There are few diseases in which a prudent employment of art is more

useful, or in which early means of relief are more requisite than in

this[114].

Where the dysentery is the original disease, and when the patient is

robust and plethoric, with acute pain and a strong pulse, blood-letting

may be practised with advantage in the beginning of the complaint. But

there is no part of the practice in this disease in which the climate

and manner of life makes a greater difference than in this; for in a

temperate climate it frequently happens that repeated blood-letting is

necessary; but in a hot climate, where the fibres are relaxed, and in

the constitutions of seamen, whom we seldom or never find plethoric,

the inflammatory symptoms requiring this evacuation do not run so high,

nor continue so long.

It is in all cases of the utmost consequence to administer as early as

possible a brisk saline purgative. An ounce and a half or two ounces

of purging salts may be dissolved in a quart of barley water or water

gruel, and given warm in cupfuls, at small intervals, till a free

and copious evacuation is produced. If there should be much fever,

or sickness at stomach, two grains of emetic tartar will be a great

improvement of this medicine; and there will be this farther advantage

from its use, that if the stomach should be loaded with bile, in which

state it is more irritable, an evacuation upwards will also be excited

to the great relief of the patient.

This early and seasonable measure will, in many cases, put a stop

to the disease, especially if the patient is thrown into a sweat

immediately after the bowels have been thus thoroughly evacuated. It

is of great service in this disease to promote free perspiration, and

even a plentiful sweat, which may be effected with great advantage by

giving, at bed time, a medicine composed of opium, ipecacuana, and a

little neutral salt, accompanying it with plentiful warm dilution.

Nothing tends more to relieve griping and tenesmus than a general,

warm moisture on the skin. The ipecacuana, which is an ingredient in

this medicine, is one of the best anti-dysenteric remedies we know;

the opium procures rest; and this, joined to the sudorific effect of

the whole, not only gives a temporary relief, but tends to carry off

the disease. It is most properly given in the evening; for there would

be this inconvenience in constantly encouraging a sweat, that if the

tenesmus should return, it would either be checked by the patient

getting frequently out of bed, or there would be danger of his catching

cold. I am well aware that we cannot be too cautious with regard to the

use of opium in the beginning of this disease; but it is admissible

more early in a hot climate than a cold one, as the inflammatory

symptoms are less violent and can be sooner subdued; besides, it

becomes an entirely different medicine when conjoined with the other

ingredients that have been mentioned.

The best medicine in the day time we found to be small doses of

ipecacuana alone twice or thrice a day; and if there should be fresh

collections of bile, small doses of the saline purgative will be

necessary. Ipecacuana in this intention, may be given in the dose of

two grains in athletic constitutions, such as those of seamen; but

in the more delicate constitutions, such as are commonly met with in

private practice, one grain is a sufficient dose. I have found manna

and tamarinds a good addition to this medicine in the earlier stages of

the disease, where there was much bile; but in a more advanced stage

of it they are apt to produce gripings and flatulence.

The marks of a redundance of bile are, a sickness at stomach, a sense

of scalding at the anus when the stools are passing, and the yellow

or green colour of the stools themselves. It is apt also to excite

symptoms of fever, such as a foul tongue, a hot and dry skin, with

thirst. When collections of it are suspected in this disease, it is

best to evacuate it by vomiting, for it is thereby prevented from

irritating the bowels, and from arriving at the inflamed parts with,

perhaps, increased acrimony, acquired in passing through the whole

length of the intestines.

Some gentlemen of the fleet informed me that they found oil of almonds

a useful addition to the purgative. Others as well as myself made a

practical comparison of the saline purgative with that composed of

rhubarb and calomel, as recommended by Sir John Pringle, and we gave

the preference to the former, as more easy, speedy, and effectual in

its operation, especially in the first stage. Cases may occur, however,

in which the other may be more advisable; for where there is a sense

of weight about the stomach, which most probably arises from the

biliary organs being clogged with bile, and where emetics have failed

to remove it, or the weakness of the patient may render them improper,

then calomel has the best effect: for it was formerly observed, that

it tends to loosen the secretions, and to stimulate the more distant

excretories, such as the biliary ducts.

It is very important to caution young practitioners concerning the

employment of opium in all stages of this disease, but especially in

the beginning; for though it is an excellent remedy when seasonably

and judiciously employed, it is very liable to abuse, particularly

in the hands of the inexperienced, who may be tempted to give it

improperly from an anxiety to relieve; but as more harm may arise from

an unseasonable administration of it than could be compensated by the

best-timed use of it, it is best to err on the side of caution and

omission. The principal caution to be observed with regard to this

remedy is, to premise suitable evacuation, such as blood-letting, if

necessary, but more especially purging. It is always pernicious to give

it in its pure state during the _tormina_, so common in the first days.

By these I mean the abdominal gripings, which denote inflammation, and

are entirely different from the _tenesmus_, which is a more constant

and characteristic symptom of the disease, and seems to arise from

irritation and spasms of the rectum and colon.

It was in this disease that I first observed the good effects of a

small quantity of neutral salt in taking off the inconveniencies

attending opium, such as the feverish heat and confusion of the

head, which it is apt to produce in many constitutions; and as the

administration of the anodyne coincided with the evening dose of

ipecacuana, I was led to adopt a form similar to that of Dover’s

powder, but with only half the quantity of opium; or, it was given

in a liquid form, by combining twenty drops of thebaic tincture and

a drachm of ipecacuana wine, with nitre from five to ten grains, in

any simple vehicle in form of a draught. There is a very observable

difference, in some cases, between opium given in a liquid and in a

solid form; and the former is much more certain in its effect when the

intention is to procure speedy and effectual ease.

I have observed great benefit from the use of external remedies in

dysentery, and these have, perhaps, been too much neglected by authors

and practitioners. The warm bath is of great service, especially where

the gripes and tenesmus are severe, and where the fever has been taken

off by previous evacuation. Fomentations or warm applications of any

kind to the abdomen give temporary relief; and it will be found of

advantage to keep those parts, at all times, well defended from the

cold air. Blisters to the abdomen were also found of use, and likewise

acrid liniments, composed of oil, volatile spirits, and tincture

of cantharides. Where the stomach has been much affected, I have

perceived relief from fomenting it with stupes, upon which thebaic

tincture and camphorated spirits were sprinkled, as recommended by Dr.

Lind. I was once affected with a bad dysentery in the West Indies,

and I thought myself much relieved by the warm bath and a blister.

Strangury is not an uncommon symptom in this disease, independent of

cantharides, and the most sensible and effectual relief is derived from

fomentations to the pubis and perinæum, as I also experienced in my own

case.

What has been hitherto said regards chiefly the acute dysentery; but

the most frequent and troublesome complaint that occurred at the

hospital, was the same disease in what may be called its chronic state.

There is a considerable variety of symptoms in all the stages of this

disease, but particularly in the more advanced or chronic state, so

that a corresponding variety is necessary in the modes of treatment,

and there are few diseases in which there is more room for exercising

the judgement.

In all stages of it an accurate discernment is necessary with regard

to the use of opiates, and great part of the practice here consists in

timing these well. They are least admissible in the beginning, where

evacuation is the principal object; but as the disease advances they

become more and more allowable and useful. The principal cautions

necessary in their administration are, 1. To premise sufficient

evacuation, so that the intestines may not be loaded with bile,

_scybala_, or any other irritating matter at the time of giving the

opiate. 2. To obviate the effects which an anodyne has of causing a

retention of the contents of the intestines. This may be done, either

by giving something purgative along with it, or after it has produced

its quieting effect. The former method seems preferable; for as soon as

the effect of the opiate is over, the purgative is ready to act; and

in this way it is so far favourable to the operation of the purgative

that large feculent stools will be discharged: whereas, had the

purgative been given alone, it would have been more apt to produce

scanty griping stools, attended with tenesmus. Rhubarb answers well in

such cases, and may be given in a dose from twelve to twenty grains,

according to the age and constitution. 3. To prevent feverish heat

and delirium. This was proposed to be done in the first stage of the

disease, by combining it with ipecacuana and a little neutral salt.

With the same intention, it may now be joined with a few grains of Dr.

James’s powder, or _vitrum ceratum antimonii_, in which form it would

not be so strongly sudorific, an effect not so much required in the

chronic as in the acute state.

The principal causes that keep up the flux, and render it so obstinate,

are, 1. A too great secretion of bile, either continual or frequently

recurring. 2. Ulcers in the great intestines. 3. A lienteric state of

the bowels. 4. A retention of _scybala_.

The first cause is much less frequent than might be expected by those

who fancy that every disease of this climate proceeds from bile.

When there does occur a redundancy of bile, there is more occasion

for the employment of evacuant medicines, and more need of caution

in that of opiates. A medicine that will dispose the liver, or the

circulating system in general, to form less bile, is a _desideratum_ in

physic; but, in case of an excessive flow of it, emetics and mercurial

purgatives, as has been already mentioned, are the best means of

evacuating it; and care should be taken that it be discharged before it

accumulates too much, or becomes acrid by too long retention.

In order to obviate that irritation in which tenesmus consists, some

benefit was found from the injection of emollient and anodyne clysters,

to wash off and dilute the acrimony, and to sooth and heal the parts. A

strong infusion or decoction of linseed or starch may first be given to

the quantity of near a pint, to be evacuated after a short retention,

and then a few ounces of the same, with thirty or forty drops of

laudanum, to be retained for a length of time, in order to procure

rest. Instead of this last, I have known a small quantity of warm

milk, with syrup of poppies, used with advantage in private practice.

I was at first tempted to think that a very frequent injection of such

clysters would be very useful, by washing and healing the colon and

rectum, and preventing farther exulceration. But besides the objection

arising from the tenderness of the parts, which, in some cases, renders

the operation itself painful, I found that if they were given oftener

than once a day, they rather increased the uneasiness, and made the

patient feel languid and exhausted; so true it is that no practical

rule can be established from reason alone without being brought to the

test of experience. The rectum seems to have a peculiar sensibility,

and a remarkable consent with the whole system; for a stool will

induce syncope, or even death, in a state of great debility. Clysters

may be pernicious, even though they produce no evacuation of _feces_;

and Sydenham has remarked, with respect to other diseases, that their

unseasonable or too frequent use greatly debilitates and disturbs the

patient. When not abused, however, they are of the most eminent service

in this and other complaints.

