The Lind Tradition in the Royal Naval Medical Service

Dudley S (1953) The Lind Tradition in the Royal Naval Medical Service. This is one of the Additional Notes in the republication of Lind’s Treatise. LIND’S TREATISE ON SCURVY A Bicentennary Volume containing a reprint of the First Edition of A TREATISE OF THE SCURVY by James Lind, M.D. with Additional Notes EDITED BY C. P. STEWART, Ph.D., D.Sc. AND DOUGLAS GUTHRIE, M.D. F.R.C.S.E Book reviews of the 1953 version https://doi.org/10.1056/NEJM195310012491410 https://doi.org/10.1001/jama.1953.03690150096035 https://doi.org/10.1113/expphysiol.1953.sp001028 Links to the original versions of Lind’s Treatise are at the end of this document. The Foreword to the Bicentennary Volume: https://zenodo.org/doi/10.5281/zenodo.10604636 This is a copy of the 1953 publication, pp.369-386, to make the text more widely available. This is located at: https://doi.org/ 10.5281/zenodo.10605144 Another series of publications to honour the 200-year anniversary of Lind’s Treatise was in the Proceedings of the Nutrition Society. A paper on Lind was published by Sheldon Dudley: Sheldon Dudley KCB. James Lind: Laudatory Address. Proceedings of the Nutrition Society. 1953;12(3):202-209. https://doi.org/10.1079/PNS19530049 The contents of the special issue: https://www.cambridge.org/core/journals/proceedings-of-thenutrition-society/issue/B5C5B1FF2F5E8592C93785E85D6DE286 Digitized in 2024 by Harri Hemilä, University of Helsinki, Finland https://www.mv.helsinki.fi/home/hemila https://orcid.org/0000-0002-4710-307X 1 THE LIND TRADITION IN THE ROYAL NAVAL MEDICAL SERVICE By Surgeon Vice-Admiral Sir SHELDON DUDLEY The preservation of health is without doubt of all blessings in this life the first and fundamental one: for the mind is intimately dependent on the condition and reactions of the body. DESCARTES, 1664 2 THESE comments of mine supplement the world’s greatest classic on scurvy. And, two hundred years after it was written, I am not competent to add a word to Lind’s clinical account of the disease. For one reason, thanks to Lind himself, I have never seen a patient suffering from scurvy, despite the fact that for over forty years—part of the time in Lind’s own hospital at Haslar—I have been following his vocation of trying to improve the health of seamen. My aim is to demonstrate the greatness of this eighteenthcentury ship’s doctor whose insight, combined with quiet pertinacity in research, led ultimately to such revolutionary changes in the naval health service, and to enquire how it was that these changes were so long delayed after publication of the observations on which they were based. The Preservation of Health James Lind was a modest, unassuming man, and although he received academic honours from France and Denmark he neither sought nor was given in his own land the public recognition which has sometimes been accorded freely to men of lesser stature. Yet his worth was appreciated by at least a few of his contemporary naval colleagues. Two of them, Trotter and Blane, did much to obtain approval for the application of the principles which Lind advocated and to ensure, moreover, that Lind received, however belatedly, p.370 due credit for his work. Indeed Trotter, who was no blind hero-worshipper and who had criticised his senior on more than one occasion, originated Lind’s well-earned title, ‘The Father of Nautical Medicine’. 3 It must be remembered that Lind’s claim to this title did not derive solely from his work on scurvy. That alone led to results of almost incalculable value, but besides the Treatise of the Scurvy1 Lind wrote two other books of primary importance. One of these, An Essay on the most effectual Means of preserving the Health of Seamen in the Royal Navy (1757),2 defines the whole duty of a ship’s doctor and is the foundation of what may be called the ‘Lind tradition’ in the Royal Naval Medical Service. Lind was by no means alone in recognising that, in practice, the preservation of health means the prevention of ill health and only secondarily the cure of individual disease, but he gave this principle a peculiar emphasis. Thus in his preface to the Essay he asserts: ‘The Prophylactic or preventive branch of medical science does, in many instances, admit of as much, or even more certainty, than the curative part… A medicine, which effectually prevents, deserves to be more esteemed than that which removes a Fever.’ Again: ‘With regard to the Royal Navy, when men are preserved in health by proper management; Courage and Activity are the certain consequences’.3 When the context permits he even prefers to use ‘preserve’ rather than ‘prevent’. 1. See links to the digitized versions at the end of this document. 