6

UNWINDING THE KNOT: ROB AND WORT AND THE TRIALS AT SEA

A PORTRAIT OF LIND in middle age shows him as an ascetic but amiable academic with a ruffled and coiffed wig, floppy cuffs, and a vest stretched over a slight paunch. Although he sits straight, his shoulders are stooped as if from many hours of reading or working by dim light. A high forehead and clear eyes are counterbalanced by a tight, knowing smile. He is a man of books, and in his hands he clutches a copy of an early edition of his own famous text, the groundbreaking but underappreciated Treatise on the Scurvy. Clearly pleased with his status as head of Haslar, England’s most prestigious hospital, he is posed with the building in the background. He had been appointed head because of his interest in scurvy and the health of sailors. An appointment of such distinction and salary would not have been made based on merit alone—some form of patronage would have been needed, and historians have proposed that this must have come from Lord Anson himself. Anson had maintained an active interest in naval disease in general, and scurvy in particular, since becoming First Lord of the Admiralty in 1751.

Haslar was a sprawling brick institution situated on the sea about a mile and a half from Portsmouth, where Atlantic storms frequently buffeted the coast and the massive ships of the British fleet would rendezvous. The huge three-storey hospital was an “immense pile of brick buildings,” according to William Barton, a visiting naval surgeon and later first surgeon general of the United States Navy. It was dominated by a “grand front and two wings of great extent running at right angles from the front, forming a very spacious area within. In the center of this area is a chapel, a neat and appropriate building.” Numerous large outbuildings dotted the extensive grounds, including workhouses and storerooms and several manses for the officers of the hospital. The thirty-two surrounding acres were hemmed in by a twelve-foot-high brick wall, making it look from the outside more like a prison than a place of healing. The walls were not to keep people out but to keep the patients in—in fact, to prevent them from deserting the Royal Navy. If given a chance, many sailors would escape as soon as they set foot ashore, fleeing to loved ones or to the grog shops in nearby Portsmouth.

Haslar was the largest and newest hospital in all of England, and probably the largest hospital in Europe. Constructed at great expense between 1754 and 1762, it could at full capacity comfortably hold as many as 2,500 patients and employed about 150 staff. Despite its formidable outer appearance, however, it was not a grim and unsanitary bunker. For its time, the hospital was a thoroughly modern, clean, and professional institution, with highly trained staff and a large annual operating budget. The hospital cost about £100,000 to build, an astonishing sum equivalent to the cost of constructing three of the largest battleships. The annual operating budget was around £20,000, a large sum in those days, when Lind earned the enviable salary of about £200 per year and a respectable house could be rented for around £40 per year. The British government had made a significant and remarkable investment in the hospital, a medical and financial commitment to the navy’s sailors once they had been brought ashore that seemed grand and excessive compared with their treatment aboard ship. Haslar was one of the great public works of the period.

James Lind (1716–1794) conducted the first controlled trial in medical history as a lowly naval surgeon researching scurvy aboard the HMS Salisbury in 1747.

The hospital was divided into numerous large wards capable of holding sixteen patients each, with a full five feet between their beds. For any wounded or sick mariner lucky enough to be brought here, it was a significant improvement over the dim, fetid, and airless compartments that passed as sick bays aboard ships. And despite the occasional nurse caught smuggling spirits to the sailors or persuading them to write wills in her favour, the medical and nursing staff were on a higher plane of professional competence than that generally found aboard ships, not to mention what the sailors could afford privately. At Haslar the convalescent sailors enjoyed comparatively spacious and clean wards, and the surgical and fever wards were also separated an enlightened attempt by Lind to prevent cross-infection and the spread of disease. In the fever wards, sailors lay sweating and insensible, wasting away from yellow fever, dysentery, or malaria caught on voyages to distant shores. Fevers were so common in that day and age that perhaps a third of Haslar’s patients were recovering from fevers at any given time.

