Lind's 1747 scurvy trial: why the Navy waited 48 years

James Lind, surgeon on HMS Salisbury, began one of the earliest controlled clinical trials on 20 May 1747, testing six scurvy remedies on 12 sick sailors kept on the same diet. The pair given two oranges and a lemon a day recovered fastest; one of them was fit for duty after six days.

The stakes were huge. During one ten-week cruise, 80 of the Salisbury’s 350 sailors went down with scurvy, and an account of Lord Anson’s voyage, published in 1748, recorded at least 380 deaths out of 510 men on a single ship. Lind’s other pairs got cider, dilute sulfuric acid, vinegar, seawater or a spiced paste. The cider drinkers improved a little; the rest barely changed.

Lind himself muddied the result. To store citrus on long voyages he recommended “rob”, juice boiled down for hours. Heat destroys much of the vitamin C, so later observers saw no benefit. The Navy waited 48 years, and the explanation came later still:

• 1753: Lind publishes A Treatise of the Scurvy. Its recommendations make little impact.
• 1754: the Navy’s Sick and Hurt Board rejects a proposal to supply sailors with fruit juice.
• 1793: a fleet stocked with lemon juice on Gilbert Blane’s advice reaches Madras free of scurvy after 19 weeks without touching port.
• 1795: Blane, now on the Board, wins a daily ration of three-quarters of an ounce of lemon juice for every sailor.
• 1928: Albert Szent-Györgyi isolates the compound later shown to be vitamin C, finally explaining why citrus worked; the work is rewarded with the 1937 Nobel Prize.

The delay was not pure stupidity. Lind’s book was one of many on scurvy, his own opinions on citrus were tentative, and the Board was swamped with rival cures. The less effective lime juice later replaced lemon on some ships, which is how the British became “limeys”.

Lind’s start date, 20 May, is now marked worldwide as International Clinical Trials Day.