))Jj Ctggg ■ 'ifiwt i v «B3 Is $ ?*l*s.< I fa js.' m Ipf! &m BE [|3jr"';i"T ■:;'*"' ^fpj t£ . ! it.. -i" ■*:* »?* i'r .:.:.....;.. «< *•':'. :.:;,•;: ":•»■ : : :■".:*' :-;l;* :-*-.•:-... : :■ mmv 3NI IIOJVY JU AflVa«M ivinui £ DICINE ^ NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY °F MED'C'NE . NAT \\ m. ..;>^?© "5 \ 1 ^ 3NIDI03W JO AJ.VMM WNOIIVN 3NIDI03W JO AJIVaflll WNOUVN _ 3NI EDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NA *f%>f ! ±kR.-\ ' 1 , J* / I X v v ^. I - X. 5' \ y ^\ i ✓ - ■ V/" RARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICI 3 X .^ 1 ^ ..&■' i W \ / ^ Aavaan wnoiivn snidiosw jo Aavaan tvnouvn 3nioi<]3w jo Aavaan wnou S ,*- x -I ^ ,f,\ E? RARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICI $$>' 1 X*fX ~S I - xfe< P- x -<^^ lO > Aavaan wnoiivn jNiDiaaw jo Aavaan tvnouvn jnidiqjw jo Aavaan wnou irr^i^l^J^ /■% RARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDIC Aavaan wnoiivn JNOiaaw jo Aavaan wnoiivn 3NiDiaaw jo Aavaan wnoi * S 'X '¥\ik ' | WX r iY^W' -• "' {#"X °" X^'h/ | ' X I Wy I \/£ ? A" | \/& \ ^ NATIONAL LIBRARY OF MEDIC PHYSICIAN FOR SHIPS; CONTAINING MEDICAL ADVICE SEAMEN AND OTHER PERSONS AT SEA, TREATMENT OF DISEASES, AND ON THE PRESERVATION OF HEALTH SICKLY CLIMATES. By USHER PARSONS, M. D., Late Surgeon in the U. S. Navy, and President of the Rhode Island Medical Society; Honorary Member of the Massachusetts, New Jersey, Philadelphia, and South Carolina Medical Societies. THIRD EDITION. «i XA r,s- f?oA: • „ .;»" BOSTON: CHARLES C. LITTLE AND JAMES BROWN. 1842. Entered according to Act of Congress, in the year 1842, by Usher Pah.-ons, the Clerk's Office of the District Court of the District of Massachusetts. Sold by the publisliers, Little & Brown, by Brewers, Stevens & Cush- ing, and by Beujamin Loring & Co., Boston ; by William C. Taber, New Bedford; Henry Whipple, Salem; Joseph Balch, and John A. Wadsworth, Providence ; B. C. Baxter, New London; Wiley & Putnam, D. Appleton & Co., E. &. G. W. Blunt, and Rushton & Aspinwall, New York. E OST on: PRINTED BY FREElHAN AND BOLLES, WASHINGTON STREET. ■J*1-"5 ADVERTISEMENT TO THE SECOND EDITION. In publishing a second edition of this book, important additions have been made, while its price has been reduced nearly one third. EXTRACTS FROM A REVIEW OF THE WORK, CONTAINED IN THE NEW ENGLAND MEDICAL JOURNAL. " We trust that this work will meet witljan extensive circulation. We think it would be an object, well worthy the attention of our principal merchants, to introduce it among the masters of vessels in their employ. They would, no doubt, find themselves amply repaid for the trifling expense to which it would subject them, in the greater safety and health of their crews, and the security of their own property. With a due observance of the precautions and preventives insisted upon in the book of Dr. Parsons, we should not so often hear of the extensive and dreadful fatality which sometimes befals merchant vessels, and sweeps off one after another their whole crews. If the commanders of vessels make it their study, as it is their duty, to understand, so far as they are capable, its contents, there can be no doubt they might arrive at tolerably correct ideas of the nature and treatment of those diseases to which seamen are more particularly subject. At any rate, they cannot fail of acquiring much very valuable infor- IV EXTRACTS FROM THE N. E. MEDICAL JOURNAL. mation from the latter part of this volume, with respect to the prevention of diseases, a subject which deserves by far the great- est portion of their attention. " Dr. Parsons has, we think, performed a valuable service to the public in this work. His official situation in the service, has given him an ample field for experience and observation, and this he has improved with great assiduity and intelligence. We find constant evidences of a thorough and well grounded knowledge of the profession, and a practical acquaintance with all its details. Nothing is done for show, or for the purpose of making a display ; nothing is out of place ; there is a constant exhibition of accurate views of pathology and practice, and, throughout, a careful adap- tation of every thing to the capacity and attainments of those for whom he has written. The descriptions of diseases are brief and perspicuous ; giving, not a medical history of its phenomena and its progress, but a view of such of its principal symptoms, as would convey a vivid impression to the mind of an unprofessional observer. The method of treatment recommended is also of that kind, which can best be understood and practised by those for whom this work is intended as a guide ; and does not run out into those details, nor include those varieties which could only be em- barrassing to individuals who are deficient in a medical education. We have no hesitation in recommending it to the attention of the public, as calculated to do much good, and to supply a deficiency, which has been, we doubt not, much felt, and which we are sur- prised there has been heretofore no successful attempt to fill." ADVERTISEMENT TO THE THIRD EDITION. The Uberal patronage bestowed on the last edition of two thousand copies, now all sold, has induced the author to spare no pains to render this third one as useful as its number of pages would permit. Many corrections have been made in every part of the book ; much of it has been rewritten, and about one fifth part of new matter added, comprising a more extended account of the diseases of sickly climates, and one entire section on the choice of climate for patients laboring under chronic bronchitis and incipient con- sumption, showing the comparative value of the places usually recommended for such patients, with advice and directions for them while travelling by land and sea, and during their residence abroad. Several dis- eases described and treated, are added to the former list, and many new prescriptions and recipes are given. The list of medicines recommended for a chest, with the requisite quantity according to the number of men on board, and the ordinary prices, has been carefully VI ADVERTISEMENT. revised, and is now adapted to the treatment of dis- eases as laid down under their respective heads in the book. The contents of the medicine chest and the direc- tions for treating diseases being thus made to corres- pond, the author would recommend to captains, who intend to consult the book for advice, to have their chests put up according to the prescribed list; they will then be sure to find the articles they want, and, if guided by the book in prescribing, to avoid the in- cumbrance of many others that are useless. This advice is not intended, however, to hinder the addition of any medicines which the captain, from long use, has become attached to. These he can order in addi- tion to the list. The author would farther recommend to captains and mates of vessels to give the book one perusal at the commencement of a voyage. They will thereby become familiar with its contents, and able to refer to it more readily, and perliaps to prescribe by it many times from memory. INTRODUCTION. It may be safely doubted whether attempts to diffuse medical science among all classes of people, and make every man his own physician, be conducive to the dignity of the medical profession or the cause of humanity. The remark of the poet, that " a little learning is a dangerous thing," is particularly true in regard to the science of medicine. The danger of tampering with remedies and assuming the important prerogatives of the profession, unqualified by previous education, appears the more striking, when it is con- sidered that a whole life spent in the investigation of disease, is in- sufficient to secure one against occasional error in practice. What is a little remarkable, popular works on medicine are in greatest circulation where they are least necessary, among large communities well supplied with physicians, while sailors and such as are liable to be out of the reach of physicians, have been quite overlooked. Had the authors of Domestic Medicine, Manuals of Health, Family Physiciuns, fyc, bestowed a small share of their labor in supplying the forlorn sailor with some directions for relieving his pains and preserving his health, when tossing upon the dreary ocean, where no physician can be consulted, human suffering would have been lessened, without any interference with the dignity or interests of the profession. From the want of a few simple directions for setting broken bones, and reducing dislocations, sailors are often crippled for life ; often the company of transport ships are swept off by the malignant dis- eases of sickly climates, that might have been arrested at the very onset; and there is scarce a marine hospital in the country, that does not exhibit noseless faces and mutilated bodies, the sad vestiges of a long protracted disease, which, with suitable instruction, the patient himself might have removed with the greatest facility. These con- siderations, and a fear that the subject will continue to be neglected by those who are better qualified for writing upon it, have induced me to put together the substance of the following pages. The diseases are classed into general and local; the first including fevers, scurvy, jaundice, dropsy, dyspepsia, epilepsy, apoplexy, lockjaw, small pox, and measles. The second class is subdivided into diseases affecting particular portions of the body, as of the head. the neck, the chest, &.c. &c. This is done with the view to assist the sailor in referring to an account of his disease. If ignorant of the name of his complaint, and therefore unable to refer to it by the index, he certainly cannot be ignorant of the part of his body that is disordered, and if it be the head, or neck, &c, he has only to turn over the pages till he arrives at the one headed with diseases of that part. Vlll INTRODUCTION. The book being intended exclusively for seafaring people, nautical diseases only are included. A great number of complaints, incident to the human body, being thus left out, enables the sailor to refer to an account of his disorder more readily, at the same time that it les- sens the expense of the book. In describing the causes, symptoms, and treatment of diseases, I have availed myself of the assistance of a variety of authors. In giving the symptoms, those only are mentioned, that are most con- stant, obvious, and invariable. The pulse, which is the grand index to constitutional affections with an experienced physician, is little understood by others, and is therefore, referred to in this book in such diseases only as where the morbid change it undergoes is great, and obvious to a common observer. In these diseases it will be advisable for the person who prescribes, to compare the pulse of the patient with his own, or that of some other healthy person. Any unusual frequency, great irregularity, or other deviation from health, will then be readily discovered. In mentioning the causes of disease, the most common only are noticed. A knowledge of these will be attended with the double advantage of enabling the patient to determine the character of his complaint, and of guarding against their influence in future. In directions for the treatment, many valuable remedies are omitted; some, because they would increase the list of articles in a medicine-chest, and make its expense objectionable, and others, because they would be unsafe in the hands of the inexperienced. Thus, arsenic for fever and ague, corrosive sublimate for syphilis, and some other complaints, and the concentrated acids in a variety of diseases, though very valuable in the hands of a physician, are un- safe for others to prescribe, and in the medicine chest of a merchant vessel, are even dangerous. The exclusion of technical language and the use of the most common and hackneyed names of medicines, may give the book a vulgar appearance to a well educated physician. To such it may be proper to say, that as the work was intended exclusively for the perusal and benefit of sailors and common readers, his taste in re- spect to style and manner of execution has been the object least regarded. THE PHYSICIAN FOR SHIPS. OF INTERMITTENT FEVER, OR FEVER AND AGUE. SYMPTOMS. It consists of regular fits of fever, between each of which, there is a distinct and perfect intermission. The fits usually commence in the morning. They recur generally every other day — sometimes daily, and in a few instances every third day only. Each fit consists of three stages, termed the cold, hot and sweating stage, which run their course in this order of succession, generally in the space of from three to six hours. The cold stage commences with languor, sense of debility ; yawning and stretching, and aversion to ex- ercise. The face and extremities become pale ; the skin over the whole body seems constricted, as if cold had been applied to it, and resembles goose-flesh. The pulse is small, frequent and irregular. At length chills come on, with pain in the head, back and loins, fol- lowed by universal shaking, and sometimes by vomit- Hot stage. After a longer or shorter continuance of the shaking, the heat of the body gradually returns, at first irregularly by transient flashes, soon however be- coming steady and intense. There is redness of the skin, increase of pain in the head, thirst, a quick, strong and hard pulse — sometimes delirium. l 10 ' INTERMITTENT FEVER. Sweating- stage. At length a moisture breaks out upon the face and neck, which is soon followed by universal perspiration. The heat noAv descends to its usual standard, the pulse is diminished in frequency, and becomes fall and free, and all the other symptoms of fever disappear, leaving the patient, however, a lit- tle debilitated. CAUSES. Debility, induced by a poor diet, by great fatigue, long watching, depressing passions of the mind, and preceding disease. Cold united with moisture, in whatever way applied to the body. These, however, only predispose to the disease, since a more efficient cause is necessary to bring it on ; and this, is exposure to marshy exhalations. In proof of this, there are large districts of country in which the disease never appears, however great the exposure of the inhabit- ants to the first mentioned causes ; while there are others, having marshes and much stagnant water, in which the disease is so common, that in the season of it, very few escape an attack, especially those who labor under any previous debility. TREATMENT. The first step in the cure is to cleanse the stomach and bowels. This sometimes arrests the disease of itself, and always renders the operation of other reme- dies more safe and certain. Twenty-five grains of ipecac, or four grains of tartar emetic, answer the purpose very well, and should be given at the com- mencement of the cold stage. During its operation, the patient may drink freely of warm water or weak chamomile tea. If the emetic fail of acting down- wards and clearing the bowels, it should be followed by a dose of calomel, four grains, or of blue pill, six grain?, taken at bed time. Having cleared the stomach and bowels, we are to commence on the day following with tonics. For- INTERMITTENT .FEVER. 11 merly bark and wine were the remedies chiefly relied on, assisted sometimes by tincture and decoction of bark and other bitters. But since the discovery of the essence of bark, in the form of quinine, these more disagreeable medicines are laid aside. The quinine may be given in doses of two grains, in pills, or dis- solved in water, or mixed in molasses or jelly, every four hours, during the intermediate day between the fits of ague and fever. But on the day following, when the attack may be expected, the dose should be doubled, and should be taken every two instead of every four hours, commencing at sunrise, and continu- ing till the time of the expected fit has passed by. This course will, in a majority of cases, prevent the fever and ague fit entirely, and if it should, we have then only to return to two grain doses of quinine, and continue them once in four hours for four or five days, when with nourishing diet and some mild tonic, as elixir vitriol, or decoction of quassia, three times a day for two or three days, the patient may be considered as cured. But should this course fail to prevent the expected ague fit on the second day after the emetic, we should then give another dose of calomel or blue pill, and proceed with a repetition of the same course as before. When quinine cannot be procured, or is of a bad quality, or has been long used to no effect, other tonic bitters are to be substituted, and taken in the same manner ; as decoction of bark, columbo, gentian, quassia, &c. Also charcoal, finely powdered, may be taken in substance. Opium has been highly recommended in intermit- tents, and well deserves a trial, since its exhibition does not interfere with the other remedies above mentioned. It may be given in doses of thirty or forty drops of the tincture, laudanum, at the commencement of the first cold fit, succeeding that in which the emetic was ad- ministered. If the. first dose fail to induce warmth in the space of ten or fifteen minutes, give thirty or forty 12 REMITTENT FEVER. drops more. The tendency of this medicine is to shorten the fit and render it less likely to return. During the fit, the patient should take freely ol warm drinks, and during the intervals or between the fits, subsist on a nourishing and easily digested food. It is of the first importance that sailors, who are obliged to wood and water, or perform other duties on shore, m situations favorable to the producmg of fever and ague, should exercise the greatest caution in their diet and regimen. As a preventive, it is advisable for persons in such situations to drink freely of strong coffee, to avoid exposing themselves to sudden changes of temperature, or to evening air, and if possible re- turn to the ship before dark. They should wear warm clothing, indulge in a plentiful diet of flesh highly sea- soned ; observe cleanliness, preserve a healthy state of the bowels, avoid exercise and all stimulating drinks. OF REMITTENT FEVER. SYMPTOMS. This disease partakes in some degree of the nature of intermittent fever, being generally produced by simi- lar causes. There is however this difference between the two, that in intermittent fever, the fits return at stated periods, and on subsiding leave the patient entirely free from all febrile symptoms ; while in the present disease, there is only an abatement between the fits, and an irregularity in the time of their recur- rence. It is impossible to describe all the symptoms of re- mittent fever, since they vary according to the situation and constitution of the patient — the season of the year — the treatment adopted, and many other circumstan- ces, too numerous to mention. Sometimes bilious symptoms predominate, sometimes nervous, and at others putrid — nor is it uncommon to find a succes- REMITTENT FEVER. 13 sion of these; or even a complication of them in the same person at the same time. Hence this disease has often been termed mixed fever. It is most prevalent in warm climates, where great heat and moisture rapidly succeed each other — and particularly in marshy situations, abounding with wood and water. Some eminent writers include under this fever, the yellow fever of the West Indies, of New Or- leans and Charleston ; also, the Bulam fever, which is so destructive of hfe at the mouth of the Gambia, and along the whole coast of Western Africa, from the river Senegal to Liberia, and also the fevers of Bengal and Batavia, all of which are highly malignant, but the propriety of it is doubtful. TREATMENT. It should be treated according to its predominant symptoms, or in the same way as that fever is treated to which this at the time bears the nearest resemblance. One remedy, however, seems well adapted to every form of this, and almost every kind of fever at its com- mencement, and that is an emetic. Take thirty grains of ipecac, or four grains of tartar emetic ; and, during its operation, drink freely of warm water or weak chamomile tea, or toast water. Should vomiting, however, already have existed in any considerable degree, the emetic may be omitted. Bleeding is proper in the early stage of the disease, provided there be a hard, full pulse, with great heat of the skin and severe head-ache. A dose of calomel should, in all severe attacks, be given early and repeated often, proportioned, however, in quantity and frequency of repetition, to the severity of the attack. Mild cases of simple remittent, as it appears on the Lakes and along the coast of Maryland and Virginia, might require a dose of ten to twenty grains, once daily, assisted with a little oil or salts, and after the operation of the medicine each day, a dose of powder of nitre, ten grains, dissolved in a wineglass of 14 REMITTENT FEVER. water, may be given every three hours, alternated with a teaspoonfull of spirits of nitre in the same quantity of water. One or the other of these medicines taken every hour and a half, should be accompanied with the free use of cooling drinks. Should the pain be severe after the first bleeding, a blister may be applied to the back of the neck, and the head be constantly wetted with cold water and vine- gar. Great heat of the skin, whenever it appears, and in whatever part, should be frequently sponged with cold water. In the early stage of the fever, great heat of the skin may be treated with cold water, dashed on the whole surface, copiously. In a few days there will be an abatement of the fe- ver, and whenever this is perceptible, quinine should be given every four hours, beginning with doses of about two grains. Should the fever, under this treat- ment, assume the intermittent form, which it is liable to do in places where the latter prevails, then it is to be treated in like manner as directed for that disease. Wherever this disease is prevalent, the same preven- tives should be taken, and the same regimen adopted, as are directed under the head of intermittent fever ; as, also, under the head of advice to strangers in hot climates. This is the most common fever in tropical climates. It is not frequent at sea, but generally attacks men when they get into harbor, particularly such as are sent on the business of wooding and watering, and are thus exposed to the noxious effluvia by which it is produced. It is of very frequent occurrence in the West Indies__ on the seaboard and banks of the rivers of the South- ern States — on the coast of Guinea in Africa, and the warmer latitudes of the East Indies. The higher the latitude it occupies, the milder are its symptoms. In 1813 it prevailed in the squadron of Com. Perry, on the south side of Lake Erie, to such an extent, as to attack one man out of four of all the crews. Its character, however, was so mild, that one LOW TYPHUS, OR SLOW NERVOUS FEVER. 15 death only occurred. We noticed that changing our anchorage from a leeward to a windward shore, or sailing out into the middle of the lake, Avould in two days arrest the progress of the disease, and materially improve the health of those already sick. OF THE LOW TYPHUS, OR SLOW NERVOUS FEVER. SYMPTOMS. It commences slowly and imperceptibly, with gene- ral languor, dejection of mind, loss of appetite, alter- nate chills and flushes, dulness and confusion of thought. In a day or two there is a giddiness and pain in the head, with aching pains over the whole body, nausea, frequent, weak, and often intermitting pulse. At first the tongue is moist, but afterwards becomes dry, brown and tremulous ; there is little thirst, and the urine is pale and watery. As the disease advances, the heat and other symptoms of inflammation increase, the urine becomes high colored; sometimes diarrhoea and im- moderate sweating ensue ; there is a low, muttering delirium, a starting and twitching of the tendons; sometimes a coldness of the extremities, convulsions and death. CAUSES. Weak and delicate habit of body; poor living; warmth of climate ; depressing passions of the mind, as grief, fear, anxiety; excessive venery, intempe- rance. It may be known from putrid or malignant fever, by the attack being more gradual, and the symptoms milder ; from inflammatory fever, by the smallness and weakness of the pulse, and by its more mild ac- cession. About the 7th, 14th, or 21st day from the attack, the disease usually abates, and the patient from that time slowly recovers. 16 LOW TYPHUS, OR SLOW NERVOUS FEVER. TREATMENT. Commence this by cleansing the stomach and bow- els with a mild emetic and cathartic combined, as fol- lows : Take ipecac, thirty grains, and calomel five ; mix them, and give the dose in any convenient vehicle. Or mix five grains of tartar emetic with two table- spoonsful of Epsom in half a pint of water, and give a wine glass every half hour till it operates. If this fail to move the bowels once or twice, take some other mild purgative, and repeat it as often as there is the least tendency to costiveness. If the disease be not arrested by this treatment with- in the first three days, apply blisters to the legs, and mustard poultices to the soles of the feet. If after this there be much stupor, blister the back of the neck. The pulp of an orange, or roasted apples, will be both cooling and agreeable to the stomach. For common drink, he may take toast-water, lem- onade, wine and water, cider, or soda water and thin gruel. One of the best remedies in the early stage of the disease, after the stomach and bowels have been moved by medicine, is cold affusions. The cold water should be dashed on from a pitcher or bucket, where- ever the heat of the skin is above the natural standard. If this heat however be confined to particular parts of the body, the cold water may be applied to them alone, with a sponge or wet cloth. The patient should be kept as quiet as possible, and with a view to promote perspiration and induce sleep, may take every evening a Dover's powder, of ten grains, and have warm poultices renewed to his feet. During the day-time, administer the following drops: — Take spirits nitre and antimonial wine equal parts, mix them, and give two tea-spoonfuls every three hours, in toast-water. PUTRID, MALIGNANT SHIP FEVER. 17 PUTRID, MALIGNANT SHIP FEVER. SYMPTOMS. The attack of this disease is very sudden. The pa- tient is hardly able to stand, and from the first mo- ment seems ready to faint without any apparent cause. There is an intense pain in the head, strong pulsa- tion and throbbing in the temples — sometimes deliri- um — sickness at the stomach, followed by a vomiting of black matter. The tongue is at first white, but afterwards appears black and chapped, and the teeth are covered with a black crust — the breath is hot and offensive. The fever continuing to increase still more in violence, symptoms of putrefaction show themselves ; the stools are dark, very offensive, and pass off insen- sibly ; blood is effused under the skin, forming purple spots ; bleeding occurs from different parts of the body; the pulse sinks and intermits ; the extremities grow cold ; hickups ensue and death. This fever may be distinguished from inflammatory, by the smallness of the pulse ; — the great dejection of mind ; — the sudden and extreme debility ; the pu- trid smell of the breath and stools — and by the pur- ple spots. It may be known from low or nervous fe- ver, by the suddeness and violence of the accession — the intensity of heat and thirst, and the high color of the urine ; — from yellow fever by the matter vomited being void of bile ; by the absence of yellowness in the eyes, and by reference to its supposed causes. It is however sometimes the case, that this is blend- ed with two or three other fevers, particularly the re- mittent, when it constitutes the fever of Batavia, Ben- gal, and Bencoolen. CAUSES. The room, or atmosphere in which a person labor- ing under the disease is confined ; — foul air, occa- sioned by the confinement of a large number of per- 18 PUTRID, MALIGNANT SHIP FEVER. sons in a narrow place not properly ventilated, as in crowded hospitals, jails or ships, especially where cleanliness is neglected; — exhalations from putrid vegetable or animal substances. Sailors are more liable to its attacks in long voyages. It is sometimes caused by putrefaction taking place in filthy ballast. In the frigate General Greene an instance of this kind occurred, and a loss of forty or fifty lives was the consequence. The same thing oc- curred also on board the frigate Philadelphia. In both these instances, the disease was entirely arrested by deserting the birth-deck and bringing the crew upon the gun and spar-decks, where there was a con- stant current of air. This fever is not confined to hot climates, though from the more sudden process of putrefaction of ani- mal and vegetable matter in warm places, and from the debility and consequently greater susceptibility of the system to the disease, it oftener appears in hot than in cold climates. TREATMENT. In this disease we should resort to proper remedies at the very onset, and not wait until the powers of the system are prostrated. The most proper remedy at first, in cases of robust frame, will be to open a vein as soon as possible, and to give an emetic. But if vomiting already exist, omit the emetic, and give twenty grains of calomel every six hours, or until it acts as physic. With the view of composing the sys- tem, combine with each dose of calomel half a grain of opium or thirty drops of laudanum. The sooner the calomel affects the system the less will be the dan- ger of a fatal termination ; and, with the view of hasten- ing a salivation, rub mercurial ointment into the inside of the thighs, of the size of a nutmeg, every eight hours. The calomel, after it has acted as a purgative, is to be continued in smaller doses until sore gums are induced, from which time there is reason to hope for a recovery. PUTRID, MALIGNANT SHIP FEVER. 19 If the surface seems unnaturally hot, apply cold water, and vinegar or spirit. When three or four doses of calomel have been given without any purgative effect, give oil, or salts to assist its operation. As soon as there is a slight abatement in the vio- lence of the fever, give two grains of quinine in solu- tion every four hours ; and when the gums are touch- ed in the slightest degree with the mercury, stop it for a day or two, and give elixir vitriol ten drops in water. Support the strength of the patient with the liberal use of wine. It may be given in barley, gruel, sago, and likewise in his drink. The effervescing mixture may be taken every three hours. In warm climates, the elixir vitriol, and quassia or bark, may be administered as soon as the stomach and bowels are cleansed, and Avithout waiting for any re- mission. Important circumstances to be attended to through- out the whole course of this fever, are to cover the patient lightly with bed-clothes, to ventilate his apart- ment, and sprinkle it with chlorine, vinegar or spirits. The bed and body linen should be changed frequently, and whenever a motion takes place, let it be removed immediately. It is of the utmost consequence in this disease to procure rest; and, therefore, where no great delirium exists, an opiate may be given toward bed-time, in the following manner : Take laudanum thirty drops, Paragoric sixty, Spirits nitre sixty, mixed in warm tea ; or give Dover's powder ten grains. On the appearance of this, or any infectious disor- der, in a garrison, hospital, ship, or other place where many persons are crowded together, every apartment should not only be cleansed and aired, but fumigated daily, with the following preparation : 20 PUTRID, MALIGNANT SHIP FEVER. Put into an earthen vessel a handful of table salt, and pour into it sulphuric acid sufficient to mois- ten it throughout. Let it remain in the apartment half an hour, Avith the doors and hatches or win- dows closed. Or, Where this is inconvenient, burn, by means of a hot iron, sulphur or gunpoAvder, previously wet with vinegar ; or sprinkle chloride of lime on the floor and on the hammock or bed. It is proper here to introduce some remarks on the nature, and best mode of treatment, of this fever in its more malignant form, as it usually appears during the sickly season in the ports of the Bay of Bengal, and the coast of Malabar from Bombay to Cape Co- morin, in Batavia, Bencoolin (in Sumatra), and Bor- neo. These remarks were derived chiefly from Drs. Clarke and Johnson. " The fever attacked in various ways, but common- ly began with chills, pain and sickness at stomach, vomiting, head-ache, &c. Sometimes, without any previous indisposition, the patients fell insensible ; as they began to recover from the fit they complained sorely of pain in the stomach and head; and after vomiting a considerable quantity of bile, they soon re- turned to their senses. " In whatever form the disease appeared at first, the pulse Avas small, feeble and quick, — the pain at the stomach increased, and the vomiting continued. As the paroxysm advanced, the countenance became flushed, the pulse quick and full, the eyes red, tongue furred, thirst intense, head-ache violent, succeeded by delirium, and the patient became unmanageable ; but a profuse SAveat breaking out in tAvelve or fourteen hours generally mitigated all the symptoms. " In the remissions, the pulse, which was before fre- quently 130, fell to 90. The patient returned to his senses, but complained of great debility, sickness at stomach, and bitter taste. This interval was very PUTRID, MALIGNANT SHIP FEVER. 21 short, and succeeded by another paroxysm, in Avhich all the former symptoms were aggravated, particular- ly the thirst, delirium, pain in the stomach, and vomit- ing of bile. " The unfavorable terminations Avere generally be- tween the third and seventh day. Sometimes there Avas yelloAvness of the skin, as in common yellow fe- ver and black vomit. A torpid or irregular state of the bowels commonly preceded this fever." TREATMENT. The treatment recommended by Dr. Johnson, and which the surgeons of our navy have, Avhile in Bengal, found most successful, is as folloAvs. First, open a vein, and let the blood Uoav until it relieves the head- ache, pain and sickness at the stomach, and vomiting. Meanwhile give a dose of 20 grains of calomel, Avith half a grain of opium (or 30 drops of laudanum). If this is immediately rejected, the dose may be re- peated. This medicine acts like a charm, and after a few hours should be folloAved by a dose of gentle physic, castor oil or salts. The more copious the dis- charge from the boAvels, the less danger there is of a return of vomiting. Should the above mentioned symptoms return, the bleeding may be repeated. Immediately after the operation of the cathartic, five grains of calomel should be given every four or five hours, combined Avith the opium, or laudanum, as above, until the mouth becomes affected, from which time there is great reason to expect a recovery. It is of the first importance to affect the gums with the mercury as soon as possible, and to this end, if the five grain powders do not produce this effect imme- diately, we should assist them by rubbing in mercurial unction on the inside of the thighs two or three times a day. The patient should be removed to the most airy part of the ship, have his feet bathed frequently with Avarm water, and his head with cold vinegar and wa- 2 22 YELLOW FEVER. ter. "Generallvon the third day," says Dr. John- son, " I found the gums affected Avith mercury, and then I felt the patient's danger to be materially les- sened. Cold water and cold gruel are of service from the first, and may be drank freely, unless they excite, vom- iting. f Emetics Dr. Johnson condemns in every stage oi this fever, on account of the great irritability of the stomach. When sickness at the stomach has subsided and mercurial action commenced, it may be advisable to give quinine, one grain tAvice or thrice a day. He does not believe the fever to be contagious, unless pa- tients are croAvdcd together, or cleanliness and ventila- tion are neglected. As a preventive of the disease when vessels lie in sickly ports, he insists strongly on abstinence from all stimulating liquors, on very moderate use of animal food, on avoiding exposure to the air on shore in the morning and evening, particularly the latter, and ab- staining from violent exercise in the sun. If com- pelled to wood and water in a marshy, noxious atmos- phere, the safest hours of the day for it are from 3 to 6 o'clock in the afternoon. As cooler weather approaches, these remittent fe- vers of the Bay of Bengal assume an intermittent character. OF THE YELLOW FEVER. SYMPTOMS. In general it begins with short alternate chills and flushes of heat, seldom, however, Avith those rigors and shakings that mark the commencement of most other fevers. These are immediately succeeded by violent headache, pain in the back, universal debility, sickness and anguish at the stomach. There is commonly, in YELLOW FEVER. 