2. The full title is: An Essay on the most effectual means of preserving the Health of Seamen in the Royal Navy, containing Directions proper for those who undertake long voyages at Sea or reside in unhealthy Situations with Cautions necessary for the Preservation of such Persons as attend the Sick in Fevers. https://collections.nlm.nih.gov/catalog/nlm:nlmuid-2498013R-bk (1757) https://archive.org/details/2498013R.nlm.nih.gov (1757) https://archive.org/details/essayonmosteffec00lind (1762) https://wellcomecollection.org/works/geeudjy2 (1762) https://archive.org/details/b30511410 (1762) https://archive.org/details/bim_eighteenth-century_an-essay-on-the-most-eff_lind-james_1774 https://archive.org/details/bim_eighteenth-century_an-essay-on-the-most-eff_lind-james_1778 3. 2nd ed., London, 1762, p. xxxi. 4 He writes of preserving the health of seamen, and in his third great classic, An Essay on Diseases incidental to Europeans in Hot Climates,4 he writes chiefly about preserving the health of Europeans. Sometimes even the word ‘health’ is dropped and Lind refers merely to preserving sailors or Europeans. In these works Lind unmistakably shows the proper spirit of Social Hygiene or true ‘Social Medicine’, p.371 the so-called ‘new’ specialism which he and his naval colleagues developed two hundred years ago—the preservation of the health of the healthy, in contradistinction to the cure of disease. Thus it is not unfair to consider James Lind the first pioneer of ‘Social Medicine’, as well as the founder of ‘Medical Climatology’ and the ‘Father of Nautical Medicine’. An example of Lind’s solicitude for the health of his beloved sailors which also illustrates his essentially practical outlook, is afforded by his insistence on a good supply of potable water. Although it is known that distilled sea water had been used before 1761, these early processes involved the use of added chemicals which were believed to be essential. In that year Lind invented a simple still and condenser, using only equipment available in ships, employing no chemical agents, and suggesting various devices for fitting it economically in the galley; this, he showed, was capable of producing ‘sweet’ water in useful amounts for 4. The full title is: An Essay on Diseases incidental to Europeans in Hot Climates with the method of preventing their fatal consequences… to which is added an Appendix concerning Intermittent Fevers, and a simple & easy way to render sea water fresh & to prevent a scarcity of provisions in long voyages at sea. https://archive.org/details/bim_eighteenth-century_an-essay-on-diseases-inc_lind-james_1768 https://archive.org/details/b3051177x (1768) https://wellcomecollection.org/works/fnvvxq2c (1768) https://archive.org/details/bim_eighteenth-century_an-essay-on-diseases-inc_lind-james_1771 https://archive.org/details/bim_eighteenth-century_an-essay-on-diseases-inc_lind-james_1777 https://archive.org/details/b30544725 (1777) https://archive.org/details/bim_eighteenth-century_an-essay-on-diseases-inc_lind-james-physician-t_1788 https://archive.org/details/b21365246 (1788) https://wellcomecollection.org/works/e2cpc5rs https://archive.org/details/b33089206 (1808) https://archive.org/details/b21299341 (1808) https://resource.nlm.nih.gov/2561034R (1811) https://archive.org/details/2561034R.nlm.nih.gov (1811) https://archive.org/details/essaisurlesmalad00lind (French) https://archive.org/details/essaisurlesmalad01lind (French) 5 drinking, at least in an emergency. So clearly did he describe this invention that it is hard to realise he wrote two centuries ago, when steam engines were yet novelties. Lind demonstrated his still to the naval authorities at Portsmouth in 1761 and communicated it to the Royal Society in April 1762 (read, May 1762). In his honour and to publicise his valuable invention in the Service, the Lords of the Admiralty ordered the publication of a new (the second) edition of Lind’s Essay on Preserving the Health of Seamen with an account of the still. This edition appeared in 1763 with the statement that it was ‘Published by Authority of the Right Honourable the Lords Commissioners for executing the office of Lord High Admiral of Great Britain, Ireland, etc.’, and thus Lind’s claim was recognised. A fuller discussion of the process was given in the second edition of the Essay on Diseases Incidental to Europeans in Hot Climates (1771). Hence it is almost incomprehensible that nearly ten years later the Admiralty awarded a prize of £5000 to Surgeon Irving, R.N., who in 1771 submitted another salt-water still for use in ships. Still more amazing is the fact that Lind was actually a member of the Board which examined and approved Irving’s claim to have devised a practicable and useful machine. The incident illustrates Lind’s exceptional power of self-effacement—yet p.372 he had himself, previously, protested when his priority had been overlooked by Poissoniere5 and he later animadverted upon Irving’s claim.6 Lind’s Two Famous Colleagues It is impossible to trace the impact of Lind’s work on the health and health services of the Royal Navy without considering the part played by his two junior contemporaries, Thomas Trotter and Gilbert Blane, both of whom were his ardent supporters and both of whom reached positions of great influence. These three Physicians to the Fleet formed a triumvirate on whose joint efforts, inspired by the senior, Lind, rests the development of the modern naval health service, as well as the conquest of scurvy itself. 