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Title: The Seaman's Medical Instructor - In a Course of Lectures on Accidents and Diseases Incident to Seamen
Author: Falck, N. D.
Language: English
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THE
SEAMAN’S
Medical Instructor,
IN A COURSE OF
LECTURES
ON
ACCIDENTS AND DISEASES
INCIDENT TO SEAMEN,
IN THE VARIOUS CLIMATES
OF THE WORLD.
CALCULATED FOR
SHIPS THAT CARRY NO SURGEON.
The Whole delivered in a plain Language, and founded
on a long and successful Experience.
---------------------------------------------------------
By N. D. FALCK, M. D.
---------------------------------------------------------
LONDON:
PRINTED FOR EDWARD AND CHARLES DILLY.
M,DCC,LXXIV.
------------------------------------------------------------------------
THE
PREFACE.
If we consider the many benefits that navigation contributes to commerce
in general, and how much the prosperity of nations are indebted to its
source, we must without hesitation declare seamen, a most respectable
part of mankind; and if we reflect a moment, on the many hazards and
perils they are exposed to on that precarious element, and the
advantages we reap from their toil, the common feelings of human
society, must awake and remind us, not only how much we are obliged as
social members, even from a motive of self interest, to study their
preservation, but as fellow creatures, how forcibly our duty calls us to
give them every aid in our power, and to lighten the burthen of their
many toils.
A ship at sea may be considered as a floating kingdom; and the subjects,
however few in number, are not only liable to the same accidents as
those on shore, but to many more, peculiar to that precarious and
fluctuating element that surrounds them. For this reason there are many
things requisite to be known by the mariners besides the art of
conducting a ship from port to port.
Of all the various knowledges that distinguish the human species from
the brute creation, what is of more value than that which tends to the
preservation of life and health? I believe that every man who is
actuated by motives of philanthropy will with me wish, that mankind in
general would advert more to it in the principles of education, than
what they at present do. Indeed it is astonishing that so valuable an
acquisition, as to have some knowledge of the body we possess, and its
preservation, should be so totally neglected, as to be entirely excluded
from education; an acquisition that not only enlivens the mind, but in
itself is so very essential to our existence; yet what is more to be
wondered at, is, that a seaman who launches into the main ocean, is cut
off from every assistance, in case of an accident or sickness, and
rendered wholly unable to give the least aid to himself, or those who
are entrusted to his care. Large ships I own are exempt from this
observation: but are not the lives of men on board of small ships
equally as valuable, and worth preserving, as those of greater burthen?
I am not the first who has had the welfare of seamen at heart; various
writers, and men of abilities too, have presented the world with
observations, that undoubtedly have proved beneficial to that class of
men; but then these books were neither intended, nor fit to be put into
the hands of such seamen, as actually stand most in need of those very
observations they have made, and only intended for the perusal of men of
physical talents; nevertheless they merit for their labour public
thanks, as useful members of society. But if we take an impartial view
of the number of seamen, I believe the greatest part are employed in
small ships, that either carry no surgeon, or (I am sorry to say it)
sometimes one they had better be without; especially in war time, when
they stand most in need of a good one.
To benefit these men, and at the same time to make that benefit
universal, is the plan I have aimed at; and I believe this is the first
attempt of the kind; at least I know of none whose steps I have followed
in this design.
Should I ask physical writers why they have neglected so valuable a part
of society as seamen, in giving them their friendly instructions
respecting their health, I doubt not, but the majority would reply, that
the education of masters of ships and seamen in general, has not enabled
them to understand a subject so much above their comprehension, or
sphere. But if seamen have not the advantage of an extensive education,
are they divested therefore of common sense and understanding? and is it
not possible to deliver them instructions, dressed in so plain a
language as to adapt it to their capacity?
Nevertheless, though men of abilities have not thought seamen worth
their pen, others have; but such whose pursuit in life has been
stimulated by motives of a different cast. Those have furnished seamen
not only with directions to cure _all_ diseases, but even given them
medicines to do it with, into the bargain; or to speak more seriously,
given them directions how to use such medicines as would yield the most
profit to the apothecary, who with pretended wisdom equipt them out: and
I am apt to think, that kind of quackery has stolen away the lives of
many valuable seamen.
It is universally asserted that seamen are not fond of reading; this in
a great measure is true, but far from being a general rule; and though
blind prejudice has given them an aversion to every thing _physical_,
yet I will venture to say so much in their behalf, that hitherto nothing
has been offered to them that could alter their opinion in this respect,
or open their eyes, in shewing them the beauties of that useful study,
and in how small a compass its true principles might be contained.
Physic like religion is rendered intricate and abstruse, the more it
abounds in errors and absurdities; but truth like the brilliant sun,
drives away all the phantoms of perplext mysteries, and proves that both
alike are simple and beautiful, founded on reason, and that its most
useful part is comprehensive to common understanding. This pleads in
favour of my attempt, and with every man of sense, must overpower
prejudice.
That I might the better succeed in my intention, I have begun the whole
at the first principles, namely the mechanism of the human body; for I
cannot see how any man can pretend to know the nature of diseases, or
presume to administer any thing with certainty, without he has some
knowledge of the parts that suffer: this then is the subject of my first
lecture; and to make it the more pleasing, and to entice the reader to
pursue, I have stript it of every thing pedantic, or the unnecessary
perplexing particulars, and confined myself to such things only, as
gives a concise and true idea of the whole animal system; and if I may
be allowed to judge from the opinion of some of my learned friends, I
flatter myself, that my readers, physical or not, will give me their
sanction, as well with respect to plainness of language, as conciseness
of the subject, and the utility of such a short dissertation, founded on
experience, and stript of prejudice and errors.
The second lecture contains equally as copious a subject as the first;
contracted in a very small compass, and which I hope will give as much
satisfaction as the forementioned.
Out of the whole _Materia Medica_, I have chosen but very few medicines,
and these I have confined myself to throughout the whole book. Many
surgeons at sea will not, I know, be contented with so small an
assortment; and I remember the time that such an observation might have
been applicable to myself; but as I have by long experience learned to
shake off prejudices, and been taught by the help of philosophy to pry
into the nature of things in general, I solemnly declare, that now, I
would venture to go to any part of the globe, not only with that little
assortment of medicines I have mentioned, but even with many less. The
_emetick tartar_, _sublimate mercury_ and the _bark_ are powerful
medicines; but they should be in very skillful hands, otherwise they are
rank poisons, and therefore I have omitted them here; but strictly
speaking, every good medicine is the same. I have two maxims in physic,
which I strictly attend to; one is, that to my friends I give the least
medicines; the other is, that the principal virtue of a medicine depends
on its application.
The form of the medicine box, I have constructed so as it appears to me
most convenient and handy; and every kind of medicine, I would advise to
have labeled with their proper names, as well as with another mark that
may take the eye at first sight; and the more to prevent mistake, one
label should be fixt on the pot that contains the medicine, and the
other on the box: for in medicines too much caution cannot be used.
One thing with respect to the medicines, I have omitted, and that is
their quantity requisite for the box, and their prices: I intended to
have taken notice of this, but found that that could not with exactness
be ascertained, unless entering into another subject, and that would
take off from the conciseness of my plan. As I have however many other
things respecting the benefit of seamen to offer, peculiarly respecting
distant climates, I shall take notice of this, where it may come in,
more pertinently to the subject: till then, that must be left to the
management of the apothecary who is applied to for fitting out the box.
If he is a man of candour and judgment he cannot be much out of his
calculation, when he knows the number of hands, and the voyage intended.
With respect to the other lectures, I have, as near as it was
practicable, divided them into their different classes and sections; at
the same time the whole is so linked together, that one lecture must
support the other. And as I have throughout the whole course of the book
differed more or less from the general mode of practice, I must hereby
declare, that I have in this consulted my own experience more than any
other authority, without fear of censure, or hope of applause, any
farther than of truth, and my own conscience.
Though I have principally written with an intent to be understood by
masters of ships who carry no surgeon; yet I am well persuaded that
every practitioner, whether on sea or shore, will find many things to
his improvement.
With respect to my receipts, they are simple and powerful; yet I do not
enjoin so strict a conformity to them, by the practitioner, who has an
extensive knowledge of the _materia medica_, and is prepossessed in
favour of some particular medicines; but as he will discover my
indications, it may serve greatly to compare that of mine with his own,
and then he may judge for himself. I have touched very slightly on the
requisite diet for patients on board a ship; though this is an essential
article regarding health in general: But I found that subject also of so
very extensive a kind, that it would swell the book; but as I have many
valuable things to offer of the same nature, I must beg, that in the
mean time, the reader will be satisfied with the universal observations
in general; namely, that temperance is the principal object and that
patients who are deprived of exercise ought to have the most easy
digesting food. Copper and lead are pernicious; but iron and earthen
ware are safest either on sea or shore.
In order to render the book as useful as my zeal has intended, I
recommend it a fair perusal, from the first page to the last; a book of
this nature is apt to be looked into, only when advice is wanted: that
method is wrong; and in such a case, the best book in the world is apt
to mislead. It is not enough that we know what we are to do with such
and such disorders, but we should previously know what the disorder is;
and how shall we know that, without having some idea of the evil before
it comes on?
A book of this size is soon perused; taking a lecture or a section at a
leisure time on board, will soon send the reader through the whole; and
I flatter myself, that one perusal will lead to the second, when then it
may be referred to for advice with safety; and I hope a study so
essential to self-preservation, will be viewed in a more agreeable
light, than it has hitherto been.
To compleat the whole, a copper-plate is annexed, wherein the most
material utensils are exhibited, which was scarce capable to be
explained by bare description, to men unacquainted with surgery.
To conclude, I must beg leave to observe, that the respect and esteem,
with which I have been constantly honoured by every worthy seaman, whose
life and health were committed to my care, have I confess, stimulated my
endeavours, to offer them this book as a grateful return. And I am happy
to reflect, that my experience in life enables me to make it worth their
acceptance. May they reap that benefit from it, which my heart has
intended them; and this is all the reward I wish to obtain.
N. D. FALCK.
------------------------------------------------------------------------
_ERRATA.[1]_
Page 5. line 22. for cataplexy, read apoplexy. Page 6. line 16. read,
that a pressure on that part, not only occasions an apoplexy, but even
stops life itself. Page 26. line 17. for theirs, read thus. Page 35. for
Sect. vii. read viii. and following ix. x. Page 61. line 4. for five or
six, read about four or five. Line 21. for iniform, read inform. Page
91. line 18. read, in order to get into. Page 131. line 29. for purify,
read putrefy. Page 135. line 12. delete them. Page 142. line 2. from the
bottom, read, and is a sufficient. Page 158. line 6. for malignitus,
read malignities. Page 239. line 7. read, the patient when not able to
crawl to the tub, so revived &c.
Footnote 1:
These errors have been corrected for this ebook (May, 2019).
------------------------------------
To the BINDER.
The Copper-Plate and its Explanation are to be placed at the End of the
Book.
------------------------------------------------------------------------
THE
CONTENTS.
------------------------------------
LECTURE I.
_An anatomical and physiological description of the human body_
SECT. I. _Of the composition 2
and close
connection of
parts in the human
body_
SECT. II. _Of the brains and 5
nerves_
SECT. III. _Of the heart and 9
lungs_
SECT. IV. _Of the circulation 12
of the blood_
SECT. V. _Of the joint 15
connection of the
brains, heart,
lungs, &c._
SECT. VI. _Of chylifaction, 19
and nutrition_
SECT. VII. _Of the bones, 28
muscles,
ligaments, tendons
and their
connection._
_A skeleton of the 31
human body_
SECT. _Of the urinary 35
VIII. organs and genital
parts_
SECT. IX. _Of the skin_ 40
SECT. X. _Of the external 43
senses_
------------------------------------
LECTURE II.
_On the requisite means and medicines towards restoring health._
SECT. I. _Of the pulse_ 50
SECT. II. _Of the effects of 55
bleeding_
SECT. III. _Of the operation of 58
bleeding_
SECT. IV. _Of the requisite 63
medicines useful
at sea_
_A plan of a 84
medicine box_—64.
_Of utensils, and
medicines_—65.
_Lancets, ibid.
scissars, probe,
spatula_—66.
_Bistouries, and
incision lancets,
teeth instruments,
syringes_—67.
_Clyster pipes and
bladders, clyster
syringe, scales
and weights_—68.
_Splints_—69.
_Bandages, rags,
tow, lint, tape,
needles, thread
and pins_—70.
_Camomile flowers,
balm, sage,
sassafrass_—71.
_Oatmeal, cinamon,
allum, chalk_—72.
_Salts, diachylon
plaister_—73.
_Mercurial
plaister,
blistering
plaister_—74.
_Spirits of wine
and camphire_—75.
_Liniment of soap,
sweet oil, sweet
spirit of
nitre_—76. _Honey,
yellow basilicon;
elixir of
vitriol_—77.
_Elixir
proprietatis,
lenitive
electuary_—78.
_Turner’s Cerate,
fever powders,
stomachic
powder_—79.
_Calomel_—80.
_Precipitate_—81.
_Mercurial
ointment_—82.
_Rhubarb, jalap,
ipecacuanha,
liquid
laudanum_—83.
_Essential oil of
peppermint,
Turlington’s
balsam_
------------------------------------
LECTURE III.
_On accidents, and their proper method of treatment_
SECT. I. _Of falls_ 89
SECT. II. _Of wounds_—91. _Cut 92
wounds_
_bruised wounds_—94. 96
_Gun-shot wounds_
SECT. III. _Of bruises_ 98
SECT. IV. _Of dislocations_ 99
_Dislocation of the 101
arm with the
shoulder_
_Dislocation of the 103
elbow or the knee_
_Of spraining the 103
wrist, or ancle_
_Dislocation of the 104
thigh bone_
SECT. V. _Of fractures_ 107
_A fracture of the 108
skull_
_Fracture of the 109
arm_
_A fracture of the 110
thigh bone_
_A fractured leg_ 111
_Compound fractures_ 114
_Conclusive 115
observations on
fractures_
SECT. VI. _Of scalding_ 118
SECT. VII. _Of burning_ 119
SECT. _Of drowning_ 120
VIII.
_The method to 123
recover a drowned
person_
------------------------------------
LECTURE IV.
_On external diseases, and their cure_
SECT. I. _Of inflammation_ 130
_Of resolution_ 132
_Of suppuration_ 133
_Of tumours_ 134
_Of mortification_ _ibid._
SECT. II. _Of ulcerations_ 137
SECT. III. _Of the diseases of 142
the skin_
_Of the itch_ _ibid._
_Of boils_ 144
_Of ring-worms, 145
daw-worms, &c.
&c._
_Of the lousy _ibid._
disease_
SECT. IV. _Of promiscuous 148
disorders_
_Of the tooth-ach_ 149
_To draw a tooth_ _ibid._
_Of sore eyes_ 152
_Of the ear-ach_ 153
_Of hoarseness and 154
sore throat_
SECT. V. _Of the venereal 156
disease_
_Of the gonorrhœa_ 157
_Of the phimosis and 158
paraphimosis_
_Of the chordee, and 159
priapism_
_Of the dysuria_ _ibid._
_Of shankers_ 160
_Of the bubo_ 161
_Of swelled 162
testicles_
_Of venereal 163
excrescences_
_Of the second 164
infection_
SECT. VI. _Of the bite of 166
venomous animals_
_To cure the bite of 167
a rattle snake_
SECT. VII. _Of the bite of a 170
mad dog_
_The signs of a mad 171
dog_
_The effect of a 172
bite of a mad dog_
_Of the cure of the 173
bite of a mad dog_
------------------------------------
LECTURE V.
_Of fevers and inflammatory diseases, and their proper method of
treatment_
SECT. I. _Of fevers in 182
general_
SECT. II. _Of accidental 184
fevers_
SECT. III. _Of a cold_ 192
SECT. IV. _Of intermitting 193
fevers, and agues_
SECT. V. _Of putrid and 203
malignant fever_
------------------------------------
LECTURE VI.
_Of the various internal diseases, and their method of cure_
SECT. I. _Of diseases of the 208
head, of the
apoplexy_
_Of the phrenzy and 210
delirium_
_Of a stupor and 211
lethargy_
_Of a violent 213
head-ach_
SECT. II. _Of diseases of the 214
neck_
_Of the malignant _ibid._
sore throat_
SECT. III. _Of diseases in the 219
breast_
_Of the cough_ _ibid._
_Of the pleurisy, 221
and a
peripneumony_
SECT. IV. _Of diseases of the 224
bowels, and the
alimentary canal._
_Of a Depraved 225
Appetite_
_Of the Colic_ 228
_Of looseness, and 230
bloody flux_
SECT. V. _Of the Scurvy_ 233
------------------------------------------------------------------------
LECTURE I.
AN
Anatomical and Physiological Description
OF THE
HUMAN BODY.
-------------------------------------------
The mechanism of the human body is so wonderfully, so curiously, and so
wisely contrived, that the more we examine it, the more we must with
admiration acknowledge, that nothing but an ALMIGHTY BEING could be its
author. This incomprehensible BEING let us ever remember to reverence
and adore, when we examine into the stupendous contrivance of our
fabric; HE is the fountain, the benevolent upholder of nature, and all
the creation; in whom we live, breathe, and have our being.
-------------------------------------------
SECT. I.
_Of the Composition and close Connection of Parts in the Human Body._
The human body is composed of solids and fluids; these are so closely,
and so intimately combined with each other, that we find upon a physical
enquiry and examination, they are scarce separable. They aid and give
action to each other, and life depends not on each singly, but on the
united, and on the separate spur, and on the soul of activity each gives
to the other: Their substances form the body, and their action produces
the operation of the mind.
Whilst every thing moves free and agreeable to the talk prescribed by
nature, the automaton is in a state of health; body and mind enjoy peace
and tranquility. So closely are body and mind in the most perfect bond
of friendship, that they share pleasure and pain sympathetically with
each other; and reciprocally contribute to each other’s welfare.
With what satisfaction is the mind continually engaged to give pleasure
to the body! and with what alacrity are for ever the Members ready to
obey the will! Happy harmony, by which we so wonderfully exist!
The _solids_ are the canals and springs of life, and the _fluids_, which
circulate in those canals, nourish them, and set the springs in action.
By the _solids_ we understand,
1st The _bones_; the frame and support of our wonderful structure.
2dly. _Gristles_ or _cartilages_; which cover the ends of the bones, in
order to make them move with ease and agility.
3dly. _Muscles_; the fleshy parts, which by a nervous sensation, are
induced, either voluntarily or involuntarily, to contract or dilate
themselves, in order to give motion to the various parts of our body, to
which they are fastened or destined to move.
4thly. _Tendons_; the chords as it were, by which the muscles are
fastened to the bones, so as to make them follow the contraction of the
muscles.
5thly. _Ligaments_; the chords by which the bones are connected with
each other, and which give a firmness to their contact and articulation.
6thly. _Arteries_; the canals which transport the blood from the heart,
to all the parts of the body.
7thly. _Veins_; the canals which carry the blood from the remotest
arteries (in the most minute parts of the body) back again to the heart,
for a new rotation of the blood.
8thly. _Lymphatic Vessels_; which are small cellular canals, that convey
the lymph in different parts of the body.
9thly. _Glands_; which are kernels formed to _secrete_ or separate
various humours from the blood.
10thly. _Nerves_; these are medullary branches springing from the brain,
and distributed in the most minute parts of the body; ordained to give
the act of sensation, as the soul of animal activity.
11thly. _Hair_ and _nails_; these are a horny substance, and
appropriated either for defence or warmth of the different parts where
they are placed.
The _fluids_; are, 1st. _Blood_; which is circulated in the arteries and
veins, and is the nutriment and source of life.
2dly. The different humours separated by the glands from the blood; of
which there are many, as the _lymph_, _serum_, _spittle_, _seed_,
_chyle_, _urine_, _gall_, &c. appropriated to different uses, as
hereafter will be described.
3dly. _Fat_, and _marrow_ in the bones; which are designed not only as a
store of nourishment, but to lubricate and warm the parts where they are
lodged.
These are the principal materials which compose our wonderful machine.
There are various other parts mentioned by Anatomists, both solids and
fluids; but as this is designed only to give a universal idea of the
most material parts of the structure of this stupendous fabric, we will
let this definition suffice, and now consider with what order the
principal organs of life act, either in consort, or in opposition to
each other.
-------------------------------------------
SECT. II.
_Of the Brains and Nerves._
The brains are by all Physiologists esteemed the most mysterious organs
of life, being the fountain of the nerves, the organs of sensation, and
hence allowed by all to be the seat of the soul, or the _sanctum
sanctorum_ of the human understanding.
They are distinguished into the common or great brain called _cerebrum_;
the small part called _cerebellum_; and the _spinal marrow_, which
projects down the back-bone. The great brain is divided into two great
lobes, seated in the upper and fore part of the skull, of which it takes
in the greatest cavity. It is so exceedingly sensible, that the least
pressure puts an immediate stop to the sensation of the animal; and
which is generally termed a _apoplexy_.[2]
Footnote 2:
Hence in a fracture of the skull, or any other heavy contusion, where
the brain is compressed either by the fractured bone, or the
extravasated blood, the patient will remain in a state of
stupefaction, till either the fracture is reduced, or the extravasated
blood removed by trepannation; after which he immediately comes to
himself, as if suddenly revived from a trance.
This part of the brain, though it is so exquisitely sensible, seems to
be designed by nature as preparatory to the _cerebellum_, the immediate
root of the nerves.
The _cerebellum_ is the lesser, but the more material part of the
brains. It is seated in the hinder cavity of the skull, (which for the
sake of protecting this exquisite sensible organ, is remarkably strong
and firm) and from thence as the fountain of life itself, the nerves,
the instruments of sensation in the whole animal frame, take their
commencement: For whereas the other is so sensible, as that the least
pressure will cause a stupor; this is so far superior in point of
exquisite sensibility, that a pressure on that part, not only occasions
an apoplexy, but even stops life itself.
From this _cerebellum_ prolongates the marrow in the back-bone, called
_medulla spinalis_, which is but a continuation of the same, and is
equally sensible, and of the same substance with the former.