Usually there were few men in the surgical wards, although after battles (quite frequent for the Channel fleet during the eighteenth century) great numbers of sailors could be bandaged and unconscious, recovering from serious wounds. Scorbutic sailors generally occupied about a third of Haslar’s wards, and for brief periods they filled nearly the entire hospital. On any given day, ships could put into Portsmouth and discharge hundreds of scorbutic patients. Lind treated three to four hundred scorbutic sailors per day during the Seven Years’ War and the War of American Independence, and occasionally double or triple that number.

Haslar hospital was admirably situated to receive the sick mariners. After disembarking from the ferries, sailors were conveyed to Haslar’s receiving room by a water-carriage running in a narrow canal that led from the Spithead road through the gates to a small outbuilding, where they were bathed in hot soapy water and provided with clean clothing for the duration of their stay. Their filthy rags were taken to a nearby brick building and fumigated with burning pitch in an effort to rid them of lice and contagion. “We are remarkably clean,” Lind wrote in a letter to a colleague. “No patient is admitted into the hospital until he is stripped of all his cloths and well washed with warm water and soap in tubs always kept for the purpose, he is allowed the hospital dress during the time he continues in the hospital or until his cloths are returned him quite clean, and he is regularly shifted and kept quite neat, clean and sweet at the Government’s expense.” When a fleet put into Portsmouth with a scorbutic outbreak, the debilitated men created a serious backlog in the admitting room. Many were billeted in tents on the hospital grounds.

Admitting this many scurvy patients on short notice was a huge logistical challenge. Hundreds of medical personnel rushed about the hospital, reorganizing beds, shifting the other patients into separate wards, and settling the newly arrived mariners in special scurvy wards. While ninety nurses kept the floors scrubbed and fumigated the wards to expunge any lingering foul vapours, purchasing agents rushed to town to arrange for fresh food for the new arrivals. Twenty-four local washerwomen were engaged to cleanse the sailors’ filthy rags and bedding, smoking them with burning brimstone in the outbuildings or burning them if they were beyond repair. Cooks were roused, clergy were called to minister to the dying, and leave was cancelled for all the doctors and nurses. The patients were hastily placed on an antiscorbutic regimen of dietary supplements and other treatments believed to be beneficial. Curing scurvy in the hospital was costing the Admiralty a vast sum of money, but it was an unavoidable expense when the threat of invasion from France and Spain required the Channel fleet to be at sea as long as mariners’ health held out.

The patients came and went by the hundreds, and as chief physician Lind was kept busy. Unfortunately, managing Haslar hospital proved to be a great deal of work and responsibility, and it consumed much of Lind’s time and energy, leaving little room for him to continue his research into scurvy even while seeing its ravages daily. In the 1760s, Lind was also writing a third groundbreaking work, Essay on Diseases Incidental to Europeans in Hot Climates, with the Method of Preventing Their Fatal Consequences. It was published in 1768 and eventually ran through at least six editions. In it, Lind described the symptoms of many of the most common fevers that affected crews in tropical climates, such as the Black Vomit, the Bloody Flux, and the Dry Belly Ache, and gave suggestions on how to prevent and treat them. To prevent malaria, Lind advised captains to forbid men from sleeping ashore near stagnant water, to avoid contact with bad air. This would have been an effective preventative, but Lind recommended it for the wrong reason—if was the mosquitoes living in the swamp that carried the sickness, not the stagnant air itself. Lind’s book remained the standard work on tropical medicine in the English language for fifty years. His suggestions for naval hygiene published in the 1757 essay (which, if implemented, would have been of great benefit to sailors) and his essay on tropical diseases (in itself a great contribution) established Lind as one of the great medical writers of the eighteenth century.