23 the beginning, much bile on the stomach, which is throAvn off by vomiting, either spontaneous, or excited by an emetic. In the course of the disease, hoAvever, it is not common for the stomach and bowels to be loaded with bile ; there is, on the contrary, rather a deficiency of it, particularly in the most violent and dangerous cases, as is indicated by clay-colored stools. The eye in a feAv hours takes a yelloAv tinge, Avhich soon after extends more or less over the face and whole skin. This is a symptom so striking and con- stant, that it gives name to the disease. Its first ap- pearance on the skin is under the ears. One of the most tormenting symptoms is a constant wakefulness. It is seldom that even delirium comes to the rehef of the patient to make him forget himself for a moment; but he continues broad aAvake, night and day, Avith his reason and senses sound, in a state of the most uneasy agitation. One distinguishing and alarming symptom is a con- stant vomiting, Avhich usually commences within the first twenty-four hours, and about the third day ends in Avhat is called the black vomit. Upon the first attack, the skin is extremely hot and dry, but the external heat soon becomes very little above the natural standard in health, and the skin feels soft and moist. The pulse, Avhich is at first hard and frequent, is afterAvards so variable as to be no sure in- dex of danger. The degree of thirst is less in this than in most other fevers, and there is no uniformity in the color of the urine. Sometimes there is a remission after thirty-six or forty-eight hours from the attack, but the symptoms often recur Avith redoubled violence. In the latter stage the debility is extremely great, and the breath highly offensive; bleeding sometimes occurs from the mouth or nose, the pulse sinks, swal- loAving becomes difficult, and death ensues. 24 AELLOAV FEVER. CAUSES. This disease, though strongly resembling the Bilious remi!tent fever in many of its symptoms, yet differs from it in" this, that the air of Avoods and marshes is not necessary to produce it. It hoAvever often arises from the foul air of a ship, either from infectious efflu- via, or from putrefaction that takes place in neglected holds. A fit of intemperance, or too much exercise in the heat of the sun, serves to hasten its attack. It is remarkable with regard to it, that it is confined almost entirely to those Avho have recently arrived from a cold or temperate climate. It appears also, that those persons Avho have been exposed to unwholesome air in the neglected holds of vessels in cold climates, are more particularly the subjects of yellow fever, when they arrive in a hot climate. Those strangers who are young and plethoric are most apt to be at- tacked. It may be distinguished from Remittent fever, to which it bears the nearest resemblance, by reference to its causes, as above mentioned. Some Avriters, however, contend that they are identical. TREATMENT. The mere name of yellow fever is sufficient to damp the spirits of sailors, since it occasions more deaths among them than all other acute diseases together; and Avith the exception of plague, the proportion of cures is less than in any other disease to Avhich that class of people are liable. We should however not despond because the fatality of the disease is discour- aging, but rather redouble our diligence in observing what assistance and relief nature may receive. It is proper in all fevers of warm climates to com- mence the cure by cleansing the stomach and bowels. In yellow fever, however, there is such constant irrita- bility of the stomach and inclination to vomit, which we find difficult to check, that taking an emetic may YELLOW FEVER. 25 be omitted. During the spontaneous vomiting, that occurs early, the patient may drink freely of chamo- mile tea. As a cathartic, the most effectual medicine is calo- mel, Avhich may be taken in syrup, or mixed Avith crumbs of bread, in a dose of tAventy grains. If this fail to open the boAvels, the dose should be repeated, or some other purge administered, such as is most agreeable to the patient, Avithin two or three hours af- ter the first. Sometimes a third and even a fourth dose may be required. The advantages calomel pos- sesses over other medicine, are, that it is less offensive to the taste, and less bulky, on account of Avhich, and of its greater weight, it is less likely to be thrown up by vomiting. With regard to blood-letting, a remedy in high re- pute with Dr. Rush and some others, the most that is said of it by a great majority of those practitioners, who have treated the disease in ships and in the West Indies, is, that Avhere the patient is young and corpu- lent, and there is a hard throbbing pulse Avith violent pain in the head and back, it may be advisable to draAv a small quantity of blood in the first tAvelve hours, but that it is not safe to take any after this pe- riod. Cold water applied externally is a poAverful remedy, and sometimes arrests the disease at the onset. When therefore a person is attacked, and there is an unnatu- ral heat of the skin, cold water should be dashed over him from a bucket or pitcher. Where the heat is confined to particular parts, the Avater should be ap- plied to these with a sponge or towel. The head will probably require this, more than any other part. The great object hi the cure of this fever is to bring the stomach to bear quinine. The only obstacle to its administration is the disposition to vomit, which is the most fatal symptom of the disease, and the princi- pal part of the management consists in the prevention or removal of it. Th% stomach is therefore to be 2* 26 YELLOAV FEVER. treated Avith the utmost tenderness, and only such medicines and drinks given as are very grateful. To quiet the stomach, the effervescing mixture' is highly recommended, and may be given every hour, and to each dose may be added 30 drops of laudanum. Or instead of these, Ave may give the chalk mixture in table-spoonful doses every half hour, and oftener if the stomach rejects it. But the most effectual remedy for allaying vomiting is a large blister applied over the stomach, and this must be laid on early, or as soon as the vomiting has commenced. No other internal medicine need be recommended, for Avhatever poAver of retention the stomach may have, should be employed upon quinine. To take inflammation from the vital parts, blisters may be applied not only over the stomach but to the legs. To hasten the draAving of them, the parts may be previously rubbed with peppered vinegar or other strong stimulants. With the same vieAv warm mus- tard poultices8 should be applied to the soles of the feet every twelve hours. It is very desirable in this fever to excite a mercuri- al action, so far at least as to induce a coppery taste, and some spitting, but this cannot be done by mercu- rial pills or other internal medicines, for reasons above stated, viz. the necessity of appropriating the retentive poAver of the stomach to quinine. The object must therefore be attained by the use of mercury exter- nally. To this end rub a portion of mercurial oint- ment of the size of a nutmeg, on the inside of the thighs every eight hours, and dress the blisters, if there be any draAvn, Avith the same substance. So soon as the bowels have been moved and the stomach Avill admit of it, administer quinine, in tAvo grain doses every tAvo hours. When the stomach becomess perfectly quieted, it Avill afford the patient great relief to procure perspiration 1 See Appendix. 2 Ibid. INFLAMMATORY FEVER. 27 and sleep, for A\*hich purpose a poAvder, consisting of calomel and camphor, of each two grains, and opium one grain, to be administered in the evening. After the first purging, the boAvels must be moved every day, but as the stomach Avill not bear strong purgatives in every case, the effect, for the three or four first days at least, must be produced by clysters of salt Avater, in connection Avith the calomel. From the first horn- of the attack, the patient should abstain from solid food, and subsist on sago, gruel, or barley-Avater. His drink may be lemonade, toast- water, tamarind-Avater, orange-juice, &c. The same directions are to be observed in regard to cleanliness, &c, as are given under the head of Putrid Fever. OF ACUTE OR INFLAMMATORY FEVER. SYMPTOMS. It commences Avith general Aveariness and anxiety, succeeded by dizziness, chills, and pains over the whole body, but more particularly in the head and back. These symptoms are folloAved by redness of the face, throbbing of the temples, great restlessness, intense heat, unquenchable thirst, and nausea. Light is offen- sive, the skin is dry and parched, the tongue becomes of a scarlet color at the sides, and furred with white in the middle ; the pulse is full, hard, and quick ; the urine red and scanty, and the body costive. When blood is draAvn, it exhibits a yelloAvish or buffy crust on its surface. When the disease is not arrested at the commence- ment, it usually goes through its course in about fifteen days and terminates critically, either by a perspiration, diarrhoea, bleeding at the nose, or the deposite of a copious sediment in the urine. In some instances it however terminates fatally. High fever Avith stupor and delirium denotes danger, but picking the bed- 28 INFLAMMATORY FEVER. clothes, tAvitching of the tendons and involuntary evac- uations, portend death. CAUSES. Exposure of the body to sudden alterations of tem- perature, particularly to cold and moisture after being heated ; intemperance ; violent exercise. This may be distinguished from all other fevers by the strength and hardness of the pulse, the whiteness of the tongue, and the other symptoms of high fever just mentioned. TREATMENT. In this and all other fevers attended with a hard, full, and quick pulse, bleeding is of the first importance, and should be employed as early as possible. The quantity of blood to be taken, must be in proportion to the strength of the patient and violence of the disease. From one to tAvo pints may serve for a sailor's con- stitution at the first bleeding ; but if after this, his pulse should again become hard and frequent, and other symptoms of fever return, it will be necessary to repeat the operation a second or even a third time, which may be done at intervals of twelve, eighteen, or twenty-four hours from each other, as symptoms may require. The next step after the first bleeding, is to cleanse the stomach and bowels, which may be done in the following manner : Take tartar emetic, five grains ; Epsom salts, two ta- ble-spoonsful : mix and dissolve them in a pint of water : give a third of this solution every half hour. If the first and second dose produce the desired effect, the third may be omitted. Or, take a common emetic, and in twelve hours after a dose of salts or some other active cathartic. During the operation of the medicine upon the boAvels, the patient may take freely of gruel or barley-Avater. To obviate a tendency to costiveness, allay thirst, and promote a gentle perspiration, the patient may INFLAMMATORY FEVER. 29 drink freely of toast-water, naxseed-tea, or barley- Avater, acidulated Avith cream of tartar. If this mix- ture be not sufficiently laxative to produce tAvo or three motions of the boAvels every twenty-four hours, admin- ister the cooling mixture1 in doses of a table-spoonful every three hours. Where the boAvels are sufficiently loose and require no laxative medicine, instead of the foregoing, give the folloAving mixture : Of antimonial Avine and spirits of nitre equal parts : give tAvo tea-spoonsful every three hours in toast- Avater. For the purpose of allaying inordinate heat of the skin of any part, sponge it frequently Avith cold Avater. If heat and thirst continue Arery great, the patient may take powder of nitre ten grams, every three hours, and drink freely of cold AArater. From the first attack, Avarm poultices, made of pounded bread, should be applied to the feet, morning and evening. If there be a tendency of the disease to any particu- lar organ, as the brain, Avhich Avill be knoAvn by the presence of great pain of the head or delirium, or to the chest, AA'hich difficult breathing Avill indicate, a blis- ter should be applied to the neighborhood of the part affected. Opium is so doubtful a remedy in acute fever, that no preparations of it should be prescribed, unless by a regular practitioner of medicine. Throughout the Avhole course of the disease the pa- tient must abstain from solid food and animal broths, supporting nature Avith gruel and preparations of bar- ley, sago, &c. His bed should be lightly covered with clothes, and his apartment preserved of a moderate and equable temperature. 1 See cooling mixture in the Appendix. 30 SCURVY. SCURVY. SYMPTOMS. It commences Avith unusual Aveariness, dejection of spirits, sluggishness, and offensive breath. The gums become soft, livid and swollen, are apt to bleed from the slightest cause, and separate from the teeth, leaving them loose. About the same time the legs swell, are glossy, and soon exhibit foul ulcers ; the same appear- ances follow, on other depending parts of the body. At first the ulcers resemble black blisters, which spread and discharge a dark colored matter. Unless the general habit be now corrected by proper diet and regimen, these ulcers increase, great emaciation en- sues, bleedings occur at the nose and mouth, all the evacuations from the body become intolerably fetid, and death closes the scene. During the progress of the disease, the pulse is generally natural, but towards the fatal termination, it becomes weak and unremitting. The appetite continues very little impaired, and in some cases the patient, even within a feAv hours of his disso- lution, is more eager than ever, in his calls for food. His mind remains sound, for the most part, to the last. The fatal termination, though gradual in some instan- ces, is generally sudden, and is frequently accelerated by attempts to move the patient on shore. CAUSES. Cold, moist air ; the long continued use of salted provisions, or other food that is hard of digestion and affords little nourishment; deficiency of vegetables ; want of cleanliness; indolence; depressing passions of the mind; smoking and chewing great quantities of tobacco; the putrid stench of bilge Avater. TREATMENT. This is to be managed by pursuing a course of diet and regimen directly opposite to that which induced SCURVY. 31 the disease. Where this can be done, medicine is al- most unnecessary. Among the most celebrated and infallible remedies, are succulent fruits, of Avhich oran- ges, lemons, limes and apples, are the best. Unfor- tunately, hoAvever, these articles are with difficulty preserved on long A-oyages, and consequently least likely to be found Avhen most Avanted. Perhaps then no article after these is so valuable in long voyages, both for its efficacy and imperishable quality, as pota- toes, Avhich have moreover the advantage of being cheap and easily supplied in almost every port. I rarely used any other remedy in a man-of-war, and always laid in a stock of them Avith the hospital stores, purposely for the cure of scurvy. Whenever a scor- butic patient reports himself unfit for duty, I direct him to abstain from all salted food, and to commence eating raAV potatoes scraped and mixed Avith vinegar, to the quantity of from one to three pounds of the po- tatoes a day, according as they may agree with his stomach and boAvels. The dish is very agreeable, re- sembling salad or sliced cabbage. With the same materials I dress scorbutic ulcers, and find it as valua- ble and as conducive to healthy action as any applica- tion I have used. It is probable that cabbages, turnips, &c, are equal- ly as valuable as potatoes. A preparation of cabbage, called krout, is a highly reputed anti-scorbutic, and can be kept for years. All vegetable acids, as lime juice, tamarinds, cider, pickles, &c, are excellent re- medies ; also all saccharine fruits, as pine apples, raisins, and figs. When neither vegetables nor lemon juice can be procured, take three or four times a day, Nitre in doses of ten grains, dissolved in vinegar and sweetened. If the vinegar of the ship be exhausted, use in place of it the concrete salt of lemon or tartaric acid dissolved in water. . . So sudden is the salutary effect of an anti-scorbutic diet, that the worst cases of scurvy are very percepti- bly relieved by it, in the first twenty-four hours. 32 SCURVY. Such is the general treatment to he adopted in scur- vy ; but particular symptoms Avill require a separate management. Pains of the belly must be allayed by emollient drinks, as barley water, or sago, and by opiates; difficulty of breathing by the pectoral mix- ture ;» diseased gums are to be Avashed with sal nitre so far diluted Avith Avater as to be agreeable to the taste, or Avith decoction of bark or quassia, or a Aveak solution of alum ; — the rigidity of the muscles, particu- larly the contraction of the hams, and the livid hard- ness of the calves of the legs, may be removed by warm bathing and emollient poultices; costiveness may be obviated by a solution of cream of tartar. It is very remarkable that this disease should at the present day be suffered to prevail in merchant ships, often to the destruction of half their crews, Avhen pre- ventives are so avcII known and so easily supplied. In crossing the Atlantic in a frigate in 1818, Ave fell in with a French ship bound from South America to Havre, Avhere this disease had prevailed to such a de- gree, that one third of her crew were dead, another third at the point of death and the other survivors more or less diseased; all which calamity might have been prevented by a supply of potatoes and lemon juice of the value of five dollars, or perhaps half that value of tartaric acid or the concrete salt of lemon. One of these acids should be introduced into every medicine chest in large quantities, since it is imperish- able by long keeping, and may be carried to sea for years, and serve as a last resort Avhen every other acid and anti-scorbutic in the ship is exhausted. It has the further advantage of being cheap, and less bulky and incommodious than other acids of equal value. An excellent Avash for scorbutic ulcers is made by dissolving a large table-spoonful of nitre or saltpetre, in half a pint of vinegar, with Avhich cleanse the ulcers tAvice a day. I may further add, that Avhere a crew 1 See Mixtures in the Appendix. JAUNDICE. 33 is threatened Avith this disease, it is of the first impor- tance to preserve the ship clean and dry, and to keep the creAV in gentle, and pretty constant exercise. JAUNDICE. SYMPTOMS. Loss of appetite — aversion to exercise — yelloAV- ness of the eyes, and subsequently, of the Avhole skin. The urine is highly colored and tinges the linen yel- Ioav ; the stools are Avhite, or of a clay color. The patient complains of a bitter taste, nausea and sickness at the stomach. Generally there is costiveness, Avhich, hoAvever, is occasionally interrupted by diarrhoea. Frequently a sense of uneasiness and darting pain is felt under the short ribs of the right side and at the pit of the stomach. CAUSES. The immediate cause is an obstruction to the passage of bile, from the hver into the mtestmes, on account of Avhich, it is throAvn back into the circulation and dif- fused over the body, imparting to it the yelloAv color above mentioned. This obstruction may proceed. 1. From the lodgment of a stone in the gall-duct. This variety of jaundice may be known from the others, by occasional acute pains under the short ribs of the right side. 2. It may proceed from indurated mucus, lodged in the passage of the gall-duct. This variety folloAvs a sedentary habit, debility, a long continued mercurial course for the venereal disease, and is gen- erally unattended by pain. 3. The obstruction may proceed from an enlargement of the liver, as in Avhat is called the ague-cake, which often succeeds the in- termittent or remittent fever, or from that chronic in- flammation of the liver Avhich is occasioned by hard drinking. In this variety of jaundice, the enlargement 3 34 DROPSY. of the hver can be felt, Avhich distinguishes it from other varieties. There arc other kinds of jaundice, but they rarely occur among sea-faring people. TREATMENT. Of the first variety. If pain and inflammation exist in considerable degree, bleed, and bathe the part Avith warm Avater ; in addition to Avhich, employ the reme- dies recommended in the second variety. Second variety. Administer an emetic every other morning, and if it fail to move the boAvels, give on the intervening days a mild cathartic, of calomel and ja- lap mixed in syrup or other convenient vehicle, and repeat the dose every three hours, till it operates. Or, Blue pills, three or four, with castor oil, a table-spoon- ful. Or, calomel alone, twenty grains. A tumbler full of SAveet oil, taken in the course of an hour after the calomel or the blue pill, is found to be a very valuable remedy. The warm bath, by its relaxing powers, proves very useful in jaundice, and should be employed frequently. Exercise of the jolting kind, as running, dancing, jumping a rope, is very serviceable. To those who reside on shore, riding on horseback is an mvaluable remedy. In the third variety. Where the hver is enlarged, mercury should be employed, as recommended under the head of chronic affection of the liver. The diet should be light and nourishing. DROPSY. SYAIPTOMS. General Dropsy commences Avith a Avatery sAvelhng in the lower extremities, and first appears towards evening in the feet and ankles, afterwards gradually ascending and occupying the thighs, trunk, and even DROPSY. 35 head. The SAvelling is not elastic, but pits, Avhen pressed Avith the fingers, and the pits are slow in fil- ling up. When it has become Aery general, the belly savcIIs, the breathing is difficult and accompanied by a cough Avith a Avatery expectoration. The urine is scanty and high colored ; sometimes, hoAvever, it is of a pale whey color and copious. There is costive- ness; paleness of the skin, and oftentimes insatiable thirst. CAUSES. An hereditary predisposition to the disease ;—cer- tain organic diseases, as of the heart and liver, pro- ducing an obstruction to the free circulation of the blood—preceding disease, as jaundice, diarrhoea, dys- entary eruptions, cv:c.—Avatery diet. A favorable result may be expected, when the cause of the disease is easily removed, when the constitu- tion is very little impaired, the appetite remains en- tire, and the respiration free. Unfavorable, when there is the reverse of these, Avhen the heart or liver is diseased,—Avhen the emaciation is great,—the thirst insatiable—and Avhere there is droAvsiness. TREATMENT. The principal indications in the cure of Dropsy are, 1. To evacuate the collected fluid. 2. To prevent its reaccumulation. The fluid is evacuated, 1. By emetics, Avhich may be taken every second or third day. 2. By cathartics, taken on intervening days. 3. By diuretics, as digitalis, squills, nitre, spirits of nitre, in the following manner: Take digitalis, one grain, nitre, ten grains, in syrup of squills, a tea-spoonful; every four hours. Or, take syrup of squills, and spirits of nitre, of each a tea- spoonful ; mix and repeat the dose every four hours. 4. Mercury ; so exhibited, as to affect the gums and 36 INDIGESTION. produce a spitting. This may be combined Avith the digitalis and squills, in the folloAving manner : Take calomel, one grain, digitalis in powder, one grain, mixed in syrup of squills a tea-spoonful, and repeat the dose every four hours, till the mouth is affected, and the SAvelling subsides. While taking the mercury, emetics and cathartics may be omitted. 5. Sudorifics; as Dover's poAvders,1 every four hours, accompanied by diluting drinks, as toast-wa- ter, &c. To prevent the reaccumulation of water, the patient should subsist on a light, nourishing, high-seasoned diet;—take bark, or quinine, or quassia, and other strengthening bitters,—use exercise, friction and cold bath. Other remedies might be mentioned, as scarifica- tions, blisters, bandages, &c, but the above are suffi- cient; to keep the disease in check, when it appears on board ship, till medical ad\*ice can be obtained from shore. Dropsy of the chest, belly, &c, are treated of, un- der diseases of those parts. OF DYSPEPSIA OR INDIGESTION. SYMPTOMS. Want of appetile,—rising of food and Avind from the stomach,—acidity of the stomach,—heart-burn,— flushed countenance after a full meal,—sense of dis- tention in the stomach and boAvels,— sometimes rum- bling and pain,— costiveness, Avhich is now and then interrupted by diarrhoea,— dryness and Avhiteness of the tongue in the morning,— paleness of the urine. There is general debility, languor and aversion to mo- tion, dejection of spirits, distm-bed sleep and frightful dreams. 1 See Powders. INDIGESTION. 37 CAUSES. Whatever debilitates the system in general or the stomach in particular, as opium, — spirituous liquors, — hot and strong tea or coffee, — tobacco, — long continued vomiting excited by too poAverful emetics, or long protracted sea-sickness, — poisons, — sedentary hfe, — depressing affections of the mind, — excessive evacuations, — diseased liver — excessive venery. CURE. The first and most important step is to avoid Avhat- ever may have tended to give rise to the disease and continues to aggravate it; until this is done, medicines will be of very httle service. The remedies then are, 1. Emetics. One of the gentle kind should be the first medicine given, and if afterAvards nausea return, accompanied by a rising from the stomach of imper- fectly digested food, or acid substances, the emetic after four or five days should be repeated. 2. Purgatives, of the stimulating and gentle kind, as poAvder of rhubarb and magnesia, of each 15 grains, AA-hich may be taken whenever there is a tendency to costiveness. If the bowels be difficult to be moved, add to the medicine tAvo or three grains of calomel. Or, in place of this, take the common aloectic pills, or blue pill. 3. A nutritious, easily digested diet. In these re- spects, animal food is preferable, but in consequence of its tendency to induce costiveness, an occasional meal of light vegetable food may be serviceable, and a moderate use of sub-acid fruits, as apples, pears, &c.' The meals should be taken at stated periods, and at intervals of three or four hours. The drink should be in small quantity, and such as does not be- come acid. Watch the effects of the different kinds of food and drink, and select that Avhich best agrees with the stomach. 3* 38 FITS. 4. Exercise. If on shore, Avalking, riding on horse- back, or in a carriage, and these in succession, as are most easily borne. Be engaged -in some active busi- ness or amusement, which Avill employ the mind. Travelling will therefore be very beneficial. 5. Cold bathing and shoAver baths, — salt water is preferable. Rubbing the surface Avith salt and brandy mixed. Lastly. Tonics, particularly vegetable bitters, as Peruvian bark, quassia, cascarilla, &c, taken in the folloAving manner: Quassia, cascarilla, or Peruvian bark decoction,1 a wine glass in every four hours, or a feAv minutes be- fore eating. After taking it for a feAv days, its effi- cacy will be increased by the addition to each dose, of ten drops of ehxir vitriol. Occasional symptoms may require additional re- medies. Acidity of the stomach and heart-burn can be re- moved by chalk or magnesia. Occasional pains of the stomach and bowels, which usually depend on windy distention, may be relieved by a few drops of pepper- mint. Diarrhoea, Avhen it occurs, may be treated by small doses of rhubarb and alum combined thus: Take rhubarb, five grains, alum two grains every three hours, till the diarrhoea is arrested. OF EPILEPSY, OR FITS WITH CONVULSIONS. SYAIPTOMS. The patient, if standing, is suddenly thrown to the ground in convulsions. During the fit, there are strong contractions of the limbs, tAvistings of the body, distortions of the countenance, grinding of the teeth and clenching of the hands. These continue for a 1 See Decoctions. FITS. 39 feAV minutes with such violence, that two or three per- sons are not sufficient to hold the patient; the fit then subsides, but shortly after is reneAved. After three or four returns, they cease altogether and leave the pa- tient senseless, generally in a profound sleep. Com- monly the patient has no Avarning of the fit, yet some- times it is preceded by pain in the head, unquiet sleep, noise in the ears ; in some instances, by a sensation of cold air commencing in one of the limbs, and gradually creeping up Avar ds till it reaches the head, when the patient falls in a fit. In those Avho are much subject to fits, they sometimes occur in sleep. CAUSES. Irritation of body or violent excitement of mind. But these causes rarely take effect, unless there exist a strong predisposition to the disease, either heredi- tary, or from debility, with great mobility either natu- ral or acquired. Perhaps no class of people of equal- ly hardy constitutions are so subject to this disease as sailors. TREATAIENT. The only thing to be attempted during the fit, is to protect the patient from bruises, which his strong con- vulsions are apt to occasion. Some physicians are in- clined to bleed, but this is difficult to do on board ship, and excepting in the robust and plethoric is not advisable in any situation. When restored to his senses, attend to the exciting cause of the fit, and remove or avoid it. In almost aU cases, it is advisable after a fit, to move the pa- tient's boAvels, with a draught of salt-water, or some other purgative. He should avoid a costive habit, and abstain from ardent spirits, with all other strong stim- ulants. . When the patient is Avarned of an attack, it may in some instances be averted by vomiting or purging. Where the fits recur very often, I have always been able to suspend them by exciting a mercurial action. 40 APOPLEXY. In cases where the fit. commences with a sensation of cold air, creeping along one of the limbs towards the head, applv a string around the limb, and direct the patient to clraAV it tight, when the sensation is first felt, by twisting a stick, which is to be Avorn in the string^ready for the purpose. I have commonly used a field tourniquet, and have seen a patient avert fits for months, who, without this apparatus, Avas attacked by them three or four times a Aveek. The pressure need not be continued more than a minute. The ap- paratus may be so applied, as to occasion no impedi- ment to exercise or labor. Those who are subject to this disease should never be sent aloft, nor indeed on shipboard. OF APOPLEXY. SYMPTOMS. Total suspension of the powers of sense and mo- tion, accompanied by snoring—foaming at the mouth, and grinding of the teeth—the eyes are prominent and fixed, and the pupils dilated—the pulse is very little disordered. Persons, from fifty to sixty years of age, are most liable to it, particularly those Avho have short necks, Avith large heads, and avIio indulge in the luxuries of the table. The fit is usually induced by some violent excite- ment of body or mind, long stooping, derangement of the stomach, overloading it Avith pastry, fumes of poi- sonous substances, foul airs, &c. TREAT.MENT. When the patient is seized, take from him a pint and a half, or two pints of blood. The difficulty of start- ing blood in a fit of apoplexy, may make it necessary to open veins in both arms, and both feet, at the same LOCKED-JAAV. 41 time. The head is to be shaved, and bathed with cold water and vinegar, the feet and legs bathed in Avarm water, and a drastic purge administered, of calomel, forty grains; or calomel thirty, jalap twenty, mixed. If this course fail to render the patient sensible, a large blister must be applied to the head and the bleed- ing repeated. The rare occurrence of this disease among sailors, renders it unnecessary to say more of it here. OF TETANUS, OR LOCKED-JAW. SA'AIPTOAIS. It commences Avith a sense of stiffness in the back part of the neck, rendering the motions of the head difficult and painful. This is soon succeeded by diffi- culty of sAvallowing ; pain, often violent, about the breast bone and thence shooting to the back; rigidity of the loAver jaAV, Avhich increasing, the teeth become so closely set together, as not to admit of the smallest opening. If the disease proceed further, a greater number of muscles become affected, and the body is forcibly bent either backAvards, or fonvards. At length the trunk, limbs, and countenance are distorted to a most painful and shocking degree. A remission of these symptoms occasionally takes place every ten or fifteen minutes, but they are reneAved Avith aggravated force by the slightest causes, even the least motion of the patient, or the touch of an attendant. Finally, a general convulsion puts a period to a most miserable state of existence. The duration of lock-jaw is Ararious. CAUSES. The disease is very common in hot climates, and is most frequent AAdien a scorching sun is succeeded by a heavy rain or dew. 42 SMALL-POX. But besides exposure to sudden changes of temper- ature, it is often caused by a Avound of a nerve or ten- don, or by a fractured bone. TREATAIENT. Give opium in large quantities, as four or five grains every hour, or three drachms of laudanum, every half hour. When the patient can no longer swallow, inject laudanum, a table-spoonful in Avarrn water, every hour, and direct it to be retained as long as possible. With the first dose of opium give twenty grains of calomel, and folioav it every six hours by a dose of five grains, till the mouth is affected. Use Avarrn and cold bathing in succession. If the disease proceed from a Avound, enlarge it pretty exten- sively, and pour into it hot spirits of turpentine, or * burn the wound Avith an iron, brought to a Avhite heat. SMALL-POX. SYMPTOMS. It begins Avith pain in the head and back, sickness at the stomach, and chills. In this stage, it may be mistaken for rheumatism or pleurisy. About the fourth or fifth day, it breaks out in small pustules upon the face, breast, and neck, and on the ninth, tenth, or eleventh day, the puslules are at their full size, when they begin to dry and scale off: this is the milder stage or distinct small-pox. In the more aggravated kind, called the confluent, the pustules are more thick and red, and running into each other, spread over the whole body. They are not at their full size till the fifteenth or sixteenth day. The eyes are completely closed the fever runs high, and the danger is very great. TREATMENT. When the disease breaks out in a vessel 1. Keep the patient as cool as possible', Avith light MEASLES. 43 covering to the body, and if the Aveather be hot, bathe the skin frequently with cold Avater. 2. Preserve a loose state of the boAvels, by admin- istering a dose of salts, or cream of tartar, or some other mild purgative, every other day. 3. Abstain from animal food, spirituous liquors, and all stimulating or acrid substances, subsisting on rice and molasses, barley, flour, gruel, &c, and SAveet or subacid fruits. This course is to be pursued as long as there is much fever, or until the pustules are filled and begin to turn yelloAv; the patient may then return to a nutritious diet, and take tonics, such as decoction of bark or quassia, and elixir vitriol. MEASLES. SYMPTOAIS. Slight fever * cough ; hoarseness; difficult breath- ing ; sneezing ; sense of Aveight in the head ; sickness at the stomach; dulness of the eyes; droAvsiness ; itching of the face. On the fourth day, small red points appear, first on the face and subsequently on the loAver parts of the body. On the fifth or sixth day, the lively red is changed to a broAvn, and in a day or two, the eruption entirely disappears. TREATMENT. Abstain from animal food and spirituous liquors; adhere strictly to a Ioav, unseasoned diet; keep in a moderately cool atmosphere, and preserve a loose state of the boAvels by taking castor oil, or cream of tartar, or sulphur and cream of tartar mixed, or small doses of Epsom, or Rochelles. 44 INFLAMAIATION OF THE BRAIN. OF INFLAMMATION OF THE BRAIN, OR BRAIN FEVER. SA'AIPTOAIS Very severe pain in the head ; extreme sensibility to light and sound ; avM expression of countenance staring of the eyes; peculiarly hard and rapid pulse restlessness ; parched tongue ; turgid and flushed face a rapid flow of ideas. Exposure to excessive heat, or to sudden changes of temperature; coup de soleil or stroke of the sun, from subjecting the head uncovered to its vertical rays ; vio- lent exercise; the abuse of spirituous liquors; exter- nal violence, &c. It may be distinguished from madness, by the symp- toms of fever and the violent headache which attend it; from the deliriums of inflammatory and typhus fevers, by reference to its causes, and by its sudden accession after exposure to them. Active inflammation of the brain usually terminates fatally, and within four days. In a feAv instances it ends favorably, in inflammation of some other part, or by some evacuation. TREATAIEXT. Depletion is the principal remedy. From one to tAvo pints of blood should be taken at the first bleeding and this operation repeated at intervals of a few hours' till the delirium is overcome. Cathartics, of the active kind, are to be employed as the following: J ' Calomel twenty grains, or calomel and jalap, salts two ounces. After the bowels have been freely moved, ffive a so- lutwn of tartar emetic, one grain every four hours.' I he heat of the head must be allayed by cold water DISEASES OF THE HEAD. 45 apphed Avith towels, and the neck may be blistered. Blisters should also be apphed to the ankles. The feet may be bathed in Avarm Avater, and poulticed with mustard-seed, spread over Indian or rye meal poul- tices. The patient must subsist on toast or barley water, and gruel. CATARRH, OR COLD. SYAIPTOMS. Inflammation of the internal surface of the nose and throat, Avith a sense of fulness, and an increased dis- charge from the nose of an irritating Avatery fluid. There is usually a sense of weight and pain in the head, oppression of the chest, Avatery inflamed eyes, soreness of the throat, and sometimes cough; cold shiverings succeeded by transient flashes of heat. CAUSES. Exposure of the body to sudden changes of tem- perature, Avearing damp clothes, &c. Sometimes it is epidemic, and is then called influenza. TREATAIENT. An emetic is a very efficacious remedy. If the pa- tient be averse to this, administer a dose of salts, or some other cooling purgative. Preserve an uniform temperature of the body, nei- ther very warm nor cold; drink freely of warm flax- seed tea, barley or toast-water, Avith cream of tartar dissolved in it. Bathe the feet in Avarm water on going to bed, and avoid exposure of the body to cold the day following. Keep the feet continually Avarm. To allay coughing and irritation of the throat, drink 46 DISEASES OF THE HEAD. spermaceti dissolved in Avarm tea, or take it in sub- stance, or, take liquorice. When the cough is very troublesome, and prevents sleep, take pectoral mixture,1 tAvo tea-spoonsful on going to bed, in a large draught of barley-Avater, or flax-seed tea; or, take Dover's powder ten grains; or the cooling mixture a table spoonful every three hours, adding to the last dose in the evening (which is to be taken on going to bed,) fifteen drops of lauda- num. OPHTHALMY, OR INFLAMMATION OF THE EYE. There are two kinds. — 1. A disease of the eyeball. 