5. See p. 363: Stewart CP (1953) The Third Edition of the Treatise. https://zenodo.org/doi/10.5281/zenodo.10604737 6. Essay on Preserving the Health of Seamen, 3rd edition. 6 Lind respected and admired both his colleagues, but for some psychological reason Trotter unjustly criticised and disliked Blane, of whom he seems to have been jealous regarding Lind; perhaps he suspected Blane of ‘stealing his hero’s thunder’, but he was probably influenced also by an important difference between Blane’s career and his own. Both Lind and Trotter joined the Navy as surgeon’s mates. To understand what this meant one should read Smollett’s Roderick Random.7 Tobias Smollett joined the Navy as a surgeon’s mate in 1739, the same year as Lind, and we can obtain from him an idea of Lind’s and Trotter’s early experiences of life at sea. Smollett paints grim pictures of the lot of a surgeon’s mate in the eighteenth century. He tells of life in the cockpit with his mates, of stowing away his rations, of struggling up on deck, when he was afflicted with yellow fever, to be alone for a time and to avoid the attentions of his medical messmates, who, with the best intentions, would have had him bled, blistered and purged to death. He tells of being disdainfully ‘cut’ by Captain Oakham, ‘who was too much of a gentleman’ to know a surgeon’s mate, even by sight. The late Sir Geoffrey Callender,8 Professor of Naval History at Greenwich Naval College, regretted the immense amount of exaggeration and caricature exhibited in all Smollett’s naval descriptions because he p.373 believed that with his great literary talents Smollett could have written a most instructive, readable and serious history of the Naval Medical Service during the eighteenth century. Nevertheless, surgeons, and a fortiori surgeon’s mates, occupied a very lowly position in the naval hierarchy of those days. Physicians to the Fleet had a much higher status than surgeons, and indeed were treated generally as the equals of wardroom officers. Whereas both Trotter and Lind had gone through the mill as surgeon’s mates before they got the opportunity to qualify as ‘Physicians to the Fleet’, Sir Gilbert Blane never 7. https://archive.org/details/bim_eighteenth-century_the-adventures-of-roderi_smollett-tobias-george_1791_1 https://archive.org/details/bim_eighteenth-century_the-adventures-of-roderi_smollett-tobias-george_1791_2 Many further digitized versions at: https://archive.org 8. Sea Passages, Cambridge, 1943. 7 suffered from the indignities of the cockpit and the lower deck. He joined the Navy as the pampered protege of a great and influential Admiral. Blane made no secret of his love for lords and princes, and on that account Trotter disliked him, considering him a snob and also (quite wrongly) a plagiarist of his hero, Lind. Trotter was unjust; Blane was a great man in his own right and supported Lind through thick and thin. Looking at Lind’s portrait9 one sees that the artist has caught a faintly humorous, understanding smile on Lind’s face. It seems to say that Lind was far too big a man to worry about the petty squabbles concerning rank and status which are continually going on in service establishments and which were probably even commoner in those days, when naval hospitals had executive commanding officers for keeping discipline as well as physicians in medical charge of the sick. If Lind’s picture was a good likeness he must have possessed a sense of humour and been able to smile as tolerantly at Trotter’s contempt for ‘gilded popinjays’ as at Blane’s great love of ceremony and titles. Lind himself had, apparently, no social ambition and loved both his faithful disciples equally. Both were great physicians and both in their writings show an all-embracing love and respect for the British sailors who owe them so much. Thus Trotter in his Medicina Nautica says of the British sailor: ‘In the hour of battle he has never left his officer to fight alone; and it is a solitary fact in the history of war’. He goes on: ‘were I ever to be reduced to the utmost poverty, I would spurn the cold threshold of fashionable charity, to beg off any seaman; when my afflictions would never be insulted, by being asked through what follies or misfortunes I had been reduced to penury’. 