Unfortunately, throughout this time, Lind’s thoughts on scurvy became ever more muddled. At Haslar, his job as chief physician was not to study scorbutic patients and conduct experiments but to return them to active duty as quickly as possible. The few trials he had the time to conduct produced variable, inconclusive, and occasionally contradictory results. He never reproduced a clinical trial like the one he ran aboard the Salisbury, and his conclusions never attained the same clarity.

After the publication of the first edition of the treatise in 1753, Lind became obsessed with concentrating citrus juice to make it more practical. A small dose of concentrated medicine given by the spoonful out of a bottle seemed more valid and dignified to the medical community than drinking a glass of fruit juice, and on ships that were already crammed with sailors and supplies, storing dozens of barrels of citrus juice was not ideal. Lemons and oranges were expensive and bulky, and the logistics of maintaining a national supply of fruit that had to be imported from the Mediterranean were complicated. Furthermore, fresh lemons could not survive at sea for months at a time any more than fresh broccoli or apples.

Lind developed a way of evaporating the water from fresh juice to create a concentrate that could be more easily stored aboard ships. He proposed “a method for preserving their [lemons and oranges] virtues entire for years in a convenient and small bulk … as oranges and lemons are liable to spoil and cannot be obtained at every port, nor at all seasons in equal plenty.” He provided detailed instructions for the preparation of this “inspissated” juice, or “rob.” He advised surgeons to pour the strained juice into a wide-mouthed bowl (to “favour evaporation”) or “a common earthen basin used for washing, if well glazed,” and to place the container into a pan of boiling water. The fruit liquid was to be kept just below boiling until sufficient water was evaporated, leaving the concentrate the “consistency of oil.” It was then poured into small vials and corked for storage. “Thus the acid,” he wrote, “and virtues of twelve dozen lemons or oranges, may be put into a quart-bottle, and preserved for several years.”

Lind failed to test his rob, in spite of his pledge in the original edition of the treatise to “propose nothing dictated merely from theory; but shall confirm all by experience and facts, the surest and most unerring guides.” If he had held true to this objective, it might not have taken several more decades for the Admiralty to implement an effective scurvy cure. Unfortunately, Lind was tricked by the fickle nature of the key ingredient, ascorbic acid, and his attempts to preserve fruits and vegetables by pickling, evaporation, or boiling destroyed the antiscorbutic properties that existed before preservation.

In the third edition of his treatise, Lind recommended as antiscorbutic numerous foods such as gooseberries, beer, and other fermented liquors such as cider, for which he provided no experimental justification whatsoever. “Green gooseberries,” he claimed, “will keep for years, if, after being put into dry bottles their moisture is exhaled by putting the bottles slightly corked into a pot of water, which is allowed to come nearly to boil.” Indeed this is true, but because Lind had no idea that ascorbic acid would be destroyed by heating, he assumed that if gooseberries remained edible and tasted fine, then they would remain antiscorbutic. Obviously he didn’t test this assumption. In a 1951 experiment published in the journal Medical History, R. E. Hughes showed that although fresh gooseberries have about 50 to 65 milligrams per 100 millilitres of ascorbic acid (slightly higher even than fresh lemon juice), the ascorbic acid content was virtually nil after heating and bottling and about a month of storage. The same approximate level of decline is also evident in spruce beer, or fermented spruce tips. Fermentation actually eliminated the bulk of the ascorbic acid, while storage for several weeks took care of the rest.

Although Lind’s concentrated lemon rob was very high in ascorbic acid when fresh, at about 240 milligrams per 100 millilitres, it had lost 50 percent of the ascorbic acid of the original lemons used to create it. That is to say, the same quantity of lemons before being made into a rob would have contained nearly 500 milligrams per 100 millilitres. After about a month of storage, 87 percent of the ascorbic acid had vanished, leaving the concentrate with about the same content as one regular fresh lemon. Although the rob was still a decent source of ascorbic acid, it was issued only in small doses because it was believed to have antiscorbutic powers ten times as great as the fluid by volume. Lind’s rob was a very inefficient use of lemon juice, considering the cost of lemons and the effort involved in making it. The level of ascorbic acid in any given batch of rob could also vary wildly depending on the age and the amount of heat used in its preparation. If an inattentive physician or surgeon allowed the concentrate to boil, virtually all the vitamin C was lost. Lind also later learned that using glazed vessels to prepare the rob created a potentially poisonous concoction—the citrus juice absorbed lead from the glaze in hazardous quantities.

