Chapter III: Part 3

13. _Sage_: This is an herb of a more hot nature; and in fevers should be used with caution, unless where a transpiration is required. It promotes urine and perspiration, in many cases it may be used with the balm, and then makes a very good tea, both for the sick as well as those in health.

14. _Sassafras_: This is one of the warming and balsamic woods, which, if it is mixed with _lignum vitæ chips_, makes an excellent decoction for all rheumatic complaints, and where the blood wants to be diluted or purified.

15. _Oatmeal_: This article cannot strictly be deemed a medicine, yet, as water gruel is frequently wanted, that of oatmeal I think the best; besides, it is excellent for making poultices, being of a softening and rich quality. But if it should be wanting, _pounded biscuit_ will answer the purposes. In regard to diet, I shall say more in its proper place.

16. _cinamon_: This is a necessary article at sea, as it is of a gentle astringent nature, together being very warming, and is undoubtedly the best of all the spices, where the bowels are weak. Its peculiar uses I shall speak more of hereafter, when I come to treat on loosenesses and fluxes, and such diseases where it is useful.

17. _Allum_: This astringent medicine is very useful for gargles, for scurvy gums, and various other uses. Burned allum (which may be done by exposing a piece on a fire shovel over the fire till it is bubbled up and become of a white cake) is an excellent medicine, for gently checking proud flesh in ulcers; besides which, it makes an excellent tooth powder.

18. _Chalk_, is as necessary an article as any medicine, and so useful is it in long voyages, that a ship should be well stored with it; for it is not only an excellent absorbent, and will stop fluxes, when made use of in decoctions for that purpose, but, makes also a great purifier of water, and thereby contributes greatly to the preservation of health; as I shall hereafter further take under a stricter consideration.

19. _Salts_: Glauber’s purging salts, is a medicine which has had many virtues ascribed to it; as a cooling purge it is very well, but further I cannot recommend it: An ounce, or an ounce and an half is the dose; and it will be best to dissolve it in a tea cup of water over night, so that it may be taken early in the morning, and worked off with drinking gradually some tea after every motion.

20. _Diachylon plaister_:

_Take lytharge fine prepared one pound, oil of olive one quart, boil them over a gentle fire, putting into the pan a little water, stir it all the while, and take care it does not burn; continue boiling, till it becomes of a consistency of a plaister, and make it into rolls; which, according to art, is best done before it is quite cold, upon a wet marble slab, and wet hands, and then put up in paper, previously rubbed over with some soap, to prevent it from sticking._

There is not a medicine so generally useful for all hands on board, as this very plaister, in case of cuts, bruises, or sores of any kind; it is not only the medicine box that should be well provided with it, but every man on board, I advise to have a roll, and some spread on cloth in his chest; for in every little accident, a cut, a broken nose, or broken shin, &c. to which a seaman is liable, nothing is handier, and nothing is more beneficial than this plaister, as it will prevent inflammation and festering, heal it up, and prevent small sores from becoming great ones.

21. _Mercurial plaister_:

_Take of the diachylon one pound, purified mercury half a pound, triturate the mercury with a little hog’s lard or turpentine, then melt the diachylon, and incorporate the triturated mercury into it._

This is principally fit for venereal cases, for buboes, and other hard tumours; it may also be put to shankers and very bad ulcers; but it should never be used unless necessity requires it.

22. _Blistering plaister_:

_Take Spanish flies eight ounces finely powdered, common drawing plaister one pound, melt the plaister and sprinkle the powdered Spanish flies till all is well incorporated, then make it into rolls according to art._

This is intended for rising blisters. In regard to the use of this, I have only to observe, that it should be made use of only, when the greatest necessity requires it; that is, in bringing on a crisis of a fever, which I shall point out in its proper place. At present I shall only speak of its application. Whatever place is intended to be blistered, either the neck, between the shoulders, or the calf of the leg, let the place first be cleaned with a little vinegar, and rubb’d till it becomes red, then let the blistering plaister, the bigness of the palm of the hand, pretty thickly spread, (best upon leather) be laid on the part, and remain there for about twelve hours, and be tied on, that it may not shift: at that time the blister will rise; let it be cut to let the water out, (but care should be taken not to pull off the skin, as is frequently practiced) dress it with _Turner’s Cerate_, spread upon a thin rag, (or what is still better, dry lint) and let that dressing be shifted once every twelve hours, till all is healed up.

I shall now proceed to the inner part of the chest.

A. _Spirit of wine camphorated._

_Take spirit of wine rectified one quart, camphor two ounces, mix it, and let the camphor be dissolved in it._

This is an external application, for bruises and other inflammations, where discussion, or dispersion of humours is necessary, its chief benefit is in sprains, dislocations, and fractures. I have this however to observe with the camphorated spirit, that though it is exceedingly useful in the forementioned, and in some rheumatic cases, yet it should be used with caution, and not too plentifully, as it is liable to dry up the vessels, and might incline the limb to wasting, if too freely made use of.