2. Of the eye-lid. SYMPTOMS. The former commences with itching, burning, and a sensation, as if sand or sticks Avere lodged under the eye-lid. The white of the eye turns red, and swells, and there is an increased sensibility of the organ to light and motion. When the inflammation runs very high, a slight fever attends it. TREATMENT. When occasioned by the presence of irritating par- ticles, these must be immediately removed Unless the ophthalmy be very violent, general bleed- ing is hardly ever necessary. In all severe cases, how- ever if leeches can be obtained, apply three or four on the temple, near the eye, every morning Take an active purgative of calomel and jalap every third or fourth day, till the inflammation abafes or salts, an ounce and a half. ' or To take off the heat of the eye by evaporation, ap- 1 See Mixtures in the Appendix. DISEASES OF THE HEAD. 47 ply frequently to it a soft linen rag, dipped in water, at first blood warm, but afterwards cold. After two or three days, if the inflammation con- tinue active, apply in the same manner the following: White vitriol and sugar of lead, each two grains, dissolved in a gill of pure Avater, or rain water. If the itching and pain be great, add to the mixture laudanum, two chachms. If the inflammation be not reduced Avithin three or four days from the attack, apply blisters behind the ears. From the first attack, abstain from stimulating food and drinks, and keep the eye lightly covered. In shght cases of ophthalmy, it may perhaps be suf- ficient to take some mild purgative, and use the above apphcations for the eye. In the other species of ophthalmy, there is usually a small ulcer at the roots of the eye-lashes ; this may be touched with a httle Avarmed citron ointment, or Avith alum-water, by means of a hair pencil. BLEEDING- AT THE NOSE. TREATMENT. During the bleeding, sit in a cool air, with the head raised, and Avet the neck frequently, with cold water. If this fail to stop the bleeding, sit on cold wet clothes, Avith the skin in contact Avith them, or in cold water. If the bleeding still continue, apply astringents to the inside of the nostrils, as the following:— Powder of alum, a tea-spoonful dissolved in one gill of water. A rag may be dipped in it, and intro- duced into the nose. Or, apply in the same manner, white vitriol, one drachm, dissolved in a gill of water. Persons subject to this complaint should avoid a costive habit, and move the bowels frequently, by a draught of sea-Avater or a dose of salts. If this be 4S DISEASES OF THE HEAD. insufficient to prevent its return, let blood from the arm. Abstain from stimulating food and drinks, and avoid every occasional cause, as violent exercise, tight neck-cloth, stooping postures, and external heat. HEADACHE. The most usual causes are indigestion, foul, or over loaded stomach, long exposure to the sun, rheumatism, intemperance, too great a determination of blood to the head. Generally, however, it is only a symptom of other diseases, as of fever, catarrh, dropsy, &c. TREATMENT. Where a headache is symptomatic of some other disease, it will readily cease on removal thereof, as in the case of fever. When a foul stomach or the presence of indigesti- ble substances is apprehended, take a gentle emetic, and if costiveness exist, remove it by some mild laxa- tive. If too great a determination of blood to the head be suspected, bleed, and subsist on a low diet. If the headache be rheumatic, apply blisters to the extremities, or to the back of the neck, and move the boAvels by common cathartics. In cases of slight headache, it may be sufficient to bathe the feet in warm water, and wet the head with ether or spirits. TOOTHACHE. TREATMENT. If the tooth be much decayed, extraction is the only sure remedy. When this is impracticable, the pain DISEASES OF THE THROAT. 49 may sometimes be relieved, by applying to it pills, made of opium and camphire, equal parts; and oil or essence of peppermint sufficient to moisten the mass. Or, apply elixir paregoric or laudanum on cotton. If the pain proceed from a cold, or be a rheumatic affection, scarify the gum Avith a lancet or sharp pen- knife, and apply a blister behind the ear. EARACHE. CAUSES. Whatever induces other inflammations; more fre- quently, exposure of the ear to a current of air, or to a cold damp Avind. TREATMENT. Syringe the ear Avith Avarm water, and fill it Avith laudanum or sAveet oil, covering the part Avith flannel. If this fail to relieve, apply a blister behind the ear, take a cathartic, and steam the ear, by holding it to the mouth of a jug filled with hot Avater. When the pain, instead of abating, increases for three or four days, the formation of matter may be expected and should be encouraged, by the frequent apphcation of warm poultices. When matter begins to be discharged, syringe the ear frequently, Avith Avarm water containing a httle soap. DISEASES OF THE THROAT. INFLAMMATION OF THE THROAT, OR QUINSY. SYMPTOMS. The throat internally, is red and swollen. There is enerally some fever, a constant flow of viscid spittle, 4* 50 DISEASES OF THE THROAT. and pain in swallowing. When the inflammation is not subdued within five or six days from the first at- tack, a tumor containing matter Avill appear in the throat, and break. CAUSES. The usual causes of inflammation; particularly sud- den cold ; occasioned by omitting some part of the covering usually Avorn about the neck ; by sleeping in a damp bed; or Avearing wet clothes. TREATMENT. As it is important to prevent the formation of matter in the throat, the treatment should be active, and early in the disease. If the symptoms be severe, bleed freely and admin- ister a dose of salts. Bathe the feet in warm sea wa- ter. Wear flannel or a stocking around the neck; or mash roasted or boiled potatoes, and apply them in a stocking, as warm as the patient can bear. Gargle the throat every ten minutes, with a mixture of warm vinegar and Avater sweetened; or, Avith Avarm vinegar containing table-salt dissolved. If this treatment fail to reduce the inflammation Avithin the first forty-eight hours, the bleeding and purging are to be repeated, and a bhster applied to the throat. Abstain from solid food and stimulants. If matter form, the difficulty of swallowing will be increased, and the patient in some danger of suffoca- tion. In this case, the suppuration must be hastened by inhaling the steam of Avarm Avater, from the nose of a tea-pot, and the apphcation of large poultices around the throat. Those who have had this disease once, are more lia- ble to subsequent attacks. In slight cases of sore throat, it may be sufficient, to wear flannel, or hot roasted potatoes around the throat, and preserve an open state of the bowels. DISEASES OF THE THROAT. 51 MUMPS. This commences AA7ith slight fever, followed in two or three days, by a SAvelling under the ear. In severe cases, the testicles are affected, and sometimes the brain. It usually requires nothing more than the apphca- tion of flannel to the part primarily affected, a gentle laxative, and a Ioav diet. When the case is very se- vere, or when the testicles and head are affected, use bleeding, purging, &c. CROUP. SYAIPTOAIS. This is an inflammation of the trachea or wind-pipe, and is mostly confined to children. There is hoarse- ness, particularly in coughing, the sound of Avhich has been compared to the barking of a young dog, or of air passing through a brazen tube. There is difficult breathing and dry cough, Avhich in severe cases in- crease, till the patient is worn out, or till suffocation takes place. When it occurs on board ship, administer an em- etic, employ the general treatment recommended in quinsy, and apply a blister to the throat. The emetic consisting of wine of antimony and squills, mixed ; a tablespoonful may be repeated often. CHRONIC BRONCHITIS AND LARYNGITIS. This disease seldom occurs among sailors ; but as those who are affected with it on shore find great benefit in change of residence from a cold to a warm 52 DISEASES OF THE THROAT. chmate during the Avinter, and are much in the habit of taking passage in ships for Cuba and the other West India islands, and for the south of Europe, some notice of the disease, from one Avho has seen many cases of it, may be acceptable to such passengers while on board ship. This disease is more prevalent among clergymen, lawyers, and other public speakers, than among labor- ing classes.' It is called Laryngitis, when the pain, soreness, and tickling exist in the top of the Avindpipe, Avhere it is most prominent, and the disease extends upward, so as to be visible in the throat. It is called Bronchitis Avhen it extends doAvnward to the sternum, and along underneath it, producing soreness and pain. Both forms of the disease are attended with coughing, but in Laryngitis, the tickling sensation which causes it, is seated in the top of the throat; in Bronchitis, the irritation seems lower down, even in the lungs ; the cough is severe, and causes the disease to be con- founded with consumption, from which it may how- ever be distinguished by the healthy natural soimd of the chest on percussion, and by the absence of those respiratory sounds known to physicians as signs of consumption; by the patient's abihty to lay on either side, and by the absence of copious expectoration of pus, especially in the early stages. There is, however, both in Bronchitis and Laryngi- tis, expectoration of specks of pus mixed with much glairy mucus, and occasionally there will be streaks of blood. These two diseases sometimes succeed to severe and long-protracted cold, but more commonly they come on spontaneously, and oftentimes so insidiously that the existence of the clergyman's sore throat is often not suspected until it has made great inroads upon the mucous surface of the throat in the form of small ex- cavations, sometimes as large as a split pea, and the whole surface appears rough, as if pitted with small pox, some specks being very high-colored, and others DISEASES OF THE THROAT. 53 presenting a foul whitish appearance. Its prevalence among ministers more than any others, is not satisfac- torily accounted for ; and perhaps it is, after aU, more apparent than real — for, Avith them, it is always soon- er knoAvn, and more generally from its disabling them for their public duties. It is doubted Avhich sex suffers most from it, but the age most affected is be- tAveen tAventy and forty. Although the surface of the air-pipes shoAvs more of the affection, yet it is beheved that muscular debility of the vocal organs is often present. The affection that appears on inspection of the throat, is probably but a small part of Avhat actually exists ; it extends doAvmvards towards the lungs, and the chief source of danger is, that it Avill run into con- sumption, and some eminent writers even maintain, that tubercles in the lungs coexist with the throat affection, but this is doubtful. Another mode of fatal termination is disorganization of the throat itself, either the cartilages composing the larynx or prominent part, or of the pipes that extend into the lungs. TREATMENT. Rest of the vocal organs is indispensable; leeches over the part most affected; a bhster apphed to the top of the sternum or breast bone, and repeated as often as it heals, Avhich is preferable to a continued one. Inhalation of the steam from simmering tar, through a tube attached to the nose of a teapot half filled Avith tar, Avhich may stand over a blazer ; or the tar may boil in like manner in a plate, and the patient inhale the steam diffused through his apartment. The vapors of iodine and of chlorine are often used Avith advantage, to the former may be added tincture of conium, as directed in several medical works. Topical applications in solution may be apphed with a swab, or, what is better, by sewing a brush of lint to the end of the finger of a glove, which is then drawn on the index finger of the right hand ; the pa- 54 DISEASES OF THE THROAT. tient is made to gargle Avith warm Avater, and the lint beino- dipt in the solution, can be readily applied to the larynx. The best solution to apply is nitrate of silver, two grains to an ounce of water, which may be repeated once a day, one in alternate Aveeks. Among the gargles that I have tried Avith most suc- cess, is the following: — R. Tr. myrrh and ether, of each half an ounce ; honey, one ounce ; and strong sage tea, four ounces. The internal use of tar Avater, to the extent of from one to tAvo pints a day, is serviceable. The daily evaporation of alcohol over the throat is by some highly recommended. A sea voyage to a Avarm climate during the Avinter, is among the best remedies. PUTRID SORE THROAT, OR SCARLET FEVER. SYMPTOMS. It commences with cold shiverings — sickness and vomiting — heat and restlessness — great debility — flushed face — hoarseness and sore throat. Upon in- spection, the internal surface appears of a fiery red color, which soon becomes darker and is interspersed A\Tith specks, of some shade between a light ash and dark broAvn. There is considerable fever, which in- creases every evening — a small and irregular pulse, and oftentimes diarrhoea. About the second or third day, large scarlet colored patches or stains appear up- on the neck and face, and afterwards over the whole body. After continuing about four days, they depart with a scaling of the skin. In bad cases, the ulcers in the throat corrode deeper and deeper, debility in- creases to complete exhaustion, and the parts mortify. The patient expires usuaUy before the seventh, often as early as the third or fourth day. This disease is epidemic, often spreading through a DISEASES OF THE THROAT. 55 whole village. Long exposure to a humid atmos- phere and a debilitated habit, predispose to an attack. This kind of sore throat may be distinguished from quinsy, or common - sore throat', by the eruption or specks above mentioned, by the Aveak fluttering pulse, general debility, and by the scarlet spots that appear on the skin. Each of these diseases hoAvever, often partakes so much of the character of the other, that it is not always easy to distinguish them. It may be known from croup, by the absence of a croaking hoarseness, and by the presence of visible inflamma- tion and specks above mentioned. The putrid sore throat prevails mostly among children, and rarely ap- pears on board ship. TREATAIENT. In the treatment of putrid sore throat, bleeding and active purging Avould be likely to increase the debility, which is already very great. The stomach and bowels must hoAvever be cleansed ; for which purpose, take Ipecac : twenty-five grains, adding to it five grains of calomel, or some other purgative in small quantity. The principal indications of cure then are, 1. To counteract the putrid tendency that prevails. 2. To Avash off frequently the acrid matter from the throat, and, lastly, to obviate debility. To correct the putrid tendency, Peruvian bark, quinine, mineral acids, and Cayenne pepper, are among the most valuable remedies. They may be taken in the folloAving manner : Take powder of bark, two table-spoonfuls, Cayenne pepper, one table-spoonful; to Avhich add three gills of boiling water, and after boiling it in a covered ves- sel ten minutes, add one gill of vinegar. Administer two table-spoonfuls every two hours. Or, take de- coction of bark, or of quassia two table-spoonfuls, with ten drops of elixir vitrol, mixed, every two hours. To cleanse the throat, use gargles of salt dissolved in vinegar ; — or elixir vitriol, a tea-spoonful to half a 56 DISEASES OF THE CHEST. pint of Avarm Avater, sAveetened, every ten minutes. Inhale the steam of Avarm vinegar and water, from the nose of a teapot. Breathe the air, made by burning nitre, thus: Close the patient's room, and upon a chafing dish of coals, throAV poAvder of nitre half an ounce; Avhich will fill the room with a thick Avhite cloud, that will last for some time. This process may be frequently repeated in the course of the day. If any particular symptom of an alarming nature arise during the progress of the disease, as diarrhoea, bleeding, &c, it must be checked immediately. For diarrhoea administer opium and lime water, or, poAV- der of alum three grains. Bleeding is also to be treated Avith astringents, both locally and generally, as directed under the heads of different kinds of bleedings. PLEURISY. Pleurisy, pneumonia, peripneumonia, and lung fever', are names given to inflammations of the lungs them- selves, or of the membrane that covers them and lines the cavity of the chest. It is however improbable that either the lungs or this membrane are ever inflamed to a great degree separately, the disease of one, being generally more or less extended to the other. On this account, and because the symptoms and treatment of the tAvo diseases are nearly the same, they are both included here under the head of pleurisy. I may re- mark, hoAvever, that painful breathing belongs more to pleurisy than to peripneumonia, whilst the latter is, of the two, more likely to prove fatal. SY.AIPTOMS. It commonly commences with the usual symptoms of fever, accompanied or succeeded by a sense of weight, and afterwards pain in the chest. This begins DISEASES OF THE CHEST. 57 in one side, ordinarily about the sixth or seventh rib, from Avhich it shoots toAvards the breast-bone and shoulder-blade. The breathing is short and difficult, and the pain is increased on drawing in the breath. There is constant inclination to cough, but every effort is interrupted by the pain it occasions, in consequence of Avhich, viscid mucus collects in the air-passages, and causes a sort of Avheezmg called rattles. The disease begins to subside from the fourth to the seventh day : if not so soon as the latter period, the case may be considered dangerous. The abatement of the inflammation is marked by an amelioration of all the distressing symptoms, and a copious expecto- ration. TREATMENT. The great remedies in pleurisy and penpneumony, are bleeding, blistering and purging. In severe cases its rapid course and fatal tendency require that these should be employed Avith promptness and energy. Blood is to be draAvn from a large orifice in the arm, till the patient is relieved of his pain and difficult breathing, provided the quantity for this be short of two pints. If the first bleeding fail to relieve, or if after relieving, the pain and difficult breathing return, the operation should, after tAvelve hours, be repeated. Move the bowels as early as convenient, by a mild laxative, as salts, one ounce. Immediately after the first bleeding, apply a large bhster upon the side, near the seat of the pain. Bathe the feet in warm sea-Avater, and apply warm poultices to them. Take very freely of Avarm barley-Avater, or flaxseed tea, made agreeable with sugar. If the above fail to relieve the pain and other symp- toms, Avithin the first thirty-six hours, move the bowels again by the cooling mixture, taking a wine-glass full every hour, till it operates. Another bhster may be apphed to the chest, and the bleeding repeated even a 58 DISEASES OF THE CHEST. third time. As soon as the pain is relieved and expec- toration has commenced, give Dover's powders, ten grains, or pectoral mixture, a tabic spoonful, every three hours, and continue the Avarm drinks. Preserve a constant Avarmth of the skin by keeping in bed, and a uniform temperature of the apartment. During convalescence, the patient may subsist on a generous diet, and use Avine. CONSUMPTION. The great length of time necessary for consumption to develop itself and become confirmed, might lead one to suppose that it can hardly occur on shipboard during a single voyage, and consequently, that medical advice Avould be unnecessary, in a book like this, which is merely intended to afford advice to sailors Avhile at sea, and out of the reach of physicians. Consumption, hoAvever, has time to commence, in a single voyage, and when it is considered, that it is in the first stage only, that advice and medicine are sure to prove beneficial, the necessity of making the sailor acquainted Avith the nature of the disease Avill be ad- mitted. But another reason for introducing some account of consumption is, that persons laboring under the ad- vanced stages of it, are not unfrequently sent to sea, Avith the hope of deriving benefit from sailing, or from change of climate, and to such, while on shipboard, the folloAving sketch may be acceptable. SA'AIPTOMS. The tubercular consumption, Avhich is by far the most common kind, may be divided into three stages or periods. In the first stage, the disease is sloAvly developed, ordinarily without being noticed. In this period it is very important to recognize it, but the phy- DISEASES OF THE CHEST. 59 sician is not often consulted so early. The first symp- toms are a short, dry cough, the breathings being more easily hurried by bodily motion, the patient's becom- ing languid, indolent and dyspeptic, and his gradually losmg strength ; at length, from some fresh exciting cause, the cough becomes more considerable, and is particularly troublesome during the night; breathing is more anxious; sense of straitness and oppression across the chest is experienced; an expectoration takes place, at first of frothy mucus, Avhich aftenvards becomes copious, viscid and opaque. These symp- toms may be gradually progressing for months. The emaciation and Aveakness go on increasing; a pam arises in some part of the breast, at first unsettled, but afterwards fixes in one or both sides, is increased by coughing, and sometimes becomes so acute as to pre- vent the patient's lying upon the affected side. The disease noAv passes to the second period, in which it is easily recognized. Purulent matter, resem- bling that made by a common ulcer, is coughed up. To distinguish whether it be such, or only mucus, mix some that is raised in the morning, in salt water ; if mucus or common phlegm, it sAvims and holds to- gether ; if pus, it sinks, and on stirring, separates into particles ; purulent matter is also opaque, has a green- ish color, and is sweet to the patient's taste. Hectic fever takes place, knoAvn by a flushing of the face, by a hard, quick and frequent pulse, beating more than one hundred in a minute, and by high colored urine. The hectic has an exacerbation or increase tAvice in the day ; the first time about noon, which is inconsid- erable, and soon suffers a remission ; the other in the evening, Avhich gradually increases until after midnight. Each of these fever-fits is preceded by chills, and ter- minates in profuse perspiration. In the morning, the patient is better, and thinks himself well. The cough and difficult breathing now go on increasing, and oftentimes there is a hoarseness or shrillness of the voice. After this stage is Avell established, by the ap- 60 DISEASES OF THE CHEST. pearanee of the above symptoms, the patient may die in six or eight weeks. * He is hoAvever able to go about, and when the expectoration of pus is first es- tablished, the appetite, that was lost in the first stage of the complaint, returns. During the fever fits, a circumscribed redness appears on each cheek, but at other times, the face is pale, and countenance dejected. The third period is that of general exhaustion, the countenance is peculiar, and easily recognized by all. The cough becomes more hard and difficult, especially in the morning, Avhen it often produces vomiting; emaciation is extreme ; diarrhoea comes on, and gene- rally alternates Avith melting sweats; the legs SAvell; little ulcers appear in the throat; still the appetite often remains entire, and the patient flatters himself with hopes of speedy recovery, and is forming plans of interest or amusement, when death puts a period to his existence. Females are more liable to the disease than males, partly from their more delicate organization, and con- sequent inability to Avithstand vicissitudes of tempera- ture, partly from errors in dress, particularly of the chest, by compressing it, and of the feet, by imprudent exposure. The age most susceptible, is between twenty and forty. It rarely pro\res fatal before the age of fifteen, and the general average of tables shoAv the greatest number of deaths happen betAveen twenty and thirty, the next in proportion, betAveen thirty and forty, and then between forty and fifty. When the disease first appears, there is always con- siderable hope, that if properly treated, it may be stayed in its progress ; and if this can be done once, and the patient in some measure improved in health, a repeti- tion of the same course of treatment may again suc- ceed from time to time, until the patient has turned the age of thirty, when the danger will, ever after, be constantly lessening. Spitting of blood sometimes induces the disease, or DISEASES OF THE CHEST. 61 is the first symptom noticed. In other cases it occurs in the course of the disease, and sometimes termi- nates it. CAUSES. Particular constitutions are more liable to consump- tion than others, as Avhere. an hereditary predisposition exists, or particular formation of body, marked by long neck, prominent shoulders and narroAv chest. The remote causes are, constitutional irritability of the lungs; a scrofulous habit, indicated by a clear skin, fah: hair, delicate rosy complexion, large veins, thick upper hp, and AAreak Aroice. In such subjects tuber- cles form in the substance of the lungs resembling in color and consistence crumbs of hard cheese, from the size of a pin's head, to that of a large pea. These tubercles may remain dormant for many years, and probably even to old age, but they are liable at any time to undergo changes that Avill induce consumption either by softening into a matter resembling pus, or by exciting inflammation in the surrounding sub- stance, and in either case causing ulcers that are diffi- cult to heal, and may extend and involve a large por- tion of lung, and finally prove fatal. In some rare instance's, they heal, and present a light-colored puck- ered scar. Many of these tubercles may ulcerate to- gether, and form"one large cavity. The more imme- diate or exciting causes are preceding disease — as spitting of blood, pneumonia, catarrh, venereal disease, fistula — depressing passions of the mind — intemper- ance — profuse evacuations, as diarrhoea; or a large ulcer. TREATMENT. In the first stage, and before hectic fever begins, or much emaciation appears, and before the lungs are much affected, which a physician can ascertain by ex- amining the chest, there is good reason to hope that 5* 62 DISEASES OF THE CHEST. the disease may be removed, or may at least have its progress stayed. The treatment may require to be modified at the outset, according to the prevailing symptoms — bleeding at the lungs, or the long existence of catarrh, or a recent lung fever, may require the use of some of the remedies mentioned under those heads. I will mention a feAv of the most approved remedies in the early stage of consumption. 1. Sailing and change of climate ; these are so im- portant that I have appropriated a separate chapter to their consideration. 2. Exercise in the open air, and travelling on horse- back, and in open vehicles. Long journeys are best, if the patient can bear them. 3. Light emetics, repeated every second or third day; Avhite vitriol, in doses of 15 grains dissolved in half a tumbler of Avarm water. 4. Mild laxatives every other morning; the best ar- ticle is probably Epsom salts in small doses. 5. A nourishing, easily digested, unstimulating diet — as milk, cheese-Avhey, eggs, broths, jellies, por- ridges, puddings, &c., and other kinds of food Avhich the patient finds by experience to agree with him. 6. A stimulating plaster worn betAveen the shoul- ders. 7. Expectorants and anodynes, which Avill allay coughing, and promote expectoration. Among the best of these is the pectoral mixture, or Dover's poAv- ders. They should be accompanied with the free use of gum Avater, flax seed tea, &c. 8. A new medicine, called hydriodate of potash, in steadily repeated doses, and the application of an ointment made of the same, over the diseased lung at the part affected. 9. Inhalation of fumes of tar, of chlorine, and burnt sponge. 10. Leeches apphed over the part of the diseased lung most affected. DISEASES OF THE CHEST. 63 If spitting of blood from the lungs occur at an early period, there is Avith it a tendency to inflammation. This must be prevented by measures of the most ac- tive kind. If the constitution do not positively forbid it, general bleeding should be employed, especially if the pulse be quick, although the patient may be feeble, smee the Aveakness mduced by spitting blood is not occasioned by the quantity that is lost. Blistering should then be employed; the patient should be con- fined to a mild diet and quietude, and should avoid speaking, coughing, ccc. The boAvels are to be moved Avith cooling laxatives, as Glauber's or Epsom salts, and the patient kept in a uniform temperature, of from sixty to sixty-five degrees, and take half a grain of opium in the evening. After the above evacuations have been made, astringents and refriger- ants will be proper ; and Avhen spitting of blood oc- curs in the latter stages of consumption, these are principally to be relied on. The astringents are elixir vitriol and alum; the former in doses of twenty-five drops, in a gill of water, every three hours; the latter in doses of six grains. As a refrigerant, common salt is a very effectual remedy, and should be given when spitting of blood has commenced, in doses of two or three tea-spoonfuls. In the latter stages of consumption, nothing more can be done than to palliate distressing symptoms. For the cough, take pectoral mixture and opium pills. SPITTING OF BLOOD, FROM THE LUNGS. SYMPTOMS. Sense of Aveight and oppression in the chest; dry tickling cough; difficulty of breathing; flushed and anxious countenance; sense of pain and heat refer- red to the breast-bone; saltish taste in the mouth; constant inclination to hawk and cough, by which 64 DISEASES OF THE CHEST. blood from the lungs is raised. In this respect it differs from the vomiting of blood, the blood in that case being raised from the stomach Avithout cough ; it is moreover sometimes clotted, and often mixed with alimentary matter. CAUSES. It may proceed from excess of blood, from a pecuhar weakness of the lungs, hereditary predisposition, or bad formation of the breast. It is often occasioned by excessive drinking, running, wrestling, singing, or loud speaking. Sometimes it is the effect of a long and violent cough, and is then the precursor of con- sumption. TREATMENT. Administer table-salt, two or three tea-spoonfuls ; or alum, fifteen grains. One of these remedies will be sufficient to arrest the bleeding, for a short time. DraAv blood from the arm on the first attack, and repeat the operation Avhenever there is any hardness of the pulse or other symptoms of inflammation, or any return of the disease, provided the quantity of blood already lost be not very great. After bleeding, open the boAvels with a dose of Glau- ber's or Epsom salts, or cream of tartar. Refrigerants and astringents are then to be taken, as ehxir vitriol, tAventy drops, in a glass of Avater, every three hours; or nitre, ten grains, dissolved in a glass of Avater, every three hours, adding to each dose, ten drops of laudanum. Also draughts of cold Avater Avith lemon juice. Carefully avoid heat, speaking, coughing, and every kind of bodily exertion. Use a light vegetable diet. DISEASES OF THE CHEST. 65 COUGH. Commonly, this is only a symptom of some other disease, as of catarrh, consumption, &c. In such cases it is to be regarded in the general treatment of those complaints. In some constitutions, however, there is such notability of the lungs, that cough is ex- cited on the least exposure to change of Aveather; and in such, it often remains after every other symptom of a catarrh is removed. When long protracted and violent, there is ahvays reason to fear the consequences, since it is often the precursor of consumption. TREATMENT. If the cough be violent, the patient young and ple- thoric, bleeding Avill be proper ; and it will be unsafe in such cases to administer opiates, to quiet the cough, till this is done or the stomach and boAvels cleansed. In ordinary cases purging alone is often sufficient to prepare the system for opiates, and this may be in- duced by salts; or sulphur, Avith cream of tartar, half an ounce of each, mixed in molasses, and taken in the evening. Emetics are among the most effectual remedies for a cough, and one alone is often sufficient to remove it, Avithout the aid of other medicines. In long protracted coughs it Avill often be necessary to excite a counter irritation by a blister or irritating plaster. Burgundy pitch, spread on a soft leather, of the size of the hand and apphed between the shoulders, will serve for this purpose : — Or, take common pitch of the ship, spread in like manner, and sprinkle on it two or three grains of the powder of tartar emetic, and apply it over the breast bone. An irritating plas- ter should be renewed once a fortnight. Opiates, combined with sudorifics, may be taken on going to bed, in the form of pectoral mixture, a table- spoonful ; or Dover's powders, ten grains, accompa- nied by warm drinks. 66 DISEASES OF THE CHEST. Wear flannel next the skin — avoid exposure to sudden changes of temperature, and abstain from ar- dent spirits, and all strong stimulants, and from animal food. ASTHMA. SA'MPTOAIS. Tightness across the chest; difficult breathing; wheezing; sense of suffocation; cough, occurring in fits; gasping for breath, that obliges the person to sit up until toAvards morning, Avhen the symptoms abate and sleep follows. The fits recur for several nights, gradually losing their A'iolence. There is not much danger in asthma, some of the French call it a lease for long life, yet it is apt to appear as a symptom of a dangerous disease of the heart. TREATMENT. To prevent asthmatic fits, avoid improper or too much food, especially suppers, exposure to damp cold air, fogs, great heat, or sharp vapors of any kind. When a fit is expected, emetics may Avard it off, ex- pectorants should folloAV, as syrup of squills, Avine of antimony and paregoric equal parts, garlic, strong coffee, ether. Smoking cigars made of stramonium give great relief. Bleeding will give temporary relief, and in full habits may be tried. In a saturated solu- tion of nitre or salt-petre, immerse some pieces of pa- per and let them dry, and then burn them near the patient, so that he may inhale the fumes. DROPSY OF THE CHEST. SYMPTOMS. Difficulty of breathing, particularly on any sudden exertion, as in ascending a hill, or stairs, or running; DISEASES OF THE EELLY. 67 it is also great during the night, Avhile the body is in a horizontal posture ; distressing sense of weight and oppression at the chest; palpitation of the heart, sometimes so great as to be seen and heard ; irregu- larity of the pulse, often intermissions ; paleness of the face ; dropsical swelling of the extremities; scar- city of urine ; sudden starting from sleep ; fluctuation of Avater in the chest. TREATAIENT. Employ the same medicines, that are advised under the head of dropsy. OF TYMPANY, OR WINDY DISTENTION OF THE BELLY. The Avind may collect Avithin the intestines ; or Avith- out them, in the cavity of the abdomen. In either case the belly, usually in a feAv hours, becomes greatly distended, tense and elastic, like a drum-head. Some- times the swelling is gradual hi its progress and pre- ceded by rumbling of the boAvels. There is dimin- ished appetite, thirst and emaciation. Unless the constitution be much impaired, the disease is generally curable. TREATAIENT. The objects are, 1. To evacuate the air ; and 2. To prevent its re-accumulation. The first object is gained by heating medicines, as ether, anise-seed, peppermint, cayenne pepper, gin- ger, nutmeg, &c, and by opium; thus, paregoric tAvo tea-spoonfuls, essence of peppermint twenty drops, poAvder of ginger half a tea-spoonful, mix in sugar, and take every three hours; or, poAvder of rhubarb and ginger, of each five grains; nutmeg, two grains; opium, half a grain, mixed, to be taken every three hours. 68 DISEASES OF THE BELLA'. To prevent the re-accumulation of air, after it has been once discharged, use tonics, as decoction of bark, or quassia, and avoid all food apt to produce wind. It is a disease of rare occurrence. In thirty years practice, I never have seen more than three cases. ASCITES, OR DROPSY OF THE ABDOMEN. SVAIPTOAIS. A sIoav, gradual SAvelling of the abdomen. When severe, there is thirst, scarcity of urine, and some de- gree of fever. CAUSES. The same as general dropsy, but the most usual is a diseased liver, occasioned either by the sudden appli- cation of cold, Avhen the body has been heated, by a long protracted fever and ague, or remittent fever, or by hard drinking. It differs from tympany, in being almost invariably consequent to some constitutional disease1 ; is more sIoav and gradual in its attack, the belly is not so elas- tic, and there is a sense of fluctuation, and generally some dropsical appearances in the loAver extremities. TREATAIENT. The general treatment may be the same as is recom- mended under the head of general dropsy, to Avhich may be added locally a tight-laced waistcoat, or tight bandages round the abdomen. This will serve to keep the disease in check, till the vessel arrives in port, where, if the SAvelling be very great, it may be advis- able to evacuate the Avater by an operation, Avhich should be performed only by a skilful practitioner. The reaccumulation of water is to be prevented by the means recommended under the head of general dropsy. DISEASES OF THE BELLY. 