Part 8

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.