Chapter IV: Part 4

When a fracture is attended with a wound, it is needless to observe, that the case is of a more dangerous nature. If the contusion has been so great, as to splinter the bones, such splints as are loose, and seem to prick through the flesh, should by all means be removed. Violence must however be avoided; for by a little patience, nature will of her own accord separate and discharge them.

Gentleness should ever be observed in surgery, though not a timid weakness, by being defective in dressing properly. The reduction of the fracture should be conducted the same as before, with this difference, that always a many-tailed bandage should be chosen, so that it may be opened when requisite.

The dressing of the wound should be the simplest possible; for the nature of bone is so delicate, that it will neither bear to be much exposed to the air, nor suffer any greasy salve or ointment to come near it; both are liable to corrode it, and bring on a carious, which is of a most dangerous tendency. Dry lint therefore is the best, particularly near the fractured bone.

In short, it is to be treated cautiously, like an ulcer, and the greatest care to be taken, that the arm, leg, or whatever fractured part it is, be kept steady, and no oftener dressed than what is absolutely necessary.

_Conclusive Observations on Fractures._

In the obscure times of surgery, various medicines were applied to broken bones, with a notion to unite them the sooner. This, however, is entirely exploded from modern practice.

The inflammation that generally attends fractures requires however a fomentation of _Camphor Spirits_ (A), in order to disperse the obstructed humour; but if there is no inflammation, the part undoubtedly is the better without such applications; as then there will be nothing to hinder a free circulation; for which reason, fomentation should be used as sparingly as possible.

It is well known too, with what difficulty the fractured bones were set formerly, owing principally to the limb being stretched out in a position that excited all the muscles to contraction. This is also here obviated.

In reducing therefore a dislocation or fracture, the muscles should be as much at rest as possible, both in the operation, as well as during the whole time of the cure. It is for that very reason my direction in this respect differs from what has been delivered to us by authors on that subject, particularly such, as might be expected to fall into the hands of a seaman.

Another error has been practised, namely, the laying on the bandage very tight. It was supposed, that that would strengthen the limb, and make the bone smooth; but it has sometimes prevented the bones from growing together at any rate. The bandage to be sure should not be too slack, for then we might as well lay it aside entirely. A bandage certainly is necessary, but merely as a support, and it should never be tighter than what the patient can well bear.

In simple fractures, the first dressing should be so permanent, as to have no need for being removed, at least for six, seven, eight, nine days, or more; if the patient don’t feel uneasy. For my own part, having ever been successful in fractures, I have not opened the first dressing for a fortnight, and sometimes three weeks.

The laying stretched upon the back when a leg is fractured, is altogether needless, troublesome, and even a hindrance to the healing. The patient should have a good wide cot, and so that it may swing pretty easy; or else entirely confined, when the ship has much motion; and having the leg well secured with splints, he may safely lay on what side he pleases, provided he does not sit up in the bed (though he may out of it) for the first three weeks; for that strains the muscles very much.

The diet should be sparing, the body kept open, and a temperate warmth should be preserved, in order to promote perspiration. Drinking of strong liquors should by all means be avoided, and the diet should be as fresh as the circumstances will permit.

Six weeks is generally the time allowed for the cure; that however is no certain rule. If the fracture is simple, and the constitution good, then at a month’s time a small trial may be made by the help of crutches, or a trusty mess-mate, in a calm day; but if it occasions the least pain, it should be postponed.

This is then all I have of consequence to observe in simple fractures; which holds good also with compound ones, except that the wound requires to be dressed oftener; but the greatest care should be taken, that it is done in a manner, so as not to disturb the knitting of the bone.

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SECT. VI.

_Of Scalding_

Scalding is another accident of much consequence, which ought to be remedied by times, in order to prevent the many evil consequences of inflammation it is liable to produce.

I must first of all refer the reader to what I have said on the skin, Lect. I. Sect. VII. for farther than this we will not suppose a scalding proceeds, unless it is very dreadful indeed.

The nature of scalding then, is this: the hot water coming upon the body, separates immediately the scarf skin from the real skin, thereby opens the lymphatic vessels, so that they discharge their lymph under the cuticula, and thence arise blisters. But withal, the heat of the water irritating the nerves, they are excited to contract and constrict the delicate vessels, and hinder the circulation; thence ensues the fiery colour and inflammation, and create acrimonious tendencies. Thence we learn, that a relaxation of the solids is to be relaxed, and the humours to be rectified.

The moment a man has scalded himself, immediately apply _Turner’s Cerate_ (K), spread upon a rag, to the part. What is equally as efficacious, and sometimes better, is the _Linament of Soap_ (B). If notwithstanding this, blisters arise, open them not, but let them remain with the application on them, whereby a cure will soon be facilitated; but if they break open on their own accord, or that the scarf skin was scalded off, then apply on the sore, _Turner’s Cerate_ (K), intermixed with a little _Calomel_ (N), and levigated _Precipitate_ (O), which will prove very beneficial.

No. III

_Take Turner’s Cerate_ (K) _one Ounce, Calomel, and fine
Precipitate_ (O) _of each ten grains, and mix it._

This spread upon a little lint will prove a fine healer. If the _Diachylon Plaister_ (20) can be applied, it will also prove so powerful an _antiphlogistic_, that any other will be unnecessary.

