circles. The James Lind Library, an online resource, was founded in Edinburgh in

1998 specifically to increase the knowledge available, in relation to the history of impartial trials and their application in the world of healthcare, to the general public and health professionals. It was re-launched in 2003 to mark the 250th anniversary of Lind’s Treatise on the Scurvy. The 20th May has been designated International Clinical Trials Day in honour of

Lind’s experiment.26 The Library’s administrative centre is the Sibbald Library at the Royal

College of Physicians, Edinburgh – Lind’s Alma Mater.

However, at the beginning of the twentieth century Lind seems to have been rarely heard of.

In 1915 Rolleston commented (when writing about Lind) that the abolition of scurvy:

…was a stroke of preventable medicine comparable…to the control of

malaria...and was so complete that James Lind is now little more than a

name.27

Meiklejohn describes Lind as ‘one of the great thinkers of eighteenth century medicine’ and that Lind has been ‘a comparatively obscure figure in the history of medicine.’ Meiklejohn believes the reason Lind was not appreciated is because he was not considered influential and perhaps not sufficiently liked. Meiklejohn also believes that insignificant men have become famous simply by the good fortune of having been noticed. 28 In 1953 Sir Sheldon Dudley remarked:

…there is no medical man of Lind’s stature who has been so consistently

ignored by his own profession.

26 Chalmers, I., Milne, I. et al ‘The James Lind Library: explaining and illustrating the evolution of fair tests of medical treatments.’ Journal of the Royal College of Physicians of Edinburgh , 38 (2008), 259-262, http://www.jameslindlibrary.org/pdf/jll-article.pdf. Consulted May 2014. 27 H.D. Rolleston, ‘James Lind: Pioneer of Naval Hygiene’ Journal of the Royal Naval Medical Service, 1 (1915), p.181. 28A.P. Meiklejohn, ‘The Curious Obscurity of Dr James Lind,’ Journal of the History of Medicine, (July 1954), p.304.

Dudley also believed that as a doctor he was better able to appreciate Lind’s ‘remarkable genius.’29 This remark should not be dismissed as medical arrogance, but taken purely as a reflection that Dudley believed he had better insight and understanding (of Lind) because of his medical training. This point will be raised again in this chapter.

Allison mentions that physicians before Lind wrote about the problems affecting seafarers’ health and even recommended improvements ‘but none did so with such wisdom and reason.’30 Allison also comments that ‘there can be little doubt’ that Sir Gilbert Blane should be credited with the implementation of lemon juice. Watt is keen to mention that Lind:

…was perhaps the greatest of all naval surgeons and his death in comparative

obscurity illustrates the fate of original thinkers dependent upon powerful and

unperceptive patrons.31

Watt, Allison, Rolleston and Dudley all believe Lind lacked a powerful patron until Blane came along. The above authors do believe in Lind and his achievements (not just in connection to scurvy) and convey the impression that the medical fraternity did very well.

Lind is credited with the idea of lemon juice and Blane with its implementation but, they tend to ignore or gloss over other aspects of this intriguing story which contribute to provide an enhanced picture of the time. In 1997 Dunn wrote that Lind was an:

…unassuming man and an accurate observer able to reason his way to logical

conclusions deservedly regarded as the first modern clinical investigator.32

29 Sheldon Dudley, ‘James Lind: Laudatory Address’ Proceedings of the Nutrition Society , 12:03 (1953), 202- 9. 30 R.S. Allison, Sea Diseases: The Story of a Great Natural Experiment in Preventive Medicine in the Royal Navy (London ,1943) p.130. 31 James Watt, ‘Some Forgotten Contributions of Naval Surgeons,’ Journal of the Royal Society of Medicine, 78 (September, 1985), p.757. 32 Dunn, Peter, M., ‘James Lind (1716-1794) of Edinburgh and the Treatment of Scurvy,’ British Medical Journal, 76 (1997), F64-F65. 13

Roddis (an American naval physician) wrote a biography of Lind in 1951 describing him as

‘the greatest name in naval medicine and one of the greatest in the whole history of medicine’. Roddis also refers to Lind as the ‘Hippocrates of naval medicine.’33 Research has failed to discover a more recent biography of Lind.

It is fair to say these accounts focus on the medical perspective and tend to simplify the matter. They are not particularly objective with another author actually describing eighteenth century medical teaching as ‘appalling nonsense’ and stating that the physicians Boerhaave and Eugalenus both taught ‘deplorable bunkum.’34 It must be remembered that the eighteenth century was still the era of humoral medicine which should not be dismissed as ‘deplorable bunkum.’ Further reading has illustrated that the non-medical writers are not necessarily any more objective in their assessments.

The history of medicine is not a straightforward affair and has been criticised for following the Whig approach. In 1931 Butterfield mentioned that it is ‘astonishing to what extent the historian has been Protestant progressive and Whig.’35 Tosh states:

Whig history exhibits a tendency to underestimate the differences between past

and present – to project modern ways of thought backwards in time and to

discount those aspects of past experience that are alien to modern ideas.36

Tosh’s comments echo Butterfield who believed that trying to understand what happened in a different time period can be complex and difficult. Butterfield believed that examining history whilst keeping ‘one eye, so to speak, on the present’ is the root of many problems and

33Roddis, James Lind Founder of Nautical Medicine, p.152. 34 Unknown Author ‘461’ ‘Scurvy’ The Naval Review, 2 (1956) 156-72. 35H. Butterfield, The Whig Interpretation of History, (New York, 1965) p.3. 36 John Tosh, The Pursuit of History, Fifth Edition (Dorchester, 2010), p.192.

the origin of fallacious arguments and transgressions in history ‘starting with the simplest of them, the anachronism.’37

Elton states the study of history amounts to a search for the truth (this leads into other complex realms of debate and opinion outside the scope of this dissertation) and that this aim can relate to that of ‘the historical process or the purpose served by the historian in studying it.’ Elton states there are

three habits peculiar to history: its concern with events, its concern with

change, and its concern with the particular… history is an unending search

for the truth.38

The carnage wrought by World Wars I and II could be seen as acting as a catalyst to history with the result there was awareness that the Whig approach was evidently inappropriate.

Evans has stated that the war years

severely undermined the belief in progress that had sustained the historians of

the pre-war era.

As a result the approach of the profession changed in the 1950s and 1960s to a more objective stance – whether or not there is, or can be, objectivity in history is a discussion outside the scope of this dissertation. Evans discusses Ranke’s contributions and mentions the ‘past could not be judged by the standards of the present’ and the need to ‘try to understand the past as the people who lived in it understood it.’ Ranke emphasised the importance of primary sources and the necessity of eliminating dishonesty from them.39

37 Butterfield, The Whig Interpretation of History, p.31. 38 G.R.Elton, The Practice of History Second Edition (London, 2002), pp.9, 35, 46. 39 Richard Evans, In Defence of History (Croydon 1997), pp. 16-7,19,33..

Brunton comments that from the 1980s the history of medicine has been studied using an approach described as the social history of medicine in which medicine is regarded from a more sociological aspect. It is recognised that medicine has not progressed simply by the cleverness and ingenuity of man but that other forces have played a role and assisted in its development.40 This new approach recognises the importance of understanding the past and the realisation that to the minds of, for example eighteenth century physicians, much of what they did made sense to them in that time and with their knowledge. It is not necessary to belittle the therapies and ideas used by medical practitioners of a very different era to the twenty-first century. Medicine needs to be seen and understood from the perspective of those at the time.

Among the non-medical writers, and detractors, are Wootton and Bartholomew. Wootton believes doctors have done more harm than good and that there was no real progress in medicine until 1865 and the development of germ theory.41 He suggests the medical establishment conveniently ‘rediscovered’ Lind (in 1951) in order to give an ‘appropriate history’ to the clinical trial.42 Perhaps this is Wootton suggesting a Whig approach on the part of those writers – the triumph of medical superiority. Wootton finds it coincidental that

Meiklejohn’s article was written in 1954 and comments that an article by Hughes, regarding

Lind’s ‘experimental approach’, in 1951 was well timed considering that clinical trials for the antibiotic streptomycin had been underway in 1946 and the findings published in 1948.

Unfortunately it has not been possible to find a reference for this article in Wootton’s book but Hughes wrote ‘James Lind and the Cure of Scurvy: An Experimental Approach’ which was published in the Journal of Medical History in 1975. Interestingly, Hughes has written in

40 Deborah Brunton, (ed), Medicine Transformed 1800-1930 (Manchester ,2004), pp.xi-xiii. 41 David Wootton, Doctors Doing Harm Since Hippocrates (Oxford, 2007), p.3. 42 Wootton, Doctors Doing Harm Since Hippocrates pp.162-166.

a clear and balanced way about Lind. He is able to see Lind’s contributions but questions other aspects of Lind’s method. He mentions the strengths and weaknesses of Lind’s experiment. More to the point, Hughes recognised the advantage of modern day perspective and knowledge. Lind knew nothing about vitamin C, had no idea regarding vitamin deficiency diseases (the avitaminoses) and was working at a time when humoral medicine was still practised. 43

Wootton comments that Lind was a surgeon and not a qualified doctor when he conducted his experiment – it is difficult to escape the inference that Lind was not qualified enough to undertake his experiment. Equally, Wootton later says Lind waited six years and qualified (as a physician) before writing the Treatise and again it’s difficult to ignore what seems to be inferred criticism. Given the status of naval surgeons at the time it is not surprising Lind waited. Wootton’s purpose is to go against established writing and to be provocative. He admits he is writing ‘against the grain of contemporary historical writing.’ Wootton continues to criticise Lind for not repeating his experiment and not being forceful in promoting his findings. He suggests Lind did not understand the significance of a clinical trial and had no comprehension of what he had unearthed. He also criticises Lind with regard to his attempts to preserve lemon juice by heating it and producing something Lind called a ‘rob’. These attempts were ineffective as heat destroys vitamin C but Lind did not know that and could not have known that. Wootton consistently fails to look at the whole matter. His approach cannot be described as Whig in its nature but it is limited. He seems not to have adopted the principles historians such as Ranke, Elton and Tosh would adhere to. Wootton states that historians ‘far from holding doctors responsible’ for deaths from scurvy praise Lind. Wootton says the Treatise did not alter the practice of ships’ surgeons – in fact there seems to be

43 R.E.Hughes, ‘James Lind and the Cure of Scurvy: An Experimental Approach’, Medical History, 19:4 (1975), pp. 342-351. 17

evidence that some ships surgeons and their captains did adopt Lind’s advice albeit unofficially.

Wootton brings his views on Lind to a close by saying that Lind ‘actually deserves to be left in obscurity.’44 Rather than discrediting Lind, this actually reminds the reader of the advantage of approximately 250 years of hindsight. Butterfield believed that a ‘historical personage’ should never be refused ‘the effort of historical understanding’ and was concerned to point out the incongruity of using a modern approach to form opinions in relation to past events. Butterfield emphasised the need for self-analysis and the necessity of understanding how different the past is to the present:

…for the chief aim of the historian is the elucidation of the unlikenesses

between past and present and his function is to act in this way as the mediator

between other generations and our own.45

Bartholomew tries to dissect and discredit Lind’s work on scurvy and comments:

‘Melancholia, Lind says, is an additional contributory factor in the onset of scurvy’.

Bartholomew then mentions that Lind ‘prudently steers clear of explaining how the mind acts on the body.’ 46 This is disappointing to read. Lind was correct to observe melancholia was a problem and associate it with scurvy. The great advantage of twenty-first century science is the knowledge that vitamin C is involved in the synthesis of the neurotransmitter, serotonin, which is found in body tissue including the brain. Serotonin is believed to play a role in regulating mood and feelings of well-being.47 Lind could not possibly have known this and

44 Wootton, Doctors Doing Harm Since Hippocrates, pp.162-166. 45 Butterfield, The Whig Interpretation of History, (New York, 1965), pp.10,14. 46 Michael Bartholomew, ‘James Lind and scurvy: A revaluation’ Journal for Maritime Research 4:1 (2002), p.6. 47 Personal knowledge; Black’s Medical Dictionary, 41st Edition, 2005. 18

the aforementioned example demonstrates inappropriate and inaccurate judgement of Lind’s work. It demonstrates a lack of awareness and consideration of the principles mentioned above. It also lends strength to Dudley’s opinion that as a doctor he was in a good position to judge Lind’s genius. However, this particular issue does demonstrate Lind was a man of observation and evidence based medicine. Bartholomew continues to criticise Lind when he says:

No consideration is given to the ethical question of withholding from ten very

sick men the oranges and lemons that were curing the pair to whom they had

been prescribed. 48

Lind actually states (with regard to the sailors receiving two oranges and one lemon a day):

…they continued but six days under this course having consumed the quantity

that could be spared.49

The only interpretation to make from this statement is that oranges and lemons were in short supply and that supply may have been used up. Interestingly, Wootton also mentions this point and says the stock had been exhausted. The word ‘spared ’may have had a different interpretation in the eighteenth century to that of today.

A final example of Bartholomew’s approach is that he describes lemon juice as being seen by

Lind as a powerful medicine rather than a basic food.50 It is not surprising. Lind states:

…in the most desperate cases, the most quick and sensible relief was obtained

from lemon juice, by which I have relieved many hundred patients, labouring

48 Bartholomew, ‘James Lind and scurvy: A revaluation.’ p.8. 49 Lind Treatise on the Scurvy,1753, p.193. 50 Bartholomew ‘James Lind and scurvy: A revaluation.’ p.10. 19

under almost intolerable pain and affliction from this disease, when no other

remedy seemed to avail.’

Lemon juice would have seemed like a very powerful medicine indeed. Lind observed that:

this acid given by itself undiluted was apt, especially if overdosed, to have too

violent an operation…and sometimes a vomiting.

Vitamin C in overdose does have unfortunate side effects! Lind then did what any good doctor would do and adjusted the dose to prevent such side effects. This point is very interesting as it raises the issue of whether or not lemon juice was deemed by some to be too simple a remedy. The line between that of a simple foodstuff and a drug can be a fine one.