69 OF THE LIVER. ACUTE INFLAMMATION OF THE LIVER. S\rAIPTOMS. Pain in the right side, under the short ribs, which is increased by pressure ; sometimes it extends to the chest, then resembhng pleurisy, and often there is pain in the right shoulder; irregular state of the bowels ; inability of lying on the left side ; dry cough. The inflammation, if not reduced by the seventh or tenth day, usually ends in the formation of matter. In the former case, a bilious looseness ensues ; if an abscess form, it may break inAvardly into the chest or abdomen, or outA\~ardly through the skin. The most frequent cause is the hot and unhealthy climate of In- dia and China, and the neighboring islands. TREATMENT. Every exertion should be made to reduce the inflam- mation, as early as possible. Bleed, and purge freely Avith calomel and oil; apply a large blister over the hver, or part affected with soreness ; and abstain from sohd food and stimulants. In India, a sahvation should be produced as soon as possible, with calomel and opium. If an abscess form and break, the patient's strength must be supported by bark and wine, and bitters, and elixir vitriol. When this disease has once attacked a person in hot climates, as India or China, he will often require the use of the blue pill, or of calomel, for years after. A change of chmate is indispensable for the restoration of health. If the abscess point outwardly, and threaten to breakthrough the skin, the part should be poulticed. 70 DISEASES OF THE BELLY. CHRONIC INFLAMMATION OF THE LIVER. The attack of this is generally so gradual, and the symptoms at its commencement so obscure, as to pass long unnoticed. There is dejection of mind; a loss of appetite ; rumbling in the bowels; sense of weight and distention in the stomach ; obstinate costiveness ; clay-colored stools ; jaundice ; and oftentimes an en- largement of the hver, that can be felt. TREATMENT. Induce a slight spitting with mercury, applied by friction, and given internally ; thus, calomel pills, or four grains of calomel, or six grains of blue pill, every night and morning, and rub mercurial ointment, of the bulk of a nutmeg, on the inside of the thighs, every evening. Apply to the part a plaster of mercury or of pitch, of the size of the hand and thickness of a dollar. SEA-SICKNESS. With very feAv exceptions, this attacks all persons, on their first voyage ; and the degree of it is generally mversely proportioned to the size of the vessel, it being most violent where the vessel is small, and least so in large vessels, on which the waves make but slight impression. Some persons, however, are more liable to sea-sickness than others. Those in the prime of hfe, and of a fair, light complexion, have been re- marked to be most susceptible of its attacks, while old persons, and those of a dark complexion suffer least. Ine duration of sea-sickness is very uncertain, being generally not above a day or two; but in many cases it continues for weeks, or even months, and there are some seamen who always suffer an attack in tempest- DISEASES OF THE BELLY. 71 uous weather, even after having followed the sea for many years. TREATMENT. Though time is perhaps the only cure, various rem- edies have been directed to alleviate this complaint. In slight but lingering cases, in which nausea and headache continue a long time, without vomiting, it will cut short the symptoms to cleanse the stomach and bowels by a draught of sea-water ; and a tea- spoonful of ether, in a glass of Avater, Avill often re- lieve slight cases. The little food taken at a time should be eaten cold and highly seasoned, and the pa- tient should keep upon the deck, with his face to the windward. In severe cases, Avhen no longer able to keep upon the deck, try a recumbent posture, resting the head on a book, or other hard substance, and continue as much as possible in a uniform position, with the eyes closed, and the thoughts engaged on some interesting and agreeable subject, till sleep comes on, or till vomiting has ceased. When the system has in this manner be- come accustomed to the rolling in one posture, and sickness has ceased, try another. In this way the rolling of the ship will cease to excite vomiting in a much shorter time than Avhen the posture is continually changing. Dr. Johnson ascribes sea-sickness chiefly to the im- pression produced on the optic nerve, and transmitted to the brain, by the continued motion of the vessel, sails, shrouds, &c, and thinks that by keeping the eyes closed, this disagreeable nausea is frequently pre- vented. Dr. Maxwell regards it as a disease of de- bility, and recommends stimulants, such as brandy, and either to walk about, or to keep in a horizontal posture. 72 DISEASES OF THE BELLY. ON THE STOMACH. INFLAMMATION OF THE STOMACH. SYMPTOMS. Fever ; anxiety; heat and pain in the space between the pit of the stomach and navel, increased when any thing is taken into the stomach; vomiting; great thirst; hiccup ; coldness of the extremities; small, frequent, hard, and contracted pulse ; prostration of strength ; cold, clammy sAveats. One of the most certain signs of this disease, is the sense of pain Avhich the patient feels upon taking any kind of food or drink, especially if it be too hot or too cold. CAUSES. Cold liquids, drank when the body has been heated by exercise ; the operation of poisons taken into the stomach, as arsenic, or of acrid substances acting chemically ihere ; something acting mechanically and lacerating the coats of the stomach ; transfer of gout from the toe. TREATMENT. As twelve horns may, in some instances, carry off the patient, no time is to be lost in applying the reme- dies, which are : 1. Copious bleeding ; to this the smallness of the pulse will be no objection, for it will become fuller by the loss of blood. 2. A large blister, applied over the stomach. 3. The use of the warm bath, even until fainting comes on. 4. Mucilaginous drinks in very small quantities, and often, as flax-seed tea, barley-water, and gum arabic, dissolved in Avater, with a few drops of laudanum. 5. Clysters of Avarm water. Where poisons have been taken intentionally, or by accident, as opium, arsenic, corrosive sublimate, ver- DISEASES OF THE BELLY. 73 digris, &c, administer an emetic immediately, of the most active kind, as Avhite or blue vitriol, fifteen grains, dissolved in a gill of water, adding twenty grains of ipecac: drink freely afterwards of diluting hquors, as barley-water, toast-water, flax-seed tea, and milk. VOMITING OF BLOOD. SATVIPTOMS. Vomiting of large quantities of clotted blood, and sometimes mixed Avith alimentary matter, generally unattended by cough, and preceded by a sense of weight and dull pain, or anxiety, a httle below the pit of the stomach. CAUSES. Generally, some external violence ; or some me- chanical injury to the stomach itself, or some great strain of the body. TREATMENT. If accompanied by heat of the skin, or other symp- toms of fever, or if the disease can be traced to vio- lence or exertion, bleed and keep the patient cool, avoiding all causes of irritation. Unless the bleeding from the stomach become alarming from its quantity, it will be advisable not to arrest it by astringents, but suffer it to stop of itself. The day following, give a mild laxative, as of cream of tartar, castor oil, or a small dose of salts, to remove the blood from the bowels. Subsist for two or three days on light food, as bar- ley, rice, fresh broth, etc. When inflammation has subsided, give decoction of bark, or quassia, in a dose of two table-spoonsful every three hours, addmg to each dose ten drops of elixir vitriol. 6* 74 DISEASES OF THE BELLY. HEART-BURN, AND SOUR STOMACH. These are caused by weakness of the stomach, and indigestion. TREATMENT. Take some alkaline substances, as powder of chalk or magnesia, a teaspoonful or tAvo, or soda in Avater, and attend to the directions given under the head of Dyspepsia, or Indigestion. Abstain from stale liquors, acids, windy and greasy aliments, and take no exer- cise immediately after a full meal. OP THE INTESTINES. INFLAMMATION OF THE INTESTINES. SYMPTOMS. Severe pain in the abdomen, increased upon pres- sure, and shooting in a twisting manner round the na- vel ; hardness of the abdomen ; obstinate costiveness. There is sometimes vomiting or straining at stool, ac- cording as the inflammation happens in the superior or inferior portion of the intestine. The pulse is quick, hard and contracted, and the urine high-colored, and there are other symptoms of fever, with great prostra- tion of strength. CAUSES. All those inducing inflammation of the stomach, also strangulated hernia, colic, long continued costiveness. It is distinguishable from colic by being accompanied with fever, and by increase of pain from pressure. TREATMENT. The indications of cure are, DISEASES OF THE BELLY. 75 1. To reduce the inflammation by bleeding once or twice from the arm, by a large blister laid over the belly, by the Avarm bath, and by total abstinence from stimulating articles of diet or medicine. 2. To move the bowels by gentle purges, as castor oil, salts, or cream of tartar ; and by clysters of salt water. CHOLERA MORBUS; OR VOMITING AND PURGING. SArMPTOAIS. A frequent discharge of bile by vomiting and purg- ing, accompanied by pain and distention of the stomach, thirst, great anxiety, cramp in the lower extremities, cold sweats, hiccups, and not unfrequently death within the space of twenty-four hours. CAUSES. Exposure to excessive heat, or sudden transitions from heat to cold; hence more frequent in autumn from exposure to cold evening air, after very hot days ; large quantities of food of difficult digestion; the colder fruits, as cucumbers, melons, &c.; active and violent purges; poisons; putrid animal food, as lob- sters ; exposure to the effluvia of putrid animal and vegetable substances. When it terminates favorably there is a gradual diminution of the symptoms, especially of vomiting, followed by sleep or a gentle moisture on the skin. The disease, Avhen protracted to the fifth, sixth, or seventh day, seldom proves fatal. Unfavorable symptoms are strong cramps in the legs or arms ; convulsions ; great prostration of strength ; cold, clammy sweats ; intermitting pulse ; foetid vom- iting ; and great distention of the abdomen. TREATMENT. The first thing to be done is to remove offending 76 DISEASES OF THE BELLY. substances from the stomach and bowels. This, how- ever, has in most cases been already effected by nature. If vomiting and purging have therefore occurred fre- quently, endeavor to allay the existing irritability by opium and diluting drinks. Begin Avith two tea- spoonsful of laudanum, mixed in gruel or tea, and repeat the dose every half hour till the vomiting is arrested. An excellent remedy is powdered sugar, chalk, and gum arabic, rubbed together — a table- spoonful of each in a gill of water till they form a sort of cream, add four tea-spoonsful of laudanum, and give a table-spoonful every half hour till the sickness abates; give at the same time thin gruel, arrow-root, or chicken-broth frequently, but in very small quanti- ties. Laudanum and spirits of hartshorn, equal parts, mixed, are to be rubbed over the stomach constantly. When, in spite of this treatment, the vomiting con- tinues unabated for two or three hours, administer laudanum in clysters, thus : <— Take laudanum, a half table-spoonful; water, one pint, mixed; inject one half, and direct the patient to retain it as long as possible; when discharged, ad- minister the remainder. A large bhster should now be applied over the stomach, the feet and legs bathed in warm salt water ; hot applications made to the feet; opium given in pills, in a dose of five grains every hour, and the diluting drinks continued. The effer- vescing mixture' should now be given every hour, adding to each dose twenty drops of laudanum. After the vomiting is allayed, give a mild purge, such as is most agreeable to the patient. SPASMODIC OR ASIATIC CHOLERA. As this disease commonly proves fatal even in the hands of skilful physicians on shore and in hospitals, 1 See Appendix. DISEASES OF THE BELLY. 77 Avhere every knoAvn or supposed remedy is at hand, discouraging must be the prospect of treating it suc- cessfully on shipboard, by persons avIio are compara- tively ignorant of its nature, and of the virtues of medicines. Still it is the author's duty to furnish the best advice he can upon the subject. Cholera may be divided into three stages. 1st. a premonitory, or threatening stage; 2d. Avhen it is fully formed ; 3d. a stage of collapse, or sinking. The first stage usually consists in a loose state of the boAvels, Avhich may continue several days, but is often of very short duration ; sickness or uneashiess of stomach, gripes, or severe pain at the pit of the stom- ach, are frequently added. The matters passed are such as are observed in ordinary diarrhoea and vomit- ing ; slight cramps may also be felt. The second is characterized by frequent vomiting and purging, almost always of a pale, Avhitish fluid, in great quantities ; by painful cramps of feet, legs, hands, arms, belly, or other parts ; a painful burning at the pit of the stomach; the features are contracted and sharp ; the eyes sunk and surrounded by a dark circle; apprehension, languor, and suffering are de- picted in the face; the pulse, scarcely quickened, is feeble; the surface, especially hands and feet, colder and perhaps of a darker color than natural; there is great thirst, Avhile drinks of every kind are generally vomited almost as soon as taken ; the breathing is slow, or not much disturbed;. the voice feeble, Avhispering, husky; the secretions in general are suspended; urine is not, apparently, formed ; hiccup is not unfrequent; there is great tendency to sinking, and the person seems older than he really is. In some feAv cases, there is not purging; in some scarcely any vomiting or cramp, the disease being chiefly marked by a pain- ful load, or tightness of chest and stomach, and a rapid sinking. The third stage, that of collapse, gradually succeeds to the second. In it the person seems to relapse into 78 DISEASES OF THE BELLY. a state of tranquil heedlessness ; he will answer ques- tions correctly, even just before death, but with slow- ness ; the pulse is lost at the wrist and other parts; tibte dark or blue color is more decided, yet in many this symptom is not observed; the vomiting and purg- ing cease, or become less frequent; " the skin is very cold, and generally damp, giving to the touch the sensation felt from handling a frog ;" the tongue, which is often furred, is cold; even the breath is cold; the fingers, hands, and other parts lose their usual plump- ness, and become shrivelled; the patient tosses about incessantly, the breathing becomes laborious, and death takes place, in most cases, without any struggle. Such is the usual course of the disease, if left to itself, many varieties occurring in quickness and inten- sity. The first stage may be so short as to seem want- ing, or consist only in pain and cramp at the pit of the Stomach. The second stage may not endure an hour, or extend to two or three days. The entire may end in death in two or three hours, or not for several days; a long premonitory stage is not always followed by a mild form of cholera. When medicine is administered, and in rare cases without it, the progress is not so certainly tOAvards death. In general a speedy convalescence may be predicted if attention be given in the first stage. A large propor- tion of deaths is clearly owing to the want of imme- diate assistance. If the first stage has been neglected, either by rea- son of its shortness, or its not causing alarm, not an instant should be lost; the friends of the patient must not yield to the same fatal listlessness that is observed to seize on the person attacked. By proper means it is still probable that the natural tendency to collapse may be averted, the evacuations checked, the spasms moderated, and health restored. These changes may, as in the first stage, be speedy, the return to health being often preceded by tranquil sleep and free pre- spiration. DISEASES OF THE BELLY. 79 Treatment in the first stage.—If it consist in purging, with occasionally shght vomiting, give a pill or a pow- der of calomel and opium, four grains of the former to one of the latter, and repeated as often as the stom- ach rejects it, and if the stomach retain it, repeat it every hour until a bihous discharge is produced, or the patient falls asleep. The person should keep warm in bed ; drink toast water, arrow root, rice water or barley water, and take nothing acid. Should the dis- ease not cease in an hour or two, but tend to Avar ds the second stage, Avith increased frequency of discharges, give three to five grains of acetate of lead, or of pow- dered alum, every tAvo hours, and apply strong stim- ulants over the abdomen, as a plaster made of mus- tard and pepper-sauce or sharp vinegar, and rub the extremities Avith mustard and Cayenne, or with spirits of turpentine. In the second stage.—There should be administered injections of thin starch or gruel, containing two tea- spoonsful of laudanum to a pint, and repeated often, the calomel and opium repeated, mustard apphed ex- tensively by mixing it in spirits of turpentine and pep- per-sauce and rubbed in hard over the limbs and trunk ; cloths dipt in hot water should be constantly applying, of greater heat than the attendants can bear their hands in, pieces of ice or cold water may be swalloAved often. Treatment of the third stage will be a continuation of that of the second stage. Cayenne may be added to the calomel and opium, or aqua ammonia, (harts- horne) half a tea-spoonful in cold Avater, ether a tea- spoonful. . The disease is not contagious, but endemic. It is apt to spread among a creAv or other community, because they are ahke exposed to one and the same atmospheric cause, but they do not communicate it to each other. 80 DISEASES OF THE BELLY. COLIC. SYMPTOMS. The principal symptom is pain about the navel, generally violent, shooting and tAvisting, occurring in fits, during Avhich the patient is disposed to bend down and press upon the part. The bowels are commonly costive, sometimes there is nausea Avith vomiting, and bitter taste in the mouth. CAUSES. Cold applied to the surface of the body, especially to the feet and belly; crude or indigestible food ; re- dundance of bile ; obstinate costiveness ; flatulency; certain metallic poisons, as lead and copper. Those, whose bowels are easily disordered, are liable to an attack of colic, from remaining in a room newly painted. TREATMENT The first step is to allay the pain by opiates. Give opium and powder of camphor, of each two grains mixed, every half hour, till the pain is relieved. Immediately after the second dose of opium, give a purgative of castor oil, three table-spoonsful,' and if it fail to operate in three hours, give a fourth table- spoonful. Or, give such other purgative as is most agreeable. It will aid the operation of the medicine to dash cold water on the abdomen. In obstinate cases, it will be necessary to give still more active cathartics, as calomel from twenty to thirty grains, and to administer injections of salt water Should vomiting ensue, and the pain still continue apply a large bhster over the abdomen, and immerse the patient in a warm bath. For a slight wind cohc, a little spirits of camphor, or a few drops of peppermint, will often be sufficient. DISEASES OF THE BELLY. 81 DIARRHCEA, OR LOOSENESS. SYMPTOMS. Frequent and copious evacuations by stool, gener- ally Avith griping; oftentimes there is nausea and vomiting; thirst; bitterness and dryness of the mouth. If the disease continue, it produces great emaciation. CAUSES. The apphcation of cold to the surface of the body, especially, if accompanied Avith moisture ; acrid; indi- gestible food; great quantities of acid or cold fruits; putrid substances. In the Mediterranean, it is often caused among sailors by drinking freely of neAv Avine. The crew of the frigate Java, while lying at Syra- cuse, 1816, Avere put upon the use of neAv wine, m place of spirits, and nearly every man suffered an at- tack of diarrhoea. In other warm climates, as the West Indies, spruce beer, and other fermented liquors, often occasion it; and in all climates, the sudden change from the long continued use of salt provisions to fresh meat and vegetables. TREATMENT. The cure consists, 1. In obviating the cause. 2. In suspending the inordinate action of the bowels. 3. In restoring their strength and healthy action. Irritating causes are often lurking in the intestinal canal, and must be removed : 1 By a cathartic, as rhubarb, magnesia, or castor oil, in a common dose, or by a draught of sea-water. 2. By diluting drinks, as gruel, flax-seed tea, or barley-water. . After the bowels have been cleansed by a cathartic, their inordinate action is to be suspended: 1. By opium, conjoined with some medicme that 7 82 DISEASES OF THE BELLY. will produce sAvcating; thus, opium, from one to two grains, ipecac, three grains, mixed in syrup, or mo- lasses, and taken every three hours; or, Dover's powder, 12 grains. In slight cases of diarrhoea, it will be sufficient, after cleansing the boAvels, to take an opium pill in the evening, or twenty drops of laudanum. 2. By astringents, as kino, twenty grains; or lime- water, from four to six table-spoonsful; or rhubarb, three grains ; or powdered alum, every three hours. When the disease proceeds from some error in diet, it will often terminate in a short time of itself, or per- haps the most that may be required in such cases will be a gentle laxative and gruel. To restore the strength: In severe cases where debility of the parts exists, their strength may be restored ; 1. By a decoction of bark, and other vegetable bitters, as columbo, quassia, ginseng, &c. 2. By moderate exercise. 3. Light nutritive diet, and port wine, should be substituted for malt liquors, as a common drink. The water of particular places often causes diarrhoea in ships' crews. The frigate Guerriere took a supply of Avater from the river Neva in Russia, and when it was used by the crew, about every sailor in the ship was affected with purging. In this instance and some other similar ones, I found that a pint of quick lime poured into each water cask corrected its purgative quahty. Soaking burnt bread, or quenching burning coals in it, produced the same effect. The last of the ebb-tide furnishes water, both at Cronstadt and Canton, that is not purgative. DYSENTERIA. SYMPTOMS. Severe gripings, often preceded by loss of appetite ; sickness at the stomach; costiveness, and chills; fre- DISEASES OF THE BELLY. 83 quent inclination to go to stool; heat and irritation in the fundament; appearance of stools various, being shmy, sometimes bloody, in this respect differing from those in diarrhoea, Avhich are like common stools, only of a thinner consistence. Sometimes hardened lumps are discharged in the slime, and then the patient is momentarily relieved of his gripings. In some cases a film of hardened mucus is discharged, resembling a coat of the intestines. There is violent strainmg at stool, and the patient feels a bearing down, as if the boAvels Avere falling out, and sometimes a part of the intestines is actually protruded. Great debility very soon ensues, Avith a quick and Aveak pulse. Sometimes it terminates fatally, and it is most severe Avhen epi- demic. In India and the neighboring islands, it dif- fers in character from the common cases of temperate regions, the liver being more affected, and pouring out an excess of bile, often Avith blood, whence it is called bloody flux. CAUSES. It may be occasioned by Avhatever obstructs perspi- ration, as a damp bed, Avet clothes, &c, also by unripe fruits; bad air ; moisture succeeding intense heat; unwholsome or putrid food; the effluvia of vegetable or animal substances, in a highly putrid state. Per- sons hving in croAvded apartments, as in ships, are more hable to attacks. TREATMENT. Cleanse the bowels with calomel, ten grains, mixed in a table-spoonful of oil. If the pain be violent, give two grains of opium, mixed with the above; or, in- stead of the above medicine, give the cooling mix- ture,1 three table-spoonsful every half hour, till it ope- rates upon the stomach and boAvels ; adding to the first dose, thirty drops of laudanum; or, where there is ' See Mixtures in the Appendix. 84 DISEASES OF THE BELLY. great aversion to an emetic, give castor oil, two table- spoonsful, Avith thirty drops of laudanum, and repeat the dose in three hours. FoIIoav the use of the above medicine, with frequent and copious draughts of diluting drinks, as flour gruel, barley-Avater, flax-seed tea, &c. After clearing the bowels, give Dover's powder, eight grains every three hours, and a table-spoonful of oil every day, until the disease yields. In severe cases, Avhere great pain and inflammation exist, after the stomach and bowels are cleared, a blis- ter may be applied over the abdomen, and fifteen or twenty drops of laudanum given every hour in the patient's drink, till rehef is obtained. In less severe cases, instead of the blister, it may be sufficient to bathe the boAvels with hot peppered vinegar, or hot water. Bleeding is a doubtful remedy in dysentery, and un- less the case be severe and the constitution vigorous, should not be employed. When there is great pain in the lower part of the abdomen and fundament, and the evacuations fre- quent, administer clysters of flax-seed tea, or barley- water, one pint, and laudanum a table-spoonful. Half of this is to be injected at a time, blood warm, and retained by the patient as long as possible. From the first attack the patient should abstain from sohd food, and take freely of gruel, barley-water, arrow-root, flax-seed tea, or solution of gum arabic. The pulp of a roasted apple, or other ripe fruit may be taken. At a more advanced period of the disease, when the frequency of the evacuations seem rather to pro- ceed from a Aveakened and relaxed state of the bow- els, than from any active inflammation, the decoction of bark, or of quassia, may be given, every three hours, beginning Avith a dose of a table-spoonful and increasing gradually. It may be mixed in gruel or barley-water ; or give one grain of quinine, every three hours. DISEASES OF THE BELLY. 85 When the pain and inflammation are abated and the stools are more natural, commence with animal broths, as of mutton, chicken, &c, at first thin and unseasoned, but gradually increasing their richness as the disease declines. Since the first edition Avas printed, I have acciden- tally met with a prescription in the hands of an irregu- lar practitioner Avhich, so far as I have known, has never yet found its Avay into any printed medical book — I have made repeated trials of it, as have my pro- fessional brethren, and no medicine in our hands has, in all common cases, ever proved so successful. It is this. Mix Avith a small phial of Avater, as much sul- phate of zinc or Avhite vitriol, as the water Avill dis- solve, take one part of this and five parts of lauda- num mixed — give to an adult fifteen drops every three hours, increasing the dose one drop daily — a dose of oil should precede the use of it, and should be repeated every other day, Avithout omitting the drops. In India, where the disease is very prevalent and destructive, large doses of calomel, say twenty grains, are given with a grain of opium every six hours, and once in twenty-four hours a dose of castor oil. When this disease appears on board ship, it is of the first importance to prevent its being communicated to all hands on board ; to do this, the most assiduous attention should be paid to cleanliness. The evacua- tions of the sick must be immediately thrown over- board, and the buckets Avashed. Those Avho are well should avoid the night air as much as possible, shun putrid smells, and avoid all communication with the sick, and the privy to which the sick go. PILES, Are painful swellings at the lower extremity of the intestine or fundament, either internal or external. 7* 86 DISEASES OF THE BELLY. The internal are most painful, especially while at stool. When external, they vary much in size, being sometimes as large as a nutmeg. Frequently they break and discharge blood, Avhich relieves the pain: the swelling hoAvever, does not then entirely disappear, and soon increases again to its former size. CAUSES. This complaint may proceed from habitual costive- ness, plethora, hard riding on horseback, strong aloetic purges, or sitting on damp ground. TREATMENT. As costiveness is the most frequent cause of piles, this must be obviated by mild laxatives, and none ap- pears to be more efficacious than the use of the poAV- der of sulphur combined with an equal quantity of cream of tartar, mixed in molasses, in a dose of a table-spoonful every evening. Or take a gill of sea- water every evening. Another excellent internal re- medy is balsam of copaiva twelve drops, given twice in twenty-four hours dropt on sugar or in a glass of water. Aloetic purgatives should be avoided, and all family pills. As an application to the tumors, various ointments and washes are recommended, among which are the folloAving. Sulphur and hog's lard, equal parts, well mixed. nutgalls and hog's lard, equal parts; mercurial oint- ment, or fresh butter ; also, tar-water, alum-water, decoction of oak bark, lead water. A favorite apph- cation Avith many sailors is wet oakum. If the piles continue after the above treatment, and are very painful, apply leeches to the part, or if they are not.to be had, make a small puncture in the tu- mors Avith a lancet, and after discharging their con- tents, apply warm poultices to the part. When the bleeding piles return periodically, once in three or four Aveeks, the discharge may be consid- DISEASES OF THE BELLY. 87 ered salutary, and should not therefore be stopped, unless it becomes so excessive as to weaken the pa- tient, in which case the decoction of bark or of quas- sia, may be taken in doses of three table-spoonsful every two hours, adding to each dose ten drops of elixir vitriol. Alum or lead water, dissolved, added to a decoction of oak bark, is to be applied to the part, and injected in small quantity into the intestine, by means of a penis-syringe. In some instances, a falling down of the intestine will be a troublesome attendant on the piles, in which case the intestine must be immediately replaced after every evacuation, by pressing gently upon the part with the fingers, until it is reduced; and its return must be prevented by astringent apphcations, as alum dissolved in vinegar, decoction of oak bark, sugar of lead dissolved. All the known causes, particularly costiveness, both during the disease and afterwards, must be studiously avoided. FISTULA. When the tumors mentioned in the foregoing disease have been suffered to inflame to a considera- ble degree, and by intemperance or ill treatment to ulcerate, a fistula is formed. In almost all cases of this disease, Avhether induced by piles, or other causes, the knife of a surgeon will be requisite. While at sea, however, and out of the reach of surgical aid, the patient, immediately on the least apprehension of a fistula, should keep his bowels open Avith mild laxa- tives of cream of tartar and sulphur, or small doses of castor oil taken every day ; should avoid every thing of a stimulating nature in food or drink, and take great care to irritate the part as little as possible, ap- plying at the same time lead-water externally. When 88 DISEASES OF THE BELLY. in spite of this the inflammation proceeds on to ulce- ration, and pus is discharged from the fundament in such large quantities as to debilitate the patient, he should take bitters and wine, and support his strength with rich diet, till he can reach medical aid. HERNIA, OR RUPTURE. The part in which hernia most commonly appears is the groin. Generally the tumor takes a direction towards the scrotum, but sometimes it pushes into the front of the thigh; the former is called inguinal, the latter femoral hernia. The contents of the tumor are a part of the intestine, or a portion of the omentum or caul, or both together. CAUSES. The most frequent causes in adults are blows, vio- lent exertions of strength, as lifting or carrying heavy weights, straining at stool, jumping, running, &c. When a rupture is produced by bodily exertion, the tumor is formed suddenly, and is generally attended with a sensation of something giving way at the part, and with considerable pain. TREATMENT. Reduce the tumor immediately by the hand. For this purpose the patient should be placed on his back, and the foot of the bed be elevated about twenty inches higher than the head, the thighs should be bent toward the body, and that on the same side with the rupture, inclined inwards. The pressure, which is made on the tumor by the hand of the operator for its reduction, should always be directed upAvards and out- wards for inguinal hernia, and first backwards and then upwards in femoral hernia. If the tumor be not sooner removed, the pressure may be continued half DISEASES OF THE URINARY ORGANS, &C. 89 an hour, but no violence is to be used, as it will tend greatly to aggravate the inflammation, — and the pressure, Avhen it becomes painful, should for the same reason be discontinued. Should these efforts fail of success, the patient must be bled, and then another trial be made, and on failure of this also, use the warm bath, and repeat the effort while the patient hes in the water. Tne next remedies to be employed are, the coldest apphcations to the tumor, as ether or pounded ice, and Avhere these cannot be obtained, a mixture of equal parts of nitre and common salt, in the proportion of half a pound of the mixture to a pint of Avater, kept constantly apphed to the tumor. Finally, try an injection of tobacco made by boiling one drachm of tobacco in a pint of water for ten minutes. When all these means fail, if a surgeon can be had competent to perform the operation for stran- gulated hernia, he should be called, and always within the first twenty-four hours. With the vieAv of guarding against the dreadful consequences of a strangulated hernia, a ruptured per- son should immediately procure a well-adapted elas- tic spring truss, and wear it during the day, without intermission. DISEASES OF THE URINARY ORGANS AND GENITALS. OF THE URINARY ORGANS. INFLAMMATION OF THE KIDNEYS. SYMPTOMS. Fever, pain in the small of the back and thence shooting downward; drawing up of the testicles; numbness of the thigh ; vomiting ; commonly at first a deep red color of the urine, which becomes pale and colorless as the disease increases, and is discharged 90 DISEASES OF THE very often Avith pain and difficulty ; costiveness and some degree of colic ; pulse frequent, hard and small. CAUSES. Acrid substances acting on the kidneys ; external injury ; long continued and violent exercise on horse- back ; violent exertions, strains, &c; but the most frequent cause is calculi or gravel, lodged in the kid- ney, or in the duct that leads from it to the bladder. TREATMENT. 1. Bleed from the arm, and repeat the operation ac- cording to the urgency of the symptoms. 2. Admin- ister cathartics of the oily kind, as castor or sweet oil, and give glisters of barley-water, or flax-seed tea. When the pain is very great, administer a tea-spoon- ful of laudanum in the clyster. 3. Give copious draughts of diluting drinks, as flax-seed tea, and thin gruel, &c. 4. Let the warm bath be repeated ac- cording to the violence of the pain. The back should be bathed with flannels dipped in hot water. INFLAMMATION OF THE BLADDER. SYMPTOMS. Fever, acute pain, tension and tumor in the region of the bladder, frequent and painful discharges of urine in small quantities and inflammation in the funda- ment ; sometimes there is complete obstruction to the passage of the urine; severe cases are attended by vomiting. CAUSES. Mechanical injury; gravel; the inflammation of a severe clap extended along the urethra to the bladder; in some persons sudden cold will cause it. URINARY ORGANS AND GENITALS. 