Gates Package — page 1004

Salisbury.15 In May 1747, a physician named James Lind was serving as a ship's surgeon in the British Royal Navy vessel Salisbury.15 He was horrified by the number of sailors who were suffering from scurvy, a condition that causes muscle weakness, exhaustion, bleeding from the skin, and eventually death. No one knew at the time what caused scurvy, but Lind wanted a cure, so he decided to try various options and compare the results. He selected twelve patients on board who had similar symptoms. They all ate the same food--gruel sweetened with sugar in the morning, mutton broth or barley and raisins for dinner--but were given different treatments. Two drank a quart of cider each day. Two others were given vinegar. Other pairs of patients got either seawater (the poor souls), oranges and a lemon, a medicine concocted by a hospital surgeon, or a mixture of sulfuric acid and alcohol known as elixir of vitriol. The citrus treatment won out. One of the two men who received it was back on duty in six days, and the other recovered quickly enough to begin tending to the rest of the patients. Although the British navy wouldn't make citrus a required part of a sailor's diet for another fifty years, Lind had found the first real evidence of a cure for scurvy. He had also run what is widely regarded as the first controlled clinical trial of the modern era.* Other innovations in clinical trials would follow in the decades after Lind's experiment: the use of placebos in 1800, the first double-blind trial (in which neither the patient nor the physician knows who is getting what treatment) in 1943, and the first international guidance on * We now know that scurvy is caused by a deficiency of vitamin C. May 20, the day Lind began his trial, has been designated International Clinical Trials Day.