B. _Liniment of soap._

_Take spirit of wine rectified one quart, distilled oil of rosemary one drachm, camphor one ounce, castile soap half a pound; cut the soap small, and let the whole be mixed and dissolved._

This is an excellent external medicine for sprains, rheumatism, bruises, &c. This medicine is commonly called opideldock, and in all such cases is far superior to the spirit of camphor singly; unless where the constitution is sluggish, and requires a greater stimulus; in general, however, this excellent composition will supply the place of both.[10]

Footnote 10:

Since these compositions are so easily made, they might occasionally
be prepared on board; Instead thereof, I would advise the seaman to
furnish the box with camphor and soap; and instead of rectified
spirit, good rum or brandy will answer equally as well.

C. _Sweet oil_: This ought to be pure and good; it is of many uses in medicine, which I shall treat of as occasion requires.

D. _Sweet spirit of nitre._

_This is a spirit distilled from spirit of wine one quart, and spirit of nitre half a pound, according to the art of chymistry._

In regard to its virtue, it is an excellent medicine in most acrimonious cases, and acts principally as a gentle diuretic; besides this, it is of an antispasmodic and antiputrescent quality, and therefore useful in all kinds of inflammatory disorders, particularly of the putrid kind of fevers; which I shall, in the course of this work, take notice of.

E. _Honey_: This is a useful article, which ought to be plenty, and of the best kind; it is particularly useful for making gargles, clysters, poultices, &c. &c. as shall be farther specified.

F. _Yellow basilicon_:

_Take olive oil, yellow bees wax, yellow rosin, Burgundy pitch, of each half a pound, turpentine two ounces; melt the whole, and mix them properly._

This is an external digestive application to cleanse ulcers, and to make them discharge good matter, by which the inflammation will abate.

G. _Elixir of Vitriol_:

_Take stomachic elixir one pint, oil of vitriol four ounces; mix them, and filter it through paper._

This is an excellent elixir for weak stomachs, that proceed from bile and other causes of indigestion; it is also a great specific against the scurvy, and the like habits; as also in feverish complaints. The dose is from 20 to 40 or 60 drops, in a little water.

H. _Elixir proprietatis_:

_Take of myrrh in powder one ounce and an half, succotrine aloes in powder an ounce, saffron four ounces, of dulcified spirit of vitriol six ounces, of rectified spirit of wine twenty-four ounces; digest them in a sand heat for four days, and then pour off the elixir from the dregs._

This elixir is an excellent stomachic, it will promote digestion, strengthen the stomach, and create an appetite; it will also keep the body gently open, and on that account be of great benefit against many ailments in the bowels. The dose is about a drachm or two, or a middling spoonful; to be taken either by itself, or in a glass of wine, and makes a most agreeable bitter.

I. _Lenitive Electuary_:

_Take dried figs one pound, tamarinds, cassia, french prunes, each half a pound, sena leaves eight ounces, coriander seed four ounces, liquorice root three ounces, double refined sugar two pounds and an half; reduce the sena and coriander to a powder, and sift it through a sieve, boil the figs, cassia, prunes, and liquorice into a pulp, and strain these also, then mix the powder gradually amongst it, and make it, with the help of the sugar, into an electuary._

This electuary is a gentle cathartic, keeping the body coolly open, and therefore very useful in fevers, and weak constitutions when openness of the body is required. The bigness of a large nutmeg is a dose, which may occasionally be repeated.

K. _Turner’s Cerate_:

_Take olive oil a pint, yellow bees wax and prepared calamine stone, of each half a pound; melt the wax and oil, and mix the calamine stone: keep stirring till it is cool._

This is a healing cerate, very useful in scalds and burns; as also to dress blisters with; likewise for the external dressing of sores, when near healing, or to keep other dressings on.

L. _Fever powders_:

_Take purified nitre powdered half a pound, crabs eyes prepared four ounces, cinnabar of antimony finely prepared two ounces, calomel one drachm, and mix them._

This is the celebrated antispasmodic powder of the great _Stahl_, with some considerable amendment by means of the calomel; which, in the course of a long practice, I have found the most beneficial for fevers. There is not a kind of fever to which mankind are subject, either at shore or at sea, but what this powder may with safety and with great benefit be applied. A scruple, or half a drachm is a dose, and which may be repeated, as the ardency of the fever shall require.

M. _Stomach powder_:

_Take purified nitre prepared and chalk, of each eight ounces, nutmeg two ounces; reduce all to a fine powder, and let them be properly mixed._

This is an excellent powder against the heart-burn, or other crudities of the stomach and bowels; for whilst it absorbs the crudities and accidities in the first passage, it is at the same time a gentle digestive, and withal a carminative: Hence in heart-burn, belching, and other disagreeable symptoms of depraved appetite it is highly useful.

N. _Calomel_:

_This is a dulcified mercury, made of sublimate mercury four ounces, pure quicksilver three ounces; intimately mixed, and sublimed six times, according to the art in chymistry._

This is the safest and gentlest of all mercurial preparations, and if judiciously administered, may be deemed one of the greatest of all medicines. I shall therefore be somewhat particular on this head. In the first place, it should be faithfully prepared; and secondly, levigated as fine as is possible; to do this therefore, I have in my Treatise on the Venereal Disease, recommended it to be ground with a little water on a flat marble, to the finest degree possible, and then dried up for use. The fineness of this excellent medicine is of the greatest importance, and ought to be strictly attended to, for not only much mischief has been done by its rough particles in the bowels, but it must follow, that the finer it is, the farther it goes. And with all mercurials, it should be strictly observed, the less quantity we can make do, the more we may hope for success.

