Proper Method of Treatment.

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I Shall now proceed to the actual assistances that the human body stands in need of, when the order of health is impaired. This is the noblest office, in which mankind can possibly give aid to each other.

Health is certainly the greatest blessing this side of the grave; and what service can we render to our fellow creature, so valuable, as to assist him in the hour of distress.

From this consideration it naturally follows, what caution it also requires, and how circumspect every one ought to be, who takes upon him that noble office.

Before therefore I begin this important lecture, let me request of the reader the strictest attention, and never to act before the ailment, as well as the method of treatment is thoroughly understood; since nothing less than health, and even life itself, is liable to be the forfeit of a fatal error.

Mankind are ever liable to accidents, how cautious soever their conduct in life may be: But seamen, particularly are more so; not only from their occupation, but from the precariousness of the element on which they are dependant, and which so often exposes them to the most imminent danger.

I shall divide the accidents of bodily dangers, into falls, wounds, bruises, dislocations, fractures, scalding, burning, and drowning; and treat on each part separately, in as plain a manner as is in my power.

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Of Falls

The man who falls, is partly bereft of his senses, or his presence of mind, and particularly so the more timorous he is of his own preservation; add to this, because he is unaccustomed to it; for custom makes us familiar in every thing: Thence we perceive the different effect in different persons in their falling; for some will fall with a good deal of judgment, prevent some unlucky blow or other; whilst another shall fall as heavy as a dead log, or like one drunk, without having the least chance of saving himself in any shape. I remember once I fell from the puttock shrowds of the fore-top, but providentially escaped without the least injury, my watch chain having catched some how, which I endeavoured to save. I confess this in a great measure was owing to good fortune; at the same time I was naturally very active, and having acquired a flight of jumping off the main-deck into the hold of a light ship, I thereby had habituated myself to stop my breath, and a presence of mind which principally saved me when I thus fell in good earnest. I only mention this to shew, that the greatest mischief in falling proceeds from timorousness and surprise. I knew a wag, who would play pranks that way to astonishment; he could let himself fall from any part of the rigging, catching as he came down like a cat, make all hands come round to his assistance, and then laugh at their credulous good nature.

A man who falls is apt to lose his breath, particularly if he is not very careful, and has not presence enough to stop it the moment he finds himself fall; and the instant he loses his breath, he loses also his mental faculties; consequently comes motionless and exposed to every fatality. Thence we generally find a man, who has fallen from a considerable height, lays motionless like death on the spot, even though he has not received the least injury otherwise.

The Method.

When I have been called to such an accident, and found my patient motionless; I have untied his neckcloth taken him by the coller of his jacket, and shaken him heartily; which in the space of half a minute has brought him to, with a heavy sigh. Next I have bled him without loss of time, but not too copiously; after which I have examined him, and acted according to circumstances.

A person falling is liable to a number of dangerous consequences, not mentioning immediate death. The consternation, the shock, fright, terror &c. are as alarming and dangerous as the external hurt itself. The brain, and the blood vessels in that part are very delicate, and by the shock, as well as the want of respiration, they often burst; thence an apoplexy is liable to hurry the patient from the stage.

A fever generally attends a fall, which ought to be strictly attended to; after, therefore, the patient is bled, and seems to have recovered his reason, he should have every six hours a dose of the Fever Powders, (L.) and drink some balm tea, in order to get into a gentle perspiration, which will in this respect soon recover his health again, and enable him to do his duty.

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SECT. II.

Of Wounds

A Wound is an unnatural separation of any part of our body, whereby the order of circulation is hindered, the solids divided, and the fluids let out; suddenly caused by some violent means or other. But when such a separation becomes ulcerated, it loses the apellation of wound, and is called a sore, or ulcer.—This distinction is requisite to be taken notice of; for wounds and sores are often confounded, which shews not only ignorance, but as their nature is materially different, their method of treatment is not less so; and ought therefore previously to be understood.

Wounds are best distinguished into three different kinds; cut wounds, bruised wounds, and gun-shot wounds. I shall briefly shew how to treat each in particular.

Cut Wounds.

A Cut wound is barely a separation of parts; and the sharper the instrument with which the wound was made, the easier will the wound be to heal up again.

It is however a natural thing to observe what parts of the body is wounded, for tho’ nature is kind in uniting the parts, yet some parts are more easier healed than others.——Observe therefore

The different Methods.