The whole brain, that is, the _great brain_, the _small brain_, _spinal
marrow_, together with all the nerves which spring from thence, are
covered with two coats, called the external stronger coat, _dura mater_;
and the thinner and inner coat, _pia mater_; which continue with each
nerve, even to its smallest ramification. The whole in a living subject
is in a continual motion peculiar to itself.[3]
Footnote 3:
This motion in the brain is not unlike the peristaltic motion; this is
an observation too seldom taken notice of by anatomists, though
evidently plain in living animals, and is of singular service in
physiological enquiries.
From the _cerebellum_, and _medulla spinalis_, all the nerves take their
commencement and origin. Ten pair spring forth from the part in the
skull; the principal are those which form the various senses, tasting,
smelling, hearing, and seeing, and that common to all, feeling. From the
_medulla spinalis_, or marrow in the back-bone, proceed thirty pair of
nerves, which spread themselves variously over the whole system.
All nerves have this in common with each other, namely, exquisite
sensibility; but in other respects they differ however widely;
particularly the nerves destined for some of the external senses.
It is from that common quality _feeling_, that they become the subtile
springs of life; and give an edge to all the animal functions.
There is nothing so plentifully, and nothing more curiously interwoven
with every other substance, as the nerves; and so amazingly quick is
their sensation, that the very instant a single nerve, even the smallest
and remotest in the system, is affected, the soul, or the common
_sensorium_, is sensible of the identical part so affected.
It has been asserted, that this amazing quick conveyance of the
sensation of the nerves, is owing to a subtile nervous fluid; but on a
rational reflection, and a just enquiry into the animal œconomy, it must
appear, that such conveyance of a fluid is inconsistent with probability
and experience: For, neither are the nerves tubulous, nor has there ever
been discovered any circulating humour in them. And secondly, is it
consistent with reason, that a conveyance of a fluid from the toe to the
finger, should be so momentarily quick, as is sometimes experienced in
the gout, and other the like ailments? That the quick transposition of
sensation of the nerves, is rather effected on a principle of
_vibration_, appears more probable, and will admit of a more convincing
experiment; which may be exemplified in the following manner: Suppose
(in the language of a seaman) a rope runs from the top-mast-head, or any
other part of the rigging, to the deck, and is kept tought and free from
any interception; then it will be evident, that the least touch at one
end will instantaneously be conveyed to the other end; in like manner
the nervous sensation may be communicated, perhaps not unlike
electricity; which similarly will in an instant be conveyed to any part,
by a direct communication, but equally subject to be intercepted.
Hence, a paralytic limb will lose, together with its irritable
sensibility, its circulation of fluids, and its nourishment; and recover
again when the pressure or interruption is ceased. Hence also, spasmodic
contractions will be affected at the irritation of some principal parts,
and from this instantaneous irritability, the motion of every part is
thought to obey the will.
-------------------------------------------
SECT. III.
_Of the Heart and Lungs._
The heart is a muscular body, situated in the breast or chest, somewhat
between the lobes of the lungs, and formed by nature to be the principal
organ for the circulation of the blood and other fluids.
Its structure is wonderful, and of a most curious piece of mechanism. It
has two principal cavities, called _ventricles_, which are separated
length-ways by a wall, and distinguished into the right and left.[4]
Footnote 4:
They might with equal propriety, be termed _anterior_, or foremost,
and _posterior_ or hindermost.
Each of these cavities or _ventricles_, have particular valves, call’d
ears, or _auricles_; which perform the function somewhat similar to the
suckers of a pump: By these contrivances the heart receives the blood
from the veins, and expels it again by the arteries, to every part of
the human body; in a manner that I shall hereafter describe.
The lungs are organs immediately concerned in the circulation of the
blood also; their function is to receive the air, to purify it, to
circulate, and to distribute it in due proportion in the sanguineous
mass, and to extract and expel that part of air already made use of; and
thus act the part of ventilators in the animal œconomy.
They are divided into two lobes. These lobes are a continuation of
little bladders, that have an immediate continuation with the wind-pipe,
_aspera arteria_. The wind-pipe from the larynx down to the very lungs,
is protected externally with semicircular gristles, in order to keep it
always open, and so shelter it from external injury; when it enters the
lungs it spreads itself into numberless branches like a tree, and sends
ramifications into every little air-bladder in the lungs.
All along these ramifications and the air-bladders, are arteries, veins,
and lymphatic vessels, which have an immediate communication with the
heart, by means of the pulmonary arteries and veins.
Now at the instant of _inspiration_, these little bladders in the lungs
are filled with air, which infuses itself by the small arteries into the
whole mass of blood; and at the _expiration_ again, the air which has
been made use of, and drawn from the neighbouring little veins, is again
expelled by the wind-pipe through the mouth: And thus is _respiration_
performed by alternate motions of the lungs; receiving the fresh, and
alternately expelling the foul air again; thence justly may they be
deemed the ventilators of the human _automaton_, and a principal organ
of life, in the animal creation in general.
The upper part of the wind-pipe, which is in the _fauces_ of the mouth,
is called the _larynx_. This is the organ of voice.
In this animal mechanism is contained, all the variety of formation
requisite to every kind of sound that can be performed upon any
instrument whatever. Its parts are chiefly of a gristly substance, at
the same time exquisitely delicate, with nerves and glands; from whence
it is subject to diseases on the slightest indisposition.
In men it is larger than in women; hence their voice is rougher; which
generally increases by exercise of the voice also. Its formation is very
complex, and too tedious here to enter upon; we will therefore pass it
over, and hereafter say as much as relates to its preservation, and
giving it relief when disordered.
-------------------------------------------
SECT. IV.
_Of the Circulation of the Blood._
We shall now consider the circulation of the blood; the grand source of
our existence. At the contemplation of which we must be lost in
admiration, at the wonderful wisdom of its contrivance; and with
uplifted eyes adore the cause of its motion!
The Heart, as I before observed, has two chambers or _ventricles_,
distinguished by the right and left; each of these chambers have also a
valvular cavity call’d _auricle_, or ear. Each _ventricle_ opens itself
into an _artery_ and _auricle_; and each _auricle_ opens itself into a
_ventricle_ and _vein_. These openings have valves, which open and shut
alternately, and by this, prevent any confusion or hindrance in the
influx and efflux of the blood.
The right _ventricle_ is the longest and greatest, but weakest: From
this ventricle springs forth the _pulmonary artery_, which spreads
itself throughout the Lungs.
The right _auricle_ is also the largest; in which opens itself the large
vein, called _vena cava_; as the common trunk that receives the blood
from all its branches spread over the whole human body.
The left _ventricle_ is shorter, but the walls are considerably stronger
than that of the right _ventricle_. Here begins the _aorta_, or the
great artery, by which the blood is sent to all the parts of the human
body.
The left _auricle_ is also somewhat smaller than the right; and in that
opens itself the _pulmonary vein_, which returns the blood from the
lungs, after it has received its necessary assistance from the vesicles
of air in the lungs.
This premised and understood, the circulation is performed in the
following manner:
The right _ventricle_ being full of blood, contracts itself. This
contraction is called the _systole_, by which it forces the blood
through the _pulmonary artery_ into every part of the lungs, even into
every vesicle; where it receives a portion of the air, drawn in by the
wind-pipe.
At the end of these _arteries_ join the ramifications of the _pulmonary
vein_, which receives the blood from the ramifications of the arteries,
by _anastomosation_; which, by little quantities, these veins gather
gradually into little branches, and at last become one common trunk,
which empties the blood into the _left auricle_ of the heart.
From the _left auricle_ it is let, by means of a peculiar constructed
_valve_, into the _left ventricle_; which, by a dilation called the
_diastole_, receives it from its _auricle_.
Immediately upon this reception, the _systole_ or contraction takes
place, and the blood is forced into the great universal artery, _aorta_;
by which it is farther transported into every part of the human body.
This _artery_ spreads as it goes, and continually decreases in
magnitude, as it becomes numerous in branches; until it terminates into
the smallest ramification in the remotest part of the body.
The _systolic contraction_, and the _diastolic dilation_, which
alternately take place in the heart, continue throughout the arteries
from the great trunk to the remotest capillary ramifications,[5] by
which means the blood is transported with more certainty and facility to
the minutest part.
Footnote 5:
Concerning this great act of continued systole and diastole,
Anatomists have greatly varied; but from the structure of the
arteries, and the continued pulsation, this way of transporting the
blood is confirmed both by reason and experience.
At the extremity of these arteries the veins take their commencement, in
ramifications equally small with the former; these take up the blood
from the arteries, by many infinite small quantities, and carry it
gradually back from those extremities to the heart again, for a new
rotation.
These veins commencing infinitely small, but gradually gathering, become
branches, and at length form one general trunk, called the _vena cava_,
(or the great universal vein); and this empties itself again into the
_right auricle_; from whence it is let again into the _right ventricle_,
whence it came; then again forced into the lungs; thence back again into
the left ventricle; from thence all over the whole body, and continues
the Circulation.
-------------------------------------------
SECT. V.
_Of the Joint Connection of the Brain, Heart, Lungs, &c._
These are the principal actions in the grand movement of the human
automaton.
The nerves are the subtile springs of the sensation, by which the whole
becomes sensible of irritation, and agitated to its functions. Their
ramifications are extended _ad infinitum_, and so curiously distributed,
that though there is not a part in the whole system exempt from their
spreading, yet they are distributed with such regularity, that they
don’t interfere with each other. A regularity absolutely requisite to
the order in the animal œconomy: For whereever the vibration of the
nerves is obstructed, life or motion must in consequence cease.
The lungs are the ventilators in the system: they receive and let in the
air; they sift it from all its gross particles, and extract the useful
parts from this universal element of life; thus they give from every
little vesicle, a due proportion of extracted air to the blood by the
adjacent veins; and by the neighbouring arteries, again extract the foul
air from the circulated blood, which by the mouth and nostrils is
expelled again; at that instant a fresh quantity of air is drawn in
again for a new supply.
Thus by intervals, the lungs, like a perfect ventilatory machine,
repeatedly, and without intermission, keep time with _systolic_ and
_diastolic_ motions of the heart, in exchanging fresh and foul air for
the support of this wonderful animal structure. This is the function of
breathing _respiration_, namely _inspiration_, or the drawing in the
fresh air; and _expiration_, the expelling the foul air.
The heart may be considered as the grand perpetual pumping engine,
constructed on principles, so as to have the least friction possible.
This curious pump, _the heart_, sends the fluid of life, _the blood_, to
all the parts, even the remotest in the whole machine. The _arteries_
are the canals of the conveyance; they are strong elastic tubes, whose
fibres are of spiral direction, and receive from the heart a power of
contraction; which is continued from the heart in the moment of the
_systole_, even to the remotest and most minute ramifications; by which
the blood is pushed along to the minutest extremities. This is
immediately succeeded with a _diastolic_ reception of a fresh quantity
of blood; so that on succession, the _diastole_ and _systole_ is
perpetuated not only in the heart, but throughout all the arteries, in a
friendly correspondence over the whole system: And this constitutes the
_pulse_.
The veins, however, are somewhat of a different texture from the
arteries; whilst the arteries transport the blood by an elastic and
pulse-like contraction, the veins on the contrary, receive it from them
at the extremities, in an easy and imperceptible gradation; for whereas
the fibres in the arteries are in a spiral direction, elastic and
strong, the coat of the veins are tender, and the fibres more
longitudinal.
Hence, the wounds in the arteries and veins differ greatly; for whilst
the arteries are for ever in a strong agitation, the veins perform their
functions with less exercise; and therefore the wounds in arteries are
always attended with danger, whilst the veins heal easy. From the same
reason also, the arterial blood differs from the venal; for as the
arterial blood is sent to all the Parts, as the grand nutriment, from
whence the glands secrete their peculiar humours; the veins only
transport it back again, to prepare it for a new rotation. Whence the
blood in the arteries is of a high colour, and of a more alkalascent
nature, than that in the veins.
Collateral with the minute ramifications of the veins and arteries, over
the whole system, are the _lymphatic vessels_, which separate from the
blood as it passes along, a transparent lymphatic humour, adapted for
the different parts, which they are connected with.[6] These vessels are
materially different, from either arteries and veins in their structure,
and justly to be compared to a continuation of little cells; so
constructed, as to transport the humours, without admitting a return.
Footnote 6:
An opinion has lately been broached, that the lymphatics are all
absorbing vessels, of the same nature with the lacteals, and that they
all join to empty themselves in the subclavian vein to the common mass
of the blood; but this to me, seems too general, and contradicts
experience.
From hence we see plainly how these three organs, the _brains_, the
_lungs_, and the _heart_, are concerned, and mutually assist each other
in the actions, and circulation of the fluid of life; nothing could move
without the sensation of the nerves; these could not exist without the
blood, from which they receive their support; the blood could not
circulate without the heart, arteries, and veins; and in them it could
not move with a necessary freedom, except its being supplied with a
sufficiency of air from the lungs: So that evidently all three are so
interested in this grand movement, that the stopping of the one, must
needs be the stopping of the whole.
-------------------------------------------
SECT. VI.
_Of Chylifaction and Nutrition._
In the preceding we have briefly considered the state of the fluid of
life, and mechanical instruments of their motion in the human machine.
In this we will consider how the whole is supported, and the vital lamp,
from time to time, becomes supplied.
Under this consideration we will examine the canal of food, and the
various changes the morsel undergoes from the time we take it in our
mouths, till the nutriment is reduced to blood, and the remaining dross
is expelled the body as useless.
The animal functions towards _chylifaction_ and _nutrition_, are
_mastication_, or chewing the _food_; _deglutition_, or swallowing;
_digestion_; _chylifaction_; _nutrition_; and the _excretion_ of the
_fæces_.
In order therefore to understand this clearly, it becomes necessary to
describe the organs which nature has formed for the requisite
performances thereof.
In the first place then, _smelling_ is that sensation which nature has
given to every animal, that has a choice of food, as the first
safe-guard to inform it of any thing agreeable or disagreeable, useful
or pernicious to its body; its seat is in the nose chiefly, but we find
by experience, that it has a friendly connection with our palate and
stomach; for the effluvia of any thing will either create a desire, or
give us the greatest aversion to every substance that throws out a
flavour.
It is performed by means of a subtile spreading of nerves, peculiarly
delicate; which continues through the membrane of the nose, the roof of
the mouth, gullet, and the very stomach.
_Taste_ is the next sensation, which nature has given us, not only as a
distinguisher of proper food, but a sensation from which we receive many
luxurious pleasures; and to the indulgence of this sensation, most evils
and plagues to mankind, take their origin.
The tongue is the principal instrument of that peculiar quality; but if
we examine somewhat closer into this affair, we shall find that the soul
of pleasure and pain of that sensation, as well as that of smelling, has
its seat in the stomach; for that which will taste pleasing and good at
the first approach, will soon lose its relish when the stomach is
gratified: and, if any thing tastes disagreeable, the stomach receives
it with reluctance, and will ever incline to discharge it again.
The tongue is an instrument (if I may be allowed the term) very
curiously constructed; it is moved by a variety of muscles, and serves
not only for tasting, but also as a labourer, to shovel and to turn our
meat between our grinders; so that nothing may escape being well
masticated, and intermixed with that fine digesting balsam, the spittle,
in order that it may be easily swallowed.
Besides this, it makes the most requisite instrument for the noble and
excellent faculty of speaking; which forms one of the principal
characteristics that distinguishes man from the brute creation.
The gullet or _oesophagus_, is the canal which conveys drink and food
from the mouth to the stomach; this canal is a muscular, tendinous, and
vascular tunic.
The commencement of it is in the mouth, and is called the _pharynx_; a
curious structure, that receives the food, and by its contractive
motion, and the help of the tongue, forces the aliment into the stomach.
The stomach is much like the bag of a Scotch bag-pipe; it lies
immediately under the _diaphragm_ or _midriff_, covered partly on the
right side with the liver, and on the left side with the spleen. The
left and superior part, is continued with the _oesophagus_; and the
right and inferior part, or orifice, commences the _intestines_.
The first orifice is called the mouth of the stomach; and the second the
_pylorus_, or _porter_: At the porter there is a curious valve which
lets the aliment out by small parcels into the intestines, where it
undergoes its various other changes.
The stomach has three teguments, a _muscular_, a _tendinous_, and
_nervous coat_; this _nervous coat_ has another slimy one, but this in
reality, is a delicate lining, interwoven with nerves, and the
ramifications of fine blood vessels.
The _intestines_ or guts, are a continuation of the stomach, they are a
canal which is generally reckoned six times as long as the subject it is
taken from; it is distinguished in small _tenuia_, and wide _crassa_.
Each again is divided into three parts: the _tenuia_, or small narrow
intestines, are the _duodenum_, or twelve finger-gut; the _jejunum_; the
_ileum_: The wide or _crassa_, is divided into the _cæcum_; the _colon_;
and the _rectum_.
Throughout the whole canal of intestines are numbers of little vessels,
called _lacteals_, which lead the chyle, extracted from the aliment,
into a _receptacle_, which is lodged in the _mesentery_, and from
thence, by another duct call’d the _thoracic duct_, is carried along the
back-bone upwards, and joins to the left subclavian vein, where the
_chyle_ gradually commences to be blood.
This short description we will let suffice, and now enter upon the
action itself.
The morsel now, which is designed for food, is taken into the mouth,
masticated with the teeth, turned about with the tongue; and as the
mouth is at work, the _saliva_ or spittle is squeezed from the salival
glands, and thus intermixed with the aliment; when enough chewed and
moistened with this saliva, it is conveyed to the _pharynx_, or swallow,
which receives it, and, by its contraction, forces it into the
_oesophagus_; and by a repeated contraction, is carried down into the
stomach.
There it is again moistened with _saponaceous liquid_, or _pancreatic
juice_; by which and by a perpetual motion of the stomach, it is brought
into a state of digestion; then by small degrees entered through the
_pylorus_ or porter, into the first division of the gut, the _duodenum_.
This gut is about twelve fingers long; and whilst the aliment is there,
it is intermixed with the gall, which is a liquor separated by the
liver, and contained in the gall bladder; this liquor, the gall, is
carried into the _duodenum_, by a small duct, called the _ductus
cysticus_; where also enters another kind of liquor called the
_pancreatic juice_.
When the aliment is thus prepared, and fit for a particular state of
dissolution, it is carried into, and through the _jejunum_. This gut is
in length about twelve or thirteen hands breadth, and its motion
somewhat brisk; through which the aliment passes pretty quick, and
hence, generally is somewhat empty.
As it passes through this part, the chyle is separated from it by the
lacteals, which are small vessels that separate the chyle from the
aliment, and abound there more than in any other part of the gut.
From thence it comes into the _ileum_; that is the longest of all the
divisions of the guts, and is in length about twenty-one hands breadth;
it has a great many circumvolutions, and next to the _jejunum_, has many
lacteals to separate the chyle.
Now the aliment comes into the wide gut, and gradually becomes fæces;
and first, the _cæcum_: This part is rather an appendix only, and hangs
from the main part like a finger to a glove. The use of this gut has
been much controverted by anatomists; it seems however, very probable,
that this appendix is designed to keep the aliment in for further
digestion, as it now begins to putrefy, and becomes fæces or excrement.
From thence it enters the _colon_, which is a long, and very winding
intestine; it runs up along and about the liver, touches the gall
bladder, and the spleen; from thence it descends again to the _os
sacrum_. It has but few lacteals, and is, as it were, the last drainer
of the fæces: It is this intestine which is the seat of the Colic, and
of most other complaints of the belly.
Next to this comes the last and straightest, the _rectum_; this gut is
closely adherent to the _sacrum_, and ends in the fundament; which is
provided with muscles to open and shut the _anus_, in order to contain
the fæces, and discharge it.
The mechanism of chylifaction in the human body differs from the brute
creation in general, except that most contemptible of the whole, the
hog; to which it bears a very near resemblance, insomuch that there is
very little distinction.
Both have that advantage over the generality of terrestrial animals,
that they are confined to no particular food; which favours greatly the
luxury of the one, and the beastiality of the other.
The brute creation are generally distinguished into _carnivorous_ and
_granivorous_: The first is that kind which feeds upon flesh; and the
latter upon grain and vegetables. Upon examination however, we find,
that the stomach and guts are peculiarly adapted to their food; and that
grass agrees no more with the dog, than mutton does with the horse.
But man is so happily made, that any thing which is food, is proper for
him, and he may become used to it; and thus is either carnivorous or
granivorous.
The whole canals, from the stomach to the anus, is in a continual
vermicular motion, which is called the _peristaltic motion_; by this the
aliments are dissolved, and disunited; and as they pass along, are
drained by the lacteals, of their _nutriment_ or _chyle_.
These lacteals are, by means of a membrane (with which they are
surprisingly interwoven, and connected to the whole canal) called the
_mesentery_, lead regularly into one common cistern, lodged almost in
the middle of the intestines, in that membrane, called the _receptacle
of chyle_; and from thence the _chyle_ is carried by a duct up along the
back-bone, called the _ductus thoracicus_, into the left _subclavian
vein_, where it gradually commences to be blood.
By this mechanism we are nourished, and the substance of our food
converted into blood, and transported through the whole animal machine,
for the support of every part of its wonderful composition.
As all animals which feed upon flesh, are more subject to diseases,
nature has provided them with these advantages: that when any thing is
obnoxious to their nature, and received into their stomach, or their
being over loaded, it can discharge itself of so troublesome a burthen,
by vomiting, which is effected thus: when the inner coat of the stomach,
which is irritable and nervous, is stimulated by whatever is obnoxious,
it will cause in the whole stomach, a contraction; and by that, force
its contents to the shortest direction of evacuation, namely, by the
canal of the oesophagus, through the mouth. This expulsion is peculiar
to carnivorous animals only.
Purging or discharging by the fundament is common to all animals of
whatever kind; and is performed by an irritation in the intestines, by
which the peristaltic motion is increased; to this I must add a
reversion of the secretion of the lacteal vessels, by which the humours
are increased, the motion accelerated, and the fæces discharged, without
giving any nourishment to the body, and consequently the system
diminished.