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SECT. VII.

_Of Burning_

This is of the same nature with scalding, but is liable to become more pernicious, in proportion to the bulk and heat of the body that does the mischief. If it is slight, the treatment is equal with the former; but if it has penetrated deeper, it follows, that the inflammation is greater, and consequently the treatment requires more care.

If the sore so burned is deep, and thence an eschar in the parts, digestive medicines should be applied. It will not be amiss to put a little Mercurial ointment (P) in the poultice. If the inflammation is very great, _Bleeding_, and other methods requisite to prevent a fever, should be observed. In general, the ointment No. III. will ever be found Efficacious.

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SECT. VIII.

_Of Drowning_

A Man who unfortunately falls over board, and is taken up for drowned (immediately) should not be given up for lost. As this is a circumstance of the utmost consequence to a sea-faring man, I shall think my time well rewarded in explaining the method of recovery contributing to the preserving the life of my fellow creature.

There are different ways of drowning; and according to the nature of the accident, the probability of recovery is founded.

A man, before he comes into the water, may receive an unlucky blow, that will not only stun him, but make him expire his breath (which is generally the case in high falls) as before observed. In this case his senses are benumm’d, and by the inspiration apt to draw in a quantity of water into his lungs instead of air; thence, both from the blow, and from the total stoppage of respiration, he may have some blood vessels burst, both in the lungs and in the brains, whereby he is instantly irrecoverably dead, beyond all hopes. In this case it may happen, that either way, separately, is enough to kill him.

A man may also, in the very act of drowning, swallow a prodigious quantity of water; not only filling his stomach and intestines; but thence forcibly infuse the water into the lacteals, thereby overload them, and force it into the blood vessels that they burst. The great quantity of cold water will also be apt to chill the stomach and intestines; thereby destroy the sensibility, and prevent them from performing the peristaltic motion; and by the universal consent, destroy the whole nervous system, which is the spring of life, that promotes the blood to circulation, and consequently stops the animal motion, and life itself.

But the most common way of drowning is by suffocation; namely, a sudden constriction of the respirative organs; whereby the supply of the air is cut off, and consequently the circulation of the blood must stop. This is verified by the frequent instances we have of people drowned, who have scarce any water, either in their bellies or in their lungs.

To understand this properly, we must first observe, that a continual supply of fresh air is requisite for the circulation of the blood; partly and principally for its motion, and partly from the nourishment the blood actually receives from the air. In the next place, we must also consider, that the lungs, appropriated barely for respiration, are so very delicate in the irritability throughout the larynx, aspera, bronchea, and vesicles themselves, that the least heterogeneous particle stimulates them to a convulsive expulsion, of what seems obnoxious to them, and thence excites a cough. But, when the parts are too irritating, the lungs are excited to a universal constriction, and occasions strangling. This we find is the case when in drinking or swallowing our aliment, that the least morsel happens by mischance coming the wrong way (as it is called) that is, into the larynx, occasions a heavy cough, or even a suffocation; to obviate which, nature has formed the epiglottis in the larynx, like a flap, that opens in respiration, but is always shut in the act of deglutition, except by some mischance or other, that it becomes lame, and unable to do its office.

These circumstances considered, we shall not only be able to account for the act of drowning, but discover the principles that furnishes us with probabilities of restoring life again.

I have mentioned three kinds of drowning that at present occurs to my memory; and unless that some blood vessels, either in the lungs or in the brains, or in some other principal viscera are burst; or, that the lungs are so much filled with water, as to be unable to recover their respirative functions again, (which is seldom the case) or, that the whole nervous system has received a universal paralytic shock by the chill of the Water in the stomach, so as to be robbed of its irritability, either way of drowning is recoverable. For the whole mystery consists, in setting the animal automaton or clock-work in motion, again; to stimulate the nerves to their sensation; to set the heart a pumping; and the lungs, in order to push forward the fluids, in respiration. I could say much on the subject; but philosophy aside, let us endeavour to recover the man to life again.

_The Method to recover a drowned Person._

Three things are to be the intention to restore life in a person taken up for drowned.

1. To liquify the fluids. For the moment the circulation of the fluids is stopt, the blood and lymph congeals; and after this, putrefaction gradually commences.

2. To stimulate the nerves. For on the irritability of the nerves life itself depends; and which sets every thing in the animal fabric in motion.

3. To restore respiration. For without this, neither can the blood circulate nor the nerves have sensibility.

The moment therefore you receive the person drowned, strip him of his wet cloaths, and wrap him up in three or four dry blankets; if his belly is swelled with water lay him across a chair or barrel upon his belly, in order to make him void the water; but in this spend not much time, but be as quick as possible. Take a good quantity of salt, the more the better, with which employ three or four handy men to rub him all over;—his temples, his wrist, his arms, his breast, his back, his groins, his knees, his ancles, &c. let this friction either be by the hands or rough woollen cloaths pretty briskly; and, whilst this is doing, let one apply his mouth to that of the patient, stop his nostrils, and with all effort blow gradually into his lungs, and try to make him breathe. If the lungs are open to this, there is a good prospect of recovery, and let the breathing into the lungs be briskly repeated. In the mean time, try to open a vein in the arm; if the head is bloated, as it frequently is, open the jugular vein, or whatever vein that appears distended in and about the head.