If an artery is wounded (which is known by the blood being of a florid colour and spinning out by starts) care should be taken to have it stopt to prevent bleeding to death. But in this you should not be too scrupulous. Two or three ounces from a wound makes a great shew; and very often a little blood lost is of great benefit to the healing. Should, however, the blood gush from the wound violently, especially from an artery, make a compress of lint, strewed with Powder’d Allum, (17) which secure well on the parts with a roller, laying over it a compress, with Spirit of Wine and Camphor; (A) if that should not be yet sufficient, put a piece of money in a compress, and secure it on the wound, that is, provided the part of the body will admit of it, such as the arms or the legs, &c.

Let the ligature, or the first dressing, lie on for two or three days, and, if no hindrance to the patient, longer. If all these things are not sufficient, recourse must be had to the needle.

In every other kind of cut wounds, care should be taken to have it first cleaned with some water; (a small matter of vinegar, and brandy may be mixed with it) next, let the lips of the wound be well closed, dressed with dry lint, and Turlington’s Balsam (W), and over which, a compress with Camphor Spirits (A).

Plaisters, salves, &c. in green cut wounds, are altogether needless. All that is required to healing, is to keep the wound clean, to give it rest, and not to aggravate it with any thing acrimonious. Turlington’s Balsam (W) is admirable, but yet it suits small wounds better than large ones.

As a finger is very liable to be cut, and sometimes gives a great deal of trouble, I will here give a simple and expeditious remedy:—If you have cut your finger, wash it in a little salt or fresh water; tie it round with a good long thread, not too tight,—take care that your wooling may keep on without being removed; and a day or two will heal it up, without any farther plaistering. If inflammation attends the wound, methods should be taken accordingly, by bleeding, fever powders, &c.

Of Bruised Wounds.

These kinds of wounds are of a worse nature, and are not so kind to heal as the former; for here the parts seem to be torn to pieces, so that there is not only a separation of parts, but a destruction of a great many tender fibres all round the wound.

Hence we see in such cases a great deal of swelling, inflammation, and pain attend it; for the blood being hindered, the circulation naturally swells up the parts; and the nerves being lacerated also, must occasion great pain. Hence it must follow, that nature must first get rid of the obnoxious and torn part before she will consent to unite the wound again; and this must be performed by suppuration.

In small cases, nothing is more beneficial than Diachylon Plaister, (20) which assuages the inflammation, corrects the acrimony, and brings the wound to a good state.

Broken shins often occur on board a ship, which is of that species of wounds. And as from such a case, (though in general slighted) many evils have arisen, I would caution the mariner to apply immediately Diachylon Plaister (20) to a broken shin; by which he will prevent having an ulcerated leg; a thing very troublesome.

If the bruised wound is on other parts, and the parts all round are bruised, care should be taken that it is cleaned as before directed, and a pledget of lint, with Yellow Basilicon, (F) will be necessary; over which a compress with Spirits of Wine and Camphor, (A) or rum, may be applied; and afterwards, when it begins to heal, it may be dressed with dry lint.

As these kind of wounds are liable of becoming ulcers, great care should be taken in the beginning to treat them properly.—Wounds in general should not be dress’d or look’d to too often; in general it aggravates the parts, and retards healing. A wound should not be opened the first three days after the first dressing: nature is very kind, and requires care only to replenish what is deficient.

When an ulcer has commenced, see the treatment under that head.

Gun-shot Wounds.

These are the most terrible of all sorts of wounds; for it is not only the contusion that attends them, but frequently the ball forces strange things, as cloaths, &c. into the wound with it.

Gun-shot wounds at best are tedious in their healing, but very often, from their nature, liable to mortification, and thence become dangerous. Besides, it is seldom that the fleshy parts alone are wounded, but they frequently penetrate into the very bones themselves.

The first care in gun-shot wounds, is to extract the ball, or whatever is forced into the wound; in the next place, the wound should be dressed with Yellow Basilicon, (F) mixed with fine Precipitate (O).

No. I

Take Basilicon one ounce, fine Precipitate one scruple, and mix them.

The parts all round should be well fomented with warm claret, intermixed with Spirits of Wine and Camphor.

If the patient is full-bloody, and no blood lost by the wound, he should be blooded, and immediately treated as a patient in a fever.