Digestion is that act by which the aliment or food is prepared, so as to
produce a good chyle, and consequently good blood, for the nourishment
of the body. Though no animal has a more delicate stomach than man, yet
it must be observed, that none has a stomach better adapted for all
kinds of food.
Whence therefore in the common course of life, temperance and gentle
exercise is what nature requires to maintain health. But nothing becomes
more obnoxious to that blessing, than gluttony, voluptuousness, and
idleness.
-------------------------------------------
SECT. VII.
_Of the Bones, Muscles, Ligaments, Tendons, and their Connections._
The bones may be considered as the timber-work of the human frame; by
which this wonderful fabric is supported, and kept in its due form, that
the whole may be brought into its various movements, without confusion
or obstruction to each other.
The bones are the most solid parts of the human body, composed of hard
and indurated fibres, striated over each other, in a manner peculiar to
that substance. The bony fibres are in themselves insensible, yet as the
parts are variously distributed with arteries and veins, and that the
nerves must necessarily have a share in their formation, they have a
peculiar sensibility, which is perceptible in some parts more than
others; they cannot strictly speaking, be deemed quite insensible.
The whole bony frame is covered with a tendinous and nervous tegument,
called _periosteum_; except such parts of the teeth as are designed for
mastication, which are provided with a peculiar enamel, that is harder
than the rest of the bony substance.
The _periosteum_ is exquisitely sensible, and is the safe-guard to the
substance of the bone, which is delicately tender notwithstanding it is
not so sensible as the skin that covers it; insomuch that it will become
_carious_ on the least exposure to the air, or the attack of any foreign
body of matter whatever; whence in wounds and fractures in general,
great attention should be paid to the substance of the bone, being very
subject to become _carious_ and to _exfoliation_, which is of the
greatest consequence; but of this I shall say more in another place.
The marrow is principally designed for the nourishment of the bones;
which is evident from its being plentiest in young people, when the
bones are strongest; and that when it is deficient, they become brittle,
and lose their tenacity.
The marrow is contained in a cellular substance, partly in vesicles of a
nervous texture, and partly bony cells. At the ends of the long bones
the texture is more spungy than in the middle, where the cavity is less,
but the substance is most compact. Though anatomically there is no
perceptible circulation in the bones, yet, that a circulation is
actually existing, is evident, from a liquor oozing out from the ends of
a fractured bone in the living animal; by which a fractured bone again
unites, and this is called the _callus_; and whilst in its liquid state,
resembles the white of an egg, which gradually ossifies, and becomes as
hard as the main substance of the bone.
The number of bones differ somewhat in various subjects; ordinarily they
amount to two hundred and fifty-two: In the head sixty-three; in the
trunk seventy; in the arms and hands sixty; and in the legs and feet
sixty.
As the bones are the support of the animal fabric, I have inserted in
the next page, a catalogue of the human skeleton, which occasionally may
be referred to:
_A Skeleton of the Human Body._
BONES in the HEAD.
The SKULL.
_The Forehead._
Os Frontis 1
_The Hindhead._
Os Occipitis 1
_The Sides of the Head._
Ossa Parietalia 2
_The Temples._
Ossa Temporum 2
_The Basis of the Skull._
Os Ethmoides 1
Os Sphenoides 1
_The Bones of Hearing._
Ossicula 8
Auditus
The FACE.
_The Upper-Jaw._
Ossa Malæ 2
——Maxillare 2
——Unguis 2
——Nasi 2
——Palati 2
Os Vomer 1
_The Under-Jaw._
Maxilla 1
Inferior
_The Teeth._
Dentes Incisivi 8
——Canini 4
——Molares 20
_The Tongue-Bone._
Os Hyoides, is 3
composed of
—
63
BONES in the TRUNK.
_The Spine._
Vertebræ 7
Cervicis
——Dorsi 12
——Lumborum 5
_The Ribs._
Costæ Vera 14
——Spuria 10
_The Shoulders._
Scapula 2
Claviculæ 2
_The Hip and Bason._
Os Sacrum, is 6
composed of
Os Coxygis, is 3
composed of
Ossa
Innomenata,
composed of
——Ischium 2
——Ilium 2
——Pubis 2
_The Breast._
Sternum, is 3
composed of
—
70
UPPER EXTREMITIES.
_The Upper Arm._
Os Humerus 1
_The Under Arm._
Ulna 1
Radius 1
_The Wrist._
Ossa Carpi 8
_The Hand._
Ossa Metacarpi 4
_The Fingers._
Ossa Digitorum 15
—
30
UNDER EXTREMITIES.
_The Thigh._
Os Femoris 1
_The Knee Pan._
Patella 1
_The Leg._
Tibia 1
Fibula 1
_Ancle._
Ossa Tarsi 7
_Foot._
Ossa Metatarsi 5
_Toes._
Digitorum 14
—
30
The connection of the bones are in various ways; those connections that
are designed for rest, are by close contact of parts, and are called
_sutures_ or _seams_; such are the bones of the skull with themselves
and the face. Those connections which are designed for motion are called
_articulation_. Some of the articulations have but an obscure motion, as
the ribs with the back-bone, and the back with itself, &c. Others have
an angular motion, as the elbows and knees; and others again have an
universal motion, as the arm-bone with the shoulder, and the thigh bone
with the hip. The _sutures_, and such connections as have no motion, are
merely dovetailed into one another in close connection; but those
articulations that are designed for motion are connected by cartilages,
either in close contact, or so as to move slippery over one another.
The ligaments are those tough tendinous parts, by which the
articulations designed for motion are joined together; at some parts
they cover the joints only, and at others, they are immediately fastened
to each other, besides the external coverings; those ligaments are very
strong and elastic, and have a close connection with the nerves that
pass by them.
The surrounding ligaments of all moveable joints, form a _capsular-bag_,
which contains a slippery liquor, called _synovia_, that lubricates the
ends of the bones covered with _cartilages_, that they may move with
ease and agility over one another.
_Muscles_ are the fleshy parts on the human body, appointed for motion.
They are a composition of arteries, veins, nerves, and tendons.
Muscles are generally divided into two kinds; those for necessary or
involuntary motion, and those for voluntary. Some again are fastened at
each end to some of the bones at their extremity, and contract
themselves in a straight direction; others again are annular, or in the
form of a ring; and by this manner open and shut. The first kind are
generally divided into three parts, the head, belly, and tail. The whole
muscle begins and ends in a tendon, by which it is fastened to the part
it is designed to move; which, when the belly of the muscle contracts
itself, must consequently draw both bones nearer together, fastened to
the head and tail; and thus performs the motion. Some of these muscles
act in consort, and others in opposition to each other.
The tendons are the principal parts of the muscle; and that part
thereof, as before observed, which is fastened in the bones, namely, at
the head and tail of the muscle, and is the chord, as it were, by which
the limb is brought into motion.
A tendon is a hard, substantial, flexible, and elastic body, which, at
the head of the muscle, is very compact; but as it enters the muscle,
spreads its fibres over the whole body, gathers again at the tail, in as
compact a manner as it began, and continues in this chord-like texture
till it fastens itself at its appropriated place.[7]
Footnote 7:
It must be observed however, that tendons take on many various forms,
as different as the muscles; which would be too tedious here to
particularize.
The tendons and ligaments are of equal substance, and differ in nothing
but their various uses; namely, the ligaments to connect the
articulation; and the tendons, or the ends of the muscles, to give
motion. The muscles are a composition of the tendinous fibres,
plentifully intermixed with small ramifications of blood vessels; all
which compose the fleshy part thereof. Hence, the tendons being white
and hard, the muscles gradually grow softer and redder in the middle of
them; and they verge gradually to become tendinous at the tail, the same
as the head.
Hence, from the close texture of the tendons, they are very painful when
wounded, or otherwise hurt; but as the muscles are softer and more
pliable, their wounds and other accidents are of less consequence, and
not so dangerous as the former.
The number of muscles are undetermined, for though the principal muscles
are so distinct that they cannot be mistaken as to their form and use,
yet there is so great a number of small ones, or so many of the great
ones capable of being subdivided again, that anatomists have not, as
yet, agreed about their number.
-------------------------------------------
SECT. VIII.
_Of the Urinary Organs and Genital Parts._
The _kidnies_, the _ureters_, the _bladder_, and the _urethra_, are the
principal urinary organs. The kidnies receive two arteries called the
_emulgent arteries_, from the great arterial trunk, called _aorta_,
before described; they each send also two veins back again, accompanying
the arteries to the _vena cava_. Whilst the blood is circulated in the
kidnies, the urine is secreted in many small quantities, and carried
from each kidney by a tendinous tube, the bigness generally of a small
goose quill, called the _ureter_ to the bladder. The _ureters_ enter the
bladder between its _lamillas_, so as not to admit of a return. Hence, a
bladder in its natural position is both wind and water tight, and if
reversed, is neither.
The bladder of urine is of a tendinous and nervous texture, and capable
of great extension, but at the same time exquisitely sensible. The neck
of the bladder is very muscular, and by this forms a _sphincter_, or
annular muscle, by which the urine is retained; and as it is of a very
sensible nature, this part is subject to inflammatory constrictions;
great pain, and many evils have there been occasioned, either from
venereal cases, or gravelous complaints.
From the neck of the bladder to the end of the _penis_, is the
_urethra_; which canal serves for the emission of the urine, as well as
that of the seed.
The whole is lined with a number of very little glans, to lubricate and
protect the sensitive lining from the sharpness of the urine.
These are the urinary organs. We will in the next place, proceed to the
organs of generation.
The _testicles_ are the principal instruments for forming the human
seed; they are generally two in number. The testicles receive the blood,
of which they secrete the seed, from the _aorta_, about the same parts,
whence the emulgent arteries project. These arteries run down from the
aorta to the testicles, in a very contorted and winding manner,
accompanied by the veins which return back again from the testicles, and
fix themselves in the ascending _vena cava_. These contorted and
interwoven vessels are called the _spermatic vessels_, which carry the
blood from the arteries in little quantities, and slowly return it again
into the great vein.
Whilst the blood is circulated in the testicles, the seed is secreted in
them; but as it is secreted, it is transported back again from thence by
tubes, called _vasa deferentia_, towards the neck of the bladder, where
there are two irregular bladder-like vessels, wherein the seed is
contained, and kept for use, called the _vesiculæ seminales_.
In these seed bladders the seed is kept for use, till it is wanted. They
are remarkably delicate and nervous; and when they are filled with seed,
they stimulate all the organs of generation with a desire for venery.
The _penis_, or the manly member of generation, is partly covered with
the common skin; the foremost part of which, that covers the glans, is
called the _præpuce_. This _præpuce_ is tied underneath to the substance
of the _penis_, by what is called the _frænum_.
The inner part of the penis is composed of two kinds of bodies, the
_cavernous bodies_ of the _penis_, and the _cavernous body_ of the
_urethra_. The first are bodies enveloped in their peculiar teguments,
and make the greatest part of the _penis_. Each of these bodies takes
its origin from the erecting muscle of the _penis_, which is near the
_pubis_; through each of them goes an artery and a nerve, which spread
themselves through these bodies.
These bodies are full of cavities, which have all a communication with
one another. The cavernous body of the _urethra_ continues from the
_bulb_, near the neck of the bladder all along to the end of the
_penis_, and includes the _glans_, or the nut of the yard; and is much
of the same substance with the former. At the back of the _penis_, goes
along the large vein, called the _vena penis_, which spreads itself all
along into numberless branches that connect themselves with the
ramifications of the arteries throughout all the cavernous bodies; and
from thence is caused the erection, as I shall presently describe. The
_glans_, or the nut of the yard, is remarkably delicate and sensible, as
being the seat of pleasure in coition; it is also of a cellular
substance, and in one continuation with the cavernous body of the
urethra.
Its sensation is greatly heightened by the _frænum_ being tied
underneath, from the _præpuce_ to that part which keeps it, as it were,
in an agreeable constriction when erect.
The penis is allowed two pair, and a single muscle. The first pair is
the _erectores_, which take their origin from the fleshy protuberances
of the _ischium_, and lose themselves in the cavernous body of the
penis. The second pair of muscles is the _transversales_; these take
their rise near the forementioned, and fasten themselves at the root of
the penis. The fifth is the _accelerator_, or the odd muscle; this
muscle takes its commencement from the cavernous body of the _urethra_,
and grasps the whole penis, and adheres to the _sphincter_ of the anus;
the muscles aid and assist each other in the erection of the penis,
which happens in the following manner:
At the influx of the animal spirits, the _vena penis_, or the great vein
in the penis is somewhat contracted, whence the blood is forced into the
cavernous bodies of the penis and that of the urethra, as the reflux of
the circulating blood from the arteries is hindered; hence, the cellulæ
of the cavernous bodies are obliged to swell up and distend all the
parts, and thus make the penis turgid and erect; when the penis is
further titillated by the friction of coition, the parts become
generally irritated to an agreeable constriction, whereby the seed
rushes from the seed-bladders into the urethra, and is thus forcibly
ejected in the time of ejaculation; then the whole fabric slackens, the
constriction of the great vein relaxes, the blood regains its free
circulation, and the penis becomes slack again.
These are the faint out-lines of the genital parts; but to have a full
description and comprehension of the peculiar properties of the genitals
of both sexes, and also the sacred act of generation, I recommend to a
serious perusal of the anatomical and physiological description of the
genital parts of both sexes, in my _Treatise on the Venereal Disease_,
where they will find a full and satisfactory account.
-------------------------------------------
SECT. VIII.
_Of the Skin._
The whole human automaton is covered with a skin, the mechanism of which
is not less curious than what we have already described.
It is a texture curiously interwoven with an infinite number of tendons,
arteries, veins, nerves, and lymphatic vessels. The tendons form the
net-work of the whole, and give it an elasticity, from whence it
requires a muscular motion; and the rest add each their parts, as I
shall hereafter describe.
The skin, universally over the whole body, is divided into three parts;
but in most parts it is found to have four.
The external, is the _cuticula_, or scarf skin; this is a horny and
insensible substance, formed by nature as a shelter for the next part of
the skin, which is exceedingly sensible; on examination it appears to be
a horny substance, and as it were, little scales continued from the
immediate skin, which on any external injury, such as repeated friction,
fire, scalding, or blistering, separates from the main skin. The next is
the real skin, called _cutis_; This is strongly interwoven with
tendinous and nervous fibres, interspersed with numberless ramifications
of arteries, veins, and lymphatic vessels; whence it is not only
exquisitely sensible, but elastic, and on the least injury, subject to
bleed. On the external surface is a very thin _plexus_, called the
_reticulare_; which has the tinge of the natural hue of the skin, and
distinguishes the complexion of the _negro_, the _tawny_, and _white_,
from each other.
The structure of the _cutis_ is peculiarly curious, and may justly be
considered as a continued _secretory_ and _excretory gland_; or more
properly, like the bark of a tree; for whilst there is continual
transpiration from the body, it, at the same time, is capable to absorb
the subtile particles of whatever surrounds it, and exclude the grosser.
Over the whole surface are innumerable little _pores_, which are nothing
but the little openings of the various lymphatics, and of the blood
vessels corresponding with their peculiar _glandules_, called the
_milliary glans_; between those on the hairy parts, the hair is planted
as it were, with their distinct roots, corresponding with the hue of the
subject they belong to. These _pores_ widen or contract according to the
internal or external warmth of the body; which when they contract, cause
a kind of roughness, or continuation of little warts; and on the
contrary, when dilated, smooth the skin. Next to this follows the fat
skin, or _membrana adiposa_; which is a continuation of cells, wherein
the fat is contained, and has an immediate communication with the
neighbouring blood and lymphatic vessels. This part is not universal,
for some parts of the face, the genitals, &c. are without it. The last
of all is the _membranosa_, a thin parchment-like texture, which adheres
spontaneously to whatever part it covers, either _periosteum_, the
_tendons_, _ligaments_, or _muscles_.
These are the four principal divisions of the skin; but that which is
the principal, is the second mentioned, namely, the _cutis_; on which I
shall have occasion to offer something hereafter, that may prove of the
greatest advantage to the sea-faring people, for whose benefit I have
particularly intended these Lectures.
-------------------------------------------
SECT. IX.
_Of the External Senses._
Feeling is the universal sensation of the nerves, on which all other
senses depend, as the subtile spring of life itself. What it is, and
whence it proceeds, has already in the foregoing been explained; namely,
a sensation of the nerves, by which we perceive an idea of _hard_ or
_soft_, _wet_ or _dry_, _hot_ or _cold_, or in general terms, _pleasure_
or _pain_. The peculiar seat thereof seems to be placed at the ends of
our fingers; whether this is the absolute seat ordained by nature, or
rendered so by custom, is not my business here to enquire; perhaps, both
conjoin to make it there most perfect, as best suited for that purpose.
_Taste_ is the next sensation of the nerves, regarding an immediate
approach and action of substances themselves, in order to distinguish
betwixt the nature of foods, by which we are enabled to form an idea of
_salt_, _sweet_, _sour_, _bitter_, _sharp_, or _mild_; which according
to their mixture and proportion, render _taste_ agreeable or
disagreeable. Its seat is principally in the tongue; but that it extends
to the very stomach itself, is evident, from the immediate consent of
parts; namely, that what is disagreeable to the palate, will ever be
nauseous to the stomach: Of which I shall say more hereafter.
_Smelling_ is that sensation given to the animal creation, as a friendly
messenger of taste, in order to enable us the better to chuse our food.
It is actuated by means of the _olfactory nerves_ spread in the
_pituitary membrane_ of the nose, and has an immediate communication
with the brain; which nervous plexus is actuated by odorous particles,
exhaling from substances, by which the olfactory nerves are stimulated
agreeably, or disagreeably, as the first intelligence to the palate, or
to the whole consent of the nervous system.
_Hearing_ is that sensation of the nerves which is occasioned by the
vibration of the air, and forms the sound, which enters the cavity of
the ear, and tremulates and puts in action, the organs of hearing. The
ear is perhaps as curious a piece of mechanism to our conception, as any
part whatever we shall meet with in anatomy.
To the organs of hearing we must reckon the external and internal
_auditory_, divided by a thin membrane, which is a thin spreading of
nerves, called the _drum_; within this, or in the internal cavity, we
observe, 1st. Four little bones called, from their forms, the hammer,
_malleus_; the anvil, _ancus_; the stirrup, _stapes_; and roundling,
_orbicularis_. 2dly. Their peculiar muscles. And, 3dly. Two considerable
cavities, the _labyrinth_ and _aqueduct_. How hearing is actually
brought about, Anatomists have not as yet agreed; and which would be too
tedious here to enquire into. That the little hammer is perpetually
moving on the _tympanum_, according to the different sounds, may be one
part; which, however, is greatly assisted by the other organs.
The _labyrinth_, with many turnings and windings, penetrates through the
skull and forms part of the aqueduct, by which the sound is modulated
and magnified, so as to cause the distinction between them, and convey
the idea of their sonorousness to the common receptacle of sensation.
_Seeing_ is that great faculty by which the form, colour, and motion of
objects is represented to our ideas. The principal conveyer of this
wonderful sensation, is the _optic nerve_; the eye is a telescope
finished to the greatest perfection; or like a _camera obscura_, where
objects are pictured to the utmost nicety, and a due proportion observed
in their nature. It is a globe enrolled with a strong tendinous coat,
and filled with three kinds of humours perfectly clear and transparent,
which differ in nothing but their various degrees of liquidity and form.
Each of these humours is enclosed in a delicate thin transparent
membrane. The external coat of the eye is called the _cornea_, from its
resemblance to horn, being a continuation of the _dura mater_ and _pia
mater_; and is every where opaque, except at the entrance of the light,
which is called _pupilla_, and projects somewhat beyond the spherical
form of the eye, similar to the crystal of a watch. Inside the _cornea_
it is lined with a spreading of the optic nerves, called the _retina_,
where objects are reflected; by which the ideas are immediately conveyed
to the brain.
The humours are the following: The _aqueous humour_, the most external,
which is designed for collecting the rays of light; the second is the
_crystaline humour_, which is in the form of a magnifying lens, and
invested with a subtile transparent tegument, and so curiously fixed, as
to be contracted and dilated, according as the objects are near, or
removed from the eye; and accordingly the crystaline humour requires to
be flattened or thickened; the last is the _vitrous humour_, which fills
the remaining cavity of the eye; this humour serves to spread the
objects again on the _retina_, and arrange them in their natural order,
so that the picture of the objects viewed, may be preserved in its due
proportion and regularity.
Now the act of vision is performed thus: The convex transparent part of
the _cornea_ faces at once every object which comes within the direct
lines thereof, and this is termed a _full view_.[8] This view enters
through the aqueous humour, where the whole is contracted according to
its convex and concave form, so as to make it fit to enter the
_pupilla_, which is a muscular continuation of the _sclerotis_, and
called the _uvea_; and from thence the whole view passes through the
crystaline lens, by which the view is again magnified, and passed
through the vitrous, and the whole depicted on the _retina_, in the same
concave curve, and at equal angles in which it was first received, and
apparently the same magnitude; thence representing the objects in their
natural perfection, figure, colour, magnitude, and motion.
Footnote 8:
It is the general received opinion, that objects are reversed in the
representation on the _retina_ of the eye. This is however a mistake;
I hope on another subject to prove this in a full and satisfactory
manner.
When, however, an object is singled out of the whole view for particular
attention, the _uvea_ then contracts or dilates, which, together with
the muscular action of the whole ball, proportions all the humours
suitable to the magnitude and distance of the object under examination,
and the quantity of light; and to make the eye more capable, the lids
are frequently moving, in order to moisten and varnish, as it were, with
a liquid pressed from the innermost gland, called _canthus major_, to
keep the surface smooth, and assist its transparency. If this intense
looking is continued beyond the strength of this noble organ, it relaxes
from its proper destined expansion, and the objects are rendered
obscure.
Darkness is ease and rest to the eye, because it is then out of action;
whilst light always keeps it in exercise; And in diseases of the eyes,
light should be kept away as much as possible.