On signs of life, continue the friction briskly, rub some _essential oil of peppermint_ (U) in and about his nostrils. If he recovers, at first he will open his eyes, heave his breast, his heart will beat, and gradually he will move some of his limbs. If he opens his mouth put a little salt in it at first, next give him the following draught.

No. IV

_Take essential oil of peppermint_ (U) _six drops, upon a lump
of sugar, which dissolve in a table spoonful of elixir
proprietatis_ (H).

If he inclines to vomiting, promote it with decoction of _camomile_ (11) or a vomit of _ipecacuanha_ (S); besides all this, blankets should continually be warming, so as to preserve a warmth of the body.

If he is fortunately brought to life, put him directly into a warm bed, and give him a dose of the _fever powder_, and let him drink freely of good sage punch, in order to promote a perspiration, which is here very requisite.

No. V

_Take sage about a pugil_ (that is as much as you can well take
betwixt three fingers) _on this pour boiling water, one quart;
to which add sugar and good old Jamaica rum, sufficient to make
it agreeable, but not too strong_. Or instead of this give him
some mulled wine.

A fever always attends a patient after the recovery of Drowning; therefore care should be taken when he is brought to himself, that he is not over heated by liquor; as this is liable to throw him into a disease as dangerous as the narrow chance he has just escaped.

Should however the above methods not succeed, you must not despair. If the lungs, or the larynx seem so contracted that it appears impossible to blow breath into him by the mouth, recourse must be had to _bronchotomy_, that is, opening the wind-pipe betwixt the third and fourth cartilage; to which a man should put his mouth and inflate the lungs; the throat should be tickled with a feather, a little pepper blown up the nostrils and the body here and there scratched with pins, or small wounds made in the legs and arms, and plentifully rubbed with salt. If there is salt enough to do it, the patient ought to be covered all over.

We have instances that patients, after two hours application, have been brought to life again; therefore every means possible should be tried. Of all the various stimulants, salt, or potashes, is the best; spirits must not be made use of, nor indeed vinegar, in the time of recovery; as that is liable to congeal the blood, and prevent it from circulation, till the recovery is procured; when the sage punch, or mulled wine, or some other cordial may be proper. Spirits of hartshorn, if it is on board may also, with propriety, be held to the nose, or poured a little down the throat, as that is stimulating, but not coagulating.

When at length the patient has recovered, let him take the forementioned draught No. IV. as also the warm sage punch No. V. and take all possible care for his recovery.—If Bronchotomy was obliged to be performed, let the wound carefully be washed, closed, and dress’d with dry lint; over which lay a compress with warm claret intermixed with _camphor spirits_; and the more to favour the healing, let his head constantly be inclined; rest should also be promoted as much as possible, for which purpose 8 or 10 drops of _liquid laudanum_ will be very proper; likewise silence should be strictly imposed on him; and that should be a material object to be observed, by those who tend him. In every respect else, let him be treated as is directed under the head of fevers and other circumstances, as they shall occur.

Here then I shall conclude this lecture, and beg leave to observe, that as mankind are ever liable to accidents, particularly that class I have here devoted myself to serve, it behoves us ever to be provided with preconsiderations, that we may be always ready to give our friendly assistance in the hour of distress. In time of need, the mind is too much hurried to read with any attention; and dangers particularly from accidents admits of no delay.

The prudent seaman, especially the father of his Crew will therefore make himself acquainted with all these circumstances in his hours of tranquillity, by which he may ever be ready with his friendly aid, and receive the blessing of him that is benefited by his Humanity and generous care.

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LECTURE IV.

ON

EXTERNAL DISEASES,

AND THEIR

CURE.

In this lecture I shall treat of external disorders, which may take their origin either from injuries, or from internal acrimony of habit; for whatever disturbs the animal œconomy, prevents the natural order of the fibres, and those again when in disorder, corrupt the fluids.

Be the causes what they will, certain it is, that there is a strict connexion between the external and the internal parts, to which due regard ought ever to be paid. I shall without delay proceed to their various kinds.

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SECT. I.

_Of Inflammation_

When either the solids are so injured that they will not transmit the circulation with their natural freedom; or when the humours are become so acrimonious, as to constrict the small tubes, that part of the fluids becomes confined in them, there must then of course be an obstruction of the circulation of the fluids, thence accumulation must follow and consequently swell the parts. And this is the nature of an inflammation.

The blood being obstructed, the parts must naturally swell; the blood being forced into the small lymphatic vessels, thence proceed the redness; and lastly, from the vessels being distended and irritated by the stagnated humours, proceeds the pain.

An inflammation terminates three different ways. When the solids relax, or the fluids become attenuated, so that the accumulated humours disperse, and are admitted a free circulation again, it is termed _resolution_; and this is the best and most favourable way for an inflamed and tumified part to terminate.

When some of the small vessels by the over-stretching of their contained humours break, together with the lymphatic vessels, and the extravasated blood intermixed with lymph is converted into matter, it is termed a _suppuration_; this is also a favourable way of termination, provided the matter is properly concocted and discharged, and the parts properly healed up again. And this ought to be the second indication when the first does not succeed.

When however the imprisoned humours enclosed by their tubulæ are inspissated, and mix irregularly with the solids that contain them, obstinate tumours are apt to ensue. This is the third kind of termination, and should be avoided if possible; for it either becomes tedious, or occasions malignant ulcers; which in glandulous parts are the first foundation of cancers.