If the pain in the parts become violent, eight or ten drops of liquid laudanum (T), together with thirty or forty drops of sweet spirit of nitre (D), should be given once, twice, or thrice a day. If the wound begins to discharge plenty of matter, it should be dressed with the same dressing often. But if the parts become black, very foetid, the patient in great pain, and grows faint, a mortification is to be feared; which I shall treat of in its proper place.

When the suppuration is unkind, and the parts are much inflamed, a poultice will be very proper.

No. II

Take oatmeal (15) or (if that is not on board) biscuit pounded about three spoonfuls, honey one spoonful, water a sufficient quantity to boil it into soft poultice; in which put of sweet oil about half a spoonful. This poultice should be renewed twice a day at least, and put on as warm as possible it can be borne.

As gun-shot wounds are apt to degenerate into malignant ulcers, I shall refer the reader to the treatment of ulcers in general.

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Of Bruises.

Bruises, in whatever degree, have more or less some blood and other vessels torn and injured, and may properly be considered as wounds under whole skin. It is from the tearing to pieces blood vessels, whereby the blood extravasates from their natural channels, that occasions the swelling. If the bruise is but slight, the vessels are soon enabled to circulate the humours; but if the contusion is great, the extravasated humours are apt to corrupt, and make a collection of matter; thence an aposthume and ulcer must naturally follow.

Bruises on fleshy parts are not so bad by far, as on the joints, because the fibres in the muscles are more pliable, and sooner unite; the ligaments on the joints are very rigid, and extremely sensible; for which reason also, they are generally more painful and tedious in their cure.

The first intention is to disperse the extravasated humour, and to strengthen the tone of the injured fibres. To this intention the parts should immediately be bathed with spirit of wine and camphor (A). But if the bruise is immediately on the joints, the linament of soap (B) is still superior. A bandage over the part, so as to keep it in rest as much as possible, is also of great service. If, however, the part is so very much bruised, that there appears a collection of crumous blood, and that an aposthume is actually the consequence, recourse may be had to the above poultice in order to ripen it the more, and bring it the sooner to a head; and then treat it as a common ulcer. But that seldom is the case.

If the contusion is great, and the patient is full of blood, bleeding is necessary; for in such a case a fever is apt to ensue, which should be guarded against, and the patient treated accordingly.

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SECT. IV.

Of Dislocations

There are many accidents by which a limb may become dislocated; the reduction of which is a material point in surgery. But if a surgeon is not at hand, a man ought nevertheless, not to remain in that painful and deplorable state, that endangers not only the limb of becoming useless, but even the loss of life itself.

I shall proceed therefore in my directions as plain as possible, avoiding every expression that may render this operation prolix.

It must first of all be remembered what was said of joints, articulations, and ligaments in the first lecture under that head. We must thence observe, that a dislocation of the upper arm with the shoulder is the most common that happens, because of the great variety of motion, and the flatness of the head of the arm-bone, and the cavity of the shoulder blade. Next to this is the thigh bone, with the hip. But this is done by much greater force, and therefore more troublesome in reducing. All other joints that are angular are seldom really dislocated, being stronger secured, and cannot be separated from their articulation, without first tearing the ligamentous capsula that surround them; yet nevertheless, some are subjected to be partly dislocated; and this is what is commonly called sprains.

Dislocations may be from two causes; first from violence, secondly from weakness of the ligament. In the latter case the reduction is the easiest, but the limb is apt to slip out again by the least accident.^[11]

I shall briefly consider each kind of dislocation, that an accident makes a man liable to.

Dislocation of the Arm with the Shoulder.

The dislocation of that, may be two ways; (viz) downwards, and forwards; but it cannot be backwards nor upwards; except some part of the shoulder-blade be broke.——The best method to examine the patient what kind of dislocation it is, (especially to one unacquainted with these branches of surgery) is strictly to compare both shoulders, and the difference will be very plain, both to sight and touch.

If the dislocation is downwards that is, the head of the arm-bone, slipt in the arm-pit, there will be a cavity on the top of the shoulder, different from the sound arm, and the elbow will be drawn upwards, without being able to be moved either towards the body; or so, as the patient to put his hand out without the greatest pain.

