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 …

Edinburgh: Sands, Murray, and Cochran, for A. Kincaid and A. Donaldson, 1753.

First edition, first issue, of Lind’s epochal work on the prevention of scurvy, the identification of a dietary deficiency as the cause (later identified as Vitamin C), and the first recorded example of a clinical trial. This work eventually had enormous impact not only on maritime health but on the military and hence economic efficacy of the British navy. Prior to Lind, as noted by him in the preface to this work, scurvy accounted for more maritime fatalities than combat or accident. On the famous circumnavigation of Admiral Anson (to whom this work is dedicated), 1000 of his crew of 1400 were lost to scurvy. “A century before the absence of vitamin C was identified as the cause of scurvy, this disease, so long endemic among seamen, had largely disappeared. This was mainly due to the work of James Lind and to the publication in 1753 of his Treatise of the Scurvy, in which he drew upon his own experiences as a naval doctor to give a clear, clinical account of the disease and to demonstrate conclusively by experiment that orange and lemon juice were the only known effective cure” (Grolier, Medicine p. 165). “James Lind (1716–1794), a Scottish-trained surgeon, began his reforms in naval hygiene with this treatise on scurvy ... his practical suggestions for including antiscorbutic foods on sailors’ daily menus during long sea voyages exerted a tremendous influence. His statements about the cause and cure of scurvy were not confirmed and elucidated until the early twentieth century, when the effects of vitamin C deficiency were precisely defined. While serving at sea as a surgeon’s mate on 1747, Lind carried out a controlled experiment on the diet of sailors. Perhaps the first clinical trial, this study showed that citrus juice could prevent and cure scurvy. Six years later ... Lind published this book. It presented a critical account of current opinion, demonstrating that the disease is not congenital, hereditary, or infectious; a description of the disease, its cause, prevention, and cure; and a digest of everything written previously about scurvy. The treatise describes Lind’s experiment. Each of six pairs of patients was given one of the following dietary supplements: cider, ‘elixir vitriol,’ vinegar, seawater, oranges and lemons, and an ‘electuary of garlic, mustard seed, radish, Peru balsam, and gum myrrh’ with garlic water. All other conditions were kept constant. In comparing the results, Lind found ‘sudden and visible effects from the use of the oranges and lemons’ ... Lind’s classic, well-controlled clinical trial offered firm support to previous recommendations ... Convinced by Lind’s work, Captain James Cook included citrus juice in the diet of the sailors on his South Sea voyage of 1772–1775 and reported its unprecedented success to the Royal Society in 1776 ... Lind also fought for the establishment of hospital ships, cleanliness and ventilation in sick bays, and other measures for which he has been called the ‘father of nautical hygiene’” (Le Fanu, p. 119). There are three issues, the first as here with the Edinburgh imprint, the second with a London imprint, also dated 1753, and the third with a London imprint dated 1754. Although this book appears not infrequently on the market, copies such as ours in unrestored contemporary bindings are rare.

Lind “was born in Edinburgh on 4 October 1716, the son of an Edinburgh merchant whose wife had medical connections. In 1731 Lind was apprenticed to George Langlands, an Edinburgh surgeon. Some researchers have wondered why Lind did not formally enrol in Edinburgh University. However, during the Edinburgh Medical School’s infancy it was common for students to attend lectures on an ad hoc basis. Lind is recorded as having attended a course of anatomy lectures in 1734 given by one of the doyens of the Edinburgh medical scene, Professor Alexander Monro primus. After his surgical apprenticeship, 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, Lind joined the 50-gun vessel Salisbury … In 1748, Lind retired from the Navy and returned to Enlightenment Edinburgh, where he set up a medical practice in a competitive field … Lind graduated MD in the University of Edinburgh in 1748, choosing venereal disease as the subject for the required thesis, presumably because of his naval experience. In May 1750 he was elected a fellow of the Royal College of Physicians of Edinburgh … It was during Lind’s stay in Edinburgh that the book for which he is best known – A treatise of the scurvy – was published in 1753, and dedicated to Lord Anson. The following year Lind published a paper in the Scots Magazine about the potentially harmful leaching of lead salts from the glazes used in earthenware vessels, and in 1757, his Essay on the most effectual means of Preserving the Health of Seamen in the Royal Navy. In May 1758, Sir Alexander Dick, President of the Royal College of Physicians of Edinburgh, received an elegant letter containing Lind’s resignation as College Treasurer and reporting his appointment as Chief Physician to His Majesty’s Royal Hospital at Haslar. The post at Haslar during this period may not have been as prestigious as its title suggests, and it is certainly possible that Lind’s medical practice in Edinburgh may not have been as successful as he had hoped it would be … Lind continued to experiment and publish while working at Haslar. In 1762 he proposed a simple method of supplying ships with fresh water by distillation. In 1763 he published Two papers on fevers and infection, and in 1771, An essay on diseases incidental to Europeans in hot climates. James Lind retired as chief physician at Haslar in 1783, and his son John, who had been his assistant, succeeded him in the post. Lind died in Gosport in 1794 …