9. https://en.wikipedia.org/wiki/James_Lind#/media/File:James_Lind_by_Chalmers.jpg https://www.jameslindlibrary.org/wp-data/themes/jameslind/images/lind-portrait.jpg https://www.rcpjournals.org/content/clinmedicine/19/1/22/F1.large.jpg [“there is no information as to its whereabouts from then until it was purchased in Johannesburg in November 1953 by Kurt and Lorna Hepner. It is not known who the seller was, but it could well have been an art dealer. Since then the portrait has remained in the Hepner family.”] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3536516 https://doi.org/10.1258/jrsm.2012.12k091 8 p.374 Blane expresses his sympathy for the seamen similarly, if less forcefully: ‘All seafaring people, especially those employed in war, are exposed to peculiar and unavoidable privations, hardships, and dangers, which ought to be mitigated as far as is practicable, by those at whose absolute will they place their lives and limbs: it is in their character to be unthinking and careless of their own welfare and interests, requiring to be tended like children, and entitled to a parental kindness from the country they protect and the officers they obey’. James Lind himself, in the preface to the first edition of his Essay, shows equal admiration and sympathy: ‘Common humanity ever pleads for the Afflicted. … But, surely, there are no lives more valuable to the State, or who have a better claim to its care, than those of the British sailors to whom the Nation, in great measure owes its Riches, Protection, and Liberties.’ These men formed a wonderful trio knit together by their love for the British seaman, a trio whose labours, with those of their great contemporary, the Army physician, Sir John Pringle, led indirectly to the development of the Public Health Service ashore, a trio who by their successes in preserving the health of the Navy did as much to win Trafalgar as the immortal Lord Nelson himself. Yet they, who founded the Royal Naval Health Service, have largely remained prophets without honour in their own country. Their worth, valour and significance have been better recognised in the more health-conscious atmosphere of the United States, so let an American naval historian write their epitaph: ‘They struggled against stupidity, ignorance, prejudice, and indifference in high places and low, the Admiralty and Forecastle; they had the hard task of seeking to break down immemorial custom; dared to challenge “tradition”; hammered at the walls of a hierarchy as soul-chilling, as rigorous, as iron-bound, as any Brahmin caste; preached seemingly frivolous novelties to an insular conservatism that held hardships essential for hardihood.’10 10. J. S. Taylor (1920), U.S. Naval Medical Bulletin, 14, p. 563. https://zenodo.org/doi/10.5281/zenodo.10604304 https://archive.org/details/unitedstatesnava14unit/page/562/mode/2up 9 for years) were to be found in the hospital boat bringing invalids from the Fleet, I got a feeling of loss, almost of guilt, because there were no more cases of Malta fever with which to fill my wards. So I can well imagine what my predecessors, performing the same duties in the same place a hundred years earlier, felt when suddenly no more cases of scurvy were found in the routine ‘hospital boats’ discharging sick men from the Fleet. Sir Gilbert Blane describes how the endorsement of Lind’s rules for the preservation of health, especially those which had eradicated scurvy, enabled a fleet of the same striking force to be maintained at sea with half the number of men and ships. For, as he explained: ‘When the Fleet could not keep the sea for more than ten weeks without being p.381 rendered unserviceable by scurvy … another force as nearly equal as possible had to be available to replace it’. Blane continues: ‘One of the most distinguished sea officers that ever lived declared to me that it was his conviction that two ships are now equal to four of former times’. I think that this comment is better able than any long statistical analysis to give the present-day sailor and doctor a real idea of the tremendous value of Lind’s work to the Royal Navy. A man who could double the striking force of the King’s Navy with no increase in the ‘naval estimates’ or use of that dread instrument, the press-gang, was worth half a dozen ordinary admirals, however skilful the latter were in handling ships at sea or in taking prizes. For in sea-battles, as well as in land campaigns, God nearly always fought on the side of the most powerful squadrons. Although Blane rated Lind’s work on scurvy first, and although many people who have heard of that work and its effects have imagined it to constitute Lind’s sole claim to