Chapter II: Part 2

The _periosteum_ is exquisitely sensible, and is the safe-guard to the substance of the bone, which is delicately tender notwithstanding it is not so sensible as the skin that covers it; insomuch that it will become _carious_ on the least exposure to the air, or the attack of any foreign body of matter whatever; whence in wounds and fractures in general, great attention should be paid to the substance of the bone, being very subject to become _carious_ and to _exfoliation_, which is of the greatest consequence; but of this I shall say more in another place.

The marrow is principally designed for the nourishment of the bones; which is evident from its being plentiest in young people, when the bones are strongest; and that when it is deficient, they become brittle, and lose their tenacity.

The marrow is contained in a cellular substance, partly in vesicles of a nervous texture, and partly bony cells. At the ends of the long bones the texture is more spungy than in the middle, where the cavity is less, but the substance is most compact. Though anatomically there is no perceptible circulation in the bones, yet, that a circulation is actually existing, is evident, from a liquor oozing out from the ends of a fractured bone in the living animal; by which a fractured bone again unites, and this is called the _callus_; and whilst in its liquid state, resembles the white of an egg, which gradually ossifies, and becomes as hard as the main substance of the bone.

The number of bones differ somewhat in various subjects; ordinarily they amount to two hundred and fifty-two: In the head sixty-three; in the trunk seventy; in the arms and hands sixty; and in the legs and feet sixty.

As the bones are the support of the animal fabric, I have inserted in the next page, a catalogue of the human skeleton, which occasionally may be referred to:

_A Skeleton of the Human Body._

BONES in the HEAD.
The SKULL.
_The Forehead._

Os Frontis 1

_The Hindhead._

Os Occipitis 1

_The Sides of the Head._

Ossa Parietalia 2

_The Temples._

Ossa Temporum 2

_The Basis of the Skull._

Os Ethmoides 1
Os Sphenoides 1

_The Bones of Hearing._

Ossicula 8
Auditus

The FACE.
_The Upper-Jaw._

Ossa Malæ 2
——Maxillare 2
——Unguis 2
——Nasi 2
——Palati 2
Os Vomer 1

_The Under-Jaw._

Maxilla 1
Inferior

_The Teeth._

Dentes Incisivi 8
——Canini 4
——Molares 20

_The Tongue-Bone._

Os Hyoides, is 3
composed of

—

63

BONES in the TRUNK.
_The Spine._

Vertebræ 7
Cervicis

——Dorsi 12

——Lumborum 5

_The Ribs._

Costæ Vera 14
——Spuria 10

_The Shoulders._

Scapula 2
Claviculæ 2

_The Hip and Bason._

Os Sacrum, is 6
composed of

Os Coxygis, is 3
composed of

Ossa
Innomenata,
composed of

——Ischium 2

——Ilium 2

——Pubis 2

_The Breast._

Sternum, is 3
composed of

—

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UPPER EXTREMITIES.
_The Upper Arm._

Os Humerus 1

_The Under Arm._

Ulna 1
Radius 1

_The Wrist._

Ossa Carpi 8

_The Hand._

Ossa Metacarpi 4

_The Fingers._

Ossa Digitorum 15
—
30

UNDER EXTREMITIES.
_The Thigh._

Os Femoris 1

_The Knee Pan._

Patella 1

_The Leg._

Tibia 1
Fibula 1

_Ancle._

Ossa Tarsi 7

_Foot._

Ossa Metatarsi 5

_Toes._

Digitorum 14
—
30

The connection of the bones are in various ways; those connections that are designed for rest, are by close contact of parts, and are called _sutures_ or _seams_; such are the bones of the skull with themselves and the face. Those connections which are designed for motion are called _articulation_. Some of the articulations have but an obscure motion, as the ribs with the back-bone, and the back with itself, &c. Others have an angular motion, as the elbows and knees; and others again have an universal motion, as the arm-bone with the shoulder, and the thigh bone with the hip. The _sutures_, and such connections as have no motion, are merely dovetailed into one another in close connection; but those articulations that are designed for motion are connected by cartilages, either in close contact, or so as to move slippery over one another.

The ligaments are those tough tendinous parts, by which the articulations designed for motion are joined together; at some parts they cover the joints only, and at others, they are immediately fastened to each other, besides the external coverings; those ligaments are very strong and elastic, and have a close connection with the nerves that pass by them.

The surrounding ligaments of all moveable joints, form a _capsular-bag_, which contains a slippery liquor, called _synovia_, that lubricates the ends of the bones covered with _cartilages_, that they may move with ease and agility over one another.

_Muscles_ are the fleshy parts on the human body, appointed for motion. They are a composition of arteries, veins, nerves, and tendons.

Muscles are generally divided into two kinds; those for necessary or involuntary motion, and those for voluntary. Some again are fastened at each end to some of the bones at their extremity, and contract themselves in a straight direction; others again are annular, or in the form of a ring; and by this manner open and shut. The first kind are generally divided into three parts, the head, belly, and tail. The whole muscle begins and ends in a tendon, by which it is fastened to the part it is designed to move; which, when the belly of the muscle contracts itself, must consequently draw both bones nearer together, fastened to the head and tail; and thus performs the motion. Some of these muscles act in consort, and others in opposition to each other.

The tendons are the principal parts of the muscle; and that part thereof, as before observed, which is fastened in the bones, namely, at the head and tail of the muscle, and is the chord, as it were, by which the limb is brought into motion.