When this is found to be the case, then, in order to reduce it, set the patient low, on a steady seat. Take a napkin or towel, of which make a girt; put one part over your neck, and the other part under the arm-pit. Let an assistant hold the patient steady, another take hold of the patient’s arm, with the elbow bent, and extend it gradually; then with both your hands take the arm, and whilst you lift up the arm by help of the napkin resting on your neck, you press gently down the arm with your hands like a lever; in the mean time the assistant extends, and thus you reduce it; which you will hear by its snapping: upon which the patient will be able to move his arm in all kind of direction, without much pain.

If the head of the arm-bone is dislocated forwards, there will be a cavity backwards on the shoulder, and the elbow will stick backwards, and remain motionless, with great pain. In this case, as before, let the patient sit low, and with the help of the napkin, and assistances, first extend the arm forwards; then like a lever bring the head of the bone in its cavity; which, like the former, will be perceived by a snapping, and the voluntary motion of the patient’s arm.

When the shoulder is reduced, secure the whole with a long double-headed bandage, cross-wide over the shoulders, and round the body. Foment it night and morning with spirits of wine and camphor (A). Keep the arm close to the body, with the elbow bent, and wear it in a sling, that it may be free from motion till it is well.

The elbow, as I said before, is very seldom dislocated, unless fractured, and the ligament tore at the same time; and when so, the case is terrible. But very often those joints receive a wrench, which, though nothing out of its place, is often very painful, on account of the many tendons that surround the parts. The only thing in such wrenching, is to foment it with spirit of wine and camphor (A), or else the saponaceous linament (B). The same method should be observed with the knee, securing it well with a bandage, in order to give it rest to recover: For rest is a principal remedy.

Of spraining the Wrist, or Ancle.

The wrist and ancle are complicated joints, and thence capable of a great number of motions, and subject to a variety of sprainings, but not a perfect dislocation; nevertheless, they are very painful, and sometimes tedious in getting well. Whatever be the matter, the sick part should be compared with the sound, and the difference is soon seen.

If it so happens, that there appears a perceivable difference, the parts should be gently extended, and reduced; and all that is to be done, is the securing it well with a bandage, and fomenting it with Spirits of Wine and Camphor, (A) or, what is yet better, Linament of Soap. (B)

The thumb, however, is liable to be dislocated, which is easily perceived; which should be immediately reduced, and secured with a bandage, and treated as already directed.

The articulation of the thigh bone with the hip is similar to the shoulder, with regard to the head of the bone, and the pan in which it moves, except that it is much deeper. It must be a great force that drives it out of its articulation, and consequently very difficult to be reduced. It may either be dislocated inwards, or backwards.

If the dislocation is inwards, which is the most common, the toes will be turned outwards, and the whole leg and thigh will be somewhat shorter than the other; so likewise, if it is dislocated backwards, the leg and thigh will appear shorter, but the toes will be bent inwards. The best way of determining, as I have said before, is to make a just comparison of the sick and sound leg.

The reduction is somewhat difficult, and will sometimes baffle the most experienced surgeon, because the acting muscles are very strong; and when they have first begun to contract the parts, they will not easily suffer themselves to be relaxed. Nevertheless, lay the patient upon his back or on the sick side, upon a steady table; let an assistant hold him fast, another extend the thigh, so as to have the knee bent; the operator having a napkin resting on his neck, and under the thigh of the patient, similar to the method directed before by the shoulder; and then with both hands bend the thigh, as with a lever, into its socket again; when it will give a loud snap, coming into its proper place.

It very frequently happens in this heavy dislocation, that either the articulation is not reduced, or that it immediately slips out again when reduced; so that the patient will never recover the former use of that limb more. In this case nature is very kind, and the part where the bone slips into will become callous, and form as it were a new acetabulum; by which the patient in time comes to walk, though (as it may be supposed) but lamely. In the course of my practice I have met with but two perfect dislocations of the thigh, both of them perfectly recovered; but it must be remembered, they had youth on their side, and the greatest care joined to favourable circumstances.

At best however, it is an ugly accident, for it is not only that the ligaments that surround the joint are generally torn, but very often the thigh bone is fractured at the same time. It requires more skill than one would suppose, to determine which is the case, whether a fracture, dislocation, or both; and am apt to believe they are often confounded with each other.