Indeed Lind seems to have been concerned about chymical (chemical) preparations and comments that when they are used as a handmaiden to medicine saying ‘non alia pejor domina’ that is, ‘there is no other worse mistress.’51 In other words Lind is saying there is no room for fanciful theories and ideas in medicine and he criticises inappropriate preparations.

Weatherall describes the Treatise as:

…being a model of what such a record should be and his conduct …of his

clinical trial leaves nothing to be desired.52

However, Bartholomew is correct when he says:

…the Treatise did not narrow the debate and channel it inexorably towards the

Admiralty’s eventual decision to issue seamen with lemon juice.’53

Haycock and Archer seem to regard Lind’s contributions, in relation to scurvy, as being over emphasised and they suggest the role of the Royal Navy has been also.54 The Introduction to

51 Lind Treatise on the Scurvy,1753 p.61. 52 Miles Weatherall, ‘Drug Treatment and the Rise of Pharmacology’ in Roy Porter (ed.) Cambridge Illustrated History of Medicine (Cambridge, 1996) p.46. 53 Bartholomew, ‘James Lind and scurvy: A revaluation’ p.12. 54 D. Haycock, ‘Introduction’ in Health and Medicine at Sea 1700 – 1900 (Woodbridge, 2009) p.5. 20

this dissertation mentioned that Rodger believes the scurvy situation has been exaggerated.

Rodger also says:

…it is necessary to be cautious in discussing a disease whose name was used

by doctors as a catch-all term for anything they could not identify or cure. 55

Baron believes that the surgeons in the army and navy had no problem identifying scurvy as it has distinctive features.56 Wilson states there was much confusion surrounding scurvy mainly due to the fact it was discussed and written about by physicians who had little or no experience, of the disease, and that Lind’s ‘great Treatise on the Scurvy’ was the exception because of his acquaintance with scurvy.57 This is a point made by Lind himself when he stated that the disease was the same everywhere ‘in every age and in every country.’58

Carpenter has produced an excellent and well balanced work. He lists the views of some eminent physicians, and their theories relating to scurvy, including the renowned Joseph

Lister (1827-1912) who thought it was caused by ptomaine poisoning which develops in decaying food matter.59 The nature and causes of scurvy continued to be obscure for a long time – there were many imponderables and these have to be placed in the context of eighteenth century medicine. Wootton forgets to mention that theories for scurvy continued to be ‘obscure’ for many years. Wilson also remarks that in spite of much experience of scurvy its prevention

remained haphazard and was marked by tragic failures so long as the

essential antiscorbutic factor remained unknown.’60

55 Rodger, The Command of the Ocean, p.308. 56 Jeremy Baron, ‘Sailors’ Scurvy before and after James Lind – a reassessment’ Nutrition Reviews, 67:6 (June 2009) p.319 57 Leonard G. Wilson, ‘The Clinical Definition of Scurvy and the Discovery of Vitamin C’, Journal of the History of Medicine and Allied Sciences, 30:1 (1975), p.40. 58 Lind, Treatise on the Scurvy, 1772 p.iv. 59 Kenneth J. Carpenter, The History of Scurvy and Vitamin C (Cambridge, 1988) p.252. 60 Wilson,‘The Clinical Definition of Scurvy and the Discovery of Vitamin C’ p.60. 21

Wootton and Bartholomew’s positions sit in neat juxtaposition to many of the medical writers previously mentioned and they are revisionist in their approach. Observations suggest that neither have shown any empathy for the plight of the eighteenth century sailor, the conditions under which surgeons worked and eighteenth century medicine generally. Wootton, in common with other authors, credits Gilbert Blane for persuading the Navy to adopt lemon juice.61 Undeniably, Wootton’s book is very interesting reading and it is certainly provocative, but he and Bartholomew seem to have given little consideration to the situation in the eighteenth century and seem not to show an appreciation for the difficulties of those times. These accounts cannot be described as Whig in their approach but neither have they adopted a rounded, balanced approach to the subject. The practices of bloodletting and purging seemed appropriate to the eighteenth century but are viewed in a very different light today - there are still conditions when doctors find it necessary to use ‘bloodletting’. These aspects need to be borne in mind when reading the historiography. Ranke would advise historians to judge by the standards of the time and in the eighteenth century bloodletting was best practice.

It is very easy to criticise and argue to the exclusion of the kindness and concern Lind displays in his works. His approach to those in his care is illustrated in the following quote:

But surely there are no lives more valuable to the state, or have a better claim

to its care, than those of British sailors, to whom this nation, in great measure,

owes its riches, protection and liberties.62

Lind is accused of being confused about his findings and again this needs to be examined further in relation to the main question in this dissertation. Research suggests Lind was faced

61 Wootton, Doctors Doing Harm Since Hippocrates, p.166. 62 Lind, Essay on the Most Effectual Means of Preserving the Health of Seamen, pp.xiii – xiv. 22

with a very complicated problem. He successfully treated scorbutic sailors with oranges and lemons but there were occasions when this remedy was ineffective - this would have added confusion to an already difficult problem. It is likely that many sailors were suffering from more than scurvy and, given the incidence of fevers in the Navy, that some had concurrent infections. These men would have needed antibiotics as well as citrus fruits. Put succinctly, the underlying pathology would be complex and beyond Lind’s knowledge - and that of other physicians of the time. Why Lind appears not to have repeated his experiment can only be guessed at. Perhaps he felt he had no need to as he was treating hundreds of scorbutic patients daily in Haslar. Equally why did other doctors not take up the challenge?

One thing all the literature has in common is that it very simply credits Gilbert Blane with the introduction of lemon juice. Broadly speaking, with a couple of notable exceptions, there is a lack of objectivity on the part of the medical authors, who see the matter purely from the medical aspects, and those such as Bartholomew and Wootton who also fail to acknowledge the larger picture. By and large the literature, mentioned in this chapter, seems to underestimate the differences between the twenty-first and eighteenth centuries with some of it failing to ‘provide the effort of historical understanding’ as mentioned by Butterfield in this essay. There seems to be a lack of appreciation of the factors to which Lind and others were subject to in the mid eighteenth century and the nature of medicine at that time. Diverse opinions such as those demonstrated in this chapter illustrate the subjectivity and lack of objectivity that can apply to such a topic.

A balanced view would acknowledge this and the fact that eighteenth century medicine was still the age of humoral medicine. There was much confusion and little understanding.

Physicians and surgeons were daily battling with diseases that were beyond their comprehension, knowledge and expertise and in conditions that were truly awful. As this

dissertation will demonstrate there appear to have been several reasons as to why Lind’s recommendation was not implemented sooner and that another factor, which research thus far seems to indicate has not previously been considered, came into the equation.

Interestingly, one of the best histories is written by Lind himself. The Treatise on the Scurvy is long and difficult to read in places, it does seem confusing at times but Lind is practical and methodical. He demonstrates concern for the plight of the sailor, he has conducted research, he has systematically examined the work of many other authors as far back as antiquity, he has examined the evidence available, his Bibliotecha Scorbutica is a list of what had been published on the subject of scurvy, analysis and findings. He would appear to have had the qualities pertaining to a good historian.

Chapter II: James Lind and Eighteenth Century Medicine

James Lind’s experiment, plus his findings, into scurvy are the bases on which the question in this dissertation has been formulated. In order to continue with this work it is necessary to provide details of Lind’s experiment and his medical education both in naval and civilian contexts.

On the 20 May 1747 Lind conducted an experiment in which he selected twelve sailors with scurvy, divided them into six groups of two and gave each a different remedy. These remedies were: a quart of cider a day; 25 drops of elixir of vitriol three times a day; two spoonfuls of vinegar three times a day; half a pint of seawater per day; an electuary (paste) of garlic, mustard seed, horseradish, balsam of Peru, gum myrrh and the final group two oranges and one lemon a day. Lind took care to ensure all the sailors had the same diet and he also ensured the twelve sailors had similar symptoms of scurvy:

…they all in general had putrid gums, the spots and lassitude, with weakness

of their knees.’63

Two patients were slightly worse than the others as they had rigidity of the hamstring tendons.

Lind, correctly as a man of medicine, spares no detail in describing the symptoms of scurvy which are distressing in the extreme. ‘It is not easy to conceive a more dismal and diversified scene of misery.’64 The reader of this essay has been spared that amount of detail.

63 Lind, Treatise on the Scurvy, 1753, pp.191-3. 64 Lind, Treatise on the Scurvy, 1753 p.166. 25

Space does not permit a detailed analysis of all the remedies Lind tried but he selected popular remedies of the time, including elixir of vitriol, about which more will follow. The result of Lind’s experiment revealed that oranges and lemons had the most dramatic and good effect - ‘oranges and lemons were the most effectual remedies for this distemper at sea.’65

However, it is more interesting to note that Lind proved the other remedies had no effect whatsoever with the exception of cider. Lind states that the sailors taking cider ‘were in a fairer way of recovery than the others at the end of the fortnight.’66 Modern day cider contains almost no vitamin C but the cider of the eighteenth century contained considerably more. The amount of vitamin C would vary in accordance with the freshness of the cider. Wilkinson suggests the slower recovery of the sailors taking cider indicates they received about 5mg of vitamin C. 67Appendix B to this dissertation lists the vitamin C content of various foods thus demonstrating how accurate Lind’s observations were.

There is evidence that members of the seafaring fraternity had known for many years that scurvy was remedied by citrus fruits. However, the significance of this knowledge was not readily understood which, when put into the context of medicine of the time, is not surprising.

Indeed Richard Hawkins observed the benefits of oranges and lemons and stated he wished

‘some learned man would write of it.’68 Lind is believed to be the first to conduct a formal investigation into the matter, the first clinical trial, thus making Lind a pioneer.69 Dudley described Lind as ‘an original investigator’ and commented on Lind’s observational skills in all his work including that devoted to fevers and hygiene as well as scurvy.70 Not only did

65 Lind, Treatise on the Scurvy 1753 pp.193,196. 66 Lind, Treatise on the Scurvy 1753 p.195 67 Kenneth Carpenter, The History of Scurvy and Vitamin C, (Cambridge, 1988), p.230. 68 Richard Hawkins, The observations of Sir Richard Havvkins Knight, in his voiage into the South Sea. Anno Domini 1593,(London 1622), p.37, Early English Books Online, https://data-historicaltexts-jisc-ac-uk. 69 Carpenter, The History of Scurvy and Vitamin C, p.52. 70 Dudley ‘James Lind: Laudatory Address’ pp.202-3. 26

Lind undertake this trial but he systematically examined all the evidence available and published his findings. This experiment demonstrates Lind’s inventiveness plus his belief in practical experience and observation. Lind’s powers of observation led him to understand that men, who had previously been punished for being lazy because they were tired and lethargic, were in fact exhibiting symptoms of scurvy.71 Lind was a forerunner with his recommendations to prevent and cure scurvy.

Lind’s reasons for his experiment originated from a genuine desire to ‘put a stop to so consuming a plague.’72 He also wished to address the subject professionally pointing out that:

No physician conversant with this disease at sea had ever undertaken to throw

light upon the subject and clear it from the obscurity under which it had lain in

the works of physicians who practised only at land.73

This point about land physicians is revealing and an issue Lind refers to often. The above remarks are demonstrative of the gulf that lay between the land physicians and those medical personnel who practised at sea. Ellis has stated that the land medical practitioners dismissed the effects of scurvy at sea and blamed the poor health of the sailors ‘on the incompetence of the sea surgeons and physicians’.74 Lind continued to say that scurvy deserved detailed investigation and he wished to correct the fatal mistakes others had made: He felt that there was:

… evident necessity of rectifying those errors on account of the pernicious

effects they have already visibly produced…75

71 Lind, Treatise on the Scurvy 1753 pp.148-9. 72 Lind, Treatise on the Scurvy 1753 p.v. 73 Lind, Treatise on the Scurvy 1753p.ix. 74 F.P. Ellis, ‘Victuals and Ventilation and the Health and Efficiency of Seamen’, British Journal Industrial Medicine (1948) 5:4. p.187. 75 Lind, Treatise on the Scurvy 1753 p.x. 27

Lind was a practical man, a questioner and an experimenter. The statement below demonstrates his aversion to theory and conjecture:

I shall propose nothing merely dictated from theory but shall confirm all by

experience and facts.76

Lind believed prevention was better than cure and explains that the lack of success in preventing scurvy was as a result of preventative methods not being implemented until too late. He also refers to land physicians and theory again saying:

Too high an opinion has been entertained of certain medicines recommended

by physicians at land… founded on their theory of disease, than from any

experience of their effects at sea.77

Lind is trying to pursue preventative and occupational medicine founded on experience, not theory.

Lind left the Navy shortly after his experiment and studied at Edinburgh Medical School receiving his degree in 1748. Edinburgh was a leading centre in the Enlightenment, it attracted gifted individuals and encouraged new ways of thinking in medicine and science.

Edinburgh was founded by Alexander Monro (1697-1738) in 1726 and based on the medical schools at Padua and Leiden. Monro had studied at Leiden under Herman Boerhaave (1666-

1738), who was the most influential physician of the early eighteenth century, so it is not surprising Leiden had a profound influence on Edinburgh.78 It can clearly be seen that Lind would have been subject to this Leiden and Boerhaave influence.

Porter mentions that eighteenth century physicians ‘assumed the mantle of the scientific revolution and carried the torch of the Enlightenment.’ It was believed that in order for

76 Lind, Treatise on the Scurvy 1753 p.190. 77 Lind, Treatise on the Scurvy 1753 p.186. 78 Harvie, Limeys: The Conquest of Scurvy (Stroud, 2002), pp.21-2.

progress in medicine to be made it had to become more scientific with the emphasis being on experimentation and surveillance. This led to understanding that observing the patient at the bedside was better than theorising from a distance. Porter mentions that ‘philosophical empiricism’ was regarded highly and not the ‘vulgar empiricism’ of the quacks.79 The word

‘empiric’ had to be used with caution as at this time it was synonymous with quack.80

Carpenter presents a different view of medicine in the Enlightenment. Instead of being a time of progression, it was also a time of great pontification and of much theorising.81 Many new medical theories were promulgated with some doctors believing medicine could be more scientific by thinking arithmetically. Boerhaave believed health and sickness were related to the movement of essential bodily fluids which in turn related to the pressure of those fluids.