A tendon is a hard, substantial, flexible, and elastic body, which, at the head of the muscle, is very compact; but as it enters the muscle, spreads its fibres over the whole body, gathers again at the tail, in as compact a manner as it began, and continues in this chord-like texture till it fastens itself at its appropriated place.[7]

Footnote 7:

It must be observed however, that tendons take on many various forms,
as different as the muscles; which would be too tedious here to
particularize.

The tendons and ligaments are of equal substance, and differ in nothing but their various uses; namely, the ligaments to connect the articulation; and the tendons, or the ends of the muscles, to give motion. The muscles are a composition of the tendinous fibres, plentifully intermixed with small ramifications of blood vessels; all which compose the fleshy part thereof. Hence, the tendons being white and hard, the muscles gradually grow softer and redder in the middle of them; and they verge gradually to become tendinous at the tail, the same as the head.

Hence, from the close texture of the tendons, they are very painful when wounded, or otherwise hurt; but as the muscles are softer and more pliable, their wounds and other accidents are of less consequence, and not so dangerous as the former.

The number of muscles are undetermined, for though the principal muscles are so distinct that they cannot be mistaken as to their form and use, yet there is so great a number of small ones, or so many of the great ones capable of being subdivided again, that anatomists have not, as yet, agreed about their number.

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SECT. VIII.

_Of the Urinary Organs and Genital Parts._

The _kidnies_, the _ureters_, the _bladder_, and the _urethra_, are the principal urinary organs. The kidnies receive two arteries called the _emulgent arteries_, from the great arterial trunk, called _aorta_, before described; they each send also two veins back again, accompanying the arteries to the _vena cava_. Whilst the blood is circulated in the kidnies, the urine is secreted in many small quantities, and carried from each kidney by a tendinous tube, the bigness generally of a small goose quill, called the _ureter_ to the bladder. The _ureters_ enter the bladder between its _lamillas_, so as not to admit of a return. Hence, a bladder in its natural position is both wind and water tight, and if reversed, is neither.

The bladder of urine is of a tendinous and nervous texture, and capable of great extension, but at the same time exquisitely sensible. The neck of the bladder is very muscular, and by this forms a _sphincter_, or annular muscle, by which the urine is retained; and as it is of a very sensible nature, this part is subject to inflammatory constrictions; great pain, and many evils have there been occasioned, either from venereal cases, or gravelous complaints.

From the neck of the bladder to the end of the _penis_, is the _urethra_; which canal serves for the emission of the urine, as well as that of the seed.

The whole is lined with a number of very little glans, to lubricate and protect the sensitive lining from the sharpness of the urine.

These are the urinary organs. We will in the next place, proceed to the organs of generation.

The _testicles_ are the principal instruments for forming the human seed; they are generally two in number. The testicles receive the blood, of which they secrete the seed, from the _aorta_, about the same parts, whence the emulgent arteries project. These arteries run down from the aorta to the testicles, in a very contorted and winding manner, accompanied by the veins which return back again from the testicles, and fix themselves in the ascending _vena cava_. These contorted and interwoven vessels are called the _spermatic vessels_, which carry the blood from the arteries in little quantities, and slowly return it again into the great vein.

Whilst the blood is circulated in the testicles, the seed is secreted in them; but as it is secreted, it is transported back again from thence by tubes, called _vasa deferentia_, towards the neck of the bladder, where there are two irregular bladder-like vessels, wherein the seed is contained, and kept for use, called the _vesiculæ seminales_.

In these seed bladders the seed is kept for use, till it is wanted. They are remarkably delicate and nervous; and when they are filled with seed, they stimulate all the organs of generation with a desire for venery.

The _penis_, or the manly member of generation, is partly covered with the common skin; the foremost part of which, that covers the glans, is called the _præpuce_. This _præpuce_ is tied underneath to the substance of the _penis_, by what is called the _frænum_.

The inner part of the penis is composed of two kinds of bodies, the _cavernous bodies_ of the _penis_, and the _cavernous body_ of the _urethra_. The first are bodies enveloped in their peculiar teguments, and make the greatest part of the _penis_. Each of these bodies takes its origin from the erecting muscle of the _penis_, which is near the _pubis_; through each of them goes an artery and a nerve, which spread themselves through these bodies.

These bodies are full of cavities, which have all a communication with one another. The cavernous body of the _urethra_ continues from the _bulb_, near the neck of the bladder all along to the end of the _penis_, and includes the _glans_, or the nut of the yard; and is much of the same substance with the former. At the back of the _penis_, goes along the large vein, called the _vena penis_, which spreads itself all along into numberless branches that connect themselves with the ramifications of the arteries throughout all the cavernous bodies; and from thence is caused the erection, as I shall presently describe. The _glans_, or the nut of the yard, is remarkably delicate and sensible, as being the seat of pleasure in coition; it is also of a cellular substance, and in one continuation with the cavernous body of the urethra.

Its sensation is greatly heightened by the _frænum_ being tied underneath, from the _præpuce_ to that part which keeps it, as it were, in an agreeable constriction when erect.

The penis is allowed two pair, and a single muscle. The first pair is the _erectores_, which take their origin from the fleshy protuberances of the _ischium_, and lose themselves in the cavernous body of the penis. The second pair of muscles is the _transversales_; these take their rise near the forementioned, and fasten themselves at the root of the penis. The fifth is the _accelerator_, or the odd muscle; this muscle takes its commencement from the cavernous body of the _urethra_, and grasps the whole penis, and adheres to the _sphincter_ of the anus; the muscles aid and assist each other in the erection of the penis, which happens in the following manner:

At the influx of the animal spirits, the _vena penis_, or the great vein in the penis is somewhat contracted, whence the blood is forced into the cavernous bodies of the penis and that of the urethra, as the reflux of the circulating blood from the arteries is hindered; hence, the cellulæ of the cavernous bodies are obliged to swell up and distend all the parts, and thus make the penis turgid and erect; when the penis is further titillated by the friction of coition, the parts become generally irritated to an agreeable constriction, whereby the seed rushes from the seed-bladders into the urethra, and is thus forcibly ejected in the time of ejaculation; then the whole fabric slackens, the constriction of the great vein relaxes, the blood regains its free circulation, and the penis becomes slack again.

