At Home - Bill Bryson [90]
In roughly the same period, James Lind, a naval surgeon, conducted a more scientifically rigorous (and personally less risky) experiment by finding twelve sailors who had scurvy already, dividing them into pairs, and giving each pair a different putative elixir—vinegar to one, garlic and mustard to another, oranges and lemons to a third, and so on. Five of the groups showed no improvement, but the pair given oranges and lemons made a swift and total recovery. Amazingly, Lind decided to ignore the significance of the result and doggedly stuck with his personal belief that scurvy was caused by incompletely digested food building up toxins within the body.
It fell to the great Captain James Cook to get matters onto the right course. On his circumnavigation of the globe in 1768–71, Captain Cook packed a range of antiscorbutics to experiment on, including thirty gallons of carrot marmalade and a hundred pounds of sauerkraut for every crew member. Not one person died from scurvy on his voyage—a miracle that made him as much a national hero as his discovery of Australia or any of his other many achievements on that epic undertaking. The Royal Society, Britain’s premier scientific institution, was so impressed that it awarded him the Copley Medal, its highest distinction. The British navy itself was not so quick, alas. Even in the face of all the evidence, it procrastinated for another generation before finally providing citrus juice to sailors as a matter of routine.*
The realization that an inadequate diet caused not only scurvy but a range of common diseases was remarkably slow to become established. Not until 1897 did a Dutch physician named Christiaan Eijkman, working in Java, notice that people who ate whole-grain rice didn’t get beriberi, a debilitating nerve disease, while people who ate polished rice very often did. Clearly some thing or things were present in some foods, and missing in others, and served as a determinant of well-being. It was the beginning of an understanding of “deficiency disease,” as it was known, and it won Eijkman the Nobel Prize in medicine even though he had no idea what these active agents were. The real breakthrough came in 1912, when Casimir Funk, a Polish biochemist working at the Lister Institute in London, isolated thiamine, or vitamin B1, as it is now more generally known. Realizing it was part of a family of molecules, he combined the terms vital and amines to make the new word vitamines. Although Funk was right about the vital part, it turned out that only some of the vitamines were amines (that is to say, nitrogen-bearing), and so the name was changed to vitamins to make it “less emphatically inaccurate,” in Anthony Smith’s nice phrase.
Funk also asserted that there was a direct correlation between a deficiency of specific amines and the onset of certain diseases—scurvy, pellagra, and rickets in particular. This was a huge insight and had the potential to save millions of shattered lives, but unfortunately it wasn’t heeded. The leading medical textbook of the day continued to insist that scurvy was caused by any number of factors—“insanitary surroundings, overwork, mental depression and exposure to cold and damp” were the principal ones its authors thought worth listing—and only marginally by dietary deficiency. Worse still, in 1917 America’s leading nutritionist, E. V. McCollum of the University of Wisconsin—the very man who coined the terms vitamin A and B—declared that scurvy was not in fact a dietary deficiency disease at all, but was caused by constipation.
Finally in 1939, a Harvard Medical School surgeon