This theory was prominent up to about 1750 when other ideas became influential such as those relating to the nervous system and its qualities. Prominent names such as William

Cullen (1710-1790) promoted this new approach. The new medical schools, such as

Edinburgh, had their own ideas and in turn influenced their students.82 Wear mentions that the complicated nature of eighteenth century medicine was not altered by the development of new ideas and there was also no change in the thorny problem of doctors not reaching an accord. 83 This conveys a picture of a complex medical world surrounded by debate and argument.

The Enlightenment followed the scientific and medical developments of the sixteenth and seventeenth centuries, such as the discovery of the heart and circulatory system by William

Harvey (1578-1657) and the work of Andreas Vesalius (1514-64), which resulted in greater

79 Roy Porter, ‘The Eighteenth Century’ in The Western Medical Tradition, (Cambridge 1995) pp.371, 375. 80 N.A.M. Rodger, The Command of the Ocean: A Naval History of Britain 1649-1815 (London 2005) p.307. 81 Carpenter, The History of Scurvy and Vitamin C, p.43. 82 Porter, ‘The Eighteenth Century’ p. 375. 83 Andrew Wear, ‘Early Modern Europe’ in Lawrence I. Conrad, Michael Neve, Vivian Nutton, (et al), The Western Medical Tradition 800 BC to AD 1800 (Cambridge 1995) p.228. 29

awareness of anatomy and physiology.84 However, Eighteenth century medicine was still steeped in humoral theory which stemmed from the teachings of Hippocrates in the 5th century BC and Galen in the second century AD.85 Humoral theory revolved around the human body being composed of four humours: blood, yellow bile, black bile and phlegm which, for good health to exist, needed to be in balance with the four elements of air, earth, fire and water. In addition to this were the four qualities of hot, cold, wet and dry, the four seasons, the four ages of man (childhood, youth, adulthood, old age) and the four temperaments melancholic, sanguine, phlegmatic and choleric.86

Galen believed that good health, eucrasia, resulted from a balance of the various humours and associated factors and that ill health, dyscrasia, was the result of an imbalance of the humours. Disease was believed to be related to specific humours or qualities, such as, too much or too little of a particular humour. It was thought that different foods had different effects or qualities, for example, mutton was thought to be good during illness as it brought about a state of humoral equilibrium.87 Boerhaave considered scurvy to be an acrid condition whereby the acridity could be saline, acid, alkaline or oily and rancid in nature. In order to achieve a cure, a medicine with the opposite effect was required. Scurvy grass, ginger and volatile salts were regarded as alkaline cures whilst vinegar, Moselle wine and citrus fruit were acidic.88 The idea of the humours being out of balance provided the basis for the removal of fluids from the body by sweating, bleeding and purging.89

84 Roy Porter, The Greatest Benefit to Mankind: A Medical History of Humanity from Antiquity to the Present (London 1999) p.245; Wear, ‘Early Modern Europe’ p.273. 85 Porter, The Greatest Benefit to Mankind, p.9. 86 Vivian Nutton, ‘The Rise of Medicine’ in Roy Porter (ed.), The Cambridge Illustrated History of Medicine, (Cambridge, 1998), p.58. 87 Janet MacDonald, Feeding Nelson’s Navy (London ,2006) p.156. Roy Porter, ‘What is Disease?’ in Porter (ed), The Cambridge Illustrated History of Medicine, pp. 28. 88 Carpenter, The History of Scurvy and Vitamin C, p.44. 89 Weatherall, ‘Drug Treatment and the Rise of Pharmacology’ in Porter, (ed) Cambridge Illustrated History of Medicine p.252. 30

In order to diagnose a problem the physician would carry out several observations. The pulse would be assessed by describing its character, for example thready or weak. The physician would use his sense of smell in order to detect gangrene; he would taste the patient’s urine, note the colour of the skin and eyes and listen for irregular breathing.90 Reading Lind’s

Treatise on the Scurvy (referred to as the Treatise from hereon) it can be noted that the first symptom Lind considers in the scurvy is ‘generally a change of colour in the face…to a pale and bloated complexion.’91

The theoretical approach to medicine, underpinned by humoral theory, encouraged the idea of many different types of scurvy such as connate (present at birth); hereditary; infectious; acid; alkaline; hot; cold; land; sea and muriatic or brine scurvy. Eighteenth century medicine had as many treatments as there were scurvies - ‘various have been the opinions concerning the cures and propagation of this evil.’92 In fact, Lind comments on Boerhaave’s ideas and is not afraid to disagree with him – influential though Boerhaave is:

…it is indeed very surprising that some very eminent authors should have

endeavoured to persuade us, that from such opposite causes, as heat and cold, or

alkaline and acid… not only the same series of symptoms should arise … but that

then likewise the same state of the blood should also exist.

Lind goes on to say that Boerhaave and Hoffman, who had given great details of different symptoms, then agreed that scurvy was caused by the blood separating from its constituent parts that is the ‘serous or watery part of the blood from the thicker part or crassamentum.’

Lind continues to say that Boerhaave’s ‘assuming of such chymical principles…is

90 Porter, The Greatest Benefit to Mankind, p.256. 91 Lind Treatise on the Scurvy 1753 p.148. 92 Lind, Treatise on the Scurvy 1753, p.78. 31

exceptionable on many accounts.’93 Lind disagreed (again) with Boerhaave this time over the use of mercury which Lind regarded as poisonous. However, Boerhaave recommended it and, because he was an influential physician, others copied him ‘with fatal results.’ Lind also comments that Boerhaave’s ‘aphorisms on this subject were of no use.’94

Lind recorded his findings in his Treatise having systematically examined all aspects and writings of scurvy. An example follows in relation to his investigation into the idea that scurvy was infectious:

I could produce many instances…which prove beyond all doubt, that drinking

out of the same cup, lying in the same bed, and the closest contact (Lind is here

referring to the idea that scurvy was a venereal disease), does not communicate

this distemper…Nor is this disease communicated by infection from those that

die...95

Lind originally thought scurvy was a disease of putrefaction but, as a result of dissecting many bodies, he began to alter his ideas and by the time of his third Treatise, in 1772, he was more inclined to believe it was: ‘where the perspiration of a multitude of people is pent up and confined’ and continues ‘together with the want of fresh green vegetables.’96

Prior to entering the Navy, Lind had been apprenticed, in December 1731, to an Edinburgh surgeon, George Langlands, who had trained under Boerhaave in Leiden. In 1734 Lind attended a course of anatomy lectures given by Alexander Monro. Lind then entered the

Royal Navy as surgeon’s mate in 1738 or 1739.97 It can be seen, therefore, that Lind was subject to the influences of Boerhaave prior to entering the Navy and again whilst at

93 Lind, Treatise on the Scurvy, 1772, pp.23-5. 94 Lind, Treatise on the Scurvy, 1772, pp.25-6. 95 Lind, Treatise on the Scurvy, 1772, p.43. 96 Lind, Treatise on the Scurvy, 1772, pp.54, 516. 97 Roddis, James Lind Founder of Nautical Medicine, pp.1-9; Michael Bartholomew, ‘Lind, James (1716– 1794)’, Oxford Dictionary of National Biography, (Oxford, 2004)

Edinburgh Medical School. Why Lind did not attend medical school immediately is not apparent particularly given Edinburgh’s excellent reputation. Lind came from a respectable, professional family with medical connections; he attended grammar school and was well versed in the classics. There is no doubt Lind underwent a beneficial practical and vocational training in advance of gaining his medical degree.

The occupation of naval surgeon in the eighteenth century was unappealing; the conditions on board ship were far from good and he was also expected to fill the roles of physician and apothecary.98 The surgeon was not a commissioned officer but part of the warrant officers, of wardroom rank.99 Prior to entering the Navy, Lind would have undergone an examination by the Court of Examiners of Barber-Surgeons after which he would have received his warrant from the Navy Board which entitled him to act as a surgeon’s mate.100 It was difficult to find the correct candidates for such a role given the circumstances under which surgeons worked.

Roddis mentions that many ‘impecunious surgeons’ from Scotland entered the Royal Navy at this time ‘that a naval surgeon from anywhere else was almost a rarity.’101

Naval surgeons were poorly paid, in addition to which they were required to provide their own instruments and drugs. There were various regulations and instructions surgeons had to abide by including to ‘use carpenters’ saws if his own instruments are insufficient.’102 There were no uniforms and the surgeons’ names were not listed in the List of Sea Officers until

1814.103 Naval surgeons were required to keep journals, relating to their work and surgery

98 Lloyd and Coulter, Medicine and the Navy, Volume III, pp.10-11. 99 Gregory Fremont-Barnes , The Royal Navy 1793-1815, (Oxford ,2007) p.23. 100 Lloyd and Coulter, Medicine and the Navy Volume III, p.10; Fremont-Barnes, The Royal Navy 1793-1815, p.30. 101 Roddis, James Lind Founder of Nautical Medicine, p.16. 102 Lloyd and Coulter, Medicine and the Navy Volume III, p.23. 103 Lloyd and Coulter, Medicine and the Navy Volume III, p.10. 33

conducted whilst on board, which were then submitted to the Commissioners for Sick and

Wounded Seamen (Sick and Hurt Board), or to the Physician at Greenwich, and to the

Governor of the Surgeons’ Company for inspection. Unfortunately, none of these journals, prior to 1793, have survived as they were not considered worth saving.104

Standards were low and illustrated by the many times the Navy Board protested about the examiners’ unprofessional and ineffective approach to their task. Various positive changes did take place during the eighteenth century but at the time Lind entered the Navy standards were poor. It is very likely that Lind’s apprenticeship to George Langlands, plus the lectures he attended at Edinburgh, meant he had a far better training and education than he would have received otherwise. In addition to their lowly status, naval surgeons had to contend with the hierarchical nature of eighteenth century medicine which dictated that land based physicians were the most authoritative of all medical men and superior to naval physicians.

Lind demonstrates his awareness of this situation in the following quote:

It became necessary, in order to save the credit of the physician, and to justify

his opinion of the disease, to pronounce it the land-scurvy, or a species of

scurvy different to that at sea. 105

It has not been possible to discover when Lind was promoted to surgeon but he was certainly surgeon on board HMS Salisbury during 1746 as he mentions in his Treatise. Lind comments that on the Salisbury’s cruise, from 10 August to 28 Oct 1746, ‘we had but one patient with the scurvy’ who had taken elixir of vitriol (dilute sulphuric acid) but still contracted the disease ‘whilst under a course of medicine recommended for its prevention.’106 This

104 Lloyd and Coulter, Medicine and the Navy, Volume III p.18. 105 Lind, Treatise on the Scurvy, 1772, p.29. 106 Lind, Treatise on the Scurvy, 1772, p.152. 34

reference to elixir of vitriol has proved to be most illuminating, and interestingly timed, as the following investigation will demonstrate.

Recent research has revealed that an anonymous letter (date of letter uncertain) ‘representing the bad consequences of the use of the elixir of vitriol’ was sent by a naval surgeon to the

Admiralty which requested the Navy Office to investigate the matter. The Navy Office replied to Thomas Corbett Esquire, (Secretary of the Admiralty 1742-1751) on 17 April 1747 having asked for the matter to be discussed by the Commissioners for Sick and Wounded

Seamen. 107 The term ‘Sick and Wounded’ seems to have been interchangeable with ‘Sick and Hurt’ both describing the same Board of the Navy. The letter from the Navy Office also indicates the matter was discussed with Dr Cockburn, Physician of Greenwich Hospital, the

Surgeons’ Company and other naval surgeons.108

Dr Cockburn presented his opinion ‘at a conference in the presence of the Commissioners for the Sick and Wounded’ and sent a letter containing his views to the Admiralty.109 Dr

Cockburn’s letter is three pages long and addresses the anonymous letter paragraph by paragraph. Dr Cockburn’s letter is polite and considerate and he seems to agree with the anonymous writer on many counts even understanding why the writer wished not to reveal his name. Interestingly, Lind mentions a Dr Cockburn in his Treatise as being a ‘judicious’ doctor and someone acquainted with scurvy but this seems to refer to Dr William Cockburn

(1669-1739) who cannot be the same Dr Cockburn mentioned here.110

The anonymous writer complains of the sailors’ improper diet and continues that the:

107 NMM: ADM B/135, 17 April 1747. Letter from Navy Office to Thomas Corbett Esquire, regarding its investigation and report into an anonymous letter pertaining to the elixir of vitriol.; Rodger, The Command of the Ocean: pp.295-6, 633 108 NMM: ADM B/135 ‘An anonymous letter has been received from a Naval Surgeon.’ 109 NMM: ADM B/135. March 1746. Letter from Dr Cockburn, Physician to Royal Hospital, Greenwich. 110 Lind, Treatise on the Scurvy, 1772, p.22. 35

…proper consideration is how to prevent them (scurvies) and that is only by a

proper diet and cleanness.111

Dr Cockburn’s letter also states that the anonymous writer suggests that other physicians:

…for want of knowing the various circumstances of the sick at sea may be

improper judges, either to prevent distempers or how to remedy them at sea.

The obvious question is whether or not the anonymous author was Lind as the above comments sound reminiscent of him. The evidence available is suggestive but not conclusive and even more intriguing considering the timing of Lind’s experiment.