There is not an acrimony in the human body but what may be corrected by this universal antacrid medicine, if properly administered. In venereal cases, it should be one of the first, and the principal remedy throughout the cure; but care should be taken that the quantity be small, and adapted to the strength of the patient, and to prevent it from falling on the salivary glands, and thence to produce salivation. The dose should never exceed one grain, a quantity sufficient for twenty-four hours, except where there is evacuation, or other discharges of the body required; in which case it may be occasionally increased, especially in malignant fluxes, or when purges are given, or in other evacuations.

It may be made up in many forms; the best, however, is in pills, with a little flower and water, &c. or it may occasionally be mixed up with other medicines, as I shall frequently have occasion to speak of.

O. _Precipitate_:

_This is made up of equal weight of Quicksilver and compound Aqua Fortis, well mixed, evaporated to dryness, in a broad bottomed vessel, by a sand heat, according to the art of chymistry; in which operation it turns red._

This is an excellent medicine, applied to all kinds of ulcers, as it will correct the malignity of the matter, take off fungous flesh, bring on a kind suppuration.

It will also clear the skin from all kinds of breaking-out, and perfectly destroy lice, nits, &c. It should, however, like the former, be levigated very fine, for thereby it loses greatly its sharpness, and becomes more efficacious. It should also be mixed with some cerate, ointment, or other dressing, and never, or very seldom, be used by itself, as I shall hereafter point out.

P. _Mercurial Ointment_:

_Take hogs lard eight ounces, purified quicksilver one ounce, Venice turpentine two drachms; rub the mercury into the turpentine in a mortar, till the quicksilver disappears, then mix the whole together._

This is popularly called Unction, and peculiarly useful in venereal cases, as also to destroy a particular vermin called _Crab-Lice_, and other foulnesses. But I must here give a caution against the too free use of mercurial ointment, as it is not only apt to bring on salivation, but if the mercury is adulterated with lead, (as sometimes is the case) it is liable to occasion many incurable pains in the limbs; and by this the remedy may prove worse than the disease.

Q. _Rhubarb._ This is a necessary article in all kind of fluxes, and relaxations in the bowels; for, besides that it purges gently, it has withal such an astringency as to brace up the weakened vessels, and to restore their proper tone again.

The dose of rhubarb is one scruple; which should be mixed with some fine chalk, or _Stomachic Powder_. (M.) about equal quantity, particularly in the beginning of fluxes.

R. _Jalap._ This of all purging medicines is undoubtedly the best, when purging is required. The dose is from a scruple to half a drachm, mixed up into a draught, with a little syrup and water, or any other form. A grain or two of calomel is ever a proper addition, let the case be what it will, that requires purging.

S. _Ipecacuanha._ This is the best of vomiting medicines; to be given about a scruple, either in form of a little draught, or in a bolus.

Vomits are often of more benefit than purges; not so much on account of cleansing the stomach, as by the agitation it gives to the whole body; whence it is brought into perspiration, and thereby promotes the circulation of the fluids that was obstructed.

T. _Liquid Laudanum_:

_Take purified opium one ounce; cinamon and cloves, of each one drachm; white wine one pint, steep them for a week without heat, and filter it for use._

This is a medicine of much use in painful and restless diseases, but should never be had recourse to, unless the greatest necessity require it. For, whilst it lulls the nerves from their irritation, it is apt to weaken their tone, and by that, greatly lessen the strength of the whole body; but where really requisite, it is a happiness that ease can be given, by which to relieve nature in pain that it may be restored again to tranquillity. The dose of this tincture is from 10 drops upwards to 30.

U. _Essential Oil of Peppermint_: This is one of the most grateful nervins in the whole materia medica; and at the same time the least stimulant. In all cases where there is weakness and feebleness, I would advise this in preference of spirit of hartshorn, or any other stimulant whatever. It warms the stomach, comforts the bowels, and infuses a liveliness over the whole nervous system. The dose is from 3 or 4 to 6 drops, on a little lump of sugar, and dissolved either in a glass of wine, or water; which may be repeated occasionally, without the least hurt to the constitution.

W. _Turlington’s Balsam_:

_Take St. Johns worth a small handful, rectified Spirit of wine two quarts; digest them for a few days, then strain and filter the extracts; then take Angelica root, Olebanum, Myrrh, and Socotorine Aloes, of each one ounce; Styrax, Benzoin, and Peruvian balsam, of each an ounce and a half; digest the whole in a slow heat for some days, and filter the balsam off for use._

This is the genuine receipt of the celebrated _Turlington’s Balsam_, and an excellent medicine it is, for many purposes. Externally, it is an efficacious remedy for all green wounds, cuts, bruises, &c. if immediately applied.

But particularly for internal uses, its virtues are great: It warms the stomach, promotes good digestion, enriches the blood, warms the whole system, and, above all, is a sovereign remedy in all rheumatic complaints. The dose is about a tea spoon full, in a glass of wine, or any other convenient vehicle; and on all occasions, where bitters are made use of, this ought to have the preference, being one of the best stomachics. But at the same time it should be observed, that where there is a fever in the system, it ought to be avoided, as it is remarkably heating in its nature, and therefore agrees best with cold constitutions, and where the habit is weak.