Here then I shall beg leave to conclude this short description of the
wonderful structure of our frame; which when we duly consider, will
never fail of filling our breasts with a sense of admiration; and induce
us to lift up our souls with reverence and gratitude, to that
incomprehensible GREAT CAUSE, by whose wisdom we are formed; and by
whose goodness we exist.
------------------------------------------------------------------------
LECTURE II.
ON THE NECESSARY
MEANS AND MEDICINES
REQUISITE TOWARDS
RESTORING HEALTH.
-------------------------------------------
Having, in the preceding lecture, given a general view of our wonderful
structure, I shall, in this, endeavour to lay a foundation of the
healing art, in order to assist nature when impaired by the attack of
disease, or any unforeseen accidents.
But that I may become useful, and yet concise, I will, without loss of
time, lead the reader to the principal distinction between health and
disease; for without forming a proper judgment of an ailment, there can
be no reasonable intention of cure. I shall therefore beg leave to
solicit a serious attention to the following important observations,
particularly, as they are founded upon the purest principles of
_physic_, authenticated by happy success in an extensive practice, and
communicated by the dictates of a candid and well disposed heart, that
wishes Existence only as a useful member to society.
-------------------------------------------
SECT. I.
_Of the Pulse._
When we consider the admirably curious structure of the human mechanism,
it must clearly appear, how easily the animal œconomy may become
disordered. But so kind has the ALLWISE AUTHOR of our existence been to
his creatures, that on the slightest indisposition, the whole system is
sensible of the least disagreeable sensation; and every part, with a
social and sympathetic friendship, is ready to relieve the fabric from
whatever is obnoxious, and causes the disturbance.
As nothing has a greater share in life than the blood, so nothing
likewise on the least indisposition, is sooner set in commotion, and
gives the alarm, than this very liquor, in which life itself is
contained; and the circulation of this fluid in the arteries, furnishes
us with the greatest prognostic, namely, the _pulse_, by which we may,
with any degree of certainty, judge of the state of the body, and
foretell good or bad events. How beneficial it is then to be acquainted
with this knowledge, I shall leave to every rational being to determine.
Every artery in the living body constitutes a _pulse_, as has been
explained in Sect. V. in the foregoing lecture.
And it is demonstrative from simple reason, that the pulsation of such
arteries must be in proportion to their magnitude, greatest in the
heart, whence they take their origin; till the vibration must gradually
be lost to the touch, as they become insensibly small, and lose
themselves in their ramificatory capillary tubes.
The artery which is most convenient to our examination, is that which
lays immediately to the touch on our wrist, below the thumb, on the
radius, just below the knuckle of that bone; and it is there we are best
able to distinguish the pulsation of the arteries, as being most exposed
to the external touch; because it is immediately between the skin and
the flat of that bone.
Thus much premised, we will first consider the _pulse_ in the sound
state; and next make a comparison with that in people labouring under
diseases.
In a full grown man, in the vigour of health, the pulse ordinarily beats
once to every second, that is, 60 times in a minute, 3600 in an hour,
and 31,536,000 times in a year. It varies however in different subjects,
according to the stature, temperament, condition, time, and action of
the same; insomuch, that two persons equally in a good state of health,
shall, however, differ widely in their pulses. Yet, notwithstanding,
there are peculiar signs, which will ever make a true distinction
between health and sickness; practice however is requisite to form a
proper judgment of such distinction.
In order to lay a proper foundation to understand the nature of this
great prognostic, I shall divide the pulse into the following classes:
1st. _A full_, _slow_, and _regular_ pulse, denotes a perfect state of
health; for whilst the blood moves regularly in the arteries, without
pain to the nervous system, or disturbance to the animal œconomy, the
pulse will beat precisely regular, without trembling, fluttering, hurry,
distinction, or feebleness, and discover to the touch, a peculiar
easiness; and this, every one, who wishes to become master of that
subject, should carefully attend to.
2dly. _A full_ and _quick pulse_, indicates a fever; for by the
irritation of the nerves, the vibration of the arteries are accelerated.
If a gentle perspiration attends it, it may be deemed salutary; and with
this pulse it appears, that nature makes a vigorous effort to expel what
is obnoxious: therefore in such a pulse, a gentle perspiration generally
gives relief.
3dly. _A full_, _quick_, and _hard pulse_, denotes great irritability in
the nerves, and a redundancy of blood; this is the pulse of a fever; and
here bleeding, if timely applied, is very requisite, as also medicines
which promote perspiration.
4thly. _A small_ and _quick pulse_, denotes an irritability in the
nervous system, and a contraction of the arteries; this is generally the
pulse which attends sudden shocks and frights, as also in the cold fits
of agues. The causes should carefully be attended to: if, from a sudden
shock, bleeding is useful; but in the latter case, it is hurtful. It
seldom lasts long, and a full feverish pulse generally follows, and the
state of the patient ought here to be the guide: for, the same pulse may
proceed from too great a plenty of blood, as well as from a deficiency;
consequently requires different treatment; and this shall be pointed out
more fully hereafter.
5thly. _An irregular full pulse_, is at all times a bad one; many may be
the causes, and generally denotes a great confusion in the nervous
system, and in the circulation of the blood. This pulse is generally the
attendant on violent inflammations, phrenzy, delirium, &c. and if it
continues any time, forebodes great danger: bleeding in time is greatly
requisite, and other remedies, in order to assist the nerves, and bring
the circulation to its proper regulation again.
6thly. _An irregular small pulse_, is frequently the attendant of an
emaciated constitution, putrid fevers, and consumptions; and this
dangerous pulse too generally forebodes the approach of death. The more
irregular the pulse grows, _small_, _weak_, _trembling_, and leaves off
by irregular intervals, the sooner dissolution is at hand; till at last,
the pulse entirely disappears, and life ceases. But dangerous as this
pulse is, yet it must be observed, that it often appears in the
strongest constitutions, as in sudden emotions of the mind, falls, &c.
or in a swooning. This is also the last and the first pulse in
suffocations; or in other words, the struggling pulse between life and
death.
These few distinctions of the pulse we will let suffice, as they, when
properly attended to, will in all cases enable us to make a true
distinction between health and the different stages of sickness, and
accordingly direct us to a true method of cure.
-------------------------------------------
SECT. II.
_Of the Effects of Bleeding_
There is, perhaps, not a greater remedy in medicine than bleeding; but
good and effectual as it is, yet I will venture to say, there is none
more pernicious than this, if injudiciously applied. As I value the life
of my fellow creatures, I would at all times caution them against the
injudicious application of this operation, being persuaded, that more
have lost their lives by the lancet, than by the sword, and pestilence
itself. Not to be tedious on this important subject, I shall give here
some very few rules, whereby a patient may be judged in a proper state
for bleeding; and likewise, where that operation ought to be avoided:
for all the service we can possibly hope and receive from bleeding, is
to lessen the quantity of blood, by which the whole body becomes
relaxed, consequently less liable to the inflammatory irritation, that a
too great quantity of blood might occasion; but on the contrary, if the
solids are but weak, and the blood poor, we only augment the evil by
bleeding, which we would wish to remove, as thereby the system becomes
weakened, and not able to disengage itself from the obnoxiousness it is
incumbered with; and thus proves the very destruction it was intended to
remedy. The notion of drawing off the bad blood by bleeding, is very
erroneous and absurd; the whole is too intimately mixed, and will ever
generate the same again till the disease is removed.
_Bleeding is requisite_
1st. When a strong robust person, of a full and sanguine complexion, by
accident receives a heavy contusion; a broken limb; or wound, whereby
the parts become inflamed; a fever like to ensue; and that the pulse
becomes hard and full, the veins distended, &c. &c.
2dly. When such a person receives a great shock, fall, terror, or any
other strong emotion of the mind; whereby the blood becomes rarefied, or
threatens a fever.
3dly. In the beginning of pleurisy, peripneumony, sudden and violent
fevers, great colds, &c. as also scalding, burning, apoplexies,
convulsions, palpitations, suffocations, and all such dangerous violent
disorders; in these cases only bleeding is useful, and then it ought to
be performed immediately, and with great moderation: six or eight ounces
is enough from the strongest man; if requisite, it may be easily
repeated, but if overdone, it is not so easily replenished.
_Bleeding in general is hurtful_
1st. In agues, notwithstanding the violent paroxysm of the hot fit,
because the solids are here too much relaxed.
2dly. In all contagions distempers; this is a circumstance worthy the
greatest attention. Reason and experience prove that bleeding here is
very improper; for by bleeding, the contagious miasmata is drawn only
the more into the whole mass of blood, and this is the fatal stumbling
block, by which thousands have lost their lives. The manner of treating
such distempers with success, I shall shew in its proper place.
3dly. In all old standing diseases, where there is a low, weak, though
quick pulse; for in such cases bleeding is very improper, as the system
is already too much reduced.
4thly. In all dropsies, scurvies, lentors, consumptions, &c. for here
instead of bleeding and lessening the power of the solids, the patient
wants strengthening, and has no blood to spare.
5thly. In all rheumatic and gouty complaints; for here nature must be
assisted in order to throw off what is painful, by such means as will
strengthen the solids, expell what is obnoxious, and prevent it from
returning to the blood, or falling upon some more important part.
6thly. In all venereal cases, particularly if recent; as by bleeding,
the pox will unavoidably be the consequence; as the venereal virus will
be absorbed in the whole mass of blood.
7thly. In all paralytic cases, and such weaknesses where the strength of
the body is already impaired.
8thly. _and lastly_, In the time of other evacuations of the body; as
purging, fluxes, bloody fluxes, &c. and particularly when the body is in
a sweat, or perspiration. From this, I hope, the good and bad effects of
bleeding will be understood in many other cases, which would be too
tedious to mention here; I shall therefore proceed to the operation of
bleeding itself.
-------------------------------------------
SECT. III.
_Of the Operation of Bleeding._
Bleeding is thought in general to be a very simple performance; but in
fact, there is not an operation in all surgery, requires more care, or
is liable to more dangerous consequences, if ill performed.
It is not only the opening a vein, but it is to open it properly,
(taking care not to prick an artery or tendon) to take away a sufficient
quantity of blood, and to heal up the orifice again.
In the bend of the arm are three distinct veins, the _head_, _median_,
and _basilican_. The ancients, before the discovery of the circulation
of the blood, fancied the _head_, or upper vein, carried the blood from
the head; the _median_, or middle, from the breast; and the _basilican_,
from the liver, &c. but this idle conjecture is laid aside, as being
highly absurd. When it is remembered what was said in the first Lecture,
in Sect. V. of the circulation of the blood, it will then plainly
appear, that all these veins become one before they enter the body; so
that there can be no difference as to their quality in being opened:
either therefore, which lays most conspicuously easy, is the vein that
should be chosen; for the arms of people differ in this respect, as much
as their features.
In order to chuse therefore properly, examine with the finger how the
veins lie; if upon a flat hard substance, it is a tendon; if a pulsation
is perceived, there is an artery; both which ought to be avoided if
there is a vein that lays more free and conspicuous to the sight and
touch. If however it cannot be avoided, the vein ought to be opened with
the greatest caution, for the pricking of a tendon would not only be
exquisitely painful, but endanger the arm by inflammation, and even life
itself; and the pricking of the artery would endanger the patient’s
bleeding to death, or else form an _anauresma_, (which is a bag of blood
protruding from the artery) equally dangerous to the life of the
patient. In general the middle vein is the safest and most convenient,
provided it does not cross the tendon: for the upper vein lies
frequently very deep, and is but small, and the lower frequently crosses
a tendon, or lies immediately over an artery.
However, one or the other will frequently suit, and, with caution, the
operation may be performed with ease.
As to the choice of the arm, it can make no difference in regard to the
effect, whether it is the right or left, for the veins of both arms end
at last in the great trunk of the _vena cava_, before they enter the
heart. To the operator, however, the right is the handiest, and to the
patient, the left is most convenient. In that arm however where the best
vein offers, that should be chosen.
When the arm is fixed on, then tie it up. The place should be on the
upper arm, about two inches from the bend, and the vein fixed on to be
bled, first drawing up the skin a little, and laving on the ligature
twice round the arm, drawn together with a draw knot; the reason of
laying on the ligature above the intended orifice of the vein, is plain,
as it stops the reflux of the blood, which is transfused from the heart
by the arteries towards the fingers, from thence taken up by the veins,
and by the ligature prevented from flowing back again, and consequently
distends the veins, and swells them up.
When the ligature is laid on, (which may be a garter, or a piece of
tape, about four or five feet long) and the veins are swelled up, then
open the vein. Bend the lancet so that the blade and handle may make an
acute angle; take the blade between the thumb and fore finger in the
right hand, if the right arm is bled, but if the left arm, the lancet
ought to be held in the left hand,[9] and open the vein obliquely, so
that the lancet cuts all the while, stretching the vein a little
downwards with the opposite thumb. The lancet should cut a little
slantingly, for if perpendicular, it would not only cause much pain, but
be apt to slip through the vein, prick a tendon or artery, and occasion
dangerous mischief.
Footnote 9:
This is the proper method of bleeding; for a bleeder ought to be
equally dexterous with the left hand as with the right, which custom
soon makes familiar; but those who are awkward with the left hand,
must stand behind the left arm to bleed, which method may be adapted
rather than to risk danger.
The orifice should be somewhat obliquely in the vein, neither directly
length-ways, as the veins would be apt to slip, and the orifice not
sufficiently opened to let the blood pass freely; neither should the
opening be right across, as thereby the vein might be divided, and the
blood not be easily stopt, or the orifice heal up. When now the vein is
well opened, let the blood run, (the arm a little bent) till it changes
to a higher colour, the surest sign of being enough, and this will be in
about four, six, or eight ounces, according to the constitution of the
patient. This simple rule I would advise to be attended to, for whatever
may be pretended about presaging the quantity of blood beforehand,
certain it is, it cannot be ascertained but in the time of bleeding.
When it is time to leave off, slacken the ligature, and gradually untie
it, when generally the blood ceases to run; draw close the orifice, and
wipe it clean all round. Let the patient bend the arm a little, and
close the orifice very close, then lay a four-folded dry compress, the
bigness of a crown, of clean tolerable fine linen rag, and tie the arm
up: lay the ligature (a garter or a piece of tape about four feet long)
at the middle of the compress, the one half round the upper arm, the
other on the lower arm, alternately, so that they always cross each
other in the bend of the arm on the compress, till at last it is either
tied or pinned; care being taken that it neither be too tight or too
slack, so that the arm may be bent or extended with tolerable ease. Let
the ligature remain on twenty-four hours, when all will be closed up.
What is to be done if unfortunately a tendon or an artery should be
pricked, I shall mention hereafter.
-------------------------------------------
SECT. IV.
_On the requisite Medicines to be used at Sea_
As my greatest ambition in this life tends only in becoming useful, I
shall studiously avoid that false pride of appearing learned.
There is perhaps not a medicine in the modern _materia medica_, but what
I have examined into, and opportunely experienced the virtue of; but so
often have I been deceived in my expectations, that out of the many
hundreds, with which I am acquainted, there are not above a score, or at
farthest two, which in any case whatever I should expect any benefit
from. Yet I mean not to throw out prejudices, for every physical man has
his favourite medicine, and we are all apt to praise the bridge that
carries us well over.
The little assortment of medicines however, which I here offer, I know
from experience to be good, and as such I recommend them. I have plowed
the ocean myself, visited most climates in the known world, and in my
practice on that precarious element, drawn such observations, as makes
me happy to think, that they may prove useful to a class of men, who
daily experience the uncertainty of human life.
In the first place I shall draw the plan of a sea medicine box, as may
suit a ship that carries no surgeon; in which I shall endeavour to be so
plain as I hope will prevent any mistake.
The MEDICINE CHEST.
+——————————————+—————————+————————+————————+——————————+————————————+
|{Lancets|A.|B.|C.|D.|11 Camomile|
|{Scissars|Spt. of Wine|Liniment of|Sweet Oil.|Sweet Spirit|12 Balm|
|1 {Probe|and Camphor.|Soap.||of Nitre.|13 Sage|
|{Spatula +—————————+————+———+——+—————+——————————+ 14 Sassafrass|
|{Teeth Instruments|E.|N.|O.|P.|G.|15 Oatmeal|
|2 Syringes|Honey.|Calom.|Fine Prec.|Me. Oi.|Elixir
of|________________________|
|3 Clyster Pipes & Bladder| +————+——————+—————+ Vitriol.||
|4 Scales and
Weights|___________________|Q.|R.|S.|____________________|16
cinamon, &c.|
|____________________________||Rhub.|Jalap.|Ipecac.||17 Allum|
||F. +————+——————+—————+ H.|18 Chalk|
|5 Splints|Yellow Basilicon.|T.|U.|W.|Elixir Proprietat.|19 Salts|
|6 Bandages||Liq. L.|E. O. Pep.|T’s. Ba.||________________________|
|7 Rags|___________________|_________|____________|__________+——————————+|
|8 Tow||||||
|9 Lint|I.|K.|L.|M.|20 Diachylon Plaister|
|10 Tapes, Thread, Needles|Linitive|Turner’s|Fever Powder.|Stomach|21
Mercurial Plaister|
|and Pins|Electuary.|Cerate.||Powder.|22 Blistering Plaister|
+——————————————+—————————+————————+————————+——————————+————————————+
_Of the Utensils._
First then, I shall speak of the utensils and the instruments which must
necessarily belong to a medicine box, be it ever so small.
_In the box_, No. 1.
_Lancets_: There ought to be three or four, and they should always be
kept clean and bright in a case, free, as much as may best from the
dampness of the sea air. The best method for this is, to wipe them often
with a dry clean linen cloth, warmed by the fire, (taking care in the
wiping of them, that the blade of the lancet lays upon one of the
handles, by which the point is preserved) and when properly cleaned,
wrap the whole case up in a large piece of dry paper. Let it be a
constant rule, to clean them well every time they are made use of.
And here I must remark once for all, that all iron or steel instruments
are ever best preserved clean and bright, by rubbing them clean with a
warm dry cloth, and then wrapping them up in clean dry paper; by which
method I have preserved my capital instruments with the same brightness,
as they came out of the workman’s hands throughout my voyages,
notwithstanding they have been made use of, and frequently too.
The notion of oiling or greasing instruments is very erroneous, and so
far from preserving them, that it will never fail of making them more
rusty. The wiping them quite clean and dry, and wrapping them up in warm
dry paper, is certainly the best secret for keeping all iron or steel
bright at sea, and deserves strictly to be attended to.
_Scissars_: There ought at least to be two pair, one for common use, and
the other for particular purposes; and if the last mentioned are
crooked, they are certainly much the better, being very handy on many
occasions. The best pair should be carefully preserved as already
directed.
_Probe_: A probe is very requisite for searching of wounds, &c. It
should be of good silver, and the smaller it is in thickness, even like
a small wire, the better for use, as it will bend and twist agreeable to
the place it is to search. At one end it should have a neat smooth
button, and at the other, be triangularly pointed, like a sail needle,
in order to wrap lint round it to clean sores with; its length should be
six or eight inches.
_Spatula_: ’Tis not much matter what the spatula is made of, whether
silver or iron, be it what it will, (provided it is neither brass nor
copper) one end should be flexible, so as to be handy in spreading
salves upon lint, or for other the like purposes; whilst the other
should be more stiff, being very useful for pressing the tongue down, in
looking and examining the throat. It should be about six or eight inches
long, and an inch broad.
_Bistouries_ and _Incision Lancets_: A bistoury, or neat sharp cutting
knife, is very useful indeed in many cases. And a large incision lancet,
in the form of a common lancet, except that the point inclines more one
way, is very necessary for opening aposthumes, and where a collection of
matter has been formed.
_Teeth Instruments_: Of the whole tribe there is certainly none more
universal than the key; this ought to have three different hooks, and so
that they may shift and unshift, according as the operation requires.
The gum lancet I have no notion of, I never saw any occasion for it, and
am apt to think it rather an hindrance to the operation. The instrument
should be kept clean in the same manner as I have said before.
2. _Syringe_: Each box ought at least to have two. Ivory is the best
substance they can be made of; they ought to be pretty thick and stout,
as they are liable to warp. A small one with a neat pipe, slender, and a
button to it, will be very useful for the clap, or other cases, where
injections are requisite. A larger one for the ulcerated sore throat, or
other the like cases, where quantities are required to be injected.
3. _Clyster Pipes_ and _Bladders_: There ought to be sundry. I would
have them previously mounted; and to prevent the bladder from being
decayed, or eaten up by vermin, or moths, fill them up with wormwood; a
method I have found very effectual.
When they are to be made use of, they are easily softened by a little
lukewarm water.
The general method of mounting the bladder on the pipe, is, by the
assistance of a cork in the pipe, which is to be drawn by a string, when
the clyster is injected; for my part, I found it always a hindrance; and
therefore instead of the cork, I always chose to secure the whole with a
string, tied with a slip knot, which when the pipe is introduced, is
much more easily undrawn.
_A clyster syringe_ of pewter, that holds at least a pint, or a pint and
an half, is far more preferable at sea, and might easily be made with an
additional pipe, by which a man may be the operator himself.
4. _Scales_ and _Weights_: This is a requisite article, in order to
proportion the doses of medicines. The scales need scarce any
description, as they require no more than their being of an equal
length, and the whole in equilibrio.
The _Apothecaries weights_ come in the following order, and signified by
these characters:
1℔—A Pound is 12 Ounces.—℥xii.
℥i.—An Ounce is 8 Drachms.—ʒviii.
ʒi.—A Drachm is 3 Scruples.—℈iii.
℈i.—A Scruple is 20 Grains.—gr.xx.
These marks are generally stampt upon the pieces. As a pound and ounce
are not generally used in the proportioning of doses, they are omitted
in the common little boxes prepared for that purpose. The rest, drachms,
scruples, and grains, are marked upon the requisite pieces; and which at
the first inspection may easily be understood.
I shall next proceed to another division of the chest or box.