“Scurvy was high on the list of dangers facing those 18th century sailors who spent much time at sea, although some authors suggest that its significance has been exaggerated. For instance, Rodger postulates in his very comprehensive book on naval history that: ‘It has been seriously suggested that a million British seamen died of it in the eighteenth century – a figure which implies that everybody who served in the Navy died of scurvy approximately twice. Rodger urges caution in discussing a disease whose name was used by doctors as a catch–all term for anything they could not identify or cure. He feels that the real killers at sea were fevers, especially gaol/camp/ship fever (typhus), and malaria.

“However prevalent scurvy may or may not have been, Lind’s 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. It was 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).

“Lind’s book is long, difficult and contradictory. He uses the work to wrestle with the contemporary theories of the causes of scurvy, and to put forward his own view – that scurvy is a disease of faulty digestion and excretion, exacerbated by environment. He believed there were multiple causes of scurvy, including diet, foul air and lack of exercise.

“There are many interesting things in the book, however. For instance it contains an early example of a systematic review of what had been written on the subject. Lind makes clear in the preface that he prefers observations to theory, and observes bluntly that ‘before the subject could be set in clear and proper light, it was necessary to remove a great deal of rubbish’ … He identified 54 books meriting critical appraisal, and wrote abstracts summarising his incisive views on each of them.

“Crucially, the Treatise contains a description of a very early ‘fair test’ – although the report of Lind’s controlled trial comparing six purported treatments for scurvy is rather hidden away and occupies just four pages, unmarked by a subheading, in the 450-page book. Lind reports the trial as having been undertaken in May 1747, while the Salisbury was at sea enforcing a blockade in the English Channel. Lind’s trial involved twelve sailors with scurvy, who were ‘as similar as I could have them,’ who were accommodated in the same quarters, and had the same basic diet. His report thus illustrates his awareness of the need to guard against selection bias and shows how he tried to hold potential confounding factors constant – clinical condition, environment, and basic diet.

“Without stating what method of allocation he used, Lind allocated two men to each of six different daily treatments for a period of fourteen days. The six treatments were: 1.1 litres of cider; twenty-five millilitres of elixir vitriol (dilute sulphuric acid); 18 millilitres of vinegar three times throughout the day before meals; half a pint of sea water; two oranges and one lemon continued for six days only (when the supply was exhausted); and a medicinal paste made up of garlic, mustard seed, dried radish root and gum myrrh.

‘The most sudden and visible good effectswere 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 being now deemed pretty well, was appointed nurse to the rest of the sick.’

“The least satisfactory feature of Lind’s Treatise is that, despite this apparently strong evidence, Lind leaves his readers confused about his recommendations. Some passages suggest that he is very clear about the implications of his review, for example, when he writes:

‘Some new preservative against the scurvy might in this treatise have been recommended; several indeed might have been proposed, and with great show of probability of their success; and their novelty might perhaps have procured them a favourable reception in the world. But these (citrus) fruits have this peculiar advantage above anything that can be proposed for trial, that their experienced virtues have stood the test of nearly 200 years.’