Here then I shall end this lecture; and only observe, that though there are various other medicines of the greatest importance, as well for external as for internal uses, I have purposely avoided them, as their application requires more care, than what we may expect from men who have not made medicine their peculiar study. At the same time I must also confess, that the forementioned will be sufficient, if managed as I have already intimated. It is a maxim with me, ’tis not so much the medicines themselves whereon the success depends, as the judgment requisite to know how and when properly to make use of them.

I must likewise take notice, that I have purposely adhered as close to the recipes of the Dispensatory as I could with propriety, because it may the better suit the apothecarys’ shops in all parts of the world; and that when a medicine is wanted it may the easier be supplied. It would have been an easy matter for me to alter every medicine in its composition; but I conceive this would have tended but to raise difficulties in procuring them, and taken away from the general utility of the book.

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LECTURE III.

OF

ACCIDENTS,

AND THEIR

Proper Method of Treatment.

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I Shall now proceed to the actual assistances that the human body stands in need of, when the order of health is impaired. This is the noblest office, in which mankind can possibly give aid to each other.

Health is certainly the greatest blessing this side of the grave; and what service can we render to our fellow creature, so valuable, as to assist him in the hour of distress.

From this consideration it naturally follows, what caution it also requires, and how circumspect every one ought to be, who takes upon him that noble office.

Before therefore I begin this important lecture, let me request of the reader the strictest attention, and never to act before the ailment, as well as the method of treatment is thoroughly understood; since nothing less than health, and even life itself, is liable to be the forfeit of a fatal error.

Mankind are ever liable to accidents, how cautious soever their conduct in life may be: But seamen, particularly are more so; not only from their occupation, but from the precariousness of the element on which they are dependant, and which so often exposes them to the most imminent danger.

I shall divide the accidents of bodily dangers, into falls, wounds, bruises, dislocations, fractures, scalding, burning, and drowning; and treat on each part separately, in as plain a manner as is in my power.

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SECT. I.

_Of Falls_

The man who falls, is partly bereft of his senses, or his presence of mind, and particularly so the more timorous he is of his own preservation; add to this, because he is unaccustomed to it; for custom makes us familiar in every thing: Thence we perceive the different effect in different persons in their falling; for some will fall with a good deal of judgment, prevent some unlucky blow or other; whilst another shall fall as heavy as a dead log, or like one drunk, without having the least chance of saving himself in any shape. I remember once I fell from the puttock shrowds of the fore-top, but providentially escaped without the least injury, my watch chain having catched some how, which I endeavoured to save. I confess this in a great measure was owing to good fortune; at the same time I was naturally very active, and having acquired a flight of jumping off the main-deck into the hold of a light ship, I thereby had habituated myself to stop my breath, and a presence of mind which principally saved me when I thus fell in good earnest. I only mention this to shew, that the greatest mischief in falling proceeds from timorousness and surprise. I knew a wag, who would play pranks that way to astonishment; he could let himself fall from any part of the rigging, catching as he came down like a cat, make all hands come round to his assistance, and then laugh at their credulous good nature.

A man who falls is apt to lose his breath, particularly if he is not very careful, and has not presence enough to stop it the moment he finds himself fall; and the instant he loses his breath, he loses also his mental faculties; consequently comes motionless and exposed to every fatality. Thence we generally find a man, who has fallen from a considerable height, lays motionless like death on the spot, even though he has not received the least injury otherwise.

_The Method._

When I have been called to such an accident, and found my patient motionless; I have untied his neckcloth taken him by the coller of his jacket, and shaken him heartily; which in the space of half a minute has brought him to, with a heavy sigh. Next I have bled him without loss of time, but not too copiously; after which I have examined him, and acted according to circumstances.

A person falling is liable to a number of dangerous consequences, not mentioning immediate death. The consternation, the shock, fright, terror &c. are as alarming and dangerous as the external hurt itself. The brain, and the blood vessels in that part are very delicate, and by the shock, as well as the want of respiration, they often burst; thence an apoplexy is liable to hurry the patient from the stage.

A fever generally attends a fall, which ought to be strictly attended to; after, therefore, the patient is bled, and seems to have recovered his reason, he should have every six hours a dose of the _Fever Powders_, (L.) and drink some balm tea, in order to get into a gentle perspiration, which will in this respect soon recover his health again, and enable him to do his duty.

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SECT. II.

_Of Wounds_

A Wound is an unnatural separation of any part of our body, whereby the order of circulation is hindered, the solids divided, and the fluids let out; suddenly caused by some violent means or other. But when such a separation becomes ulcerated, it loses the apellation of wound, and is called a sore, or ulcer.—This distinction is requisite to be taken notice of; for wounds and sores are often confounded, which shews not only ignorance, but as their nature is materially different, their method of treatment is not less so; and ought therefore previously to be understood.

Wounds are best distinguished into three different kinds; cut wounds, bruised wounds, and gun-shot wounds. I shall briefly shew how to treat each in particular.

_Cut Wounds._

A Cut wound is barely a separation of parts; and the sharper the instrument with which the wound was made, the easier will the wound be to heal up again.