fame, this eighteenth-century physician was in fact responsible for much more. His claim to be considered the founder of Social Medicine has been mentioned in the first section of this essay; let us now consider one or two examples of the observations and pronouncements on which this claim rests. ‘Fever’ (Malaria). One of the main objects of Lind’s third great classic, the Essay on Diseases of Europeans in Hot Climates, was to give advice on the recognition of unhealthy and healthy sites for dwelling-places abroad. He 16 enumerates four signs of unhealthy locations: sudden big changes in temperature between night and day; ‘noisome fogs’ at sundown; numerous swarms of flies, gnats and other insects; the rapid spoiling of food. Lind’s description of dangerous jungle air is an interesting piece of imaginative self-deceptive writing. He avers (without real justification) that ‘the air was vitiated, noisome and thick in so much that lighted torches and candles burnt dim, and seemed ready to be extinguished; even the human voice lost its natural tone … but the greatest plague was the mosquitoes and sandflies whose incessant buzz and painful stings were more insupportable than any symptoms of fever’. More than anyone else who wrote in the pre-Manson era, Lind keeps referring to mosquitoes. Of course, he had no p.382 more idea of regarding them as a direct cause of malaria than he had of associating lice with the typhus infection. But with the same uncanny insight which caused him to recommend a modern delousing technique to preserve men from gaol-fever he now recommended anti-mosquito methods to render unhealthy sites healthy, that is the draining of marshes and the clearing of scrub and undergrowth away from dwelling-houses. Moreover, he pointed out that in most places in the tropics there are local sites on high, dry ground where Europeans can live and sleep, safe from fever, even during the rainy season. The Ship as a Health Resort.—Lind stressed continually the importance and value of using as depots (barracks), ‘factories’ and hospitals, ships and hulks moored off-shore or proceeding as tenders to the Fleet. He noticed, as have all his professional successors, how ships off-shore were never bothered by fevers and fluxes, as long as the men did not sleep ashore, and he urged this policy on his masters with the same lack of success that all his successors have had, even including the persuasive Sir Gilbert Blane, who was just as enthusiastic about hospital ships but for once failed to sway Lord Rodney. Lind gave numerous examples of the immunity of those who slept in their ships. He instanced the great danger of boat work, how men who left the ships in boats to draw water, provisions, fuel, etc., or went on ‘cutting-out expeditions’ up rivers always fell, almost 100 per cent, sick with fever. 17 One of the most interesting examples is quoted from Pringle’s Diseases of the Army.15 Off Walcheren in 1747 the British troops ashore suffered severely from sickness, one-seventh being unfit for duty. At the same time the naval squadron, at anchor in the channel between Walcheren and the mainland, enjoyed perfect health amidst all that sickness. Here if anywhere was a prophetic warning to keep away from that fateful island, but about fifty years later a still worse defeat at the hands of the malarial mosquito awaited British troops, for in 1809 another British Army in Walcheren was decimated by sickness; by a strange irony of fate it was the former ship’s doctor, Sir Gilbert Blane, who was sent out to see what was medically p.383 wrong with the soldiers, and who had to advise the immediate return to England of what was left of this Army. Mosquitoes, unless they are carried by wind, are unable to travel far from land, and it seems a simple and obvious thing to use ships, as Lind advised, to protect life and health and to conserve man-power in expeditions abroad, whether they are hostile or peaceful. But the method has never found 15. Observations on the Diseases of the Army. https://wellcomecollection.org/works/xj5xh2ne (1761) https://wellcomecollection.org/works/re2kkv6s (1775) https://wellcomecollection.org/works/xh37sa3v (1810) https://wellcomecollection.org/works/gxjh5dug (1812) https://archive.org/details/b30502962 (1752) https://archive.org/details/bim_eighteenth-century_observations-on-the-dise_pringle-sir-john-bart_1752 https://archive.org/details/observationsondi00prin (1753) https://archive.org/details/bim_eighteenth-century_observations-on-the-dise_pringle-john_1753 https://archive.org/details/bim_eighteenth-century_observations-on-the-dise_pringle-john_1761 https://archive.org/details/bim_eighteenth-century_observations-on-the-dise_pringle-sir-john_1764 https://archive.org/details/bim_eighteenth-century_observations-on-the-dise_pringle-john_1765 