These are the faint out-lines of the genital parts; but to have a full description and comprehension of the peculiar properties of the genitals of both sexes, and also the sacred act of generation, I recommend to a serious perusal of the anatomical and physiological description of the genital parts of both sexes, in my _Treatise on the Venereal Disease_, where they will find a full and satisfactory account.

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SECT. VIII.

_Of the Skin._

The whole human automaton is covered with a skin, the mechanism of which is not less curious than what we have already described.

It is a texture curiously interwoven with an infinite number of tendons, arteries, veins, nerves, and lymphatic vessels. The tendons form the net-work of the whole, and give it an elasticity, from whence it requires a muscular motion; and the rest add each their parts, as I shall hereafter describe.

The skin, universally over the whole body, is divided into three parts; but in most parts it is found to have four.

The external, is the _cuticula_, or scarf skin; this is a horny and insensible substance, formed by nature as a shelter for the next part of the skin, which is exceedingly sensible; on examination it appears to be a horny substance, and as it were, little scales continued from the immediate skin, which on any external injury, such as repeated friction, fire, scalding, or blistering, separates from the main skin. The next is the real skin, called _cutis_; This is strongly interwoven with tendinous and nervous fibres, interspersed with numberless ramifications of arteries, veins, and lymphatic vessels; whence it is not only exquisitely sensible, but elastic, and on the least injury, subject to bleed. On the external surface is a very thin _plexus_, called the _reticulare_; which has the tinge of the natural hue of the skin, and distinguishes the complexion of the _negro_, the _tawny_, and _white_, from each other.

The structure of the _cutis_ is peculiarly curious, and may justly be considered as a continued _secretory_ and _excretory gland_; or more properly, like the bark of a tree; for whilst there is continual transpiration from the body, it, at the same time, is capable to absorb the subtile particles of whatever surrounds it, and exclude the grosser. Over the whole surface are innumerable little _pores_, which are nothing but the little openings of the various lymphatics, and of the blood vessels corresponding with their peculiar _glandules_, called the _milliary glans_; between those on the hairy parts, the hair is planted as it were, with their distinct roots, corresponding with the hue of the subject they belong to. These _pores_ widen or contract according to the internal or external warmth of the body; which when they contract, cause a kind of roughness, or continuation of little warts; and on the contrary, when dilated, smooth the skin. Next to this follows the fat skin, or _membrana adiposa_; which is a continuation of cells, wherein the fat is contained, and has an immediate communication with the neighbouring blood and lymphatic vessels. This part is not universal, for some parts of the face, the genitals, &c. are without it. The last of all is the _membranosa_, a thin parchment-like texture, which adheres spontaneously to whatever part it covers, either _periosteum_, the _tendons_, _ligaments_, or _muscles_.

These are the four principal divisions of the skin; but that which is the principal, is the second mentioned, namely, the _cutis_; on which I shall have occasion to offer something hereafter, that may prove of the greatest advantage to the sea-faring people, for whose benefit I have particularly intended these Lectures.

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SECT. IX.

_Of the External Senses._

Feeling is the universal sensation of the nerves, on which all other senses depend, as the subtile spring of life itself. What it is, and whence it proceeds, has already in the foregoing been explained; namely, a sensation of the nerves, by which we perceive an idea of _hard_ or _soft_, _wet_ or _dry_, _hot_ or _cold_, or in general terms, _pleasure_ or _pain_. The peculiar seat thereof seems to be placed at the ends of our fingers; whether this is the absolute seat ordained by nature, or rendered so by custom, is not my business here to enquire; perhaps, both conjoin to make it there most perfect, as best suited for that purpose.

_Taste_ is the next sensation of the nerves, regarding an immediate approach and action of substances themselves, in order to distinguish betwixt the nature of foods, by which we are enabled to form an idea of _salt_, _sweet_, _sour_, _bitter_, _sharp_, or _mild_; which according to their mixture and proportion, render _taste_ agreeable or disagreeable. Its seat is principally in the tongue; but that it extends to the very stomach itself, is evident, from the immediate consent of parts; namely, that what is disagreeable to the palate, will ever be nauseous to the stomach: Of which I shall say more hereafter.

_Smelling_ is that sensation given to the animal creation, as a friendly messenger of taste, in order to enable us the better to chuse our food. It is actuated by means of the _olfactory nerves_ spread in the _pituitary membrane_ of the nose, and has an immediate communication with the brain; which nervous plexus is actuated by odorous particles, exhaling from substances, by which the olfactory nerves are stimulated agreeably, or disagreeably, as the first intelligence to the palate, or to the whole consent of the nervous system.

_Hearing_ is that sensation of the nerves which is occasioned by the vibration of the air, and forms the sound, which enters the cavity of the ear, and tremulates and puts in action, the organs of hearing. The ear is perhaps as curious a piece of mechanism to our conception, as any part whatever we shall meet with in anatomy.

