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Previous Volume 347:692 August 29, 2002 Number 9 Next

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To the Editor: Boylston (April 25 issue)¹ reminds us that clinical trials have been around a long time and that they are available to all, and he cites William Watson's contribution to the understanding of smallpox in 1767 as perhaps the first. But I offer James Lind's A Treatise of the Scurvy,² published in 1753, as an even earlier report of a clinical trial. It was simple and controlled and was not burdened by P values, review boards, or other impediments of modern science. Lind's two oranges and one lemon saved lives on his ship and soon saved lives the world over. He reports:

On the 20th of May 1747 I took twelve patients in the scurvy on board the Salisbury at sea. Their cases were as similar as I could have them . . . and had one diet common to all. Two of these were ordered each a quart of cyder a day. Two others took 25 gutts of elixir vitriol [sulfuric acid] three times a day. . . . Two others took two spoonfuls of vinegar three times a day. . . . Two of the worst patients . . . were put under a course of sea water. Of this they drank half a pint every day. . . . The two remaining patients took the bigness of a nutmeg three times a day of an electuray of garlic, mustard seed, rad. raphan, balsam of Peru and gum myrrh. . . . The consequence was that the most sudden and visible good effects were perceived from the use of oranges and lemons, one of those who had taken them being at the end of six days, fit four [sic] duty.²

Frank J. Lepreau, M.D.
74 Old Harbor Rd.
Westport, MA 02790

References

1. Boylston AW. Clinical investigation of smallpox in 1767. N Engl J Med 2002;346:1326-1328. [Free Full Text]
2. Lind J. 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. London: A. Millar, 1753.

To the Editor: Dr. Lepreau prefers Lind; I prefer Watson, for the reasons outlined in the last paragraph of my article. Lind clearly understood the principles of controlled trials, as did Boylston and Jurin before him. Unfortunately, the Royal Navy, Lind's employer, did not appreciate the importance of his findings. Citrus supplements did not become mandatory on His Majesty's ships until 1795.

Arthur W. Boylston, M.D.
University of Leeds
Leeds LS9 7TF, United Kingdom
boylston{at}btinternet.com

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Related Letters:

Ancient Clinical Trials
Lewis E. J., Lepreau F. J.
Extract | Full Text | PDF  
N Engl J Med 2003; 348:83-84, Jan 2, 2003. Correspondence

This article has been cited by other articles:

• Lewis, E. J., Lepreau, F. J. (2003). Ancient Clinical Trials. NEJM 348: 83-84 [Full Text]