When the dislocation is reduced it should be well secured with a long double-headed bandage; the patient kept still, the part well fomented, and if requisite, some blood taken away: a fever generally attends, which should be duely taken care of.

On the whole, dislocations when they proceed from violence, are sometimes attended with severe symptoms, the parts being very sensible, and it will require sometime for the patient to recover his strength again.—Care therefore should be taken to keep the parts warm, and give them as much rest as possible.

A strengthening plaister spread upon leather, and put for a constancy round the parts after the inflammation is gone of, will also prove of singular service.

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Of Fractures

We come now to fractures. There is something terrible in the sound of broken bones; and yet in common they are by far more easier managed and healed than a dislocated joint: nature is very kind; from the fractured parts of a broken bone, there exsudes a gelatenous matter called Callus, that very soon glews them together again, and makes them stronger than ever. As easy as a fracture is ruined, as easily it may be well treated. I shall therefore lay down some few rules, which if properly observed, will ever be attended with success, as they are founded upon happy experience, in my own practice.

In the first place, a fracture should be reduced as soon as possible. Secondly, the part should have as much rest as possible till the callus is formed, or the bone knitted together again. Thirdly, bandages should not be laid on too tight. Fourthly, camphorated fomentations should not be too plentifully made use of. Fifthly, the habit of body should be kept in a slate of health; and Sixthly, the diet during the time should be wholesome and sparing.

With regard to the reduction, it was formerly a great error for a limb to be stretched out in an extensive posture; for the extension of the muscles contracted the limb, and made the reduction both painful and troublesome.

I shall here recommend a better method; namely to have the muscles in a flexible position, during the operation and the cure. But to proceed to particulars.

A Fracture of the Skull.

This accident is frequently attended with many bad symptoms, and often requires the operation of the trepan; which I shall here pass over, being too prolix for this place. I have only to observe, that we have frequent instances of the patient doing well without any other help than bleeding; and where there is no surgeon on board, this is the only remedy first to fly to, and gives the greatest chance for the patient’s life: next to this, shave the head, and treat him as circumstances shall direct, without meddling with the fracture, any farther than applying gentle fomentations, with flowers of chamomile (11) boil’d in claret, and some linament of soap (B) added to it; and if there is any wound, have it properly dressed as directed in the article of wounds.

If the upper arm is fractured, proceed in the following manner:

First of all be sure it is a fracture; to know this, put one hand on the middle of the arm, and the other on the elbow, move it gently to and fro, and if there is a fracture, you will find it crackle by the touch, which sometimes is so distinct as to be heard. The arm at the same time is somewhat swelled, and either the patient cannot move it, or else it is attended with very great pain.

When the fracture is certain, then proceed in the following manner; Let the patient sit upon a low chair, or chest, let an assistant hold him steady, and let another lift up the arm, and extend it gradually, horizontal to the shoulder, keeping the elbow bent somewhat all the while.

Then with both your hands gently press the fractured bone, so that it may feel perfectly joined again. Sometimes it happens that the ends of the bones are somewhat slipt over each other; in which case, extension is the more requisite.

When this is done, then take a bandage of about two yards long, first rolled up, and wrung out of spirit of wine and camphor (A.); begin near the elbow, and lay it smoothly on, laping over a little; and proceed gradually till it comes to the shoulder, and then return with it back again till it is done.

This bandage should not be too tight, nor too slack, but so as immediately to suit the arm exactly. Over this bandage again, lay a double folded rag, called a compress, so as to cover the bandage; and over this again two splints, one above, and another below; which tie gently together with some tape in three places. Then put the arm into a sling; cover up the whole arm and hand, and let the patient go to rest.

If the fracture is upon the under arm, the reduction is a little more difficult; but only in the care it requires of reduction. As there are two bones in the under arm, it should well be examined which it is, or if both. In reducing of it, let the arm be bent as before; one assistant to hold the patient, one to hold the elbow, and another the wrist; gently extending, till the fracture is reduced, as before directed, and the bandage, compress, and splints, put on according to the same Method.

In this fracture the wrist and hand should be kept from moving; as the motion of their muscles will be apt in a great measure to hinder the bones from uniting again.

A fractured Thigh bone.

This is of very great importance; which, from its situation, and the strength of the muscles, in general, even by the best method is very difficult to reduce.

