Observations on the Diseases of Seamen

It frequently happens that men bleed to death before assistance can be procured, or lose so much blood as not to be able to go through an operation. In order to prevent this, it has been proposed, and on some occasions practised, to make each man carry about him a garter, or piece of rope-yarn, in order to bind up a limb in case of profuse bleeding. If it should be objected, that this, from its solemnity, may be apt to intimidate common men, officers at least should make use of some such precaution, especially as many of them, and those of the highest rank, are stationed on the quarter deck, which is one of the most exposed situations, and far removed from the cockpit, where the surgeon and his assistants are placed. This was the cause of the death of Captain Bayne, of the Alfred, who, having had his knee so shattered with a round shot, that it was necessary to amputate the limb, expired under the operation, in consequence of the weakness induced by loss of blood in carrying him so far. As the Admiral, on these occasions, allowed me the honour of being at his side, I carried in my pocket several tourniquets of a simple construction, in case accidents to any person on the quarter deck should have required their use.

It sometimes happens, however, that no hæmorrhage arises from a limb being carried off by a ball. The surgeon of the Fame related to me an instance of this, in which the thigh was cut through by a shot near its upper part, all except a little flesh and skin, and yet not the least hæmorrhage followed. This may have been owing to the limb being entirely severed, or nearly so, whereby the vessels contracted more easily than if they had been partially divided. All that was done for this man was to remove the limb, and to saw off the jagged end of the bone. He survived six days, still without bleeding, and died of the locked jaw.

I was informed by several of the surgeons, that the method of taking up the vessels by the tenaculum was found to answer extremely well; and many of them imagined that the locked jaw was not so apt to be brought on by this mode of operation as by that of the needle. But it is hardly to be attempted in time of action, for want of steadiness and a good light, and it was chiefly at the hospitals that this practice was found so successful.

Mr. Alanson’s method of amputation by a great retraction of the muscles, so that the fleshy parts shall meet over the bone and unite in the first intention, was attended with great success in the West Indies, particularly at the hospital at St. Lucia, under the care of Mr. Bulcock.

It may be remarked, that though all sores and wounds in the foot and leg are difficult of cure in a hot climate, I have observed, that, where the constitution is good, those in the thighs, arms, trunk, and head, are rather more easy of cure than in Europe, and that parts divided by incision very readily unite by the first intention. In reasoning upon this, it may be said, that as healing depends on a certain degree of vigour in the powers of life, this should not err either on the side of excess or defect. If it is too great, as in the case of a hale, plethoric constitution in a cold climate, too much inflammation is apt to be excited; and if too feeble, as happens in a hot climate, in the lower extremities, which are far removed from the source of life and circulation, the salutary effort is not strong enough to generate new organised parts. But in the trunk of the body, in such a climate, the powers of the animal œconomy are in that just medium which is most favourable to this operation of nature.

THE END.

APPENDIX

TO

PART III

It has been suggested to me, that it would add to the utility of this Work to subjoin a list of the remedies best suited to the practice of physic at sea, with their quantities, and to give a set of formulas for the direction of young practitioners. I have accordingly made out a gross computation of the requisite quantities of the most useful and necessary articles of the Materia Medica, and also a few of the most commodious and simple forms of administering some of the most efficacious remedies for the most common diseases.

It is of consequence every where, but especially on board of a ship, to simplify practice, as much as possible, with regard to the number, the preparation, and the administration of medicines. Where a great number of compound medicines are given, it is extremely difficult to ascertain, by accurate and satisfactory observations, what are their real effects; and as there are not conveniences at sea for great pharmaceutical nicety, the plainest forms should be adhered to. And as all operations are rendered more practicable and easy by being reduced to a stated method, this is an additional inducement for studying plainness and simplicity in preparing and administering remedies. This uniformity is more attainable in the public service than in private practice; for in the former all the patients are of one sex, they are all adults, and they are generally of robust constitutions.

