Thread by @ajcdeane

#Deanehistory 90. Today is “International Clinical Trials Day.” That which might once have felt rather obscure feels vital & relevant, so here’s the story of James Lind, the British naval surgeon who pioneered the 1st clinical trials on board HMS Salisbury on 20 May 1747.

In those times, scurvy was a huge threat for navies. Indeed, it caused more deaths amongst British sailors than French and Spanish forces combined. We now know that scurvy is caused by vitamin C deficiency, but vitamins were then unknown.

Lind thought scurvy was caused by “putrefaction of the body” and that that could potentially be cured through the introduction of acids. He therefore recruited a dozen men with scurvy for a “fair test.”
(his informed consent process would… not satisfy modern day requirements.)

Without telling them who was getting what Lind allocated two men to each of six different daily treatments for a fortnight.

The six treatments they got (hold on to your hats) were:

- 1.1 litres cider (these subjects did not complain about their allocation)
- 25 ml, er, dilute sulphuric acid
- 18 ml vinegar three times a day
- 1/2 pint sea water
- 2 oranges & 1 lemon for 6 days (supplies ran out)
- a paste of garlic, mustard seed, radish root & gum myrrh

As you’ve already guessed, those who got the citrus fruits experienced “the most sudden and good visible effects.” Even though they ran out of fruit, one of those sailor was fit for duty and the other was almost recovered.

It took time for the lessons to be accepted, but in due course lemon juice was issued routinely to all sailors in the British fleet.

Lind is recognised as the man who pioneered comparing like with like, & his trial’s design informed future clinical trials.

Lind was made Knight Commander of the Order of the Bath & his name is engraved in stone on the frieze of the London School of Hygiene & Tropical Medicine.
(His son, also James, was a successful captain in the Royal Navy in his own right, knighted after the Battle of Vizagapatam.)

Anyway, from that time on, we have demonstrated over the decades a constancy of faith and practice in clinical trials. This discipline has been a major factor in the successes that we have seen fighting coronavirus.

So spare a thought this 20 May for those who led the way some 274 years ago to the discipline that is freeing us from lockdown today.

#CTD2021