91 TREATMENT. In severe cases adopt the same treatment that is re- commended in inflammation of the kidneys. In shght cases, proceeding from cold, or a clap, it may be sufficient to open the bowels. Inject the urethra and bladder Avith flax-seed tea, or barley-Avater, milk warm. Five or six penis-syringes full are to be fre- quently thrown in at a time, in order that some may pass into the bladder, Avhere it is to be retained as long as possible; and some kind of fluid is to be drank in frequent and copious draughts. After the bowels have been moved, laudanum may be given in doses of 40 to 60 drops. BLEEDING FROM THE BLADDER, OR BLOODY URINE. SYMPTOMS. When not the effect of violence, it is preceded by a sense of weight and pain in the loins. It is distin- guished from the high colored urine attendant on many diseases, by the deposite of a coagulum on the bottom of the vessel, and by its staining linen of a red color. CAUSES. It is most frequently caused by gravel in the kidneys, but sometimes arises from external violence or great exertion. TREATMENT. If the disease be the consequence of injury, bleed and give a dose of Glauber's or Epsom salts, or of cream of tartar; also, frequent and copious draughts of flax-seed tea, or barley-water, elixir vitriol, twenty- five drops every two hours, and an opium pill or 60 92 DISEASES OF THE drops of laudanum, every four hours, till bleeding is arrested. If the discharge of blood be very great, give alum, 4 grains every two hours, dissolved in a gill of Avater, or sal nitre 10 grains. If no violence has been sustained to cause the dis- charge of blood, a vein need not be opened, but the other treatment must be adopted. INCONTINENCY OF URINE. SYMPTOMS. In this disorder the urine passes off involuntarily by drops, but does not exceed the usual quantity, as in diabetes, nor is the disease attended with pain. It is rather troublesome than dangerous. CAUSES. Sometimes it proceeds from blows and bruises, or is the effect of fever, or of strong stimulants on the bladder. In old people it may often be owing to a palsy of the neck of the bladder. TREATMENT. The most proper remedies are general tonics, as bark, quinine, or bitters, elixir vitriol, and cold-bath. Perhaps the most effectual remedy ever used is a blis- ter applied to the lower extremity of the backbone. It sometimes cures cases of long standing in twenty- four hours. Until these or some other means succeed, the patient should wear a sponge or bladder, to pre- vent excoriation of the parts. OF STRANGURY, OR SUPPRESSION OF URINE. It is called suppression, when there is an entire stop- page of urine; and strangury, when there is a fre- URINARY ORGANS AND GENITALS. 93 quent inclination to void it, and it is discharged in drops, Avith pain and difficulty. CAUSES. This complaint may proceed from a variety of causes ; as inflammation of the kidneys or bladder ; gravel, or small stones obstructing the urinary passages ; a spasm, or contraction of the neck of the bladder ; acrid injec- tions ; cantharides, either taken internally or absorbed from a blistering plaster. The particular symptoms attending it commonly designate the seat of the disease. TREATAIENT. In all cases of suppression of the urine, it will be advisable to bleed from the arm, in quantity propor- tioned to the strength of the patient, and the urgency of the symptoms. This should be folloAved by gentle purgatives of salts, oil, or cream of tartar, by warm injections of barley-Avater, or flax-seed tea, by the warm bath, the patient sitting up to the middle in Avater, and by flannels dipped in hot Avater, and applied to the abdomen. Administer repeated doses of opium, or of laudanum, a tea-spoonful, mixed in Avarm drink, and repeat the dose every half hour, till it relieves. The apphcation of ice to the feet and legs is highly recommended. If a suppression of urine do not yield to the above treatment, introduce a catheter or bougie, as directed under the head of Operations, and draw off the water. The diet, during the continuance of the complaint, should be of a light kind, and taken in small quantities. GONORRHOEA, OR CLAP. This disease is communicated from one individual to another by sexual inter course, and is generally con- sidered a local affection. It sometimes commences in 8 94 DISEASES OF THE two or three days after the infection has been received, and at others, not before the lapse of several weeks; but it commonly makes its appearance in between six and ten days. The first symptom is an itching at the orifice of the urethra, or urinary passage, and shortly after, there is a discharge from the part, of a thin, trans- parent matter, Avhich soon becomes Avhite, and after- Avards changes to a yellow or green color. A slight degree of redness and inflammation begins to appear about the lips of the urethra, and a heat and smarting pain in most cases are felt in every attempt to make water. There is commonly a sense of fulness about the end of the penis, and frequently a soreness along the course of the urethra, accompanied AA^ith more or less pain in erection. In severe cases the erections become more frequent and lasting than in health, particularly Avhen the patient is Avarm in bed, and the penis is curved dowinvard Avith considerable pain, Avhich is called eltordee, and this is sometimes attended Avith a slight bleeding at the time of passing the urine. When inflammation runs high, the heat and scalding of the urine, as Avell as the chordee, are extremely troublesome ; there is a constant inclination to discharge urine, Avhich is often attended with much difficulty, and sometimes it is rendered only by drops. There is also a sense of pain, heat, and fulness about the testicles and fundament, and the running is very copious, of a greenish and sometimes a bloody color. But in ordinary cases, where proper attention is paid to the disease, feAv or none of the last mentioned symp- toms occur, the disease merely consisting in a slight heat and scalding in making water, and a running, all Avhich gradually subside, in ten or fifteen days. In consequence of violent inflammation, the prepuce or foreskin sometimes becomes so swelled, that it can- not be draAvn back; Avhich symptom is called a phymo- sis ; or that being draAvn behind the glans or head of the penis, it cannot be brought fonvard; which is known URINARY ORGANS AND GENITALS. 95 by the name of paraphymosis. The treatment of these Avill be given hereafter. A SAvelling of one or both testicles often arises in gonorrhoea in consequence of cold, severe exercise, or astringent injections. (For the treatment of this, see SAvelled Testicles.) TREATMENT. On the first appearance of the clap abstain from every kmd of high seasoned food, as Ave 11 as stimulating liquors, and subsist on a mild, easy diet, as of milk, ATegetables, broths, puddings, rice, &zc, and commence taking freely of barley-Avater, flax-seed tea, or a solu- tion of gum arabic. Avoid all severe exercise, particu- larly Avalking, or riding on horseback, as Avell as vene- real intercourse, and even lascivious thoughts. During the inflammatory stage use injections of a mild and soothing kind, as flax-seed tea, new milk, or barley-Avater, blood-Avarm, repeating them as often as eArery two or three hours. In this stage also it is of importance to move the boAvels every two or three days, Avith a mild purge, as castor oil, cream of tartar, or salts. If chordee be troublesome, take a grain of calomel and opium, on going to bed, and apply frequently to the extremity and along the under side of the penis, rags Avet Avith a solution of sugar of lead, made Avith one drachm of the lead to a pint of Avater. When the inflammation runs very high, is attended Avith great pain and a constant inclination to make Avater, inject flax-seed tea and laudanum into the rec- tum, in the quantity of one gill of the former to a tea- spoonful of the latter, and continue the diluting drinks aboAre mentioned. With this treatment relief Avill be obtained imme- diately, and the inflammation, in most cases, subdued in two or three days. After which, instead of the above, it will be advisable to use for the urethra one of the folioAving injections: 96 DISEASES OF THE Sugar of lead and white vitriol, of each six grains, water one pint; or ten grains of either may be used separately. These injections should be used cold every three or four hours. If employed before inflammation be sub- dued, they are apt to cause a SAvelling of the testicles. There are many practitioners, even at the present day, who maintain that gonorrhoea or clap, and the venereal disease or pox, are one and the same disease, arising from the same infectious matter ; and recom- mend the use of mercury alike in both. On this sub- ject, ten years very extensive practice in these com- plaints, on board ships of Avar, and tAventy on shore, have serATed to convince me, that the two diseases are essentially different, and that a mercurial action, Avhich may, in some cases, be necessary in the cure of pox, is of no sort of utility in gonorrhoea. Another mode of treating clap, and Avhich I have more generally adopted of late years, is to give balsam copaiva, tAventy drops, three times a day, on sugar or dropped on the surface of a wine-glass of water, to Avhich a tea-spoonful of spirits of nitre may be added — this, Avith a very abstemious course of living, and mild laxatives daily, as Epsom salts, Avill alone effect a cure Avithout the use of injections. GLEET. When a clap is neglected, or ill treated, or the pa- tient irregular in his habits, it may continue for many months, and on subsiding leave a Aveakness and mu- cous discharge from the urethra, called a gleet; it is unattended by pain or scalding, in making water, and is the consequence of relaxation. TREATMENT. It may be treated by stimulating diuretics, as bal- URINARY ORGANS AND GENITALS. 97 sam of copaiva, and spirits of nitre, in a dose of tAventy drops of the former, to a tea-spoonful of the latter, in a wineglass of Avater, three times a day ; by injections of blue or Avhite vitriol and alum dissolved in Avater, made of such strength only, as to irritate the part in a slight degree. They are to be used four times a day, and continued many days after the run- ning has ceased. Cold Avater or ice should be applied near to the seat of the affection, night and morning. STRICTURE. Another evil to be apprehended from the long con- tinuance of clap, especially, if it has been attended AA'ith inflammatory symptoms, or has recurred fre- quently, is the taking place of stricture in the urethra, causing a partial and sometimes total closure of the passage. This complaint is particularly apt to folioav those cases of clap, Avhich are apparently cured, but AAThich break out from time to time, in consequence of some irregularity in the patient's habits, as drinking freely of stimulating liquors, taking too much exer- cise, venereal gratification, ece. TREATAIENT. The daily use of a bougie. Previous to its intro- duction, it should be shghtly curved, and covered with oil, to prevent irritation. It ought to be Avorn at first for about half an hour, gradually increasing the time, from day to day. The size of the bougie is also to be increased, as the resistance to its passage becomes diminished. In those cases Avhere a bougie, even of the smallest size, cannot be passed, as likeAvise in those of such long standing as to preclude the hope of a recovery from its use, recourse is to be had to the application of caustic, which is to be trusted only in the hands of a surgeon. 8* 98 DISEASES OF THE OF THE GENITALS. SYPHILIS, OR VENEREAL DISEASE. CHANCRE. This disease is induced by the operation of a spe- cific poison, generally imbibed from an affected person during sexual intercourse, and circulated through the Avhole system. In almost every case it first appears in the form of an ulcer or chancre, about the glans or head of the penis, frequently near the frenum or string. Generally a small itching pimple, containing a Avatery matter, is first discovered, Avhich soon bursts, and leaves a circumscribed painful sore, but some- times the first appearance is an abrasion of the skin. The ulcer assumes a foul and rough appearance, with hardened edges, discharges a foul greenish matter, and differs from other ulcers, in its total indisposition to heal. The period of the appearance of chancre, after receiving the infection, varies from five or six days, to as many weeks. TREATMENT. This may be divided into general and local. In the former, Avhich is by far the most important, mercury is not indispensably necessary, especially when the disease is recent. On the first appearance of chancre, the patient should take a dose of physic of a cooling kind, as salts or oil, and abstain from all stimulants, and from animal food, for several days. He should, on the day after taking the physic, apply the stick of caustic to the surface of the chancre; the physic and the caustic may be repeated tAvo or three times on the succeeding days. After each touch of the caustic, the chancre should be dressed Avith lint, besmeared with soft ointment or Avith talloAv or oil; and a soft rag Avet several times a day in lead Avater should be applied over the part. In most cases this Avill effect a cure without the aid of mercury. URINARY ORGANS AND GENITALS. 99 But if, from neglect of any part of the treatment or any other cause, the disease Avill not yield, — and one sign of this Avill be the appearance of a bubo in the groin, — then the patient must resort to the use of mercury. The best form of this Avill be the blue-pill at night and morning, and if it excites diarrhoea, ten drops of laudanum may be taken at bed-time. A calomel pill of tAvo grains may be taken instead of the blue pill. With the vieAv of hastening mercurial action in the system, blue ointment may be used in conjunction Avith the pills, and indeed, after one or tAvo doses of the pills, it may be Avell to trust to the ointment alone. It may be used by rubbing a tea-spoonful of it on the inside of the thighs every day, for the space of five or ten minutes, continuing to Avear the same draAvers. This course is to be continued until some impression is made on the system, knoAvn by an uneasy feeling at the back of the head and neck, a slight coppery taste and clamminess of the mouth, and fetor of the breath, with perhaps a slight tenderness of the gums. Any action beyond this, such as salivation, or spitting and sore mouth, Avill do more harm than good. The slightest constitutional impression that can be made is the best; and Avhen this once appears, stop the mer- cury in every form for tAvo or three days, Avhen a blue pill or tAvo may be given to preserve the slight mer- curial action, Avhich should be continued a Aveek or ten days. After this time it Avill be best to discontinue the mercurial course entirely for a Aveek or two, even though the local disease be not cured, for the reason that the long continued use of mercury injures the constitution. It may hoAvever, be resumed in the same manner, and if necessary, for the same length of time, or until the local affection has entirely disappeared. During a mercurial course, abstain from high- seasoned food and spirituous liquors, and subsist on an easily digested diet, as fresh meat, broths, porridges, tea and biscuit, rice puddings, and fruit; preserve a 100 DISEASES OF THE pretty uniform temperature, and keep the clothing dry. If unluckily salivation be produced, or soreness of the gums, use a Avash of Aveak solution of alum, and take sulphur and cream of tartar every evening. I have been thus particular about the use of mer- cury in syphilis, because I think it is likely to be used too indiscriminately. In former editions of this book, I recommended it in all cases of chancre ; but I am now convinced that in recent cases of chancre, it is almost always best to dispense with mercury ; and even in cases of bubo, if recent, it would be advisable to defer its use, provided there is any prospect of soon arriving in port Avhere medical advice can be ob- tained, and Avhere the patient can be less exposed to Avet and cold Avhile under the mercurial influence, and to adopt in the mean time the other remedies before mentioned. But in the commencement of whaling or other long voyages, it may be unsafe to defer the use of mercury as here directed. Avoid irritating the part by exercise, by sexual in- tercourse, and even by lascivious thoughts. PHYMOSIS. Not unfrequently it happens from neglect of large chancres on the head of the penis, that the prepuce or the foreskin becomes inflamed, and so contracted round the head of the penis that it cannot be drawn back, so as to expose the chancres to view, and admit of their being dressed. In such cases the general treatment recommended for chancres is to be continued as above directed, and warm water, containing a little soap, to be injected several times a day, betAveen the skin and head of the penis, for the purpose of cleaning the part, and allaying inflammation. Warm poultices, made of flax-seed and pounded bread, should be ap- URINARY ORGANS AND GENITALS. 101 plied to the part. Occasional attempts may be made to draAv the skin back, and the penis be suspended against the body. If the inflammation be great, lose a pint of blood, and take a close of salts. When these means fail to reduce the inflammation, and large ulcers exist under the skin, Avhich cannot be brought to view, the stricture may be divided Avith a sharp instrument or scissors, its Avhole length, and the part bathed fre- quently in Avarm Avater, and poulticed three times a day, for two days ; after which, dress the Avound Avith lint and simple salve, and the chancres as formerly directed. When the stricture or contraction is caused by the inflammation and discharge of a virulent gonorrhoea, it is to be treated in the same manner as above directed. PARAPHYMOSIS. This is a contraction of the prepuce or foreskin, back of the head of the penis, so that it cannot be brought forAvard. It is induced by the same causes as the pre- ceding disease. The same means are to be employed to reduce the inflammation as in phymosis, adding the frequent ap- phcation with rags of sugar of lead, dissolved in Avater, one drachm of the former, to four ounces of the latter. This and other cold substances are to be applied to the head of the penis, and occasional attempts are to be made to draAv the skin over the part. If, notAvithstanding this treatment, the swelling in- crease, there is danger of mortification ; the skin must therefore be divided by making an incision upon each side Avith a lancet, and the Avound be treaied as direct- ed after the operation for phymosis, 102 DISEASES OF THE BUBO. A bubo is generally the consequence of chancre, though sometimes it is the first symptom of the vene- real. It is a hard, painful tumour, seated generally in the groin. If not subdued the inflammation ends in the formation of matter. TREATAIENT. As the ulcer formed by a bubo, that is suffered to break, is troublesome and difficult to heal, it is of the first importance to subdue the inflammation early, be- fore matter has formed. This must be effected, 1. By purgatives, as salts, or a draft of sea-Avater, taken every two or three days, and subsisting on a light diet, as broths, gruel, sago, barley, rice, puddings, &c. 2. By rubbing the inside of the thigh and leg Avith mer- curial ointment, in quantity equal to the size of a nut- meg, three times a day, continuing it Avith occasional omissions, as hereafter directed, till the bubo is nearly dispersed. 3. By cold applications to the bubo, as Epsom or Glauber's salts, laid on in a small bag, and frequently moistened Avith cold Avater and vinegar, or by a solution of salt and nitre in vinegar and Avater, used very cold, and applied Avith rags every hour. When these means fail to arrest the progress of the inflammation, Ave may hasten the formation of matter by applying caustic to the centre of the swelling, and when matter has formed, a soft poultice maybe applied, till the abscess is about to break, Avhen a small puncture is to be made Avith a lancet, in the most depending part, and Basilicon ointment applied on lint. If after some days the SAvelling continue, apply over it a thick cover- ing of mercurial plaster, spread on soft leather, leaving an orifice in the centre over the sore for the discharge of matter and the introduction of lint. A mercurial action is generally deemed necessary in buboes, but as they are a long time in subsiding, not URINARY ORGANS AND GENITALS. 103 unfrequently some months, a constant mercurial action, kept up all this time might create an unnecessary de- bility of the system ; besides this, it sometimes hap- pens, that from the long continued action of mercury upon the system, the sore turns to Avhat is termed a mercurial ulcer, and is then aggravated, rather than benefited, by the medicine. In buboes of long stand- ing, therefore, after having excited a slight mercurial action by friction, as aboAre directed, and continued it for some days, omit the unction for a Aveek or ten days, and then return to it for five or six days only at a time. The degree to Avhich mercurial action should be ex- cited, need be only till a copperish taste and some fetor of breath appear. The same precautions are necessary in regard to exposure to cold and moisture, that are mentioned in the treatment of chancres. SWELLED TESTICLE. It may be induced by any of the common causes of inflammation, but is more frequently brought on by the use of strong urethral injections, or incautious intro- duction of bougies. It often follows a sudden sup- pression of the gonorrhoeal discharge from cold; sit- ting on Avet grass often occasions it. TREATMENT. The patient should confine himself to a spare diet, and remain in a recumbent posture, Avith the part su- pended or triced up, by means of a bag-truss or band- age. The bowels should be moved by a dose of salts, and if inflammatory symptoms run high, general bleed- ing will be necessary. One of the best local applica- tions is Epsom or Glauber's salts, laid on the part in a small bag, and frequently moistened Avith cold Avater. A strong solution of sugar of lead may be applied cold, every ten minutes, by means of rags, immersed in the liquid. 104 DISEASES OF THE When the disease proceeds from the sudden sup- pression of a clap, a return of the running is to be favored by injections of Avarm flax-seed tea. Should the swelling continue increasing and matter appear to be forming, the part is to be bathed and poulticed. DROPSY OF THE SCROTUM, Is an accumulation of Avater, first perceived at the bottom of the scrotum, Avhich gradually increases, and gives the part a pyramidal shape ; a distinct fluctua- tion is generally to be distinguished. There is no pain or discoloration, and in vieAving the parts near to a strong light a transparency is observable. TREATAIENT. At the commencement of the disease, and when a small quantity of fluid only is collected, it may some- times be dispersed by cold and stimulating applications, as sal ammoniac, dissolved in vinegar and spirit; ni- tre, or Epsom, or table-salt dissolved in the same fluids, applied cold very frequently Avith soaked rags. In general, however, it Avill eventually become necessary to evacuate the fluid by an operation. DISEASES OF THE LIMBS AND LARGE JOINTS. RHEUMATISM. There are two kinds: acute, Avhich is inflammatory, and of short duration; and chronic, Avhich is of long duration, and accompanied by debility. SYAIPTOAIS OF ACUTE RHEUMATISM. They commence with slight fever; very soon fol- LIMBS AND LARGE JOINTS. 105 loAved by an inflammation, sharp pain, and SAvelling in the neighborhood of one or more of the large joints, and this pain increases Avhen the patient becomes Avarm in bed. It is variable, shifts from joint to joint, and leaves the part it occupied, swollen, red, and tender to the touch. The joints most subject to this disease, are the hip, loins, back and shoulder. The pulse is full and hard, the tongue has a slight Avhiteness, the urine is high colored, the blood, Avhen drawn from a vein, exhibits a light colored crust on its surface; cos- tiveness prevails; and sometimes there is profuse sweating Avithout rehef. CAUSES. Obstructed perspiration, occasioned by AATearing wet clothes, lying in damp linen or damp rooms, or by being exposed to cold air, Avhile heated by exercise. Sailors are particularly liable to this complaint, on ac- count of their frequent calls upon deck in rainy Aveather, and sleeping in Avet clothes. Often it attacks sailors on their approach from a AArarm to a cold climate. TREATMENT. This is to be commenced by bloodletting and purg- ing ; the quantity of blood to be taken from a sailor, may be betAATeen one and two pinls, according to the strength of his constitution and the violence of the at- tack, and if the symptoms continue unabated, the ope- ration may be repeated on the folloAving day. As a cathartic, give a dose of salts, or of castor oil, or floAvers of sulphur and cream of tartar, half an ounce of each mixed Avith molasses. When the bowels have been moved, take Dover's poAvders, eight to twelve grains every four hours, and drink freely of warm herb tea and toast-Avater, or barley-waler and gruel. An- other remedy of great value in acute rheumatism, is opium, one grain, taken every three hours, keeping constantly Avarm in bed, and drinking freely of herb 9 106 DISEASES OF THE teas, until the pain is carried off by profuse sAveating. This course should be preceded by a cathartic. When fever has subsided, and the pain is confined to one part, blisters Avill prove useful. Warm fomen- tations tend rather to aggravate the pain of acute rheumatism. The patient should subsist on a Ioav diet, abstain from stimulating drinks, and preserve an open state of the boAvels by occasionally repealing the purgatives before recommended. When the inflammatory symptoms have subsided, the patient may return to a generous diet, and the use of Avine and strengthening medicines. In approaching a cold climate, the master of a ves- sel should attend to the clothing of his creAv, and see that its Avarmth increases in proportion to the coldness of the weather; he should also prevent the men's sleeping on damp beds, or in Avet apparel. If woollen shirts are best for sailors in all climates, they are more particularly so in approaching from a warm to a cold one. CHRONIC RHEUMATISM. It may be either a consequence and termination of the acute rheumatism, or it may be independent of it. In the first case, the parts Avhich were affected Avith inflammation, are left weak, stiff, in some instances swelled, and the pain, before movable, is now usually confined to particular parts: sometimes, however, it still shifts from joint to joint, but is unattended by any inflammation or fever. When not the consequence of acute rheumatism, it is most commonly met with in people at the decline of life. The pains are felt in the large joints, which are increased upon motion, and relieved by artificial Avarmth; the part affected is pale and cold, even Avhen the other parts of the body are warm. LIMBS AND LARGE JOINTS. 107 TREATAIENT. This must differ from that Avhich is recommended in acute rheumatism. General bleeding, as Avell as much purging, Avill be inadmissible. The part affected may be rubbed several times a day Avith volatile lini- ment, or Avith spirits of camphire, and the part rolled in flannel. In long continued and obstinate rheumatic affections, leeches applied to the part Avill be service- able, as also blisters kept constantly running. A val- uable application to the part is a plaster of common pitch, spread as thick as a dollar on soft leather, and sprinkled OArer Avith tartar emetic, five grains to a sur- face as large as the hand. These local applications must be accompanied with such internal medicines as are best adapted to stimulate and AATarm the system and alleviate pain. G um guai- acum is one of the most poAverful general stimulants, and may be taken in doses of fifteen grains, or a small tea-spoonful of the povvder mixed with sugar, molasses, or gruel, every three hours. Or take of the tincture of Guaiacum from two to four tea-spoonsful, in Avine or gruel. Mustard and horse-radish may be used freely. The diet should be rich and stimulating; flannel Avorn next the skin: and exposure to cold night-air, wearing damp clothes, and wetting the feet, should be carefully avoided. To relieve pain and promote sleep, take Dover's powders, ten grains on going to bed. Or a powder of calomel, ipecac, and opium, of each one grain. In the Avinter season a Avarm climate Avould prove highly beneficial. Such persons who Avish to make the tour of Europe, Avould find Italy a suitable resi- dence — Barcelona, Valencia, in Spain, and the Avhole shore of France, from Pau to Piedmont, are good. 108 DISEASES OF THE SPRAINS. Are violent stretchings or twistings of joints, folloAved by painful swellings. They are often a1 tended with Avorse consequences than broken bones, on account of their being more neglected. When a bone is broken, the limb is kept easy, because it is useless ; but Avhen a joint is sprained,'it is slill used, by Avhich it may finally be rendered incurable. The most essential measure is perfect rest, and to insure this, if the case be at all serious, the part may be confined by a pasteboard splint. Warm bathing generally gives more relief than cold. If inflamma- tion run high, or a large joint is affected, leeches or bleeding and general cooling measures must be adopted. AfterAvards liniments may be useful, mod- erate exercise, and bandaging Avith flannel. DISLOCATIONS OF THE LOWER JAW. The lower jaAv maybe disjointed by yawning, or blows. It is readily knoAvn by the patient's inability to shut his mouth — a Avant of correspondence of the patient's teeth—hanging down of the chin, Avhich is sometimes turned to one side — inability to speak dis- tinctly, or to swallow Avithout considerable difficulty. The bone may be replaced by silting the patient upon a Ioav stool, so that an assistant may hold the head firmly against his breasl. The operator is then to thrust his two thumbs, previously wrapped in linen, far back into the patient's mouth, and, applying the fingers to the jaw externally, is to press it strongly doAvnvvards and backAvards, by Avhich the dislocated heads of the jaw may be easily forced into their pro- per cavities. LIAIBS AND LARGE JOINTS. 109 DISLOCATION OF THE SHOULDER. The humerus or upper bone of the arm may be dis- located in Ararious directions ; it happens, hoAvever, most frequently downwards, and very seldom directly upAvards. From the peculiar structure of the joint, as Avell as from its exposure to external injuries, this bone is the most subject to dislocation of any in the body. A dislocation may be knoAvn by a depression or cavity on the top of the shoulder, and an inability to move the arm. When it is doAvmvard or forAvard the arm is lengthened and a sAvelhng is perceived un- der the arm-pit, Avhen it is backAvard, there appears a protuberance behind the shoulder and the arm is throAvn forAvard toAvard the breast. The two shouh ders should be carefully compared. TREATAIENT. A bandage or strong belt is to be passed under the arm-pit of the injured side, and carried over to the opposite shoulder, a common roller toAvel or strip of sail cloth will answer. A second belt or strong hand- kerchief is to be tied round the dislocated arm, just above the elboAv. By the latter of these, a gradual extension must be made by one or tAvo persons, in a direction obliquely doAvmvA-ards and outwards; the body being at the same time kept immovably fixed, by assistants draAving the former belt in an opposite direction. After this extension has been kept up for a short time, during which it should be gradually in- creased in force, the operator is to lift the head of the bone into its cavity. DISLOCATION OF THE ELBOW. The bones of the fore-arm may be dislocated in almost any direction. When this is the case, a protu- 9" 110 DISEASES OF THE berance or hard SAvelling may be observed on the side of the arm to Avhich the bone is pushed. It may be knoAvn by the patient's inability to bend the arm, and by comparing its shape Avith the other elboAv. Extension is to be made by assistants pulling grad- ually in opposite directions, Avhile the operator returns the bones into their proper place. Afterwards the arm must be bent and suspended for some time Avith a sling about the neck. Luxations of the wrist and fingers are to be reduced in the same manner as those of the elboAv; viz. by making an extension in opposite directions, and thrust- ing the head of the bone into its place. DISLOCATION OF THE THIGH. When the thigh bone is dislocated forward and downward, the knee and foot are turned out, and the leg is longer than the other; Avhen it is displaced backAvard, it is usually pushed upAvards at the same time, by Avhich the limb is shortened, and the foot is turned inwards. When the thigh bone is displaced forward and dowmvards, the patient, in order to have it reduced, must be laid upon his back, and made last by band- ages or held by assistants, while by others extension is to be made by means of slings fixed about the thigh, a little above the knee. While the extension is making, the operator must push the head of the bone outward, till it enters the socket. If the dislocation be outAvard, the patient must be laid upon his face, and during the extension, the head of the bone must be pushed inward. LIMBS AND LARGE JOINTS. ill DISLOCATIONS OF THE PATELLA, OR PALM-BONE OF THE KNEE. The patella may be throAvn out of its place either sideAvays or upAvards ; in the latter case, the ligament Avith Avhich it is connected is broken, and the bone is draAAii up several inches among the muscles of the thigh. The nature of the case can be distinctly as- certained, both by the sight and feeling. TREATAIENT. In the dislocation sideAvays, the limb must be firmly extended; when, pressure being made upon the pro- truding edge, the bone immediately regains its former situation. When the dislocation is upAvards, it is to be treated precisely as a transverse fracture of the bone ; which see. DISLOCATION OF THE KNEE-JOINT. The principal bone beloAV the knee may be partially dislocated, either inwards, outAvards, or backwards. In either case it is obvious to the sight. It very rarely occurs. Extension is to be made upAvards, by the thigh, and doAvnAvards, by the leg, Avhile the bones are replaced by pressure with the hand. DISLOCATION OF THE ANCLE. A dislocation of this joint may take place, either in- wards, outwards, or forwards. The two former cases may be ascertained by the inclination of the foot, and by the unnatural protu- berance on one side, and deficiency on the other. 112 FRACTURES. When the end of the bone of the leg is forced for- AAards on the foot, the instep will be observed to be considerably shortened; and there is a great and un- usual projection of the heel. The bone is to be replaced by extension, made in the same manner as in dislocation of the knee. DISLOCATION OF THE THUMBS, FINGERS, AND TOES. These are to be replaced by making extension, at the same time gently bending the joint, and applying pressure with the thumb upon the end of the bone, that is out of place. FRACTURES, OR BROKEN BONES. GENERAL REAIARKS. In the fracture of a large bone, the patient should be put upon a light, unstimulating diet, and if young and plethoric, he may be bled. He should be kept dry and clean, that the parts Avhich bear hard upon the bed may not be galled. While at sea, where the ship is rolling, it Avill be indispensably necessary for him to swing in a cot. It has been customary with many to keep the limb continually upon the stretch, but this posture is uneasy to the patient and unfavora- ble to a cure. It will be preferable to keep the limb a little bent, either by laying the patient upon the side, or by making the bed so as to favor this posture. The dressings of the fracture should be re-applied every three or four days, or oftener if they become loose, and the lint should each time be Avet with some cooling wash, as a solution of sugar of lead, or vine- gar and water. FRACTURES. 113 OP FRACTURES. FRACTURE OF THE BONES OF THE NOSE. When the bones of the nose are broken in, they may be raised to their place by means of a quill, or other instrument introduced by the nostril, and in gen- eral they will retain their situation, Avithout any further assistance. FRACTURE OF THE LOWER JAW. The nature of the injury is obvious to the sight. The parts being accurately replaced, and kept firm by an assistant, a thick pad of lint should be placed over the seat of the fracture, and a bandage applied, by means of Avhich the jaAV may be firmly held upwards and backAvards; for this purpose the most effectual is a bag or purse, to receive the chin, Avith four tapes, or ends, attached to it; the two inferior of which are tied over the top of the head, and the two superior carried back of the head. During the cure, the patient should be kept quiet, and not suffered to exercise his jaws in cheAving his food. FRACTURES OF THE CLAVICLE OR COLLAR-BONE. The existence of its fracture may be knoAvn by tracing the collar-bone along with the fingers, when one of the fractured ends will be found to project over the other, and a crackling noise of the bones Avill be perceptible. TREATAIENT. The arms and shoulders of the patient, are to be 114 FRACTURES. firmly draAvn backwards by an assistant, Avium the fractured ends immediately come in apposition. The part is iioav to be covered Avith a thick adhesive plas- ter or one of common pitch, and a bandage is to be applied to retain the bones in their place. The ban- dage should be long, and commencing Avith it on the part injured, is to be carried under the arm-pit, across the back, and over the other shoulder, then under the arm-pit of that side, and back over the injured shoul- der ; thus describing on the back the figure cc. The turns should be repeated two or three times, and be draAvn Avith considerable tightness, and the arm should afterwards be supported with a sling from the neck. FRACTURE OF THE RIBS. The characteristic mark of a fracture of the ribs is the crackling or grating of the bones, which may be distinctly felt and heard, upon the patient's coughing, or during a dee}) inspiration, and by a sharp pain of the part, at the same moment. TREATAIENT. In this, the principal attention is to be directed to the general symptoms. Bleeding in almost all cases is necessary, and such other means should be adopted as are calculated to allay inflammation, as gentle purging, and abstinence from the use of stimulants. An adhesive plaster may be applied over the fracture, and the body tightly encircled Avith a broad bandage. FRACTURE OF THE ARM, BETWEEN THE SHOUL- DER AND ELBOW. This fracture is simple and easily recognized. In order to bring the fractured extremities into their FRACTURES. 