To the organs of hearing we must reckon the external and internal _auditory_, divided by a thin membrane, which is a thin spreading of nerves, called the _drum_; within this, or in the internal cavity, we observe, 1st. Four little bones called, from their forms, the hammer, _malleus_; the anvil, _ancus_; the stirrup, _stapes_; and roundling, _orbicularis_. 2dly. Their peculiar muscles. And, 3dly. Two considerable cavities, the _labyrinth_ and _aqueduct_. How hearing is actually brought about, Anatomists have not as yet agreed; and which would be too tedious here to enquire into. That the little hammer is perpetually moving on the _tympanum_, according to the different sounds, may be one part; which, however, is greatly assisted by the other organs.

The _labyrinth_, with many turnings and windings, penetrates through the skull and forms part of the aqueduct, by which the sound is modulated and magnified, so as to cause the distinction between them, and convey the idea of their sonorousness to the common receptacle of sensation.

_Seeing_ is that great faculty by which the form, colour, and motion of objects is represented to our ideas. The principal conveyer of this wonderful sensation, is the _optic nerve_; the eye is a telescope finished to the greatest perfection; or like a _camera obscura_, where objects are pictured to the utmost nicety, and a due proportion observed in their nature. It is a globe enrolled with a strong tendinous coat, and filled with three kinds of humours perfectly clear and transparent, which differ in nothing but their various degrees of liquidity and form. Each of these humours is enclosed in a delicate thin transparent membrane. The external coat of the eye is called the _cornea_, from its resemblance to horn, being a continuation of the _dura mater_ and _pia mater_; and is every where opaque, except at the entrance of the light, which is called _pupilla_, and projects somewhat beyond the spherical form of the eye, similar to the crystal of a watch. Inside the _cornea_ it is lined with a spreading of the optic nerves, called the _retina_, where objects are reflected; by which the ideas are immediately conveyed to the brain.

The humours are the following: The _aqueous humour_, the most external, which is designed for collecting the rays of light; the second is the _crystaline humour_, which is in the form of a magnifying lens, and invested with a subtile transparent tegument, and so curiously fixed, as to be contracted and dilated, according as the objects are near, or removed from the eye; and accordingly the crystaline humour requires to be flattened or thickened; the last is the _vitrous humour_, which fills the remaining cavity of the eye; this humour serves to spread the objects again on the _retina_, and arrange them in their natural order, so that the picture of the objects viewed, may be preserved in its due proportion and regularity.

Now the act of vision is performed thus: The convex transparent part of the _cornea_ faces at once every object which comes within the direct lines thereof, and this is termed a _full view_.[8] This view enters through the aqueous humour, where the whole is contracted according to its convex and concave form, so as to make it fit to enter the _pupilla_, which is a muscular continuation of the _sclerotis_, and called the _uvea_; and from thence the whole view passes through the crystaline lens, by which the view is again magnified, and passed through the vitrous, and the whole depicted on the _retina_, in the same concave curve, and at equal angles in which it was first received, and apparently the same magnitude; thence representing the objects in their natural perfection, figure, colour, magnitude, and motion.

Footnote 8:

It is the general received opinion, that objects are reversed in the
representation on the _retina_ of the eye. This is however a mistake;
I hope on another subject to prove this in a full and satisfactory
manner.

When, however, an object is singled out of the whole view for particular attention, the _uvea_ then contracts or dilates, which, together with the muscular action of the whole ball, proportions all the humours suitable to the magnitude and distance of the object under examination, and the quantity of light; and to make the eye more capable, the lids are frequently moving, in order to moisten and varnish, as it were, with a liquid pressed from the innermost gland, called _canthus major_, to keep the surface smooth, and assist its transparency. If this intense looking is continued beyond the strength of this noble organ, it relaxes from its proper destined expansion, and the objects are rendered obscure.

Darkness is ease and rest to the eye, because it is then out of action; whilst light always keeps it in exercise; And in diseases of the eyes, light should be kept away as much as possible.

Here then I shall beg leave to conclude this short description of the wonderful structure of our frame; which when we duly consider, will never fail of filling our breasts with a sense of admiration; and induce us to lift up our souls with reverence and gratitude, to that incomprehensible GREAT CAUSE, by whose wisdom we are formed; and by whose goodness we exist.

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LECTURE II.

ON THE NECESSARY

MEANS AND MEDICINES

REQUISITE TOWARDS

RESTORING HEALTH.

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Having, in the preceding lecture, given a general view of our wonderful structure, I shall, in this, endeavour to lay a foundation of the healing art, in order to assist nature when impaired by the attack of disease, or any unforeseen accidents.

But that I may become useful, and yet concise, I will, without loss of time, lead the reader to the principal distinction between health and disease; for without forming a proper judgment of an ailment, there can be no reasonable intention of cure. I shall therefore beg leave to solicit a serious attention to the following important observations, particularly, as they are founded upon the purest principles of _physic_, authenticated by happy success in an extensive practice, and communicated by the dictates of a candid and well disposed heart, that wishes Existence only as a useful member to society.

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SECT. I.

_Of the Pulse._

When we consider the admirably curious structure of the human mechanism, it must clearly appear, how easily the animal œconomy may become disordered. But so kind has the ALLWISE AUTHOR of our existence been to his creatures, that on the slightest indisposition, the whole system is sensible of the least disagreeable sensation; and every part, with a social and sympathetic friendship, is ready to relieve the fabric from whatever is obnoxious, and causes the disturbance.

