Part 5

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._