Certain medicines, which have been called _sheathing_, have been

recommended to be taken by the mouth. Of this kind are mucilage, oil,

and wax. I have made trial of mucilage, such as starch, without any

sensible effect, probably because it loses its qualities by the powers

of digestion before it reaches the part upon which it is intended

to act. With regard to oil, I have hardly enough of experience of

my own to decide; but some of the surgeons of the fleet informed me

that they found advantage from combining it with the purgatives. I

was discouraged from using it by finding that it was apt, in the West

Indies, to become rancid on the stomach, and, for this reason, I

seldom, in any case, employed the castor oil, which, though produced in

that climate, seems to answer better as a medicine in Europe. But since

my return to England I have used, with great benefit, at St. Thomas’s

hospital, a medicine, composed of tincture of rhubarb and oil, in old

dysenteries, attended with discharges of blood. I took the hint of this

from finding it of great service in deep-seated piles, as recommended

by Dr. Griffith[115]. It is necessary to combine something purgative

with the oil, otherwise it might be altered by digestion, or absorbed,

or might become rancid by too long retention in the first passages. Wax

is a body not changeable by digestion, and seems therefore well suited

for the purpose of sheathing the bowels; and I have found advantage

from the preparation of it recommended by Sir John Pringle[116], on the

authority of Dr. Huck. I have also seen some advantage in old fluxes,

in St. Thomas’s hospital, from the use of spermaceti, given with an

equal quantity of conserve of roses and half as much absorbent powder,

agreeably to a form in use at that hospital.

The climate has a great influence in preventing these ulcers from

healing, upon the same principle that it prevents the cure of external

sores and wounds, so that there are cases that admit of no cure but

from a change of climate. I have seen in some cases of old dysentery,

small, round, ill-conditioned ulcers break out on the surface of the

body, which seemed to proceed from the same general habit that produced

those of the intestines. There was something peculiar in the appearance

of those external sores, being like small round pits, as if a part of

the skin had been removed by caustic, and with little or no discharge.

In a case of this kind, which proved fatal, I found the whole surface

of the great intestines beset with small ulcers, not unlike those on

the skin.

Since the first edition of this work was published, I have met with a

pamphlet, written by Dr. Houlston, of Liverpool, in which the friction

of mercurial ointment on the abdomen is recommended as a cure for

old fluxes; and I have tried this practice in some very obstinate

cases in St. Thomas’s hospital with evident success. In these cases

it is probable the disease is kept up by a vitiated state of some of

the various secretions belonging to the intestinal canal, which the

mercurial alternative tends to correct.

The next cause that was mentioned of the long continuation of fluxes,

was a lienteric state of the bowels. This consists in a great

irritability of the whole alimentary canal, whereby all the _ingesta_

are transmitted so fast, that there is no time for assimilation. Liquid

aliment, such as broth, is particularly subject to this inconvenience.

There are few cases of long-protracted fluxes in the West Indies,

without this symptom in some degree.

The remedies that are here found of most service are such as counteract

irritability or relaxation. It is in cases where this is the prevalent

symptom that opium may be most freely used. Frequent and small doses of

the compound officinals, such as theriaca, pulvis e bolo compositus, or

diascordium, have been found of service. Though the relaxation would

seem here to indicate the Peruvian bark, yet I have hardly ever known

it employed in any form in this or any other stage of the disease,

without being hurtful. But there are other bitters not only safe but

useful in restoring the tone of the bowels; of this kind are simaruba,

quassia, and chamomile flowers. The first has been reckoned a specific

in this sort of flux; but though its powers are undeniable, it will

be found frequently to fail[117]. I have also used, with advantage, a

tincture of gentian and cinnamon in Port wine. Something aromatic has

a good effect when added to the bitter, being adapted to prevent or

obviate flatulence, which is a common and troublesome symptom in this

complaint.

That class of remedies which may be called pure astringents, might seem

at first sight well calculated for cases of this kind. Of this sort are

the _terra Japonica_ and _extractum campechense_; but though I have

seen evident benefit from this last, there are few cases in which such

medicines are found by experience to be of material service. Where the

cause consists in simple relaxation, they will effect a cure; but it

more frequently happens that the disease is kept up by a vitiated state

of the secretions, or a depraved action of the bowels.

The absorbent earths are a more useful remedy in this form of the

disease. They have, perhaps, a restringent effect independent of their

power of absorbing acid. It is certain, however, that great part of

their use consists in the destruction of acid, which is very apt to

be generated in that depraved state of digestion which takes place in

advanced fluxes, particularly in this lienteric state of the bowels. In

the early and acute state the vegetable purgatives, such as cream of

tartar, tamarinds, and manna, are proper; but in this advanced stage

they are hurtful by the acidity and flatulence which they produce, and

both the food and medicines should be so calculated as to avert and

correct those inconveniencies. There is something in vegetable acids

extremely unfriendly to a weak state of the bowels in general, tending

to bring on spasmodic gripings, and preventing a healthy digestion and

assimilation, as we know in the case of heartburn, and of those who

make use of vinegar to check corpulency, by preventing the formation

of blood. Vegetable acids, however, are admissible where there is

a redundancy of bile, or where the excrements are putrid; and Dr.

Zimmerman recommends tamarinds as a useful medicine in what he calls

the putrid dysentery.

Lime water has been recommended in old flaxes, and I tried it in

several cases; but, except in one, I could not perceive any benefit

from it.

Absorbents may very properly be combined in prescription with some of

the compound-officinal opiates, and a medicine will thereby be formed,

which will have at once the advantage of an anodyne, a bitter, an

astringent, a carminative, and absorbent. As these earths have little

or no taste, they may also be added, with propriety, to the common

drink, as in the form of the chalk julep, or _decoctum album_. It

may be thought that here and elsewhere I have not been so particular

as I ought to be concerning the forms and doses of medicines; but

circumstances, such as age, constitution, and symptoms, make these,

in a great measure, discretionary; and any one who is sufficiently

conversant with physic to be entrusted with the charge of the sick,

will have sufficient judgement to vary his practice accordingly. It

has, therefore been my object rather to give the general principles of

treatment than the particular forms of medicines.

A proper regulation of diet, as well as medicine, is of the utmost

consequence in this disease. A free indulgence of animal food is

pernicious, particularly in the first stage of it. In the chronic

state, a moderate use of it is allowable, and in the lienteric state

it answers better in a solid form than that of broth, which is apt to

gripe and to run quickly through the bowels. The best general articles

of diet are farinaceous bodies; and these are greatly improved by

being toasted brown before they are used. It was observed, in a former

part of this work, that the flux was supposed to have been prevented,

in the fleet commanded by Sir Charles Saunders, by throwing burnt

biscuit into the water used by the crews of the ships. It is a good

practice to put a well-burnt toast into all that the patient drinks,

and toasted bread, or panada made of toasted bread or biscuit, is one

of the best articles of diet. Brackish water ought to be avoided, as it

ruffles the bowels when in so delicate a state. Fermented liquors are

improper, except when the disease is advanced, and where weakness and

relaxation are the prevailing symptoms. Malt liquor will hardly ever

agree, on account of its acidity and flatulence. Of wines, Port is to

be preferred as the most strengthening; Madeira as the least subject

to acidity; and, for the common men, no drink of the fermented kind is

safer than a moderate quantity of spirits diluted with water.

Warm clothing is of the utmost consequence in this disease, and

external warmth of the abdomen tends greatly to sooth the bowels. I

have seen good effects from a warm gum plaster constantly worn on that

part. Though cold is in general hurtful and unsafe, I have nevertheless

known the sailors, who, by their habits of life, are commonly heedless,

bathe in the sea when labouring under what they call the white flux,

without any bad effects.

It sometimes happens that this disease baffles every effort both

of medicine and diet, so that a change of climate becomes the only

resource.

The last cause of habitual flux that was mentioned was the retention

of _scybala_, which keep up the irritation and tenesmus. It is very

natural to neglect purgative medicines when there seems already to be

too great a discharge by the bowels; but there is this inconvenience

from omitting them for a length of time, that those hard lumps of

feces, called _scybala_, are apt to collect in the cæcum and cells of

the colon, as I have seen upon inspecting the dead bodies; and the

fibres of the intestines being weakened, their natural strength is not

sufficient to expel them without being stimulated by a purgative. It is

therefore necessary to give some evacuant medicine from time to time,

even though there should be no griping nor any marks of acrimony in

the intestines. Rhubarb is allowed to be one of the best medicines for

this purpose; and I have also known a combination of salts and sena

have a good effect after a long neglect of purgative medicines. It is

probable, from the durable effects produced, that these do not operate

merely by the expulsion of _scybala_; and we can conceive that they may

be of service by the removal of certain depraved fluid secretions, or

that they may stimulate the vessels to a more healthy action and a more

natural secretion. Be this as it will, experience teaches that in all

fluxes it is of advantage to interpose from time to time some purgative

medicine.

From the preceding view of the variety of causes which tend to keep up

this disease, it will appear that great judgement and discrimination

are necessary in varying the practice according to circumstances; and

there is no disease in which there is room for more attention and

nicety in adapting the different remedies to the different symptoms.

We can hereby also account for the various characters that different

remedies have had, some having been extolled by one practitioner

while they have been pronounced insignificant by another; for no one

remedy will suit all the various cases of this disease. As it is of

the greatest consequence to distinguish these cases, I have been more

particular and diffuse on this article than any other; and having

laboured under this complaint myself, I was naturally led to take

a greater interest in its treatment, and had also thereby a better

opportunity of making observations on it.

CHAP. III.

Of the SCURVY.

I shall not be so minute either in the description or treatment of the

scurvy, as of the preceding diseases. A detail of this kind would lead

to unnecessary prolixity and repetition; for the prevention and cure

of it consisting in diet rather than medicine, have been fully handled

in the former parts of this work; and the subject, in the descriptive

as well as the practical part, has, in a manner, been exhausted by Dr.

Lind. With regard to the theoretical part, I refer the reader to the

ingenious treatise lately published by Dr. Milman.

It has appeared that the principal source of scurvy is a vitiated or

scanty diet, and that it is very much promoted by cold, moisture,

filth, sloth, and dejection of mind. Hard labour has been assigned

by some as a cause; but this is not conformable to my observation

in general, and what has been related to have happened in the

Conqueror[118], more particularly led me to be of a contrary opinion.

The principal differences of the symptoms of the scurvy in hot and

cold climates, so far as I have observed, are, that in the former the

livid hardness on the extremities is an earlier symptom, and in the

latter the gums are sooner affected, and the difficulty of breathing is

a more frequent and more uneasy symptom. This difficulty of breathing

is one of the most fatal symptoms, and is most frequent in those cases

in which there are the fewest external marks of the disease, and is

probably that form of the complaint which attacks a vital part by a

sort of translation from the extremities.

There is a remarkable symptom sometimes attendant on this disease which

has escaped authors, and is mentioned in Mr. Telford’s Report, page 23.

This is the _nyctalopia_, or weakness of the eye-sight, which was also

common in the garrison of Gibraltar[119], among those who were affected

with the scurvy, a disease that prevailed much during the late siege of

that place.

With regard to the cure, enough has been said in the preceding parts

of this work to prove that fresh vegetables are the most effectual

antiscorbutics. I shall here mention a fact farther in proof of this,

which has not before been taken notice of. When the fleet arrived at

Barbadoes in May, 1781, part of the soldiers, who served as marines,

were affected with the scurvy, and being sent to the army hospital,

where, at that time, no fresh animal food was allowed, they recovered

much faster by being confined to vegetable articles, than the seamen

who were fed upon fresh animal food without any fresh vegetables.