Without doing an empirical test on the rob’s effectiveness, Lind would have had no logical reason to presume that creating the rob would have been detrimental to the “special” property of the acid. The concentrate looked fine, tasted fine, and was still acidic, so he surmised that it was still effective. Lind could never make the logical leap to understand why the special antiscorbutic property of a food should disappear after time or treatment—probably because he skipped a thorough test of this very hypothesis. A simple test would have revealed this flaw and taken one of the great mysteries out of his equation, leading him to a firmer conclusion of the curative powers of fresh citrus juice and perhaps an earlier or better understanding of scurvy. Lind had a difficult time convincing anyone to use his concentrated rob, however, even on navy-sponsored voyages to test various antiscorbutics, because it was very expensive and time-consuming to manufacture.

By the 1760s, there was an uneasy consensus amongst naval medical professionals that many of the time-honoured scurvy cures, such as smearing mercury paste on the open sores, consuming sulphuric acid as a dietary supplement, putting hydrochloric acid in the drinking water, and even the granddaddy of universal panaceas, bloodletting, were not contributing anything positive to the debate. The problems in the Royal Navy caused by scurvy, on the other hand, were if anything becoming more severe. Since the time of Anson’s voyage in the 1740s, the incidence of scurvy aboard ocean-going ships had been increasing. Ships were spending an ever-greater time at sea, in distant and possibly hostile lands, while naval strategy increasingly involved patroling foreign coasts. Ships were becoming larger, tours of duty longer, the demand for sailors greater. In 1764—after several decades that saw the publication of numerous treatises, tracts, essays, and proclamations on scurvy, its causes, and its cures, and several inconclusive experiments at the naval hospitals in Plymouth and at Haslar—the British Admiralty proposed to test antiscorbutics at sea, where no non-nautical influences might taint the outcome. The Seven Years’ War with France had just ended, and the Admiralty had time to spare on non-military matters. The trial was an effort to acquire some reliable information on scurvy by sifting through the vast number of conflicting claims and suggestions.

The Admiralty commissioned John Byron to command a ship to do some preliminary exploration in the South Pacific while monitoring the effects of fresh provisions on the incidence of scurvy in his crew. It proved to be a short voyage returning in under two years, in April 1766—and Byron’s conclusions regarding antiscorbutics were sketchy and unreliable. The men had suffered terrible ravages from the disease, but owing to the Admiralty’s instructions for Byron to purchase and outfit the ship with fresh vegetables whenever convenient, there were not a large number of deaths. Byron ordered scurvy grass and coconuts for his men, and while he claimed that the scurvy grass was of “infinite service” it was the coconuts that saved them from certain death. “It is astonishing the effect these nuts alone had on those afflicted … . Many in the most violent pain imaginable … and thought to be in the last stage of that disorder, were in a few days by eating those nuts (tho’ at sea) so far relieved as to do their duty, and even to go aloft as well as they had done before.” For the return voyage, Byron stocked up on more than two thousand coconuts and kept scurvy blessedly at bay. Byron’s unscientific opinion that coconuts were a useful antiscorbutic was of little practical value to the Admiralty, however, as coconuts were not readily available in England. All in all, it was not a very illuminating trial.