5. _Splints_: Of those there should be at least four pair; two pair for
broken legs, and two pair for broken arms. They are generally made of
very thin deal boards, pasted on leather, and slit, so as to bend to the
parts applied, sideways, but remain stiff length-ways.
Paste-boards may however be made use of with good success; and if the
paste-boards are kept in sheets, they have the advantage, that splints
may be made of them occasionally; but by fomentation they are apt to
become soft and flabby, which ought to be guarded against.
6. _Bandages_: There ought to be three or four long ones, two or three
yards each, torn length-ways off an old sheet, not too much worn,
stitched together so as not to make a seam, three fingers broad, and
neatly rolled up, so that they always may be ready for use.
7. _Rags_: are a most requisite article at sea, and I can only say, the
more there are the better. They should by all means be clean, and
neither too coarse nor too fine.
8. _Tow_: is also a very requisite article. A good large bundle should
be provided, and it should be cleared from the shaggins, as they render
it stiff and unpliable: the grey is generally the best for medicinal
purposes.
9. _Lint_: should also be somewhat plenty; but as this may be made at
leisure, the quantity of that is not so material. Lint in the common
method is best made from rags torn length-ways, about three fingers
broad, and the transverse thread drawn by the help of a knife.
10. _Tape_: is very useful, particularly that of two fingers breadth,
and ought to be pretty fine. At least a dozen of yards should be
provided.
_Needles_, _threads_, and _pins_ should by no means be omitted, being
highly useful on many occasions.
_Secondly._ I shall now proceed to the herbs, which need but be few, as
they are very subject to decay.
11. _Camomile flowers_ are much used by some, and supposed to strengthen
the stomach; I could never think them of that effect. When however a
vomit is given, camomile tea is very useful, and promotes greatly the
operation; but it should not be made too strong: as much as may be taken
between three fingers, pouring on it a quart of scalding water, and thus
made into a tea. But that kind of tea should not be too often repeated,
unless it particularly agrees with the stomach.
12. _Balm_: This is an excellent herb on many occasions; it is cooling,
and there is not a tea I have more to recommend to sea-faring people,
let their ailment be what it will; it is of a balsamic and healing
nature, and will not easily pall on the stomach, except where there is
an universal weakness in the system; where then what is more warming to
the body than balm, may with propriety be added.
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.
------------------------------------------------------------------------
LECTURE III.
OF
ACCIDENTS,
AND THEIR
Proper Method of Treatment.
-------------------------------------------
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.
-------------------------------------------
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.
-------------------------------------------
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.
-------------------------------------------
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.
-------------------------------------------
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.
-------------------------------------------
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._
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.
-------------------------------------------
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.
-------------------------------------------
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.
-------------------------------------------
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.
------------------------------------------------------------------------
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.
-------------------------------------------
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.
-------------------------------------------
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.
-------------------------------------------
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.
-------------------------------------------
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.
-------------------------------------------
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.
If the _injection_, No. XXI. is made use of in time, all this will be
prevented; but sometimes it is of a very stubborn nature. If the
inflammation is very great, the poultice, No. II. should immediately be
applied, to which it will yield; being of a very powerful quality,
particularly, if to the poultice _mercurial ointment_ (P) two drachmes
is added, by which it becomes an immediate antidote to the venereal
virus.
_Of the Chordee, and Priapism._
A priapism is an involuntary erection; and the chordee is a stricture in
the urethra, by which the penis is bent either ways, according to the
seat of the contraction, this however is generally downwards; whereby it
makes the involuntary erection prodigiously painful.
It proceeds from some imprisoned virus in the urethra; which together
with its contraction, irritates the penis to erection.
The _antacrid injection_ No. XXI. will generally, if timely applied,
prevent this; but if by neglect, or the great virulence of the venom, it
has actually commenced, recourse should be had to mercurial ointment;
which should three or four times of the day be rubbed on the penis.
Should the priapism be very violent, the poultice, No. II. with the
addition of _mercurial ointment_ (P) must be applied.
_Of the Dysuria._
The dysuria is a scalding of the urine in the urethra; this likewise is
obviated by timely using the _injection_, No. XXI. or No. VIII. But when
it is actually become troublesome, drink plentifully of diluting drinks,
such as _balm tea_, &c. and take a few fever powders which will soon set
this to right again; particularly as that is a symptom which generally
vanishes, as the disease becomes milder.
_Of Shankers._
These are little ulcers coming upon the glans, the frænum, and the
præpuce of the yard. They are not only troublesome, but sometimes
tedious in the cure; the _antacrid injection_ No. XXI. if timely
applied, will generally prevent them.
But sometimes these very unwelcome visitors will appear even without a
clap; and then they generally gain great ground, before timely remedies
can be applied.
The _injection_ No. XXI. should in this case be injected betwixt the
præpuce and glans; but if this is not sufficient, apply the following.
No. XXII
_Take mercurial ointment, two drachmes; calomel_ (N), _two
scruples; precipitate_ (O), _ten grains. Mix it into an
ointment._
By the dressing with this, all the shankers will speedily heal up.
If warts sprout out, they should immediately be cut off, with a pair of
good sharp scissars, and then dressed with the above ointment.
Shankers, when they appear, without a previous gonorrhœa or clap, ought
always to be taken as a forerunner of the pox itself; and the patient
must have immediately recourse to the _mercurial pills_, No. X. one to
be taken night and morning, in order to prevent the threatening evil
consequences.
_Of the Bubo._
A Bubo is a swelling that appears on a venereal infection, sometimes in
one, sometimes in both groins. This swelling proceeds either from a
transposed virus, or comes as the first messenger of a venereal
infection.
A bubo appears with symptoms of a heavy dull pain in the groin, which on
examination discovers itself with a little kernel that is painful to the
touch: If left to itself it gradually encreases both in bulk as well as
in pain, and at length forms a collection of matter.
The moment a bubo appears, take a purge, No. IX. rub the part in the
groin with _mercurial ointment_, and spread a _mercurial plaister_ the
bigness of a crown-piece, which, (the hair being removed,) lay on the
part; let it remain on, till it separates from the skin, and the
swelling is dispersed; the patient should be kept warm, and not have
much exercise; at the same time the body should be kept open.
By this means the bubo will soon disperse, and the virus be destroyed in
its first bud. But if it has already gained too much head to be
dispersed, and matter is formed, it becomes larger and soft, and a
fluctuation of matter is felt, then suppuration must be promoted; and
when ripe be opened as soon as possible, for an outlet of the matter.
When it is come to its maturity, (that is the matter plainly perceived,)
open it and dress it like an ulcer, first with the ointment, No. I. and
when it discharges pretty well, dress it with the ointment, No. XXII.
By this management, though easy, you will not fail of success.
_Of Swelled Testicles._
The venereal virus is liable to attack the testicles, which makes one of
the most disagreeable circumstances of all venereal diseases; sometimes
one, and sometimes both will be the seat of this complaint.
It begins with a heavy dull pain, attended with a disagreeable tightness
in the spermatic vessels, leading from the testicle into the bowels.
Gradually the testicle swells, becomes hard and grows very painful, and
if not timely remedied, a suppuration, or a scirrhus, or even a gangrene
and sphacelus, may be the consequences.
The moment the pain in the testicles is perceived, remove the hair all
round the scrotum, and apply a mercurial plaister spread upon leather;
over which put a suspensorium, and tie it up to the body as tight as it
can be borne; which together with a purge, No. IX. will not fail of
giving immediate relief.
The patient should be kept as quiet as possible; for hard labour not
only retards the cure, but becomes very painful. Should this not be
sufficient, apply the poultice, No. II. with the mercurial addition as
warm as sufferable, and repeat it as often as it is necessary for
keeping it warm to the part. By this method it will not fail of
dispersing.
Should it however against all expectation come to a suppuration, it must
be opened the same as another aposthume, and treated accordingly. But
should a scirrhus, or a mortification ensue, extirpation is the only
recourse. For which see my treatise.
_Of Venereal Excrescences._
Besides all these disorders before mentioned that are the consequence of
impure coition, there is one more to be mentioned, and that is a variety
of disagreeable excrescences, which sometimes arise about the penis, the
scrotum perinæum, and about the fundament.
When these appear, I generally take it for granted, that the pox is in
the blood, and the patient ought to be treated accordingly.
If there is a possibility of extirpating them, either by a bistoury, or
a pair of good sharp scissars, it ought to be done, and dressed with the
following ointment.
No. XXII
_Take mercurial ointment_ (P), _and precipitate_ (O) _equal
parts: mix them._
The roots of these stubborn companions are frequently seated very deep;
if this is particularly taken notice of, together with proper internal
medicines, the excrescences taken away at the root, and the ointment
applied, they may all of them soon be drove off from the field.
_Of the second Infection._
In regard to the second infection, this is too tedious here to enter
into, and to do properly justice, I must refer the reader to the
treatise itself.
All I have at present to say, is, that my method of cure is particularly
easy and simple, in itself; and I am happy to think at the same time,
that it is more efficacious, than any former method, or practice, made
use of.
The _antacrid injection_ No. XXI. is the most efficacious for subduing
the gonorrhœa, and all the evil consequences in that part; and the other
mercurial preparations in the manner I have recommended them, is equally
powerful.
I am utterly averse to salivation; it is using mercury as a poison; very
few have ever been cured by it, and those few have been more indebted to
their good constitution, than the treatment which they have with so much
danger undergone. But many, very many, have had their constitutions
ruined by salivation, past the art of man to recover; and thousands have
been sent miserable objects to the grave.
I am also averse to bleeding in venereal cases, unless the greatest
necessity requires it; for in general it serves only to infect all the
fluids, since the veins emptied, will naturally absorb from all parts of
the body, and thence liable to infect the whole mass of blood. Purging
needs but be used very sparingly.
Mercury inwardly taken, should be used with the greatest moderation, and
taken in very small doses; for with such judicious management it becomes
one of the best medicines in the whole Materia Medica; but if abused, it
is converted into a poison. The decoction of the sassafras should be
plentifully made use of during the whole course of the venereal disease.
And lastly, from the real effect that the mercury has on the blood, I
must add, that the same gentle method with respect to its internal use,
as is recommended for the first infection, must also be pursued for the
second infection; let the malignities be ever so bad, even in the most
inveterate diseases of the bones themselves; with this difference, that
in proportion as the disease is engrafted, time must be allowed for the
cure.
Nature may be led by the gentle hand of assistance, and tenderness; but
he who attempts to do good by main force, acts as a fool, and deceives
not only himself, but those who are so unfortunate, as to trust to his
pretended skill.
-------------------------------------------
SECT. VI.
_Of the Bite of Venomous Animals_
It has been observed by all diligent inquirers into nature, that poisons
are of two kinds, with respect to their effect in the animal œconomy.
One kind will destroy if taken inwardly, but not have such ill
consequences in wounded parts, externally. Another kind will be fatal in
wounds; at the same time it does not affect the viscera.
The first which destroys internally, are poisons, either from corrosive
minerals, or vegetables; but of the latter, namely what seems
inoffensive taken in the mouth, is the poison that follows the bite of
most venomous animals whose poison are natural; such is the scorpion,
the adder, the rattle snake, &c. whose poison have by various
experiments, been found to be attended with no ill consequences
internally taken. This was known to the ancients, as well as to us; for
we find Celsus,[13] to have spoken of this in his medical works.
Footnote 13:
_Nam venenum serpentis, ut quaedam etiam venatoria venena, quibus
Galli præcipue utuntur non gusto, sed in vulnere nocent. Ergo
quisquis, exemplum Psylli secutus, it vulnus exsuxerit, et ipse tutus
erit, et tutum hominem præstabit. Medicin. lib. v. c. 27._
Without any farther preface, I shall proceed to give the immediate
remedies for such unfortunate accidents as happen by the bite of these
animals.
_To Cure the Bite of a Rattle Snake._
The poison from this venomous beast, is more deadly than any other of
the serpentine tribe. If its venom by a wound is infused into the blood,
a mortification, and speedy death must follow.
The part bit, should immediately be sucked with the mouth, either of the
patient itself, or one who will risk himself to be so much the friend of
the wounded. Dr. Mead has recommended, that oil should be held in the
mouth all the time of sucking, but we have it from good authority, that
the spittle itself is an antidote to that kind of poison.
It is needless to say, that the person who sucks the poison, should
frequently spit out, as not to run the risk of swallowing it; and care
should be taken, that his mouth is free from sores, or wounds.
When this is performed for a quarter of an hour, the part should be
dressed with _mercurial ointment_ (P). Sweet oil is much recommended,
and may be plentifully used as an embrocation to the inflamed part;
particularly if the oil is impregnated with camphor.
No. XXII
_Take oil_ (C) _two ounces; camphor, one scruple; mercurial
ointment, one drachm; mix it._
The patient should take a vomit of _ipecacuanha_ (S) _one scruple_; and
a few drops of the essential _oil_ of _peppermint_ (U), on a lump of
sugar, and dissolved in water, which should be repeated after the
operation of the vomit as often as occasion requires. The fat of a
rattle snake, is accounted a sovereign specific, if applied immediately
to the wounded part, and the patient drinking a decoction made of
_snakeroot_.
The same remedy here recommended to the bite of a rattle snake, (namely,
sucking the fresh made wound) is also recommended to all other venomous
bites. The _viper_, the _adder_, the _santapea_ or _scolopandra_, the
_scorpion_, _tarantula_, &c.
That oil is an antidote, (or as we may say a poison) to all these
venomous animals is evident from their expiring in great agony, when oil
is poured on them; but whether this effect is because of the penetration
it has on their bodies, or annihilating their poison, is as yet
undetermined.
I was once told a secret for the sting of a scorpion, avered to have
been experienced, by a commander of a ship, trading to the bay of
Honduras, viz. that the part stung by a scorpion should be touched with
the glans of the penis, which would immediately draw out the poison,
without effecting the glans that touched it; and it differs not, whether
the patient himself or any other person does it.——If there is any virtue
in this, I own it is beyond my comprehension.——I thought proper however
to mention it, though I cannot advise it as a safe experiment, unless
farther confirmed by those who have actually experienced it.
I have however a great opinion of mercurials in such exigencies; and
would advise recourse to be had to it immediately, both external as well
as internal; this we are at least assured of, it cannot be attended with
danger.
-------------------------------------------
SECT. VII.
_Of the Bite of a mad Dog_
There are many surprizing things in nature, in so much, that ocular
demonstration can only convince us of their existence. Amongst those
wonderful phenomenons, the direful effect of the bite of a mad dog is
equally astonishing as it is melancholy.
That dogs and wolves are more liable to madness of this kind, called the
_Rabies_, is because of their deficiency of external perspiration; and
are obliged to supply that defect with their open mouth and their
lolling-out the tongue; whence their blood is subject to become
overheated, and thence generate a malignant inflammation, which infects
the saliva with this direful poison. But the astonishment is, why it
should have so very powerful a contagion as to infect the mass of blood
of every animal that receives the least atom of it? Yet so it is,
confirmed by sad experience.
From frequent observation we are able however to communicate such signs,
which attend the symptoms of madness in a dog, whereby we may the better
avoid the danger of being plunged into the most deplorable misery by
this wretched animal.
_The Signs of a mad Dog._
The dog with symptoms of madness evidently discovers a malignant fever;
he runs confusedly forwards; the tongue hangs out of the mouth with much
slabber; his head hangs downwards; his eyes look dull and heavy; his
tail is drawn up between his legs; and in every respect he has all the
sign of confused wildness and pain; he runs confusedly forward, and
snaps about him without distinction of persons or fear. He is always
restless; will neither eat nor drink; and is terrified at the sight of
water; the tongue hanging out of his mouth, grows black; and at last
expires a spectacle of horror, unless the poor beast is put out of his
misery, and thereby many dreadful consequences prevented.
_The Effect of the Bite of a mad Dog._
So subtile is this fatal poison, that the symptoms do not appear
immediately; but the part bitten will sometimes even heal up, the same
as any other wound; and two, four, or six months after the injury, the
symptoms of the malady will appear and gradually reduce the patient to
the most deplorable state in nature.
The first symptoms of the disease are, a pain in the part where he was
bit, which gradually spreads all around; the whole body in general is
attended with a dull heavy pain, a lassitude and weariness. The mind
grows depressed and anxious, together with a loss of appetite and a
nausea at the stomach; and, in particular, a difficulty of swallowing,
sore throat, and accumulation of spittle.
Soon these symptoms encrease. The peculiar soreness of the throat, which
renders the swallowing liquids very painful, begins to create the utmost
horror and dread of every thing that is liquid; and this first gives
rise to the _Hydrophobia_, or dread of water, which compleats the
patient’s misery in this terrible disorder.
The eyes become full and staring, the face bloated, florid intermixed
with lividness; the mind is impaired; rage, lust and mischief, agitates
the confused will; at length, convulsions, foaming of the mouth,
priapisms, and seminal emissions, barking, howling, and endeavouring to
bite every thing near, ends the wretched life of the most deplorable
object in nature.
_Of the Cure of the Bite of a mad Dog._
With respect to the remedies, we have had many delivered to us; but few
indeed with success. Before I enter on the best method that I know, by
experiment, to recommend, I must beg leave to mention a peculiar
successful instance, in the course of my practice, in this deplorable
case.
A mad dog on shore, in the West-Indies, bit two men, one belonged to my
ship’s crew, the other to a ship in the same harbour; both were bit in
the calf of the leg. It happened that the surgeon of the other ship and
myself were immediately at hand at the time of the accident. I was for
cutting the part bitten fairly out without delay; to which the man of my
ship readily contented; and it was done accordingly upon the spot,
having fortunately my pocket instruments about me. But this operation
was not approved of by Mr. E——; nor suited it the timidity of the man
belonging to his care; it was therefore omitted.
When I had performed the operation, viz. (as near as I can guess) I cut
more than an ounce and a half of flesh out of the gastrocnemius muscle
(every where round the bitten part) I spread a pledget with basilicon,
mixed with precipitate, and laid it on the wound, having first let it
bleed, perhaps six or eight ounces; over the pledget I laid plenty of
dry lint; and when he was carried on board, I fomented it with spirits
of wine and camphor, in which _sublimate mercury_ was dissolved (about
one grain to about four ounces of the spirit). Inwardly I gave him one
grain of calomel every morning and night for at least a fortnight. The
sore I continued to dress with mercurial ointment; which within a month
healed up perfectly sound. From the mercurial treatment, the patient had
a small ptyalism, which I checked by gentle cathartics. My patient, by
this severe, though efficacious method, recovered perfectly well, and
remained so at least three months after the accident, when we parted.
The other unfortunate man, however, had not so good luck; for, as I was
afterwards informed (the ship going soon to sea after the accident) the
unhappy sufferer died a horrible object, raving mad in the
_hydrophobia_.
Mercury is certainly the greatest antacrid we have; and I am firmly of
opinion, that in this case it is the most powerful of any medicine that
is yet known.
The cold bath is strenuously recommended by Dr. Mead; and since his
recommending it, is generally practised on suspicion of this misfortune;
but in real cases, very seldom with the wished-for success. Yet, Reason
says much in its favour, and should by all means be had recourse to.
Others have recommended strong salt brine, which also is not to be
rejected.
Before I lay down the method to be observed, I shall first give Dr.
Mead’s recipe in his own words.
“Let the patient be blooded at the arm nine or ten ounces. Take of the
herb called in Latin, _lichen cinereus terrestris_; in English
_ash-coloured ground liverwort_, cleaned, dried, and powdered half an
ounce. Of _black pepper powdered, two drachmes_, mix these well
together, and divide the powder into four doses, one of which must be
taken every morning fasting, for four mornings successively in half a
pint of cow’s milk warm. After these four doses are taken, the patient
must go into the cold bath, or a cold spring, or river, every morning
fasting for a month: he must be dipt all over, but not stay in (with his
head above water) longer than half a minute, if the water be very cold.
After this he must go in three times a week a fortnight longer.”
But to speak my real sentiments, I have no great opinion of this recipe;
yet as other methods may be pursued along with it, I thought proper to
insert it, as in a malady of this consequence, nothing should be left
undone that is practicable with propriety.
Celsus I think was the first who recommended cold bathing[14]; but
indeed to a degree of drowning and reviving the patient again
alternately. In the mania itself, it carries much reason with it in this
miserable extremity, for the poor wretch at the eve of expiring, a
spectacle of horror, may as well run the risque of drowning; and
besides, the shock that plunging gives to the whole system, may probably
work an alteration in the malignant habit.—But alas! when the
hydrophobia has actually commenced; Death, and death only—can give
relief! Yet let it ever be a maxim, (and especially with a seaman)
_never_ to forsake _hope_; for _despair_ is only a punishment reserved
for the damned. I repeat it; no means should be left untried, that has
the least prospect of recovery.
Footnote 14:
_Unicum remedium est, nec opinantem in piscinam non ante ei provisam
projicere, et, si natandi scientiam non habet, modo mersum bibere
pati, modo attollere; si habet, interdum deprimere, ut invitus quoque
aqua satietur: sic enim simul et sitis, et aquæ metus tollitur. Lib.
v. cap. 27._
But to avoid being tedious, I will proceed to the method I would have
pursued in an accident of that terrible kind.
If you by the before description find that the dog who gave the wound is
actually mad, then without a moment’s delay let the piece bit, be cut
fairly out; if that is not practicable, apply immediately the ointment
made of _mercurial ointment_ and _precipitate_, No. XXI. Over which
apply _mercurial plaister_. Give one of the pills No. X. every morning
and night, and continue this course for a whole month. Let the plaister
remain on the place a good while after the sore is healed up.
This method I pursued with a gentleman, and a little boy in New-York,
who both were bit by the same dog, without provocation, the dog having
never attempted the like before; upon which he was immediately shot, and
was found to have all the signs of madness.——The accident happened at
noon, and I was immediately sent for; but not being in the way, my
assistant dressed it with basilicon, and laid over it a compress with
_spirit of wine and Camphor_, supposing it of no consequence, as the
wound was but very small. But on my hearing of it in the evening, I went
that moment to their assistance, removed the dressing and applied what I
have before mentioned.