It has farther appeared, that there is something in a particular class

of fruit of the lemon and orange kind, which far surpasses every other

remedy, whether dietetic or medicinal. Numberless instances have

occurred, in the preceding part of this work, of men having recovered

at sea from using the juice of this fruit alone, even under all the

inconveniences of a sea diet. When the juice is intended to be kept for

a length of time, it should be expressed and bottled, a small quantity

of spirits being added to preserve it for if fire is used in preparing

it, as in the form of a rob, I know for certain that its virtues will

be thereby very much impaired. It is very difficult to say upon what

principle these fruits act, for no sensible effects are produced by

them except a small increase of some of the secretions.

It ought to be mentioned here as a fact of great consequence, though

very little known, and never, I believe, published before, that

the juice of limes and lemons is the best detergent of any external

application that has yet been tried in scorbutic ulcers. Nothing was

found so effectual in preventing these from spreading, and in disposing

them to heal, as an emollient poultice with[120] lemon or lime juice

sprinkled on its surface; or it was applied by soaking in it the lint

with which the sore was dressed, and also as a lotion, in which case

it was used diluted with two or three times its quantity of water; for

if used pure, it was found too irritating, and was apt to bring on a

fungous disposition. This precaution is particularly necessary with

regard to limes, the juice of which is a much more concentrated acid

than that of lemons. Mr. Lucas, surgeon of the Conqueror, favoured me

with several valuable remarks in proof of this practice. A poultice

was always found a good application in these cases, by its power of

absorbing the acrimonious discharge, which would otherwise irritate the

neighbouring parts. I have been informed by a navy surgeon, who served

in the former war, that he has known the most obstinate ulcers cured

by applying a paste of oatmeal and water, the surface of which was

sprinkled with Goulard’s preparation of lead.

The fleet was furnished with essence of malt; but its powers were so

inconsiderable, that some of the surgeons denied that it had any. In

trials, however, that were made in an early state of the disease, it

was found to have a sensible effect in checking and removing it. It

was also found of evident use in the bad ulcers so apt to arise in

scorbutic habits, and in this intention was superior to the Peruvian

bark as an internal alterative. Indeed, in those ulcers that were truly

scorbutic, the bark was found to be of very little use; and, next to

what has been already mentioned, joined to the advantages of diet,

opium was found of the greatest service in disposing these, as well as

all other ill-conditioned sores of hot climates, to heal.

I have mentioned the scorbutic habit as distinguished from the scurvy,

but there seems to be no difference except in degree; for a person may

be laid to labour under the disease before it betrays itself by any

obvious symptom, and it must have gathered a certain degree of force

before visible symptoms are produced. The chief mark of this latent and

incipient stage of the disease is that incurable state of ulcers that

has been mentioned, whether they appear spontaneously or in consequence

of slight accidents. There is another mark of this scorbutic habit

which is not mentioned in any description of the disease I have ever

seen. It is a soft, indolent tumour which arises under the skin on a

part which has received a small blow, or contusion, so slight as not to

break the skin. It most commonly appears about the elbow or fore-arm,

and generally disappears without any inconvenience, what it contains

being absorbed. A surgeon, who opened one of them, (a practice,

however, not to be approved of) informed me that it consisted of

fluid blood. We may also reckon a languor, or sense of weight, as one

of those marks of scurvy which occur before the more obvious symptoms

appear.

In this state of the disease, the articles of lesser powers, such

as malt and melasses, may be of service by preventing its farther

progress, or the appearance of actual symptoms, and by restoring the

constitution.

In some of the early stages of this disease the effervescing mixture

of acids with fixed alkali may probably also be of use. I never could

perceive any sensible benefit in those cases in which I tried it,

though some of the gentlemen of the fleet reported to me that they

thought it of service.

There is no article of the _Materia Medica_ yet known that possesses

any considerable power over this disease without the assistance of

proper diet. With this assistance, however, it is found, that whatever

tends to increase the fluid secretions, hastens very much the recovery

of the scorbutic patient. I have observed a very striking instance of

this in the effects of a spontaneous diarrhoea; for I have seen those

hard livid swellings on the legs, that form one of the most constant

symptoms of this disease, almost disappear, and the hams, from being

contracted, become flexible in the course of twelve hours after the

purging came on. I have endeavoured to imitate this with purgatives,

but never with the same effects as the natural looseness. A free

flow of urine is also found to promote the recovery, and vinegar of

squills is one of the most effectual medicines in this intention. It

is likewise of singular service to excite sweat; for an obstruction

of perspiration seems to be one of the principal constituents of the

disease. The goose skin, which is an early and constant symptom of this

disease, seems to be owing to a constriction of the exhaling vessels.

Dover’s powder has been employed with advantage as a sudorific, with

decoction of the woods drank warm, and plentiful warm dilution.

Camphor, combined with nitre, has been found one of the best remedies,

and it acts both as a diaphoretic and diuretic.

Such external applications as relax the skin are found also to forward

the cure. The contraction of the hams and the livid hardness of the

calves of the legs are relieved by emollient cataplasms. Burying the

legs in the earth, which has a sensible good effect, seems to act on

the same principle, for it makes the parts sweat profusely.

There can be no doubt that in the scurvy there takes place in certain

parts of the body a stagnation of the humours in the small vessels,

particularly of the lower extremities, and that it is to this

circumstance that the livid hardness of the fleshy parts of the legs

is owing. The effect of medicine in removing this, must be to restore

the action of those torpid vessels, so as to bring the stagnated

fluids again into circulation[121] Purgatives seem to act upon it as

they do in the dropsy, by exciting absorption. The irritation of the

bowels and their increased secretion thus affecting the minute vessels

in all parts of the body, is the result of that sympathy or balance

established between every part of the system, in order to support the

harmony and effect the purposes of the animal œconomy.

It has long appeared to me, that the scurvy is owing rather to a defect

of nourishment than to a vitiated state of it. In fact, that sort of

food which is supposed most commonly to induce the scurvy, is, in most

cases, not putrid, but is in an unnatural and depraved state by being

drained of its juices, which run off in brine; and perhaps some of the

more subtile and nutritious parts are wasted by evaporation. It is not

found that salt of itself has any effect in inducing the scurvy, and

indeed it can be induced under a state of diet in which there is no

salt, as we know from some instances quoted by Dr. Lind; and some cases

are related by Dr. Monro and Dr. Milman, in the Medical Transactions,

which are in proof of the same opinion. But the case most in point to

prove that it depends on a defect of aliment, is that of Dr. Stark,

who, by way of experiment on himself, reduced his diet to the least

quantity he could subsist upon, and was thereupon affected with the

symptoms of the sea scurvy. I have also known some symptoms of it arise

in old people in consequence of long abstinence, owing to the want of

appetite.

It would appear that the aliment we take in acts in two ways in

increasing the vigour of the body. First, by assimilation, whereby it

affords the matter of which the solids of the body are made, in order

to carry on growth in youth; and to repair the waste of parts in adult

age. A very small quantity of matter is necessary for these purposes;

and as a proof of it, we see people supported equally well with very

different quantities and qualities of food. Secondly, Food is necessary

as a stimulus, either by a power it has of soothing the nerves of the

stomach, and the other surfaces to which it is applied, or by its

volume in distending the intestines and blood vessels. It is upon this

principle that luxury renders the great quantities of food we take

in necessary; and those species of food which satisfy most by their

stimulus are by no means such as are the most nutritious. It is also

upon this principle, that in cases of accidental hardship from want

of food, or in barren and inclement countries where food is scarce,

the body is supported, in some measure, by what contains little or no

nutritious matter, such as pure water, or the bark of trees powdered

and kneaded into a sort of bread, as we are told of the inhabitants of

Lapland.

There are other familiar and well-established facts, which prove, that

either from the influence of disease, from habits of life, or the

nature of particular animals, life can go on for a length of time with

little or no aliment. This is the case in fevers, in sea-sickness,

in certain singular cases that have been recorded[122], in torpid

animals, and in animals of cold blood. Though a man in health will die

if deprived of food for a very few days, it does not follow that this

is owing to the want of matter to repair the waste of the body. The

craving for food, and the faintness from long abstinence, arise from

the want of the accustomed stimulus, especially in those who are used

to live well; and a person feels himself most refreshed by food and

drink when newly taken in, and before it can be applied to the purpose

of nutrition.

As there is a continual waste and decay, however, both of our fluids

and solids, some degree of reparation is absolutely necessary,

especially to animals of warm blood; and such _ingesta_ as would

give the stimulus of food, without being possessed of any nutritious

principle, would indeed continue life for a certain time; but disease

would ensue. The provision used at sea answers, in a great measure, to

this description; for unless the powers of digestion and assimilation

are remarkably strong, salt beef and biscuit, which have been long

kept, do not contain much more nourishment than saw-dust, or the bark

of a tree, and the disease induced by this diet is the scurvy.

The nature and symptoms of the scurvy countenance this opinion: for

as the means of renewing the animal matter of our bodies is withdrawn

under this course of diet, nature, in consequence of an accommodating

principle, observes a sort of frugality, and the animal œconomy adopts

such measures as may be productive of the least possible waste and

corruption of the fluids. Accordingly all the secretions become scanty;

and, in particular, one of the first symptoms of this disease is a

suppression of perspiration, as appears by the goose-skin that attends

it. There is a paucity of urine. There is also a great languor in

the circulation, which may be considered either as a means adopted by

nature to prevent that vitiated and effete state of the fluids which a

brisker action might induce; or it may happen from a want of that due

supply of nourishment necessary to produce a vigorous action of all the

functions.

We have a proof of this general languor not only from the great

aversion to motion, and the great disposition to syncope, but from

the inspection of the dead body, from which it appears that the

whole circulating system, being more flaccid and less elastic, is

subject to preternatural distention. The heart is accordingly found

enlarged in bulk, the size of the cavities being increased; and in

the extremities, where the circulation is naturally most languid,

the small vessels carrying the colourless part of the blood, are so

far enlarged as to admit the red part of it, as appears by the livid

colour; and where this is the case, these vessels being unable to

carry on the circulation, a stagnation ensues, as is evident in those

livid appearances most common about the calves of the leg, which feel

like a hard cake. I have examined those parts in the dead subject, and

found a want of fluidity in the contents of the vessels, but could not

discover any thing like _eechymosis_; from which I concluded that the

colour was owing to an _error loci_, and the hardness to stagnation and

coagulation of the fluids, and a want of action of the vessels.

The incurable state of ulcers, so common in this disease, is also

what we might expect from the defect of fresh assimilated juices; for

where a breach is made, either by nature or accident, in the solids,

particularly of the extremities, the proper suppuration is prevented by

the depraved state both of the fluids and vessels; and we cannot expect

that renewal of solid parts in which healing consists, where both the

instruments and materials of its formation are so defective.

I shall conclude what I have to say on this subject, by shortly

considering whether or not this disease is ever contagious.

