Journal of Clinical and Preventive Cardiology

EDITORIAL
Year
: 2020  |  Volume : 9  |  Issue : 3  |  Page : 92--93

Commemorating James Lind: The man who gave us the concept of controlled clinical trials


Satyanarayana Upadhyayula1, Ravi R Kasliwal2,  
1 Division of Cardiology, Medanta Mediclinic, New Delhi, India
2 Division of Clinical and Preventive Cardiology, Medanta Heart Institute, Medanta - The Medicity, Gurgaon, Haryana, India

Correspondence Address:
Dr. Ravi R Kasliwal
Division of Clinical and Preventive Cardiology, Medanta Heart Institute, Room No. 9, 3rd Floor, Medanta - The Medicity, Sector 38, Gurgaon - 122 001, Haryana
India




How to cite this article:
Upadhyayula S, Kasliwal RR. Commemorating James Lind: The man who gave us the concept of controlled clinical trials.J Clin Prev Cardiol 2020;9:92-93


How to cite this URL:
Upadhyayula S, Kasliwal RR. Commemorating James Lind: The man who gave us the concept of controlled clinical trials. J Clin Prev Cardiol [serial online] 2020 [cited 2020 Dec 2 ];9:92-93
Available from: https://www.jcpconline.org/text.asp?2020/9/3/92/296186


Full Text



“Without experiment, nothing can be sufficiently known”

Bacon, Roger (1266)

In the eighteenth century there were two famous physicians by the same name “James Lind” in Scotland, with an age difference of about 20 years. The younger James Lind wrote his doctoral thesis on malaria in Bengal and was physician to the Royal Household. The elder James Lind, who is being commemorated hereunder for having given us the concept of controlled clinical trials, is historically more important with lifelong interest in scurvy while working as chief physician at the Royal Naval Hospital in Haslar [Figure 1].{Figure 1}

James Lind was born in Edinburgh on October 4, 1716, the son of an Edinburgh merchant whose wife had medical connections. In 1731, he apprenticed to George Langlands, an Edinburgh surgeon. Lind is recorded as having attended a course of anatomy lectures in 1734 given by one of the doyens of the Edinburgh, Professor Alexander Monro primus.

After his surgical apprenticeship, James Lind joined the Royal Navy in 1738 as a surgeons mate on a ship captained by Rear Admiral Nicholas Haddock, at a time when Haddock was successfully attacking Spanish shipping. In 1740, during the War of the Austrian Succession, he joined the 50 gun vessel Her Majesty's Ship Salisbury.

He is widely regarded as the “First modern clinical investigator”, “Father of Naval Medicine”, “Hippocrates of Naval Medicine”, and every year since 2005, the European Clinical Research Infrastructures Network and European Communication on Research Awareness Needs have celebrated 20th of May as the International Clinical Trials Day commemorating the day James Lind started his famous experiment comparing possible treatments for scurvy on HMS Salisbury Ship in 1747.

In 1748, he retired from the Navy and graduated from Edinburgh after submitting his thesis on venereal disease as the subject presumably because of his naval experience.

“James Lind has been the means of saving innumerable lives and preventing an incalculable amount of suffering; yet even to the members of his own profession today his name is almost unknown. Of his life even less is known than that of Shakespeare”.(Anonymous)

Visitors to the Edinburgh University quadrangle in Teviot Place, which used to house the Medical School, are unlikely to miss the large plaque put up by the Sunkist Growers of Citrus Fruit listing three of his four books.

A treatise of 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 was clearly regarded as an important book, first published in 1753, and appeared in two subsequent editions in English (1757, 1772); and translations were published in French (1756, 1783), Italian (1766), and German (1775)An essay on the most effectual means of preserving the health of seamen (James Lind 1762)An essay on diseases incidental to Europeans in hot climates (James Lind 1771).

In 1747, ships were cold, damp, and unwholesome, while the food was abominable (putrid beef, rancid pork, mouldy biscuits, and foul water) and scurvy was a grievous disease, rampant among sailors making long voyages across the Atlantic Ocean. As the cause of scurvy was unknown, many different treatments were proposed.

