The Seaman's Medical Instructor / In a Course of Lectures on Accidents and Diseases Incident to Seamen

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 oeconomy 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 oeconomy, 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.

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.

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.—?viii.
?i.—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]

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.

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