There is something in the nature and history of the scurvy that

would lead us at once to pronounce that it is not infectious; for

the external causes on which it depends are so obvious, and seem so

adequate to account for its appearance and prevalence upon certain

occasions, as at first sight to exclude every other external cause.

But it seems extremely unphilosophical to deny the reality or

possibility of any thing in Nature, from our supposed knowledge of the

means and causes she employs, particularly in a branch of science so

obscure as the animal œconomy. Could we, therefore, prove the point

as a matter of fact, it would be in vain to deny it, from our fancied

acquaintance with Nature’s modes of operation.

The facts which give a suspicion of the scurvy being infectious are,

1st, What is related by Dr. Lind, that the sea scurvy spread at one

time from the naval hospital to the people of the adjacent country.

2dly, There occurred several instances, in the first part of this

work, of this disease prevailing to a much greater degree in some[123]

particular ships than others, though upon the most accurate inquiry

there was found no difference in the diet, or any other external or

predisposing cause adequate to account for this. We can conceive, that

those ships having accidentally a few men, whose constitutions were

remarkably predisposed to this disease, might catch it earlier than in

other ships, and communicate it to the rest of the crew.

The only practical inference that would lie from the establishment

of this fact would be, that when the disease begins first to appear,

the men affected should be separated from the rest; and this is a

good practice, whether this opinion is true or not; for such men

ought to be put in one mess, in order that they all may live upon the

same antiscorbutic articles of diet, and that they may more easily be

debarred from the use of their common provisions, of which this disease

does not make them lose the relish.

CHAP. IV.

Of the WOUNDS received in the Actions of April, 1782.

Loss in the Battle and from Wounds--Fatality of the locked

Jaw--Treatment of it--Some Ships more subject to it than

others--Different from other Cases of Tetanus--It is not cured by the

Removal of the Part--It may come on after the Part is cured--Effect of

Climate in producing it--Accidents from the Wind of a Ball--Accidents

from the Explosion of Gunpowder--Means of preventing them--General

Observations on Sores and Wounds.

Though surgery was not properly in my department, yet, having had

a fair opportunity of collecting facts concerning this branch of

practice, I thought it my duty to pay some attention to it.

The whole number of men wounded in the actions of April, 1782, amounted

to eight hundred and ten.

Of these, sixty died on board before the end of the month, five in the

course of the following month, and two in June.

There were ninety-seven wounded men sent to the hospital at Port Royal,

of whom there had died twenty-one when the fleet left Jamaica on the

17th of July.

So that the whole loss of men in the battles of April, and their

consequences, is as follows:

Killed outright 266

Died of their wounds on board 67

Died of their wounds at the hospital 21

---

Total 354

Of those who died on board, fifteen[124] were carried off with the

Symptoms of the locked jaw; but of those sent to the hospital, only

one. The reason that so few in proportion were affected with it in the

hospital may have been, that none of the wounded were landed till near

the end of the third week after the principal action. The danger of

this symptom was then, in a great measure, past, though I have known

it to take place in every period from the second or third day till the

fourth week.

Only three men in the whole fleet recovered from this alarming

complaint; and as it is interesting to know every thing relating to so

desperate a symptom, I shall give a short account of each.

The first was a seaman of the Montagu, who had his thigh wounded by

a splinter which carried away part of the integuments and _membrana

adiposa_, and lacerated in a small degree the _vastus externus_

muscle. The wound did extremely well till the 23d day, when the jaw

became almost entirely fixed, and the whole muscles of the wounded

side were thrown into frequent spasms. Mr. Young, the surgeon, who

was always anxious and assiduous in his duty, consulted with me, and

we had immediate recourse to the warm bath, which gave a degree of

instantaneous relief, and was repeated twice a day for half an hour.

He was sensibly better every time; in nine days was entirely free of

the symptom, and continued afterwards to do well. The only other means

taken for this man’s recovery, besides what were used with the other

wounded men, were from three to five grains of opium, which he took

every day, in divided doses.

The next was a seaman of thirty years of age, belonging to the

Magnificent, who had the _humerus_ broken and shattered by a splinter

which entered the deltoid muscle. Several large portions of bone were

extracted, and the artery was laid bare on the inside. On the fifth day

there came on a large ichorous discharge, with a low quick pulse and

depressed spirits, and the jaws began to close, with pain and stricture

on both sides about the articulation of the lower jaw. He had every day

since the accident taken half an ounce of Peruvian bark, combined with

opium or rhubarb, according as it made him loose or costive. This was

continued, and the part externally was kept constantly moist all round

with volatile liniment, to which a fourth part of _tinctura thebaica_

was added. Next day the jaw was almost entirely fixed, so that it was

with difficulty that a little wine and water could be introduced with a

spoon. Mr. Harris, the surgeon, now wisely determining to do something

vigorous in this unpromising situation, beat up twelve ounces of opium

moistened to the consistence of a cataplasm with the thebaic tincture,

and applied one half to each side of the jaw. The patient this day

swallowed a pint of the bark decoction with half an ounce of nitre, and

took a diaphoretic draught of twenty drops of thebaic tincture and

thirty of antimonial wine. He had also the smoke of tobacco thrown up

his nostrils.

On the third day after the attack he could open his mouth half an

inch. The cataplasms were taken off, beat up afresh with the tincture,

and applied anew. The bark and other medicines were continued. On the

fourth day the stricture and pain of the jaw went entirely off, but the

cataplasm and volatile liniment were applied for three days longer. The

wound produced a laudable discharge, every symptom became favourable,

and he continued to recover.

The only other person who recovered from this symptom was a man in the

Bedford. Several died of it on board of this ship; and as the same

means of relief were skilfully employed in all the cases by Mr. Wickes,

the surgeon, the success seemed owing more to something favourable in

the man’s constitution, than any thing peculiar in the treatment, which

consisted in the administration of the warm bath, opium and camphor,

with mercurial friction on the jaw.

This accident affected some ships remarkably more than others,

particularly the Barfleur and Bedford, though their wounds had nothing

peculiar, nor were in a greater proportion than in the rest of the

fleet. Four were carried off by it in each of these ships. It has

formerly been observed, that great ships acquire peculiar habits, or

dispositions, which incline the constitutions of the men to one disease

more than another. This complaint took a run in some particular ships

last year also after the battle of the Chesapeak; and I have known it

prevail in some particular hospitals more than others. In the present

instance, it may have been owing either to something peculiar in the

constitution, or air of the ships; or we can conceive it to be owing

to some sort of nervous sympathy, just as the _epilepsy_[125] has been

known to spread from one boy to another, at a school, in consequence

of imitation, dread, horror, or some such delicate nervous or mental

affection. We have in yawning an example of a spasmodic affection

spreading from one person to another. If this is the case in the locked

jaw, those affected by it should be removed from the presence of the

other wounded men, lest the idea of the sufferings of others should be

so fixed in their mind, or so impress them with the fear of the like,

as to invite the attack of the same complaint.

Though the locked jaw, in consequence of wounds, resembles frequently

in its symptoms the tetanus which arises without any external accident,

yet there are many cases of the former which differ materially from

the violent symptoms of the other, as described by authors. In most

cases of the locked jaw from wounds the spasms are not so general, so

violent, nor attended with such exquisite pain. It sometimes happens

that the convulsive twitchings are even accompanied with a sort of

pleasure, as in the case of a lieutenant of the Montagu, whose case was

related to me by Mr. Young, the surgeon of that ship, a man of skill

and observation in his profession, and upon whose fidelity and accuracy

I could perfectly rely. This officer had been wounded in the elbow at

the battle of St. Christopher’s by a splinter, whereby the capsular

ligament of the joint was injured. On the ninth day, symptoms of the

locked jaw came on, and soon after the whole muscles of the wounded

side were affected with frequent convulsive twitchings, which, as he

himself said, afforded a pleasant sensation, exciting laughing like an

agreeable titillation. He died on the fourth day after it came on, and

had no pain to the last.

The locked jaw from accident differs also from other cases of tetanus,

in respect to its cure; for the latter has been successfully treated by

cold bathing, as is related by Dr Wright[126] and Dr. Cochrane[127];

but it is acknowledged by the latter that this treatment did not answer

when the complaint proceeded from a wound.

It is to be remarked, that the locked jaw did not take place in those

cases in which the wounds had a foul and gangrenous appearance more

than others; for those that digested and cicatrized favourably, were

equally apt to be affected by it; and though amputations are most

liable to this symptom, the slightest injuries, even a scratch, will

sometimes bring it on.

It would be difficult, therefore, to establish any particular treatment

that would tend to prevent accidents of this kind; but Mr. Bassan,

surgeon of the Arrogant, one of the line-of-battle ships engaged on the

12th of April, mixed laudanum with the dressings of all the wounds, and

no locked jaw occurred.

In the Bedford there occurred a curious circumstance concerning this

complaint. In one of the cases that proved fatal, the symptoms did not

come on till the wound was so far healed that all dressing had been

laid aside.

Mr. Wood, surgeon of the hospital at Jamaica, informed me, that in

cases of the locked jaw from injuries to small members, such as

fingers, he had tried the effect of amputating the part after the

symptoms had come on, but without any effect in putting a stop to them.

Would it not appear, from the two last mentioned facts, that this

symptom is not kept up, nor even takes place in the first instance,

from an immediate present irritation, but that the constitution comes

to be so modified, or receives such an impulse, as it were, that

the complaint runs its course independent of the presence of that

_stimulus_ which excites it?

It would be difficult to assign a satisfactory reason why this accident

is more frequent in hot than in cold climates. The effect of external

heat upon the living body is not to raise its temperature even when the

heat of the air exceeds that of the body[128]; so that we are to seek

for the effects of it in some of those affections peculiar to animal

life. And as the outward temperature of the air does not affect the

general mass of the body, all the effects produced by it must depend

on impressions made on the external surface of the body and lungs; and

the skin, which may be considered as a large expanded tissue of nervous

fibres endowed with universal sympathy and great sensibility, affects

every organ and every function of the body, according to the state of

the air in contact with it, whether cold or hot, moist or dry, pure or

vitiated. This sympathetic sensibility of the skin is chiefly affected

by the state of the perspiring pores on its surface; for it is only

when these are open that the impression of the air on the skin produces

catarrhs, rheumatisms, and internal inflammations in cold climates;

and the external temperature in hot climates being such as to keep

the pores almost always open, this seems to be a principal reason

of that universal irritability prevailing there, and of the general

sympathy that prevails between every part, particularly as connected

with the organs of perspiration[129]. This readiness of one part to be

affected by another in hot climates is well illustrated by the sudden

translation of certain diseases. I have seen, for instance, a catarrh

cease, and be converted, as it were, into a diarrhœa, and this as

quickly disappearing, a pain in the foot would arise, like an attack of

the gout. All this would happen in the space of a few hours.

But, in cold climates, wounds are by no means exempt from the locked

jaw; for it sometimes occurs in England, where I have seen it even in

the winter season[130].