It is however a natural thing to observe what parts of the body is wounded, for tho’ nature is kind in uniting the parts, yet some parts are more easier healed than others.——Observe therefore

_The different Methods._

If an artery is wounded (which is known by the blood being of a florid colour and spinning out by starts) care should be taken to have it stopt to prevent bleeding to death. But in this you should not be too scrupulous. Two or three ounces from a wound makes a great shew; and very often a little blood lost is of great benefit to the healing. Should, however, the blood gush from the wound violently, especially from an artery, make a compress of lint, strewed with _Powder’d Allum_, (17) which secure well on the parts with a roller, laying over it a compress, with _Spirit of Wine and Camphor_; (A) if that should not be yet sufficient, put a piece of money in a compress, and secure it on the wound, that is, provided the part of the body will admit of it, such as the arms or the legs, &c.

Let the ligature, or the first dressing, lie on for two or three days, and, if no hindrance to the patient, longer. If all these things are not sufficient, recourse must be had to the needle.

In every other kind of cut wounds, care should be taken to have it first cleaned with some water; (a small matter of vinegar, and brandy may be mixed with it) next, let the lips of the wound be well closed, dressed with dry lint, and _Turlington’s Balsam_ (W), and over which, a compress with _Camphor Spirits_ (A).

Plaisters, salves, &c. in green cut wounds, are altogether needless. All that is required to healing, is to keep the wound clean, to give it rest, and not to aggravate it with any thing acrimonious. _Turlington’s Balsam_ (W) is admirable, but yet it suits small wounds better than large ones.

As a finger is very liable to be cut, and sometimes gives a great deal of trouble, I will here give a simple and expeditious remedy:—If you have cut your finger, wash it in a little salt or fresh water; tie it round with a good long thread, not too tight,—take care that your wooling may keep on without being removed; and a day or two will heal it up, without any farther plaistering. If inflammation attends the wound, methods should be taken accordingly, by bleeding, fever powders, &c.

_Of Bruised Wounds._

These kinds of wounds are of a worse nature, and are not so kind to heal as the former; for here the parts seem to be torn to pieces, so that there is not only a separation of parts, but a destruction of a great many tender fibres all round the wound.

Hence we see in such cases a great deal of swelling, inflammation, and pain attend it; for the blood being hindered, the circulation naturally swells up the parts; and the nerves being lacerated also, must occasion great pain. Hence it must follow, that nature must first get rid of the obnoxious and torn part before she will consent to unite the wound again; and this must be performed by suppuration.

In small cases, nothing is more beneficial than _Diachylon Plaister_, (20) which assuages the inflammation, corrects the acrimony, and brings the wound to a good state.

Broken shins often occur on board a ship, which is of that species of wounds. And as from such a case, (though in general slighted) many evils have arisen, I would caution the mariner to apply immediately _Diachylon Plaister_ (20) to a broken shin; by which he will prevent having an ulcerated leg; a thing very troublesome.

If the bruised wound is on other parts, and the parts all round are bruised, care should be taken that it is cleaned as before directed, and a pledget of lint, with _Yellow Basilicon_, (F) will be necessary; over which a compress with _Spirits of Wine and Camphor_, (A) or rum, may be applied; and afterwards, when it begins to heal, it may be dressed with dry lint.

As these kind of wounds are liable of becoming ulcers, great care should be taken in the beginning to treat them properly.—Wounds in general should not be dress’d or look’d to too often; in general it aggravates the parts, and retards healing. A wound should not be opened the first three days after the first dressing: nature is very kind, and requires care only to replenish what is deficient.

When an ulcer has commenced, see the treatment under that head.

_Gun-shot Wounds._

These are the most terrible of all sorts of wounds; for it is not only the contusion that attends them, but frequently the ball forces strange things, as cloaths, &c. into the wound with it.

Gun-shot wounds at best are tedious in their healing, but very often, from their nature, liable to mortification, and thence become dangerous. Besides, it is seldom that the fleshy parts alone are wounded, but they frequently penetrate into the very bones themselves.

The first care in gun-shot wounds, is to extract the ball, or whatever is forced into the wound; in the next place, the wound should be dressed with _Yellow Basilicon_, (F) mixed with fine _Precipitate_ (O).

No. I

_Take Basilicon one ounce, fine Precipitate one scruple, and mix
them._

The parts all round should be well fomented with warm claret,
intermixed with _Spirits of Wine and Camphor_.

If the patient is full-bloody, and no blood lost by the wound, he should be blooded, and immediately treated as a patient in a fever.

If the pain in the parts become violent, eight or ten drops of _liquid laudanum_ (T), together with thirty or forty drops of _sweet spirit of nitre_ (D), should be given once, twice, or thrice a day. If the wound begins to discharge plenty of matter, it should be dressed with the same dressing often. But if the parts become black, very fœtid, the patient in great pain, and grows faint, a mortification is to be feared; which I shall treat of in its proper place.

When the suppuration is unkind, and the parts are much inflamed, a poultice will be very proper.