This letter, from the Navy Office, is then followed by several pages of Extracts from

Surgeons’ Journals (there is no date on this document but it is likely to have been created at the end of 1746 or the beginning of 1747) and their thoughts on elixir of vitriol. There are forty-five extracts with the vast majority in favour of its use. One surgeon believed elixir of vitriol prevented scurvy and another found it ‘of great service in scorbutics.’112 However,

George Bogue from the hospital ship Sutherland, ‘found no effects from it’, and George

Aynsworth from HMS Argyle, ‘found no success until the blood and juices were altered by a fresh diet and the use of vegetables.’ These extracts are followed by further extracts from letters received from surgeons abroad in such places as Jamaica and Gibraltar. The final affirmation in favour of elixir of vitriol came from no lesser man than Admiral Vernon at

Jamaica who reportedly said ‘your elixir of vitriol… has the general approbation of our surgeons.113

111 NMM: ADM B/135. March 1746. Letter from Dr Cockburn, Physician to Royal Hospital Greenwich. 112 NMM: ADM B/135 1746-47.Extracts from Surgeons’ Journals on Elixir of Vitriol. 113 NMM: ADM B/135 10 February 1747. Extract of letter from Admiral Vernon.

The Surgeons’ Company also concurred saying that the anonymous surgeon’s experience is:

so contrary to our experience at land…that what he hath taken the liberty to

found on experience is not true…College of Physicians has thought fit to

recommend it…we submit it whether they are not the properest persons to be

advised with on this occasion.114

It is of note that the College of Surgeons seems to criticise the anonymous writer for taking the liberty to discover something by experience and the suggestion therein lies that theoretical medicine is still very persuasive at this time. The letter from the Navy Office ended with:

…that as the College of Physicians have thought fit to recommend the use of

the aforesaid medicine, they are the proper persons to be advised with on this

occasion.115

There is no escaping the conclusion that the influence and opinion of the College of

Physicians was paramount. Dr Cockburn also generally concurred in agreeing with the efficacy of elixir of vitriol but he was a little more reserved in his recommendation. His opinion could be interpreted as a qualified statement and one that certainly needs more clarification:

…when properly prepared it is a noble medicine in a relaxed state and

diseases depending on such a state.116

Considering the evidence gathered, particularly the extracts taken from the surgeons’ journals, which were prepared by someone at the Sick and Hurt Board, it is very difficult to know how well the surgeons’ journals were being interpreted as the originals are not available. The evidence needs to be considered with a considerable degree of scepticism. It is not known if the

114 NMM: ADM B/135. 2 April 1747. Letter from the Surgeons’ Company pertaining to elixir of vitriol. 115 NMM: ADM B/135. 17 April 1747. Letter from Navy Office to Thomas Corbett Esquire, regarding its investigation and report into an anonymous letter pertaining to elixir of vitriol. 116 NMM: ADM B/135. March 1746. Letter from Dr Cockburn ,Physician to Royal Hospital, Greenwich. 37

naval surgeons were to report on elixir of vitriol only but, judging by the available evidence, it would seem likely. This suggests, most strongly, there was an element of selectivity present and perhaps the surgeons felt they should report favourably. There is no doubt though that opinion came down firmly on the side of the efficacy of elixir of vitriol and the anonymous naval surgeon was probably very glad he kept his name a secret. However, it is interesting to note that some surgeons were not afraid to report the failure of elixir of vitriol. Nevertheless, this episode does demonstrate the difficulty of raising an issue which went against traditional thinking and the ingrained hierarchical nature of medicine at this time. No one it seems was prepared to argue with the authority of the College of Physicians.

Lind was appointed Chief Physician at Haslar Hospital in 1758 and, during the intervening ten years, Roddis suggests Lind probably worked in private practice and was part of the

Edinburgh medical scene.117 However, further investigation suggests Lind may have been offered the position of surgeon on board HMS Chichester in 1755.118 A letter, from the Navy

Office and addressed to John Cleveland Esquire (Secretary to the Admiralty (1751-1763) states Lind is

to be employed in something suitable to his standing… in order to make his

observations on the disorders incident to the seamen, particularly the scurvy

on which he has wrote a treatise. 119

This would seem to demonstrate Lind’s work on scurvy was known (his first Treatise had been published in 1753) and he was required to conduct further research. No evidence has been found to confirm Lind took up this appointment but as the letter directs him to take up

117 Roddis, James Lind: Founder of Nautical Medicine, p.79. 118 NMM: ADM B/149, 15 February 1755. Letter appointing James Lind to HMS Chichester. 119 Rodger, The Command of the Ocean, p.633; NMM/ADM/B/149, 15 February 1755. Letter appointing James Lind to HMS Chichester.

his warrant then it seems quite possible he did so. It also seems possible Lind commenced the position at Haslar following this post on HMS Chichester.

The picture that emerges of Lind, when he entered the Navy, is one of a young man confronted with a complicated, distressing and confounding situation made more complex by diseases beyond his (and others) knowledge and expertise - disease was also rising. Thomas

Trotter (1760 – 1832) comments on the increase in disease facing doctors and was in no doubt where the problem lay:

It was the extent of navigation and commerce that gave birth to a new train of

distempers.120

These difficult circumstances were exacerbated by the knowledge that a naval surgeon was of very low status and, as this essay has demonstrated, the opinion of theorising physicians was great. It is no wonder Lind left the service and gained his medical degree, thus becoming a respectable physician, before writing the Treatise.

Lind was original, a questioner and an experimenter – he argued against established practice and was unafraid to disagree with other physicians, including eminent ones. This is particularly interesting as Lind’s medical education at Edinburgh was based on the teachings of the influential Boerhaave. However, Lind was able to detach himself from this influence and report matters as he observed them. This suggests a man of courage, integrity and of intellectual honesty but this may have isolated Lind from other physicians who were more orthodox in their approach and more aware of the power of influence. This point will be considered as one of the possible reasons for the delay in the implementation of lemon juice in the next chapter.

120 Thomas Trotter, Medicina Nautica: An Essay on the Diseases of Seamen: Comprehending the History of Health in His Majesty’s Fleet under the Command of Richard Earl Howe, Admiral, (London 1797) p.10. 39

Chapter III: The Delay Examined

The dilatory process regarding the introduction of lemon juice to the Royal Navy has been the subject of much debate and evoking of strong opinions. Lloyd has called it ‘criminal and disastrous’ and ‘a notorious scandal in medical history.’121 Baugh believes the Navy’s reluctance to introduce lemon juice ‘came not from complacency but from confusion.’122

Wootton, though, suggests Lind himself was part of the problem accusing him of being uncertain of his findings and equally not being more forceful in promoting them.123

Bartholomew tends to agree with Wootton describing Lind’s third Treatise as ‘the record of a boxer on the ropes’ and that Lind was bewildered by the medical evidence confronting him.124

Much of what Lind found perplexing, and for which he has been unreasonably criticised, is explainable in the twenty-first century.

One particular aspect to consider, when discussing the delay in the implementation of lemon juice (referred to as ‘the delay’ from hereon), is the hierarchical nature of eighteenth century medicine as mentioned in the previous chapter. The Medical Register for the Year 1783 is very revealing with regard to the social structure that existed in medicine at the time. Forty doctors are listed as Fellows of the Royal College of Physicians of London and only four of those had trained outside England. Of the forty-eight Licentiates just two had trained in

England; the vast majority trained in Edinburgh.125 There is a striking difference between the higher and lower echelons of the College of Physicians.

121 Lloyd, ‘The Conquest of Scurvy’, The British Journal for the History of Science, 1:4 (December 1963), p.360; C. Lloyd, ‘Victualling of the Fleet (18th and 19th centuries)’ in J. Watt, E.J. Freeman, F.J. Bynum (eds.), Starving Sailors: The influence of nutrition upon naval and maritime history (Bristol 1981), p.13. 122 Daniel Baugh, ‘The Eighteenth Century Navy as a National Institution 1690-1815) J.R. Hill (ed.), The Oxford Illustrated History of the Royal Navy (Oxford 2002) p.142. 123 Wootton, Doctors Doing Harm Since Hippocrates, pp.162-6. 124 Bartholomew, ‘James Lind and scurvy: A revaluation’ p.11. 125 The Medical Register for the Year 1783. (London 1783) Eighteenth Century Collections Online, Print Editions.

Edinburgh was also very popular amongst the provincial physicians, 128 of whom (an impressive 46.8%) trained there. This was followed by Cambridge with just thirty-four. 126

The dominance of Edinburgh, plus its progressive style, must have been a source of resentment to the London physicians. It is feasible that the Edinburgh teachings were perceived as a threat to the more traditional, orthodox, theorising style of the London medical men. This theoretical approach is criticised by Lind whose remarks are quite blunt:

The mischief done by an attachment to delusive theories and false

hypotheses, is an affecting truth… It is indeed not probable, that a remedy for

the scurvy will ever be discovered, from a praeconceived hypothesis; or by

speculative men in the closet, who never saw the disease, or who have seen,

at most, only a few cases of it.127

This statement portrays clearly that the ‘speculative men in the closet’ were an obstacle whom, Lind felt, were able to influence and cast opinion on a disease they had little experience of. In addition, Lind clearly implies these men were very unlikely to find a solution to the problem of scurvy. The above statement can be interpreted as a direct challenge to this particular type of practitioner to whom Lind is clearly opposed.

It has previously been mentioned that the naval service was unpopular with the land physicians, in addition to which, the naval medical men trained at Edinburgh. Bynum describes Lind, Cullen and other contemporaries such as Robert Robertson (1742-1829) as being ‘either Scottish born or educated dissenters’ who were excluded from the powerful

London medical world. Lind and Robertson (who became physician to Greenwich) did not become Fellows of the College of Physicians. Bynum mentions that only the army physician,

126 Joan Lane, ‘The Medical Practitioners of Provincial England in 1783’, Medical History, 28 (1984), p.366. 127 Lind, Treatise on the Scurvy, 1772 p.v. 41

John Pringle (1707-82), achieved Fellowship of the College and also became President of the

Royal Society.128

Anthony Addington (1713-1790) is an example of a physician who possessed the correct background. He attended Winchester College, underwent medical training at Oxford and, in

1756, he was admitted as a Fellow of the Royal College of Physicians.129 He practised in

Reading, was influential and had many rich patients including royalty.130 His experience of scurvy seems to have been limited but he wrote on the subject in 1753. Lind does not hesitate to describe Addington’s ideas as being ‘borrowed from Cockburn, Boerhaave, Hoffman,

Eugalenus, Lord Anson’s voyage etc.’131 Meiklejohn describes Addington’s work as an

‘excellent example of the armchair medical learning of the day.’132 Addington recommended the internal and external use of sea water – a remedy Lind had proved to be ineffective. Sea water had two advantages that may well have appealed, for practical and financial reasons, as it was readily available and very cheap!

Nathaniel Hulme (1732-1807) also appears in the Medical Register for the Year 1783 as having been appointed a Licentiate in 1774 and is still in that position nine years later. Hulme received his medical education at Edinburgh, was a follower of Lind and a believer in the efficacy of oranges and lemons. However, not all who trained at Edinburgh were progressive.

Charles Bissett (1717-91) did have some experience of scurvy at sea and wrote his own

Treatise on the Scurvy published in 1755 just two years after Lind’s first Treatise. Bissett believed sugar was a good antiscorbutic:

128 W.F. Bynum, ‘Cullen and the Study of Fevers in Britain 1760 – 1820’, Medical History, 1 (1981), p.141. 129 The Medical Register for the Year 1783. 130 Meiklejohn, ‘The Curious Obscurity of Dr James Lind’ p.305. 131 Lind, Treatise on the Scurvy, 1753, p.443. 132 Meiklejohn, ‘The Curious Obscurity of Dr James Lind’ p.305. 42

…sugar, notwithstanding the groundless prejudice many entertain against it,

is …an excellent medicine against the scurvy.133

It is evident that not everyone thought so highly of sugar and in view of the fact Bisset’s

Treatise was published two years after Lind’s then it is feasible Lind could be one of those considered to have ‘groundless prejudice.’ Bissett then adds that the prepared sugar drink could be enhanced by ‘the addition of fresh lime or lemon juice.’134 By following this method it is quite possible Bisset had some success in treating scurvy, but erroneously crediting sugar with antiscorbutic properties probably contributed to an already very confused and perplexing medical picture.

There is another very influential figure of the time who deserves to be mentioned in the reasons behind the delay. Captain James Cook (1728-1775) has been credited by many for conquering scurvy and his voyage aboard HMS Resolution (1772-1775) was lauded for being scurvy free. He certainly was very successful. Cook ensured he gained fresh provisions as often as he possibly could but he did not comprehend the importance of this measure thinking instead that cleanliness and fresh water protected against scurvy.135 It was Cook’s first action to

procure what could be met with either by every means in my power, and to

oblige our people to make use thereof both by example and authority.’136

It is evident Cook would enforce these measures on his men if they did not accept them willingly. Unfortunately, for Lind, Cook adopted the recommendations of Dr David MacBride

(1726-78) who recommended malted barley from which sweet wort could be produced. Wort

133 Charles Bisset, A Treatise on the Scurvy: Designd Chiefly for the Use of the British Navy (London 1755), p.47. Eighteenth Century Collections Online Print Editions. 134 Bisset, A Treatise on the Scurvy, p.47. 135 Lloyd, ‘The Conquest of Scurvy’, p.359. 136 James Cook,‘The Method Taken for Preserving the Health of the Crew of His Majesty’s Ship the Resolution during Her Late Voyage Round the World’, Philosophical Transactions of the Royal Society of London , 66 (1776), 403-6.

contained minute quantities of vitamin C as illustrated in Appendix A. The rationale behind wort was that it would ferment in the body and counteract the putrefaction scurvy was believed to cause. By the time of his 1772 Treatise Lind had altered his thoughts regarding the putrefaction theory as a result of post mortem examination of a number of scorbutic bodies.137

Unfortunately for Lind, MacBride’s writings were the most authoritative in addition to which, MacBride’s brother was an admiral who had apparently used wort with a degree of success – this connection would no doubt have helped MacBride.138

Another aspect of Cook’s voyage, that historians seem not to consider when discussing the excellent health record of Cook’s crew, is the fact chronometers were used to assist in navigation. The chronometers, by enabling fixation of longitude, produced greater navigational accuracy thus resulting in shorter sea passages between ports of call. This, in turn, would reduce the risk of supplies becoming exhausted. Most naval vessels did not carry chronometers in the eighteenth century as they were deemed too expensive – Cook was a special case. Indeed, Cook had his own chronometer and stated:

Our error can never be great so long as we have as good a guide as Mr

Kendall’s watch.139

It cannot be said with absolute certainty whether the chronometers contributed to Cook’s success but it is a point well worth considering.