Since my return to England I have received some new and useful

information on this subject in conversing with Dr. Warren, physician

to the King; and as any observations derived from so much acknowledged

skill and sagacity must be valuable, I shall here relate what he was so

kind as to communicate to me.

This eminent physician, in attending a case in which he was nearly

interested, and in which his endeavours were rewarded with success,

found the greatest benefit from opium and the warm bath. The opium was

given in the form of tincture, in moderate, but pretty frequent, doses.

The bath was composed of milk and water, and the addition of milk was,

no doubt, an improvement; for there is something in this as well as

oil extremely soothing to the human nerves. Dr. Warren had intended to

make trial of a bath of oil in case this had failed. He mentioned the

following observation, with regard to the external application of oil,

which could only have been suggested by that anxious attention that was

paid to the case. It was found, that the uneasiness arising from the

spasm was allayed by constantly drawing a feather wetted with oil over

the temples, which had an evident effect in lulling the pain and spasm;

for when this operation was left off, there was an immediate recurrence

of these symptoms[131].

It would appear, therefore, from this as well as the former cases,

that opium and the warm bath are the only remedies yet known which

are of service in this complaint, and much will depend on the

judicious management of them. The method of administering the opium,

recommended by Dr. Warren, seems to be the most judicious, especially

in constitutions not habituated to this medicine.

There is a certain medium in giving opium, by which its best effects

are obtained, for in an under dose it will produce disturbance instead

of rest; and when it is given in large quantities it frequently

defeats the very end for which it is given, by throwing the body into

convulsions which terminate in death. The rule for judging of the

proper limits of this dose is, by its effect in inducing that stupor

or insensibility which renders the senses incapable of irritation; for

in this, as well as in every other case of disease, the cure seems

ultimately to be the work of nature, the effect of medicine being only

a secondary operation, by which it removes some obstacle to the natural

efforts of the constitution. Though a dose of opium greater than

ordinary is required to produce this insensibility in cases of spasm,

and though the constitution in that situation will bear more, yet even

here it may be given to excess; and by beginning with small quantities,

and giving it in frequent rather than large doses, the constitution

will thereby be better reconciled to it, and it will also with more

convenience admit of that gradual increase which is peculiarly

necessary with this medicine. These ideas were suggested to me by Dr.

Warren; and it may be farther added, in recommendation of his method,

that the liquid form is preferable to the solid, as the effects of it

will sooner be seen, and a better judgement can be formed how far it is

proper to push it.

Great attention is also necessary in regulating the heat of the bath;

for if it is not sufficiently warm, it will not have the effect of

producing a due relaxation; and if it should be too hot, it will

stimulate too much, and will have the farther inconvenience of making

the patient very faint in a short time. It cannot be well regulated

without a thermometer, and 93° upon Fahrenheit’s scale is perhaps the

best temperature. I have kept a patient in a bath of that heat for six

hours, which he could not have endured for half an hour had the heat

been three or four degrees higher.

The circumstance next in consequence, in the cure of this complaint,

is the keeping up a moisture on the skin, and guarding the surface of

the body from the access of the air. This is particularly necessary

with regard to the part itself, which should be constantly enveloped in

warm, anodyne, and emollient applications. The good effects of this is

particularly exemplified in the case which recovered under the care of

Mr. Harris, who gave the diaphoretic medicine, composed of antimonial

wine and laudanum, and applied the anodyne cataplasm to the external

_fauces_. It was remarked, that the locked jaw was most incident to

those wounded men who lay in parts of the hospital where they were

exposed to a current of air; and the cases of tetanus that most usually

occur in the West Indies, independent of wounds, are those of slaves

who fall asleep in the night-time in the open air.

Since the first edition of this work, there has appeared an Essay on

the Locked Jaw by Dr. Rush, physician to the American army in the late

war, in which he recommends, from his own observation, Peruvian bark,

wine, and blisters, and to dress the wounds with mercurial ointment, in

the cure of this complaint. From some trials I have since made of the

bark in St. Thomas’s hospital, I have reason to think well of it as a

remedy in this disease.

There is a singular species of accident to which engagements at sea

are liable, the WIND OF A BALL, as it is called. If a cannon ball in

its flight passes close to any part of the body, it renders it livid

and numb for some time[132]. It is most dangerous when it approaches

the stomach; and there was an instance of a man in the last battle,

who, upon a ball passing close to his stomach, dropped down dead

instantaneously, without the least visible marks of injury. Another,

in consequence of a ball passing close to his belly, remained without

sense or motion for some time, and a large livid tumor arose on the

part, but he recovered. I attended a man at the hospital at Barbadoes,

who had the buttons of his trowsers carried off by a cannon ball,

without its having touched the body. The _pubis_ was livid and swelled

for some time after: he suffered exquisite pain from strangury, which

seemed to proceed from a _paralysis_ of the bladder, for he voided no

water without a catheter for near three months, after which time he

recovered. I know a brave young officer[133] in the army, who had his

epaulette carried off by a cannon ball at Charlestown, in consequence

of which the shoulder and adjacent parts of the neck were affected

for some time. A like accident happened to a marine officer in one of

the late engagements; but in neither of these was the head materially

affected, nor is it so apt to be affected in this way as the stomach.

I never knew death the consequence of the wind of a ball on the head;

though an officer[134] in the Sultan, at the battle of Grenada, was so

stunned by a shot passing near his temple, as to be insensible for some

time, but he recovered entirely in a few hours[135].

The class of wounds most peculiar to a sea engagement are scorches from

the accidental explosion of gunpowder; and in most of the campaigns

in which I have served they have been very frequent and fatal. Few

accidents, however, of this kind happened in the late engagements; so

that we had but little experience of this sort of wounds in April,

1782. But on former occasions they were very frequent, and the best

application to the burnt parts was found to be linseed oil, which

some of the surgeons mixed with lime water, others with cerusse, and

both compositions answered well. Opium was found of great use in

alleviating pain and procuring rest, care being taken to guard against

costiveness by the use of clysters. In the battles of 1780 and 1781,

one-fourth part of the whole killed and wounded was from this sort of

accident; but on the 9th and 12th of April, 1782, only two accidental

explosions of gunpowder happened in the whole fleet, by one of which

one life was lost, by the other, two. This difference was owing partly

to greater experience and habits of caution acquired in the course

of the war, and partly to certain improved methods in working the

artillery introduced by Sir Charles Douglas, which, like all his other

valuable improvements, tend to give facility and expedition, as well

as to save the lives of men. The circumstances which tend to prevent

explosions are, 1st, The wetting of the wads, which prevents their

inflaming and blowing back when they fight the weather side of the

ship; a circumstance which, without this precaution, gives occasion

to a number of accidents by the burning parts catching the loose

powder, or setting fire to the cartridges. 2dly, The use of goose-quill

tubes and small priming boxes, made of tin, instead of the large horns

formerly in use, whereby great quantities of powder were scattered

about and exposed to accidental fire. 3dly, The use of locks, which was

practised with great success in several ships, and was found to make

the operation both more safe and more expeditious.

It frequently happens that men bleed to death before assistance can

be procured, or lose so much blood as not to be able to go through

an operation. In order to prevent this, it has been proposed, and on

some occasions practised, to make each man carry about him a garter,

or piece of rope-yarn, in order to bind up a limb in case of profuse

bleeding. If it should be objected, that this, from its solemnity, may

be apt to intimidate common men, officers at least should make use of

some such precaution, especially as many of them, and those of the

highest rank, are stationed on the quarter deck, which is one of the

most exposed situations, and far removed from the cockpit, where the

surgeon and his assistants are placed. This was the cause of the death

of Captain Bayne, of the Alfred, who, having had his knee so shattered

with a round shot, that it was necessary to amputate the limb, expired

under the operation, in consequence of the weakness induced by loss

of blood in carrying him so far. As the Admiral, on these occasions,

allowed me the honour of being at his side, I carried in my pocket

several tourniquets of a simple construction, in case accidents to any

person on the quarter deck should have required their use.

It sometimes happens, however, that no hæmorrhage arises from a limb

being carried off by a ball. The surgeon of the Fame related to me an

instance of this, in which the thigh was cut through by a shot near

its upper part, all except a little flesh and skin, and yet not the

least hæmorrhage followed. This may have been owing to the limb being

entirely severed, or nearly so, whereby the vessels contracted more

easily than if they had been partially divided. All that was done for

this man was to remove the limb, and to saw off the jagged end of the

bone. He survived six days, still without bleeding, and died of the

locked jaw.

I was informed by several of the surgeons, that the method of taking up

the vessels by the _tenaculum_ was found to answer extremely well; and

many of them imagined that the locked jaw was not so apt to be brought

on by this mode of operation as by that of the needle. But it is hardly

to be attempted in time of action, for want of steadiness and a good

light, and it was chiefly at the hospitals that this practice was found

so successful.

Mr. Alanson’s method of amputation by a great retraction of the

muscles, so that the fleshy parts shall meet over the bone and unite

in the first intention, was attended with great success in the West

Indies, particularly at the hospital at St. Lucia, under the care of

Mr. Bulcock.

It may be remarked, that though all sores and wounds in the foot and

leg are difficult of cure in a hot climate, I have observed, that,

where the constitution is good, those in the thighs, arms, trunk, and

head, are rather more easy of cure than in Europe, and that parts

divided by incision very readily unite by the first intention. In

reasoning upon this, it may be said, that as healing depends on a

certain degree of vigour in the powers of life, this should not err

either on the side of excess or defect. If it is too great, as in the

case of a hale, plethoric constitution in a cold climate, too much

inflammation is apt to be excited; and if too feeble, as happens in

a hot climate, in the lower extremities, which are far removed from

the source of life and circulation, the salutary effort is not strong

enough to generate new organised parts. But in the trunk of the body,

in such a climate, the powers of the animal œconomy are in that just

medium which is most favourable to this operation of nature.

THE END.

APPENDIX

TO

PART III.

It has been suggested to me, that it would add to the utility of this

Work to subjoin a list of the remedies best suited to the practice of

physic at sea, with their quantities, and to give a set of formulas

for the direction of young practitioners. I have accordingly made out

a gross computation of the requisite quantities of the most useful

and necessary articles of the Materia Medica, and also a few of the

most commodious and simple forms of administering some of the most

efficacious remedies for the most common diseases.

It is of consequence every where, but especially on board of a ship,

to simplify practice, as much as possible, with regard to the number,

the preparation, and the administration of medicines. Where a great

number of compound medicines are given, it is extremely difficult to

ascertain, by accurate and satisfactory observations, what are their

real effects; and as there are not conveniences at sea for great

pharmaceutical nicety, the plainest forms should be adhered to. And as

all operations are rendered more practicable and easy by being reduced

to a stated method, this is an additional inducement for studying

plainness and simplicity in preparing and administering remedies. This

uniformity is more attainable in the public service than in private

practice; for in the former all the patients are of one sex, they are

all adults, and they are generally of robust constitutions.

