How the British defeated Napoleon with citrus fruit.
Everyone knows that Britain’s conclusive victory over Napoleon was at Waterloo.
The story of that day – the squares of infantry repulsing cavalry charges, the Imperial Guard retreating under murderous musket fire delivered by a red line of soliders, the just-in-time arrival of Field Marshal Blücher’s Prussian army – is one of excitement, horror and heroism. However, Britain’s biggest contribution to Napoleon’s defeat was much less romantic. It involved the first randomised controlled trial.
This article is the opinion of the author Andrew George, Brunel University London and not necessarily that of the UK Defence Journal. If you would like to submit your own article on this topic or any other, please see our submission guidelines.
Without the trial, the years of blockades of French ports by the Royal Navy would not have been practical. The blockade kept the French fleet confined, preventing Napoleon from invading Britain. It gave the British freedom to trade across the world, helping finance not only the British but other European armies and nations.
It threatened France’s trade and economy, which forced Napoleon to order the continental system: a Europe-wide embargo against trade with Britain. He invaded both Spain and Russia to enforce this boycott – actions that ultimately brought about his downfall.
Blockade work was often tedious, always dangerous. Navy frigates, keeping close to the shore, would watch the French ports, using signal ships to notify the main fleet over the horizon if the French were to sail. The ships (and sailors) had to maintain station for months without relief. In 1804-5, Admiral Horatio Nelson spent ten days short of two years on HMS Victory, never stepping on dry ground, most of the time enforcing the blockade of Toulon.
The scourge of scurvy
The ability of the sailors of the Royal Navy to operate for such long periods at sea was remarkable. For most of the 18th century, ships could only stay at sea for relatively short periods (six to eight weeks), without the sailors developing scurvy.
Victims would feel weak, bleed at the gums, old wounds would break down and they would get infections. In the later stages of scurvy, sailors would have hallucinations and could go blind before dying.
More sailors died from scurvy than enemy action. In 1744, Commodore George Anson of the Royal Navy returned from a nearly four-year circumnavigation of the globe with just 145 men left from the original complement of 1,955. Four died as a result of enemy action. Most of the rest died from scurvy.
This was not unusual – 184,889 sailors were enlisted into the Royal Navy during the Seven Years’ War and 133,708 died or were lost due to sickness, again mostly scurvy, and just 1,512 died in combat. There is no way that the navy could have maintained the blockade of France for so long without preventing this disease.
A breakthrough experiment
The cause of scurvy was unknown, and many cures were proposed. The Portuguese explorer, Vasco da Gama, made his men use urine as a mouthwash, an intervention that did not prevent nearly two-thirds of them dying from scurvy.
The breakthrough experiment – the first randomised controlled trial – was carried out by Scottish Royal Navy surgeon James Lind in 1747. After eight weeks at sea on HMS Salisbury, there was an outbreak of scurvy. He took 12 sailors with the disease and, ensuring the cases were as similar to each other as possible, he put them together in the same part of the ship and gave them the same diet.
He divided them into six groups and gave each group a different treatment. For example, one group was given a quart of cider every day, another had to drink half a pint of seawater. Two sailors were given two oranges and a lemon daily. After six days, one recovered and returned to duty, the other was deemed well enough to nurse the remaining ten patients.
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In 1753, Lind wrote a treatise describing this crucial experiment. While others had previously used citrus fruit to treat scurvy, this trial proved its effectiveness.
We now know that scurvy is caused by lack of vitamin C or ascorbic acid, present in large amounts in citrus fruit. In the Napoleonic wars, all British sailors were issued with lemon juice or other fruit. In 1804, 50,000 gallons were purchased by the Royal Navy. The effect was remarkable. In 1809, the Naval Hospital, at Haslar near Portsmouth, did not see a single case of scurvy.
Lind’s controlled trial was essential for the defeat of Napoleon. Without it, the blockade could not have been sustained, Napoleon’s fleet could have disrupted British trade, and, more importantly, allowed the emperor to invade Britain.
Delayed recognition
The story isn’t so simple, however. It involved big admiralty egos and political infighting. Lind’s treatise was largely ignored when it was published. It took decades of work by others – notably Thomas Trotter and Gilbert Blane – to fight for the adoption of lemon juice by the navy.
It was not until 1795, after Lind’s death, that his findings were fully adopted. Other countries were also slow to follow the British example. Even though Americans knew that British sailors drank lemon juice (the origin of the slang-term “limey”), scurvy remained a major problem for soldiers in the American Civil War.
One lesson is that it is not enough to do good science and assume any finding will be instantly adopted. There are many barriers to adoption and people like Blane and Trotter who fight and overcome those barriers are as important to the story as those, like Lind, who make the original discovery.
Andrew George, Deputy Vice-Chancellor, Brunel University London. This article is republished from The Conversation under a Creative Commons license. Read the original article.
We are humans so barriers will always be there.