https://archive.org/details/bim_eighteenth-century_observations-on-the-dise_pringle-sir-john_1768 https://archive.org/details/bim_eighteenth-century_observations-on-the-dise_pringle-sir-john_1774 https://archive.org/details/b30522225 (1775) https://archive.org/details/bim_eighteenth-century_observations-on-the-dise_pringle-sir-john-bart_1775 https://archive.org/details/b32886901 (1810) https://archive.org/details/2567046R.nlm.nih.gov (1810) https://collections.nlm.nih.gov/catalog/nlm:nlmuid-2567046R-bk (1810) https://archive.org/details/2567047R.nlm.nih.gov (1812) https://collections.nlm.nih.gov/catalog/nlm:nlmuid-2567047R-bk (1812) https://archive.org/details/observationssurl01prin (in French) https://archive.org/details/observationssurl02prin (in French) 18 favour with the civilian or executive administrators. In peace-time there is little need for this special use of ships, for fleets and troops can avoid malaria-infested swamps and go to places where anti-malarial control is properly developed and the hospitals are as safe and healthy as in London. In war, however, the matter is very different. Ships and armies generally have to exist for months off and on the most unhealthy shores and in undeveloped swamps and jungles, where, as we now know from direct observations, Lind’s policy will reduce a sick-list of over 50 per cent to zero. Why has this policy not been generally used in the last two hundred years ? Because in war ships are worth their weight in gold and are needed for carrying stores, troops and ammunition. Only the American Navy, with its far greater respect for doctors and sick men, has recognised and applied Lind’s policy. The Americans, in the war against Japan, at first tried placing so-called hutted ‘mobile’ hospitals all over the Pacific, but in practice these proved to be perfectly stationary, as there were, of course, no ships to move them. The American General Staff soon saw their mistake and, less hide-bound by tradition than the British, cut their losses and replaced their immobile ‘mobile’ hospitals by the finest fleet of specially designed and air-conditioned hospital ships which has ever been used. After a time-lag of two centuries they validated Lind’s policy in a way that no transport officer could ever again argue about. In this connection it is interesting to note how Lind recommended ‘open-air treatment’, saying, ‘Where contagion is eminently malignant, spacious tents … are greatly preferable to any closed houses for dissipating infection and for the recovery of the diseased’. Lind describes how this practice was first carried out as a desperate expedient when there was no other accommodation, and goes on, ‘These poor fellows were thought to be badly accommodated but it was very observable that most of those who lay in the tents recovered; p.384 when the mortality in the House was so great that, in some Wards, not one in three escaped’. This has been a common experience down the years since Lind’s day, but the natural timidity of both medical and civilian authorities makes them very chary of employing the policy unless circumstances force it on them. I have often wanted, when accommodation in the naval barracks and training establish19 ments was cramped or overcrowded, to put the sick (and healthy) under canvas, but I quite realised the reluctance of my superior officers to do so, in the face of the constant uninformed and irresponsible criticism a Government service receives from the outside public. Venesection.—A good test of an eighteenth-century physician’s clinical sagacity is his attitude towards promiscuous venesection. Lind, in writing of the ‘autumnal fever16 of Great Britain’, says, ‘the symptoms were at first alarming, but when the lancet was withheld and bark17 plentifully given in large doses few died’. Elsewhere he cannot refrain from a mild dig at that vastly overrated physician, ‘the immortal Sydenham’. Speaking of the diseases in Guinea he says: ‘And indeed so much harm has been done there by the lancet, in the hands of such as have read only Sydenham’s works … that it is most desirable for the inexperienced in such climates to abstain altogether from its use’. On the other hand, Lind held a strange theory that by repeated blood-letting there could be developed an immunity against tropical fevers such as was to be observed in the natives and a few European inhabitants of the West Indies. His theory was that the blood which replaced that drawn off was made from the specific foods of the locality and conferred immunity against the local specific diseases. To an immunologist this fantastic hypothesis is fascinating in showing how a great genius, however handicapped by the state of contemporary knowledge, may think along lines that are not very far from the truth. Had Lind gone one step further and replaced the blood removed at venesection by blood or serum taken from ‘immunes’ (natives or old inhabitants) he would have carried out the modern practice of producing passive immunity. But antibodies were still undreamt of, and Lind’s little experiments were futile because of the state of p.385 medical knowledge in his time. Nevertheless, they show him to have been a thinker and an observer of the very first class. 