In the list hereto subjoined the articles are distinguished into

PRINCIPAL and SECONDARY; and when a surgeon considers how limited his

funds are, I hope he will not think that I have made a disproportionate

assortment in reducing the number and quantities of the latter, my view

in this having been that he may better afford an ample proportion of

such medicines as are really efficacious and indispensable in the cure

of diseases. It may be affirmed, without vanity or arrogance, that the

printed list of articles with which the navy surgeons are enjoined to

supply themselves is very injudicious considering the present improved

state of the medical art; and it is of great importance that the

due proportion of each article should be ascertained as nearly as

possible, that no unnecessary expence may be incurred, and that the

chest may not be encumbered with unnecessary articles.

There are no simple distilled waters in the following list, as they

are very corruptible, and too bulky to carry to sea. Their place is

supplied by a small quantity of oil of mint, which may be occasionally

added to common water, in the proportion of a drop to an ounce. There

are no tinctures inserted, except laudanum, the traumatic balsam, and

compound spirit of lavender, as the surgeon, having a proper supply of

spirit of wine or rum, may make them on board of the ship.

In the following list the surgical articles are not enumerated. There

is a new article which I beg leave to recommend, as it has lately been

found extremely useful, and is now used in large quantities in the

hospitals in London. This is linseed meal for poultices. The surgeon

should also be provided with a sufficient quantity of linseed oil, as

it has been found to be one of the best ingredients in dressings for

scorches. See page 540.

The quantity of each article is adapted to an hundred men for one year,

so that a calculation can easily be made for any number of men, and for

any length of time.

ASSORTMENT OF MEDICINES

TO BE

CARRIED TO SEA,

FOR

ONE HUNDRED MEN, FOR ONE YEAR.

PRINCIPAL ARTICLES.

Peruvian bark, ten pounds, and if the ship is destined for a hot

climate, twenty pounds. This article should be provided by the Public.

See p. 359.--Calomel, two ounces and a half--_a_ Emetic tartar, one

ounce and a half--Ipecacoanha, four ounces--Opium, one ounce--_b_

Purging salts, ten pounds--Senna leaves, two pounds.

SECONDARY ARTICLES.

Aloes, half an ounce--Ammoniacum, two ounces--Balsam of copaiva,

three ounces--_c_ Traumatic balsam, four ounces--Camphor, three

ounces--Cantharides, one ounce--Capsicum, three drachms--Castor, an

ounce and a half--Chamæmile flowers, or hops, two pounds--Cinnamon,

an ounce--Prepared chalk, or oystershells, six ounces--Conserve of

roses, half a pound--_d_ Cordial confection, two ounces--_e_ Cathartic

extract, half an ounce--Extract of hemlock, three ounces--Extract of

logwood, one ounce--Gentian, five ounces--Ginger, three ounces--Gum

arabic, four ounces--Gum guaiacum, three ounces--Powder of jalap,

one ounce and a half--_f_ Laudanum, four ounces--Linseed, one

pound--Magnesia, six ounces--Manna, eight ounces--Whole mustard seed,

half a pound--Myrrh, four ounces--_g_ Crude mercury, two ounces--

_Names in the last Edition of the London Pharmacopœia._

_a_ Antimonium tartarisatum.--_b_ Either Glauber’s salts, natron

vitriolatum, or sal catharticus amarus, magnesia vitriolata. Glauber’s

salt answers better in a hot climate, being less deliquescent

from the heat and moisture of the climate.--_c_ Balsamum benzoes

compositum.--_d_ Confectio aromatica;--_e_ Extractum colocynthidis

compositum.--_f_ Tinctura opii.--_g_ Hydrargyrus.

_a_ Corrosive sublimate, an ounce--Nitre, eight ounces--Oil of

almonds, one pint--_b_ Castor oil, half a pint--Linseed oil, three

pints--Essential oil of mint, one ounce--_c_ Jamaica pepper, four

ounces--_d_ Blistering plaster, ten pounds--Quaffia, eight ounces--Salt

of hartshorn, two ounces--_e_ Salt of steel, half an ounce--_f_ Salt of

wormwood, ten ounces--Castile sope, half a pound--Sarsaparilla, three

pounds--Serpentary, four ounces--Spermaceti, four ounces--Rectified

spirit of wine, one pint--_g_ Weak spirit of vitriol, half a pint--_h_

Volatile aromatic spirit, half a pint--_i_ Spirit of Mindererus,

two pints, or the volatile salt and vinegar may be kept separately,

and added occasionally--Spirit of turpentine, four ounces--Dried

squills, half an ounce--Flowers of sulphur, one pound--Golden sulphur

of antimony, half an ounce--Cream of tartar, one pound--Vinegar, six

pints--_j_ White vitriol, six drachms--Wormwood, one pound--_k_ Flowers

of zinc, two drachms.

NECESSARIES _to be put in charge of the Purser, and served out to the

Sick in place of the common sea provisions. See page 358._

BARLEY, three hundred pounds--Eggs, greased and put in salt, twenty

dozen--Extract of spruce, twelve pounds--Lemon juice clarified, and

preserved by adding to it a small proportion of ardent spirits, five

gallons--Raisins, fifty pounds--Rice, two hundred pounds--Coarse sugar,

one hundred pounds--Sago, twenty pounds--Salep, ten pounds--Portable

soup, fifty pounds--Tamarinds, ten pounds--Best white wine, three

hundred gallons--Best red wine, one hundred gallons.

_Names in the last Edition of the London Pharmacopœia._

_a_ Hydrargyrus muriatus.--_b_ Oleum ricini.--_c_ Pimento.--_d_

Emplastrum cantharidis.--_e_ Ferrum vitriolatum.--_f_ Kali

præparatum.--_g_ Acidum vitriolicum dilutum.--_h_ Spiritus ammoniæ

compositus.--_i_ Aqua ammoniæ acetata.--_j_ Zincum vitriolatum.--_k_

Zincum calcinatum.

FORMULÆ QUÆDAM

MEDICAMENTORUM

IN MEDICINA FACIENDA APUD NAUTAS

ACCOMMODATIORES.

IN FEBRE CONTINUA.

PULVIS EMETICUS COMMUNIS.

℞. Pulveris radicis ipecacoanhæ grana decem, antimonii tartarisati

grana duo, misce.

MISTURA CATHARTICA COMMUNIS.

℞. Foliorum fennæ uncias sex, aquæ ferventis libras sex. Macera donec

pene refrixerit & adjice vel natri vitriolati vel magnesiæ vitriolatæ

libram unam cum semisse. Dein cola & admisce tincturæ sennæ uncias

octo. Dosis est ad uncias tres.--Interdum conducit adjicere singulis

dosibus, vel pulpæ tamarindo um semunciam, vel mannæ semunciam, vel

antimonii tartarisati semigranum, vel pulveris jalapìi grana decem.

ENEMA COMMUNE.

Aquæ marinæ tepidæ uncias duodecim.

POTUS COMMUNIS.

Decoctum hordei.--Conveniat adjicere singulis libris pro re natà, vel

pulpæ tamarindorum unciam dimidiam, vel crystallorum tartari drachmam

unam, vel nitri scrupulum unum, vel acidi vitriolici diluti guttas

decem, vel succi limonum unciam unam, vel gummi arabici scrupulos

duos, vel vini uncias quatuor, vel frustum panis tosti.

VINUM EMETICUM.

[136]℞. Antimonii tartarisati scrupulos duos, aquæ ferventis uncias

duas, vini albi uncias octo. Solve antimonium in aquâ & adde vinum.

Assumatur drachma una omni quadrante horæ, donec vel vomitus cieatur,

vel alvus moveatur. Deinde assumatur semi-drachma sextâ quâque horâ.

PILULA FEBRIFUGA.

℞. Pulveris antimonialis, (Pharm. Lond.) vel pulveris febrifugi Dris.

James drachmam unam, conservæ rosæ quantum latis sit. Simul contunde

& divide in pilulas duodecim. Deglutiatur una quartâ vel sextâ quâque

horâ.

MISTURA SALINA ET ANTIEMETICA.

℞. Kali præparati drachmam unam, succi limonum, vel aceti, vel acidi

vitriolici quantum satis sit ad saturandum salem, aquæ puræ uncias

sex. Bibatur tertia pars ter die.--Conducit pro re nata adjicere,

vel pulveris antimonialis grana quinque, vel acidi vitriolici diluti

guttas quinque, vel cretæ præparatæ scrupulum unum, vel aquæ menthæ

semunciam.--Interdum conducit sumere hanc misturam statim postquam

Kali & succus limonum mixta fuerit, scilicet in ipsâ ebullitione. Hoc

imprimis utile est quando vomitus vel nausea molestus sit, & licet

adhibere magnesiam vice Kali, & acetum vice succi limonum.

[137]PILULA DIAPHORETICA.

℞. Opii purificati grana duodecim, antimonii tartarisati grana sex,

conservæ rosæ semi-drachmam, farinæ glycirrhizæ, vel tritici quantum

satis sit. Contunde simul & divide in pilulas viginti quatuor.

Devoretur una horâ somni. Interdum prosit dare unam bis die.

[138]MISTURA SEDATIVA.

℞. Misturæ camphoratæ uncias sex, tincturæ opii guttas viginti Misce.

Bibatur tertia pars ter die.--Aliquando conducit admiscere singulis

dosibus aquæ ammoniæ acetatæ drachmas tres, vel vini emetici guttas

triginta.

[139]BOLUS SEDATIVUS.

℞. Confectionis aromaticæ scrupulum unum, opii purificati grani

quartam partem, castorei Russici grana decem, tincturæ opii guttas

quatuor. Misce. Assumatur sextâ quâque horâ.

BOLUS SERPENTARIÆ COMPOSITUS.

℞. Pulveris serpentariæ Virginianæ grana decem, camphoræ grana

quatuor, confectionis aromaticæ quantum satis sit. Assumatur ter

die.--Interdum conducit addere pulveris corticis Peruviani drachmam

dimidiam, vel superbibere decocti corticis Peruviani uncias duas.

ELECTUARIUM AD CONVALESCENTES.

℞. Pulveris corticis Peruviani, florum chamæmeli, singulorum unciam

unam, pulveris zinziberis scrupulos duos, syrupi quantum satis

fit. Dosis est circiter drachma ter die.--Interdum adjiciantur vel

rubiginis ferri drachmæ tres, vel pulveris terpentariæ Virginianæ

drachmæ duæ.

IN FEBRE INTERMITTENTE.

Adhibeantur in initio eadem medicamenta ac in initio febris continuæ.

Deinde

Sumatur corticis Peruviani drachma una, secundâ vel tertiâ quâque horâ,

vel etiam singulis horis, absente paraxysmo febrili.--Interdum confert

dare singulas doses ex spiritûs vini tenuis (_rum_ dicti) unciâ unâ.

Si cortex frustra adhibeatur fauste adhiberi possint medicamenta infra

præscripta.