But, when the humours that are obstructed get malignantly corrupted into a pernicious acrimony, and stimulate the distended solids, so that they stretch beyond their natural tone, without admitting any circulation, the parts become insufferably painful; the patient is restless, anxious, and attended with an acute fever; the humours become offensive and fœtid, and the parts at length turn of a livid colour, and this is then called a _gangrene_. Gradually the parts begin to putrefy and grow black, the humours acquire a cadaverous fœtor, the solids lose their natural texture, and die. This is called a _sphacelus_, or mortification; and unless the mortified parts are removed from the sound, death must inevitably be the consequence.

These are the different terminations of inflammation; and whether the cause is from external injuries, or from internal acrimony, the indication must ever be the same, I shall consider each separately.

_Of Resolution._

Inflammation that attends wounds, contusions, &c. should be dispersed by the application I have already mentioned in the foregoing lectures, viz. _camphorated spirit_ (A), or _liniment of soap_ (B), the first suits best the fleshy part, and the latter the inflammation on the joints and tendinous parts. But when with the inflammation a wound is compounded, and is obstructed in its suppuration, recourse should be had to poultices; as thereby the fibres may be the more relaxed, so that the ulcer may the freer discharge the matter, thence drain the inflamed part of the obstructed humour, and consequently remove the cause of the inflammation.

_Of Suppuration._

When an inflammation arises from an internal cause, there generally is some acrimonious humour that wants to be discharged; in this case resolvents is not always safe, as it is ever apt to increase the pain and inflammation. Of that kind are the boils and swellings under the armpits, hams, and other parts. In this case, poultices should be applied as warm as possible; the ingredients may be oatmeal, or biscuit powdered, honey and a little butter, warm and largely applied. When the swelling increases, grows red, and acquires a top, together with constant throbbing, it is a sign that matter is forming, which is the more confirmed by its growing soft. When the fluctuation of matter is actually felt, and that the top becomes somewhat of a black and yellow colour, it then is mature for being opened, in order to let out the matter, which is best performed with a lancet: this being done, apply the poultices again. And when the matter is fully discharged, lay on the diachylon plaister, in order to heal up the part. Should however an ulcer be the result, it must then be treated accordingly, as will be directed under that head.

_Of Tumours._

When inflammations will neither disperse nor come to suppuration, it is apt to form hard tumours; sometimes they are indolent, at other times very painful. In this case, nothing is better applied, than _mercurial plaister_ (21), and especially if there is any venereal taint in the habit. At the same time, whenever tumours are dispersing, care should be taken to use internal medicines, in order to correct the acrimony, and a purge now and then, in order to incline the humours to be carried off. If, however, they incline to suppuration, poultices should be again applied; and to bring them sooner to a head, purges should be omitted, till after the matter is discharged.

_Of Mortification._

A Mortification has two degrees; gangrene, the beginning, and sphacelus the compleated mortification. When an inflammation will neither disperse, suppurate, nor become indurated, but, on the contrary, increase with a burning inflammation, and is prodigious painful; when the swelling continually increases, the parts become uncommonly tender, attended with a numbness; the colour changing from a fiery red into a livid ash colour, and the cuticula seems to separate on the touch, a gangrene has commenced. In this melancholy case there is no time to lose.—Apply the following powerful medicine, which in a gangrene, and even a sphacelus, has proved beneficial to a miracle.

No. VI

_Take Mercurial Ointment_ (P) _one ounce; Calomel_ (N) _and
Powder’d Precipitate_ (O) _of each one drachm; Oil of
Peppermint_ (U), _one drachm; Spread this upon a rag, and apply
it to the gangrenous part._

If a sphacelus has commenced, the skin turned livid, attended with a cadaverous fœture, and seems to the touch to be rotten, it must be scarified to the quick with the lancet, and then the above remedy applied. But if it has already reached the bone, (which a mortification soon will) and seems to make a rapid progress, all external remedies are of little avail, and nothing but amputating the limb can save life. But as that operation ought to be performed by a skilful surgeon, I shall therefore omit it here; only observe, that there are very few cases, but that this dreadful catastrophe may be prevented, if timely assistance is given.

To conclude this section, I think it requisite to observe, that a gangrene and sphacelus, or mortification, is far from being so often the case as many from the pain they undergo, are apt to persuade themselves. A common boil, whilst it is in an inflamed state, is sometimes so very painful as to put the patient in a fever, and will be excessively tender. But, notwithstanding, a suppuration is the result.

A gangrene and mortification is only to be dreaded, when a whole limb is inflamed, such as an arm, a leg, &c. When the inflammation is dreadful, that the blood can find no passage at all, but is obstructed on all sides, then the part must naturally die, and become cadaverous. The cause of this misfortune may be either a heavy contusion, a compound fracture, a gun-shot wound, or an internal malignity of the bone itself; and as a caution, I must also add, that pricking a tendon in bleeding may occasion this dreadful malady.

There is another kind of mortification which proceeds from a bad habit of body, a poorness of constitution, or when the whole mass of blood is corrupted by the scurvy. This shall be taken notice of in its proper place.

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SECT. II.