A second voyage was hastily organized, this time specifically to test certain items that were thought to have the greatest antiscorbutic effect. Within a few months of Byron’s return in the spring of 1766, two ships under the overall command of Samuel Wallis were outfitted and provisioned for an August sailing. Lind’s rob was again not one of the antiscorbutic remedies to be evaluated—it was too expensive and its effectiveness was in question. The Sick and Hurt Board wrote to Lind in 1767 to express their doubts that citrus rob would be of use, since their own tests had proved equivocal, and they pointedly highlighted its expense and the impracticality of furnishing it in sufficient quantities to satisfy the navy. After the death of Lord Anson in 1762, Lind had no influential patron in the upper echelons of society to champion his cause and ideas. Although he was convinced of the value of his rob of oranges and lemons in combating scurvy, a new theory was on the ascendancy, and this one placed no stock in expensive citrus concentrates.

 

 

David MacBride was a Dublin physician who had served at sea briefly and was thirty-eight years old, ten years younger than Lind, when he wrote a medical tract titled Experimental Essays in 1764. He was a prime proponent of the putrefaction/fermentation theory of scurvy, which had been gaining in popularity throughout the mid-eighteenth century. The fashionable theory was based on ideas originally presented to the Royal Society by the Scottish physician Sir John Pringle in the 1750s. Pringle had been studying which substances either sped up or slowed down the putrefaction, or decomposition, of meats that were submerged in warm water. He discovered that fermenting bread seemed to significantly slow down the process. Based on Hermann Boerhaave’s theory that scurvy was a “putrid disease” (with which even Lind agreed, claiming in the first and second editions of his treatise that it was blocked perspiration that caused the “putrefaction” in scurvy), anything that could delay, hinder, or prevent putrefaction was believed to be a strong candidate for countering the progression of scurvy. Pringle himself felt that sugar might even be an effective defence against putrid diseases because it stimulated fermentation.

MacBride’s theory on scurvy was based on the premise that all living bodies have a certain quantity of “fixed air” within them. When bodies become putrefied or decomposed, a gas is released, which he believed was the fixed air escaping once it was no longer trapped within the living creature. Since all creatures release this gas, or fixed air, when they decompose, MacBride reasoned that the fixed air must be the binding agent for all living creatures. Fermentation would inhibit putrefaction because it created more fixed air, which then replaced the air that escaped during putrefaction or decomposition. Following this somewhat peculiar line of reasoning, a food that was easily fermented during digestion would be ideal for curing putrid diseases such as scurvy and tuberculosis. Malt of barley, MacBride felt, would be the most suitable substance for use by mariners since it was cheap, could be preserved for great periods of time, and could be quickly fermented into “sweet wort” whenever scurvy appeared in a crew. MacBride believed that with a regimen of several pints a day of the fermenting wort, scurvy would retreat because the body’s supply of fixed air would be replenished. Wort of malt, MacBride proclaimed, “is to the full as powerful with respect to antiscorbutic virtue as the fresh juice of the acid fruits.”

MacBride, taking Pringle’s experiments with meat one step further, made the remarkable claim that he had prevented the putrefaction of meat by exposing it to fixed air in a bottle. He claimed also to have halted putrefaction by smothering meat in suet, thereby preventing the fixed air from escaping. MacBride also argued that fresh greens and fruits were antiscorbutic simply because they fermented easily during digestion; the standard seamen’s ration of salt meat and biscuit was theoretically difficult to digest. In 1764 sweet wort was tested in the Royal Naval Hospital at Plymouth, but it showed no beneficial effects on the scorbutic sailors despite being issued in copious quantities. After one of the test patients wasted away and died, the others rebelled and refused to continue with the trial, claiming that “the wort produced very bad effects.” Lind also conducted a two-week trial of the sweet wort at Haslar around the same time, and he too reported, not surprisingly, that it did little to halt the progression of scurvy. MacBride, whom the medical historian Sir James Watt has described as “a physician in search of a reputation,” attributed the failure of these experiments not to his own ill-founded and self-serving theories but to the closed-minded nature of the Royal Navy (and presumably naval physicians). The failure, he wrote, “may easily be accounted for from that aversion to innovation and experiment which is so prevalent among mankind, but especially among seamen.” MacBride later had his wort tested by the surgeon aboard his brother’s ship, and the surgeon reported that it cured scurvy during the voyage. The wort of malt was rich in B-complex vitamins, which would have improved the nutritional content of the sailors’ diet and reduced the incidence of beriberi and night blindness, but anyone who reported that the wort had beneficial effects on scurvy patients was either deluded or lying. Modern research has shown that wort made from fermented malt actually contains almost no vitamin C. “More trials we certainly shall have,” MacBride announced, “now that the ice is fairly broken.”