No. II

_Take oatmeal (15) or (if that is not on board) biscuit pounded
about three spoonfuls, honey one spoonful, water a sufficient
quantity to boil it into soft poultice; in which put of sweet
oil about half a spoonful. This poultice should be renewed twice
a day at least, and put on as warm as possible it can be borne._

As gun-shot wounds are apt to degenerate into malignant ulcers, I shall refer the reader to the treatment of ulcers in general.

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SECT. III.

_Of Bruises._

Bruises, in whatever degree, have more or less some blood and other vessels torn and injured, and may properly be considered as wounds under whole skin. It is from the tearing to pieces blood vessels, whereby the blood extravasates from their natural channels, that occasions the swelling. If the bruise is but slight, the vessels are soon enabled to circulate the humours; but if the contusion is great, the extravasated humours are apt to corrupt, and make a collection of matter; thence an aposthume and ulcer must naturally follow.

Bruises on fleshy parts are not so bad by far, as on the joints, because the fibres in the muscles are more pliable, and sooner unite; the ligaments on the joints are very rigid, and extremely sensible; for which reason also, they are generally more painful and tedious in their cure.

The first intention is to disperse the extravasated humour, and to strengthen the tone of the injured fibres. To this intention the parts should immediately be bathed with _spirit of wine and camphor_ (A). But if the bruise is immediately on the joints, the _linament of soap_ (B) is still superior. A bandage over the part, so as to keep it in rest as much as possible, is also of great service. If, however, the part is so very much bruised, that there appears a collection of crumous blood, and that an aposthume is actually the consequence, recourse may be had to the above poultice in order to ripen it the more, and bring it the sooner to a head; and then treat it as a common ulcer. But that seldom is the case.

If the contusion is great, and the patient is full of blood, bleeding is necessary; for in such a case a fever is apt to ensue, which should be guarded against, and the patient treated accordingly.

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SECT. IV.

_Of Dislocations_

There are many accidents by which a limb may become dislocated; the reduction of which is a material point in surgery. But if a surgeon is not at hand, a man ought nevertheless, not to remain in that painful and deplorable state, that endangers not only the limb of becoming useless, but even the loss of life itself.

I shall proceed therefore in my directions as plain as possible, avoiding every expression that may render this operation prolix.

It must first of all be remembered what was said of joints, articulations, and ligaments in the first lecture under that head. We must thence observe, that a dislocation of the upper arm with the shoulder is the most common that happens, because of the great variety of motion, and the flatness of the head of the arm-bone, and the cavity of the shoulder blade. Next to this is the thigh bone, with the hip. But this is done by much greater force, and therefore more troublesome in reducing. All other joints that are angular are seldom really dislocated, being stronger secured, and cannot be separated from their articulation, without first tearing the ligamentous capsula that surround them; yet nevertheless, some are subjected to be partly dislocated; and this is what is commonly called sprains.

Dislocations may be from two causes; first from violence, secondly from weakness of the ligament. In the latter case the reduction is the easiest, but the limb is apt to slip out again by the least accident.[11]

Footnote 11:

I remember a man who frequently had his shoulder dislocated, and was
his own operator in reducing it again. The first time the accident
happened in the ship I was surgeon of, I was naturally called to his
assistance: “Stop Doctor,” (said Tom) “I have got a tackle in my
chest, and I will soon bouse it in again;” and sure enough, he had a
pully, with which he immediately reduced it.

I shall briefly consider each kind of dislocation, that an accident makes a man liable to.

_Dislocation of the Arm with the Shoulder._

The dislocation of that, may be two ways; (viz) downwards, and forwards; but it cannot be backwards nor upwards; except some part of the shoulder-blade be broke.——The best method to examine the patient what kind of dislocation it is, (especially to one unacquainted with these branches of surgery) is strictly to compare both shoulders, and the difference will be very plain, both to sight and touch.

If the dislocation is downwards that is, the head of the arm-bone, slipt in the arm-pit, there will be a cavity on the top of the shoulder, different from the sound arm, and the elbow will be drawn upwards, without being able to be moved either towards the body; or so, as the patient to put his hand out without the greatest pain.

When this is found to be the case, then, in order to reduce it, set the patient low, on a steady seat. Take a napkin or towel, of which make a girt; put one part over your neck, and the other part under the arm-pit. Let an assistant hold the patient steady, another take hold of the patient’s arm, with the elbow bent, and extend it gradually; then with both your hands take the arm, and whilst you lift up the arm by help of the napkin resting on your neck, you press gently down the arm with your hands like a lever; in the mean time the assistant extends, and thus you reduce it; which you will hear by its snapping: upon which the patient will be able to move his arm in all kind of direction, without much pain.

If the head of the arm-bone is dislocated forwards, there will be a cavity backwards on the shoulder, and the elbow will stick backwards, and remain motionless, with great pain. In this case, as before, let the patient sit low, and with the help of the napkin, and assistances, first extend the arm forwards; then like a lever bring the head of the bone in its cavity; which, like the former, will be perceived by a snapping, and the voluntary motion of the patient’s arm.

When the shoulder is reduced, secure the whole with a long double-headed bandage, cross-wide over the shoulders, and round the body. Foment it night and morning with _spirits of wine and camphor_ (A). Keep the arm close to the body, with the elbow bent, and wear it in a sling, that it may be free from motion till it is well.

