Part II Jeffrey Bland Bastyr Lecture June 2009
Jeffrey Bland uses scurvy to show why scientific breakthroughs take decades to reach patients. James Cook cut scurvy deaths on his ships by feeding sailors citrus, but the medical establishment resisted the evidence for years because it conflicted with existing theory.
Chapters
The future about an illumination, about an idea. Now, you're going to have to judge as I go through this whether you think this is like a 10 watt bulb or a laser or a searchlight, you know, how bright is this light and what impact could it have on improving health if we would have it ready to the whole crime. So the past really starts very interesting. And being a voter, as one of my hobbies, our family hobby, I've been reading a lot of, you know, Captain Cook and George Vancouver's logs and all those things. And this story of scurvy is an unbelievably fascinating story. I could easily spend two hours talking about scurvy because scurvy as a disease is a metaphor and how it was ultimately discovered as a vitamin C deficiency is a metaphor to everything we're going through right now with eliminated crown as it pertains to this aspect of medicine. So I'll try to just summarize without taking two hours, but maybe two minutes, why I think this is so important. Scurvy has caused the death of more people on the oceans than all other causes of death in time together. By far, it has exceeded all the combined deaths of shipwrecks and killed in battle and capsizing. And all these things pale in comparison to the number of deaths that occurred from scurvy. In fact, interestingly enough, in the 18th century in Britain. Now you think of 18th century, that's not that really that long. You open, when you think about it, in a couple hundred years ago, three, three hundred years ago, you think of these, these sailors that were in the channel between France and England. Now, remember, they were not really friendly. Maybe they're not so friendly even today, but they were a lot less friendly then. And so there was constant battles going on between France and England. Both sides had fleets that would constantly patrol that channel, in that channel, because they would now stay out with the bigger ships that they would be able to develop. By the way, it would take between 200 and 300 trees to make a ship. This to give you an idea of the number of amount of wood that would go into these ships in that channel. Because these guys were at sea for some time, even though they were often in the sight of land, 47% of the men had scurvy within something like 10 to 12 weeks on shipboard. So the implications of this, not just those that died, but in terms of the battles that were fought and lost by the, the crew being having scrubbing. In fact, we won supposedly the great ship battle with, when I say We, I really mean the British here, I guess won the battle with the French and Spanish because their armadas, which were bigger and more really well equipped, more cannons, their crews were so yellow scurvy by the time, because they were decal for so many days that by the time they got to battle when the winds came up, because you didn't have motors to get people to engage, the wind came up. Finally air crews had such scurvy, whereas the British sailors did not because they already started to introduce some of these principles. This is in the early 19th century, I'm not talking about during the Poland stuff. So scurvy has been a big deal. Now why is this very interesting? Because it turned out that there was one person after the first clinical trial in the Western literature ever reported. And you know what that is, right? The first human clinical trial in western literature is supposedly this very small trial of Robert Lynn, the Scottish surgeon in the British Navy, who decided to break up a crew in the boat that he was the surgeon on into little cohorts and do a semi controlled study to see if hygiene and sanitation and nutrition played a role in this dreaded disease. And was able to find that the group that got certain kinds of hygiene, nutrition, sanitation had a. They really didn't get this group. Now you might say how well was his study powered, right? Did it meet statistical significance? Was it a PO5 or better? And the answer is he had 15 sailors in each group, 15. This wouldn't even get to the first level of referee of a tertiary journal today. But from that ultimately he wrote his treatises. When he finally retired, he was given the chief of staff responsibility for the largest hospital in Britain. And he wrote this up and then he became a member of the Royal Society and very, very esteemed for this discovery. And did it get it introduced into the British Navy? No, it did not. Did not get introduced into British navy. But he had a call, a younger colleague that was coming up the ranks and this, this colleague was named James Cook. James Cook was a very smart guy, wasn't from a, you know, a well down family, but he was very, very good. He already gone in as a first mate and navigator to, to France and to, to Quebec and in the French northeast to engage in battle there. And he'd been very successful. And so when he came back he was given the opportunity to have this big scientific mission, right, to go and look at the lunar eclipse that they were going to actually measure on Tahiti. And so he had to take this transect and go into the Pacific Ocean. With these ships. So clearly his men were all going to get scurvy. Now, just to give you an idea, Anson, who was the senior Lord Anson, who was the head of the British Navy and later became the head of the Royal Society, had previously taken 3,000 sailors and three ships. Now, that's a big number of people and gone to the Pacific Ocean to fight the Spanish and for land around South America. And when he returned, do you know how many men returned? Out of over 2,000 men, 350. And how did they all die? Scurvy. There were hardly anybody killed in battle. In fact, they couldn't even get a ship to engage at that. We couldn't even find them. But it was such a tragedy. And they said, we've got to do something about scurvy. Now, this is after Robert Lynnon made his discoveries. So then Cook said, well, I'm going to introduce these concepts because I can't afford to lose all my sailors going way out there in the Pacific on this exploration. So in three voyages, how many sailors died? In all of Cook's voices by scrutiny, the answer is one. And that was problematic according to the records. So basically he didn't have skirting. Now, how did he do it? He implemented these concepts, right? Now you would say, well, that's a proof of concept for sure. Even though he died in Hawaii, certainly people came back with this idea and must have convinced everybody that whatever this is in these fruits and vegetables, they either thought it was sauerkraut or that it was citrus. And they made this kind of concentrate of citrus fruits. It must be something in that that does it. So did it get introduced? No, it didn't get introduced until a third gentleman came along who is now more. Well, from a higher family stock. He was another surgeon in the British Navy. He was doing it kind of to gain his pedigree. And he went and he was a student of Brock and a student of Lynn. And so he introduced the concepts. And finally, the third time around, now, suddenly, because of his station and his communication coming from the right social stock, the concept stuck and other ship captains started using this. And then finally with George Vancouver, which is now the 18th, early 1800s, 19th century, finally the British Navy, 37 years later, says, this is standard affair for our sailors to start using this intervention. Now, during that period of time, tens of thousands of men or died reflected by scurvy, from the first observation of Lynn until the final incorporation into the British navy. And it was that then ultimately led the British navy to be successful over the French and Spanish commander. So what I'm saying is, how bright does the light have to be? Right? You get my metaphor. To drive these concepts through to create change when it seems so reasonable. Because you would say, well, what's the resistance? The resistance then was virtually identical to the resistance we have today. Just kind of, you know, maybe a more modern language today. But it was eugenic arguments. It was that these were sailors and they were a poor social class and they had bad jeans. They had know about genes, but they knew about inheritance because of Gregor Mendel. And so basically these people were just kind of low class people. So they probably get these things anyway. Secondly, it's because of bad air, right? And there was a huge amount of discussion about air because the dominant theme at that time was still the four humors from Galenistic medicine. Moist, you know, warm, hot and cold, those four things. So it was all about balancing the humor. So you had the black and you had the yellow and you had the. And all this stuff. So that they were just driving all this into that model saying, well, the humor must not be balanced correctly. So you have all these competing theories that are the dominant thoughts of the day.