Cook wrote the following to the army physician, John Pringle, 5 March 1776:

137 Lind, Treatise on the Scurvy, 1772, pp.iv, 495-504. 138 Carpenter, The History of Scurvy and Vitamin C, pp.64-5; John G. McEvoy, ‘Macbride, David (1726–1778)’, Oxford Dictionary of National Biography, (Oxford , 2004) 139 Richard Hough, Captain James Cook: A Biography, (Chatham, 1994), p.238; ‘James Cook Journal, Volume II,’ p.315 cited in Hough, Richard, Captain James Cook: A Biography, p.286.

We had on board a large quantity of malt… This is without doubt one of the

best anti-scorbutic sea-medicines yet found… I am persuaded will prevent the

scurvy from making any great progress for a considerable time: but I am not

altogether of the opinion that it will cure it in an advanced state at sea.140

With such support from so great a person as Cook, it is no wonder that there was little interest in providing oranges and lemons to the fleet even though Cook seems to express doubt about the efficacy of malt in advanced cases of scurvy. Cook did many good things including providing sauerkraut which contains a small amount of vitamin C. This would assist in conferring protection against scurvy (Appendix B), but may have fuelled the confusion further. Unknowingly, Cook was implementing beneficial health measures and he actually mentioned that, in some cases, oranges and lemons were useful. However, he also believed sugar was a good antiscorbutic. With regard to citrus fruits Cook wrote to Pringle on 7 July

1776:

I entirely agree with you that the dearness of rob of lemons and oranges will

hinder them from being furnished in large quantities, but I do not think this so

necessary; for though they may assist other things, I have no great opinion of

them alone.141

Pringle presented this information in his presidential address to the Royal Society in 1776 and, according to Kodieck and Young, omitted Cook’s comments regarding advanced scurvy.

Pringle favoured MacBride’s wort which resulted in misleading information and contributed to the delay.142

140 Cook, ‘The Method Taken for Preserving the Health of the Crew of His Majesty’s Ship the Resolution during Her Late Voyage Round the World’, p.402. 141 Cook, ‘The Method Taken for Preserving the Health of the Crew of His Majesty’s Ship the Resolution during Her Late Voyage Round the World’, p.406. 142 E.H. Kodieck, and F.G. Young, ‘Captain Cook and Scurvy’ Notes and Records of the Royal Society of London, 24:1(June 1969), p.49. 45

Cook’s influence also seems to have spread to Spain. Alexandro Malaspina (1754-1810), an

Italian nobleman and officer in the Spanish Navy, adopted sauerkraut and malt as recommended by Cook. It is suggested Malaspina considered Lind a lowly naval surgeon

(surgeons were not of commissioned rank) and favoured the recommendations of Cook who was a commissioned naval officer and a navigator of repute.143 This not only demonstrates the power of status, reputation and influence but is particularly ironic in view of the fact there were plenty of oranges and lemons available in Cadiz. It seems however, that the Spanish naval doctors had read Lind’s Treatise and ensured the inclusion of citrus fruits with the ships’ supplies.144 Nevertheless, it appears Cook inadvertently brought confusion to the

Spanish as well as the British.

A picture is emerging of the ingrained power of the land physicians, as represented by the

College of Physicians, and the powerful role of influence to which was added the confusing medical situation surrounding scurvy. There were many imponderables which were puzzling and probably contributed to the delay. Vitamin C has many functions and its metabolism is complicated - knowledge that was not available in the eighteenth century. It needs to be acknowledged that in association with scurvy there would have been instances of other avitaminoses (vitamin deficiency diseases) such as beriberi which develops as a result of the deficiency of vitamin B1. Watt commented that Lind observed the fact scurvy did not always follow an identical pattern and that Lind was noting the symptoms of beriberi although he did not understand this – it was another confusing factor at the time.145

143 J. de Zulueta, J., and L. Higueres, ‘Health and Navigation in the South Seas’ in J. Watt, E.J. Freeman, F.J. Bynum. (eds.), Starving Sailors: The influence of nutrition upon naval and maritime history, (Bristol, 1981), pp.93-4. 144 de Zulueta and Higueras, ‘Health and Navigation in the South Seas’pp.93-4. 145 Watt, James ‘Some Forgotten Contributions of Naval Surgeons’ p.757.

Apart from obvious scurvy, depletion in an individual’s intake and bodily storage of vitamin

C results in anaemia, reduced immune response leading to infection, haemorrhage, delayed healing, lessened resistance to trauma and shock, increased risk of rheumatic complaints, possible cataract formation, psychological disturbances and decreased awareness.146 The rate of metabolism of vitamin C is increased by stress, infection, exercise, cold, tobacco and high alcohol consumption – all of which naval personnel were subject to. Scurvy would appear in land from time to time but not in the degree seen at sea. These aspects played into the hands of the land physicians who belittled the seriousness of scurvy and attributed the sickness of the crews to the naval medical personnel.

It has been mentioned that the popular remedies of the time, such as, elixir of vitriol

(mentioned in detail in Chapter II) vinegar and sea water, had been clearly demonstrated by

Lind to be ineffective but what explanation could there be for the resistance to oranges and lemons in the face of evidence, albeit sometimes confusing, that they were efficacious?

Lloyd opined that a lemon was far too simple ‘for academic physicians enamoured with theories about the humours of the body, or the dangers of sea air.’147 Lind went against traditional opinion and wisdom by recommending it. Other ideas abounded one of which was that lemons caused gastrointestinal problems (this occurs in overdose) a side effect Lind countered by reducing the dosage. Carpenter mentions that other theories related to the idea that citrus fruits produced fevers and ‘obstruction of the vital organs’ with the result the sailors were advised to eat very little of them.148 However, Lind makes it quite clear where part of the problem lay:

146 Geoffrey Taylor, ‘Clinical manifestations of vitamin deficiencies’ in Watt, Freeman and Bynum (eds), Starving Sailors The influence of nutrition upon naval and maritime history (Bristol, 1981), pp.41-2. 147 Lloyd, ‘The Conquest of Scurvy’, p.359. 148 Carpenter , The History of Scurvy and Vitamin C, p.46. 47

Nothing can be more absurd, than to object against the efficacy of these fruits

in preventing and curing the real scurvy, because they do not cure very

different diseases.149

Interpretation of this statement suggests these particular physicians simply did not recognise scurvy. Lind was aware that episodes of misdiagnosis occurred and of the lack of clarity that surrounded scurvy:

Thus the original and real disease has been lost and confounded amidst such

indefinite distinctions and divisions of it…150

Lind also expressed concern regarding the numerous medicines ‘with which the present age abounds.’ These were founded on theory, not from experience at sea, and recommended by the land physicians.151 Lind firmly believed that sickness should be prevented by principles that could be adhered to easily and that medicines should be employed only in cases of necessity.152

Various other factors went against Lind such as his ‘rob’ of lemon juice which was prepared by heating. Unfortunately the vitamin C content was destroyed in the process thus the preparation lost its potency – something Lind could not possibly have known.153 This did nothing to enhance Lind’s credibility and must be considered a contributory factor in the delay. The copper pans used for cooking, on board ship, actually extracted vitamin C from the vegetables thus negating any antiscorbutic effect - another perplexing factor. Lind also observed people of the northern latitudes to be healthy on a diet of fresh seal and whale meat and no vegetables. The reason being that fresh meat contains some vitamin C; this was

149 Lind, Treatise on the Scurvy, 1753, pp.204-05. 150 Lind, Treatise on the Scurvy, 1753, p.77. 151 Lind, Treatise on the Scurvy, 1753, pp.75,186. 152 James Lind, An Essay on the most effectual means of preserving the health of seamen, in the Royal Navy, p.xiv. 153 Lind, Treatise on the Scurvy, 1753, p.190. 48

another unknown factor in the eighteenth century and for many years to come. Incredibly, when sailors were reduced to eating rats it actually conferred some protection against scurvy.

Rats are able to manufacture their own vitamin C and thus contributed to yet more confusion in an already profoundly complex situation.

It was observed that more corpulent people seemed to contract scurvy especially the ships’ cooks who ate leftover fat. The fat was often rancid thus causing difficulties with the absorption of nutrients including vitamin C – another factor explainable with modern day knowledge.154 Corpulent people were associated with laziness which was a prominent theory of scurvy. The following extract from the Treatise is graphically illustrative of this approach and attitude towards the sailors:

…an uncommon degree of sloth and laziness which constantly accompanies

this disease, is often mistaken for the wilful effect of the patient’s natural

disposition. This has proved fatal to many, some of whom when obliged by

their officers to climb up the shrouds have been seen to expire, and fall down

from the top of the mast.155

Lind had already identified lassitude as a symptom of scurvy but he was contradicted by, for example, the influential physician William Cockburn and the laziness theory continued to prevail.156

This brief précis, of some of the complex factors facing Lind, provides an explanation for the puzzlement Lind must have felt and it explains his reluctance to be more assertive in his

154 James Watt, ‘Some consequences of nutritional disorders in eighteenth century British circumnavigations.’, in Watt, Freeman and Bynum. (eds.), Starving Sailors, pp.58-9. 155 Lind, Treatise on the Scurvy, 1772, p.221. 156 Carpenter, The History of Scurvy and Vitamin C, p.46. 49

findings. Lind wanted to feel absolute conviction, but was confronted by some inexplicable situations - perhaps they provide a part of the explanation for the attitude of other physicians.

These circumstances must have been extremely difficult for Lind to address - on the one hand there was evidence of a cure and prevention of scurvy and on the other some confounding occurrences where the known remedies, citrus fruits and green vegetables, did not seem to have the desired effect. These difficulties would seem to contradict Lind’s findings and would thus encourage the creation of more theories. Lind is concerned and very aware of the contradictions and confusion. He commented on the remaining ideas which were ‘agreeable to the present theories of physic’ and added that they have resulted in

several contradictions, which could not easily be avoided; but the theory of

this, as well as of many other diseases…is always the most exceptionable part

of the medical performance.157

Lind mentions the current ‘theories of physic’ and is plainly demonstrating his aversion to theory by his use of the word ‘exceptionable.’ It is difficult to imagine this would be appreciated by the theorising physicians who were represented by the powerful College of

Physicians.

This chapter has demonstrated both the perplexing and misleading nature of the medical situation surrounding scurvy and the ingrained hierarchical and obstructive nature of the land based medical fraternity represented by the College of Physicians. These two main groups of facts provide enough explanation for the delay but the Admiralty has also been criticised for

‘wilful neglect and the corrosive poison that patronage induced in society.’158 However, it is insufficient to lay the blame without thought.

157 Lind, Treatise on the Scurvy, 1772 p.v. 158 Harvie, Limeys, p.8. 50

The Admiralty was composed of a First Lord, appointed by the King on advice from his ministers. Gradish mentions that the candidates would be recommended if they had the appropriate ‘social connections’ and political beliefs. There were also six junior commissioners who presumably also had the appropriate contacts; the candidates did include senior naval officers as many were active in the political world.159 The main functions of the

Admiralty were appointment and promotion of officers, it was a source of patronage and it dealt with such matters as discipline. As far as financial considerations were concerned, the

Admiralty applied to Parliament for whatever was required and it had to present a strong case in order to do so.160

The members of the Admiralty were not medical men and would turn to the acknowledged experts, the College of Physicians, for advice on drugs and victualling.161 It is evident prestige and connections played a role in this but the difficulty the Admiralty faced, very simply, was the advice it received. The superior nature that existed within the College of Physicians, in which it seems that the land based medical practitioners were very quick to blame their naval counterparts for the poor health of the sailors, leads on to the consideration of how to make an informed decision if the apparent experts, in this case the College of Physicians, were denying, or at least not acknowledging, the severity of the problem.