_Dislocation of the Elbow, or the Knee._

The elbow, as I said before, is very seldom dislocated, unless fractured, and the ligament tore at the same time; and when so, the case is terrible. But very often those joints receive a wrench, which, though nothing out of its place, is often very painful, on account of the many tendons that surround the parts. The only thing in such wrenching, is to foment it with _spirit of wine and camphor_ (A), or else the _saponaceous linament_ (B). The same method should be observed with the knee, securing it well with a bandage, in order to give it rest to recover: For rest is a principal remedy.

_Of spraining the Wrist, or Ancle._

The wrist and ancle are complicated joints, and thence capable of a great number of motions, and subject to a variety of sprainings, but not a perfect dislocation; nevertheless, they are very painful, and sometimes tedious in getting well. Whatever be the matter, the sick part should be compared with the sound, and the difference is soon seen.

If it so happens, that there appears a perceivable difference, the parts should be gently extended, and reduced; and all that is to be done, is the securing it well with a bandage, and fomenting it with _Spirits of Wine and Camphor_, (A) or, what is yet better, _Linament of Soap_. (B)

The thumb, however, is liable to be dislocated, which is easily perceived; which should be immediately reduced, and secured with a bandage, and treated as already directed.

_Dislocation of the Thigh Bone._

The articulation of the thigh bone with the hip is similar to the shoulder, with regard to the head of the bone, and the pan in which it moves, except that it is much deeper. It must be a great force that drives it out of its articulation, and consequently very difficult to be reduced. It may either be dislocated inwards, or backwards.

If the dislocation is inwards, which is the most common, the toes will be turned outwards, and the whole leg and thigh will be somewhat shorter than the other; so likewise, if it is dislocated backwards, the leg and thigh will appear shorter, but the toes will be bent inwards. The best way of determining, as I have said before, is to make a just comparison of the sick and sound leg.

The reduction is somewhat difficult, and will sometimes baffle the most experienced surgeon, because the acting muscles are very strong; and when they have first begun to contract the parts, they will not easily suffer themselves to be relaxed. Nevertheless, lay the patient upon his back or on the sick side, upon a steady table; let an assistant hold him fast, another extend the thigh, so as to have the knee bent; the operator having a napkin resting on his neck, and under the thigh of the patient, similar to the method directed before by the shoulder; and then with both hands bend the thigh, as with a lever, into its socket again; when it will give a loud snap, coming into its proper place.

It very frequently happens in this heavy dislocation, that either the articulation is not reduced, or that it immediately slips out again when reduced; so that the patient will never recover the former use of that limb more. In this case nature is very kind, and the part where the bone slips into will become callous, and form as it were a new acetabulum; by which the patient in time comes to walk, though (as it may be supposed) but lamely. In the course of my practice I have met with but two perfect dislocations of the thigh, both of them perfectly recovered; but it must be remembered, they had youth on their side, and the greatest care joined to favourable circumstances.

At best however, it is an ugly accident, for it is not only that the ligaments that surround the joint are generally torn, but very often the thigh bone is fractured at the same time. It requires more skill than one would suppose, to determine which is the case, whether a fracture, dislocation, or both; and am apt to believe they are often confounded with each other.

When the dislocation is reduced it should be well secured with a long double-headed bandage; the patient kept still, the part well fomented, and if requisite, some blood taken away: a fever generally attends, which should be duely taken care of.

On the whole, dislocations when they proceed from violence, are sometimes attended with severe symptoms, the parts being very sensible, and it will require sometime for the patient to recover his strength again.—Care therefore should be taken to keep the parts warm, and give them as much rest as possible.

A strengthening plaister spread upon leather, and put for a constancy round the parts after the inflammation is gone of, will also prove of singular service.

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SECT. V.

_Of Fractures_

We come now to fractures. There is something terrible in the sound of _broken bones_; and yet in common they are by far more easier managed and healed than a dislocated joint: nature is very kind; from the fractured parts of a broken bone, there exsudes a gelatenous matter called _Callus_, that very soon glews them together again, and makes them stronger than ever. As easy as a fracture is ruined, as easily it may be well treated. I shall therefore lay down some few rules, which if properly observed, will ever be attended with success, as they are founded upon happy experience, in my own practice.

In the first place, a fracture should be reduced as soon as possible. Secondly, the part should have as much rest as possible till the callus is formed, or the bone knitted together again. Thirdly, bandages should not be laid on too tight. Fourthly, camphorated fomentations should not be too plentifully made use of. Fifthly, the habit of body should be kept in a slate of health; and Sixthly, the diet during the time should be wholesome and sparing.

With regard to the reduction, it was formerly a great error for a limb to be stretched out in an extensive posture; for the extension of the muscles contracted the limb, and made the reduction both painful and troublesome.

I shall here recommend a better method; namely to have the muscles in a flexible position, during the operation and the cure. But to proceed to particulars.

_A Fracture of the Skull._

This accident is frequently attended with many bad symptoms, and often requires the operation of the trepan; which I shall here pass over, being too prolix for this place. I have only to observe, that we have frequent instances of the patient doing well without any other help than bleeding; and where there is no surgeon on board, this is the only remedy first to fly to, and gives the greatest chance for the patient’s life: next to this, shave the head, and treat him as circumstances shall direct, without meddling with the fracture, any farther than applying gentle fomentations, with _flowers of chamomile_ (11) boil’d in claret, and some _linament of soap_ (B) added to it; and if there is any wound, have it properly dressed as directed in the article of wounds.