I was not mistaken, for the sore and all around, after some time grew
angry, and had an unfavourable appearance; but with diligent attendance
gradually became better.—— The little boy was bit deeper than the
gentleman; His wounds were on both sides of the _tendo achillis_: But
the gentleman’s wound was a little above the _maleolus externus_ on the
right leg, inclining to the _tendo achillis_.
It was in the month of July—I ordered bathing every morning and night,
which suited the season. In the mean time, during three months, I gave
one grain of calomel every morning and night; and every thing succeeded
to our wishes.
But to return; should the mercurial medicines go to the mouth, a gentle
cathartic will divert this, for I am an utter enemy to salivation. If
however these remedies are administered too late, so that,
notwithstanding all those applications, the patient should grow
melancholy, have a difficulty in breathing, and a sore throat; but
especially a pain in the sore, or bitten part, recourse should be had to
frequent cold bathing, or rather plunging; mercurials should be
continued, and every method pursued as will be advised in the putrid
malignant fevers.
Should the patient however be seized with madness, care should be taken
that those about him have no wounds where the least of his spittle may
be introduced; and that the deplorable patient is rendered incapable to
make any wounds or mischief on himself, or those who attend him; as he
will be apt to snap and bite about him like a dog. He should be sewed up
in a hammock, to which his arms should also be confined: in this method
he may, by help of a tackle, be plunged up and down in the sea, but not
his head under water. This is far superior to the unnatural and cruel
way of smothering with beds, where the patient has no chance at all
left.
The subject is melancholy; but, willing to contribute all the relief in
my power to the distressed, I have been insensibly led on; and summed up
all that might promise success. Innumerable are the remedies delivered
to us, but few prove successful if the case be real.
Of all, I never knew any meet with better success than where mercury was
concerned; and as I have been so fortunate as to have experienced the
exalted virtue of that great medicine, in this and other deplorable
cases, I stand so much upon the firmer grounds, to recommend it beyond
any other medicine that I am acquainted with at present.
To conclude, I think it requisite to observe, that, dreadful as the bite
of a mad dog is, when the poison has infected the unfortunate patient,
yet this unlucky accident happens much seldomer, than mankind from the
dread of the misfortune, are apt to apprehend it does. Many nostrums are
published as specifics, and their virtue artfully confirmed, with cases
of being bit by dogs, that had however not the least symptom of madness;
and thence cures enumerated, that could have no foundation on reality;
by which artifices much mischief has been done in real cases. Due
observance should therefore be had to the state of the dog that has
given the wound, and the circumstances attending; that either the
patient may not be brought into unnecessary pain, or that proper and
substantial remedies may not be neglected.
------------------------------------------------------------------------
LECTURE V.
OF
FEVERS AND
INFLAMMATORY DISEASES,
AND
THEIR PROPER METHOD OF TREATMENT.
We now proceed to the more internal diseases; in which, the various
steps that we intend to take of restoring health again, must be guided
with the greatest caution, as the seat of the malady is hid from our
external examination.
It is for this very reason I designed previously to prepare the reader
with the two first lectures; particularly the second, I must beg the
reader thoroughly to examine, and to understand; for on this will in a
great measure depend the proper application of the various experienced
remedies, which I here mean to unfold.
-------------------------------------------
SECT. I.
_Of Fevers in General_
Hippocrates, the father of physic, was wont to say, “A fever is so
universal, that no patient dies without it.” This is so true, that there
is hardly an exception to it, even in the most momentary apoplexy
itself.
To conceive this properly, we must observe, that every diminutive part
in the animal fabric, like in a commonwealth, is endued with a sense of
self-preservation; and the whole fabric is in so strict a conjunction
with all its various particles, both solids and fluids, that nothing
which may cause the least disturbance can pass unnoticed; but, let the
injury be where it will, every individual particle, as a member of the
whole animal state, feels the shock, and is immediately concerned for
its own preservation.
This then is the cause of a fever in the general sense; and thence we
shall be led to understand what this disturbance in its nature actually
is; namely, an unnatural action of the solids upon the fluids.
Now as the fluids are the most yielding parts, that must submit to the
pressing motion of the solids, we may without much difficulty, see one
principle reason of its being set into a disturbed commotion, when the
irritability of the nervous fibrillæ are acted upon.
Again, when we consider that the blood is liable to become acrimonious,
and thence by its stimulus apt to act upon the coats of its containing
vessels, we see demonstratively plain, how the solids are subject to be
excited to act upon the very blood that stimulates them.
Moreover, as motion must naturally produce heat, and heat motion, and
motion expansion, and expansion rarefaction, we at once bring to view
the principal laws of mechanism, that governs the human automaton in the
various degrees of health as well as disease. However, let me not forget
to whom I write, but haste to the point I am at.
A fever may proceed from many different causes, and may affect many
different constitutions, and also produce many different effects; it is
therefore just that a proper distinction should be made.
Indeed, it is a subject that cannot be too minutely handled; because it
is scarce possible that there is a disease void of a fever in some
degree or other.—But preciseness and utility is the object I have in
view.
-------------------------------------------
SECT. II.
_Of Accidental Fevers._
How uncertain is human life! One moment in a perfect state of health,
the next perhaps no more; or confined under the painful sensations both
of body and mind!
Every accident is liable, and unavoidably must bring on a fever; and
this, like fire, should be extinguished in its earliest commencement.
But in that, as I have before observed, the constitution should
principally be consulted.
I have in the lecture of accidents, at every opportunity, recommended
bleeding, but always with a proviso, _if requisite_; and, as this is of
more consequence than generally is supposed, I find it necessary here to
expatiate farther on it.
In the first place, no man should be bled who has lost a considerable
quantity of blood, unless indeed he was known in his state of health to
be very strong and robust; and that the fever sets on with such fury,
that the system requires absolutely to be reduced; for the solids and
fluids have such a strict dependance amongst themselves, that they keep
each other in an equipoise. If therefore the blood is of an acrimonious
nature, and at the same time impoverished by lessening its quantity, the
coats of the arteries and veins will be the more stimulated; thence the
fever will naturally encrease, and generate more acrimony; which at
length will destroy the patient. I have been an eye witness more than
once, that the fever has actually increased upon every repeated
bleeding, till the whole supply of life was spent; and all my
persuasions have not been listened to till too late. Nay, a fever is
sometimes absolutely necessary; and proves to some constitutions a
remedy on its own account, provided it is properly treated, and kept
within due bounds.
Secondly, If the constitution of the patient before the accident was but
slender, and of a phlegmatic nature, bleeding should be very little or
cautiously performed; for the blood of itself being but poor, must
naturally be impoverished by being lessened; and whilst the tenseness of
the fibres is lost, it is the more acted upon and rendered more
acrimonious, and still unable to strengthen the tone of the irritated
fibres; whence a relaxed body, together with a poor acrimonious blood,
and all its evil tendencies must be the consequence.
Let it once for all be observed, that all the benefit we can possibly
hope and expect from bleeding, is to lessen the whole system, to reduce
the quantity of the fluids, and to relax the solids. This lessening of
the system I must own is very often highly necessary; But, let us not
fall into the ridiculous notion to suppose that bleeding will draw off
the bad blood, and leave the good behind; far otherwise; the quantity of
the blood is soon replenished, but the quality becomes impoverished.
The principle intention in fevers of whatever kind, should be to promote
perspiration. This is the grand restorative of nature; and I cannot
recommend it too much. Nature designed this evacuation in the formation
of man; and by that, fevers were cured in time of yore, many ages before
art contrived either lance or lancets.
But here let me not forget another great caution; namely, not to mistake
profuse sweating for perspiration; for this is an extreme into which
many have erroneously fallen. Nature frequently produces a sweat without
force or compulsion; and if so, it should be favoured, but never brought
on by stimulants, or strong forcing medicines.
Perspiration, sweat and urine, are the natural evacuations intended, for
the purifying the system from animal acrimony; and when these excretions
are in a just balance with the secretions of the fluids and motion in
the system, without pain or fatigue; then nature is at peace with
itself.
Lastly, I must observe, that the stomach is an organ which, by the
nervous consent, carries on an immediate correspondence with every part
in the human fabric; whence this viscera should likewise ever be
consulted in fevers; that is, never to impose on it any aliment against
its own inclination and appetite.
The want of appetite in a fever is a natural cause, and very often is in
the patient’s favour; but the mistaken notion, that a patient must eat,
even against his inclination, in order to recover strength, is not only
highly absurd, but has been the destruction of many, who otherwise would
have recovered, had they with patience waited the kind dictates of
Nature.
Let the system be free from diseases, and the stomach will soon crave
food, when there is a probability that the aliment may be converted into
good blood; but whatever is forced into the stomach before that time,
will instead of nourishing the body, only add fuel to the destructive
fire, and encrease the already malignant blood.
Upon the principles of these observations, I shall lay down the rules
that should be religiously observed in accidental fevers; and when they
are well considered, we shall find that they will hold good also in all
other kind of fevers, notwithstanding they arise from internal acrimony
of the body; for the difference is barely this, whether the fire is
kindled within or from without;—but to proceed.
Whatever then be the accident, a fall, a wound, a fracture, dislocation,
bruise, &c. observe what the patient was before the accident.
If the patient was a stout hearty man, it naturally follows, that the
fibres of his body were also in a rigid robust state; and the quantity
and richness of the blood was in a due proportion; for this very reason,
health being at such an _acmé_, a fever is the more to be feared, and
ought studiously to be avoided.
If this patient has not lost any blood by the accident, by all means
bleed him; but never exceed eight ounces at farthest; it is as much as
the strongest man ought to lose at once.
In the next place, perspiration should be the principal object in view.
To this end, let the patient immediately after bleeding go to rest, and
take a dose of the _Fever Powder_ (L); upon which let him drink plenty
of _Balm Tea_ (12); which will generally bring on a perspiration.
If however the fever increases, the pulse continues to beat hard and
full, the head-ach, difficulty of breathing, a great draught and
delirium should ensue, bleeding indeed may be repeated, provided it is
within the same twenty-four hours; but if the symptoms come on beyond
that time, then bleeding will seldom prevail, or do any good, but rather
mischief; for by this time, the fever is generally agitated by acrimony,
and the blood is of its own accord poor enough without being made more
so by bleeding.
In the symptoms which I mentioned, regard should be had to the body
being gently kept open, not by purges but by clysters; for purges in
fevers are precarious, and liable to bring on heavy fluxes. If the
patient under this high fever is costive, give him the following
clyster.
No. XXIII
_Take warm water one pint, or something more; in which scrape
about one ounce of castile or hard soap, and let it perfectly
dissolve; then add a spoonful of honey to it, and let it be as
warm as that it may be easily borne to your cheek._
Let the patient keep this clyster within him as long as he can, till it
comes away with a stool.
If the patient is sick at the stomach, a vomit of _ipecacuanha_ (S) or
No. XXVI, will be very proper, and nothing in such a case can be given
more safety and better advantage; for it is not only the stomach that
gets relieved, but the whole body is brought thereby into perspiration,
by the universal strain it occasions. After the vomit, or after the
clyster, give the following draught.
No. XXIV
_Take of fever powder_ (L) _one scruple; common water or balm
tea, one ounce or half a tea cup full; then take a lump of
sugar, on which pour essential oil of peppermint_ (U) _three
drops; liquid laudanum_ (T) _eight drops; sweet spirit of nitre_
(D) _thirty drops; and mix them with a tea spoon._
This draught will not only promote perspiration, but it will comfort the
stomach, and incline the patient to an agreeable rest; by which he will
be greatly refreshed. If occasion requires, it may be repeated every six
hours.
If rest comes of its own accord, the _liquid laudanum_ (T) may be
omitted; and if the stomach does not stand in need of any carminatives,
the _oil of peppermint_ (U) may also be omitted, &c. The constant drink
when dry may be balm tea; in which, if it suits the palate of the
patient, a slice of lemon may be put, and then sweetened with sugar.
The diet, as I have before observed, should be sparing; and the
patient’s palate in this should principally be consulted. The following
water gruel, or rather wine soup, or whatever other name it may acquire,
I have often ordered to my patients at sea; and which has suited most
stomachs, and proved an agreeable mess.
No. XXV
_Take oatmeal, or pounded biscuit, a couple of spoonfuls; water,
a quart; a small handful of raisins; a little allspice, a little
mace, tied up in a fine rag; which boil together in a tin
saucepan till consumed to a pint and a half; then add a gill of
good wine, red or white, and sweeten it with sugar to suit the
palate. You may put a little lemon peel in, to give it an
agreeable flavour._
A little roasted fresh meat will hurt nobody; and broths most certainly
are good, particularly if the body is costive; but when the body is
inclined to looseness, I have known the best broth to produce a
dangerous flux; and this should be taken notice of.
If the patient however who has met with the accident is of a puny weak
constitution, or has lost a sufficient quantity of blood by the wounds,
bleeding then is not so requisite as in the former case; though the
treatment otherwise must be equally the same.
By this method of proceeding, there is little fear but that the patient
will soon perfectly recover, even in the highest fever that may suddenly
befall a man from an accident; provided the injury is not of a dangerous
tendency. But as an acrimonious habit of body is liable on its own
accord to diseases, it is easily imagined that an accident may become
accessory, and heighten the malignity; hence often a fever of that kind
is liable to degenerate into a malignant one, or even from the accident
itself, when of a dangerous nature; and this I shall explain as I
proceed. I shall therefore leave the accidental fever that proceeds from
an external cause, and proceed to those which take their origin
internally.
-------------------------------------------
SECT. III.
_Of a Cold_.
The fever now to be treated of is the most common amongst mankind;
especially seamen, who are ever exposed, to have the perspiration
obstructed. It however would save many from the grave, and almost as
many from being food for the fish, was it a little more regarded than
what it actually is.
The sound of a cold is so gentle, that custom has almost made it
effeminacy to pay any regard to it; and yet, if we maturely examine, we
shall find the most malignant, acute, and mortal diseases, first make
their appearances by the symptoms of a cold,——But let us proceed to
particulars. A cold is an obstruction of perspiration; which may become
destructive to the animal œconomy if neglected, in so much, that it may
be considered as the first foundation of most diseases.
In my treatise on diseases of the lungs, I have enumerated the many
causes of a cold to which mankind are liable, and their precautions to
avoid them. To sea-faring men, I have one principal cause to mention
whereby they make themselves subject to colds, and sow the seed of many
dangerous diseases in their system, and that is their carelessness in
shifting, after getting wet; in this respect, I have however a remedy to
offer, which is as valuable and as efficacious to their preservation, as
it is easily put in execution. The remedy is simply this:
A man who has been exposed on duty in the rain, and is become thorough
wet, should not only shift himself in dry cloaths, but previously wash
all over with sea water: if he carefully observes this, he will never
get cold on that account. I have not only experienced this personally
many times, but ever found it productive of salutary effects to those I
have persuaded to it.——If we but make some observations on the
accidental occurrences that happen at sea, we shall see the just
foundation of this. When do we find a man who is continually washed by
the sea to have a cold? while on the contrary a foul rainy day, will
almost breed a general sickness.——These observations first brought me on
the notion of washing the body with salt water, and having verified it
by experiment, I soon saw the propriety of it; namely, that the fresh
water being of a sluggish nature, and having a tendency to putrefaction,
is not only apt to infuse a putrescency into the system, but from its
slimy nature apt to clog up the pores, and thus obstruct perspiration;
whilst on the contrary, salt water is not only antiseptic, but
stimulates the pores of the skin to their secretory and excretory
functions.——Nay so perfectly have I experienced this remedy, that I have
persuaded the people to salute one another by way of play with buckets
of sea water on a foul rainy day, and with pleasure I have experienced
that they have all remained brisk and hearty after it, and evidently
seen the difference, that on a similar day the sea water play being
omitted, scarce one who has been thorough wet, escaped a cold in some
degree or other.——I must not forget, that a draught of grog is likewise
no bad preservative. But this is best taken when the watch is out, and
that rest and sleep can be indulged upon it, as that will then be apt to
throw them into a gentle perspiration; whilst however their watch is
upon deck, the best warmth is that which is produced by exercise; except
liquors is taken with the greatest moderation.
But when a cold has actually commenced, care should be taken immediately
to have it subdued in time. The term cold however is a very vague
expression, that includes a great many disorders, occasioned by an
obstruction of perspiration, which all in turn shall be taken notice of:
But as I am now on the subject of fevers, I shall confine myself to that
at present, and consider the cold as it affects the body universally;
namely headaches, a weakness in all the limbs; intermittent fevers,
intermixed sometimes with flushes of heat, and at other times shivering,
chilling, &c.
These are not only the symptoms of a cold, but of almost all
inflammatory fevers; which in fact, the cold is a commencement of. Now
all that nature requires is a perspiration; for thereby the imprisoned
acrimony is expelled, and which nature is always engaged to throw off
from the system.—To this intention, if the patient is rich of blood,
bleeding should be performed; but with such caution, as I have before
recommended. Next give the _fever powder_ (I), together with a good
quantity of balm tea, or if the constitution is of a phlegmatic habit,
sage tea, or even sage punch ( No. V.) will not be improper; but care
should be taken, that if there is much fever, all those things should be
omitted, as it is liable to increase the fever. If there is a nausea at
the stomach, give a vomit: take the following:
No. XXVI
_Take Ipecacuanha_ (S), _one scruple: sugar a little lump: water
half a Tea cup full, and make it up into a draught._
This vomit should be well worked off with chamomile tea, or even common
luke warm water; first letting the vomit operate, and then drinking
plenty of the water after every operation. When this is over, the
patient should keep his bed or hammock, and take either the _fever
powder_ (L), or the before mentioned draught, No. XXIV.
The catarrhal fever, and all the other symptoms of cold, viz. cold in
the head, cough, hoarseness, &c. generally keep one another company,
leave the patient generally at one time; and in fact, one method of
cure, namely, promoting a perspiration, serves for all; for thereby the
obstructions become removed, and nature is restored to its primitive
tranquillity again.
-------------------------------------------
SECT. IV.
_Of Intermitting fevers, and Agues_.
There is scarce a disease that makes a patient more wretched, and
unhappy, than the fever and ague. The causes of these kind of fevers is
principally from a pituitous, or slimy blood, together with its being
loaded with acrimony; and a flacidity of the moving fibres.
They are divided into various classes; though in fact all of one nature.
When the ague with its succeeding fever comes on regularly every day, it
is called _quotidian_, or every day’s ague; when every second day,
_tertian_, or third day’s ague, and when every third day; a _quartan_,
or fourth day’s ague. There are many other classes as subdivisions of
these, but they are the mere speculations of physical pedants, who are
ever sworn enemies to plain understanding, and delight in perplexities;
which therefore, we shall neither spend paper nor time upon to recount.
Suffice it, let their paroxysms return at what stated period of time
they will, either regularly or irregularly, they differ in nothing but
this, that the farther the fits are distanced, the severer they
generally are, when they come on; and the more regular, the more
obstinate in their cure; though in this even there are exceptions.
It is surprizing to imagine, how many different opinions have been sent
into the world concerning the returns of the periodical fits of the
ague; and equally astonishing, how few with any probability of truth or
reason.
I shall not here enter into an enquiry of this nature; certain it is,
that at the stated times of these returning fits of the ague, there is
an obstruction in some particular part of the system, that corresponds
with the dated time of the circulation of fluids in such parts—which
when disturbed, effects by the nervous consent, the whole animal
structure.
The principal intention in all intermitting fevers, should be to correct
the petuity and acrimony of the blood; to remove the obstructions; and
to strengthen the solids.
With respect to the blood, it is an inevitable consequence, that when it
is loaded with a vicidity and lentor, that it will ever occasion a
depraved nutrition; and hence we see, that people labouring under agues,
and intermittent fevers of any kind, have a depraved appetite, and many
disagreeablenesses in the first passages.
The intermittent fever and ague approach with the following symptoms,
viz. a heavy dull head-ach, a shivering chill all over the body, with a
yawning, &c. pain in all the limbs attended with weariness, a nausea at
the stomach, a depressed pulse; which after it has lasted for half an
hour, changes into a burning heat, a throbbing head-ach, pain in the
loins, and in every limb, a great draught, a _full hard pulse_, and
which at last terminates in a profuse sweat; this seems to give the
patient ease, for one, two, or three days; and then attacks the patient
with the same symptom, increasing every time, and reduces the patient
both in body and spirit.
The first thing to be done is to give a vomit, like No. XV. and XXVI.
This is best taken at the approach of the cold fit, and worked well off
with plenty of luke warm water. After the operation of the vomit is
over, let the patient take the following draught.
No. XXVII
_Take fever powder_ (L), _thirty grains; calomel_ (N), _one
grain; elixir of vitriol_ (G), _sixty, or seventy drops;
essential oil of peppermint_ (U), _four drops upon a little lump
of sugar; to which add water, half a tea cup full._
This draught will not only promote perspiration, but help to dissolve
the siziness in the blood; and may therefore be repeated every six
hours, for a few days. But the patient should always be kept moderately
warm upon it, that it may work by perspiration.—This simple method I
have known put the patient to rights again, after a severe onset.
But sometimes this wretched disorder will require more powerful
medicines to keep it in subjection. When the fibres are debilitated, and
the blood still retains its viscid corruptive quality, the ague is apt
to hang on the patient a long time, the succeeding fever apt to melt the
patient down to a mere skeleton, and even destroy him. In this it is
requisite to brace up the solids, and to infuse an astringency into the
blood.
To this intent, the Peruvian bark is now frequently prescribed, and if
judiciously administered it is an excellent medicine; but as it is
liable however, to be improperly given, and then productive of
irreparable mischief, I have purposely omitted it in this catalogue;
nevertheless, I shall give in its stead a medicine, superior both in
virtue, and by far more safe in the application; not only in this kind
of complaint, but in scorbutic cases, as I shall hereafter take notice
of. The medicine is this,
No. XXVIII
_Elixir of Iron._
_Take a quantity of rusty iron, the smaller the pieces are, the
better, for the less quantity will do_; pour on it good strong
vinegar, sufficient to cover it; _let them steep till the
vinegar becomes of a deep brown colour, which it soon will, and
at length acquire a consistence of a black elixir. The vessel
should be either stone or glass; but what is yet better is an
iron pot, which of itself will contribute to the medicine._
If the patient therefore, after the vomit, and the above draught, is
attacked again with the fit of the ague, and succeeding fever, have
immediate recourse to your elixir of iron.——Let him take after the fever
is off, every three hours, a table spoonful of the elixir, and should it
seem to come up again at first (which it sometimes will, particularly if
the stomach is yet foul) give immediately another spoonful, and repeat
this at least three times of the day.