The Admiralty has been blamed for the delay, because it was mistaken in supporting the incorrect antiscorbutic measures, but it was following advice from those deemed to be the acknowledged experts. In January 1740, acting on advice from the College of Physicians, the

Admiralty ordered the Sick and Hurt Board ‘to provide a sufficient quantity of elixir of

159 S.F. Gradish, The Manning of the British Navy during the Seven Years’ War, (London 1980), p6. 160 Clive Wilkinson, The British Navy and the State in the Eighteenth Century (Woodbridge 2004), pp.20-3. 161 Lloyd and Coulter, Medicine and the Navy, Volume III, p.39. 51

vitriol’ to the Navy.162 Admiral Anson’s ships were thus equipped prior to his four year voyage. Watt mentions that following Anson’s terrible journey the Admiralty acted on advice from the influential physician Dr Mead, and introduced vinegar and bitters in place of fruits and vegetables.163 This action seems staggering from a modern perspective, but needs to be considered in the context of the eighteenth century. Watt also mentions the Admiralty, in

1767, rejected oranges and lemons on advice from the Sick and Hurt Board who did not deem the fruits of use in scurvy. Watt continues by suggesting this rejection resulted from Anson’s promotion of Lind over others more senior in London. 164

The Admiralty also accepted advice from Pringle (or perhaps MacBride) that malt was a reliable antiscorbutic which then became the main antiscorbutic until 1795.165 This episode is most interesting, as Lind mentions in his Treatise that MacBride wished to perform ‘a trial

…of wort on scorbutic patients.’166 There is an intriguing (and very easy to miss) footnote written by Lind at this point in which he says:

By an admiralty order, a trial of the effects of wort on scorbutic patients was

made in Haslar Hospital; I was then in London.167

Lind was Chief Physician of Haslar and this comment seems to suggest that the Admiralty ignored or overruled Lind and insisted on the trial with or without his acquiescence. It seems evident the trial took place whilst he was away and this episode provides insight into the situation of the time. Someone had enough influence to persuade the Admiralty to direct a trial at Haslar over and above Lind. There is no date given by Lind but this must have

162Institute of Naval Medicine, Collection of Admiralty Papers, January 1740. Letter from the Sick and Hurt Commissioners regarding the Admiralty’s instruction to issue elixir of vitriol to the Navy. 163 Watt, ‘Some Consequences of nutritional disorders in eighteenth-century British circumnavigations.’, pp.56- 7. 164 Watt, ‘Some consequences of nutritional disorders in eighteenth-century British circumnavigations’ p.58. 165 Watt, ‘Some consequences of nutritional disorders in eighteenth-century British circumnavigations.’ p.58. 166 Lind, Treatise on the Scurvy, 1772, p.471. 167 Lind, Treatise on the Scurvy, 1772, p.472. 52

occurred sometime between MacBride’s Experimental Essays in 1764 and before Lind’s third edition of the Treatise in 1772. It is not possible to know how Lind felt, he is believed to have been a quiet and studious man, but it seems reasonable to suggest he was affronted by this action. Lind had commented:

… the fruits have stood the test of two hundred years and are above anything

else that could be proposed for trial.168

The Sick and Hurt and Victualling Boards are also criticised with regard to the delay but again it must be pointed out that they applied to the College of Physicians for advice. Charters suggests that the Sick and Hurt Board was actively seeking a solution to the complicated problem of how to provide an antiscorbutic for an increasing number of men (the Navy was growing) and one that could be preserved at sea for many weeks.169 Crimmin believes that the

Sick and Hurt Board was concerned about the health of the sailors but it may have been a purely practical consideration as without fit men there would be no Navy.170 It is interesting to note that the composition of the Sick and Hurt Board changed and at times, prior to the late

1760s, was purely composed of administrators. Crimmin also remarks that there is much still to be investigated regarding the role of the Sick and Hurt Board and that it has been unfairly criticised.171

Baugh states that the Victualling Board commissioners were not concerned with health and were probably opposed to any suggested changes that may have been made.172 Their business was to keep the men fed as cheaply and easily as possible considering the problems of food

168 Lind, Treatise on the Scurvy, 1753, p.205. 169 E.M. Charters, ‘The Intention is Certainly Noble’ in David Boyd Haycock and Sally Archer (eds.) Health and Medicine at Sea 1700 – 1900 (Woodbridge 2009) pp.19-37. 170 P.K. Crimmin, ‘The Sick and Hurt Board and the Health of Seamen c. 1700-1806’ Journal for Maritime Research (1999) 1:1 p.52. 171 P.K. Crimmin, ‘The Sick and Hurt Board: Fit for Purpose?’ in Haycock and Archer (eds) Health and Medicine at Sea 1700 – 1900, p.107. 172 Baugh, Daniel ‘The Eighteenth Century Navy as a National Institution 1690-1815’ p.143. 53

storage at sea. Lloyd comments that Lind had mentioned vegetables could be preserved by salting them but the Victualling Board and the Admiralty gave this no attention.173 Gradish mentions that the Victualling Board defended itself by saying it was not composed of medical men but administrators. It was therefore not qualified to judge the standard of the diet supplied to the fleet.174 This is perhaps a convenient method of avoiding responsibility and apportioning the blame elsewhere but in essence the Board was correct. It believed responsibility for medical matters, which included new types of food and any medicines, lemon juice was perceived as such, lay with the Sick and Hurt Board and the Admiralty who turned to the College of Physicians for advice. Lloyd also mentions the situation was made more complicated by the sailors’ stubbornness as they were extremely fond of their salted provisions. It took much persuading, or force, to effect a change therefore it could have been easier for the Victualling Board and for life on board to give the men the food they preferred.175

This chapter has demonstrated that Lind must have been adversely affected by the policies and prejudices of the day and it seems his ideas, his training and background would have been at odds with the hierarchical nature of medicine at this time. Those authors who blame Lind for contributing to the delay fail to recognise the situation with which he was faced. The delay could have partly been the result of a perplexing medical situation, which was far beyond the knowledge and expertise of eighteenth century medical practitioners, and the ingrained power of influence and patronage represented by the College of Physicians. These

173 Lloyd, ‘Victualling of the Fleet’, p.12. 174 Gradish, The Manning of the British Navy, p.140 175 Lloyd, ‘Victualling of the Fleet’, p.9. 54

are very credible explanations but do not answer the next part of the question - what occurred to persuade the Admiralty to change its mind and introduce lemon juice?

Chapter IV: The Examination Continued.

The previous chapter of this dissertation suggested that the Admiralty may not have been fully aware of the true situation regarding scurvy partly because it derived medical advice from the powerful College of Physicians. This chapter will explore the evidence further and analyse the situation in the latter eighteenth century particularly the pivotal year of 1795.

The Introduction to this dissertation mentioned Lind’s comments in relation to the War of

Jenkins’ Ear and the fact that scurvy had killed more men than had the enemy. He also described the appalling losses suffered by Lord Anson and the losses sustained in the Seven

Years’ War. The outbreak of scurvy in 1780 was so severe extra accommodation had to be erected in the form of tents at Haslar. Lloyd and Coulter mention that, from a medical perspective, the Navy was in a sickly condition between the years 1778 – 1783, partly as a result of inadequate victualling, lack of hygiene and condition of the recruits which in turn contributed to the loss of the American colonies.176 Lind was still physician at Haslar during this time with 9,818 sick men admitted to the hospital during 1780.177 This is a reflection of the health status of the Navy and an indication that Lind’s methods and recommendations had not been adopted by those in authority.

In 1778 Sir Gilbert Blane, an admirer of Lind and believer in the efficacy of lemon juice, began collecting data for the size of the Navy and its overall sickness rate. According to

Blane’s data, the Navy doubled in size from 60,000 men voted in 1778 to 120,000 men voted in 1797 but there was not a doubling of the sickness rate - in fact the figures show an overall improvement in the rate of sickness. Please see Graph 1 below. The increase in sickness in

176 Lloyd and Coulter, Medicine and the Navy, Volume III, p.122. 177 Gilbert Blane, Statements of the Comparative Health of the British Navy from the Year 1779 to the Year 1814 with Proposals for its Further Improvement by Sir Gilbert Blane, Bart. F.R.S. Physician to the Prince Regent.Read June 20, 1815p.542. 56

1780 is apparent and attributed to scurvy and fever. Scurvy afflicted 1,457 men in the

Channel Fleet:

…the only instance that occurred of the channel fleet being in a considerable

degree affected with this disease.178

The interesting words here are ‘of the channel fleet’ which suggests that scurvy was not normally seen, or not that common an occurrence, in the Channel Fleet. It could also be interpreted as suggesting that scurvy was a problem in more distant waters. However, the data does seem to contradict Lloyd and Coulter’s comments that the Navy was in poor health, but it does illustrate again that the available evidence from the eighteenth century can be confusing. Furthermore, subsequent interpretation of the data may add another layer of complexity.

Graph 1. Data demonstrating the improving health of the Navy in the latter eighteenth century.179 Percentage Sent Sick 45.00 40.00 35.00 30.00 25.00 20.00 15.00 10.00 5.00

0.00

1781 1806 1778 1779 1780 1782 1783 1793 1794 1795 1796 1797 1798 1799 1800 1801 1804 1805 Year

178 Blane, Statements of the Comparative Health of the British Navy .p.552. 179 Blane, Statements of the Comparative Health of the British Navy, p.541. 57

There is no data for the ten years between 1783 and 1793 as it was a short period of peace.180

In 1793 there is another increase, possibly due to yellow fever, and there continues to be a decline in the rate of sickness until 1797 which, Blane says, developed a result of mutiny that continued for several months.181 Blane considers the improvement from 1795 to 1796 as being entirely due to the introduction of lemon juice.

This is satisfactorily accounted for by its being the first year in which the

general supply of lemon juice took place.182

The increase seen in 1800 may have been due to yellow fever in the West Indies.

The improving picture of health is attributed to many factors which include a gradual improvement in the hygiene and cleanliness of the Navy and the belief that many ships’ surgeons, officers and captains had, unofficially, followed Lind’s recommendations including citrus fruits. Watt mentions the example of Samuel Wallis’ voyage, 1766-1768, in which John

Hutchinson (surgeon) knew the physician, Nathaniel Hulme, who relayed Lind’s ideas on hygiene and diet stressing the value of fresh provisions. Wallis also preserved his men’s energy by implementing an extra watch period. This equated to a reduction in energy output and therefore a reduction in the rate at which vitamin C would have been metabolised. This was very fortunate as, following Admiralty orders, the ship had been loaded with MacBride’s malt.183

Crimmin is of the opinion that the more enlightened officers, such as the Admirals Anson,

Vernon and Howe were most concerned about the men’s health and wished to ensure the

180 Blane, Statements of the Comparative Health of the British Navy, p.494. 181 Blane, Statements of the Comparative Health of the British Navy, p.495. 182 Blane, Statements of the Comparative Health of the British Navy, p.494. 183 Watt, ‘Some Consequences of Nutritional Disorders in Eighteenth Century British Circumnavigations.’pp.61-2. 58

ships were in a state fit for the crews.184 These admirals had seen only too well the havoc disease could bring – they were motivated to do something about it and were capable of presenting their views to the Admiralty. Crimmin comments that, during the 1770s, captains were regularly relaying their good experience of lemon juice to the Admiralty and she also believes the Navy genuinely wished for an improvement in health.185 This does make sense as without fit men there could be no fighting force – or at the very least an ineffective one.

Crimmin states that things slowly improved as a result of better hygiene, diet and hospital care. 186 These were all measures proposed by Lind and are apparent in his writings. Gradish has also remarked that victualling standards improved which, in combination with better hospital care, resulted in an overall improvement in health than at any time in the past.187

If the above is an accurate portrayal of an improving situation, in the latter eighteenth century, then it is conceivable that the Admiralty would not feel it necessary to introduce any new measures, at considerable cost, when there appeared to be no need. Blane’s data is a general guide and indication of an improvement in health and that is all – nothing more. The fact that enlightened officers and naval surgeons were acting on their own initiative is an appealing explanation, particularly considering that in the years preceding 1795 the recommended antiscorbutics were sauerkraut, elixir of vitriol, malt and essence of wort.188 The only useful substance of these was sauerkraut. This evidence really demonstrates how slowly things changed and supports the idea that the more caring personnel, wishing to promote the health of the crews, acted on their own initiative.

184 Crimmin,‘The Sick and Hurt Board and the Health of Seamen.’ p.58. 185 Crimmin, ‘The Sick and Hurt Board and the Health of Seamen.’ p.59. 186 Crimmin, ‘The Sick and Hurt Board and the Health of Seamen.’ pp.58-60. 187 Gradish, Manning the Navy, p.139. 188 Lloyd and Coulter , Medicine and the Navy, Volume III, p.323. 59

Whatever was happening in the late 18th century it is certain that Thomas Trotter (appointed

Physician to the Fleet on the 3rd April 1794) thought scurvy was under control - he considered there was good prospect of the Channel Fleet being free of it. This is interesting as it suggests scurvy was, or could be, a problem in the Channel Fleet but that measures had been taken to conquer it. He wrote the following words in his Medical and Chemical Essays (published in

1795):

The Channel fleet since April (1794) has not afforded me any experience of

this disease.189

Trotter also comments on a report from Mr Ballantyne, surgeon of HMS Colossus, that two cases of scurvy on board had been rapidly cured with lemon juice. This would seem to be further evidence that lemon juice was being used even if unofficially. Trotter continues to express his opinion that the prevention and cure of scurvy ‘are so well understood’ and the cure ‘so easily commanded’ that:

…it can be nothing but the grossest indifference and neglect that could permit

a fellow creature to perish under it.190

It is very evident from this statement that Trotter was in no doubt about the cure but that he also considered it shameful should someone be allowed to die from scurvy. It is also possible this was a veiled comment towards those in authority.

No sooner had Trotter thought scurvy was under control then things began to go awry:

…unforeseen causes began to operate, which in a few weeks produced a more

general scurvy than had ever been known on home service.