115 place, a slight extension should be made, Avith the elboAv bent at a right angle. The arm is then to be encircled Avith a piece of soft flannel, or cotton, and tAvo splints applied, one on the inside, and the other on the outside of the arm. They may be made of pasteboard or thin slips of Avood, an inch and a half broad, and to extend the Avhole length of the bone, to be bound on Avith a bandage. The forearm should be suspended by a handkerchief from the neck, in such a manner that the Avrist may be more supported than the elboAv, so that the Aveight of the arm counteracting the contraction of the muscles, may serve to keep the ends of the bone in their proper place. The bones should be retained in their place for two weeks, by Avhich time it Avill be united. FRACTURE OF THE ELBOW. The fracture of this is readily knoAvn. The piece of bone Avill be found drawn upAvard. It is to be re- placed and confined by a bandage rolled round the limb, as directed in fracture of the patella, and the arm should be kept nearly straight, by means of a splint bound upon the inner side, and extending near- ly to the hand and shoulder. By persevering in this, the knob of bone forming the elbow, will be joined to the arm from Avhich it has been broken. FRACTURE OF THE BONES OF THE FOREARM. The existence of a fracture of these bones may be knoAvn, by tracing the course of the bones with the fingers, from the elboAv to the Avrist, comparing the limb Avith the other, and by the crackling or grating of the ends of the bones against each other. The same treatment is required as in fracture of the 116 FRACTURES. arm between the shoulder and elbow. The splints should be laid one on the inside, and the other on the outside of the arm; so that both bones may be at once effectually compressed; that on the inside should reach to the palm of the hand, by means of which the wrist will be kept steady, and the bones prevented from rolling on each other. They may be confined by a bandage rolled round the limb, and the arm worn in a sling. The splints should be loosened every day, and the arm bathed in cold water or vinegar. FRACTURE OF THE BONES OF THE HAND AND FINGERS. The fracture of the bones of the hand are readily replaced, and may be easily preserved in their natural situation, by accurately adapting a pad or cushion to the palm of the hand, and applying a bandage over all, beginning at the wrist, and extending it to the fingers. When the fingers are broken, they are to be neatly set Avith pieces of pasteboard, moistened ; over Avhich a small roller is to be applied. FRACTURE OF THE THIGH-BONE. The existence of this fracture may be knoAvn by the crackling or grating of the broken ends, made in moving the limb, and by a projecting point that may be felt on the inside of the thigh. Also, by the ina- bility of the patient to cross the injured limb over the other. TREATAIENT. The patient should, if possible, be moved to a cot, smee a common fixed birth will hurt the limb during FRACTURES. 117 the motion of the ship, and a hammock is rendered objectionable by its curved shape. The patient thus conveniently situated, a gentle extension is to be made by an assistant, Avhile the operator replaces the bones in exact apposition, and apphes over the limb a soft rag A\Tet Avith a strong solution of sugar of lead ; and over this, the many-tailed bandage, made in the fol- loAving manner : — take common rollers or bandages of cotton, tAvo mches Avide, and of sufficient length to pass round the limb, and lap over, two or three inches ; spread as many of these by the side of each other, as AAall extend from near the groin to the knee. Another bandage of the same kind is then to be laid across, and stitched to them. The Avhole are iioav to be placed under the thigh in such a manner, that the cross bandage shall stretch along under the bone, and each of the tails is to be brought separately over the limb, beginning at the one next the knee, and crossing it by the one opposite. AVhen all the tails are thus brought over, and made fast Avith pins, three splints are to be applied, one on each side, and a third on the top, that on the outside being of sufficient length to reach from the hip to the knee. These being tied firmly Avith tapes, the limb may now be placed, either in a straight position, or in a fracture-box, shaped like the roof of a house, Avith the knee bent to a consider- able angle, which is preferable ; or the thigh may be laid smoothly upon a pillow, on one side, a little out from and higher than the body. The limb must re- main in this position for several weeks. If possible a surgeon should be called soon after the fracture, as it may lead to the prevention of a crooked limb. Fractures of the bones of the leg belovj the knee, are to be treated in nearly the same manner as the above. 10 118 FRACTURES. FRACTURE OF THE PATELLA, OR PALM-BONE OF THE KNEE. The fracture is generally transverse, and rarely long- itudinal. In the former case the upper portion is draAvn up several inches among the muscles of the thigh. TREATAIENT. In the longitudinal fracture, continued extension of the limb and the application of a bandage to the knee Avill be sufficient to effect a speedy union. In cases of transA'erse fracture, owing to the great separation of the divided portions, it is extremely difficult, and nearly impracticable to effect a union by bone. The fractured portions being made to approach each other as nearly as possible, the middle of a band- age of considerable length is to be applied over the upper part of the patella, and being carried round the thigh just above the joint, it is to be crossed under the ham, and carried round below the knee, so as to draw the fractured portions together, and having thus de- scribed the figure x around the joint, it is to be firmly secured and daily increased in tightness. As it Avill be necessary to keep the limb constantly extended; a splint, lined Avith tow, wool, or cotton, may be applied under the ham, and made fast to the limb with tapes. A fracture of that projection of bone that makes the elboAv, may be treated in nearly the same manner. DISEASES OF THE SKIN. ERYSIPELAS. SYMPTOAIS. It begins with symptoms of fever, confusion of the head, sometimes delirium, sickness at the stomach. DISEASES OF THE SKIN. 119 About the second or third day, the skin of some part of the body, generally the face, becomes inflamed. The redness commences about the eyes and nose, or one of the ears, is attended Avith itching and burning, and extends from the forehead to the mouth. If the disease continue, the Avhole of the head becomes in- flamed, and often one or both eyes are closed. As the redness extends, it frequently leaves or is abated in the part it at first occupied. After a longer or shorter time, the redness terminates in small watery pimples. or in a scaling of the skin. The fever, hoAvever, does not always at this period suffer a remission, but on the contrary, is frequently aggravated, and sometimes the patient expires about the ninth or eleventh day. TREATAIENT. Reduce the inflammatory state of the system by cooling, or mercurial purges, as calomel, from six to ten grains Avith as many grains of jalap, or by the cooling mixture, (see Appendix) a table-spoonful every three hours. Take diluting drinks, as lemonade or water, containing cream of tartar, barley-water, &c, avoid stimulating food or drinks. Evaporate spirits on the part by frequently applying it Avith a soft rag. As soon as the bowels have been moved, if the dis- ease continue to increase, it is recommended to give quinine two grains, every two hours, in a draught of water, till the inflammation and extent of the disease manifestly lessen. The room should be kept cool and dark, and the patient still. ITCH. One of the best medicines for this complaint is sul- hur which should be used both externally and m- >rna'lly The parts most affected may be rubbed every ieht with ointment, made of flower of sulphur two 120 DISEASES OF THE SKIN. ounces, and hog's lard or butter rubbed together ; chloride of lime, a table-spoonful, dissolved in a wine- glass of water, may be rubbed over the pimples. As much flower of sulphur as is requisite to keep the boAvels open, may be taken every night. It Avill be necessary to observe cleanliness, and after the disease is removed, to fumigate the clothes Avith sulphur, or to immerse them in Avater. NETTLE RASH. This resembles the eruption produced by the sting- ing of nettles ; there is itching, and the eruption comes and recedes with quickness; rubbing or scratching brings it out. It is caused by swallowing cold drinks, or crudities, when heated, also by sour milk and rancid cheese, and by shell fish. The treatment may be simply magnesia, or a Ro- chelle powder, followed by a cup of tea without milk. PRICKLY HEAT. (Lichen Tropicus.) This is among the primary effects of a hot climate, and may be called one of the miseries of a tropical hfe, Avhich assails at all, and particularly the most un- seasonable hours. " Many a time (says Dr. Johnson) have I been forced to spring from the table and aban- don the repast, which I had scarcely touched, to writhe about in the open air for a quarter of an hour; and often have I returned to the charge, with no better success, against my ignoble opponent! The night affords no asylum. For some Aveeks, after arriving in India, I seldom could obtain more than an hour's sleep at one time, before I Avas compelled to quit my couch WOUNDS. 121 Avith no small precipitation, and, if there Avere any water at hand, to sluice it over me for the pmpose of allaying the inexpressible irritation! But this Avas productive of temporary relief only, a more violent paroxysm frequently succeeded." It may be entirely absent while we are sitting still, but appears on the least exercise, or on taking any thing hot or stimulating. The only means, says Doctor Johnson, which I ever saw productive of any good effect in mitigating its violence, till the constitution got acclimated, were light clothing, temperance in eating and drinking, rest in the heat of the day, open boAvels, and last, not least, a determined resolution to resist, with stoical apathy, its first attacks, by which the enemy will generally sneak off, and leave us victorious for the time. WOUNDS. As an enumeration of the many classes, into Avhich wounds are divided by surgical writers, would confuse those for Avhom this book is intended, they are here included in three divisions, viz., Incised wounds, or simple cuts, made with a sharp instrument; Contused wounds, or bruises, including gunshot and lacerated Avounds; Punctured wounds, or those produced by a sharp pointed instrument, as a nail or dirk. INCISED WOUNDS, OR CUTS. The first object of attention in cuts, is to stop the bleeding. In wounds of the limbs, where the bleeding is alarming, a tourniquet or bandage is to be applied above the part in the following manner: a strip of can- vass or strong cloth, an inch and a half wide and two vards long, is to be passed twice round the limb, the best place being about the middle of the arm or thigh, 10* 122 WOUNDS. and tied in a hard knot ; introduce between the turns of the bandage a stick three or four inches long, and turn it like a screAv, till the tAvisting of the bandage arrests the Aoav of blood. A strong pocket handker- chief, passed twice round the limb and tied in a hard knot may ansAver the same purpose.1 We then Avash and cleanse the Avound, in order to ascertain Avhere the bleeding orifice of the vessel is. It may be necessary, for this, to slacken the tourniquet, so as to make the blood Aoav again; then, screAving it again, take up the artery, if there are suitable instru- ments on board — if not, try the folloAving : take a sew- ing needle and insert the eye into a handle, like an awl, hold the point of the needle in the flame of a candle till it is red-hot, then cool it slowly, which Avill take out the temper of it, so that it can be bent into a fine hook; with this transfix the end of the bleeding vessel, and hook it out, so as to admit of a thread be- ing put round it and tied. This is the most effectual Avay of stopping blood, if the vessel be large ; and which I have, in the absence of the proper instrument, more than once used Avith success. The next surest way Avill be, to take a large wire, or even a common board nail, and heating it, sear the vessel. If the artery be very small, cobAvebs or scrapings of sole-leather, or sponge or flour, may be pressed against the bleeding vessel, and pressure applied Avith a bandage. The wound is then to be dressed by bringing its edges accurately together, and confining them with shps of adhesive plaster three or four inches long, laid across the cut. A narroAv slip of lint or rag, spread with simple ointment, is to be laid over the wound on the adhesive plaster ; lint or tOAv then applied to absorb the discharge, and, lastly, a bandage rolled on to confine the dressings. An assistant is then to make pressure !i It*6 au,thor has the satisfaction of learning, that the New Bedford and Nantuket whalers, in most cases, have in their medicine chests a first-rate ■tourniquet. This fact, with many others, speaks well for the liberality of their owners. WOUNDS. 123 on the Avound, while the tourniquet is gently slackened. The tourniquet is, hoAvever, to be continued loosely round the limb, ready for use, in the event of a return of bleeding. The dressings may be rcneAved in three or four clays, excepting the adhesive plaster, Avhich should be continued till adhesion of the wound has taken place, or for six or seven days. It aviII be advisable to move the boAvels with a mild cathartic, as cream of tartar, and to subsist on a light, unstimulating diet. If an artery is Avounded AAdiere no tourniquet can be apphed, the bleeding must be stopped by filling the Avound AAith bits of sponge or dry lint, and applying pressure; the lint or sponge not to be removed till it suppurates and can easily be taken out. If the bleed- ing artery can be taken up and tied, it should be done ; and if not, the bleeding orifice may be seared Avith a large wire heated. In slight cuts, a tourniquet wrill not be required. In other respects the above treatment should be adopted. If the Avound gapes open a stitch may be taken in it. Contusions or Bruises, and Lacerations, as Avell as Gunshot Wounds, are more painful than incised ones ; are SAvelled, ragged, and not attended with much bleeding. The principal objects in the treatment, are to mod- erate inflammation, and to accelerate the healing pro- cess. The first is to be effected by Avarm poultices made of Indian meal and flax-seed, or pounded biscuit and flour boiled together, applied every three or four hours, and by bathing the part in Avarm water. When inflammation has abated, the healing of the wound may be promoted by dressing it with lint, spread with basilicon. ' r- • If the form of the AA-ound will admit of its edges being drawn towards each other, their approximation should be supported by adhesive plasters and bandages. 124 BURNS AND SCALDS. If the Avound be attended Avith great swelling and pain, the patient must be bled and purged, in propor- tion to the violence of these symptoms, and stimulants of every kind avoided. A feAv drops of laudanum may afford relief. Punctured avounds are frequently produced by nails or sail needles, and stabs are sometimes made by knives or dirks. The consequences may be lock-jaw or extensive abscesses. The most effectual Avay of preventing these evils is to enlarge the opening Avith a lancet or sharp knife, and thus convert the puncture into a simple cut, which is to be dressed accordingly. When this is not done, the part should be kept still, and dressed frequently with warm poultices. If the wound be deep and un- attended with much bleeding, there will be danger of violent inflammation, that may require bleeding and purging to subdue it. BURNS AND SCALDS. The part should be immersed in cold water or other cold fluid immediately, and continue there till some raAV cotton is brought, and ready for application to the burn. This article Avill allay the inflammation, and if seasonably used, Avill even prevent the formation of bhsters. It may be renewed every twelve hours, care being taken to preserve the skin from injury. If the pain be excessive, give a grain of opium every half hour, till it is alleviated. If no cotton can be had, continue cold applications and apply a poultice made of scraped raAV potatoes. Should the burn be very severe and extensive, it may be necessary to adminis- ter gentle laxatives and to abstain from stimulants. Should the burn be deep, apply soft poultices made of Indian meal or pounded bread and flax-seed, or CHILBLAINS. 125 flour, and after the inflammation has abated, the heal- ing of the ulcer may be promoted, by dressings of simple ointment, made of spermaceti, olive, or sperm oil and beesAvax, equal parts, spread on soft lint, over which a bandage may be applied moderately tight. When fungus or proud flesh appears, it may be touched Avith blue stone. The blisters occasioned by burns should not be opened immediately, as the ac- cess of air Avill cause deep ulcers. After a day or two, they may be punctured Avith a lancet, or needle, and the skin suffered to remain on. A liniment made of lime Avater and oil shaken to- gether, and applied, Avith a feather or soft rag, to ulcers from burns Avill be useful. A cooling ointment for burns, may be made by melting together sperm or olive oil, beesAvax, and spermaceti — and Avhile liquid add half the quantity of lead Avater, made by dissolv- ing 4 or -5 grains of sugar of lead in a wine glass of water, and stirring it into the ointment whilst it is cooling. CHILBLAINS, OR FROST-BITES. When the extreme parts of the body are exposed to severe cold, they are first affected Avith numbness, and afterAvards with swelling and inflammation, and sometimes mortification. Immediately on perceiving the numbness, the pa- tient should immerse the part in cold water, or rub it in snow, and on no account approach the fire, till its feeling is restored. He should also abstain from stim- ulants and Avarm drinks. When these precautions have been neglected, and a high degree of inflammation has ensued, the part should be dressed, at first with cold and afterwards with Avarm poultices, till the inflammation is subdued, when the ulcers may be dressed with some mild oint- ment. 126 ULCERS, ETC. ULCERS. These may be occasioned by wounds, bruises, burns, frost, &c. Where there is a tendency to scurvy, even the scratch of a pin may produce an ulcer of great malignancy. Old sailors, whose constitutions are much impaired by intemperance, are often afflicted Avith obstinate ulcers on the shin. The longer such sores continue, the greater Avill be the length of time necessary to heal them. Receiit and healing ulcers should be Avashed daily, and dressed Avith mild ointments applied on lint; all sources of irritation should be avoided ; the part kept still and in a horizontal posture. If the ulcer be of long standing and slow in healing, the edges of it may be drawn towards each other, by means of straps of adhesive plaster. If the ulcer be on the leg, a band- age should be applied over the adhesive straps from the foot to the knee, Avith as much firmness as the pa- tient can bear. The edges of the ulcer should be oc- casionally touched with blue stone. If a high degree of inflammation and swelling be induced in an ulcer by cold or other causes, it should be bathed with warm \Arater, and poulticed frequently. BITES OF THE VIPER, SNAKES, ADDERS, &c. The symptoms that usually follow are a swelling of the part, faintness, giddiness, vomiting, difficulty of breathing, cold sweats, convulsions, and sometimes death. The most effectual way of obviating these symp- toms, is the immediate cutting out of the part or burning it Avith fire. Where this is not done salt may be applied to the part and the wound sucked for a long time, the mouth being defended by oil. A tight ligature should at the same time be kept on the limb, GUINEA AVORM, ETC. 127 above and near the Avound. It is recommended by some to apply hot spirits of turpentine to the part. The Indians burn gunpoAvder on the part bitten. In the south of France the bite of the scorpion is not dangerous, rarely Avorse than the sting of a Avasp. In tropical climates it is much more deadly, and is to be treated like viper bites. The viper bite is often at- tended Avith danger, especially in the summer, and Avhen the reptile is strong and enraged. GUINEA WORM. In Guinea and in some parts of the East and West Indies, foreigners, as Avell as inhabitants, are often troubled Avith the Guinea Worm, AAmich the celebrated Dr. Lind thus describes; " This is a white, round, slender worm, often some yards long, lodged in the interstices of the muscles, commonly in the legs, feet, or hands; Avhen it attempts to escape through the skin, it occasions a SAvelling, resembling a boil, at- tended Avith great pain, until its httle black head ap- pears in a small Avatery bladder, on the head of the boil. When this bladder breaks, the head of the Avorm is to be secured by tying it to a small roll of linen, spread Avith plaster ; and part of the Avorm is once or twice a day to be drawn forth, Avith care not to break it, and Avrapped round this roll, until it be brought aAvay entire; then the ulcer heals soon; but if part of the Avorm breaks off, the portion remaining in the flesh can be extracted only by painful and te- dious suppurations in different places." OF PERSONS APPARENTLY DROWNED. When the body is taken out of the Avater, it is to be stripped as soon as possible, wiped perfectly dry, and 128 POISONS SWALLOAVED. then laid between two blankets. The head is to be cOAered with Avarm flannels, hot substances applied to the feet, belly, and breast, and the body constantly rubbed with the hands. The lungs are to be inflated as soon as possible Avith a pair of bellows, by inserting the pipe in one nostril, while me other nostril and mouth are kept closed, and bloAving forcibly. AVhen the breast is swelled by it, the bellows should stop, and an assistant should press the belly upwards to force the air out. This process should be repeated, twenty or thirty times in a minute, so as to imitate natural breathing as nearly as possible. If a bellows cannot be procured, some person should blow into one of the nostrils through a pipe or quill, whilst the other nostril and mouth are closed as before. During this time a large quantity of ashes, or Avater, should be heated, and as soon as it is milk warm, the body placed in it; the blowing and rubbing continued as before, and, when the ashes or Avater are cooled, more is to be added, so that the whole may be kept blood-Avarm. When signs of returning life are appa- rent, the frictions must be continued, but more gently. These methods are to be continued three or four hours. When the patient can swallow, he is to take some Avarm spirits. POISONS SWALLOWED. When laudanum, opium, or morphine, or other poisonous vegetable substance is swallowed, a stomach pump should be used immediately, by which fluids may be pumped into and out of the stomach. In case a pump is not to be had, the stomach should be excited without delay by emetics, to throw off its contents, such as white vitriol, or blue vitriol, fifteen to twenty grains, or about a tea-spoonful dissolved in half a tumbler of water, and assisted by passing a finger or OPERATIONS. 129 feather doAvn the throat, sAvallowing Avarm Avater, and if necessary, repeating the emetic. He should not be alloAved to sleep, but kept constantly in motion, have the head dashed Avith cold Avater, and the Avhole surface rubbed and stimulated Avith small rods or twigs. After the first effect of the poison has subsided, give a dose of Epsom. If mineral or other poisonous acids have been SAval- loAved, give magnesia, or soda, or sakeratus dissolved in Avater; or if these cannot be had, shake a piece of hard or shaving soap in Avater, and give the Avater to drink, afterAvards thin gruel, rice Avater, or starch. If arsenic or corrosive sublimate has been sAvalloAved, beat up the whites of half a dozen eggs in water, and give them, or starch made of a similar consistence; milk with wheat flour stirred in it, will be useful. A medicine called the hydrated peroxyde of iron is a known antidote to arsenic, but this cannot be obtained on board a ship, nor is arsenic likely to be taken there. Poisonous Fish are often taken, especially on the shores of South America. The usual symptoms are irritability of the skin, swollen eyelids, difficult breath- ing, and convulsions. The treatment consists in emetics of ipecac, or Avhite vitriol, folloAved by castor oil. OPERATIONS. BLOOD-LETTING FROM THE ARM. The operator and patient being placed in proper re- lative situations, which it will be needless to describe a ligature or narrow bandage is.to be passed round the arm, just above the elbow, so as to compress the vein abou/two inches above the part from which he blood fetobe drawn; and having been suffered to remain some minutes, in order for the vein to become distend- 11 130 OPERATIONS. ed, the thumb of the left hand should be pressed upon the vein made choice of, about two inches beloAV the point Avhere the orifice is to be made. The operator is noAv to take the lancet, previously bent nearly to a right angle, betAveen the finger and thumb of the right hand, leaving at least half the blade uncovered. He is then to rest his hand on the three remaining fingers, while he pushes the point of the instrument cautiously through the integuments into the vein ; Avhen, having thus pierced its coats, he is to carry it forwards in a direction rather obhquely, until an orifice of sufficient size is made. When a sufficient quantity of blood has been draAvn, the ligature is to be untied, and the lips of the wound being carefully brought together, a small piece of fold- ed linen is to be applied upon the orifice, and secured in that situation by a roller, passed alternately above and beloAV the elbow, so that when applied it may de- scribe the figure oo by crossing at the bend of the arm. Faintness, which sometimes occurs during bleeding, may be removed, by a draft of cold Avater, or by taking a horizontal position. If the blood runs slowly, immerse the hand in very Avarm water. The ligature applied above should not press so hard as to stop the pulse. Every direction given for blood-letting in the arm, is applicable to the foot, the bandage to be placed an inch or two above the ankle. OF THE APPLICATION OF LEECHES. The manner of applying these is too well known to require a description. _ Success is rendered more cer- tain, by previously drying them, or alloAving them to creep over a dry cloth; the part also, to attract them, may be moistened with cream, sugar, or blood, or punctured with a needle. OPERATIONS. 131 OPENING A TUMOR OR ABSCESS. The opening should be made in the most prominent part, and if it be on a limb, the incision is to be made lengthwise, and not across the hmb. The part should be covered Avith plaster to exclude air. AMPUTATION. As accidents sometimes happen at sea, in situations where it is impossible to obtain a surgeon, and Avhich require the immediate amputation of a limb, it is pro- per to say a few words on that subject. To perform the operation is one thing, to knoAv Avhen it ought to be performed is another. Any man of common dex- terity and firmness, can cut off a leg, but to decide upon the necessity of doing so, requires much judg- ment ; instances having occurred Avhere, under the most seemingly desperate circumstances, the patient has through fear or obstinacy, refused to submit to the knife, and yet afterAvards recovered. Although in many cases much doubt may exist, in determining whether it is proper to amputate or not, yet in others all difficulty vanishes, as Avhen a ball has carried aAvay an arm. Suppose for a moment, while rolling in a heavy sea, during a gale, the lashings of a gun give aAvay, by Avhich a man has his knee, leg, or ankle completely mashed, or either of these parts is crushed by a fall from a topgallant yard. The great laceration of blood vessels, nerves, and tendons, and the crushing and splintering of the bones, almost necessarily resulting from such accidents, render im- mediate amputation an unavoidable and imperious "if there are none of the regular instruments on hand, you must provide the following, which are always to be had. 132 OPERATIONS. A razor, opened straight, and made fast at the joint with tAvine ; a carpenter's tenon saAV ; a darning-needle inserted into a handle like an aAvl, one third of it to- wards the point to be heated red in the blaze of a candle, and suffered to cool very sloAvly so as to draw out the temper, and then bent like an awl; in the place of a tourniquet, a handkerchief and stick ; a piece of cotton or leather, five inches Avide and tAventy long, slit up the middle to half its length ; a dozen ligatures, each a foot long, made of Avaxed thread, bobbin, or fine twine, several narroAV strips of sticking plaster; dry lint; a piece of linen large enough to cover the edge of the stump, spread Avith simple oint- ment, or lard; a bandage 3 or 4 yards long, the Avidth of the hand, sponges aud warm water. AMPUTATION OF THE ARAL Give the patient 60 drops of laudanum, and seat him on a narrow and firm table, of a convenient height, so that some one can support him by clasping him round the body. Place the handkerchief and stick as high up on the arm as possible, (the stick be- ing very short) and so that the knot may pass on the inner third of it. Your instruments having been re- gularly placed on a table or Avaiter, Avithin reach of your hand, while some one supports the loAver end of the arm, take the razor and make one straight cut all round the limb, through the skin and fat only ; then cut these up from the flesh one inch higher, let the as- sistant hold them back, Avhile you cut through the flesh at one SAveep, down to the bone. The assistant next puts on the slit piece of linen astride the bone, and pulls back the flesh from the bone, Avhile you saw as high up as possible Avithout wounding the flesh. With the curved needle or pincers, you then seize and tie up every vessel that bleeds, the larger ones first; when this is done, relax the stick a little, if an artery springs, tie it as before. The wound should now be gently cleansed with a sponge and Avarm Avater, and OPERATIONS. 133 the stick be relaxed. If the arteries are evidently all tied, bring the flap of skin over the end of the stump, draAv its edges together Avith long strips of sticking plaster, leaving the ligatures hanging out at the angles, lay the piece of hnen spread Avith ointment over the strips, a pledget of lint over that, and secure the Avhole by the bandage, Avhen the patient may be car- ried to bed, and the stump laid on a pilloAV. The handkerchief and stick, are to be left loosely round the limb, so that if any bleeding happens to come on, it may be immediately tightened by the per- son who is Avatching by the patient, when the dres- sings are to be taken off, the flap raised, and the vessel sought for and taken up, when every thing is to be placed as before. In saAving through the bone, a long and free stroke should be used to prevent any hitching, as an addi- tional security against which, the teeth of the saAV should be Avell sharpened and set Avide. The most painful part of the operation, Avill be the first incision through the skin; the saAving gives no ^If by any means, there is a difficulty in applying a b>ature round the artery, pass the crooked needle w°ith a strong thread round the end of it, and tie it; the less of fleshy substance included in the thread, with the artery, the better. The bandage that is put round the stump, should be rolled round from above, downwards, so as to support the fleshy part, and the straps of plaster that hold the flaps together, in order that the skin of the two oppo- site sides of the stump may be preserved in exact contact. These bandages should not be disturbed for four or five days, by Avhich time there is reason to hope Sat the stump has formed a firm adbesion. In chandn* them, they should be well soaked with warm watef then plasters, lint, and bandages are to be apphed and changed again every two days. In ten days the ligatures may be drawn away. J 11* 134 OPERATIONS. Amputation of the thigh is performed in the same manner, as that of the arm. In aaiputating the fore-arm, and leg, in which there are Iavo bones, a sharp penknife will be wanted to divide the flesh between the bones, after having made the circular incision with a razor, down to the bones. The shp of cotton or leather, that is to serve for a retractor of the flesh during the saAving, should be divided at one end into three instead of tAvo slips, and the middle slip is to be passed betAveen the bones, which Avith the other two will hold the flesh back out of the Avay of the saAV. In other respects, the opera- tion should be performed as in the arm, already de- scribed. Aaiputation of fingers and toes, will require a penknife. DraAv the skin back and make an incision round the finger, a little below the joint it is intended to remove ; turn back a little flap to cover the slump, then cut doAvn to the joint, bending it so that you can cut through the ligaments that connect the tAvo bones, the under one first. The head of the bone is then to be turned out, Avhile you cut through the remaining soft parts. If you see an artery spirt, tie it, especially in the great toe, but generally it Avill soon stop bleed- ing of itself. Bring doAvn the flap and secure it by a sticking plaster, and a narrow bandage over the Avhole. INTRODUCTION OF THE BOUGIE. The patient may either stand or lie; a middle-sized bougie is to be well covered with olive oil, and the penis taken in the left hand; the point of the instru- ment should then be very cautiously introduced into the urinary passage ; when it meets Avith obstruction, it must be gently moved backwards and forwards OPERATIONS. 135 several times. If unsuccessful, the bougie is to be AvithdraAvn, and after an hour or tAvo a smaller one tried. In some cases a middle-sized bougie Avill pass, when a smaller one cannot, and therefore that size should be always tried first. If introduced for a stric- ture, it should be repeated morning and evening, and remain from a quarter of an hour to an hour. INTRODUCTION OF A CATHETER. In introducing the catheter, the patient may he Avith his head and knees raised. The catheter must be Avell covered AAith olive oil, and the penis held in the left hand, Avhile the point of the instrument is cautiously introduced into the urinary passage, gently moving it backAvards and forwards, till it enters the bladder, which may be ascertained by its havmg overcome all resistance ; then the Avire inclosed in the catheter be- ing drawn out, the urine AvillfloAV off, when the instru- ment may be AvithdraAvn. CLYSTERS, HOW TO BE ADMINISTERED. These may be administered with a pipe or tube, in- serted into the neck of a bladder; or a syringe, an instrument, Avith which every medicine chest should be supplied. The fluid to be injected, being intro- duced into the bladder, through an opening made m the side, which is to be tied up Avith a piece of twine, the pipe is to be well oiled, Avhen the patient himself may introduce it into the fundament. He should then hold his breath, while the bladder is gradually pressed from the top to the tube, till all the liquid is injected. The point of the pipe, should be directed backward a httle, rather than in the line of the body. Every medicine chest should be supplied with a pewter syringe. DIRECTIONS FOE PKESEEVING THE HEALTH OF SEAMEN AND PASSENGERS, IN MERCHANT VESSELS, IN SICKLY CLIMATES. PRELIMINARY REMARKS. The foregoing pages contain some brief instructions for the treatment of diseases, when they have actually appeared on ship-board. A long sea service has, how- ever, convinced me, that on board merchant vessels, prevention is more important than cure. In vessels exclusively devoted to the purposes of commerce, the necessities of the sick can hardly be looked for. In long voyages especially, in Avhich it is important that the ship be as perfectly filled with cargo as possible, little room can be spared for the accommodation even of healthy seamen. When disease occurs during such voyages, it is peculiarly distressing. Conveniences are unprovided — attendants cannot be spared from the crew — and the patient is liable to error in the selection of his remedies. But if there be any marine service in which the occurrence of disease may be in the surest manner prevented, it is in the merchant ser- vice of this country. In the first place, voyages in general are performed in a length of time, which can be tolerably well calculated on ; the means necessary for the prevention of diseases can therefore be accu- rately estimated, and most of them are of such a na- ture, that, if not necessary for one voyage, they will be in readiness for another. In the next place, the nautical skill of our seamen is such, that a feAv men only are found necessary to take every care of large vessels. This very circum- REMARKS. 