[140]℞. Zinci calcinati semi-drachmam, conservæ rosæ quantum satis

fit. Contunde simul & divide in pilulas quindecim. Sumatur una ter

die, augendo dosim si premerit morbus & si ferat ventriculus.

Vel,

℞. Zinci vitriolati grana duodecim aquæ puræ uncias tres Sumatur

tertia pars ter die augendo dosim si opus fuerit & si ferat

ventriculus.

Vel,

[141] ℞. Tincturæ rhabarbari uncias duas, tincturæ sennæ drachmas sex.

Misce. Sumatur paucas horas ante paroxysmum.

Vel,

[142] Cortice Peruviano frustra dato, aliquando conferat dare ægro

quotidie, vel calomelanos, vel pilularum ex hydrargyro quantum &

quamdiu sufficiat ad levem ciendum ptyalismum, & deinde instituere

curam de integro cum cortice Peruviano.

Vel,

[143] Sumantur tincturæ

IN DIARRHŒA SIMPLICI.

BOLUS AD DIARRHOEAM.

℞. Cretæ præparatæ scrupulum unum, pulveris rhabarbari grana

quindecim, pulveris corticis cinnamomi grana sex, opii purificati

granum dimidium, tincturæ opii guttas quinque, syrupi quantum satis

fit. Semel sumatur.

℞. Misturæ cretaceæ (Pharm. Lond.) cum duplici gummi arabico libram

unam, tincturæ opii guttas decem. Absumatur totum partitis vicibus

nychthemero, incipiendo duodecim horas post datum medicamentum

novissime præscriptum.--Interdum adjiciatur tincturæ cinamomi uncia

dimidia.

IN CHOLERA MORBO.

℞. Decocti hordei vel avenæ libras tres, pulveris gummi arabici unciam

unam cum semisse, tincturæ opii guttas triginta. Hauriatur quam primum

libra una, & deinde libra dimidia omni horâ usque ad levamen mali.--Si

parabilis fuerit caro vitulina, vel pullus, jusculum tenue ex altero

utro factum vice decocti supra dicti adhibeatur.

IN DYSENTERIA ACUTA.

Sumat æger quamprimum emeticum commune.

℞. Decocti hordei libras duas, salis cathartici unciam unam cum

semisse, antimonii tartarisati grana duo. Misce. Hauriatur tepide

primò libra dimidia, & deinde unciæ quatuor omni horâ donec alvus

copiose & iteratim dejecerit.

℞. Pulveris ipecacoanhæ grana duodecim, conservæ rosæ quantum satis

fit. Contunde simul & divide in pilulas duodecim. Sumatur una ter die.

Si æger vehementer febricitârit satius erit dare ter die vini emetici

drachmam unam ex cyatho amplo decocti hordei tepidi.

[144]℞. Pulveris ipecacoanhæ grana duo, pulveris opii purificati

exsiccati granum unum, nitri grana octo. Misce. Sumatur horâ somni.

ENEMA EMOLLIENS.

℞. Amyli unciam dimidiam, aquæ puræ uncias decem. Coque ad idoneam

spissitudinem.

Vel,

℞. Seminum lini drachmas sex, aquæ puræ uncias duodecim. Coque per

quadrantem horæ & cola liquorem pro enemate.

ENEMA ANODYNUM.

℞. Enematis emollientis uncias quatuor, tincturæ opii guttas

quadraginta. Misce.

IN DYSENTERIA CHRONICA.

BOLUS CATHARTICUS.

℞. Pulveris rhabarbari grana quindecim, calomelanos grana quinque,

conservæ rosæ quantum satis fit ut fiat bolus. Mane sumendus, &

repetendus post paucos dies si opus fuerit.--Vice hujus interdum

conducat dare misturæ catharticæ communis uncias duas.

SOLUTIO CAMPECHENSIS.

℞. Extracti ligni Campechensis drachmam unam cum semisse, tincturæ

cinamomi unciam unam. Tere simul & admisce aquæ puræ uncias quinque.

Sumatur uncia una ter die.

DECOCTUM AMARUM.

℞. Corticis simaroubæ vel quassiæ drachmam unam, aquæ puræ libram unam

cum semisse. Decoque ad libram unam. Absumatur totum quotidie tribus

vicibus. Adjici possint singulis dosibus pro ratione symptomatum, vel

cretæ præparatæ scrupulus unus, vel pulveris ipecacoanhæ granum unum,

vel tincturæ cinamomi drachmæ duæ, vel tincturæ opii guttæ quinque.

[145]In casibus rebellibus confert illinere quotidie hypogastrium

unguenti ex hydrargyro drachmâ dimidiâ.

Sit pro potu communi in hoc morbo aqua pura, frusto panis recens tosti

adjecto, & pauxillo spiritus vini tenuis (_rum_ dicti) admixto. Sit

pro victu communi salab, vel farina tritici in pulmentum tenue ex aquâ

purâ cocta.

IN INTESTINIS INFLAMMATIS.

[146]SOLUTIO SALIS CATHARTICI.

℞. Decocti hordei libram unam, magnesiæ vitriolatæ uncias duas. Misce

ut fiat solutio. Bibatur, post sanguinis missionem, uncia una omni

semihorâ donec alvus bis dejecerit.

Adhibeantur hypogastrio cucurbitulæ cruentæ, vel hirudines plures.

Applicetur ibidem epispasticum satis amplum. Injiciatur enema cum oleo

& pauxillo sale cathartico.

IN ILEO, vel COLICA PICTONUM, vel morbo in regionibus æstuosis _DRY

BELLY ACHE_ dicto.

[147]PILULÆ CATHARTICO-ANODYNÆ.

℞. Extracti colocynthidis compositi drachmam dimidiam, opii granum

unum & dimidium, olei menthæ guttam unam. Contunde in massam & divide

in pilulas decem. Sint pro una dosi. Paucas post horas, si alvus non

rite responderit, exhibeantur misturæ catharticæ unciæ duæ, vel[148]

olei ricini uncia una, & repetantur ut opus fuerit.--Interdum in hoc

malo divexat vomitus cui auxilio est, mistura antiemetica. Vide page

551.

Perfricetur hypogastrium oleo tepido.

Ineat æger in balneum tepefactum ad 93° therm. Fahren. per horam unam

vel etiam diutius.

Denique suffletur in anum fumus nicotianæ.

Vel,

℞. Nicotianæ drachmas duas aquæ puræ ferventis libram unam.--Fiat

infusum & cola pro enemate.

IN HÆMORRHÖIDE.

BOLUS HÆMORRHOIDALIS.

℞. Florum sulphuris drachmam dimidiam, conservaæ rosæ, vel pulpæ

tamarindorum quantum satis fit. Assumatur bis die.

Si sanguinis ex ano profluentis magna fuerit vis, & præcipue si ex

alto fonte effluxerit, valde proderit medicamentum infra præscriptum.

[149]℞. Olei lini recens expressi drachmas sex, tincturæ rhabarbari

drachmas duas. Misce. Sumatur bis die.--Vice olei lini adhibere licet

olei amygdalæ unciam dimidiam, cum mucilaginis gummi arabici drachmis

duabus.

IN ALVO ASTRICTA.

PILULÆ LAXANTES.

℞. Aloes socotrinæ drachmam unam, syrupi quantum satis sit. Contunde

& divide in pilulas viginti. Sumantur duæ pro re natâ.--Aliquando

conducit adjicere vel pulveris zinzberis vel pulveris capsici grana

quindecim, vel olei menthæ guttas decem.--Vice aloes licet adhibere

extractum colocynthidis compositum.

ELECTUARIUM ECCOPROTICUM.

℞. Pulveris jalapii unciam dimidiam, pulpæ tamarindorum unciam unam,

pulveris zinziberis semi-drachmam, syrupi _melasses_ dicti quantum

satis sit. Sumatur circiter drachma pro re natâ.--Interdum prosit

adjicere crystallorum tartari drachmas duas.

IN CATARRHO.

LINCTUS.

℞. Conservæ rosæ unciam unam, mucilaginis gummi arabici unciam

dimidiam, olei amygdalæ drachmas duas, succi limonis, vel acidi

vitriolici quantum satis sit ad gratum saporem conciliandum. Misce.

Sumatur pauxillum sæpius.--Interdum adjiciatur vel salis nitri drachma

una, vel tincturæ opii guttæ decem.

Sit pro potu communi decoctum hordei in quo coquatur uvarum passarum

uncia una, & sub finem cocturæ seminum lini drachmas duas pro singulis

libris decocti.

Si febricitârit æger, sumantur mistura salina & pilula febrifuga ter

die.

IN PLEURITIDE ET PERIPNEUMONIA.

℞. Decocti hordei libras duas, pulpæ tamarindorum quantum satis-fit ad

gratum saporem, nitri drachmam unam. Misce. Hauriatur affatim pro potu

communi. N. B. Si tamarindi moverint alvum sæpius quam semel aut bis

die adhibeatur vice ejus syrupus _melasses_ dictus.

Sumatur mistura salina & pilula febrifuga sextâ vel quartâ quâque horâ.

IN HÆMOPTÖE.

Hauriat æger infusi rosæ uncias tres quater die. Interdum adjiciatur

vel tincturæ opii guttæ quatuor, vel nitri grana decem.

HAUSTUS OLEOSUS.

[150]℞. Olei amygdalini, aquæ menthæ simplicis singulorum unciam unam,

manræ drachmas tres. Misce. Sumatur ter die. Sæpe conducit adjicere

singulis dosibus tincturæ opii guttas quatuor vel quinque.

IN TUSSI ASTHMATICA.

PILULÆ PECTORALES.

[151]℞. Gummi ammoniaci drachmas tres, saponis Hispaniensis drachmas

duas, pulveris radicis scillæ grana sex opii purificati grana tria,

syrupi _melasses_ dicti quantum satis sit. Contunde simul & divide in

pilulas quadraginta octo. Sumantur quatuor bis die.

IN ASTHMATE A DIATHESI HYDROPICA PROVENIENTE.

PILULÆ SCILLITICÆ.

℞. Radicis scillæ aridæ grana duodecim, conservæ rosæ quantum satis

sit. Contunde simul & divide in pilulas duodecim. Sumatur una vel duæ

bis vel ter die.

Vel,

[152]HAUSTUS DIURETICUS.

℞. Aquæ puræ unciam unam & dimidiam, pulveris scillæ aridæ grana duo,

tincturæ lavendulæ compositæ guttas trigintæ, kali præparati grana

decem. Misce. Sumatur bis vel ter die.--Interdum adjicere liceat

haustui vespertino tincturæ opii guttas viginti.

Vel,

BOLUS CÆRULEUS CUM SCILLA.

[153]℞. Pilularum ex hydrargyro grana quinque vel usque ad decem,

pulveris radicis scillæ grana duo. Misce. Sumatur horâ decubitûs, per

tres vel quatuor noctes consequentes.

IN RHEUMATISMO ACUTO.

