Sir Gilbert Blane
For much of the Age of Sail, scurvy was considered an occupational hazard of oceanic travel. The disease, which we now know was caused by a lack of vitamin C in the naval diet, would normally appear a few months into a voyage. The initial symptoms were mild, but as time went on, they became steadily worse. Skin bruised, gums bled, teeth and hair fell out, and old wounds reopened. If left untreated, victims would eventually die, a fate that an estimated 2 million sailors suffered between the 16th and 18th centuries.
Matters came to a head in 1744, when Commodore George Anson returned from a four-year circumnavigation of the globe with only 188 of the 1,854 men he had departed with, most of whom had been lost due to scurvy. It was news of this catastrophic loss that inspired a young Scottish naval surgeon called James Lind to find a cure. Three years later he was serving on board HMS Warwick when an outbreak of the disease occurred. He divided his patients into pairs and gave each one an alternative cure. This was the world’s first randomised drug trial, and even included a control pair of patients who received no cure at all. The result was conclusive, with only those given citrus fruit making a full and rapid recovery.
With the publication of Lind’s results in his A Treatise on the Scurvy in 1753, one might assume that the disease was banished forever. Unfortunately, thousands of sailors continued to die of it annually. Part of the reason was that Lind could not explain to his own satisfaction, still less to the rest of the medical community, why his cure worked. 18th century medicine knew nothing of vitamins, and was still based on the ancient Greek model of balancing the four humors, into which Lind’s results could not be easily fitted. When Lind tried to turn his cure into a practical remedy that could be stored for months on board a ship, he chose a method of preserving fruit juice that involved boiling and distilling it. This process destroyed almost all the vitamin C, so that when naval officers like Captain Cook were asked to try his cure, they reported no measurable benefit.
And there things might have rested were it not for the intervention of Gilbert Blane, a younger and influential Scottish surgeon. Blane was a medical reformer who was convinced by Lind’s original experiment, and deduced that it was Lind’s method of preservation that was at fault. His chance to prove this was when he joined the staff of Admiral Rodney as Physician to the Fleet in 1779. After considerable experimentation he discovered that a mixture of nine parts lemon juice with one part “spirits of wine” (ethyl alcohol) would preserve the juice almost indefinitely without destroying its ability to cure scurvy. When the first cases appeared in the fleet, Blane swiftly dealt with the outbreak.
Rodney was so impressed with Blane that he used his considerable influence to have him appointed as Commissioner of the Sick and Hurt Board. In this role Blane persuaded the Admiralty to introduce a daily supplement of lemon juice to their sailors’ diet. From 1795 onward, three-quarters of an ounce of lemon juice per day was given to every sailor, almost ending scurvy at a stroke. It was a huge logistical challenge for the navy, who had to obtain over 50,000 gallons of lemon juice annually. Most of this production was Spanish, which became problematic when Spain declared war on Britain in 1804. The Admiralty’s response was to switch from lemons to limes that could be grown on British islands in the Caribbean. In the War of 1812, this practice resulted in U.S. sailors calling their opponents Limeys, a term still in use today.
Although Blane’s motives were undoubtedly humanitarian, there were also considerable military benefits that flowed from controlling scurvy. During the long war with Napoleonic France, Britain blockaded much of the coast of Europe, and, from 1812, most of the U.S. coastline, too. The fleet expanded to more than 1,000 warships, many remaining at sea for extended periods. Manning such a fleet would have been impossible without an effective remedy for scurvy. Many of Nelson’s ships at Trafalgar, for example, including his flagship Victory, had spent almost all of the previous two years at sea. Despite this they were able to perform well during the battle. This contrasts with the French and Spanish ships which had only been at sea for at most six months prior to Trafalgar, but had no similar preventative measure for the disease in place. Several ships in the Franco/Spanish fleet had more than 200 cases of scurvy each, and one ship had more than 300.
Blane’s influence on the navy was not just in the control of scurvy. In his role in charge of medical care afloat he produced new regulations for Royal Navy ships, which were now to be kept scrupulously clean, properly ventilated, and sailors were to be issued with adequate supplies of soap (and made to use them). He also introduced a mandatory seven years of training for all naval surgeons, followed by an exam to prove their competence prior to being appointed, which improved their quality dramatically.
Blane continued as an influential figure in medicine after the Napoleonic Wars ended. He campaigned and lobbied on public health issues and was an active member of the Royal Society right up until his death in 1834. An example of how farsighted he was comes from one of the ideas that he was unable to see introduced. He believed that every sailor should be issued with a tourniquet prior to battle so that they could supply immediate assistance to a wounded comrade. Although it was never introduced, it is the forerunner of the field dressings carried into battle by service personnel today.