_Fracture of the Arm._

If the upper arm is fractured, proceed in the following manner:

First of all be sure it is a fracture; to know this, put one hand on the middle of the arm, and the other on the elbow, move it gently to and fro, and if there is a fracture, you will find it crackle by the touch, which sometimes is so distinct as to be heard. The arm at the same time is somewhat swelled, and either the patient cannot move it, or else it is attended with very great pain.

When the fracture is certain, then proceed in the following manner; Let the patient sit upon a low chair, or chest, let an assistant hold him steady, and let another lift up the arm, and extend it gradually, horizontal to the shoulder, keeping the elbow bent somewhat all the while.

Then with both your hands gently press the fractured bone, so that it may feel perfectly joined again. Sometimes it happens that the ends of the bones are somewhat slipt over each other; in which case, extension is the more requisite.

When this is done, then take a bandage of about two yards long, first rolled up, and wrung out of _spirit of wine and camphor_ (A.); begin near the elbow, and lay it smoothly on, laping over a little; and proceed gradually till it comes to the shoulder, and then return with it back again till it is done.

This bandage should not be too tight, nor too slack, but so as immediately to suit the arm exactly. Over this bandage again, lay a double folded rag, called a compress, so as to cover the bandage; and over this again two splints, one above, and another below; which tie gently together with some tape in three places. Then put the arm into a sling; cover up the whole arm and hand, and let the patient go to rest.

If the fracture is upon the under arm, the reduction is a little more difficult; but only in the care it requires of reduction. As there are two bones in the under arm, it should well be examined which it is, or if both. In reducing of it, let the arm be bent as before; one assistant to hold the patient, one to hold the elbow, and another the wrist; gently extending, till the fracture is reduced, as before directed, and the bandage, compress, and splints, put on according to the same Method.

In this fracture the wrist and hand should be kept from moving; as the motion of their muscles will be apt in a great measure to hinder the bones from uniting again.

_A fractured Thigh bone._

This is of very great importance; which, from its situation, and the strength of the muscles, in general, even by the best method is very difficult to reduce.

Let the patient lay on the opposite side, and with the knee bent; let the limb be extended by assistances, and carefully set it according to the situation, similar to the beforementioned method.

This limb requires a very long bandage, and very large splints. The method of treatment must be as before, and the patient must be well secured in bed. He should not lie constantly upon his back in a straight posture, as formerly was practised; but most part upon either side, with his knee bent, which should be kept bent as much as possible; if he can lay chiefly upon his sick side, so much the better; he may also move a little his joints, in order to prevent them from growing stiff.

_A fractured Leg._

This accident is more common, and therefore ought to be paid the greatest attention to.

To know for certain whether the leg is fractured, let the patient lay on his back or on either side, with his leg and thigh bent, so that the muscles are entirely at ease, and out of action. Let an assistant hold up the leg by the knee; then take with one hand the ancle, with the other the middle of the leg, and move the ancle to and fro, holding the other hand steady, and if you feel a crackling, and the patient feels great pain in those parts, the leg is certainly fractured; particularly if the patient could not stand upon it before. This being fully discovered, we must next examine which bone is fractured, the _Tibia_ or _Fibula_; and then proceed in the following manner.

Let the patient lie as before directed; one assistant holding the knee in a bent position, another holding the leg near the foot, both gradually extending.

Then with both your hands reduce the fracture, by gently pressing it with the palm of your hand while it is extending. Then lay on a long roller; or, what is still better, a many-tailed bandage, which is made thus: Take nine or ten slips of linen, about two inches broad, increasing from twelve to twenty inches in length, laying over each other about half an inch. The whole bandage must be secured with a slip of linen behind, so as to make the breadth of the bandage the length of the leg; either of these must be previously wrung out in camphor spirits.

If you make use of the roller, begin laying it on from the ancle, going gradually upwards, folding each round over half an inch at a time; and under the calf of the leg, give the bandage a single twist, by which it will always suit. Continue this till the whole is finished.

Over this again put a compress, and then put on the splints, (previously bolstered with some tow) which secure with tape, as before observed with the fracture of the arm.

The many-tailed bandage is however superior to the roller, in the fracture of the Leg. The method of laying it on is this: the patient laying upon his back, with his thigh lifted upwards by the assistant, put the bandage under the calf of the leg; then begin from the ancle upwards, folding over alternately the tails of the bandage, so that they secure each other. When this is compleated, put over the whole a _Compress_, as before directed, as also the _Splints_; or in the room of common splints, put on the new invented splints of Mr. Sharp; of which a ship should have three or four pair of different sizes, both for the right and left leg.

When this is performed, the patient should be put to rest as soon as possible; and he will lay easiest upon the side where the fracture is, with his thigh and leg bent forwards. This position suits not only best on board a ship where the motion is continually apt to disturb the sick part, but is also most natural both for ease, and for healing; as the muscles are all at rest, and adds firmness and ease to the body.

_Compound Fractures._