“However, despite the fact that references to the beneficial effects of fruits and vegetables outnumber references to any of the other purported treatments in the trial, Lind nowhere states clearly that citrus juice is a cure for scurvy …

“The dominant 20th century view of Lind is well represented by the précis of David Harvie’s 2002 book Limeys:

‘Limeys is the dramatic history of Dr James Lind’s heroic efforts to find a cure for the dreaded disease of scurvy in the face of the corrosive patronage and establishment antipathy of the times. Lind recommended lemons and oranges. Yet he was unable to penetrate the Admiralty high-mindedness, or to persuade them to enforce the fruits’ universal application. Only in 1795, when court physician Gilbert Blane championed Lind’s work, were the Sea Lords persuaded to act.’

“It is possible to trace the start of this viewpoint to the 1893 Dictionary of National Biography, in which Lind’s biographer (Norman Moore MD) wrote that:

‘… the issue of an order by the admiralty to supply the navy with lemon juice in 1795, two hundred years after it was first known as a specific and forty years after Lind’s conclusive evidence of its worth, supplied Mr Spencer with an effective illustration of administrative torpor in his Study of Sociology. [Herbert Spencer (1820–1903), was an eccentric but influential philosopher, social theorist, and sociologist].

“There is little evidence, however, that Lind ever clearly recommended the use of lemon juice to the Admiralty or to others. At least two factors may have explained the failure to make use of antiscorbutics (there were preventable outbreaks of scurvy well into the 20th century). The first reason was practical – the expense and perishability of fruit and vegetables. In response to this problem, Lind used a complicated method to prepare an inspissated juice (‘rob’), which has subsequently been shown to contain practically no vitamin C. The second reason was that researchers had no concept of vitamins – let alone vitamin C – until Frederick Gowland Hopkins’s paper on ‘accessory food factors’ was published in 1912.

“Lind writes in the advertisement contained in the third edition of the Treatise:

‘The mischief done by an attachment to delusive theories and false hypothesis is an affecting truth, as will appear from a perusal of the following sheets. It is indeed not probable, that a remedy for the scurvy will ever be discovered, from a preconceived hypothesis; or by speculative men in the closet, who never saw the disease, or who have seen, at most, only a few cases of it.’

“Unfortunately Lind did not follow own advice. He was reluctant to either use or clearly recommend treatments whose mechanism of action he didn’t understand. Lind was not alone. Many other 18th century researchers, including Dr Nathaniel Hulme, Sir John Pringle, Dr David McBride, Dr Thomas Trotter and others, all contributed to the confusion in the second half of the 18th century.

“Even allowing for the luxury of hindsight it is surprising to discover that Vasco da Gama wrote that, when his sailors were suffering from scurvy in 1498, he sent a man on shore to ‘bring off a supply of oranges that were much desired by our sick’. This is reported by Kenneth Carpenter in his magisterial The History of Scurvy and Vitamin C (1986). Carpenter also quotes Sir Richard Hawkins who, when scurvy began appearing in 1593 as he sailed near Santos, in southern Brazil, reported that:

‘There was great joy amongst my company and many with the sight of the oranges and lemons seemed to recover heart. This is a wonderful secret of the power and wisdom of God that hath hidden so great and unknown virtue in this fruit to be a certain remedy for this infirmity.

“Although it may be understandable that Lind made no reference to Vasco da Gama or Richard Hawkins, it is surprising that he did not refer to John Woodall, the first surgeon-general of the East India Company, who reported on the antiscorbutic properties of lemons in his 1617 book The Surgions Mate. He recommended making sure that ‘There is a good quantity of juice of lemons sent in each ship’.

“Lind is rightly recognised for having taken care to ‘compare like with like’, and the design of his trial may have inspired Thomas Trotter to use a similar approach (1792). Even if Lind’s report of a controlled trial may be a fabrication, as some have alleged because his patients did not appear on the ship’s sick list, his account nevertheless illustrates a way of thinking about how to compare treatments, and this is of historical interest in its own right” (Milne).

Garrison and Morton 3713; Grolier Medicine 44; Le Fanu, Notable Medical Books, p. 119; Norman 1354; ESTC N13974. Milne, ‘Who was James Lind, and what exactly did he achieve,’ Journal of the Royal Society of Medicine 105 (2012), pp. 503-508.

8vo (201 x 128 mm), pp. xvi, 456. Contemporary calf, spine gilt with red lettering-piece (rubbed, spine ends and corners worn with minor loss). A very fine and unrestored copy.

Item #5100

Price: $65,000.00