When Wallis returned from the Pacific with his report on the effectiveness of various antiscorbutics in 1768, he was vague and inconclusive about the benefits of MacBride’s wort. The other substances he tested were portable soup and saloup (a mild, greasy beverage made from orchid roots and sauerkraut). Although scurvy was rampant on both of the ships, the antiscorbutic remedies were issued on an as needed basis, and fresh food was eaten whenever the ships put in to shore. Wallis and the commander on the second ship, Philip Carteret, had no scientific or medical training, so their reports did nor clarify which, if any, of the Admiralty’s substances were beneficial against scurvy.

Lind never wavered in his belief that the stress of a naval life increased scurvy’s hold upon men, and that lemon juice was the best antiscorbutic he had rested throughout his career. “To what has been said of the virtues of oranges and lemons in this disease, I have now to add, that in seemingly the most desperate cases, the most quick and sensible relief was obtained from lemon juice; by which I have relieved many hundred patients, labouring under almost intolerable pain and affliction from this disease, when no other remedy seemed to avail.” It seems that Lind gave his patients at Haslar the fresh juice and created the rob for use on ships, and that he failed to test the rob at Haslar because he needed to cure the men as quickly as possible and had no time to create and experiment. Perhaps, too, Lind so strongly wanted the rob to be useful that he became blinded to its defects, since his friend and colleague Dr. Edward Ives had also found the rob “inferior to stored fruit juice” in his own personal tests. Yet Lind, unlike other contemporary physicians then writing about scurvy, did not deliberately conceal evidence that ran counter to his own theories and observations; if something didn’t work and he knew of it, he included the information in the treatise.

 

 

Lind was fifty-six years old in 1772 when the third and final edition of his treatise was published. Overworked and increasingly dispirited from the results of his decades-long quest to understand scurvy, he seems to have given up hope of ever unravelling its mystery. “I carry my researches no further,” he wrote. “A work, indeed, more perfect, and remedies more absolutely certain might have been expected … but, though a few partial facts and observations may, for a while, flatter with hopes of greater success, yet more enlarged experience must ever evince the fallacy of all positive assertions in the healing art.” Although the third edition of the treatise was well received, and was published in French, Spanish, and Dutch, Lind seems to have admitted defeat and left off pursuing any further scurvy research. So close to a solution in his younger years, he lost the vigour to continue his research in a meaningful way as he neared retirement, and he also lost the energy or disposition to advocate for his early findings. Although he knew that fresh greens and citrus fruits could cure the affliction, he never concluded that the lack of them might be the cause of it. He never believed that scurvy was a deficiency disease, and he could never understand why fresh greens and citrus fruits should be beneficial, except that they were more easily digested than salt meat and hardtack.

In one instance, Lind went so far as to criticize the one person who had come to the conclusion that scurvy was a deficiency disease. “Others again,” he wrote in the final edition of the treatise, referring to Johan Friedrich Bachstrom, the one theorist who truly understood scurvy, “have supposed such to be the constitution of the human body, that health and life cannot be preserved long, without the use of green herbage, vegetables, and fruits; and that a long abstinence from these, is alone the cause of the disease.” Lind disputed that scurvy was caused directly by diet and cited several examples where scurvy apparently ran rampant despite the sailors’ consuming fresh vegetables. “Upon a daily comparison of the state of those patients,” he wrote, “I was surprised to find them all recovering pretty much alike, and though they abstained altogether from vegetables, yet they in general grew better.” He concluded that “the disease would often, from various circumstances, take a favourable turn, which cannot be ascribed to any diet, medicine, or regimen whatever.”