Let the patient lay on the opposite side, and with the knee bent; let the limb be extended by assistances, and carefully set it according to the situation, similar to the beforementioned method.

This limb requires a very long bandage, and very large splints. The method of treatment must be as before, and the patient must be well secured in bed. He should not lie constantly upon his back in a straight posture, as formerly was practised; but most part upon either side, with his knee bent, which should be kept bent as much as possible; if he can lay chiefly upon his sick side, so much the better; he may also move a little his joints, in order to prevent them from growing stiff.

A fractured Leg.

This accident is more common, and therefore ought to be paid the greatest attention to.

To know for certain whether the leg is fractured, let the patient lay on his back or on either side, with his leg and thigh bent, so that the muscles are entirely at ease, and out of action. Let an assistant hold up the leg by the knee; then take with one hand the ancle, with the other the middle of the leg, and move the ancle to and fro, holding the other hand steady, and if you feel a crackling, and the patient feels great pain in those parts, the leg is certainly fractured; particularly if the patient could not stand upon it before. This being fully discovered, we must next examine which bone is fractured, the Tibia or Fibula; and then proceed in the following manner.

Let the patient lie as before directed; one assistant holding the knee in a bent position, another holding the leg near the foot, both gradually extending.

Then with both your hands reduce the fracture, by gently pressing it with the palm of your hand while it is extending. Then lay on a long roller; or, what is still better, a many-tailed bandage, which is made thus: Take nine or ten slips of linen, about two inches broad, increasing from twelve to twenty inches in length, laying over each other about half an inch. The whole bandage must be secured with a slip of linen behind, so as to make the breadth of the bandage the length of the leg; either of these must be previously wrung out in camphor spirits.

If you make use of the roller, begin laying it on from the ancle, going gradually upwards, folding each round over half an inch at a time; and under the calf of the leg, give the bandage a single twist, by which it will always suit. Continue this till the whole is finished.

Over this again put a compress, and then put on the splints, (previously bolstered with some tow) which secure with tape, as before observed with the fracture of the arm.

The many-tailed bandage is however superior to the roller, in the fracture of the Leg. The method of laying it on is this: the patient laying upon his back, with his thigh lifted upwards by the assistant, put the bandage under the calf of the leg; then begin from the ancle upwards, folding over alternately the tails of the bandage, so that they secure each other. When this is compleated, put over the whole a Compress, as before directed, as also the Splints; or in the room of common splints, put on the new invented splints of Mr. Sharp; of which a ship should have three or four pair of different sizes, both for the right and left leg.

When this is performed, the patient should be put to rest as soon as possible; and he will lay easiest upon the side where the fracture is, with his thigh and leg bent forwards. This position suits not only best on board a ship where the motion is continually apt to disturb the sick part, but is also most natural both for ease, and for healing; as the muscles are all at rest, and adds firmness and ease to the body.

When a fracture is attended with a wound, it is needless to observe, that the case is of a more dangerous nature. If the contusion has been so great, as to splinter the bones, such splints as are loose, and seem to prick through the flesh, should by all means be removed. Violence must however be avoided; for by a little patience, nature will of her own accord separate and discharge them.

Gentleness should ever be observed in surgery, though not a timid weakness, by being defective in dressing properly. The reduction of the fracture should be conducted the same as before, with this difference, that always a many-tailed bandage should be chosen, so that it may be opened when requisite.

The dressing of the wound should be the simplest possible; for the nature of bone is so delicate, that it will neither bear to be much exposed to the air, nor suffer any greasy salve or ointment to come near it; both are liable to corrode it, and bring on a carious, which is of a most dangerous tendency. Dry lint therefore is the best, particularly near the fractured bone.

In short, it is to be treated cautiously, like an ulcer, and the greatest care to be taken, that the arm, leg, or whatever fractured part it is, be kept steady, and no oftener dressed than what is absolutely necessary.

Conclusive Observations on Fractures.

In the obscure times of surgery, various medicines were applied to broken bones, with a notion to unite them the sooner. This, however, is entirely exploded from modern practice.

The inflammation that generally attends fractures requires however a fomentation of Camphor Spirits (A), in order to disperse the obstructed humour; but if there is no inflammation, the part undoubtedly is the better without such applications; as then there will be nothing to hinder a free circulation; for which reason, fomentation should be used as sparingly as possible.

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.

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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.

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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.

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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.