MISTURA DIAPHORETICA.

℞. Aquæ puræ uncias tres, aquæ ammoniæ acetatæ unciam unam & dimidiam,

pulveris antimonialis grana quindecim. Sumatur tertia pars ter

die.--Interdum adjiciantur nitri grana quinque singulis dosibus.

Bibatur affatim decoctum hordei tepidum, cum nitri scrupulis duobus in

singulis libris.

HAUSTUS SUDORIFICUS.

℞. Misturæ camphoratæ unciam unam & dimidiam, aquæ ammoniæ acetatæ

unciam dimidiam, vini emetici guttas quadraginta, tincturæ opii guttas

viginti. Misce. Sumatur horâ somni, vel etiam sæpius sed cum dimedia

tinctura.

IN RHEUMATISMO CHRONICO.

℞. Tincturæ guaiaci volatilis drachmas duas. Sumatur ex cyatho potûs

communis ter die. Vel sumatur gummi guaici semidrachma super bibendo

haustum ex salis cornu cervi serupula aquæ unciis tribus.

℞. Pulveris ipecacoanhæ compositi (Pharm. Lond.) scrupulum unum.

Sumatur hora somni alternis noctibus.

In casibus rebellibus pro remedio efficaci compertum est dare quotidie

calomelanos granum unum vel grana duo.

IN HYDROPE.

PULVIS HYDRAGOGUS.

℞. Crystallorum tartari unciam dimidiam, pulveris jalapii grana

quindecim, pulveris zinziberis grana quinque. Misce fiat pulvis,

fumatur alternis diebus.

MISTURA DIURETICA.

℞. Infusi gentianæ uncias decem, spiritus vini tenuis uncias duas,

kali præparati drachmam unam. Misce. Hauriamur unciæ tres bis

die.[154]Vice infusi gentianæ licet adhibere infusum absynthii.

TINCTURA SCILLÆ. Pharm. Lond.

Sumatur drachma una bis die ex haustu potûs communis.

PILULA EX ELATERIO.

℞. Elaterii grana duodecim, syrupi quantum satis sit. Dividatur in

pilulas sex. Sumatur una bis die.

[155]Ægro licet, imo prodest hoc morbo laboranti bibere ad libitum ex

liquore aliquo siti extinguendæ accommodato, veluti aquâ hordei cum

crystallis tartari.

IN ERYSIPELATE.

[156]℞. Pulveris corticis Peruviani drachmam unam. Sumatur omni horâ

vel interpositis duabus vel tribus horis.

IN MORBO VENEREO.

1. IN GONORRHOEA.

Hauriatur ad libitum infusum lini, vel decoctum hordei cum gummi

arabici drachmis sex in singulis libris.

Sumantur calomelanos grana duo quotidie per viginti circiter dies.

[157]℞. Aquæ puræ distillatæ uncias octo, hydrargyri muriati granum

unum. Misce. Injiciatur pauxillum in urethram bis vel ter die.

IN GONORRHOEA BENIGNA.

℞. Balsami capaivæ drachmam unam, tincturæ lavendulæ compositæ guttas

triginti. Misce. Sumatur bis die.

2. IN ULCUSCULIS.

In initio feliciter adhibetur causticum.

℞. Calomelanos drachmam dimidiam, conservæ rosæ quantum satis sit.

Contunde in massam & divide in pilulas triginta. Sumatur una quotidie,

vel interdum dimidia ter die, ut cieatur ptyalismus modicus. Perstet

æger in usu medicamenti hujus per dies acto postquam sanata fuerint

ulcuscula.

Pro medicamento topico, utile erit inspergere ulcusculum cum pulvere

hydrargyri nitrati.

3. IN BUBONE.

Illinatur artus lateris affecti infra inguen cum unguenti ex hydrargyro

drachmâ dimidiâ quotidie.

Si abierit bubo in ulcus mali moris omittatur pro tempore usus

hydrargyri & sumatur quotidie [158]opii purificati granum unum primo

semel, dein bis, denique ter die vel etiam sæpius, & pulveris corticis

Peruviani drachma una ter quaterve die.--Interdum conducit sumere

pulveris sarsæparillæ drachmas duas ter die, vel extracti cicutæ grana

tria ter die, augendo paullatim usque ad grana decem.

4. IN VERA LUE, anginâ scilicet osteocopiis, exostosibus & defædatione

cutis.

Illinantur membra quotidie cum unguenti ex hydrargyro drachmis duabus

quotidie usque dum cieatur ptyalismus[159] per dies triginta ad

minimum vel donec evanuerint symptomata.--Interdum vice litûs adhibere

conveniat vel calomelanos granum unum ter die, vel pilularum ex

hydrargyro grana quinque bis die, vel

℞. Hydrargyri muriati grana octo, spiritus vinosi tenuis libram

unam. Fiat solutio, & sumatur uncia dimidia bis die. In ulceribus

tonsillarum pernotabili est auxilio suffitum ex cinnabare in fauces

inhalare semel vel bis quotidie.

Si ulcera mali moris exorta fuerint in quavis corporis parte, eadem,

ut jam de bubone dictum est, fiant.

IN SCORBUTO MARINO.

Sumat æger quotidie succi limonum unciam unam ter quaterve die.

℞. Aquæ puræ paullulum tepefactæ congios triginta, syrupi _melasses_

dicti libras sedecim pondere, extracti pini uncias octo pondere,

spumæ vel fæcis cerevisiæ libras duas mensurâ. Misce & agita valide

cum baculo, dein sinatur abire in fermentationem, ut fiat cerevisia,

deinde servetur in vase clauso. Ut diutius servari potest, proderit

admiscere spiritûs vini tenuis Gallici, vel qui _rum_ dicitur, libras

duas aut tres. Si infirma fuerint viscera adjicere juvabit vel lupuli

vel summitatum absinthii vel quassiæ, vel zinziberis quantum satis

sit. Hauriat æger libras duas quotidie.

℞. Farinæ avenaceæ libras tres, aquæ puræ congios quatuor. Misce.

Macera donec liquor fiat acidulus, dein effunde dimidium & adjiciatur

par copia aquæ puræ, & coque ad idoneam spissitudinem, ut cogatur in

pulmentum. Sit pro victu assiduo cum vini & sacchari non purificati,

vel syrupi _melasses_ dicti quantum sufficiat ad gratum saporem

conciliandum.

Ad alvum solvendam commode adhiberi potest electuarium eccoproticum

cum crystallis tartari. Vid. p. 556.

THE END.

INDEX.

A.

ABSORBENTS useful in fluxes, 491, _& seq._

_Action_, close, the advantages of it, 103, _& seq._

_Air_, superiority of that at sea, 225.

--Noxious effects of it at land in a hot climate, 227.

--Extent of its influence, 228.

_Alcide_, sickly on the passage to America, 36.

--Subject to various forms of fevers, 39.

_Aliment_, want of proper, chief cause of scurvy, 300.

--Increases the vigour of the body in two ways, 510.

_America, North_, hotter in summer than the West Indies, 30.

--Fleet goes there to avoid the hurricanes, 35, 146.

--Uncommon season there, 156, _& seq._

_Amputation_, the number that died of it at Barbadoes, 190.

_Amputation_, Mr. Alanson’s method of performing it, 543.

_Antimonials_, best adapted to bilious fevers, 420.

--A caution with regard to them, 422.

_Army_ at St. Lucia, diseases in it, 127.

--Mortality in it, 27, 228, _& seq._

_Asthma_, climate in the West Indies favourable to it, 97.

B.

_Barbadoes_, more refreshments at it than any other island, 27.

--Ravaged by a hurricane, 41.

--Composed of coral rock, 89.

--Conjecture concerning its origin, _ibid._

_Barfleur_, fevers on board in consequence of recruits from a French

jail, 142.

_Bark, Peruvian_, its effects in preventing fevers, 230, _& seq._

--When useful in continued fevers, 390, _& seq._, 402, 422, _& seq._

_Bark, Peruvian, red_, some account of it, 457.

_Barricading a ship_, what meant by it, 21.

_Bath, warm_, of use in the dysentery, 480.

--In the locked jaw, 522.

--Its proper temperature, 535.

_Battle_, the ardour of, favourable to health, 22, 77, 101.

--Number killed in, 209.

--Loss in those of April, 1782, 520.

_Bedding_, utility of airing it, 260.

_Bile_, a defect of it in the worst cases of yellow fever, 429,

_& seq._

--Theoretical disquisition on its influence in fevers, _ibid._

_Bile_, the marks of a redundance of it in dysenteries, 477.

--Its tendency to prolong fluxes, 483, _& seq._

_Blindness_ from the scurvy, 24, 501.

_Blisters_ of use in the ship fever, 399.

--For removing irritability of stomach in the yellow fever, 453,

_& seq._

--Of service in dysentery, 480, _& seq._

_Blood_, a remark concerning the buff upon it, 450.

_Bloodletting_, cautions with regard to it in ship fevers, 388.

--In bilious fevers, 418.

--In the yellow fever, 450.

_Butter_, objections to its use, 310.

C.

_Calomel_, in certain cases, the best purgative, 421.

_Camphor_, estimate of its virtues, 407.

_Catarrh, epidemic_, one in Europe affected men at sea, 157.

--Communicated by strangers not affected with it themselves, in one

of the Western Islands, 244.

_Causes_, a combination of them necessary to produce diseases, 126,

_& seq._

_Chronic complaints_ brought on by hardship, 218.

_Cleanliness_ the principal means of health, 254, 337.

_Clothing_, its great influence upon health, 238.

--Advantages and disadvantages of it, 334, _& seq._

_Cocoa_ substituted, with advantage, for butter, 311.

_Cold_ favourable to infection, 258.

_Cold_ hurtful in all climates, 297.

_Colica pictonum_, forms of medicines adapted to it, 555.

_Coma_, a symptom in the ship fever, 373.

_Commission, Ships long in_, most healthy, 54, 79, 93, 167.

_Constitution_, the great variety of it, 294.

--Regard to be had to it in practice, 406.

_Coppers_, cautions with regard to them, and instance of poison from

neglect of them, 317, _& seq._

_Cordials_, a caution with regard to them, 410.

_Crowding_, bad effects of it, 192.

_Cruises_ to windward of Martinico, 48, 180.

--Near Jamaica, 120.

--How long they ought to be continued

consistent with health, 148, _& seq._

--A long one off St. Domingo, without the scurvy appearing, 154,

_& seq._

_Cullen, Dr._, his opinion of the origin of nervous fevers, 237.

--His great merit, 445.

D.

_Delirium_, a remarkable symptom in the ship fever, 373.

--Explanation of it, _ibid._, _& seq._

--Means of removing it, 398, _& seq._

--Sudden and violent in bilious fevers, 416.

_Diaphoretic_, what safest and best, 395.

_Diet_, a table of the daily allowance of it in the navy, 311.

--A method of providing what is suitable to the sick, 335.

_Diet_, a caution with regard to it in convalescent fevers, 358.