Although Lind never lost his desire to ameliorate the suffering of sailors in the navy, he had taken his understanding of scurvy as far as he could. His thinking had become muddled and his cherished early notions had been disproved by his own observations. He also became convinced that his early belief that scurvy had to do with the body’s putrefaction was wrong or misleading. His experiments accurately showed that scorbutic patients were in no greater state of putrefaction than non-scorbutic patients (their blood or tissue had not actually decomposed, even at the height of the scorbutic symptoms). Lind’s observations on putrefaction should have put a damper on Pringle’s and MacBride’s theories as well, but in the 1770s the idea that wort was an agent for counteracting the putrefying aspects of scurvy was gaining respect, helped greatly by the influence and stature of Pringle, who by 1772 was the president of the Royal Society.

The support for wort of malt as an antiscorbutic must have disillusioned Lind even further. He strongly suspected that the great idea that was being heralded as the best hope for a scurvy cure was false, and yet his own dear rob seemed equally ineffectual, perhaps making him second-guess the results of his original clinical trial from twenty-five years earlier. It must have been a bitter time for him. Eventually, a few years before his retirement, he went so far as to recommend as a scurvy deterrent cream of tartar—a substance he had already proved to be of no effect whatsoever. Lind had come full circle, and he ended up less clear on scurvy than when he was a lowly surgeon aboard the Salisbury.

But this failure to conduct rigorous and accurate scientific experimentation should be viewed less as a blemish on Lind’s character than a sign that he was a product of his time. Lind could no more escape entirely the fashion in medicine and science than he could the fashion in clothing, writing, or politics. He was such a perceptive individual that he knew it. “It is perhaps the vain and chimerical belief of the existence of a never failing remedy for most diseases,” he wrote, “ … which has rendered the art of healing as variable and unconstant, as our dresses.” Because of lack of communication, it was difficult for even informed members of the scientific community to trust each other’s findings. There were no reliable or trustworthy peer-reviewed journals, no conferences, and few attempts to empirically prove theories. In the eighteenth century, there were no standards by which information could be accepted or verified other than by reproducing the experiment oneself—and without an accepted standard for experimental design, it was nearly impossible to conduct experiments that would yield meaningful results. Influential contacts had the greatest effect on a theory’s acceptance.

Lind was never elected to the Royal Society, though many men of much lesser ability and accomplishments were readily admitted. Lind received no other honours in England during his lifetime, although he was elected to the French Royal Society of Medicine in 1776. He was prevented from achieving distinction within the scientific establishment because of his outspoken criticism of influential colleagues and his mediocre social standing. When he retired from Haslar in 1783 at the age of sixty-seven, it was with little fanfare, though his son, John, was allowed to succeed him in the lucrative position. Because he never wrote a memoir, little information exists about his personal life. Presumably he enjoyed a retirement free from financial worry with a pension of £200 per year. He died at Gosport in 1794 at the age of seventy-eight, three years before his wife.

Perhaps Lind’s greatest professional accomplishment was that he inspired a generation of disciples, such as the future physician to the Channel fleet Thomas Trotter, James Cook, and the young Gilbert Blane. Although Lind never completely unbound the complex knot of scurvy, he set others onto the path that would see it virtually eliminated in the Royal Navy. Lind was a researcher, not an advocate. During the course of his life, he did not write a single essay, article, tract, or book devoted to publicizing his ideas. Refusing to be drawn into the battle, he never responded to public criticisms of his work by other physicians, instead merely plodding along revising his texts for the next edition. He was not interested in being the standard-bearer for an assault on contemporary naval and medical practices, or he feared that vocal criticism of his superiors in the navy might endanger his appointment at Haslar. His character can be best summed up by one of his own statements: “The Province has been mine to deliver Precepts: the Power is in others to Execute.”