Many people forget that wars have been won and lost because of how effective or not nations and armed forces were at combating disease.whole field armies of died or been destroyed because of the effects of disease..as have nations ability to raise armies…
Public health and health system developments were as much about nations being able to raise large field armies as anything else.
ignoring those conflicts in which one side decided to use biological warfare… and biological warfare is very very old…the first recorded biological warfare was recorded in 1500bc, 3500 years ago in which people infected with the plague would be driven into an opposition armies lines..another example that every knows is in 1346 at the siege of kaffa, when the besieging army of tartars fell to disease and as their army disintegrated as a last act they fired the bodies of their army into the besieged city so it also fell to disease.
if we look at the pre 20c wars disease was just about the single biggest factor on survival of a field army and winning or loosing a war:
Peninsular wars 70% of combatants died of disease
crimean war 55% of British combatants died of disease
American civil war: 56% of combatants died of disease
First and second Boar war 66% of British combatants died of disease…
If we look at the First World War, a war in which we actually new about disease management and public health, we knew what diseases to expect in Europe and the British army ( and many others really) marched to war without the public health experts and medical professionals to protect them from decimation..meaning war was very much sculpted by disease as the war itself overwhelmed nations and armies ability to manage disease…when the British army entered the war it had 10 bacteriologists and as a nation at best we could call on 5000 civilian medical practitioners…when thee US entered the war it had 26,000 drs on its medical reserve.
Because of this lack of medical services..all the British army could do was treat wounds and it forget about the public health element of warfare..this came back to bit the British army as by late 1915 its combat effectiveness was significantly impacted by an outbreak of treachfevor ( a nasty non fatal but debilitating disease) it was finally discovered it was a bacterial infection spreed by lice..but not before it had infected 800,000 solders or 97% of allied forces..74,000 British troops were incapacitated by trenchfoot another microbial disease. This is before the fatal and more serious diseases even come into play…the Macedonian campaign..essentially for three years the French, British and German armies spent the entire campaign hospitalised with disease. One french general sent a telegram to his command saying “ regrets but my entire army is in hospital with Malaria”..it’s estimated in that campaign the British army lost 2million man days to hospitalisation.
in regards to deaths amongst combatants in WW1 the estimate is 10 million or so..of those the estimate is 4 million died of disease…or 40% down on the previous century..but this was not really a victory of managing disease instead it showed at machinguns and modern artillery were just more effective at killing people than the weapons of the previous century…this can truly be seen in the wider population as the inability of nations to manage disease during war caused catastrophic casualties…1918 H1N1 started to impact troops and populations in 1916..fuelled by war it ended up killing 50 million people in 1918-19….TB rates in both the UK and Germany had increased by around 30% between 1914 and 1918..3 million Europeans ended up dying of typhus….indeed it was the mounting burden of disease that shorted WW1.
when we look at WW2 the US forces hospital admission rates give you a good indication of the balance of disease vs battlefield injury…during WW2 the U.S. forces had 17.7 million admissions for medical treatment related disease and harm not related battle field injuries and only 700,000ish related to battlefield injuries…
Disease is the ultimate killer, if you fail to manage it in war, in either your armed forces or your civilian population then you will risk losing that war. It’s why health systems are a profoundly important part of national security and anyone who thinks they are not has not studied the history of war very well.
So more US soldiers were hostipalised in WW2 than the entire US military of the time (Navy, USAAF & Army). I think your numbers are out.
These were episodes of care visits to the hospital..due to none combat related illness or disease ( remember people would have multiple problems and diseases over their wartime service. The figures come directly from a U.S. army paper published in the 1950s when they audited every service persons medical records for treatment….one person would not get the shits or the flu once..they would get it a lot.
True not true. The history of scurvy and its cure was found, lost found and lost again. In 1497 de Gamma noticed the impact of citrus fruit on scurvy, yet he did not put 2+2 together when in 1499 lost most of his crew to scurvy on a voyage to India. In England Thomas Cavandish in 1585 left the country with 3 ships and 123 men on route to the Pacific. He stopped of in West Africa to pick up lemons as learnt from his predessesors. He had no scurvy on his ships. John Woodall, surgeon general of the East India Company in the 17th century noted the effect of citrus notably lemons on scurvy patients. Yet, no one put 2+2 together.
So it can be seen that the cure was found, lost, refound but unofficial, lost, refound not official and then became official in the late 18th early 19th century. The reduction in seamen lost meant sometimes winning a battle rather than loosing. If only the hypocratic medical persons stopped believing in the humoral theories of disease. Hundred of thousands of mens lives would have been saved if it was not for the doctors of the time.
Even Lind could not get past his humoral theory when he in his report said in his Treatise on the Scurvy 1753 that it was a confusing result.
Napoleon was right an Army marches on its stomach. That is the main or most important issue with front line combat forces in the field be that army, navy or airforce, supplies. Be that spare parts for the equipment, kit for the folks on the ground and food to keep them fit, healthy and happy. A good meal soon turns bad moral around.
For all of us older folks here that served, we all remember the ten man ration pack, no fresh fruit, veg and when we got back to barracks a raid on the kitchen fruit salad ot the everything in the pot stew. Or a bad Chrismas dinner served by the officers, (food fight anyone, had that happen)