The symptoms of scurvy manifest after about 8 weeks at sea. James Lind believed that scurvy causes putrefaction of the body which can be prevented by intake of acids. In what was considered the first clinical trial in history, on May 20, 1757, James Lind enrolled 12 sick sailors for his systematic clinical trial. He divided the sick sailors into six pairs and provided each of them with a different supplement in their diet: cider, vitriolic elixir (diluted sulfuric acid), vinegar, sea water, two oranges, and a lemon, or a purgative mixture.

The two sailors who took the fruit recovered. James Lind wrote in 1753 in his historical work “A Treatise of the Scurvy.” “The most sudden and visible good effects were perceived from the use of oranges and lemons, One of those who had taken them being at the end of six days fit for duty … The other was the best recovered of any in his condition; and was appointed nurse to the rest of the sick.”[1]

In May 1750, he was elected a fellow of the Royal College of Physicians of Edinburgh and also became a member of the Philosophical and Medical Society of Edinburgh. In 1753, he published “A Treatise of the Scurvy” which ran to three editions over the next 15 years. Though his initial belief/hypothesis that there were multiple causes of scurvy, including diet, faulty digestion and excretion, exacerbated by environment, foul air, and lack of exercise was only partially correct, his final conclusions were totally correct.

In 1757, Lind wrote his essay on the most effectual means of preserving the health of seamen in the Royal Navy. In 1758, he was appointed physician to the Naval Hospital at Haslar in Gosport, where he investigated the distillation of fresh water from salt water for supply to ships.

In 1763, James Lind wrote about typhus fever in ships and in 1768 published “An Essay on Diseases Incidental to Europeans in Hot Climates” which ran to six editions, the last appearing after his death. He summarized the prevalent diseases in each colony and gave advice on avoiding tropical infections. In 1783, James Lind became a Fellow of the Royal Society of Edinburgh and in the same year resigned from Haslar Hospital because of failing health, but he was able to enjoy 11 years of retirement.[2],[3]

He died on July 13, 1794, at the age of 78, 2 years before his wife, and was buried in Porchester Church-thus passed away a quiet unassuming man of acute observation and independent thought, unbiased, hooked to reason, steered to logical conclusions leading to the conquest of scurvy, development of modern naval hygiene, occupational health, and tropical medicine.

Multifaceted as he was, he showed how 18th century technology could be used to distill fresh water from sea water (Lind 1761). He recommended prevention of scurvy by including fresh citrus fruits and vegetables in the diet of seafarers. He argued for the availability of fresh lime juice when citrus fruits and vegetables were out of stock. Thus, the British seamen earned the nickname of “Limeys.” Legend says that his recommendations were ignored by the Admiralty for over four decades. In 1795, physician Gilbert Blane successfully persuaded the British Navy to provide juice of citrus fruits to sailors protecting them from scurvy, a deadly disease in those days. With James Lind's evidence-based recommendations in position, scurvy disappeared almost completely from the Royal Navy.[4]

“Ironically, James Lind, the man who gave us the concept of controlled clinical trials, remembered as a kind man with intelligent eyes with his four books in hand and Haslar Hospital in the background, perchance never heard of the phrase “controlled clinical trials” in his medical practice or lifetime.”

References

1Milne I. Who was James Lind, and what exactly did he achieve. J R Soc Med 2012;105:503-8.
2Milne I, Chalmers I. Documenting the evidence: The case of scurvy. Bull World Health Organ 2004;82:791-2.
3Chalmers I, Dukan E, Podolsky SH, Davey Smith G. The advent of fair treatment allocation schedules in clinical trials during the 19th and early 20th centuries. JLL Bulletin: Commentaries on the History of Treatment Evaluation; 2011.
4Lind J. An essay on the most effectual means of preserving the health of seamen, in the Royal Navy. London: Printed for D. Wilson; 1762.P85-93.