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There’s science… and then there might be policy change…
  1. C Ronny Cheung1,2,
  2. Nick Brown3,4
  1. 1 General Paediatrics, Evelina London Children's Hospital, London, UK
  2. 2 Institute for Women & Children's Health, School of Life Sciences, King's College London, London, UK
  3. 3 Department of Women's and Children's Health, International Child Health and Nutrition, Uppsala University, Uppsala, Sweden
  4. 4 Department of Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
  1. Correspondence to Dr C Ronny Cheung, General Paediatrics, Evelina London Children's Hospital, London, UK; ronny.cheung{at}

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Naval diet

The astuteness of the naval physician James Lind in the 1740s led him to postulate that the remarkably high incidence (approaching 25%) of scurvy in crew members might be caused by a dietary deficiency. He set out to test this in a (non-randomised) trial aboard the ‘Salisbury’. Twelve sailors afflicted with scurvy were allocated to receive various promising interventions: but only the two sailors offered daily portions of citrus fruit showed any significant recovery.

He noted:

… (citrus) has the advantages, when newly made, to be extremely palatable… …it is a very nourishing liquor, well adapted for scorbutic patients 1

The initial response? None: both the naval and medical authorities were unconvinced and baulked at recommending a rethink in off-shore diet. The years that followed resembled a Machiavellian drama, policy ultimately changing some 70 years later—20 years after Lind’s death. By this time, ironically, prophylactic citrus use had already become the norm in the wake of overwhelming observational evidence.

Bad water

In 1849, John Snow first postulated that London’s infamous cholera epidemics might be related to contaminated water supplies.2 The response? Precisely none. A denial from the government and, apart from the pronouncement by a prominent cleric that the epidemic was ‘God’s will’, it caused no more than a ripple. It was not until 1854, some 5 years after Snow’s initial hypothesis was published, that the celebrated ‘Eureka’ moment in this story, the notorious Broad Street pump episode, occurred: the …

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

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