This, again, is suggestive of the fact scurvy was not often seen whilst ships were in home waters. Part of the explanation would lie in the length of time the ships were at sea but also in

189 Thomas Trotter, Medical and Chemical Essays: Containing Additional Observations on Scurvy, with Cases and Miscellaneous Facts in Reply to Dr Beddoes and Others, p.106. 190 Trotter, Medical and Chemical Essays p.111.

the recent nutritional status of the crews, that is, the body’s storage of vitamin C. Trotter continues to describe a very severe frost in December 1794 and a cold north - easterly wind which lasted for three or four months. 191 He mentions that many of the ships were being refitted having experienced ‘a long course of boisterous weather in September, October and

November.’192 The enemy’s fleet was also at sea and experienced a long storm from which five of their ships foundered. The Channel Fleet:

having put into Torbay from contrary winds, experienced much cold weather,

and a dangerous gale…

During this time there was no fresh beef available to the ships as they lay in Torbay but, eventually, the conditions relented sufficiently to enable them to move to Spithead - please see map at Appendix A. The men had survived for five weeks on salt provisions only. Trotter states that, in February 1795, numerous cattle and sheep had died, ‘due to the rigours of the season’ and that vegetation was ruined. The price of beef had increased, the contractors were unable to buy more, and Trotter continued to say that the Victualling Board decided to reduce the ships’ allowance to ‘one day’s fresh meat in the week.’193 Trotter was plainly annoyed and commented that such an alteration in the victualling of the fleet should never have occurred without ‘consulting officers on the spot.’ In March the vegetables in the locality of

Portsmouth were destroyed and Trotter admits he was worried ‘in this state of the Fleet.’194

Trotter expressed this situation in a short but very impactful sentence:

At this time there is not a cabbage brought to any ship at Spithead.195

191Thomas Trotter, Nautica Medicina Nautica: An Essay on the Diseases of Seamen: Comprehending the History of Health in His Majesty’s Fleet under the Command of Richard Earl Howe, Admiral, (London 1797), p.405. 192 Trotter, Medicina Nautica, pp. 114, 406. 193 Trotter, Medicina Nautica, p.406. 194 Trotter, Medicina Nautica, p.407. 195 Trotter, Medicina Nautica, p115. 61

Trotter was cognisant of the potential disaster knowing, very well indeed, the conditions were conducive to the development scurvy.196 In early March Trotter had asked for dietary items he considered useful but the Victualling Board vetoed almost all; the exception was molasses and these, Trotter said, arrived too late to be of use.197

The Victualling Board, government and Admiralty, were confronted with a very difficult and serious situation which was now exacerbated by rising prices. Knight and Wilcox mention that the highest price paid, by the Victualling Board, for a quarter of wheat in 1794 was £2

19s 8d which increased to £5 6s 1d in 1795. The price of a sack of flour also increased from

44s in 1794 to 83s in 1795.198 The Victualling Board had a very difficult problem to meet the

Navy’s requirements in addition to the demands of being at war. Rodger provides a very good idea of what was required in terms of provisions for the Channel Fleet of 36,000 men: 2,925 tons of biscuit, 1,671 tons of beef, 835 tons of pork, 626 of pease, 313 tons of oatmeal, 156 tons of butter, 313 tons of cheese, 32,000 tuns of beer.199 This diet would have been almost devoid of vitamin C. In May 1795 Trotter demanded five thousand pounds of green vegetables for the Fleet which previously had rarely received one hundred pounds of such produce. Trotter scoured the gardens and market stalls in the locality of Portsmouth himself in order to procure the produce. He did not consider such action below his dignity and he continued by serving it himself from the quarter deck of the Charon which the men referred to as the ‘Doctor’s garden.’200

196 Trotter, Medicina Nautica, p.408. 197 Trotter, Medicina Nautica, p.408. 198 Knight, Roger and Wilcox, Martin, Sustaining the Fleet 1793-1815:War, the British Navy and the Contractor State, (Woodbridge, 2010), p.74. 199 Emma Laird, ‘The Victualling of the Channel Fleet’(Greenwich MA Dissertation 2001) cited in Rodger, Command of the Ocean, p.484. 200 Trotter, Medicina Nautica, p.128. 62

The meteorological evidence provided by Trotter is supported by the weather diary of Francis

Beaufort who was on board HMS Phaeton in 1795. The Phaeton was moored at the Nore

(near the entrance to the river Medway) then, by May, had moved to Spithead to join the squadron of Admiral Cornwallis which was going to conduct a blockade off the port of Brest.

The entries are most illuminating regarding the weather, with many descriptions of hard frost, heavy snow, hail, thick ice, heavy rain, strong gales. Winds continued to flow from a northerly or north-easterly direction which would have added an unpleasant wind chill factor to an already cold and miserable situation.201 Information from Lamb also demonstrates that the usual wind direction of south - westerly, decreased in the late 1780s – ‘90s to about 60 days a year.202 Apart from the cold brought by the north - easterly winds, many ships would then have been making passage home against the wind - it is not difficult to imagine and comprehend the developing catastrophic situation with regard to the health of the crews.

The Met Office provides a record of Central England Temperatures (from 1659 – 2013) inspection of which reveals that the winter of 1794 to1795 was not a normal winter but an exceptionally severe one. January 1795 was the coldest month on record and the winter months of December (1794), January and February (1795) the fifth coldest in the complete series.203 Please see Graph 2 which depicts a period of twenty-five years for illustrative purposes. It is of interest to note how much warmer the years preceding 1795, January of

1796 and the winter quarter 1795-1796 were.

201 Met Office Archives Z11.E-Z10.B Item ID: 912891-1001 Private Weather Diary of Sir Francis Beaufort 1794-1800. 202 Lamb,H.H., Climate, History and the Modern World, (Oxford, 1982) pp.53-54. 203 D.E.Parker, T.P. Legg, and C.K. Folland. ‘A new daily Central England Temperature Series, 1772-1991’. International Journal of Climate, 12, (1992) 317-342, Central England Temperature Series, Met Office, http://www.metoffice.gov.uk/hadobs/hadcet. Consulted July 2014.

The autumn of 1794 had been very wet having received 140% of the average rainfall with the inevitable ruination of harvests.204 There was much flooding which was then followed by extremely cold temperatures.

The frost continued till the 6 of January 1795…and continued frosty with

snow…till the 26 of January when we had a great thaw …57 sheep and 14

pigs and a dog all drowned. 205

Graph 2. Comparison of January and Winter Quarter 1780-1805.

T e 6 m p e C r e 4 a n t t u i r 2 DJF g e r Jan a D d 0 e e

1782 1786 1781 1783 1784 1785 1787 1788 1789 1790 1791 1792 1793 1794 1795 1796 1797 1798 1799 1800 1801 1802 1803 1804 1805 r 1780 e -2 e s

-4 Year

The frost returned and lasted until March; both the Severn and Thames rivers were frozen.

The warmer temperatures of April 1795 resulted in significant flooding which was then

204 Alexander, L.V. and Jones, P.D. Updated precipitation series for the U.K. and discussion of recent extremes. Atmospheric Science Letters doi:10.1006/asle.2001.0025 (2001), Monthly England and Wales Precipitation, Met Office, http://www.metoffice.gov.uk/hadobs/hadukp. Consulted July 2014. 205 National Meteorological Library and Archive: Z11.E-Z10.B, Item ID: 912897-1001 Private Weather Diary for Alton, Hampshire. 64

followed by further snow fall in May.206 Gilbert Blane mentions that from inspection of

Parliamentary returns ‘there was considerable increase of mortality in 1795 all over

England.’207

In April 1795 Trotter stated in a letter to the Sick and Hurt Board that scurvy did occur, from time to time, in harbour but ‘never so great as at this time.’ Trotter believed the unusual situation was attributed to:

…the joint influence of a severe winter, the scarcity of vegetables but above all to

the very small proportion of fresh beef.208

The Admiralty forwarded fresh supplies of lemons, oranges and salad to Trotter aboard the

Charon. Trotter states that lemons cured 3,000 scorbutic men on board ship and about twice that number, with less severe symptoms, from a combination of salad and juice. He is also of the opinion that the Navy’s success off the Isle de Groix would not have occurred without the timely arrival of these supplies.209

Beaufort set sail with the rest of Cornwallis’ squadron on the 26th May and it is telling that only one ship, the Mars, was free from scurvy when they sailed. There was a quantity of salad and lemon juice, on board the ships, and these were of great benefit. Trotter reported that over a hundred men had been cured on board the Triumph ‘but the general taint among the crews was not corrected.’ Trotter was disappointed with the supplies received as the quantity was insufficient to eradicate scurvy. He also preferred, if he could, to utilise lemons for curative purposes only.210 Trotter has been criticised for being reluctant to use lemons prophylactically but it is worth considering how precious this fruit and its juice were – it

206 Weather Booty – http://booty.org.uk/booty.weather/climate/1750_1799.htm. Consulted 20 October 2013 207 Gilbert Blane, ‘Observations on the Comparative Prevalence, Mortality and Treatment of Different Diseases’, Medico-Chiurgical Transactions, 4 (1813) p.110. 208 NMM ADM/E/45. 20 April 1795. Letter from Thomas Trotter regarding scurvy in the Channel Fleet. 209 Trotter, Medicina Nautica, p.134-5. 210 Trotter, Medicina Nautica, pp.127-8. 65

seems natural he would keep it as a cure to be used if other measures had failed. Trotter seemed to agree with Lind that prevention was better than cure.

In June 1795 Captain Collingwood (HMS Excellent moored at Spithead) wrote to the Board of Admiralty requesting lemon juice to cure and prevent scurvy.211 Mr Scott, the surgeon on board Excellent testified that ‘lemons are a certain cure.’ Trotter refers to the ‘uniform testimony’ of the surgeons and their positive experience of the beneficial effects of lemons and vegetables.212 The Admiralty received letter after letter requesting antiscorbutics – oranges, lemons, vegetables.

Mr Ballantyne, of the Colossus, found himself with 120 scorbutic sailors all of whom he cured in June 1795. Mr Ballantyne confirmed the good effects of fruit and vegetables in the cure as well as the prevention of the scurvy. Trotter commented that the salad had been very helpful as the men had been subjected to a diet that did not include vegetables and fresh beef.213

In July 1795 the Admiralty wrote to the Sick and Hurt Board commanding them to assist

Captain Durham ‘whose ship is afflicted with a severe scurvy.’214 In August 1795 Trotter mentions that he returned, on board the Charon, to Lord Bridport’s squadron with sheep and vegetables and found that 475 men were ill with scurvy after ten weeks at sea. Trotter believed that if the salad been supplied sooner, or continued to be served longer, then there

211 NMM: ADM F/26. Board of Admiralty In-Letters. 15 June 1795. Letter from Captain Collingwood of HMS Excellent requesting lemon juice. 212 Trotter, Medicina Nautica, p.410. 213 Trotter, Medicina Nautica, p.132 214 NMM: ADM E/45 Sick and Hurt Board In-Letters and Orders. 30 July 1795.Letter from Admiralty ordering assistance to be given to Captain Durham.

would not have been such a quick resurgence of scurvy. Trotter made the following critical statement:

…on my part, some reasons for regret, that the improvements in diet, which I

had suggested so early in the month of March had not been complied with.215

Scurvy was still gaining ground by the end of August 1795 with some men being left in hospital at Haslar. In September Lord Bridport’s ships arrived in Plymouth with 1,085 men ill with scurvy of whom 170 were admitted to hospital.216 Trotter was desperate to cure as many men aboard ship as possible. Leaving men behind in hospital meant taking unknown new recruits which, apart from discipline problems, equated to an increased risk of introducing further disease.

In September the Commissioners of the Sick and Hurt Board informed Trotter that the supply of lemon juice was low and that no more could be obtained – this just before Trotter was due to take the Charon to assist the ships stationed off Quiberon. Trotter immediately organised fifty bushels of apples to be bought. Apples have far less vitamin C than oranges and lemons

(Appendix A) but are better than nothing. Trotter was clearly working very hard for the crews. Trotter also remarked that the effectiveness of lemons and salad, provided to the

Valiant’s crew previously, had continued to protect them so effectively that when they returned to Spithead they were in good health. 217

Trotter relates many examples of cure on board ship and it is evident tremendous work was carried out by the surgeons. It is also evident that some of the pursers acted in a kind and concerned fashion. Mr Unwin of the Prince George ensured the ships were supplied with

215 Trotter, Medicina Nautica, p.143. 216 Trotter, Medicina Nautica, p.146. 217 Trotter, Medicina Nautica p.146. 67

vegetables in abundance - he could not ‘forget the men in their distress.’218 Trotter then continues to mention that the Lord Commissioners of the Admiralty:

…having observed the good effects of supplying the seamen with

refreshments, had ordered bullocks and sheep to be sent from Cork and

Plymouth, with potatoes, cabbages and onions, for Admiral Harvey’s

ships.’219

The words ‘having observed’ perhaps confirm the suggestion that there was little scurvy seen in home waters, that the Admiralty may not have been fully aware of it, and that finally they were convinced of the efficacy of a good diet. They had now witnessed scurvy close to home and its devastating impact. It does seem incredible that this could be the situation but it is difficult to interpret otherwise.

Finally, late in 1795 the Admiralty, apparently having been persuaded by Gilbert Blane who had been appointed a commissioner on the Sick and Hurt Board, agreed to the general supply of lemon juice. In amongst many other Admiralty documents, at the National

Maritime Museum, is one headed ‘Remarks on the intended general supply of lemon juice to the fleet as an article of diet for the prevention of scurvy.’ There is no date on the document but it is filed with others at the end of 1795 and beginning of 1796. The following quote, which probably relates to the voyage of HMS Suffolk in 1794 during which lemon juice was issued to the crew, on the recommendation of Blane, and during which the crew remained healthy, would seem to confirm that view.

218 Trotter, Medicina Nautica p.147. 219 Trotter, Medicina Nautica, p.410, 148. 68

About two years since it was mentioned that a seaman who daily consumes a

given proportion of lemon juice, will never have the scurvy, let the other parts

of his diet consist of what they will… 220

The words ‘let the other parts of his diet consist of what they will’ would have annoyed

Trotter greatly.

In December 1795 Trotter found himself in trouble having bypassed official channels, with regard to ordering livestock and vegetables, for the squadron due to relieve Admiral Harvey’s on the coast of France. He was most concerned for the health of the crews as he felt the length of time the ships would be at sea would predispose the men to scurvy and regarded it as his duty ‘to use the proper precautions should this be the case.’ The Admiralty were not amused:

Their lordships are much surprised by the measure adopted by Dr Trotter… he

ought not to have exercised discretion to order the relief of the squadron. 221

The difficulties Trotter faced can only be imagined but it is evident his main priority is that of a good doctor – the care and cure of the sick.

Trotter believed the control of scurvy dated from January 1796. He made it clear what he thought of previous attention to the matter:

However vague and uncertain the records of naval transaction left this point

on former occasions; the late occurrences in the Channel Fleet have

sufficiently established the fact that scurvy can always be prevented by fresh

vegetables, and cured effectively by lemon or the preserves juice of that fruit.

