1.1 Scurvy: The first clinical trial

Scurvy, a common condition amongst sailors in the 18th century, is rarely seen nowadays, as a result of greater understanding of the causes of this often deadly condition.

Historically, from Greek and Roman times it had been noted that sailors out at sea for periods of more than three months often showed a range of symptoms, including:

• feeling very tired and weak all the time (fatigue)
• a general sense of feeling ‘out of sorts’
• pain in the limbs, particularly the legs
• the appearance of small red-blue spots on their skin.

The condition was reported to cause ‘funguous [sic] flesh... putrid gums and... dreadful terrors’ (according to Lind’s Treatise on Scurvy, 1753), all now known to be symptoms of scurvy.

Figure 1  Historical symptoms of scurvy – ‘funguous [sic] flesh and putrid gums’ – courtesy of the Institute of Naval Medicine Historic Collections.

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This historic illustration shows some hand-drawn medical illustrations of scurvy.

The illustrations are annotated, although the writing is not all legible: the artist appears to be one John Collins, and the date is Sept 30^th 1851.

On the left are two views of a foot and lower leg, one labelled ‘inside view of right leg’. These show the small red-blue spots on the skin, and in places large red-black welts, on both the leg and feet. At top right is a sketch of an open mouth, labelled ‘appearance of the mouth’: the gums are an unnatural shade of bright red. The teeth are decayed and appear to be beginning to loosen in the receding gums. At lower right are another pair, this time two views of the left foot, again showing some large red boils or welts.

Figure 1  Historical symptoms of scurvy – ‘funguous [sic] flesh and putrid gums’ – courtesy of the Institute of Naval Medicine Historic ...

Watch Video 1 (What the Industrial Revolution did for us, 2003) to discover more about scurvy.

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Transcript: Video 1  What the Industrial Revolution did for us. Presenter Dan Cruickshank tells the story of the first clinical trial, proving that oranges and lemons could save the lives of sailors by preventing scurvy.  (2:48 min)

INTERVIEWER

But in the cramped well below decks, lurked a disease that would take more than just fresh air to overcome. When Lord Anson returned from his round the world expedition of 1744, his men had been slaughtered. Over half the original crew of nearly 2000 men had died of the same illness, scurvy.

The sailors suffered terribly. Their teeth loosened and fell out. Their gums bled and haemorrhaged, which, [SNIFFS] oh, dear, gave a terribly bad smell. Sorry, old chap, but it’s true. And then, the skin was covered in bruises. Finally came heart failure and death.

Scurvy was killing more men than enemy action. A huge array of treatments were being used haphazardly to try and tackle the condition. James Lind, a Scottish Naval surgeon, proposed a new kind of trial to find out whether any of them actually worked.

So time to test these six proposed cures in these very sick looking sailors.

SIR IAN CHALMERS

Indeed, they all look very sick. This is some cider for you. We’re going to give you some seawater, sir. This is sulfuric acid. And this is a mixture of nutmeg and garlic and other things. Now we ought to give some vinegar. Now, we’ve got for you, sir, an orange and a lemon. And be careful that you eat all of these, it’s a very valuable part of the ship’s provisions.

If you’re going to have a fair test, clearly you have to make sure that the people that are given the different treatments are otherwise alike. They had to have scurvy of equal severity, the same basic diet. He nursed them all in the forehold. The only way in which the sailors receiving the treatments differed would be in respect to those treatments. Otherwise, they would be similar.

INTERVIEWER

That he’s methodical, scientific. He has these clinical tests, clinical trials.

SIR IAN CHALMERS

That was the really important breakthrough. And that way of thinking is exactly the way that we today distinguish useful treatments from useless or positively harmful ones.

[MUSIC PLAYING]

INTERVIEWER

The world’s first controlled clinical trial demonstrated that one of the treatments had won hands down. Within a week, the sailors who had eaten the oranges and the lemons were fit for duty and were nursing the others back to health. Science had categorically proved Lind’s case, but the admiralty was stuck in a different age. It ignored Lind’s findings for over 40 years, and thousands of sailors died needlessly.

[MUSIC PLAYING]

End transcript: Video 1  What the Industrial Revolution did for us. Presenter Dan Cruickshank tells the story of the first clinical trial, proving that oranges and lemons could save the lives of sailors by preventing scurvy.  (2:48 min)

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Video 1  What the Industrial Revolution did for us. Presenter Dan Cruickshank tells the story of the first clinical trial, proving that oranges and lemons could save the lives of sailors by preventing scurvy.  (2:48 min)