16. Malaria. 17. Peruvian bark, the natural source of quinine. 20 Typhus.—Lind seemed to possess the remarkable faculty of knowing instinctively how to preserve health from attack by a specific disease even though the specific cause was still completely unknown. Of course, literally, instinctive knowledge has no place in the human cultural heritage, for apparent intuition or instinct in human beings is really due to careful and meticulous (possibly subconscious) observation, and, as Trotter said, Lind was the ‘man of observation’. Lind’s instructions on the prevention of gaol-fever (typhus) are a case in point. Here they are: “The most effective preservation against this infection during a press18 would perhaps be to appoint a ship for receiving all ragged and suspected persons, before they are admitted to the receiving guardship. This ship would be furnished with slops, sheets, bedding, and all the necessary articles of seamen’s apparel, with soap, tubs and proper conveniences for bathing and a room on the upper deck for fumigating the clothes. Every suspected person, whether impressed at sea or ashore, should be put aboard her: their stay in her should be short, as soon as they are all stripped of their rags and all well washed and clean, they should be supplied with new clothes and bedding and sent on board the receiving guardships. Such of their apparel as appear tolerable good ought to be cleaned, or if necessary fumigated with brimstone and returned to them, but it will be absolutely necessary to destroy all filthy rags and all such clothes as are brought from Newgate and other prisons.” This extract from Lind’s Essay on the preservation of seamen reads like a simple paraphrase of the delousing instructions to be found in any modern manual of Military Hygiene before the advent of DDT. Lind ‘knew’ that ‘the mischief lurks in the tainted apparel of the pressed man’, but the idea that lice might carry the infection would have appeared to him as bizarre as the idea of mosquitoes carrying the specific cause or causes of tropical fevers. Or would it ? It was in connection with gaol-fever and cleanliness as a 18. Compulsory enlistment, generally of the inhabitants of prisons, poor-law institutions or merchant ships, or by the operation of pressgangs, rounding up men by violence to become sailors. Only seamen were legally liable to be pressed. 21 p.386 health preservative, that Lind was so keen on the institution of a proper naval uniform. He says that ‘if the seamen in his Majesty’s Service were put into a uniform SeaHabit, with some little movable badges or variations by which it might be known to which ships they belong’ they would start clean and could then be kept clean. Moreover, a uniform improved discipline, encouraged self-respect and made desertion more difficult. This was the origin of the blue-jacket’s rig and cap-ribbon, adopted many years later. Lind’s recommendations and inspirations when ultimately implemented, thanks to Rodney and Blane, drove from the high seas typhus, the second greatest cause of mortality in seamen. Thus it is to Dr James Lind that all those who sail the seas owe the preservation of their lives from what were the two fiercest and most unmerciful killers of the sea ─scurvy and typhus fever. 22 Lind J. A Treatise of the Scurvy in Three Parts (1753/1757/1772) https://doi.org/10.1111/j.1753-4887.1983.tb07177.x https://doi.org/10.1017/CBO9781107256644 https://archive.org/details/b30507054 (1st ed 1753) https://wellcomecollection.org/works/xc2t7736 (2nd ed 1757) https://archive.org/details/treatiseonscurvy00lind (2nd ed 1757) https://archive.org/details/treatiseonscurvy1772lind (3rd ed 1772) https://openlibrary.org/books/OL24970496M (3rd ed 1772) https://openlibrary.org/books/OL26752931M (3rd ed 1772) https://archive.org/details/b30511902 (3rd ed 1772) https://archive.org/details/bim_eighteenth-century_a-treatise-on-the-scurvy_lind-james_1772 (3rd ed) https://babel.hathitrust.org/cgi/pt?id=ucm.5320216006 (3rd ed 1772) https://archive.org/details/b28771308_0001 (French, 1783) https://archive.org/details/b28771308_0002 (French, 1783) https://archive.org/details/traitduscorbutdi00lind (French, 1783) https://archive.org/details/traitduscorbutdi00lind_0 (French, 1783) https://archive.org/details/TrattatoDelloScorbutoDivisoInTreParti (Italian, 1766) 23