As nothing has a greater share in life than the blood, so nothing likewise on the least indisposition, is sooner set in commotion, and gives the alarm, than this very liquor, in which life itself is contained; and the circulation of this fluid in the arteries, furnishes us with the greatest prognostic, namely, the _pulse_, by which we may, with any degree of certainty, judge of the state of the body, and foretell good or bad events. How beneficial it is then to be acquainted with this knowledge, I shall leave to every rational being to determine.

Every artery in the living body constitutes a _pulse_, as has been explained in Sect. V. in the foregoing lecture.

And it is demonstrative from simple reason, that the pulsation of such arteries must be in proportion to their magnitude, greatest in the heart, whence they take their origin; till the vibration must gradually be lost to the touch, as they become insensibly small, and lose themselves in their ramificatory capillary tubes.

The artery which is most convenient to our examination, is that which lays immediately to the touch on our wrist, below the thumb, on the radius, just below the knuckle of that bone; and it is there we are best able to distinguish the pulsation of the arteries, as being most exposed to the external touch; because it is immediately between the skin and the flat of that bone.

Thus much premised, we will first consider the _pulse_ in the sound state; and next make a comparison with that in people labouring under diseases.

In a full grown man, in the vigour of health, the pulse ordinarily beats once to every second, that is, 60 times in a minute, 3600 in an hour, and 31,536,000 times in a year. It varies however in different subjects, according to the stature, temperament, condition, time, and action of the same; insomuch, that two persons equally in a good state of health, shall, however, differ widely in their pulses. Yet, notwithstanding, there are peculiar signs, which will ever make a true distinction between health and sickness; practice however is requisite to form a proper judgment of such distinction.

In order to lay a proper foundation to understand the nature of this great prognostic, I shall divide the pulse into the following classes:

1st. _A full_, _slow_, and _regular_ pulse, denotes a perfect state of health; for whilst the blood moves regularly in the arteries, without pain to the nervous system, or disturbance to the animal œconomy, the pulse will beat precisely regular, without trembling, fluttering, hurry, distinction, or feebleness, and discover to the touch, a peculiar easiness; and this, every one, who wishes to become master of that subject, should carefully attend to.

2dly. _A full_ and _quick pulse_, indicates a fever; for by the irritation of the nerves, the vibration of the arteries are accelerated. If a gentle perspiration attends it, it may be deemed salutary; and with this pulse it appears, that nature makes a vigorous effort to expel what is obnoxious: therefore in such a pulse, a gentle perspiration generally gives relief.

3dly. _A full_, _quick_, and _hard pulse_, denotes great irritability in the nerves, and a redundancy of blood; this is the pulse of a fever; and here bleeding, if timely applied, is very requisite, as also medicines which promote perspiration.

4thly. _A small_ and _quick pulse_, denotes an irritability in the nervous system, and a contraction of the arteries; this is generally the pulse which attends sudden shocks and frights, as also in the cold fits of agues. The causes should carefully be attended to: if, from a sudden shock, bleeding is useful; but in the latter case, it is hurtful. It seldom lasts long, and a full feverish pulse generally follows, and the state of the patient ought here to be the guide: for, the same pulse may proceed from too great a plenty of blood, as well as from a deficiency; consequently requires different treatment; and this shall be pointed out more fully hereafter.

5thly. _An irregular full pulse_, is at all times a bad one; many may be the causes, and generally denotes a great confusion in the nervous system, and in the circulation of the blood. This pulse is generally the attendant on violent inflammations, phrenzy, delirium, &c. and if it continues any time, forebodes great danger: bleeding in time is greatly requisite, and other remedies, in order to assist the nerves, and bring the circulation to its proper regulation again.

6thly. _An irregular small pulse_, is frequently the attendant of an emaciated constitution, putrid fevers, and consumptions; and this dangerous pulse too generally forebodes the approach of death. The more irregular the pulse grows, _small_, _weak_, _trembling_, and leaves off by irregular intervals, the sooner dissolution is at hand; till at last, the pulse entirely disappears, and life ceases. But dangerous as this pulse is, yet it must be observed, that it often appears in the strongest constitutions, as in sudden emotions of the mind, falls, &c. or in a swooning. This is also the last and the first pulse in suffocations; or in other words, the struggling pulse between life and death.

These few distinctions of the pulse we will let suffice, as they, when properly attended to, will in all cases enable us to make a true distinction between health and the different stages of sickness, and accordingly direct us to a true method of cure.

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SECT. II.

_Of the Effects of Bleeding_

There is, perhaps, not a greater remedy in medicine than bleeding; but good and effectual as it is, yet I will venture to say, there is none more pernicious than this, if injudiciously applied. As I value the life of my fellow creatures, I would at all times caution them against the injudicious application of this operation, being persuaded, that more have lost their lives by the lancet, than by the sword, and pestilence itself. Not to be tedious on this important subject, I shall give here some very few rules, whereby a patient may be judged in a proper state for bleeding; and likewise, where that operation ought to be avoided: for all the service we can possibly hope and receive from bleeding, is to lessen the quantity of blood, by which the whole body becomes relaxed, consequently less liable to the inflammatory irritation, that a too great quantity of blood might occasion; but on the contrary, if the solids are but weak, and the blood poor, we only augment the evil by bleeding, which we would wish to remove, as thereby the system becomes weakened, and not able to disengage itself from the obnoxiousness it is incumbered with; and thus proves the very destruction it was intended to remedy. The notion of drawing off the bad blood by bleeding, is very erroneous and absurd; the whole is too intimately mixed, and will ever generate the same again till the disease is removed.