_Of Ulcerations_

This is a part of surgery that many pretend to, but what very few really understand. There are however laws in the animal œconomy, which when they are violated, leads us to trace its many evil consequences.

An ulcer is a dissolution of solids, occasioned by acrimonious humours, which not only act spontaneously upon each other, but prevent the remaining circulating part from the formation of unnatural substances.

Exulceration, strictly speaking, is what every part of the animal fabric is subject to; from the external surface, to the very substance of the bone itself. In this sense, every eruption, as well as the carius of the bones come under that denomination; but more particularly, the corruption of the softer parts on the surface of our body, is here the subject.

I shall not enter into a detail of the many kinds of ulcers generally enumerated; they have all in common an corruptive acrimony, and a depraved accretion of excressence in their nature; which differ only, according to the parts ulcerated, and the habit of body; and I have ever found in my practice, that one proper method serves for all; I shall therefore in a simple manner give such directions as will ever be attended with success.

The principal intention is to correct the malignity of the humour peculiar to ulcers; to bring them into a good suppuration, and nature, all kind NATURE! will perform the rest.

When an ulcer is inflamed all round, filled up with fungous substance, of various colours, the matter thin, ferous, and is very fœtid; then first wash the sore gently with some good soap suds, or let the part ulcerated be steeped in it for some little time, which will draw out the malignity; then apply the following dressing:

Take the powder of burn’d _Allum_ (17), and with a little lint dab it all over the fungous part, then spread a pledget of the salve mentioned in gun-shot wounds, No. I. and over which apply a good warm poultice there also mentioned. Let this dressing be repeated twice or thrice a day, till the inflammation ceases, and the fungous substance becomes reduced; when then, the washing, the allum and poultice may be left off, but the mentioned salve continued till the sore looks of a pale red, and begins all round the edge to heal up.

Cleanliness is very commendable; but in this case, when a sore looks well, the matter becomes of a pale yellow; wiping should be very sparingly; and then, dressing once a day (the morning) is full sufficient; for by wiping, and often meddling with it, the small granulations of the flesh is hindered from growing, and healing is retarded.

A sore leg is very troublesome, and very often attended with pain and expence, to no purpose. It generally swells, is inflamed and troublesome at night. Let the leg be bathed every night, (with the open sore) in some good warm soap suds; or instead of that, take what you can have plenty of, namely, sea water. If you can have it warm, it is well, if not, make use of it cold, rather half a dozen times of the day, than omitting it altogether; and by dressing the leg as before directed you’ll have reason to thank me for my good advice.

Sometimes the bone is affected; in which case, the cure with the best dressing in the world will frequently be tedious. A sore of this kind will not heal till the bone has discharged a scale, (termed _exfoliation_.) But tedious as it is, very often it is made more so, by unnecessary trouble. Without intending to give offence to my brother surgeons, I have frequently seen bad consequences attending methods taught with diligence in hospitals; take my word for it, you will do no good with your scraping tools, throw them over board, and you’ll succeed better than using them in this case.

The bones, though the hardest, are the most delicate parts in the whole body; but when it is affected, nature forms a new periosteum over the sound part, and gradually pushes forward the decayed scale. This wonderful work is performed by nature only, and must not be disturbed. By scraping, and boring of it, the tender periosteum will only be molested, the sound bone will become foul again, and so you may go on for ever; and I never saw a sore of that kind healed up by this improper method, till nature over-powered art, or the surgeon was tired with scraping, perforating, &c. but I have known many amputations in consequence of it, and many lives lost in consequence of that again; yet there is no rule without exception. There are cases where operations of that kind on the bones is required; but that ought to be referred to a judicious and experienced surgeon.

When the sore remains fungous, the proud flesh sprouts out in little bunches, and the matter is muddy and stinking, it is almost a sure sign the bone is foul; and if you examine with a probe, you may generally feel it, or even see it, and the bone, is sometimes black, brown, &c. and generally very rough on the surface. In such a case, continue the dressing as before observed, and frequently examine whether the scale loosens; at the same time examine (not too roughly) which way the scale inclines, also the bigness of it; and if there is a probability of extracting it, so that the fungosity only stops it, then freely use a bistoury to make way for it; but in this be not in too great a hurry, for care should be taken (as I have said above) not to extract the scale, till the separation from the fresh bone is mature.

If an ulcer is sinous, inject in the sinus, a mixture of burnt allum and water, viz.

No. VII

_Take water two ounces; burnt allum_ (17) _two drachms; mix them
well for injection._ After two or three dressings with this,
inject the _antacrid injection_.

No. VIII

_Take two ounces of water, with one scruple of calomel_ (N), as
I have described in my treatise on the venereal disease.

This is the proper management of ulcers in general, and will ever be attended with success, even in the most inveterate kind. In venereal ulcers, the mercurial ointment with the precipitate, may be applicable, especially in shankers. I shall therefore end this section, for having directed the management of the worst of ulcers, the inferior kind will of course yield to the same method.

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SECT. III.

_Of Diseases of the Skin_

Under this head I shall consider all kinds of breaking out, exclusive of that, which attends inflammatory and acute fevers, as they are all of one nature, and will all yield to one method of cure.—All proceed from a corrupted humour, which nature endeavours to expell from the body, by driving them to the surface, as that is the least resisting part.