137 stance is of great consequence, in the prevention of disease ; for as a general rule, prevention is easy in proportion to the fewness of the individuals, among AArhom it is to be attempted. The exception Avill be, in those Aroyages in Avhich from unusual circumstances the duty of men is very constant and severe. The unusual circumstances alluded to, are storms in lati- tudes and seasons, Avhich are ordinarily temperate — the employment of old vessels for long and fatiguing voyages, in which the labor of pumping, &c, is almost incessant — and voyages so calculated, that the Ameri- can coast shall be made in the Avinter or early spring season, Avhen the exposure of the men is necessarily very great, and endured under circumstances ex- tremely favorable to the production of disease, viz. the return from a long voyage with perhaps a short alloAvance of provisions, and almost certainly Avith a very scanty supply of clothing. Except the concur- rence of many, or all these circumstances, Avhich in- deed is very rare, prevention, as Avas observed, Avill be most certain among small creAvs. Furthermore, men are more regularly employed. Indolence, therefore, which is among the predisposing causes of nautical disease, is not a habit of the crew. The men can be kept cleaner, for their habits can be more easily observed. Their berths are more easily cleansed and their apartments ventilated. Finally, the means of prevention A\4iich are to be found in diet, can Avith greater certainty, because Avith less expense, be provided. Those articles which are not usually employed except during disease, may be more readily and willingly laid in, and the attention of officers more certainly directed to the use of preventive and cura- tive methods. In all this, the seaman has principally been regarded. But the OAvner is not altogether with- out interest in the discussion. It is of importance to him, if his creAV be small, that their health be pre- served. The loss of a man, Avith the sickness of three or four, may frustrate the best concerted voyage. 138 DIRECTIONS. These considerations alone, are sufficient to establish the truth of the importance of preventing disease on board merchant vessels. It may be further added, that the means of preven- tion are readily understood and easily applied. It is of no consequence that the commander is not a medical man ; for if he, his owners, and his creAv perform their various obligations to each other, disease at sea must be of rare occurrence. What these obligations are, may, in some measure, be gathered from the folloAving pages. In offering them I have to acknowledge my- self indebted, for many useful suggestions, to the writ- ings of Drs. Lind, Turnbull, and Sir Gilbert Blane. Directions, Sfc. The only very fatal diseases incident to seamen are fevers, fluxes, and scurvy, in hot climates ; and pulmo- nary affections and scurvy, in cold climates. If I Avere to add any other complaint, says Dr. Blane, to those just mentioned, as most prevalent, and peculiar to a sea-life, it Avould be those foul and incurable ulcers, which are so apt to arise at sea, particularly in a hot climate. The slightest scratch, or the smallest pimple, more especially on the lower extremities, is apt to spread, and to become an incurable ulcer, so as to end in the loss of a limb. The nature of the diet and the malignant influence of the climate, both conspire in pro- ducing them. The distinguishing characteristics, causes, and treat- ment of these diseases, are given in the former part of this Avork; the object, more immediately before us, is to prevent them. The records of nautical medicine furnish abundant evidence, that if proper precautions are taken in manning, victualling and governing a ship, the diseases, Avhich may, in some measure, be consid- ered as peculiar to a sea-life, Avould be unknoAvn. The subject is, therefore, addressed alike to captains, own- ers, and creAvs. It has been remarked, that the prevention of diseases AIR OF TROPICAL CLIAIATES. 139 has relation only to external causes that affect health; and some of these Avill noAv be considered under the three heads of 1. Air.—2. Aliment. — 3. Clothing. AIR. 1. On the air of tropical climates, as a cause of disease among seamen. In treating on air, as a cause of nautical diseases, it Avill be considered under two general heads, viz., as constituting climate, and as the pecuhar atmosphere of the internal parts of ships. Over the first Ave have no control. The hot and oppressive atmosphere of the healthiest West India stations, and the deleterious effluvia from morasses and marshes of the unhealthy ones, are equally uncontrollable. Whether these, hoAvever, shall act as causes of disease on ship-board, depends very much on creAvs, but still more on their commanders. The state of the air at sea is likewise beyond control. It may be damp, wet, and cold, and the demand for almost perpetual exertions on the part of the seamen be too imperious, to be evaded, under the wish to preserve the health of the creAv. But even under these circumstances disease is not a necessary occurrence. Means may be, and are occasionally adopted, Avhich result in a remarkable exemption from disease, Avhere to escape seemed impossible. As far as climate is concerned, or may .become a cause of disease, nothing is more obvious, in inquiring into the means of prevention, than the importance of removing men as far as possible from its influence. The methods by which this may be effected are not quite as evident as the importance of the rule. Some of these methods will noAv be stated. Experience has abundantly established the fact, that, except the scurvy, all the diseases incident to vessels are more apt to arise 140 DIRECTIONS. in a harbor than at sea, and particularly the destructive fevers, peculiar to hot climates. While riding at anchor in a harbor, situated in such climates, the habits of sea- men are necessarily, in some measure, altered. The regularity of sea-duty is broken in upon, a sudden and great change is made in the diet, a temperature very different from the coolness of sea-air is endured. The harbor may have in its neighborhood, or on its very shores, extensive marshes, from Avhich the heat of the sun is constantly raising deleterious effluvia. The sun is at times pouring an intense heat on the men Avhile at Avork, and their duty often calls them on shore, for j the purposes of Avooding and watering. In such cli- mates, more particularly in the West Indies, spirituous liquors and unAvholesome fruits are generally easily i obtained, and at times the men, from eluding the vigi- lance of their officers, sleep in a state of intoxication j on the ground on shore. There is also in such climates sudden changes, from excessive heat to cold or cooler air, and generally at night a cold damp air is experi- enced. There is something so refreshing in this change that the chances of diseases are frequently Avillingly run, rather than submit to a caution Avhich seems to ! require too great a sacrifice of personal comfort. The { evils, hoAvever, Avhich Avould seem to be the necessary consequences of circumstances, just enumerated, may be avoided, and the, diseases, of Avhich they seem al- most necessary causes, may be prevented. " I have | knoAAm," says Sir Gilbert Blane, " a hundred yards in a road make a difference in the health of a ship at an- chor, by her being under the lee of marshes in one sit- uation, and not in the other. Where people at land are so situated as not to be exposed to the air of woods and marshes, but only to the sea-air, they are equally healthy as at sea. There Avas a remarkable instance of this on a small island, called Pigeon island, Avhere forty men Avere employed in making a battery, and they Avere there from June to December, Avhich includes the most unhealthy time of the year, Avithout a man dying, and AIR OF TROPICAL CLIMATES. 141 with very little sickness among them, though they worked hard, lived on salt provisions, and had their habitations entirely destroyed by the hurricane. Dur- ing this time near one half of the garrison of St. Lucia died, though in circumstances similar in every respect, except the air of the place, Avhich bleAv from Avoods and marshes." Facts, similar to these^ are to be found scattered through all the books Avhich have been Avrit- ten for the presentation of the health of seamen. The practical advantages to be derived from them are plain and obvious to the most common understanding. Dis- eases of a fatal nature, occurring in a climate and harbor, such as has noAv been alluded to, are to be checked, Avhere it is possible, by altering the anchorage ; and it appears that in some instances a very small al- teration Avill be found quite suflicient. If chcumstances prevent this, other means of prevention must be re- sorted to. It is a Avell knoAvn fact, that in the climates alluded to, the winds, after the first hours of the morning, bloAV from the sea toAvards the land, and that the land breeze, or the breeze off shore, takes place in the evening, and continues during the night. During the day, therefore, the sailor is in little danger of disease from the effluvia from shore. He is chiefly to be on his guard against the night air. He Avill best do this by carefully avoiding to sleep on deck ; and by atten- tion to his clothing. Other means of great impor- tance, are those medicinal articles, Avhich are knoAvn to give and preserve the tone of the system, and which experience has satisfied us, will protect men against fevers. Such are the Peruvian bark, and other bitters, the capsicum, and other spices, common to the climates under consideration. In those seasons, there- fore, which are known to be unhealthy, these means should be early resorted to, and the consequences will in general, be the safety of those who must be in some degree, exposed to the influence of the causes of disease. 12 142 DIRECTION.?. Having noAv stated the methods by which the health of seamen, may be preserved in situations Avhich ex- pose them to the influence of noxious eflluvia from morasses, and marshes, I shall in the next place speak of the sensible qualities of the air of hot climates, in their connections Avith disease. " If I were required," says Blane, " to fix on a cir- cumstance, the most pernicious of all others to Euro- peans, particularly those ncAAdy arrived in the West Indies, I Avould say, that it is exercise in the sun." The same remark is repeatedly made by Johnson, on the climate of India, Batavia, Java, and the southern coast of China. Heat is not only by itself a very poAverful cause of febrile diseases, but the exhaustion, Avhich it induces in laboring men, exposes them strongly to the temptation of the excessive use of spirituous liquors, Avhich, next to heat itself, is one of the most hurtful practices that can be indulged. Another excess, to which seamen are exposed in hot chmates, is in the use of the various fruits Avhich are common to such climates. It is hardly possible to de- ter men from these practices, and their consequences frequently are, fevers and fluxes, of a very severe na- ture, and occasionally of a fatal issue. One of the principal means of diminishing the chances of disease, which may arise from the action of excessive heat, is to employ, as far as it is practi- cable, the natives of hot climates in ihe hard labor that may be required for the ship on shore. More es- pecially, let these men be employed to procure Avood and water, should these be necessary on ship-board. Of all occupations, the most pernicious is that of clearing a foul hold, in tropical parts, and therefore ships requiring it, should be sent to a more northern and cooler port, and on no account employ the crew in such duties, Avhere natives can be had. In seasons peculiarly unhealthy, let natives be also employed in getting the cargo on board. In this way, opportuni- ties for procuring spirituous liquors Avill be much AIR OF TROPICAL CLIMATES. 143 diminished, men Avill more rarely be found exposed, Avhile drunk, to the burning heat of the sun on shore. Fevers, Avhich are among the most dangerous and fatal diseases of hot climates, Avill be less frequent. There is a peculiar improvidence, and Avant of all caution, to be observed in the character of sailors. The chances of disease and death are most willingly incurred, for they are never adverted to. It requires more than precepts on the part of officers, to keep the men out of the Avay of evil. The secret of preserv- ing health, under the exposures noAv under considera- tion, is to put the men as far as possible out of the influences of the causes of disease. If anchoring ground is occasionally to be changed, because the present one exposes a creAv to the destructive air and morbid effluvia of a Ioav putrid marsh, the officers of a ship in hot climates are, as far as practicable, to re- move men from all other causes of disease. But as Avooding and watering in sickly climates are sometimes the unavoidable duties of creAvs, it may be expected that those Avho undertake them, should be furnished Avith some advice for their preserA'ation. "I Avould advise," says Dr. Lind, "all who are employed in cutting down Avoods, or in other laborious and dangerous services in hot chrnates, during the heat of the day, to have their heads covered with a bladder dipt in vinegar, and to Avash their mouths often Avith vinegar, never to sAvalloAV their spittle, but rather to cheAv a little rhubarb, or some other bitter, and spit it out frequently ; to stop their nostrils with a small piece of linen, or tow, dipt in camphorated vinegar ; and to infuse some bark, garlic-, and rhubarb in brandy, of which a dram is to be taken either by itself, or diluted Avith Avater, morning and evening. " In the evening, before sunset, they should leave off Avork, and not return to their labor in the morning, till the sun has dispersed the unwholesome dews and vapors. For their safety during the night, they should retire to a close hut, as the dews may penetrate a 144 DIRECTIONS tent, and here, in the absence of the sun, a constant fire should be kept; or if that be found impracticable, the apartment in which they lie should be Avell fumi- gated Avith gunpoAvder, as fire and smoke Avill afford them a most excellent defence against the noxious qualities of the night air. The smoking of tobacco in their huts, and chewing of garlic, and not sleeping on the ground, are circumstances Avhich Avill also con- tribute to their preservation. " If, from a neglect of these precautions, the noc- turnal chill fog has made an impression on the body, a vomit should be immediately administered near a fire, and a plentiful SAveat excited after it, Avhich will often prevent fatal consequences. If any symptoms of a Ioav fever still continue, as a headache, sickness of the stomach, chills, 6cc, a blister ought immedi- ately to be applied, as these complaints, though so slight as not to confine the patient to his bed, are de- ceitful, and often terminal e in a fatal malignant fever. If this fever can be brought to intermit, let the bark be immediately taken, to the quantity of a quarter of an ounce, or more, in red wine, every tAvo hours, and the patient quickly removed into a better air." AVhen a vessel arrives at a port, in the latitudes now under consideration, Avhether the voyage have been long or short, the men should be instructed not to in- dulge freely in the various fruits peculiar to such cli- mates. The exception to this rule, Avill be found in those cases in Avhich scurvy exists in the vessel. They are more especially to avoid the free use of spirituous liquors. They should avoid all unnecessary exposure to the night air, particularly sleeping uncovered on deck, after the fatigues of the day. They should never sleep on shore, and as far as their duty permits, be as little exposed as possible, during unhealthy sea- sons, to the excessive heat of a tropical sun. These methods of prevention are extremely simple. They can be very easily adopted, and their objects to the merchant service, I again repeat,; are extremely im- FOR PREArENTION OF CONTAGIOUS DISEASES. 145 portant. Suppose for a moment, that a large propor- tion of a small creAv is SAvept off, by the diseases of a hot climate ; new men must be shipped, a most diffi- cult, and expensive alternative; the vessel must be delayed hi port; all the incidental expenses necessa- rily increased, and very frequently the principal ob- jects of commercial enterprise defeated. Notwithstanding, hoAvever, the use of such means of prevention, as circumstances admit of, should the febrile diseases of hot climates occur, how are they to be knoAvn ; and how are they to be treated ? It would be useless to enter on a detail of the symptoms of such diseases ; they are most generally recognized at a very early stage of them, by the captain, or the creAv themselves, and their violence, rapidity, and fre- quently fatal termination, very soon discover their true character. If the disease occur in port, recourse should at once be had to a physician of the place. When a physician cannot be obtained, lose no time in applying the remedies laid doAvn in the former part of this work. If notAvithstanding the treatment, one or more cases should prove fatal, means should be at once adopted, to prevent the propagation of the disease among the creAv, by infection. This may be attempted hi the following manner. Means to prevent the spreading of contagious or infec- tious diseases in a ship. 1. Let the sick be separated from the healthy; and thus attempt to prevent its progress, by cutting off all intercourse Avith each other. 2. Articles of clothing, bedding, &c, have been considered as dangerous vehicles of infection, as the persons of men. " It should be made a strict and in- variable rule, that in case of death from fever and flux, every article of the description mentioned, be throAvn overboard Avith the bodies of those dead of these diseases." 3. Should the sick recover, as they might not be 12* 146 DIRECTIONS. able to spare these articles of clothing, &c, they should be smoked, and then scrubbed and washed, before the men join their messes, and return to duty. In ships of Avar and transports, this direction should be most carefully observed, " because their hammocks will fre- quently be brought in contact Avith those of the other men, by being stowed with them in the netting." 4. As infection sometimes adheres to the timbers of a ship for a long time, such cause of disease should be thoroughly eradicated as soon as the disease itself dis- appears. This can only be effectually accomplished by fumigation. For this purpose, pots of charcoal and sulphur may burn betAveen decks, after having carefully shut the hatches. Dr. Blane remarks, that an action Avith an enemy has been knoAvn to purge a ship from infection. Fires should be more frequent betAveen decks during the prevalence of infection. The decks, beams, &c, should be washed and sprinkled with hot vinegar. The fume of pitch, tar, and other resinous substances, has a more powerful effect than any other smoke ; and besides what is throAvn upon the fires, it Avould be useful to throw pitch upon a red hot iron, or to immerse a loggerhead in a vessel where there is pitch or tar. 4. WhiteAvashing the decks and beams Avith quick- lime, has been found extremely useful in eradicating infection. 5. Let the air of the well and the hold be carefully attended to, and such means used as will best tend to purify it. This may be done, by letting doAvn into the well and hold a grate or pot of fire daily, and alloAving it to remain there for an hour, and in frequently sprinkling a solution of chloride of lime between the timbers and under the limber boards. 6. The ship should above all things be kept well aired, and as dry as possible. Dr. Blane recommends that scuttles be cut in the sides of frigates destined for the West India station, in order that a free circulation of air may be maintained through the decks, whenever SIGNS OF AN UNHEALTHY COUNTRY. 147 necessary. Some captains, Avho have been convinced by experience, that a moist or wet state of a ship is the most frequent cause of disease, are in the practice not only of abstaining from pumping in Avater in order to sAveeten their ships, but bail out the Avater from the well, Avhen the pumps Avill not exhaust it all, and never let then vessels make above five inches. Where, hoAvever, from previous neglect, or unavoidable leak- age, a ship becomes very putrid beloAV, it may be ad- visable to pump in Avater, in order to.renuwe these causes of disease from the crew. Signs of an unhealthy country. In giving directions for the preservation of seamen in hot and sickly climates, it av ill be proper to enume- rate the most certain signs or proofs of an unhealthy country— extracted from the Avritings of Dr. Lind. " The first proof of an unhealthy country is a sud- den and great alteration hi the air at sun-set, from in- tolerable heat to a chilling cold. This is perceived as soon as the sun is set, and for the most part is accom- panied with a very heavy deAv. It sIioavs an unhealthy, SAvampy soil, the nature of Avhich is such, that no sooner are the sun-beams withdraAvn, than the vapor emitted from it renders the air raw, damp and chilling, in the most sultry climates; so that even under the equator, in some unhealthy places, the night air is cold to an European constitution. " The second is, thick, noisome fogs, arising chiefly after sun-set from the valleys, and particularly from the mud, slime, and other impurities. In hot countries the scent of these fogs may be compared to that of a neAv cleaned ditch. Diseases, therefore, arising from this cause, generally take place in the night, or before sun-rising. " The third is, numerous swarms of flies, gnats, and other insects, which attend stagnated air, and un- healthy places covered Avith wood. " The fourth is when all butcher's meat soon cor- 14S DIRECTION'S. rupts, and in a feAv hours becomes full of maggots ; Avhen metals are quickly corroded on being exposed to the open air; and Avhen a corpse becomes intolera- bly offensive in less than six hours. These are proofs of a close, hot, and unwholesome spot. In such places, during excessive heats and great calms, it. is not alto- gether uncommon for foreigners, especially such as are of a gross habit of body, to be seized at once Avith the most alarming and fatal symptoms of what is called yelloAV fever, without any previous complaint of sickness, or other symptoms of the disease. There has first been perceived an uneasy itching sensation, commonly in the legs, and upon pulling doAvn the stockings, streams of thin dissolved blood folloAved ; a ghastly, yelloAV color quickly diffused itself over the Avhole body; and the patient has been carried off in less than forty-eight hours. " The fifth is, a sort of sandy soil, commonly a small, loose, Avhite sand, such as that at Pensacola, Whydah, and the island of Bonavista, which is found by experience to be injurious to health." 2. On the air of temperate climates, more particularly sea-air, as a cause of disease among seamen. In the preceding pages, some of the diseases of hot climates Avere mentioned, and the means of preven- tion pointed out. The following section will be prin- cipally devoted to the consideration of the influence of cool air over the health of seamen at sea. Much may be done on the part of the officers as Avell as men, to diminish the unfavorable effects of cold air, whether moist or dry, on the health. Much should be done ; for the diseases Avhich may be induced by a cold, damp atmosphere, may incapacitate men for duty Avhen their services are most Avanted. This cause of disease will be found to act most powerfully, when assisted by the debilitating effects of unusual fatigue, and of the un- Avholesome diet a creAv is at times obliged to use, in the course, or near the close, of a long voyage. Men AIR OF TEMPERATE CLIMATES. 149 who have in a great measure recovered from some of the severer diseases incident to a sea-life, by the help of mild, Avarm, and dry Aveather, even though the diet has remained the same, have sunken with astonishing rapidity, and died, merely from entering a higher lati- tude in a cold season. The necessary exposure, inci- dent to ordinary ship duty, in the cold and damp air into Avhich they have newly, and perhaps suddenly ar- rived, has as suddenly been followed by an astonishing fatality. It is therefore of the last importance that men situated as those alluded to, should, as far as pos- sible, be removed from the influences of cold and moisture. The diseases, by Avhich most suffering may be en- dured under these circumstances, are, complaints of the chest, rheumatism, and the scurvy. The first, from the imperfect means of relief afforded on ship- board, and the perpetual neAv exposures of a sea-life, Avill in many cases become a chronic complainl, and from the diseased condition of the lungs induced by it, be folloAved by consumption. Hence we actually find that a large proportion of the deaths, Avhich happen in our marine hospitals, are from pulmonary consump- tion. Chronic rheumatism, if not so fatal, is hardly a less distressing complaint than the one just mentioned. Men are disabled by it, they are rendered unfit for duty ever after, and this too, generally, in the prime of hfe. The consequence is, that they either become the permanent residents of a hospital, or lead an useless, vagrant life in the streets. The scurvy, Avhich occurs in all climates, though more frequently in the cold and temperate, Avill be considered .hereafter, Avhen speak- ing on the subject of diet. To prevent these diseases will be a much easier task than to cure them. When a man falls sick at sea, nothing is more common, than either to consider his complaints imaginary, or to take up the impression that the disease, from some fancied resemblance, is exactly similar to one casually observed by the patient, at some previous time, in some one or more of his shipmates. The next step is most vigor- 150 DIRECTIONS. ously to adopt the treatment Avhich in such case Avas found to be salutary. "A man avIio had been ex- tremely ill of the fever of Calcutta, suffered a relapse at sea ; calomel had been prescribed by a physician in the first attack Avith advantage, and the same reme- dy Avas now freely used by the man himself at sea. He recollected also that he had seen a severe case of fever treated successfully by dashing pailsl'ul of sea- water over the patient, and at four in the morning, went on deck and submitted for some time to the same treatment. His superior officer remonstrated, and forbid the men to continue or repeat the operation. The calomel and cold affusions, hoAvever, Avere re- peated at the same time the next morning. Delirium and violent fever folloAved, and although the patient survived the first consequences of the treatment, he ultimately sunk exhausted under the disease." In temperate climates, coughs and colds, pain in the side, difficulty of breathing, Avith heat of the skin, and thirst, are common complaints of sailors, and seem to be caused as follows. The apartments in Avhich sailors sleep are extremely liable to become heated at night, in consequence of the number of men sleeping in them at the same time, and from their necessary closeness at such periods. In order to avoid the evils Avhich would folloAV from alloAving a free current of air through the berth-deck at night, the avenues to the air are closed, and the sailors take their Aval eh on deck in a full perspiration, or at least in a state Avhich renders them peculiarly susceptible of inflammatory diseases. Hence the inflammatory affections of the lungs under consideration. The most obvious causes are here principally alluded to ; the symptoms and treatment are given in the former part of this Avork. How are Ave to prevent these evils ? To diminish the number and lessen the violence of lung diseases, in as much as they proceed from the causes now mentioned, it Avould seem principally necessary to diminish the exposure of men to cold, especially after being in a situation Avith regard to Avarmth, of all others the most favorable for AIR OF TEAIPERATE CLIMATES. 151 the production of these affections. To keep the berth- deck cool at night, without exposing the men Avhile asleep to a free current of air, the air-pipes lately in- vented by a Mr. Sutton are admirably contrived. They consist of tubes leading from the berth-deck and hold, into the open air. Wind-sails need not be men- tioned, as they have been in use time out of mind. "The extreme of cold ought equally to be avoided during sleep. Many pulmonic affections are caught by men falling asleep in the open air, on their watch." If men must be turned out at night, to take their Avatch, and in case of sudden squalls, storms, &c, they may be still farther exposed, tfeey are to be guarded from the evil consequences Avhich may ensue, by proper clothing, particularly by flannel Avorn next the skin, and by overcoats of tarpaulin or India-rubber, the cheapness of Avhich at the present day will enable the officer of the deck and helmsman to be ahvays provided for stormy Aveather. This Avill be an essen- tial precaution against such inflammations, in cold cli- mates and seasons. Another, hoAvever, equally im- portant, is to change the clothing Avhen wet; for Avhich purpose every sailor should be provided Avith at least two or three changes of clothes, and should avail him- self of every fair day to dry them. Other means for lessening exposure to damp air, Avhether Avarm or cold, have been particularly mentioned in the former part of these directions. With regard to rheumatism, the same causes ope- rate in producing it, as catarrhal affections. More frequently, however, it is induced by Avearing wet clothes and sleeping in the cold. Persons avIio are thus exposed, Avhile under the influence of mercury, are more likely to suffer, and are with great difficulty relieved. As a preventive of rheumatic attacks, thick flannel, constantly worn next the skin, is highly im- portant. Being a bad conductor of heat, it prevents the body from experiencing such sudden changes of temperature, as it does when cotton or linen are worn. 1-32 DIRECTION'S. DIET. Diet is properly divided into solid food and drink. Of the former, the chief articles given out for a ship's company, are salted meat, biscuit, and pease. The first, though unavoidably used in this state, may be considered, more than any other article employed, as the cause of disease ; and as it cannot be corrected < either by the biscuit or pease, it requires either to be abridged in the quantity used, or else to be conjoined with such vegetables as are of a correcting nature. But as a sailor's life in a merchant vessel, is a hard one, and those subjected to it require a large propor- tion of animal food, the quantity usually allowed can- not avcII be diminished. The only alternative then, is * to qualify the salt provisions by such vegetables as j correct their bad qualities, particularly that of pro- ducing scurvy. These vegetables are, all the succu- lent or juicy fruits; and such should be laid in, as are capable of preservation during sea voyages. Among the best are lemons and oranges. Since the juice of the former of these articles has come into general use in the British navy, scurvy has quite disappeared. " The power it possesses over this disease," says Sir Gilbert Blane, "is peculiar and exclusive, Avhen com- pared to all other alleged remedies. Its efficacy may also be stated as singular when compared to that of any other remedy in any other disease. It is a certain preventive as well as cure; no other remedy yet knoAvn, can Avard off this dreadful scourge of mari- ners, for an indefinite length of time, under the use of salt provisions." In the former part of this Avork I spoke particularly of this acid in a concrete state, as being valuable both for its antiscorbutic qualities, and imperishable nature. In the latter respect it is worthy of a place in every medicine chest. The article is, hoAvever, expensive, and on this account, may be objected to. In this case DIET. 153 I would strongly recommend supplying ships on long voyages, Avith the lemon juice, as is done in the Brit- ish service; since as much can be laid in for a trifling sum, as AAdll be adequate to every medicinal purpose, and Avithout its taking up much room. The quantity Avhich, in the British navy, has been found sufficient to ward off the scurvy during a six months' cruise, is one ounce to a man per day. At this rate a gallon would serve for ninety-six days, Avhich is but little short of the average length of East India passages. In concluding the subject of animal food it may be Avell to describe a new method for preserving fresh meat, Avhich Avas proposed by a Mr. Appet, and has been found by ample experience, to be perfectly suc- cessful. The method is as folio ays : —" The fresh meat is put into a pot, the bones being first removed, to be boiled in the ordinary Avay. When it is about three-fourths boiled, it is to be taken out and put into jars, which are filled up Avith broth made from other portions of the same meat. The jars are then corked, luted, and put into bags ; they are neAvly placed in a boiler of cold Avater, heat is applied till the Avater boils, and the boiling temperature is kept up for an hour; the fire is then extinguished, the water then draAvn off from the boiler, and the bottles or jars taken out, Avhich completes the process." For the sick and convalescent a sufficient quantity of provis- ions thus prepared, might be supplied Avith little ex- pense, and hereafter, it may be managed on a larger scale, so as to render fresh provisions occasionally available to the Avhole of a ship's company. The next article of sailors' diet to be considered is bread. It is given at sea in the form of hard biscuit. By long keeping, these lose much of their nourishing principle, and in Avarm chmates they are liable to be- come acrid and produce complaints of the bowels. To avoid the danger of sickness from this source, it would be better that only a certain quantity of biscuit should be carried to sea, and an equal or greater pro- 13 154 DIRECTIONS. portion of flour, of Avhich bread could be made. Flour, by being Avell pressed and rammed, Avill keep as long as biscuit, and can be stowed in one fifth part of the space. Thus the freight of it Avould be less than that of biscuit; and it could be baked as occa- sion might require. This plan of baking at sea has been constantly practised in the French navy; and has likeAvise been adopted in the British service at different times, under peculiar circumstances, Avhen the superior advantages of it have been very appa- rent. What is chiefly A\ranted, to render it complete, is a substitute for yeast; and such a substitute may be formed in the folloAving manner : " Let a quantity of yeast be spread thin upon boards, and exposed to a moderate degree of heat, so that the humidity may be evaporated, and that it may be left in a dry granulated state. It must then be put into phials well corked and sealed. Let there be next a strong solution of honey, or molasses and Avort, into Avhich throw a small pro- portion of the above powder, and in the ninetieth de- gree of Fahrenheit a brisk fermentation will be soon excited, perfectly qualified for every purpose for which Avort is employed. Bread made in this manner will possess every advantage of that baked on shore ; and the trouble attending the preparation of it Avill be very trifling, compared Avith the benefit Avhich both the healthy and the sick Avill derive from it." Upon the articles of pease, or beans, we have little to say. They are evidently very nutritious, and agree well with the stomach of a seaman, whose digestion is strong. Indian meal, rice, barley, raisins, and molasses are articles much used at sea, and make up an agreeable variety. To these, potatoes are a most valuable addi- tion, as they are known to keep a great while in Avarm climates, and, as Ave have observed while speaking on scurvy, are in their raw state an excellent antiscor- butic. " One article we must not omit to mention here as DRINK. 155 being a good one, in so far as it renders that part of the diet, Avhich consists of grain and vegetables, more palatable, and thereby induces the seamen to eat more ; this is butter. The principal objection to it is its tendency to rancidity, and to corrupt in a Avarm climate ; but even this inconvenience may be coun- teracted by proper precaution. By the folloAving method it may be preserved sAvect, and in a solid state, during a three years' tropical station, provided it Avas originally in this condition. Instead of firkins, let it be put hi Avaxed canvass bags, containing each about fifty pounds Aveight. Let these bags be throAvn into casks constantly kept filled Avith salt Avater, Avhich should be reneAved once or tAvice a Aveek, according to circumstances, by draAving off the old from a cock fixed near the loAver end, Avhile the neAv Avater is ad- mitted from a bunghole made in the upper end. By this plan, the butter Avill be preserved ahvays sweet." The above remarks on the salutary effects of acid fruits, and juices, in sea diet, may lead one to attach an undue importance to them at all times, and to use them freely, even in sickly ports. In such situations it must be recollected that scurvy is not to be appre- hended, and that large quantities of fruit, especially if cold or unripe, are oftentimes productive of cholera morbus, fluxes, and fevers. This circumstance Avas particularly mentioned, Avhen speaking on " the air of tropical climates as a cause of disease." From the consideration of seamen's food, we pro- ceed to that of drink ; and first of Avater. " Water is the best, and certainly the only natural drink of man. It has been considered by many as one of the prevailing causes of scurvy, Avhen of a bad quality. As the health and comfort, therefore, of the men at sea depend so much on its purity, particular attention should be paid to this beverage. Spring wa- ter is preferable to any other for sea use, seeing that it is less apt to be impregnated Avith decayed vegetable and animal substances, than running and stagnant 156 DIRECTIONS. Avaters. This preference is more especially to be at- tended to in Avarm climates, Avhere every thing, it may be said, teems Avith life, and Avhere the materials of putrefaction are so abundant. Where river Avater must be taken, Avhich often happens in Avarm climates, although it may be drawn as near as possible to its source, yet certain precautions should be employed before it is used. These consist in throAving a hand- ful of lime into each cask, or dissolving two ounces of alum to a hundred gallons, or passing through it a red hot iron several times, or even throAving into it a httle burnt biscuit." Water, hoAvever pure it may be col- lected, is always apt to corrupt Avhen kept in Avooden vessels, and this is one of its greatest inconveniences at sea. Different methods have therefore, been fallen upon, either to prevent this corruption, or to counter- act it Avhen it has taken place. The former consist in various modes of preparing the vessels that hold the Avater; and it must be observed, that there is a great difference in this respect, between a neAv cask made of moist wood, and one that has been hardened and seasoned by age and use. One method of preparing the vessel is by firing the cask, when putting the staves together, until a charred coat is extended over its whole surface. This will preserve the Avater pure and sweet for any length of time, and Avill have the same effect as another im- provement, that of filtering it through charcoal, Avhich has been found to correct the most putrid state of the fluid, and to render it Avholesome and pure, although someAvhat insipid. The most common expedient, hoAvever, for the purification of Avater, has been by quicklime. This is equally effectual, whether slacked or un- slacked ; but should always be carried slacked to sea, to obviate the danger arising from heat, Avhich is apt to ensue on its being touched by Avater in its unslacked state. To counteract the bad taste of water in a state of DRINK. 