_Bleeding is requisite_

1st. When a strong robust person, of a full and sanguine complexion, by accident receives a heavy contusion; a broken limb; or wound, whereby the parts become inflamed; a fever like to ensue; and that the pulse becomes hard and full, the veins distended, &c. &c.

2dly. When such a person receives a great shock, fall, terror, or any other strong emotion of the mind; whereby the blood becomes rarefied, or threatens a fever.

3dly. In the beginning of pleurisy, peripneumony, sudden and violent fevers, great colds, &c. as also scalding, burning, apoplexies, convulsions, palpitations, suffocations, and all such dangerous violent disorders; in these cases only bleeding is useful, and then it ought to be performed immediately, and with great moderation: six or eight ounces is enough from the strongest man; if requisite, it may be easily repeated, but if overdone, it is not so easily replenished.

_Bleeding in general is hurtful_

1st. In agues, notwithstanding the violent paroxysm of the hot fit, because the solids are here too much relaxed.

2dly. In all contagions distempers; this is a circumstance worthy the greatest attention. Reason and experience prove that bleeding here is very improper; for by bleeding, the contagious miasmata is drawn only the more into the whole mass of blood, and this is the fatal stumbling block, by which thousands have lost their lives. The manner of treating such distempers with success, I shall shew in its proper place.

3dly. In all old standing diseases, where there is a low, weak, though quick pulse; for in such cases bleeding is very improper, as the system is already too much reduced.

4thly. In all dropsies, scurvies, lentors, consumptions, &c. for here instead of bleeding and lessening the power of the solids, the patient wants strengthening, and has no blood to spare.

5thly. In all rheumatic and gouty complaints; for here nature must be assisted in order to throw off what is painful, by such means as will strengthen the solids, expell what is obnoxious, and prevent it from returning to the blood, or falling upon some more important part.

6thly. In all venereal cases, particularly if recent; as by bleeding, the pox will unavoidably be the consequence; as the venereal virus will be absorbed in the whole mass of blood.

7thly. In all paralytic cases, and such weaknesses where the strength of the body is already impaired.

8thly. _and lastly_, In the time of other evacuations of the body; as purging, fluxes, bloody fluxes, &c. and particularly when the body is in a sweat, or perspiration. From this, I hope, the good and bad effects of bleeding will be understood in many other cases, which would be too tedious to mention here; I shall therefore proceed to the operation of bleeding itself.

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SECT. III.

_Of the Operation of Bleeding._

Bleeding is thought in general to be a very simple performance; but in fact, there is not an operation in all surgery, requires more care, or is liable to more dangerous consequences, if ill performed.

It is not only the opening a vein, but it is to open it properly, (taking care not to prick an artery or tendon) to take away a sufficient quantity of blood, and to heal up the orifice again.

In the bend of the arm are three distinct veins, the _head_, _median_, and _basilican_. The ancients, before the discovery of the circulation of the blood, fancied the _head_, or upper vein, carried the blood from the head; the _median_, or middle, from the breast; and the _basilican_, from the liver, &c. but this idle conjecture is laid aside, as being highly absurd. When it is remembered what was said in the first Lecture, in Sect. V. of the circulation of the blood, it will then plainly appear, that all these veins become one before they enter the body; so that there can be no difference as to their quality in being opened: either therefore, which lays most conspicuously easy, is the vein that should be chosen; for the arms of people differ in this respect, as much as their features.

In order to chuse therefore properly, examine with the finger how the veins lie; if upon a flat hard substance, it is a tendon; if a pulsation is perceived, there is an artery; both which ought to be avoided if there is a vein that lays more free and conspicuous to the sight and touch. If however it cannot be avoided, the vein ought to be opened with the greatest caution, for the pricking of a tendon would not only be exquisitely painful, but endanger the arm by inflammation, and even life itself; and the pricking of the artery would endanger the patient’s bleeding to death, or else form an _anauresma_, (which is a bag of blood protruding from the artery) equally dangerous to the life of the patient. In general the middle vein is the safest and most convenient, provided it does not cross the tendon: for the upper vein lies frequently very deep, and is but small, and the lower frequently crosses a tendon, or lies immediately over an artery.

However, one or the other will frequently suit, and, with caution, the operation may be performed with ease.

As to the choice of the arm, it can make no difference in regard to the effect, whether it is the right or left, for the veins of both arms end at last in the great trunk of the _vena cava_, before they enter the heart. To the operator, however, the right is the handiest, and to the patient, the left is most convenient. In that arm however where the best vein offers, that should be chosen.

When the arm is fixed on, then tie it up. The place should be on the upper arm, about two inches from the bend, and the vein fixed on to be bled, first drawing up the skin a little, and laving on the ligature twice round the arm, drawn together with a draw knot; the reason of laying on the ligature above the intended orifice of the vein, is plain, as it stops the reflux of the blood, which is transfused from the heart by the arteries towards the fingers, from thence taken up by the veins, and by the ligature prevented from flowing back again, and consequently distends the veins, and swells them up.

When the ligature is laid on, (which may be a garter, or a piece of tape, about four or five feet long) and the veins are swelled up, then open the vein. Bend the lancet so that the blade and handle may make an acute angle; take the blade between the thumb and fore finger in the right hand, if the right arm is bled, but if the left arm, the lancet ought to be held in the left hand,[9] and open the vein obliquely, so that the lancet cuts all the while, stretching the vein a little downwards with the opposite thumb. The lancet should cut a little slantingly, for if perpendicular, it would not only cause much pain, but be apt to slip through the vein, prick a tendon or artery, and occasion dangerous mischief.

