Part 9

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.