_Of the Itch._

The itch may either proceed from original acrimony, or it may be catched from a mess-mate who is infested with the disease. In itself it is of different kinds, but the diversity in this respect depends principally on the habit of body afflicted with it. Sometimes it is dry, scaly, and attended with very great itching; in that case, it proceeds generally from a scorbutic habit, and is attended with a slow inward fever. Sometimes it is more moist, and utters itself with bladders all about the hands, particularly betwixt the fingers, and is a sufficient testimony of the disorder. The principal indication is to purify the blood; and in the mean time recourse may be had to external means. A purge is first requisite.

No. IX

_Take powder of jalap_ (R) _one scruple; calomel_ (N) _three
grains, mix it with a little sugar and water, and let the
patient take it early in the morning, working it off with balm
or any other tea_; after this some pills may be made of calomel.

No. X

_Take stomach powder_ (M) _two scruples, calomel_ (N) _one
scruple; sugar about one scruple; mix them, and with a few drops
of water make it into a mass, and divide it into twenty pills._
Of which let him take one every morning and night.

Externally make use of the following:

No. XI

_Take Turner’s Cerate_ (K) _two ounces; Precipitate_ (O) _two
drachms; mix them._

Let this be sparingly rubb’d on the itchy part; if it should be too hard, mix with it a little sweet oil. When the pills are all used, another purge like the former may be given; after which if requisite, a few of the same pills, one every night, will not be amiss. Should it be very obstinate, a little _mercurial ointment_ (P) about one drachm to the above quantity may be added; particularly if the ship is in a warm climate. Should these medicines seem to affect the mouth, as people vary much in this respect, a purge will set all to rights again. This is a safe and expeditious method of curing the rankest itch, even of the worst kind. If however there is a fever attending, a few _fever powders_ (L) should be given when going to rest, in order to promote perspiration; at the same time using the before mentioned medicines. In regard to the scorbutic itch, that I shall take notice of, under the title of that disorder. During the cure of the itch, a decoction of the _sassafras_ (14) should be drank, as that is a great purifier of the blood.

_Of Boils._

Boils are sometimes very troublesome, and at times exquisitely painful; especially when they are on tendinous parts: they are always a sign of foul blood, and nature very often that way frees the body from diseases. They may frequently be dispersed in the beginning of their coming, by pressing, and gently pinching them: but unless they are very numerous, such a method is unsafe; because it forces into the blood again what nature endeavours to discharge. The best method is to bring them to a head as soon as possible, to which purpose I shall here recommend a paste that is very powerful.

No. XII

_Take oatmeal and make it into a paste with honey_ (E); _this
will speedily ripen them, and facilitate the collection of
matter._

Should the boil not open of its own accord, and matter should be observed to fluctuate in it, open it with the incision lancet; and continue with your honey paste, till the core is discharged; when the _diachylon plaister_ will heal it up.

_Of Ring Worms, Daw Worms_, &c. &c.

These are very troublesome, and though at first they seem but insignificant, very often they lay the foundation to stubborn evils. In fact they are but a peculiar kind of itch; and the very same remedy that is recommended above for the itch, is equally powerful to remove this: what necessity is there then, of increasing words with a tedious description of their various appearances; since they will all yield to one substantial remedy?

_Of the Morbis Pedicularis_, or, _Lousy Disease_.

It is an unhappy circumstance on board a ship, when a man is afflicted with this filthy distemper; and such a man is as pernicious to a ship’s crew, as a rotten sheep in a whole herd. If it proceeds from a lazy filthiness of body, a gentle washing with a good scrubbing-brush, and rubbing the back with the boatswain’s towel,[12] is a pretty amusement enough to circulate the blood and to excite cleanliness. But sometimes this disorder has its seat in the very blood itself, and that filthy vermin will breed under the skin, and eat their way through, by clusters.—I have opened boils as big as pigeons eggs, from which large bunches of lice have followed the lancet.

Footnote 12:

A cat of nine tails.

These patients are in every respect wretched, and are actually objects of pity. They generally have a pale, sullen, heavy, half-starved, cowardly, in short a lousy, look; habitually lazy, and seem to be void of every manly passion; neither good nor ill-natured; and are stimulated by nothing but pusillanimity; and as they seem neither sick nor well, I say they are objects both of pity and contempt; though the latter is unjust, because they cannot help it.

The reason of all this wretchedness is because the blood is degenerated into a lifeless mass of pituitous corruption; and wants that spirit which gives a relish to life. Hence we see in this one instance, how much the mental faculties depend upon the state of the body.

In order to cure this unhappy patient, the blood must be purified, and the whole system stimulated to a brisk circulation. Nothing less than mercury will do the one, and stimulants together with exercise, effect the other.

In the first place give him the following medicine.

No. XIII

_Take ipecacuanha_ (S) _one scruple; jalap_ (R) _ten grains;
calomel_, (N) _four grains; make it into a draught or bolus._

Let him take this in a morning upon a fasting stomach, and let him drink plenty of chamomile tea after every vomiting; then give him the following electuary.

No. XIV

_Take lenitive electuary_ (I.) _two ounces; black pepper
powdered, two drachms; calomel_ (N), _one scruple; mix them._

Of this let him take every morning one tea spoonful; upon which let him rub himself all over with the mercurial cloth as follows, till he comes by this exercise into a breathing sweat, at least for an hour; and for the rest of the day keep him in continual exercise.