Footnote 9:

This is the proper method of bleeding; for a bleeder ought to be
equally dexterous with the left hand as with the right, which custom
soon makes familiar; but those who are awkward with the left hand,
must stand behind the left arm to bleed, which method may be adapted
rather than to risk danger.

The orifice should be somewhat obliquely in the vein, neither directly length-ways, as the veins would be apt to slip, and the orifice not sufficiently opened to let the blood pass freely; neither should the opening be right across, as thereby the vein might be divided, and the blood not be easily stopt, or the orifice heal up. When now the vein is well opened, let the blood run, (the arm a little bent) till it changes to a higher colour, the surest sign of being enough, and this will be in about four, six, or eight ounces, according to the constitution of the patient. This simple rule I would advise to be attended to, for whatever may be pretended about presaging the quantity of blood beforehand, certain it is, it cannot be ascertained but in the time of bleeding.

When it is time to leave off, slacken the ligature, and gradually untie it, when generally the blood ceases to run; draw close the orifice, and wipe it clean all round. Let the patient bend the arm a little, and close the orifice very close, then lay a four-folded dry compress, the bigness of a crown, of clean tolerable fine linen rag, and tie the arm up: lay the ligature (a garter or a piece of tape about four feet long) at the middle of the compress, the one half round the upper arm, the other on the lower arm, alternately, so that they always cross each other in the bend of the arm on the compress, till at last it is either tied or pinned; care being taken that it neither be too tight or too slack, so that the arm may be bent or extended with tolerable ease. Let the ligature remain on twenty-four hours, when all will be closed up.

What is to be done if unfortunately a tendon or an artery should be pricked, I shall mention hereafter.

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SECT. IV.

_On the requisite Medicines to be used at Sea_

As my greatest ambition in this life tends only in becoming useful, I shall studiously avoid that false pride of appearing learned.

There is perhaps not a medicine in the modern _materia medica_, but what I have examined into, and opportunely experienced the virtue of; but so often have I been deceived in my expectations, that out of the many hundreds, with which I am acquainted, there are not above a score, or at farthest two, which in any case whatever I should expect any benefit from. Yet I mean not to throw out prejudices, for every physical man has his favourite medicine, and we are all apt to praise the bridge that carries us well over.

The little assortment of medicines however, which I here offer, I know from experience to be good, and as such I recommend them. I have plowed the ocean myself, visited most climates in the known world, and in my practice on that precarious element, drawn such observations, as makes me happy to think, that they may prove useful to a class of men, who daily experience the uncertainty of human life.

In the first place I shall draw the plan of a sea medicine box, as may suit a ship that carries no surgeon; in which I shall endeavour to be so plain as I hope will prevent any mistake.

The MEDICINE CHEST.

+——————————————+—————————+————————+————————+——————————+————————————+
|{Lancets|A.|B.|C.|D.|11 Camomile|
|{Scissars|Spt. of Wine|Liniment of|Sweet Oil.|Sweet Spirit|12 Balm|
|1 {Probe|and Camphor.|Soap.||of Nitre.|13 Sage|
|{Spatula +—————————+————+———+——+—————+——————————+ 14 Sassafrass|
|{Teeth Instruments|E.|N.|O.|P.|G.|15 Oatmeal|
|2 Syringes|Honey.|Calom.|Fine Prec.|Me. Oi.|Elixir
of|________________________|
|3 Clyster Pipes & Bladder| +————+——————+—————+ Vitriol.||
|4 Scales and
Weights|___________________|Q.|R.|S.|____________________|16
cinamon, &c.|
|____________________________||Rhub.|Jalap.|Ipecac.||17 Allum|
||F. +————+——————+—————+ H.|18 Chalk|
|5 Splints|Yellow Basilicon.|T.|U.|W.|Elixir Proprietat.|19 Salts|
|6 Bandages||Liq. L.|E. O. Pep.|T’s. Ba.||________________________|
|7 Rags|___________________|_________|____________|__________+——————————+|
|8 Tow||||||
|9 Lint|I.|K.|L.|M.|20 Diachylon Plaister|
|10 Tapes, Thread, Needles|Linitive|Turner’s|Fever Powder.|Stomach|21
Mercurial Plaister|
|and Pins|Electuary.|Cerate.||Powder.|22 Blistering Plaister|
+——————————————+—————————+————————+————————+——————————+————————————+

_Of the Utensils._

First then, I shall speak of the utensils and the instruments which must necessarily belong to a medicine box, be it ever so small.

_In the box_, No. 1.

_Lancets_: There ought to be three or four, and they should always be kept clean and bright in a case, free, as much as may best from the dampness of the sea air. The best method for this is, to wipe them often with a dry clean linen cloth, warmed by the fire, (taking care in the wiping of them, that the blade of the lancet lays upon one of the handles, by which the point is preserved) and when properly cleaned, wrap the whole case up in a large piece of dry paper. Let it be a constant rule, to clean them well every time they are made use of.

And here I must remark once for all, that all iron or steel instruments are ever best preserved clean and bright, by rubbing them clean with a warm dry cloth, and then wrapping them up in clean dry paper; by which method I have preserved my capital instruments with the same brightness, as they came out of the workman’s hands throughout my voyages, notwithstanding they have been made use of, and frequently too.

The notion of oiling or greasing instruments is very erroneous, and so far from preserving them, that it will never fail of making them more rusty. The wiping them quite clean and dry, and wrapping them up in warm dry paper, is certainly the best secret for keeping all iron or steel bright at sea, and deserves strictly to be attended to.