A little gentle exercise upon taking the elixir is highly beneficial;
and if it throws a gentle warmth over the body, and brings it into a
gentle perspiration, you are sure of success.
The quantity of it should be adapted to the condition of the patient,
and the strength of the stomach; if it sits easy, a larger quantity may
be taken, and seldomer; and if it is more nauseous, a smaller dose and
oftener.—Should the fits seem obstinate, the following electuary may be
used; and is a powerful specific.
No. XXIX
_Take stomach powder_ (M), _two drachmes; nutmeg powdered, one
drachm; powdered alum_ (17), _half a drachm; essential oil of
peppermint_ (U), _twenty drops; calomel_ (N), _ten grains;
honey_ (E), _one ounce: the whole well mixed._
Of this let the patient take every eight, or twelve hours, the bigness
of a nutmeg, taking his elixir as before observed; and this will ever
prove successful in the most obstinate case.
As patients of that kind at sea, have ever a taint of the scurvy in
their composition, or at least have a tendency towards it, exercise and
freshness of food, will prove one of the restorative means. The malt
decoction should also be their drink, as well as in the scurvy.
To conclude, I shall only observe, that bleeding in agues must at all
events be omitted, as being absolutely pernicious, as it cannot fail of
impoverishing the blood; which is the principle source of the disorder.
Also, in the intermitting time, exercise should be observed, and the
diet should, when the stomach craves, be good. Sometimes indeed, the
stomach is too ravenous and greedy; but that is a default which proceeds
from the same cause as that which makes it loath its victuals; a vomit
in either case is the most effectual medicine, and may be repeated as
often as it is requisite, without the least fear of injury, particularly
in this disease.
-------------------------------------------
SECT. V.
_Of Putrid and Malignant Fevers._
I Shall on this head restrain myself from saying more than what is
absolutely requisite to the cure. It seldom happens to infect a ship’s
crew at sea, unless the ship has carried it from some place where the
disease was contagious.
Though notwithstanding, great sickness on board may give rise to it, if
care is not taken to prevent it. I would therefore ever advise, in case
of sickness, to steam the birth with vinegar; namely, taking a vessel
with vinegar, in which put a hot iron, and thereby raise a steam, which
is a powerful preservative.
A putrid fever may be generated from the contaminated atmosphere of a
sick person, though it rarely is the case; yet prudence demands every
precaution that is in our power.
The fever that I now speak of is of the malignant kind, and peculiar to
the hotter climates.
The patient is seized first with a shivering chilliness, which is soon
succeeded with a weak unequal fluttering pulse; the body is seized with
a universal pain, together with a great debility; the mouth is hot and
dry; the respiration depressed; and the mind labours under a heavy
anxiety.—The fever continues, though not very high; and the pulse not
very full;—a delirium or else a stupor ensues; the urine becomes deep
coloured, and has an oily skim at top; and the patient is in so imminent
a state of danger, that, unless a favourable crisis happens soon,
twenty-four hours rapid progress is liable to put him beyond all help.
The first and immediate remedy should be a vomit, No. XXVI, which is the
grand step to be taken in all fevers; not so much for the sake of
cleansing the stomach, as for the universal ease it gives to nature.
The next step is to correct the putrescent acrimony in the system; for
which purpose make the following draught.
No. XXX
_Take fever powder_ (L) _one scruple; elixir of vitriol_ (G)
_thirty drops; sweet spirit of nitre_ (D) _thirty drops;
calomel_ (N) _two grains; essential oil of peppermint_ (U) _four
drops; upon a lump of sugar; and half a tea cup full of water._
Let the patient take this draught every six hours; and after four have
been taken, the calomel should be omitted. If the nerves seem to be
affected, the essential oil of peppermint may be increased. If a
delirium should come on, the _liquid laudanum_ (T) from ten to twelve
drops and upwards may be given in the draught.
I know many will think it odd, that I should give calomel in a fever;
but all this is merely the effect of blind prejudice; a better medicine
than calomel is not in all Nature, if judiciously applied; and so
fortunate have I been in my success with this exalted medicine in
contagious fevers, that I have preserved myself and my patients in the
midst of Death’s spreading horror around us. But to proceed; if the
patient continues to be dry on the surface of the skin, and perspiration
seems backward, a blister betwixt the shoulders, the bigness of the palm
of the hand[15], will greatly facilitate the crisis or turn of the
fever; but let it not be erroneously supposed, that a blister will draw
off the bad humour, or that it does good by such an operation; for this
notion has proved destructive to many patients. All the good a blister
does is to spur on the animal function; by which sometimes the acrimony
is thrown off from the system; but if thus irritating the system be
overdone, or wrong applied, it is productive of many additional evils to
the disease; causes spasms, strictures, and other acute disorders, that
of themselves may become mortal. Therefore blisters should never be used
but when the body is defective of perspiration, or when the debilitated
system is defective in its excretory functions.
Footnote 15:
The method how to apply a blister is described under the article of
Blister Plaister, in the second section, p. 75.
When the patient is rid of the fever, a general weakness will be left
behind; this is best assisted with the _elixir of iron_; and now and
then as a stomachic, a tea spoonful of _Turlington’s balsam_ (W), or
some few drops of _oil of peppermint_ (U), as also the malt decoction,
and fresh diet.
Malignant fevers are generally attended with eruptions on the skin,
which is sometimes in favour of the patient, and therefore by no means
to be hindered; but if there appears purple spots on the skin, and that
they incline to turn black, it is rather a dangerous symptom, and
indicates very little hope of the patient’s recovery.
The same method as above must be observed; which if medicine can avail,
will afford benefit.
On the whole, I have this to observe, that all acute fevers are liable
to become malignant and putrid; and in my practice I never found, that
there was any real distinction to be made in the method of cure, whether
the acrimony was generated in the habit by disease, or introduced by
contagion; and if I may be allowed to judge by comparison, it must
appear that my method is superior to the more general doctrine; because
I have ever found it to be attended with much more success.
------------------------------------------------------------------------
LECTURE VI.
OF THE
VARIOUS INTERNAL DISEASES,
AND
THEIR METHOD OF CURE.
Having in the foregoing said what I thought most material to be observed
in fevers, as the universal disorder that attends almost every ailment
in the human body, I shall for regularity sake, treat on the most
material diseases, as they may seem to follow in order in the various
divisions of the human body; and be as concise in their description and
cure, as their nature will admit of.
-------------------------------------------
SECT. I.
_Of Diseases of the Head,_
_Of the Apoplexy._
The apoplexy is a disease, wherein the patient falls down motionless,
void of sense and sensation, and is, in fact, a temporary death. It will
scarce however admit of a strict definition; for there are not only
various degrees of this disorder, but even different disorders under the
same denomination, that have quite distinct different causes for their
effect. Many indeed may be accounted for, but many more cannot.
The brain is the root of the nerves, and consequently the fountain of
all sensation, and life itself. That part of the human fabric is
extremely delicate, and blood vessels plentifully distributed. When
therefore these vessels become either so distended with blood, so as to
press the substance of the brain, that it is hindered from its motion,
confusion to the animal œconomy must naturally ensue; thence an apoplexy
in its various gradations is liable to be the consequence; but as the
vessels in such a distention are liable to break, and the extravasated
blood pressing the brain more forcibly without a chance of dispersing,
we plainly see one reason, why such a malady is apt to turn out fatal,
as we find it sometimes does.
Such causes may either proceed from external, or internal injuries;
thence we see that a heavy fall, or contusion on the head, may occasion
an apoplexy, or at other times, a congestion of blood to the head may
produce the same malady.
Sometimes the patient is motionless; and to all appearance dead, and
nothing but a faint pulsation remains; at other times there is indeed
more signs of life, but more terrible in appearance,—namely a convulsive
breathing and foaming at the mouth, without the least signs of sensation
or perception; in which case there is much to be feared, that vessels in
the brain are burst.
However in all these extremities, nothing can contradict the indication
of bleeding, except extreme weakness, and debility of the system; which
here is very rarely the case.—After bleeding, a large blister between
the shoulders should immediately be applied, and treated as directed in
the second lecture, page 75.—A draught like No. XXX. will also be of
singular service, till the patient comes to; after which he will require
such treatment as is directed under fevers; for that disorder will
always attend the shock that the apoplexy gives to the animal system.
_Of the Frenzy and Delirium._
When the root of the nerves are stimulated by acrimony, so as to
heighten their sensibility, or set their regulated perception in
confusion, the ideas become bewildered, and the sensations act at
random. This is generally the case with patients in acute and malignant
fevers; and this conception differs from dreaming in this respect, that
the phantoms of the confused imagination may be somewhat guided by the
objects around them; as they may be said to dream with their eyes open
and full awake.
When the frenzy attends acute fevers, the blood is generally in a great
confusion, and the pulse high and fluctuating. Yet bleeding should by
all means be avoided, unless indeed the disorder has come on remarkably
sudden. Blisters here are requisite; and in order to take off the
stimulus of the nerves, give the patient the following draught.
No. XXXI
_Take Fever Powder_ (L) _one Scruple; Liquid Laudanum_, (T) _ten
Drops; Spirit of Wine and Camphor_ (A) _twenty Drops; Essential
Oil of Peppermint_ (U), _four Drops upon a lump of Sugar; Water
half a Tea Cup full._
This draught may be taken every fourth or sixth hour; and now and then a
grain of calomel may with great success be added to it. Cooling clysters
in this case are also of singular service; for example:
No. XXXII
_Take cold water, eight ounces; Nitre, or instead of this[16]
Fever Powder_ (L) _two drachms; spirits of Camphor_ (A) _thirty
drops, mix them_.
Footnote 16:
The fever powder may be steept in a little water before hand, and the
clear poured off, because nothing but the nitre here is useful.
If the patient is very costive, a little honey and soap may be added,
previously dissolved; which will both open the body, and promote urine.
For the rest, every method must be taken as is already observed in
fevers.
_Of a Stupor, and Lethargy._
This is a symptomatic affliction, that attends acute and malignant
fevers, in its nature quite opposite to the former; in which the nervous
system is benumbed, and have lost their sensation; this is very apt to
succeed, but seldom precede the Frenzy. When a patient lays in that kind
of stupefaction in a continual dosing, there is in general little hopes
of recovery; nevertheless remedies must be applied.
Blisters here are very proper, and these should be pretty large. Horse
radish should be frequently held to the nose, which has a reviving
quality, and is very innocent with respect of adding acrimony to the
system.
A vomit has often in this extremity proved very beneficial; which the
patient’s weakness should not retard, unless very weak and near the end
indeed. The following draught may also prove highly beneficial.
No. XXXIII
_Take Sweet Spirit of Nitre_ (D) _one drachm; Essential Oil of
Peppermint_ (U) _ten drops upon a lump of sugar; water one
ounce, mix them._
Let the patient take this every four or six hours, till he comes to
himself again:
But care should be taken that a good sound sleep, is not mistaken for a
stupor; for it frequently happens that a patient upon a favourable
crisis will fall into a long sound deep, that terminates all his danger;
if therefore the patient breathes freely, and has a moistness all over
the body, together with a tolerable regular pulse, disturb him not; but
let nature finish her gracious work.—This kind of sleep is materially
different from the stupor, wherein the patient neither sleeps nor wakes,
but is equally insensible when the eyes are open, as when they are shut.
_Of a Violent Head-Ach._
A Violent head-ach often attends fevers, or comes spontaneously without;
it generally precedes a delirium, as the irritation of the nerves is the
principal cause thereof.
The first intention must be to draw the humours from the head. A
compress with vinegar, in which is dropt a little spirits of wine and
camphor, is of great service, and will often have the defined effect to
carry it off. Warm foot-baths also is of great use; a blister may be
applied, and the draught No. XXXIV. will also prove of great service.
The head-ach may proceed from many other different causes, and in the
general is only a symptomatic affection; therefore particular attention
should be had to the primitive seat of the disorder.—Frequently a foul
stomach will occasion the head-ach, and a vomit most times prove the
best application.
-------------------------------------------
SECT. II.
_Of Diseases of the Neck_
The diseases in that part, are indeed very numerous; but as they have so
strict a connexion amongst themselves, the classes may be considered but
very few; of which some have been already taken notice of.
_Of the malignant Sore Throat._
Every body who is liable to catch cold, is frequently apt to have a
hoarseness and consequently in some degree, more or less, a sore throat.
If a fever attends it, methods should be used accordingly, as is
mentioned under the head of colds: with respect to the throat, use the
gargle, No. XVIII. pretty frequently, and the disorder will soon go off
again.
But when an ulcerated sore throat is attended with a malignant fever and
inflammation, it is called a quincey; this case is alarming, and
requires very careful treatment; for first we must observe, that the
larynx is of a very complicate and curious structure; and secondly, it
is composed of various, and delicate materials; namely, cartilages,
membranes, muscles, and glands.
The glands are very numerous in the various parts of the composition,
whence the inflammation becomes not only painful, but is apt to swell up
and obstruct respiration; wherefore an inflammation in such parts
becomes highly dangerous to the life of the patient.
When the patient perceives a burning pain in the throat, and the parts
all round swell up, respiration becoming difficult, add to this a
hoarseness, great difficulty in swallowing, there is no time to lose,
for immediate assistance is wanting.
Bleeding is indispensably necessary, particularly if the inflammation is
sudden; warm foot-bathing also is highly requisite; to remove the
humours downwards; a gargle should also immediately be applied like the
foregoing No. XVIII. with the addition of a little _camphor spirits_.
Externally apply the poultice, No. II. and give the following draught.
No. XXXIV
_Take fever powder_ (L), _one scruple; calomel_ (N), _two
grains; liquid laudanum_ (T), _twelve drops; water two
spoonfuls; mix it into a draught._
This may be given every six hours, for two days successively; and this
generally will break the disorder. The patient should be made to drink
as freely as he possibly can; and perspiration should ever be promoted.
A blister as the case requires, may also be used with much advantage. If
the body is bound, clysters may tend to incline the humours to be drawn
down from the part.
No. XXXV
_Take Glauber’s salts_ (19), _one ounce and a half; honey_ (E),
_one spoonful; hot water, a pint and a half._
Sometimes the inflammation is so very great, as to choak up both the
passage of respiration, as well as that of deglutition; so that the poor
afflicted patient can neither breathe, nor swallow; and is not only
liable to be suffocated, but even starved to death, besides the danger
from the malignant inflammation.
In this exigency, have recourse to the following simple but excellent
remedy.
No. XXXVI
_Take a pipkin, or a tin sauce-pan, with a quart of water, a
pint of vinegar, and two spoonfuls of honey; then take a funnel
that will pretty well cover the vessel; then take a piece of
iron, or some old nails, or a little stone, or what you have
handy; heat it red hot, and put it into the pipkin, and put on
the funnel so that steam may ascend through it. Over this let
the patient hold his mouth, so that he breathes nothing but the
steam; and to secure it the better, put something over his head,
that he may reap the more the benefit of it. When the steam
ceases, heat it again as before. Instead of heating it with the
iron, it may be shifted with boiling, but the former is
generally more handy._
In the mean time, if the patient should by the inflammation, be deprived
of all nutriment, recourse must be had to nourishing clysters: milk in
this respect is the best; but in want of that, fowl broth may be used;
and if that is wanting, take water gruel. Milk however is superior to
all: I shall give a receipt of each kind.
No. XXXVII
_Take milk and water, of each a pint; cinamon (16), one drachm;
boil them and strain the liquor; then dissolve one ounce and an
half of good loaf sugar; add six drops, of the essential oil of
peppermint_ (U), _upon a little lump of sugar._
No. XXXVIII
_Take half a fowl, bruise the bones, and cut the flesh small;
this boil in three pints of fresh water, with about one drachm
of cinamon; strain it clear, and add as before, an ounce of
sugar, with a few drops of the oil of peppermint.—A tea cupful
of good white wine may be added, if the patient is very weak,
and not feverish._
No. XXXIX
_Take oatmeal, two spoonfuls; malt, one spoonful; cinamon, two
drachmes. Boil it in two quarts of water for some time, till
when it is strained, it becomes one quart; put to it fine sugar,
six ounces; a few drops of essential oil of peppermint, and a
tea cupful of good wine._
These clysters are perfectly safe, and very nourishing. Some have added
salt to the animal broth, perhaps through a notion to make it the more
palatable, and so of course more nourishing; but probably they forget
that the part they are now about to feed, differs widely from the
depraved taste of the palate.
Salt is stimulating; besides, it indurates the aliment, that it never
yields so much nourishment, because it always opposes assimulation; and
it is universally known, that salt victuals is by far, less nourishing
than fresh.
The quincey is sometimes so desperate, as to strangle the afflicted
patient, particularly if assistance is given too late; in so much that
_bronchotomy_, or opening the wind-pipe, has been the last resource in
this deplorable dilemma. I have mentioned this operation, in the third
lecture, and have only to observe, that in this case little hope is left
after that operation, on account of the great inflammation of the parts;
though we have instances of its success. If however the method which I
have here laid down, together with strict observance of managing fevers
is duly observed, there can scarce be a failure of success; for if I may
be allowed to judge from my own experience and success, it is merely
neglect, in the first setting out of these diseases, that for the most
part, renders them so very desperate and mortal.
-------------------------------------------
SECT. III.
_Of Diseases in the Breast_
Under this head, I mean principally to treat of diseases of the
wind-pipe, the lungs, and the pleura, or membrane that lines the cavity
of the breast, and encompasses the lungs.
_Of the Cough._
A Cough is generally occasioned by a cold; unless it is symptomatic with
other inflammatory diseases, or the relict of a heavy sickness; in which
case, it is either near a-kin to, or else the consumption itself.
If from a cold, it seldom is deep founded, and generally has its seat in
the larynx, or in the wind-pipe; though indeed sometimes in the lungs.
It generally begins first with a tickling in the throat, and occasions a
short dry cough; which gradually becomes strong, and is attended with a
discharge.
It is surprizing what absurd remedies are sometimes given for the cough;
as if they supposed that every thing taken should immediately march at
the word of command into the wind-pipe, and there set to work
accordingly. Amongst the many celebrated nostrums, spermaceti, or whales
fat is remarkably celebrated; it softens the phlegm say they; but in
fact, a little fat pork, or hog’s lard will do equally as much
good.——The truth of the matter is, the cough proceeds from an obstructed
perspiration. When a person gets cold, he generally first feels a
snuffling, and obstruction in the nose, then a sore throat or
hoarseness, and lastly a cough; all which is a gradual defluxion from
the pituitous membrane, which reaches from the cavity of the nose, all
down the lungs. Whatever medicines therefore, are capable of yielding
benefit, must be calculated to open and remove the obstruction, and
promote universal perspiration; whence therefore we find it is
impossible to cure one, without the other.—Medicines neither do, nor is
it fit they should come immediately farther, than the top of the larynx;
for if they happen to come into the wind-pipe, the most innocent
medicine would certainly act the part of a poison.
The first indication therefore in a cough, is to promote perspiration;
for then nature will repair the respirative organs with the rest.
Let the patient take a draught or two of good sage punch, No. V. and
thereby promote perspiration; and in order to continue this principal
intention, and to assuage the slight inflammation in the throat, which
the heavy cough occasions; make the following electuary.
No. XL
_Take honey, or sugar dissolved to syrup, two ounces; lemon
juice, half an ounce; or elixir of vitriol, two drachmes; sweet
oil, one ounce; mix them into a linctus._
Take of this, every half hour, but half a tea spoonful; and swallow it
gradually, so that it may as it slides by, do some service to the
larynx; and keeping the body all the time in a gentle perspiration. This
method is superior to all your nonsensical pectorals, which have nothing
but quackery for their foundation; for whatever you may take for the
cough, it cannot possibly have any other effect on the part, till the
real cause is removed, than barely to touch the larynx; for all goes to
the stomach, and undergoes the same chance as your victuals. Therefore
strike at the root of the evil; namely, to promote perspiration; and all
the rest of the complaints will vanish, in consequence of this principal
intention.
_Of the Pleurisy, and Peripneumony._
The _pleurisy_ is an inflammation of the lining of the inside of the
pectoral cavity and lungs; and the _peripneumony_ an inflammation of the
lungs themselves.
These two principal kinds of inflammation have given birth to the names
of many other inflammations contiguous to those parts, which I hope to
be excused from entering into, as it is of very little signification to
the proper treatment of those disorders; for I have often known the most
skilful practitioner, to be mistaken of these disorders in his
diagnostics, and yet been successful in his cure. The signs of this
inflammatory disease, is an acute fixt pain in the breast; on whatever
side the disorder is in, with a difficulty of breathing, and frequently
attended with a small short dry cough, which however stings the patient
like so many daggers. A constant fever attends with all its symptoms;
which adds greatly to the patient’s misery.
On the immediate signs of these symptoms, bleeding must be had recourse
to; and if the inflammation is great, and the pain pungent, it must be
repeated; though with skilful management. Bleeding may be repeated after
the first twenty-four hours; yet in general it is needless, and
sometimes dangerous; for my own part, I never approved of it; nor have I
seen any necessity for it. Perspiration however should be promoted.
If the pain is violent, let the patient use the following medicine.
No. XLI
_Take sweet Spirit of Nitre_ (D) _twenty drops; Spirit of Wine
and Camphor_ (A) _ten drops; Fever Powder_ (L) _one scruple; mix
it up with sugar and water into a draught._
Let the patient take this every six hours; if there is a great nausea at
the stomach, a small vomit of twelve grains of _Ipecacuanha_, (S) may be
given first, notwithstanding it is great pain to the patient; and I have
often known it productive of great good, and laid the first foundation
to a successful cure.