No. XV

_The mercurial cloth._

_Take a cloth or rag as much as half a yard square, upon which
spread one ounce of mercurial ointment; let the patient work
this into the cloth with his hands, so that it is equally all
over alike._

With this cloth let him rub his wrists, arms, shoulders, top of his head, his back, knees, waist, thighs, and legs; and continue this rubbing once every morning with the same cloth for a whole month, putting the cloth in his pocket when he has done.

His sores may be dressed with the above ointment No. XI. The decoction of sassafras, and a dram of spirits, with a little _Turlington’s Balsam_ after his morning’s exercise, will prove greatly to facilitate the cure. This is the method I have pursued with this filthy disorder; and I have succeeded to my most sanguine expectations. And by this, I have been fortunate enough to be the means of making men again, of wretches that were a burden to themselves, and a nuisance to the people that were obliged to associate with them.

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SECT. IV.

_Of Promiscuous Disorders._

Having thus treated on the most material ailments that want immediate assistance, I shall in this section consider promiscuous disorders, that have no relation to each other; but set them down as they occur to my memory.

_Of the Tooth-Ach._

Those who have experienced the tooth-ach, best know how much they have wished for ease. No man can preserve attention to his affairs, who has bodily pain; and a severe tooth-ach is enough to disturb both body and mind.—But what is to be done?

Tooth-achs are of two kinds;—It may either proceed from cold, or from a decayed tooth, or from both. If the tooth is decayed, the sooner you have it out the better; but if your tooth is sound, then it is as unreasonable to draw it, as it would be to sling you over board, because you feel the pain. In regard to drawing the tooth, take this direction.

_To draw a Tooth._

Observe first, what tooth it is; and shift the hook on the key instrument accordingly. Ordinarily the hook is to be inside, and the comb outside. When this is adjusted, wrap a little rag on the comb of the key, so that it may bear a little softly on the gums.—Then seat the patient steady on a chair or chest, (and if he is a coward, let somebody hold his hands, but a man of spirit will not want this officiousness) place yourself right before him—then fix the instrument on the tooth, the hook inwards, and the comb outwards; the hook on the tooth close to the gum, pushed a little towards the jaw bone, and be careful that you have hold but of one tooth, and the right one.

When your instrument is fixed as gentle as possible, without giving pain, (for if you fumble too long, and give pain, you intimidate the patient) I say then, when you have fixed your instrument properly on all sides, so that you have the condemned tooth, and no more; then shift your hand so, that you may have a good and firm hold, allowing for the turning of your hand.—Thus being ready, give your hand a gradual, and steadfast turn, and wrench the tooth out of its socket. In this you must be calmly resolute, neither spare your strength if requisite, nor let an untimely compassion get the better of your duty; but keep your hold till you have performed the operation. When the tooth is out of its socket, it will sometimes hang a little by the gum; introduce your fingers, and they may nimbly perform the rest if requisite.—It will sometimes happen, especially by the grinders, that a little of the jaw bone follows, sticking to the tooth;—let this not frighten you, it is sometimes impossible to avoid it; but not to frighten the patient with it, pick it off before he perceives it.

The moment the tooth is out, introduce your thumb and fore finger, and compress the socket of the drawn tooth; by which you replace every thing in order again; and after which, one dram of good old stingo, for washing the mouth, and another for comforting the heart, will make the patient forget all the pain he felt in the operation.

This method is certainly the most substantial for the tooth-ach. But sometimes this is not practicable, either because that the stump is so rotted as not to suffer a hold; or that none on board are intrepid or capable enough to perform the operation; in this case a Palliative will be very acceptable.—_Turlington’s Balsam_ (W), upon a little lint put into the hollow tooth will frequently give ease, a _little Spirits of Wine and Camphor_ (A), or if very raging, a _little Liquid Laudanum_ (T). But as I have said, they are only palliatives; and neither spirits, or any thing else can be depended upon for a certainty. Sometimes stopping up the hollow tooth with wax, with lead, or sometimes putting in a little saltpetre will give ease—each method may do, and each method may fail: so that sometimes if the tooth is not extracted, all powerful _Patience_ at last must step in and prove the best doctor, till nature recovers, and comforts the patient with the balm of Ease.

Very frequently a cold occasions this troublesome pain; in which case the head should be well muffled up, in order to bring on a perspiration, and a blister behind the ear also of singular service—rubbing the face also with some _spirits of wine and camphor_ is of great benefit, and attention should be had, if there be any fever in the system.

_Of sore Eyes_.

Bad weather sometimes will effect the eyes, whence they will become raw and blood shot; which ought to be remedied in time, in order to prevent further inflammation. In this case make the following eye water.

No. XVI

_Take Alum, One Scruple._ _Fine Sugar, Two Scruples._ _Spirit of
Wine, and Camphor_ (A) _Ten Drops._ _Fresh Water, Three Ounces._

_Mix them in a vial, and hang it up so that it may settle; then pour off the clear into another vial, which keep for use._

Of this excellent eye-water, drop a few drops into the blood-shot eye, which in a little time, will bring it to health again.——If the eye lids are raw and inflamed, _Turner’s Cerate_, or what is yet better, No. XI. which prove very beneficial.—Should the inflammation be very heavy, apply the following poultice, from which you may expect great benefit.