_Scissars_: There ought at least to be two pair, one for common use, and the other for particular purposes; and if the last mentioned are crooked, they are certainly much the better, being very handy on many occasions. The best pair should be carefully preserved as already directed.

_Probe_: A probe is very requisite for searching of wounds, &c. It should be of good silver, and the smaller it is in thickness, even like a small wire, the better for use, as it will bend and twist agreeable to the place it is to search. At one end it should have a neat smooth button, and at the other, be triangularly pointed, like a sail needle, in order to wrap lint round it to clean sores with; its length should be six or eight inches.

_Spatula_: ’Tis not much matter what the spatula is made of, whether silver or iron, be it what it will, (provided it is neither brass nor copper) one end should be flexible, so as to be handy in spreading salves upon lint, or for other the like purposes; whilst the other should be more stiff, being very useful for pressing the tongue down, in looking and examining the throat. It should be about six or eight inches long, and an inch broad.

_Bistouries_ and _Incision Lancets_: A bistoury, or neat sharp cutting knife, is very useful indeed in many cases. And a large incision lancet, in the form of a common lancet, except that the point inclines more one way, is very necessary for opening aposthumes, and where a collection of matter has been formed.

_Teeth Instruments_: Of the whole tribe there is certainly none more universal than the key; this ought to have three different hooks, and so that they may shift and unshift, according as the operation requires. The gum lancet I have no notion of, I never saw any occasion for it, and am apt to think it rather an hindrance to the operation. The instrument should be kept clean in the same manner as I have said before.

2. _Syringe_: Each box ought at least to have two. Ivory is the best substance they can be made of; they ought to be pretty thick and stout, as they are liable to warp. A small one with a neat pipe, slender, and a button to it, will be very useful for the clap, or other cases, where injections are requisite. A larger one for the ulcerated sore throat, or other the like cases, where quantities are required to be injected.

3. _Clyster Pipes_ and _Bladders_: There ought to be sundry. I would have them previously mounted; and to prevent the bladder from being decayed, or eaten up by vermin, or moths, fill them up with wormwood; a method I have found very effectual.

When they are to be made use of, they are easily softened by a little lukewarm water.

The general method of mounting the bladder on the pipe, is, by the assistance of a cork in the pipe, which is to be drawn by a string, when the clyster is injected; for my part, I found it always a hindrance; and therefore instead of the cork, I always chose to secure the whole with a string, tied with a slip knot, which when the pipe is introduced, is much more easily undrawn.

_A clyster syringe_ of pewter, that holds at least a pint, or a pint and an half, is far more preferable at sea, and might easily be made with an additional pipe, by which a man may be the operator himself.

4. _Scales_ and _Weights_: This is a requisite article, in order to proportion the doses of medicines. The scales need scarce any description, as they require no more than their being of an equal length, and the whole in equilibrio.

The _Apothecaries weights_ come in the following order, and signified by these characters:

1℔—A Pound is 12 Ounces.—℥xii.
℥i.—An Ounce is 8 Drachms.—ʒviii.
ʒi.—A Drachm is 3 Scruples.—℈iii.
℈i.—A Scruple is 20 Grains.—gr.xx.

These marks are generally stampt upon the pieces. As a pound and ounce are not generally used in the proportioning of doses, they are omitted in the common little boxes prepared for that purpose. The rest, drachms, scruples, and grains, are marked upon the requisite pieces; and which at the first inspection may easily be understood.

I shall next proceed to another division of the chest or box.

5. _Splints_: Of those there should be at least four pair; two pair for broken legs, and two pair for broken arms. They are generally made of very thin deal boards, pasted on leather, and slit, so as to bend to the parts applied, sideways, but remain stiff length-ways.

Paste-boards may however be made use of with good success; and if the paste-boards are kept in sheets, they have the advantage, that splints may be made of them occasionally; but by fomentation they are apt to become soft and flabby, which ought to be guarded against.

6. _Bandages_: There ought to be three or four long ones, two or three yards each, torn length-ways off an old sheet, not too much worn, stitched together so as not to make a seam, three fingers broad, and neatly rolled up, so that they always may be ready for use.

7. _Rags_: are a most requisite article at sea, and I can only say, the more there are the better. They should by all means be clean, and neither too coarse nor too fine.

8. _Tow_: is also a very requisite article. A good large bundle should be provided, and it should be cleared from the shaggins, as they render it stiff and unpliable: the grey is generally the best for medicinal purposes.

9. _Lint_: should also be somewhat plenty; but as this may be made at leisure, the quantity of that is not so material. Lint in the common method is best made from rags torn length-ways, about three fingers broad, and the transverse thread drawn by the help of a knife.

10. _Tape_: is very useful, particularly that of two fingers breadth, and ought to be pretty fine. At least a dozen of yards should be provided.

_Needles_, _threads_, and _pins_ should by no means be omitted, being highly useful on many occasions.

_Secondly._ I shall now proceed to the herbs, which need but be few, as they are very subject to decay.

11. _Camomile flowers_ are much used by some, and supposed to strengthen the stomach; I could never think them of that effect. When however a vomit is given, camomile tea is very useful, and promotes greatly the operation; but it should not be made too strong: as much as may be taken between three fingers, pouring on it a quart of scalding water, and thus made into a tea. But that kind of tea should not be too often repeated, unless it particularly agrees with the stomach.

12. _Balm_: This is an excellent herb on many occasions; it is cooling, and there is not a tea I have more to recommend to sea-faring people, let their ailment be what it will; it is of a balsamic and healing nature, and will not easily pall on the stomach, except where there is an universal weakness in the system; where then what is more warming to the body than balm, may with propriety be added.