If the pain still continues, twelve drops of _liquid laudanum_ (T) may
be added to the above draught; No. XLI. If the spirits of the patient is
low, give the _essential oil of Peppermint_ (U) to the quantity of three
or four, or six drops upon a lump of sugar, either put, into the draught
above-mentioned, or give it by itself occasionally.
To the inflamed side, warm cloths may be put wrapt up with a hot made
trencher, brick, a bag of sand, or whatever will retain heat; as that
will greatly facilitate the internal resolution.
Perspiration is the principal object to be considered in this acute
disease, and should therefore be promoted; but every thing forcing that
produces profuse sweats should be avoided, as that only encreases the
fever.
If the patient is very restless, the fever depressed, and greatly
oppressed in respiration, blisters may be applied; but if the patient
can do without them, it is much better; as they very often are apt to
encrease the inflammation.
Cooling clysters, No. XXXII. which at the same time promote urine, is of
singular service; and in every respect methods must be taken, as have
been directed in fevers, and the ulcerated sore throat; as all these
inflammatory diseases are of one nature, and require almost one method
of treatment. For farther particulars on this head, see my treatise on
diseases of the lungs.
-------------------------------------------
SECT. IV.
_Of Diseases of the Bowels, and the Alimentary Canal_
Diseases of mankind under this head are very numerous indeed; which are
for the most part owing to their deviating too much from the common path
of nature. But besides all this, seamen are particularly liable; not so
much indeed on account of luxury as the confined diet, and the different
climates they visit.
I shall in this be as concise as the subject will admit of, and confine
myself to such diseases as occur most commonly; and by which others that
are here omitted, may be understood.
_Of a Depraved Appetite._
There is nothing that people in general are more apt to fly to, when
appetite fails them, than bitters; but if we consider what bitters
really are, and by what means they act in the alimentary canal, we shall
find them, either only to stimulate the coat of the stomach, or else add
to the strength of the bile.
But generally the default of a bad appetite is a pituitous slime in the
stomach, that prevents this viscera from performing its part towards
assimilation; and therefore we generally find that such stimulants only
spur it on for a little while longer, till at length it loses its tone,
so as to be wholly unable to prepare the food for a good nutrition; or
else the stomach becomes so used to these forcing stimulants, as not to
be able to do without them.
But this is not all; for in bilious complaints, when the stomach is most
disordered, bitters never fail of making evil worse. The stomach is a
delicate viscera, and should ever be the most cautiously dealt with.
Whatever part of the human body is in exquisite pain, the stomach from
the nervous consent always partakes, and is apt to be depraved in its
functions; whence a nausea is liable to ensue; and in such a case any
stimulants, particularly where bitters are concerned, is ever of evil
tendency.
In general however, a vomit is what nature points out; and which gives
not only relief to the stomach, but assists in giving a general effort
to the whole animal fabric. In short, there are so very few cases where
bitters are of any benefit at all, except where the stomach has
injuriously been used to those stimulants, that I have entirely exploded
them from my catalogue; being persuaded that every body will do better
without them.
When the stomach loaths victuals, the mouth is slimy, has a bitterish
taste, and attended with sour belching, and the victuals siting heavy on
the stomach, nothing is preferable to a vomit.
This I know has also been carried into abuse, as well as many other good
medicines.——Yet that should be no rule; for if a vomit is properly and
timely given, it will ever be attended with success. Take here the
following direction for a foul stomach.
First take a vomit, and work it well off with bare luke warm water; then
take every night, or when going to rest, a dose of _stomach powder_ (M).
If the stomach seems very weak, add a few drops of the _essential oil of
peppermint_ (U), which will soon convince you of the good effects.
If you require a stimulant in the morning, take _Turlington’s balsam_
(W), about a tea spoonful in a glass of wine, previously put on a lump
of sugar, that it may the better incorporate: which is a good stomachic,
and ever preferable to the customary bitters.
Dram drinking is another pernicious custom, whereby many have been sent
to eternity long before the period of life prescribed by nature; and of
which I would advise every man, who has the least regard for his health,
to beware, as of a deadly poison.
On the whole, the want of appetite is what many complain of without
reason. Some fancy themselves very bad, because they cannot eat their
breakfast; those I would advise to stay till dinner time; others again
have no appetite for their dinner, unless they wet their stomach with a
glass of Stoughton, or some other bitters: Those should eat nothing in
the morning, or else stay till supper time.——In short, nature should be
consulted, both in the state of health, as well as in diseases, and her
salutary dictates should be followed.
The custom of seasoning victuals with strong stimulating condiments is
often prejudicial, and nothing should be used with more moderation; for
though it may warm and stimulate the stomach, yet, it frequently gives
cause to great weaknesses, and generally are the primitive causes of
chronic distempers; as it hurries on the chylefaction, and thence is apt
to feed the blood with many acrimonious humours.
This little dissertation on depraved appetite I hope will suffice, and
doubt not if attended to, that health and longevity will become the
intimate acquaintances of the man who wishes to enjoy their blessings.
_Of the Colic._
If we consider the length of the ailmentary canal from the mouth to the
anus, namely six times the length of the subject they belong to; and if
we consider the delicacy of its substance, as also, the office for which
it is ordained; we shall not at all wonder, that so many disorders are
incident to mankind in that part.
The colic however is the general term for various painful sensations in
the intestines; though the causes as well as the seat, and the manner of
its affecting the system, is materially different.
The general cause however, is a stimulant, which irritating the inner
coat of the intestines to constriction; and whence a spasmodic
contraction, and a perverted peristaltic motion is produced.
If the stomach is affected with the pain of the colic, so that a nausea
and reaching attends, or has been previously felt, a vomit is the first,
and most expedient method to be had recourse to; for by this, not only
the crudities in the stomach gets disburdened, but from the joint action
on the internal canal, a stool or two is generally produced, by which
frequently the offending acrimony is carried off.
When however this avails not sufficiently, and the pain rather
increases, particularly if the body at the same time is costive,
recourse should be had to clysters; for purges in this case, do not
operate speedily enough, and in cases of costiveness, is not always
safe. The clyster No. XXIII. may be of great benefit, and if necessity
requires it, occasionally repeated.
But more frequently, it is from a nervous affection, and then
carminatives prove the most effectual; in such cases give the following,
No. XLII
_Take essential oil of peppermint_ (U), _six drops on a lump of
sugar; elixir proprietatis_ (H), _five large tea spoonfuls; wine
or water, half a tea cupful._
Let the patient take this immediately; a little _Turlington’s balsam_
(W) about a tea spoonful, also is very beneficial. If the pain still
continues violent; let ten or twelve drops of _liquid laudanum_ (T), be
added. Clysters should not be neglected, but plentifully administered;
the same medicines as is given to the patient, may also be added to the
clyster.
The dry belly-ach, is a spasmodic contraction of the intestines, and
throws the patient into the greatest misery imaginable; clysters is the
only recourse and anodynes, together with gentle mercurials will
likewise prove beneficial; warm clothes and something that can retain
the warmth should constantly be put to the bowels; and in great
extremities, cold foot baths have often given immediate relief.
The bilious cholic is of a dangerous tendency, and always attended with
the bilious belching and vomiting of bile. In this case vomits is the
only method to be used with safety; and if properly continued, as long
as the bile is brought up, will never fail of success. But bleeding in
bilious complaints is ever pernicious. If a fever attends, method must
be used accordingly.
_Of Looseness, and the Bloody Flux._
A Cholic is often the forerunner of a looseness, and if the looseness is
not too violent very often is salutary, and carries off many kind of
disorders in the body. But if a looseness continues after twenty-four
hours, it is time something should be done, in order to prevent a bloody
flux.
If the flux is attended with a nausea at the stomach, and an inclination
to vomit, give without delay the following draught:
No. XLIII
_Take rhubarb_ (O) _one scruple; ipecacuanha, ten grains;
stomach powder_ (M) _fifteen grains; calomel_ (N) _three grains;
mix them and make it into a draught or bolus, with sugar and
water._
This probably will vomit a few times, and then occasion a few stools;
but as the rhubarb has an astringency as well as cathartic quality, it
will in general, after the purging has gently carried off the acrimony,
act as an astringent; particularly if after the above draught, the
following paragoric is taken.
No. XLIV
_Take oil of peppermint_ (U) _four drops upon a lump of sugar;
liquid laudanum_ (T) _eight drops; sweet spirits of nitre_ (D)
_twenty drops; mixt in a glass of wine._
But if the patient still continues after these medicines, with great
griping, a succession of stools, together with a _tenesmus_, (that is a
perpetual inclination to go to stool) then give the following:
No. XLV
_Take rhubarb_ (O) _ten grains; stomachic powder_ (M) _fifteen
grains; essential oil of peppermint_ (U) _three drops; calomel_
(N) _one grain; and make it into a bolus or draught._
Let the patient take this every six hours, for the first two days. If
the stools are bloody, slimy, and attended with great pain; recourse
must immediately be had to clysters, such as No. XXXVII, XXXVIII, XXXIX.
mentioned in the quincey; for the more nourishing they can be made the
better; as thereby they will lubricate the bowels, and strengthen them.
In the mean time the _white decoction_ should be used as a constant
drink, which make as follows:
No. XLVI
_Take chalk_ (18) _pounded small, three ounces; cinamon_ (16)
_bruised, two drachms; boil them in two quarts of water for one
hour, and strain off the decoction._
Of this let the patient drink for his constant drink; a few drops of oil
of peppermint may be dropped upon a lump of sugar, and dissolved in it.
The same decoction may also be given as a clyster when the flux is very
violent. After the two first days the rhubarb should be given but
sparingly; for if the flux is bloody, we may justly suppose the
intestines are in a state of inflammation, and even ulceration. In such
extremity, a little calomel mixed with the clyster, as also liquid
laudanum, will not only correct the acrimony, but give ease to the
emaciated stamina of the intestines.
By this treatment the most inveterate bloody flux may be subdued,
especially with the help of patience, cautious diet, and cleanliness.
-------------------------------------------
SECT. V.
_Of the Scurvy_
If I was to write as much on that subject, as I have already written in
this treatise, the whole would only amount to this, that the scurvy is a
state of putrifying corruption in the living human body.
The causes of this disorder is a defective diet, contaminated air, and
want of proper exercise.
In regard to the diet, salt provisions and foul water are the accessory
means, which not only impoverishes the blood, but gives it a tendency to
a putrescency, whereby it loses its spirit, the lymph its
gelatinousness, and the crasamentous part its resinous consistency.
Thence the serum becomes sharp and acrimonious; the lymphatic part in
the blood unable to nourish the stamina of the solids; and the red
crasamentous part becomes crumous, and void of its vivacity: and as the
solids must in consequence suffer in proportion to the state of the
blood, from whence they have their existence, and become maintained, it
must follow also, that they degenerate into the same state of
corruption: thence we find not only a universal lassitude and debility
in the limbs, but gradually the smaller vessels become unable to
circulate the corrupt humours, break, bleed, and even mortify of their
own accord, without any other cause than the putrescent nature of their
containing fluids.
Though the symptoms are in general too well known, not to be easily
mistaken; yet I shall here describe this destructive disease in its
various gradations.
When a patient first begins to be tainted with the scurvy, he feels a
lassitude all over his body, and a peculiar proneness to indulgence and
idleness; work becomes irksome; and neither has he strength, nor
inclination, to do his work with the same chearfulness as before. He
sleeps more in general, but his rest is for ever disturbed with heavy
and melancholy dreams; and particularly of that nature, as for ever to
be engaged in escaping from some sad danger, but unfortunately that his
limbs are so remarkably heavy, that he cannot move them. With these and
the like labour in vain phantoms his sleep is disturbed, till at length
he awakes, and finds himself more fatigued than when he first went to
rest. The mouth is always foul and slimy, and frequently attended with a
disagreeable taint. The appetite is depraved, and the victuals sits very
heavy on the stomach.
This is the first stage of the scurvy; and when a patient is sure of
those symptoms, it is time some remedy should be used, in order to
prevent the approaching evils; which gradually come on thus.
The gums begin to swell, though not very sore; and frequently bleed
either on their own accord, or at the least touch of any thing that
comes near them. The breath becomes very disagreeable, even to the
patient himself. The teeth grow dark, brown or black, become loose, and
the very jaw bone, together with the roots of the teeth are exposed and
seem uncovered from the decayed gum.
Sometimes a scurfy itch ensues, and sometimes little spots appear. The
body becomes remarkably weak, and sensibly falls away, and the colour of
the skin gets a disagreeable tawny hew; which is most remarkable,
together with other emaciated features in the patient’s countenance.
This is the second state, and now dissolution actually begins to take
place.
The patient loses his strength sensibly, so as not to be able to be
supported by his own limbs. Over his body variously appear red, scarlet,
yellow, green, livid and black spots, of various magnitude; some of
which will bleed on their own accord; others will break into malignant
ulcers, and others again will mortify. The appetite fails; a flux
frequently ensues; the urine will be thick and stinking; and the poor
wretch gradually dies merely by putrefaction.
The scurvy has had many definitions, and has been divided into various
classes. All the difference of the disorder is, that sometimes it is
attended with a fever, only in some degrees, more in one habit, than in
another; which may be owing either to the nature of the constitution
itself, but principally depends on the climate the patient is in: to
which I must not forget to add, that frequently the scurvy is
complicated with other disorders. I could make many observations on this
head, but, this perhaps would serve more to indulge myself than to
benefit my reader.
I shall therefore suppose that I have said enough, to proceed to the
cure; which I do with the more chearfulness, as I am happy in knowing it
by experience to be not only easy, but efficacious.
The first time I ever experienced, and had it in my power to examine
into the nature of the _true_ scurvy, I was fortunate enough to discover
so much of its corruptive quality, as to hit upon the true antidote;
namely, the sacharine quality and acidity of vegetables; and upon this
foundation I established my method of cure with success.
I shall not here enumerate the many experiments that I made in the
course of these inquiries, but proceed to the result thereof, and the
method to be observed.
In the first place, sugar is an article of more virtue, than what is in
general known; and of so great a value to seamen, that he ought to
esteem it as one of the greatest preservatives of his health. Next to
this is vinegar, which is not only a resister of putrefaction, but has a
coagulating, and condensing quality to the animal juices; whereby it not
only consolidates the fluids without adding acrimony, but on the
contrary, absorbs animal acrimony, and braces up the solids.
On the same principle, I have found _dried malt_, to be of great
advantage in scorbutic cases; in which, both the saccharine and acidity
of vegetables is contained even in a heightened degree,——This being
premised, I proceed in the following manner:
When a man is found to have evident signs of the scurvy, let his drink
be acidulated with one fourth, or third, &c. of good vinegar, or what is
yet better, lemon juice, and well sweetened with sugar.
If there is malt on board, let a malt decoction, or temporary beer be
made in the following manner:
No. XLVII
_Take malt bruised, a pound, or three handfuls; sassafrass
chips, a small handful; boil it in a gallon of water for an
hour, and strain it off for use._
Let this be the constant drink, which in a short time will revive the
already tainted habit. Onions, horse-raddish, and mustard, &c. such as
will keep on board, should plentifully be made use of, and the pills No.
X. should be taken every twenty-four hours, at a time when going to
rest.
This method will soon bring the patient to health again, particularly if
in the first stage; but when it is come to the second degree, or in a
state of rapid decay, more effectual and immediate means must be taken.
Here then I shall present the method, which by experience I know to be
efficacious.
No. XLIX
_Take a large tub, (a butt sawed in two) in which place a stool,
or something to sit on; Then let the patient be stript naked and
seated in the tub; pour into the bottom of the vessel about one
gallon of good vinegar; put a blanket all over the patient, and
the tub, so that the whole is covered like a hut. Then heat a
large poker; which put into the vinegar in order to rise a
steam; which continue for about a quarter, or half an hour, or
longer, according to the circumstances._
If the patient is very scorbutic, it should be repeated three times a
day, or even oftener, for the effect of this steam-bath is so powerful,
that I have with pleasure seen the patient when not able to crawl to the
tub; he has been so revived by the operation, as to come out of his own
accord quite refreshed.
In the mean time the elixir of iron as is described No. XXVIII. should
be taken; the mouth often washed with vinegar, lemon juice, or rather
with the elixir of the iron, and sugar, should be both plentifully used
in the drink, and with the victuals.
Salt provisions should be avoided as much as possible, or else
previously well deprived of its salt.
By this method the scurvy may not only be prevented at sea, but even
cured in the most inveterate degree.
If however there is an opportunity for the patient to come on shore, it
will greatly facilitate his cure; though he should reap no other benefit
than the exhalations of the earth in the warmth of the day: and I have
with astonishment seen patients devour vegetables in large quantities,
and mended surprizingly, even in a few hours; so powerful an antidote is
the vegetable effluvia to an animal putrescency.
To conclude, I have only this to observe, that the scurvy is principally
owing to defaults with respect to provisions, and the customary way of
living in ships in general; and such as might be much amended, both with
respect to conveniency, wholesomeness, and expence.
I speak this from long experience, from the many observations I have
made, and the good success that have attended my improvements, when it
has been in my power to put them in execution. I have many things to
offer with respect to provisions at sea; but as that is too extensive to
be inserted in this volume, I shall treat of it distinctly. In the mean
time give me leave to close these lectures: and being conscious that
truth and utility has guided my endeavours through the whole, I lay down
my pen for this time, with the pleasing reflection, that I have advanced
one step farther in the performance of my duty, and in answering the end
of my existence.
FINIS.
------------------------------------------------------------------------
[Illustration: Medical Instruments.]
EXPLANATION OF THE PLATE.
_Fig. 1._ A common bleeding lancet. A. The blade; which, when it is
wiped after bleeding, should always be laid upon the handle B. and
wiped but one way, to save the point.
_Fig. 2._ An incision lancet. A. The point of the blade, which ought to
incline one way most, in order to make it the better fit for opening
of aposthumes.
_Fig. 3._ A bistoury for opening of sores, &c. in general use. A. The
blade. B. The handle in which the blade folds.
_Fig. 4._ A pair of strong scissars.
_Fig. 5._ A spatula. A. The part for spreading of plaisters. B. The part
for pressing down the tongue; for which reason it is made full of
holes that it may the better press down the tongue.
_Fig. 6._ A probe. A. the probe. B. A triangular point on which lint may
be wrapped to wipe the sore with, as it is easy taken off again.
_Fig. 7._ A arm tied up for bleeding, with the three veins as they
generally appear when swelled up.
_Fig. 8._ A vein of a kind of three orifices. A. Is a longitudinal
orifice, which will not let the blood run freely. B. Transverse; in
making such orifice the vein is apt to be divided; besides it is not
very easily stopped, and will not admit of an orifice large enough to
let the blood run out with freedom. C. An oblique opening, the medium
between the two former; and always the best orifice.
_Fig. 9._ A key-tooth instrument. A. The handle, made of ivory. B. The
comb of the instrument, which should be wrapped round with a little
rag, and is that part which rests against the jaw bone. C. The hook
which is brought over the tooth. D. The screw at the end of the key,
by which the hook is shifted as occasion requires. E. The screw by
which the handle is fixed to the instrument.
_Fig. 10._ Common splints used for fractures; these splints are made of
thin boards of pine or cedar, glewed on to leather, and then ridged
so, that they may easily bend and suit to the limb which they are
applied to.
_Fig. 11._ A single headed rowler, or bandage, this bandage is generally
used for a fractured arm or leg.
_Fig. 12._ A double-headed rowler, generally for dislocations.
_Fig. 13._ A many-tailed bandage. A. The back part slip, that keeps the
bandage together. B. The stitches coming thro’ the bandage. C. The
slips of the bandage. D. The part next the ancle, from whence the
parts upwards have a gradual increase.
_Fig. 14._ Mr. Sharp’s invented splints, made of paste-board. A. The
external splint. B. The leather straps. C. The strap, that comes under
the foot. E. The internal splint. F. The loop through which the strap
that comes under the foot is put. G. Small iron buttons, on which the
straps are fastened.
_Fig. 15._ A leg with the many-tailed bandages. A. The slips laid over
each other. B. The under slip that secures the whole. C. A slip that
secures the bandage to the foot.
_Fig. 16._ A leg dressed with the splints. A. The bandage. B. The
splint. C. The tie knots of the tape that secure the splint to the
leg.
_Fig. 17._ The inner view of a leg with Mr. Sharp’s splints.
_Fig. 18._ The external view of the same. These two are copied from Mr.
Sharp’s pamphlet.
_Fig. 19._ A clyster syringe. A. the syringe made of pewter. B. A pipe
made in such manner, as to enable a man to administer a clyster to
himself. C. A common clyster pipe, that occasionally may be screwed on
to the syringe.
_Fig. 20._ A clyster pipe and bladder. A. The bladder. B. The pipe. C.
The manner of fixing the bladder to the pipe. D. The tying of the
bladder when it is filled, with a slip knot; which is handier than the
customary way of the cork.
_Fig. 21._ The manner of closing a wound with plaisters, called the dry
_suture_.
_Fig. 22._ A common syringe made of ivory.
------------------------------------------------------------------------
● Transcriber’s Notes:
○ In Lecture VI, Sect. VI. has been corrected to Sect. V. to match
the table of contents.
○ In SECT. VI. on page 118 there is a reference to the authors
description of the skin in Lect. I., Sect. VII. The discussion of
the skin is actually in Lect. I., Sect. IX. on page 40.
○ There are two SECT. VIII. in LECTURE I. They have been left with
geh duplicate number.
○ The “recipes” for various medicines are numbered somewhat
sequentially with Roman numerals across all Lessons and Sections.
However there are “recipes” with duplicate numbers (XXII appears
three times in Section V of Lect. IV.) and some recipe numbers are
missing altogether.
○ Missing or obscured punctuation was silently corrected.
○ Typographical errors were silently corrected.
○ Inconsistent spelling and hyphenation were made consistent only
when a predominant form was found in this book.
○ Text that was in italics is enclosed by underscores (_italics_).
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