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James Lind: The Visionary Behind Modern Clinical Trials

Clinical Research

James Lind: The Visionary Behind Modern Clinical Trials

The history of clinical trials has amazed many. The journey of clinical trials originated from the first recorded clinical trial from biblical era where Daniel tested the effects of a diet of pulses rather than meat. History was again inked with an iconic event when a surgeon from Edinburgh Dr. James Lind (1716-94) investigated the best treatment for scurvy and was probably the first person to have conducted a controlled clinical trial of the modern era.

James Lind is considered the first physician and father of clinical research who conducted a controlled clinical trial of the modern era. Dr. Lind (1716-94), a surgeon, serving on a ship, was appalled with high mortality from scurvy amongst the sailors. As a preventive measure he planned a comparative trial which resulted in most promising cure for scurvy. His description of the trial stated below covers the most essential elements of a controlled trial. His vision resulted in revolutionizing the research arena.

Lind describes “On the 20th of May 1747, I selected twelve patients in the scurvy, on board the Salisbury at sea. Their cases were as similar as I could have them. They all in general had putrid gums, the spots and lassitude, with weakness of the knees. They lay together in one place, being a proper apartment for the sick in the fore-hold; and had one diet common to all, viz. water gruel sweetened with sugar in the morning; fresh mutton-broth often times for dinner; at other times light puddings, boiled biscuit with sugar, etc., and for supper, barley and raisins, rice and currants, sago and wine or the like. Two were ordered each a quart of cyder a day. Two others took twenty-five drops of elixir vitriol three times a day … Two others took two spoonfuls of vinegar three times a day … Two of the worst patients were put on a course of sea-water … Two others had each two oranges and one lemon given them every day … The two remaining patients, took … an electary recommended by a hospital surgeon … 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 for duty … The other was the best recovered of any in his condition; and … was appointed to attend the rest of the sick. Next to the oranges, I thought the cyder had the best effects …” (the very same description of Dr James Lind’s appears in “Treatise on Scurvy” which was published in Edinburgh in 1753)

Dr. Lind wrote the Treatise in 1953, while he was resident in Edinburgh and a Fellow of the Royal College of Physicians. This Treatise stressed the description of his conducted controlled trial with results showing that oranges and lemons were dramatically better in treating scurvy. The highlight was of this Treatise was a systematic review of previous literature on scurvy.

This very vision of having a systematic review that depict the effects of healthcare interventions when unreliable, should be complimented with research in the form of controlled trials was way ahead of his times.

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