220 NMM: ADM F/26 Board of Admiralty In-Letters. Undated. ‘Remarks on the intended general supply of lemon juice to the fleet as an article of diet for the prevention of scurvy.’ 221 NMM: ADM E/45 Sick and Hurt Board In-Letters and Orders, 9 December 1795. Letter regarding Dr Trotter’s actions in ordering relief for Admiral Harvey’s squadron. . 69

Trotter believed that ‘vegetable matter imparts a something to the body which fortifies it against the disease.’ He was also astute enough to realise thet the ‘something’ needs to be in the correct proportion and that allowance needs to be made for external factors which affect the constitution. If symptoms appear then use the cure – lemons.222 Trotter was averse to the idea of dosing the men with lemon juice routinely and believed a proper diet containing vegetables was the correct course of action - this made him unpopular. The Admiralty decided lemon juice was easier to store on board than providing livestock and vegetables with the result Trotter was replaced by Dr Andrew Baird.223

Sir Gilbert Blane, whose name does not seem to appear as a Commissioner of the Sick and

Hurt Board until late 1795, credits the Medical Board (Sick and Hurt) for the introduction of lemon juice and, being politically astute, praises Earl Spencer who was First Lord of the

Admiralty:

This salutary measure was accomplished by a representation from the

Medical Board of the navy in the year 1795 during the administration of Earl

Spencer from whose enlarged and benevolent mind everything was to be

expected.’224

However, in spite of this ‘salutary measure’ the supply was not straightforward. Blane mentions that at first things did not run smoothly and lemon juice was provided only to ships destined for foreign service. This required instructions from the Admiralty such as those issued in February 1796 that the Sick and Hurt Board supply the ships of Admiral Cornwallis with lemon juice prior to their departure for the West Indies.225 Blane explains that the supply

222 Trotter, Medicina Nautica, pp.420, 429. 223 Rodger, Command of the Ocean, p.485. 224 Blane, Statements of the Comparative Health of the British Navy from the Year 1779 to the Year 1814 , p.496. 225 NMM: ADM E/45. Board of Admiralty In-Letters. February 1796. Instruction to provide ships of Admiral Cornwallis with lemon juice. 70

problems were due to war having broken out with Spain, thus interrupting the supply of fruit, but that plentiful supplies were obtained from Sicily.226

Lloyd and Coulter, in association with many other authors, credit Blane with persuading the

Admiralty to introduce lemon juice to the sailors and comment that if this had not occurred

‘the age of Nelson might well have proved as disatrous as the preceding age of Rodney’ 227

Knight and Wilcox remark that scurvy gradually disappeared from the Navy when Admiral St

Vincent, who was convinced of the beneficial health effects of citrus fruits, became

Commander-in-Chief of the Channel Fleet in 1800. Gradually, according to Knight and

Wilcox, lemon juice was added to the seamen’s diet as the Sick and Hurt Board was able to supply sufficient quantities.228 Trotter had a different point of view, as mentioned above, and

Blane dates the conquest of scurvy in the Navy from 1796.229

Research thus far has indicated that other historians have paid little attention to the impact of the weather and under emphasised the seriousness of the 1795 scurvy problem. Rodger does refer to outbreaks of scurvy, which were cured on ship, and the serious problem in summer

1795 but he seems to place little emphasis on how significant this actually was.230 Knight and Wilcox also mention the winter of 1795 as being one of the coldest. They comment on the scarcity of food, the associated rise in prices and unrest among the population but seem not to appreciate the severity of scurvy and the real impact of the weather.231 Harrison refers to the weather and the fact scurvy appeared in the fleet but seems to underplay the

226 Blane , Statements of the Comparative Health of the British Navy from the Year 1779-1814, p.494. 227 Lloyd, ‘The Conquest of Scurvy’, p.360. 228 Knight and Wilcox, Sustaining the Fleet, pp.64-5. 229 Blane, Statements of the Comparative Health of the British Navy from the Year 1779-1814, p.498. 230 Rodger, Command of the Ocean, p.484 231 Knight and Wilcox, Sustaining the Fleet, p.74. 71

significance – he mentions just two hundred men being admitted to hospital.232 Harrison remarks the outbreak did not lessen until summer and the arrival of fresh fruit. It was demonstrated above that this was not the end of the matter as September 1795 brought a further 1,085 cases.

It does seem that the 1795 outbreak of scurvy has not been adequately examined by historians and the role of the weather examined less so. This is intriguing considering the impact the weather has on all our lives and the well-known British obsession with it! The weather of

1794-95 created a perfect storm of extreme cold, ruined crops and reduced food supply with the inevitable result of scurvy that manifested itself close to home whilst Britain was at war and vulnerable. The Admiralty acted and lemon juice was finally introduced to the fleet. It is interesting to consider that, the year after Lind had died, the weather achieved what Lind had been denied.

232 Mark Harrison, ‘Scurvy on Sea and Land: Political Economy and Natural History c.1780-c.1850’ Journal for Maritime Research,15:1 (2013), p.11. 72

Conclusion

The year 1795 is prominent in the literature, associated with the history of scurvy and the

Royal Navy, as being the year in which the Admiralty decided to mandate the introduction of lemon juice. It is also most noticeable that many authors, such as Sir James Watt and Lloyd and Coulter, have ascribed the introduction of lemon juice to the influential and well- connected Sir Gilbert Blane.233 It would be unfair to suggest Blane had no role to play but the prominence given to him is not justified and does not provide adequate elucidation to this question.

It is the opinion of this author that there is no simple and straightforward explanation as to why the implementation of lemon juice to the Navy was so delayed - the Admiralty,

Victualling and Sick and Hurt Boards have all been assigned the blame at different times by different authors. However, this dissertation has demonstrated that there are several complex underlying themes, the first of which is the, very understandably, confusing nature of eighteenth century medicine. In addition to this, the attitudes that existed within the eighteenth century medical hierarchy were probably significant factors in the delay. It is also feasible the Admiralty may not have been fully aware of the scurvy problem. This can be accounted for by the attitude of the College of Physicians, who seem to have ignored or denied the experience of the seagoing medical practitioners, basically dismissing this valuable source of knowledge. The influence of others, such as Captain Cook, also played a not insignificant role in the delay. It was mentioned in Chapter III that Cook used chronometers, as a navigational aid, which in turn may have contributed to the favourable outcome of his voyage. This would have added to the overall perplexing and misleading situation surrounding scurvy whilst simultaneously enhancing Cook’s apparent success.

233 Watt, James, ‘Some Forgotten Contributions of Naval Surgeons’ p.757; Lloyd and Coulter, Medicine and The Navy, Volume III, p.319. 73

A further contributory factor would appear to be that scurvy may not have been overly apparent in the Channel Fleet unless it spent many weeks blockading a foreign port. The health of the sailors would depend on the length of voyage undertaken and their nutritional status prior to departure. A well-nourished individual can probably tolerate a diet devoid of vitamin C for about twelve weeks but this is variable - in addition other influences play a role in the metabolism and utilisation of the vitamin. There is also sufficient evidence to suggest that the more enlightened naval officers and medical personnel were acting on their own initiative. This would not be surprising considering the obstruction from the College of

Physicians and lack of support from official bodies. However, it must be remembered that the official bodies did seek advice from the College of Physicians on medical matters. It seems many cases of scurvy were cured on board ship the number of which will never be known.

Many will also have died.

Conducting the research for this dissertation has been a stimulating and enlightening experience leading to the discovery of new material. Lind’s Treatise has been an immense and rich source of information providing the clues to the reasons behind the delay as well as many other matters including insight into Lind as a person. Perhaps one of the most telling and poignant letters found in the Caird Library, National Maritime Museum, was that from the Admiralty in October 1795, instructing the Sick and Hurt commissioners to provide

Lind’s old ship, HMS Salisbury, the site of his experiment, with citrus juice before it sailed

‘on distant service.’234 Lind had died the previous year but, had he known, it is likely his thoughts would have been with the sailors and their improved health.

234 NMM: ADM E/45 Sick and Hurt Board In-Letters and Orders. Admiralty Instruction to provide HMS Salisbury with citrus juice. 23 October 1795.

Chapter IV of this dissertation subsequently revealed that the causes leading to the introduction of lemon juice could be found in Thomas Trotter’s Medicina Nautica, the reading of which directly led this author to research the meteorological conditions of the time. It is impossible to escape the impact of the weather of autumn 1794, followed by the winter of 1795, which precipitated the subsequent outbreak of scurvy in the fleet whilst it was moored in home waters. It would seem a very reasonable suggestion to say that this was a timely reminder to the Admiralty and the government of the outbreak of scurvy in 1780 and the disastrous loss of the American colonies. This is not to say that scurvy alone was the reason for the loss of the colonies but it can be seen as a contributory factor. It is not beyond credibility to say that Britain did not wish for a repeat of that disaster.

During the Introduction to this dissertation it was mentioned that Rodger considers the importance of scurvy has been the subject of some hyperbole and that fevers were responsible for a greater number of deaths. Rodger is not in error, with regard to the problem of fevers, but far from saying scurvy has been exaggerated it is feasible it has not been considered enough. Research, conducted in the course of this work, has illustrated that vitamin C has a number of roles and a complex metabolism. There are many other conditions under the heading of, for example, anaemia, lethargy, depression, rheumatism and some fevers that could have been symptomatic of vitamin C deficiency. These were not recognised as being associated with scurvy and therefore not treated as such. It would seem ‘vitamin C deficiency’ rather than scurvy may be a better term to employ.

Rodger has also commented that naval medicine has been studied in greater detail in France and Germany than in Britain. He also suggests that scurvy has been the only disease of interest to British medical historians and comments that ‘the antiquarian productions of

retired doctors recycling tired myths are still painfully evident.’235 Rodger’s point is well made and understandable but, placing the antiquarian contributions to one side, there seems to be more to the history of scurvy, or vitamin C deficiency, than has been relayed so far. It is a subject deserving of greater scrutiny.

The weather was, in effect, the catalyst required for a decision to finally be made in favour of lemon juice – a decision which many authors believe had taken too long and cost too many lives. The weather had created a shortage of food which led directly to a severe outbreak of scurvy. This situation combined with a state of war stimulated the Admiralty to finally take the correct course of action. The Admiralty could not ignore the body of evidence it was facing at Spithead and the continuing reports of scurvy in the fleet. Equally, no one could deny or hide the truth that a diet containing fresh fruit and vegetables was a healthy diet and that the humble lemon cured the disease. It must be remembered that the official antiscorbutics of choice were still elixir of vitriol and MacBride’s malt.

This dissertation has demonstrated that the investigation into the delay in the implementation of lemon juice is about far more than the history or medicine from a purely medical view. It is not a straightforward case of having a good idea and it being implemented into practice.

It is an insight into social status, the hierarchical nature of medicine, patronage and influence and the role of chance that existed in the guise of the weather. It demonstrates that, sometimes, human nature being what it is, in order for the correct action to be taken a catalyst is required. That catalyst is often war but in this case the weather brought about the desired effect at a propitious moment. The meteorological situation demonstrated more than anything

235 Rodger, N.A.M., ‘Recent Books on the Royal Navy of the Eighteenth Century’ The Journal of Military History, 63:3 (July 1999), p.694. 76

the dangers to and fragility of the health of the Navy. This naturally leads to consideration of what might have happened had the weather not intervened but that, as Lind would have agreed, is conjecture.

Opinions are divided on the role of lemon juice in the defeat of Napoleon but it is of interest to note Admiral Villeneuve’s concerns about the condition of the Spanish fleet prior to the

Battle of Trafalgar in October 1805. Villeneuve observed that scurvy and dysentery were commonplace and the ships in such disrepair they should never have sailed.236 Watt remarks that the French medical historian, Adrien Carré, believed that the good health of the Royal

Navy contributed to the French defeat.237

History has demonstrated that the introduction of lemon juice was not the end of the scurvy story but at least it was a beginning. Occasionally, the Admiralty would be presented with other potential remedies, such as nitre mixed with vinegar, but the Board had been convinced of the virtues of lemon juice and that other remedies were not credible.238 Different theories continued to be formed, for example that of Sir Almwroth Wright (1861-1947) who believed scurvy was due to the blood being insufficiently alkaline – this seems uncannily similar to the eighteenth century. Eventually, vitamin C (ascorbic acid) was identified in the 1930s by the

Hungarian scientist Szent-Gyorgi who received the Nobel Prize for Physiology and Medicine in 1937.239

The final words in this dissertation should go to James Lind who had long known the cure of scurvy but who had been faced with insuperable obstacles:

236 Nicholson, Adam, Men of Honour, (London ,2005),p.15. 237 Watt, ‘Some Forgotten Contributions of Naval Surgeons’, p757. 238 Lloyd and Coulter, Medicine and the Navy, Volume III, p.325. 239 Carpenter, The History of Scurvy and Vitamin C, p.192 77

It would indeed be happy for mankind, if in all the various calamities and

distresses, to which they are subject, the means of relief were so well

ascertained, as they are in this painful disease, an ignorance of the nature of

which, has long been productive of fatal consequences.240

240 Lind Treatise 1772, p.544 78

Appendix A

Map depicting positions of Royal Hospital, Haslar, Portsmouth and Spithead.241

241 George Washington Bacon, Southern Hampshire, 1896, Antique Maps. http://www.antiquemaps.com/maps/hk/hampshire/

Appendix B

Foods Containing Vitamin C (mg/100g of flesh)

➢ Watercress 662

➢ Rosehip syrup 200

➢ Blackcurrants 180

➢ Lemon 53

➢ Orange 53

➢ Cabbage 45-60

➢ Potatoes (baked in skin) 30

➢ Cabbage (boiled) 20

➢ Lime juice 20

➢ Sauerkraut 10-15

➢ Potatoes (boiled) 15

➢ Apples 5

➢ Malt 0.6

➢ Wort 0.1

Vitamin C requirements for health are approximately 30 mg per day and 10mg per day to prevent scurvy. However, many recommendations have been made by different authorities on health.242

242 Carpenter, The History of Scurvy and Vitamin C, pp. 203-8; I.M. Sharman, ‘Vitamin requirements of the human body’ in Watt, Freeman and Bynum (eds), Starving Sailors, pp.23-4. 80

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Plaque dedicated to Lind in St Mary’s Church, Portchester. Photograph by Clare Grange.