In the list hereto subjoined the articles are distinguished into PRINCIPAL and SECONDARY; and when a surgeon considers how limited his funds are, I hope he will not think that I have made a disproportionate assortment in reducing the number and quantities of the latter, my view in this having been that he may better afford an ample proportion of such medicines as are really efficacious and indispensable in the cure of diseases. It may be affirmed, without vanity or arrogance, that the printed list of articles with which the navy surgeons are enjoined to supply themselves is very injudicious considering the present improved state of the medical art; and it is of great importance that the due proportion of each article should be ascertained as nearly as possible, that no unnecessary expence may be incurred, and that the chest may not be encumbered with unnecessary articles.

There are no simple distilled waters in the following list, as they are very corruptible, and too bulky to carry to sea. Their place is supplied by a small quantity of oil of mint, which may be occasionally added to common water, in the proportion of a drop to an ounce. There are no tinctures inserted, except laudanum, the traumatic balsam, and compound spirit of lavender, as the surgeon, having a proper supply of spirit of wine or rum, may make them on board of the ship.

In the following list the surgical articles are not enumerated. There is a new article which I beg leave to recommend, as it has lately been found extremely useful, and is now used in large quantities in the hospitals in London. This is linseed meal for poultices. The surgeon should also be provided with a sufficient quantity of linseed oil, as it has been found to be one of the best ingredients in dressings for scorches. See page 540. (#Page_540)

The quantity of each article is adapted to an hundred men for one year, so that a calculation can easily be made for any number of men, and for any length of time.

ASSORTMENT OF MEDICINES

TO BE

CARRIED TO SEA,

FOR

ONE HUNDRED MEN, FOR ONE YEAR

PRINCIPAL ARTICLES

Peruvian bark, ten pounds, and if the ship is destined for a hot climate, twenty pounds. This article should be provided by the Public. See p. 359 (#Page_359). – Calomel, two ounces and a half —a Emetic tartar, one ounce and a half – Ipecacoanha, four ounces – Opium, one ounce —b Purging salts, ten pounds – Senna leaves, two pounds.

SECONDARY ARTICLES

Aloes, half an ounce – Ammoniacum, two ounces – Balsam of copaiva, three ounces —c Traumatic balsam, four ounces – Camphor, three ounces – Cantharides, one ounce – Capsicum, three drachms – Castor, an ounce and a half – Chamæmile flowers, or hops, two pounds – Cinnamon, an ounce – Prepared chalk, or oystershells, six ounces – Conserve of roses, half a pound —d Cordial confection, two ounces —e Cathartic extract, half an ounce – Extract of hemlock, three ounces – Extract of logwood, one ounce – Gentian, five ounces – Ginger, three ounces – Gum arabic, four ounces – Gum guaiacum, three ounces – Powder of jalap, one ounce and a half —f Laudanum, four ounces – Linseed, one pound – Magnesia, six ounces – Manna, eight ounces – Whole mustard seed, half a pound – Myrrh, four ounces —g Crude mercury, two ounces —

Names in the last Edition of the London Pharmacopœia

a Antimonium tartarisatum. —b Either Glauber’s salts, natron vitriolatum, or sal catharticus amarus, magnesia vitriolata. Glauber’s salt answers better in a hot climate, being less deliquescent from the heat and moisture of the climate. —c Balsamum benzoes compositum. —d Confectio aromatica; —e Extractum colocynthidis compositum. —f Tinctura opii. —g Hydrargyrus.

a Corrosive sublimate, an ounce – Nitre, eight ounces – Oil of almonds, one pint —b Castor oil, half a pint – Linseed oil, three pints – Essential oil of mint, one ounce —c Jamaica pepper, four ounces —d Blistering plaster, ten pounds – Quaffia, eight ounces – Salt of hartshorn, two ounces —e Salt of steel, half an ounce —f Salt of wormwood, ten ounces – Castile sope, half a pound – Sarsaparilla, three pounds – Serpentary, four ounces – Spermaceti, four ounces – Rectified spirit of wine, one pint —g Weak spirit of vitriol, half a pint —h Volatile aromatic spirit, half a pint —i Spirit of Mindererus, two pints, or the volatile salt and vinegar may be kept separately, and added occasionally – Spirit of turpentine, four ounces – Dried squills, half an ounce – Flowers of sulphur, one pound – Golden sulphur of antimony, half an ounce – Cream of tartar, one pound – Vinegar, six pints —j White vitriol, six drachms – Wormwood, one pound —k Flowers of zinc, two drachms.