In Lind’s defence, the theories and recommendations of individual physicians or surgeons could have had little positive effect in the eighteenth century. Although his Salisbury clinical trial was truly revolutionary, and his suggested cure for scurvy was more accurate than those of any of his contemporaries, Lind’s advice alone would have been of little impact even had it been completely effective. To eliminate scurvy in the navy, an institutional revolution was needed. Merely providing evidence of an effective cure was not enough. The vast majority of ships that were large enough to be sailing on long voyages, or that had missions that kept them from port for extended periods of time, were owned and run by the government. This was true not only in England but in France, Spain, and Holland as well. The provisioning of these ships was organized by centralized victualling boards. So long as the standard, centrally purchased naval rations remained of poor nutritional content and quality, and entirely lacked in foods containing ascorbic acid, scurvy could never be cured on a meaningful scale.

The upper echelons of the naval establishment—people with busy schedules who were constantly bombarded with outlandish suggestions on all manner of naval matters (from victualling to the calculation of longitude to ship design) and whose attention was frequently diverted by wars, trade disputes, and other political considerations—had somehow to be persuaded. It was not an easy task even for someone with the proper connections and political clout, let alone for an obscure naval surgeon squarely from the middle classes, whose practical solutions were contradicted by other contemporary medical men and whose philosophical theorizing was as obtuse and bewildering as anything written in the eighteenth century. Naval surgeons and physicians pushing for a scurvy cure were like peeping mice in the corner of a great audience chamber—the decision makers could barely hear them and certainly could not understand their language.

But by the late 1760s, there was an awful lot of peeping vying for the Admiralty’s attention. The benefits of solving the greatest medical mystery of the era could not only secure a reputation and a career but also, if the invention could be patented, make a man fabulously rich. It was becoming evident that scurvy was not caused by poor ventilation or damp air inhibiting natural perspiration. Nor was it caused by contagion or a blockage of the spleen. The potential cure that had the greatest institutional clout, and the support of the Royal Society, was MacBride’s wort. It satisfied all the other required criteria admirably: it was portable; it could easily be stored shipboard for more than a year, and perhaps indefinitely; it wasn’t overly bulky before being reconstituted; it didn’t require too much fresh water, and fresh water was a rare commodity at sea; and most important, it was readily available at reasonable cost. But did it actually work? That had certainly been the great problem with other scurvy cures considered by the Admiralty. Although the first experimental voyages had proved inconclusive, the negative results had been vocally dismissed by MacBride, and Sir John Pringle remained convinced of wort’s potential.

The members of the Admiralty board, perhaps disappointed with the results from their two previous ad hoc antiscorbutic trials, began planning a trial that would be more comprehensive and compelling; they were looking for a captain whose temperament would prove more thorough than that of Wallis or Carteret and whose conclusions would therefore be more persuasive. It would also have to be a voyage that wasn’t dominated by an overriding and potentially vital military objective. The Admiralty certainly didn’t think they could make a decision or advise the victualling board based on the scattered and distracted reports they had read, and another trial gave the appearance of their doing something to address the problem without the difficult responsibility of making an expensive or potentially embarrassing decision. Fortunately, England was not at war between 1764 and 1775, and the immediate pressure was taken off the Royal Navy, reducing the length of time ships spent at sea and therefore the incidence of scurvy. Early in 1768, the Royal Society proposed a joint mission with the Royal Navy to the South Pacific, and a young, scientifically minded ship’s master named James Cook was promoted to lieutenant and chosen as the commander. The objectives of the mission were threefold: the discovery of new lands, the recording of celestial phenomena, and, perhaps most significantly, the rigorous testing of a wide array of antiscorbutics.