But no one could definitely say what was true and what was bunk

From The Illustrious Dead by Stephan Talty, page 54.

Describing the emergence of the scientific method in the field of health.

But no one could definitely say what was true and what was bunk.

One physician had attempted to change that. On May 25, 1747, twenty-two years before Napoleon's birth, an experiment took place on board the Royal Navy warship Salisbury that would change the course of medicine.

The doctor's name was James Lind, and he was a Royal Navy surgeon and a specialist in diseases that affected mariners. Just thirty-one, the Scottish-born doctor had sailed all over the world as a surgeon's mate, watching men die from typhus and scurvy from the west coast of Africa to the ports of Jamaica. He knew that the two maladies killed far more sailors than the king's enemies ever managed to. Lind would do remarkable work in the understanding of both.

Lind's 1747 experiment looked at scurvy. Twelve sailors who had the illness were divided into six groups. The accommodations and diet of all the sailors were identical, but each received a different remedy: one group received cider; one got seawater; another, "elixir of vitriol"; the fifth group, two oranges and a lemon; and the sixth, a mix of spices and barley water. It was the first documented clinical trial in medical history.

"I shall propose nothing dictated merely from theory," wrote Lind. "But shall confirm all by experience and facts, the surest and most unerring guides." This in itself was revolutionary, in an age when so much superstition and ancient theory overlay the world of medicine. When the sailors who received the citrus recovered completely, and the others did not, Lind had proved that orange and lemon juice was the true and universal corrective for the disease. He had created a blind test whose results were irrefutable.

It wasn't the oranges and the lemons that constituted the breakthrough, as using citrus had been one of the folk remedies against scurvy for well over a century. And, in fact, Lind didn't propose that scurvy was a deficiency disease caused by lack of a mineral (vitamin C, as it turned out) contained in the fruit. He thought that moist air blocked the pores in scurvy patients, and that lemon juice helped toxins escape the body through the skin. But he didn't need to know why the cure worked so long as he knew that it did. This is what the blind test proved. He had invented a way of evaluating medical knowledge.

When it came to the other great killer of mariners, typhus, Lind made signal contribution in a 1763 paper. The Royal Navy at the time took anybody for its ranks, often by force: slums, criminal courts, and taverns were swept for new recruits, who often came to the ships infested with lice and bacteria. The surgeon recommended that the newcomers be sent to a receiving ship and quarantined there for a few weeks to see if any diseases revealed themselves. They were given hot baths, and their old clothes were thrown away and a fresh set provided. By the time the men went on board their new ships, the sick had been culled from their ranks.

The British Admiralty didn't implement the typhus-defeating quarantine until 1781 and didn't fully provide an allotment of citrus until the 1790s, but when these measures were implemented piecemeal, the results were astonishing. In the months before the 1795 Battle of Quiberon, Lind instructed that provision ships carrying fresh vegetables and citrus fruits be ferried to the twenty-three ships of the line blockading French Ports. On the day of battle, out of 14,000 men, only about 20 were listed as sick and unfit for duty, an unheard-of number for an eighteenth-century fleet. One of Lind's biographers estimated that his recommendations added the equivalent of six warships to the British fleet that day, in which the British decimated the French. The Royal Navy's policy of blockading ports, so devastating to Napoleon's plans for defeating the English commercially, would have been unthinkable had scurvy or typhus been allowed to ravage its crews.

Taking Lind's warning about noxious air seriously, British captains paid attention to the cleanliness of their ships, regularly airing them out and scouring the bedding and sailors' clothing. The incidence of typhus in the Royal Navy dropped dramatically. Lind remarked that for the first time in history, sailors "enjoy a better state of health upon a watery element, than it can well be imagined so great a number of people would enjoy, on the most healthful spot of ground in the world."

The navy's procedures proved that a large military institution could keep infectious disease at bay indefinitely. In a sense, typhus had been "cured." But there were many times when the mystery of typhus was believed to be solved; in fact, it was "solved" over and over again, but the insight kept slipping away.

Why didn't Lind's insight hold? Why didn't Dr. Larrey and his colleagues adopt Lind's protocols for preventing typhus? And why, at the very least, didn't they use his idea of the blind test to evaluate different treatments and prevention methods?

Simply put, because the breakthrough Lind ushered in - the idea of an empirical test that measured the effects of disease on all men uniformly - went so radically against the reigning ideas of the time: specificity and miasmism. The blind test entered a different mental and theoretical world than exists today. Medicine was not the uniform place we know, where s discovery in Berlin or California is tested, reviewed, published, put through clinical trials, and then adopted worldwide. Lind couldn't with one stroke realign centuries of though on the humors, on the origins of different fevers and the effects of weather. Medicine was a spooky art, and Lind's insights would need many decades, and further breakthroughs in the areas of disease theory, to change history.