Necessaries to be put in charge of the Purser, and served out to the Sick in place of the common sea provisions. See page 358 (#Page_358).

BARLEY, three hundred pounds – Eggs, greased and put in salt, twenty dozen – Extract of spruce, twelve pounds – Lemon juice clarified, and preserved by adding to it a small proportion of ardent spirits, five gallons – Raisins, fifty pounds – Rice, two hundred pounds – Coarse sugar, one hundred pounds – Sago, twenty pounds – Salep, ten pounds – Portable soup, fifty pounds – Tamarinds, ten pounds – Best white wine, three hundred gallons – Best red wine, one hundred gallons.

Names in the last Edition of the London Pharmacopœia

a Hydrargyrus muriatus. —b Oleum ricini. —c Pimento. —d Emplastrum cantharidis. —e Ferrum vitriolatum. —f Kali præparatum. —g Acidum vitriolicum dilutum. —h Spiritus ammoniæ compositus. —i Aqua ammoniæ acetata. —j Zincum vitriolatum. —k Zincum calcinatum.

FORMULÆ QUÆDAM

MEDICAMENTORUM

IN MEDICINA FACIENDA APUD NAUTAS

ACCOMMODATIORES

IN FEBRE CONTINUA

PULVIS EMETICUS COMMUNIS

℞. Pulveris radicis ipecacoanhæ grana decem, antimonii tartarisati grana duo, misce.

MISTURA CATHARTICA COMMUNIS

℞. Foliorum fennæ uncias sex, aquæ ferventis libras sex. Macera donec pene refrixerit & adjice vel natri vitriolati vel magnesiæ vitriolatæ libram unam cum semisse. Dein cola & admisce tincturæ sennæ uncias octo. Dosis est ad uncias tres. – Interdum conducit adjicere singulis dosibus, vel pulpæ tamarindo um semunciam, vel mannæ semunciam, vel antimonii tartarisati semigranum, vel pulveris jalapìi grana decem.

ENEMA COMMUNE

Aquæ marinæ tepidæ uncias duodecim.

POTUS COMMUNIS

Decoctum hordei. – Conveniat adjicere singulis libris pro re natà, vel pulpæ tamarindorum unciam dimidiam, vel crystallorum tartari drachmam unam, vel nitri scrupulum unum, vel acidi vitriolici diluti guttas decem, vel succi limonum unciam unam, vel gummi arabici scrupulos duos, vel vini uncias quatuor, vel frustum panis tosti.

VINUM EMETICUM

[133 - Hæc formula ex Pharmacopœia Nosocomii Sti. Thomæ excerpta est.]℞. Antimonii tartarisati scrupulos duos, aquæ ferventis uncias duas, vini albi uncias octo. Solve antimonium in aquâ & adde vinum. Assumatur drachma una omni quadrante horæ, donec vel vomitus cieatur, vel alvus moveatur. Deinde assumatur semi-drachma sextâ quâque horâ.

PILULA FEBRIFUGA

℞. Pulveris antimonialis, (Pharm. Lond.) vel pulveris febrifugi Dris. James drachmam unam, conservæ rosæ quantum latis sit. Simul contunde & divide in pilulas duodecim. Deglutiatur una quartâ vel sextâ quâque horâ.

MISTURA SALINA ET ANTIEMETICA

℞. Kali præparati drachmam unam, succi limonum, vel aceti, vel acidi vitriolici quantum satis sit ad saturandum salem, aquæ puræ uncias sex. Bibatur tertia pars ter die. – Conducit pro re nata adjicere, vel pulveris antimonialis grana quinque, vel acidi vitriolici diluti guttas quinque, vel cretæ præparatæ scrupulum unum, vel aquæ menthæ semunciam. – Interdum conducit sumere hanc misturam statim postquam Kali & succus limonum mixta fuerit, scilicet in ipsâ ebullitione. Hoc imprimis utile est quando vomitus vel nausea molestus sit, & licet adhibere magnesiam vice Kali, & acetum vice succi limonum.