No. XVII

_Take Oatmeal, and Sugar powdered an equal quantity, and make it
into a poultice with the yolk of eggs; upon which pour a few
drops of the spirit of Camphor._

This kind of poultice you will find very cooling and agreeable to the eye, in order to assuage the pain; or take the following.

No. XVIII

_Take the white of an egg upon a stone, or pewter plate, which
rub with a piece of alum, till you get a fine white cream-like
substance._

This is a fine cooling application. The Camphor agrees very well with some people, but with others it will not, in which case the last is preferable; or the _spirits of camphor_ may be rejected from the other receipts.

_Of the Ear-Ach._

The causes of that complaint are many. I shall only here observe two kinds; namely that proceeding from cold, and that which is occasioned from hardened ear wax.

In the first case, be very cautious how you tamper with your ears—a few drops of the spirit of Camphor upon a bit of lint, and that gently put into the ear, will sometimes perform great benefit; but never drop any thing considerable into the ear itself; it is frequently dangerous; from more reasons than what I here have room to enter into.

In cases where the ear wax is hardened, put in a little slice of _rusty bacon_, or a _bit of fat ham_, which you will find very powerful in softening the ear wax; and then with gentleness you may pick them; take care however not to go too deep.——Ear-ach frequently follows a heavy fit of sickness; in which case you can’t do any thing better with safety, than keeping them warm.

_Of Hoarseness and Sore Throat._

There are many degrees of this ailment. I shall first mention that of a common cold; which is either without a fever, or only a slight one.

Immediately on perceiving symptoms of a sore throat, a gargle should be applied. This, make of the following ingredients.

No. XIX

_Take vinegar, and water, each four ounces._ _Alum powdered half
an ounce._ _Honey about a good spoonful._

This gargle should be used two or three times of the day——if it is warm, it is so much the more powerful——a mouthful at a time is sufficient. If the palate is down,

No. XX

_Take alum powdered, common salt, of each two drams, black
pepper, ten grains, mix it into a powder._

Of this powder take a little on the tip of your spatula, and apply it to the palate, when it will immediately shrink up; and frequently make the person who before was hoarse, speak immediately quite clear again with a distinct voice; then proceed with the gargle as above directed.

But if the sore throat is of a more malignant nature, the parts inflamed and swelled, the patient seeming almost strangled, and attended with a high fever; it is certainly the quincey, and should be treated accordingly. In this case you must bleed freely and repeatedly, and give the fever powders, as will be directed in the treatment of the fever, and the management of the quincey.

The gargle notwithstanding should be plentifully used——a blistering plaister betwixt the shoulders, and if need requires, on the calves of the legs, the bigness of the palm of the hand, will also prove of singular service; and in every respect the treatment, as I shall observe under its proper head.

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SECT. V.

_Of the Venereal Disease_

I have written and published a full treatise of this disease; divided in three parts; namely, I. An anatomical and physiological description of the genital parts of both sexes. II. An ætiological enquiry in the various stages of this disease. III. A true and rational method of cure. Nevertheless I shall here concisely give a safe method of the cure, in its various local degrees. But to those who would wish to know more circumstantial the true nature of that malady, and of the animal œconomy, I must refer to the above treatise.

The venereal disease may be considered in different degrees; namely the _first_ and _second infection_.

To the first, I consider the gonorrhœa or clap, the phimosis, paraphimosis, chordee, priapism, shankers, dysuria, bubo, swelled testicles, and venereal excrescences, in their various degrees, in a local state. To the second infection, I consider those diseases that proceed from the venereal virus, infecting the whole mass of blood; namely cutaneous diseases; glandular diseases; diseases of the bones; dry pox; and the confirmed lues itself.

The first infection is what I shall here briefly consider, and give such remedies, which though simple and few, will prove efficacious. But the second I shall here only consider in the general.

_Of the Gonorrhœa_.

The gonorrhœa or clap, commences with an agreeable tickling in the urethra, attended with a thin limpid ouzing, which however soon degenerates into a disagreeable pain. A discharge of sharp fœtid matter, gradually commences with a scalding of urine; the præpuce and glans sometimes swells, with inflammation and a painful involuntary erection, which adds considerable pain to the patient, and under which, the whole system seem disordered.

When all these symptoms appear, there is no room left to doubt a confirmed clap.

The first thing to be done, is to take some of the _fever powders_ (L) in order to promote a perspiration, and to abate the scalding of the urine.

In the next place, and which is the principal object; have immediate recourse to my antacrid injection, which is simply this,

No. XXI

_Take clean water one ounce_, _Calomel_ (N) _one scruple_, _Mix
it, and shake it when it is made use of._

Let this be injected up into the urethra, three times of the day, which if duely performed will stop the evil in its first bud; and prevent all the generally attending consequences. For it perfectly eradicates all the malignities of the venereal virus; prevents shankers, priapism, chordee, and any farther spreading of the infection. At the same time the calomel should be given internally; namely the pills, No. X. to be taken every morning one.

_Of the Phimosis, and paraphimosis._

A Phimosis is when the præpuce is so swelled, that the glans cannot be uncovered; and a Paraphimosis is when the præpuce is swelled behind the glans, so as not to cover the glans. Either way proceeds from the venereal virus having insinuated itself into the præpuce.