157 putrefaction, vinegar and other vegetable acids are usually employed.- A still better method is, to put two ounces of chloride of lime into 60 to 100 gallons of Avater; after a day or tAvo the Avater, Avhen alloAved to stand aAvhile in an open vessel, Avill be freed from its putrid smell. Various methods have been used for purifying Ava- ter by filtration. The dripping stone is often used for this purpose, but for a large creAv the quantity it affords is insufficient. Pouring it through gravel or a layer of gravel and charcoal, Avill afford a more abun- dant supply, and be equally serviceable. A very'simple filtering machine is mentioned by Dr. Blane. " Let the narroAV mouth of a large funnel be filled Avith a bit of sponge, over which let there be a layer of clean gravel, or of sand, covered with flan- nel, and over the Avhole another layer of sand. Mud- dy or offensiA'e Avater, being poured into this, runs or drops out clear ; and care must be taken to change the sand, sponge, &c., frequently, as they will become loaded Avith the impurities of the water." These remarks on the purification of water, Ave shall folloAv Avith directions for distilling sea Avater, for the benefit of those Avho have used or lost all their fresh water at sea, and may not have taken the precaution of carrying out a still-head. " When sea water is boiled in a close covered pot or vessel, it may be observed, that the steam arising from it is converted into fresh water on the inside of the cover of the pot. From a pot of thirteen inches diameter, by frequently removing the coyer, and pour- ing off the water collected upon it, a gill of fresh wa- ter may be procured in an hour. The cover of the pot should be, at least, five or six inches above the surface of the sea water, to prevent its boiling up ° " Let us suppose a ship at sea to be in distress for Avant of water, having eight men on board, and that the pot for boiling their provisions can contain live 13" 158 DIRECTIONS. gallons and a half, being twelve inehes in diameter ; by the following simple contrivance, Avith only a lea- kettle, a musket, and a cask, one gallon of fresh wa- ter may be procured every three hours, Avhich is a pint for each man. " File off the handle of the tea-kettle, and fix the head of the kettle Avhen inverted, into a hole made for that purpose in the cover of the pot; this will prove a complete still-head. Take the barrel of the musket out of the stock, and after unscreAving the breeching pin, pass the barrel through the cask by two holes made on each side, Avith a proper descent for the dis- tilled Avater to run off; then stop up the holes in the cask-, and fill the cask with cold sea-Avater ; which will be a refrigeratory or cooler to condense the steam. In order to carry on the distillation, they should be joined, by inserting the spout of the tea-kettle into the upper end of the musket barrel, all the joints and places from Avhence the steam could escape should be luted or stopped up ; a paste, composed of equal parts of chalk and meal, moistened with salt water, will do this effec- tually, and may be easily obtained ; the tea-kettle and cover of the pot should also be kept down by a weight to prevent the steam from forcing them up. " If the cask should be too near the fire, the musket barrel, in Avhich the steam is condensed, may be pro- longed by the addition of the barrel of another musket, or by Avooden pipe. If the barrel of another musket be used, whose bore is not large enough to receive the extremity of the former, one end of it should be heated in the fire, and dilated Avith a marline spike. If a wooden pipe be used it should not be bored Avith a hot iron, as it is found by experience, that burnt Avood Avill impart a permanent disagreeable taste to the dis- tilled Avater. " If Ave may suppose a ship at sea to have no tea- kettle on board, then let the Avooden hand-pump, Avith Avhich the Avater or beer is pumped out of the casks, be cut through obliquely, and, joined, so as to form an DRINK. 159 acute angle. One end of this tube should be fixed into the hole made in the cover of the pot, the other should be fastened to the musket-barrel. By this nearly the same quantity of water may be procured as by means of a tea-kettle. " It may justly be supposed, that the coppers used for boiling the provisions Avill, in every ship, contain more than the proportion of tAvo quarts of Avater for every person on board ; if these Avere furnished with proper still-heads, they Avould be sufficient to yield in distillation the proportion of three pints of fresh and wholesome Avater for each man. In a British ship, called the Dorsetshire, by means of a tea-kettle and musket-barrel, tAventy-tAvo quarts of sea-Avater yielded nineteen quarts of fresh Avater in four hours, at an ex- pense of ten pounds of Avood." AVhen sea-Avater has thus given off two-thirds of its bulk, the remaining third will be too salt for distillation, and should be throAvn aAvay, and the vessel should be replenished from the sea. " The distilled sea-Avater is purer than spring, river, and even rain water. The taste which it receives from the distilling vessel is, in some measure, lessened by throAving away the first running from the still; and is Avholly removed by keeping the Avater for some time, or exposing it to the air, Avhen it will be found an ex- cellent well-flavored Avater, which will keep perfectly SAveet for many years, if put into clean vessels. " In cases of extremity, such is the constitution of our body, that thirst may be alleviated, and the morbid consequences, arising from a Avant of Avater, obviated, by wetting the skin or surface of the body with sea- Avater, Avhich becomes thus inhaled, and ansAvers, in some degree, the common purpose of drink. " The pernicious effects of ardent spirit in very hot Aveather, and Avhen heated by exercise, haye already been adverted to. In such situations, molasses and water, tea and sugar, small-beer, lemonade, soda- 160 DIRECTIONS Avater, or Avater slightly acidulated with vinegar or cider, are most conducive to health." OF CLOTHING. The chief object of attention in a seaman's clothing is to guard against moisture. This moisture, accord- ing to the climate he is in, must be accompanied either by heat or cold. A covering, therefore, Avhich will protect the body in both situations, is the great object to be aimed at; and no substance is so well calculated for this purpose as Avoollen. By its use, the suppres- sion of the discharge from the skin, the great source of all inflammatory diseases, is prevented, and the skin itself being kept as it were moistened by its own se- cretion, the natural heat is thus retained, and the access of the external air prevented. Although in the Avarmer climates this covering is less necessary for the sake of Avarmth, yet it is well knoAvn, that exposure of the body is apt to produce a general uneasy irritation upon it, and even to lay the foundation of many dangerous affections. Besides this, the excessive discharge of the skin, Avhich then takes place, is absorbed by this covering, and thus the after consequences of cold are avoided. Even the night damps, in such situations, are greatly counteracted; and the dry bellyache, and many other complaints, seldomer occur in the West India service, than they did before woollen Avas preferred to cotton or linen. From the advantage of such clothing, it is of great importance that every seaman should have a proper supply of it, and that the captain should lay in a small supply for his creAv, suited for the station to Avhich the ship is destined. This subject merits particular atten- tion from the captain, for in general, sailors are too indolent and improvident to suit their dress to circum- stances, unless they are forced to it; " nor is any thing more common, than to see some of them with linen FOR THE PREVENTION OF DISEASES. 161 troAvsers in the severity of Avinter, and a pair of greasy woollen ones in the hottest of summer." In hot climates, the dress should be Avhite, even to the hat and shoes. In cold climates a kind of cloth called Fearnought is very suitable. After a rain, both clothing and bedding should always be dried, and whenever the Aveather Avill admit of it, bedding should be aired every day. On the subject of cleanliness of person and clothing, nothing need be here said, since every commander of a merchant vessel must be fully sensible of its impor- tance. CONCLUSION. The foregoing directions, for the prevention of dis- ease among seamen, may be briefly comprised in the folloAving particulars : In hot climates. 1. In choosing anchorage to the \vindAvard of the land. 2. In keeping the ship dry, clean, and ventilated. 3. In preventing the creAv from sleeping on shore or on deck. 4. In their avoiding violent exercise under a scorch- ing sun. 5. In employing natives to wood and water the ship. Where these duties must necessarily be performed by the creAv, to use the precautions recommended under such circumstances. See page 143. 6. In avoiding entirely the use of all stimulating liquors, and in abstaining from the free use of cold fruits, and especially those that are unripe. 7 In adapting the dress to the temperature of the Aveather; wearing flannel, however, next the skin at 8"when disease of a malignant character has al- ready appeared on ship-board, in arresting its progress anion- the crew by the "means" formerly recom- 162 DIRECTIONS. mended " to prevent the spreading of contagious dis- eases in a ship." See page 145. In cold climates. 1. In Avearing flannel next the skin. 2. In preserving the lodging rooms, whether berth- deck, cabin, or forecastle, of an equable and rather cold temperature. In this way the sudden transition from heat to cold, so often experienced, Avhen called out to take watch on deck, and Avhich is one of the most productive causes of disease in cold climates, will be avoided. 3. In dissipating the moisture of the lodging apart- ments every day Avith fires, and in scraping and holy- stoning the deck instead of Avashing. 4. In changing the clothing when wet, and in keep- ing the bedding dry and Avell aired. 5. In avoiding ardent spirits. While at sea, in all climates. 1. In using freely of vegetables and other antiscorbutics, particularly vine- gar and lemon-juice. An ounce of the latter per day to a man, or a pint for twelve days, will, as I have formerly observed, (p. 153) prevent the scurvy during the longest sea-voyages, even Avhen confined to a diet of salt meat. 2. In using pure and Avholesome water. 3. In observing cleanliness in person and clothing. THE SEASONS OF SICKNESS, AND THE DISEASES INCI- DENT TO STRANGERS IN DIFFERENT SEAPORTS IN THE WORLD. To OAvners and masters of vessels, Avho are fitting out ships for foreign voyages, it may be of some im- portance to knoAv particularly Avhen and where diseases are most prevalent; and to travellers, Avho contemplate visiting foreign ports and Avish to arrive in them in a healthy season, this subject must be particularly inter- SEASONS OF SICKNESS. 163 esting. The account here furnished is very imperfect, and is principally taken from the writings of Lind and Turnbull. Seasons of sickness, and the diseases in the sea-ports of the United Slates, and the British ports eastward. New-England and Eastward. In the summer and autumn, there are a feAv cases of inflammatory fevers, occasionally a case of Ioav typhus and some bowel complaints. Bilious remittent lever occurs very rarely, and still more so intermittent fever. In the heat of summer, the yelloAV fever appears once in twenty or thirty years, in one or two of the principal sea-ports. The Avinter season is most sickly, and the prevailing diseases are, inflammations of the chest, as pleurisies, catarrhs, sore-throat, &c. Rheumatism and frost-bites are very common disorders. The greater number of deaths are occasioned by pleurisies and consumptions. Middle and Southern States. Travelling along the sea-board, from New Jersey to Virginia, Avhere the heats are greater, and the soil more moist, especially hi the neighborhood of Avoods or stagnant AA-ater, Ave find agues, fevers, and fluxes of very frequent occur- rence among strangers. The agues are apt to termi- nate in hver complaints and dropsies. The winter season is, hoAvever, less productive of inflammatory complaints here than in NeAv England. In Carolina and Georgia, we find the summer and autumnal diseases last mentioned, much more obstinate, acute, and violent. In the months of July and August, they sometimes partake of the nature of West India fevers. The Avinter season is healthy. In East and West Florida, the summer diseases ap- proach still nearer to those of the West Indies. In some seasons the excessive heat, Avith the concurrence of other circumstances, produces the yellow fever. In other seasons, however, there is quite an entire exemp- 164 SEASON'S OF SICKNESS, ETC. tion from this and all other violent fevers, from Carolina to New Orleans. Pensacola seems to be rendered unhealthy by its sandy and barren soil. In Mobile, intermittent fevers are very prevalent in the months of July, August, and September. The Avinter seasons are generally healthy in the Floridas. Most unwholesome seasons, and the diseases in the West Indies. Comparative degree of health in the different islands. " The most healthy of all the English possessions, in this part of the Avorld, is the island of Bermudas ; next to AAdiich is the island of Barbadoes, if Ave except that spot of ground upon Avhich Bridge-toAvn, its capital, is situated. The air, in many parts of St. Christopher's, is also pure. That of Antigua is bad, and that of Jamaica is reckoned st ill more unhealthy ; though much less so than it formerly Avas. The color of the Euro- pean inhabitants in the island of Montserrat, is a proof of the salubrity of its air ; the same may be said of Nevis. In general, the rainy season in those islands happens in August, September, October, and Novem- ber. In the settlements on Grenada, the Grenadines, and particularly at Tobago, the health of the inhabi- tants has been little attended to. In the island of St. Vincent, the toAvn of Kingston is rendered very un- healthy by an adjoining morass. With respect to the settlements of other European nations, we shall briefly observe, that ihe French set- tlement of Cayenne has proved very sickly. The climate of St. Domingo is also unhealthy ; that of Martinico less so. At Guadaloupe, Martinique, and most of the other French West India islands, there are Ioav SAvampy grounds, commonly called Basse Terre, Avhich are particularly unhealthy. The Dutch settlements at Surinam, St. Eustatia, and Curraeoa, are all very unhealthy. In different parts of the Spanish West India domin- IN THE AATEST INDIA ISLANDS. 165 ions, the air varies greatly in point of purity, according to the situation of the places. The port of Havana, in Cuba, is sickly, Avhile the highlands are not. The city of Mexico is very healthy, Avhile La Vera Cruz, its sea-port, is remarkable for its bad air. It is observ- ed, that in the West Indies the periodical rains, and the sickness Avhich attends them, are much more violent in the hot, marshy, Avoody, and uncultivated places upon the continent, than upon the adjacent islands; the inland provinces are, however, found to be, in general, more healthy than the sea-coast. Were Ave to take a survey of the Avhole coast of the Spanish continent in the bay of Mexico, Ave should find feAv sea-port toAvns or rivers, during the rainy season, tole- rablv healthy. "Shoals of large and ravenous sharks, crowding into the harbors, a dark thick cloud to the southward, with thunder and lightning, sloAvly approaching, foretell the coming on of the sickly season, and are the awful preludes of those impetuous torrents which, in a feAV days, burst from the clouds, 'and cover with water the whole face of the country." " Some of the harbors in the bay of Mexico, and those generally the most secure, prove fatal to Euro- peans, besides the usual causes of sickness, from Avant of a due ventilation. Thus in Port Maho, near the island of Ruattan, ships lie in a basin of water so environed Avith high mountains, that the wind can have- no access to them; in this respect, they suffer more than even at English-Harbor, in Antigua. Ihe stag- nated air thence becomes so unwholsome, that men, after being there a few days, are suddenly seizedj i h violent vomitings, headaches, deliriums &c and in two or three days more, the dissolved mass of blood iS^^Taro7fionduras and the Musquito shore, although ve/y unhealthy, are far better than Carpenters river and Rio Morte, or the river of Death, in theuuu of Mexico This was so named by the Spaniards from 14 166 SEASON'S OF SICKNESS, ETC. the death of all that nation, avIio, at different times, have attempted to make a settlement upon it; the English, howcA-er, have since, by settling on a different spot of ground, been more fortunate, and call it the NeAv river. The most frequent and fatal diseases in the West Indies are, 1. Fevers, \\x., the bilious remittent fever and the yelloAV fever. The former is here so violent and rapid that it often proves fatal betAveen the third and seventh day. It chiefly prevails during the months of June, July, and August, beginning to abate in September. The latter, or yelloAV fever, is the most fatal disease of the West Indies. lis attack is so sudden and violent, that oftentimes the patient is throAvn doAvn, almost in- sensible, Avithout any previous complaint. Vomiting and headache attend him till Avithin a feAv hours of his death, when he experiences a slight abatement of his distress, but soon after relapses and dies, not unfrc- quently in betAveen tAventy-four and thirty-six hours from the commencement. 2. Dysenteria, which, in point of frequency, comes next to fever in the East and West Indies. 3. Dry bellyache or colic, Avhich occurs often. 4. Tetanus or lock-jaAv. 5. Fish poison, which is of frequent occurrence. " It is a general observation that Avomen enjoy much better health in the West Indies than men, and are not so subject to the yelloAV fever as they are, owing, pro- bably, to their more temperate way of living." The folloAving table, recently drawn up by the Brit- ish commissioners of health, is extracted from the London Quarterly Review, of July, 1840, and exhibits the annual ratio of mortality per one thousand mean strength of British troops in the British West India islands. IN THE WEST INDIA ISLANDS. •■BOlUUXBf CO o5 •SU!X *iS ofcTof cT of ~cf TT i—l t^ •BnSiiuv o •BOIUIUIOQ co oo i^ co_ co t^. x^ cTau-4" cT l.O~ "t-t CO "Bion^ "tg — 1.0 CO CO 13 TO 0, -* —. T?( •^- CO 00. of OJ •saopBqiEg X X -*__ oq_ CO^ i3>_ —"io"—" o" co~ of co" i— i-i 0! LO. xf L0> ■s^uaouiA "IS 0) O O CJ CO o ;f S~~ of °r"« •BpBU9J»3 w W ^> O ^1 Ol Oi T"^ 00^ •oSuqox *3> — 0! "* LO CO CO ~ — Oi x^ of in •p^piuux o^in^-H^ ^ t--_ «>,ao co_ o -BUBino qsjiijg of w~r*' xT T" Jl" ^r" •epnuijag l>. UO^ CO^ „"-2.t"U —r-zT " o~ of xT OJ - By levers. Diseases of the lungs " of the liver. " of the sto- ~) mach and bowels. ) Diseases of the brain, Dropsies. All other diseases. c i 168 SEASONS OF SICKNESS, ETC. The Western shore of South America and the Islands of the Pacific. In turning Cape Horn, Avhether outAvard or home- Avard bound, inflammatory affections are very com- mon, as rheumatism, catarrhs, pleurisies and pneumo- nias, all Avhich should be carefully guarded against by Avarm clothing. The coast of Patagonia is healthy, and nearly so is the coast of Chili, particularly Valparaiso; but the inland is less so. Santiago, situated ninety miles in- land from Valparaiso, is remarkable for the extreme heat of the day and coldness at night. Remittent and bilious fevers are here very frequent. Lima is tolerably healthy, much more so than places of corresponding latitude on the Avestern shores of Africa. The ah is too arid and is unfavorable to pul- monary diseases, it is moreover eneiwating and injuri- ous to persons Avho reside here; for any length of time. The remarkable property of the atmosphere to dry up moisture, (as is evinced in the manner of curing jerked beef merely by hanging it in the open air,) is probably one cause of there being no malignant diseases arising from putrid exhalations. Coquimbo, situated three degrees further north, is very healthy. From Guayaquil to Panama, the coast during the Avet season is rather unhealthy, fevers and fluxes, and liver complaints being the prevailing dis- ease. But as a general remark, it may be said that the Avhole Avestern coast of America is quite free from all malignant fevers, and from the destructive fluxes that prevail in corresponding latitudes in the other hemi- sphere. All the islands lying in the eastern longitudes of the Pacific, as the Sandwich, Fejee, Friendly, Society, and Gallapagos, and all others near them, are very healthy. Essex Bay, situated in the Gallapagos, is often visited by whalemen. Emigrants from G ua'ya- quil have, made settlements there. IN THE MEDITERRANEAN. 169 Payta, an island only three days' sail from Callao, has a clear, dry atmosphere, and regular winds that moderate the extreme heat of the day, and the changes of temperature are very slight. It is the port of Piura, a city having a population of 4000, and derives its name from the purity of its air. The cruising ground of whalemen is directly off this port, and in conse- quence of its excellent climate, fine market, and easy access, is much frequented by them. Diseases in the seaports of Great Britain. Diseases along this coast vary very little from those hi the northern ports of the United States, excepting that intermittent fevers are frequent, Avhich are attrib- uted to fogs and east winds. " An east Avind here is usually accompanied by a cold, damp, and unwhole- some vapor, Avhich is observed to affect both animal and vegetable health, and in many places to give rise and obstinacy to intermitting fevers, as also to produce frequent relapses." In the southern part of England, particularly in the British Channel, pleurisies are less violent than in North America. The complaints most frequent and troublesome, are typhus or common fever, intermittents, rheumatism, catarrhs, and consumption. Sickly season and diseases of the Mediterranean. The most fatal disorders to strangers on board ships, are consumptions. This applies more particularly to the crcnvs of men of Avar, or vessels stationed for a long time in this sea. In some of the islands, particu- larly Minorca and Majorca, pleurisies are very preva- lent in winter. Catarrhal affections and rheumatisms are frequent in every port in the Mediterranean. In the summer season, the neighborhood of marshes is sicklv especially the Pontine marshes near the liber in Italy' where intermittents and bilious remittents are very fatal. The African shore of the Mediterranean, excepting when the plague prevails, is very healthy, from the 14* 170 SEASONS OF SICKNESS, ETC straits to Tripoli. From Tripoli to Alexandria, Jaffa, and Smyrna, some of the ports suffer more or less eATery year Avith the plague. " It is said to be most prevalent soon after the inundation of the Nile, or rather its recession. Next to the plague in frequency, comes sore eyes. It is called Egyptian ophthalmy. If less fatal than plague, it is more distressing, and is as frequent among creAvs in vessels at anchor, as among people on shore. Besides these epidemics, that are peculiar to this country, strangers are apt to be seized in the summer season with bilious disorders, fluxes, and fe\ers. Sickly season, and Diseases on the Western shore of Africa. The neAv colony of Liberia, and other settlements along this coast, and the constantly increasing inter- course Avith them for the purposes of trade, require a particular account of their climate and diseases. The British settlements in Western Africa are Sierra Leone, Gambia, the Isles de Loss, Cape Coast Castle, and Accra. They are scattered over a line of coast, Avhich, from St. Mary's on the Gambia to Ac- cra, is nearly 1600 miles in extent, and Avhich every Avhere exhibits the same remarkable hostility to foreign constitutions. The coast is generally Ioav ; its eleva- tion from Senegal to Sierra Leone, a distance of 100 miles, being only a feAv feet above the ocean • its rivers are sluggish and flooded during rains, when the mud they deposit, and the moisture they supply eive rise to an interminable wilderness of forest and brush wood among which lies rotting the decayed vegeta- tion ol many centuries. ° In the Sierra Leone command, are comprised the stations of Sierra Leone, the Isles de Loss, and the Gambia. The peninsula of Sierra Leone,'occupies an intermediate position in the British settlement along this coast, being about 300 miles to the somh of the Gambia, and 1100 to the north of Accraf and ON THE AVESTERN SHORE OF AFRICA. 171 comprehends a tract of land extending about eigh- teen miles from north to south, and tAvelve from east to Avest. St. Mary's, near the entrance of the Gambia, is fatal to foreigners, by reason of the great degree of heat, (the thermometer often indicating 100° in the shade,) and the putrid exhalations arising from its shores. The rainy season commences in July and continues about four months, and the diseases that accompany and folloAv it are, intermittent, remittent, and continued fevers, dyscnteria, and cholera-morbus. These prevail at all seasons among recent visiters, and in a milder form often attack seasoned residents. Free ToAvn, the capital of Sierra Leone, is about six miles from the mouth of the Bunch river, on the south side, and from 40 to 70 feet above the general rise of the river, which is here about 10 miles across. No situation could be more unfavorable for foreign constitutions ; the supply of good Avater being the only thing in its favor. The rainy season lasts from June to October, and is introduced and closed Avith tornadoes. In one year there were fifty-four of these ; no part being more liable to them than this and the grain coasts. The temperature at Sierra Leone, is generally not higher than 95°, but the tranquil state of the air makes it very sultry and oppressive. The mean temperature is about 83°. Continued and remittent fevers, (com- monly called yellow fever) intermittents, dysentery, cholera-morbus, enlargement of the spleen, and chronic inflammation of the liver, are the most com- mon diseases, and are annually fatal to about two- fifths of the Avhites. Of these, about four-fifths die ol fevers, arising from the same causes, though of various types. • , ii t After passing Sierra Leone, the country is hilly and woody. As Ave approach the bay of Sherbro, it grows more level. The distance here is about 80 miles • within Avhich empty four considerable rivers. 172 SEASONS OF SICKNESS, ETC. This bay is formed by a range of low islands, whose south-east extremity touches the continent, and leaves it obliquely, opening Avide to the north-Avest. The country is Ioav and SAvampy, and though a sandy beach edges the land, the soil is a deep and heavy clay. For more than 70 miles beyond, the country is Ioav and SAvampy, Avith many rivers, until Ave arrive at Cape Mount. This mountain is on the south side of a large river of the same name. The elevation soon lessens, and in a feAv miles the same loAvness is seen. The country is thickly Avooded. Cape Mezurado, is about 50 miles beyond cape Mount, and is the south- ern barrier to a river bearing the same name. These rivers overflow during the rains. The Grain Coast begins at the Mezurado, (6° 30' north latitude, 10° west longitude,) and terminates at cape Palmas, (4° north latitude, 7° 20' Avest longi- tude.) The land is uniformly Ioav, Avith thick Avoods, and many small streams, navigable only by canoes. The coast is shelving, and the SAvell from the Atlantic renders the shore generally impracticable. The villages are on the sea side, near the streams. The soil is deep, rich, and heavy. "The plain be- comes almost an entire morass during the rainy sea- son, hence rice is mostly cultivated and eaten by the natives. Occasionally, one or more trees rise high above the rest, and form the most striking landmark. Places designed for the growth of farinaceous vegeta- bles or roots, have their exuberant, but now Avithered productions, towards the end of the dry season, set on fire, and the seeds are then put into the ground." The quantity of rain is nearly the same as in the part of the coast last described. This season begins in June, and lasts about four months, with almost con- tinued thunder and lightning, the wind being generally south-Avest. After this is about a month of fogs, with an almost tranquil atmosphere. The prevailing diseases of Liberia, are fevers and fluxes, and diseases of the hver. Almost every for- ON THE AVESTERN SHORE OF AFRICA. 173 eigner is attacked Avith fever Avithin the first nine months, varying in type and severity according to the prudence he exercises in his diet and regimen, and in the other known measures that experience has taught, as being effectual in preA^enting or mitigating its force. In reflecting upon the sickness and loss of life sus- tained by this colony since its commencement, it affords some relief to knoAv that it is every year be- coming more healthy. Ivory Coast, commences at Cape Palmas, and ex- tends to Cape Lahou, in -3° north latitude. It is, like the Grain Coast, Ioav and swampy; tOAvard the Gold Coast it is more level, like table-land. For 700 miles from Sherbro to Cape Lahou, there is a uniformity in soil and seasons, in the luxuriance of the vegetable kingdom, in the natural scenery, and in the character and severity of diseases. The Gold Coast runs about 500 miles, to Rio Volta. Apollonia, the first settlement, is in a rich, fertile country. Next to it are Axim and Hollaiuiia, belong- ing to the Dutch ; Dixeove, Sueeondee, and Commenda, belonging to the English ; also Anamaboo, and beyond this the Accra country, Avhere English, Dutch, and Danes, have settlements in a finely cultivated and comparatively healthy country. The rains commence in Mav and terminate in the beginning of August. Between Accra and Rio Volta, Avhich terminates the Gold Coast, are the settlements of Pramjiram and Ningo, the soil of which is hght, sandy, and well cul- tivated by the Dutch. The Slave Coast commences at Rio Volta, and ex- tends to Biaffra, in latitude 3° north. The whole coast is Ioav and swampy, indented by creeks and rivers the largest of which are the Formosa, old and new Calabar, the Croos, and Del Rcy rivers. OAving to the extensive trade through them in palm oil, ivory, and ebony, these rivers are more frequented than any on the coast. The climate is so unhealthy that, on an average, not more than one half of those here em- 174 SEASONS OF SICKNESS, ETC. ployed in trade ever return. " The necessity for ves- sels to proceed some distance up these rivers, in order to enter on the field of traffic, brings them Avithin the sphere of action of the malaria, generated from the mud, ooze, and decaying matters which continually cover their banks. These sources of disease are greatly multiplied both during and after the rainy sea- son." The prevailing diseases are continued and re- mittent fevers, dysentery, and cholera morbus. There is a great sameness in the soil and face of country along the coast of Africa, from the mouth of the Senegal, to cape Lopez, in latitude 3° south, and consequently a great sameness in the nature of the diseases, being mostly comprehended under the names of fevers and fluxes. Those who arrive on the Avest- ern coast of Africa, between the Senegal and Ben- guela, and especially betAveen Gambia and cape Lo- pez, are subject Avithin the first nine months, and more frequently Avithin as many Aveeks, to the endem- ic yelloAV fever, to bilious diarrhoea, to cholera-mor- bus, and dysentery. If a bilious diarrhoea or cholera precede an attack of fever in the new comer, (com- monly called the seasoning,) both diseases may be comparatively mild. Fevers are the most destructive diseases, and equal- ly fatal Avith those of the West Indies. The Avorst forms in the tAvo regions resemble each other so close- ly, as to have given rise to the opinion that the ma- lignant yelloAV fever of the West Indies, was imported from the island of Bui am, latitude 11° north. No doubt, hoAveA^er, the disease is of local origin in both regions, since they both abound in those marshy miasms which are noAv generally acknowledged to be its sole cause. There are, however, milder grades ol fever, as intermittents and simple continued, Avhich rarely prove fatal, though the former are often found to leave a disordered state of the liver, called ague- cake. Among the natives, fever is very slight, ap- pearing under the form of a headache, or disordered stomach or boAvels, and is of short duration. ON THE AVESTERN SHORE OF AFRICA. 175 Dysentery is also common, and in new comers very acute. It is most frequent on the Gold Coast, proba- bly owing to the scarcity of good Avater. Complaints of less magnitude, but very trouble- some, are the dry bellyache, prickly heat, Guinea Avorm, and stroke of the sun. The fatal diseases prevail mostly during the rains, and for sometime after they have ceased. The rainy season begins in Senegal early in July, and continues till the end of October; at Gambia, a Aveek or tAvo sooner ; at Sierra Leone, and Liberia, at the begin- ning of June; and along the coast of Guinea, about the middle of May. These rains last about four months, with almost continual thunder and lightning, the Avind being generally south-west. To the rain season succeeds about a month of fogs, with an almost tranquil atmosphere, arising from exhalations. This is the most noxious season. But for the almost daily tornadoes, Avhich carry before them the stagnant pes- tiferous air in a tumultuous sweep, much of the coast would probably be uninhabitable. The following table exhibits the dreadful mortality that prevails in the Gulf of Guinea, as Avell as at Sierra Leone. Wijhin a feAv years past the British government has taken possession of the island of Fer- nando Po, in this gulf, and made it the head quarters of its military establishment in this section of the Af- rican coast. The Avaste of life at Cape Coast castle, and at other stations along the main, made it neces- sary. Happy Avould it be Avere this island free from tropical diseases. Its commanding situation for the suppression of the slave trade through the gulf, ren- ders it a most desirable possession lor the English, who are so heartily engaged in endeavoring to stop the traffic in human flesh. Would to God their noble philanthropy were backed by other nations of Europe, instead of being thwarted by the French, Spanish and Portuguese flags. But Fernando Po was formerly very sickly, and it is to be feared will ever remain so under its neAv possessors. 176 SEASONS OF SICKNESS, ETC. From Biafra south to Cape Lopez, and the Portu- guese and other settlements, along the coast of Loan- go, Congo, Angola, and Benguela, die salubrity of the climate varies. St. Paul de Loango is tolerably healthy, St. Salvador, the most so in this division of the globe, Avhilst Benguela is very sickly. ~5 -=: O ■^ >.—? "-- c = S ■^ rv r~ tr. ^ -*" ^ S^ ^ ; s^p •aauBjj jo apj i-i lO)"'*' o" r-T of " i-f i^ Of ■i o 5 adojj poog jo adBQ aqj jo jaijuojj uiaisBg C*,T1< ^ CO_ i-Ttrf" of t^O 30^ CO adojj poo*) jo adBO —~CO~rt~ CO CO —„ "'->. co" •Bviuinjf) jo jjnf) pue ';sbo^ adB3 382,6 1,6 14,3 220,6 r-Tco tt" CO oo to •aiioa^ Bjaaig O) cr: ^ co^ TT Tt OJ < < 3 S W -SpiIB[SJ UB -iuoj aqi jo aSsjaAy r.^'Q, OJ in OJ •jB)iBiqij) CO_ CO_tT_ —■_ cii£ " of O^lO^CO t^ of " ~-T oi ■bubjm r-. o —n o_ oi t£«" eo" cq^Tr io^ 5 •uiopSuiji pav.ufi 0> l^ CO '/^ -T ~ 'of so By fevers. Diseases of the lungs. " of the liver. " of the sto- ) mach and bowels. S Epidemic Cholera. Diseases of the brain. Dropsies. All other diseases. *e3 o Eh fN THE EAST INDIES. 177 AFRICAN ISLANDS. Of the Canaries, Cape de Verd Islands, the Island of St. Thomas, Princess, Fernando Po, St. Helena, Cape of Good Hope, Madagascar, Mascarenhas, Mauritius, Eastern shores of Africa. The Canaries are remarkable for their healthiness. The Cape de Verds are rather unhealthy. St. Anto- nio and St. Nicholas are the only tAvo islands in that cluster, AAhere strangers are exempted from a general sickness during the rains. These generally begin in July, and continue till November. Sickness is par- ticularly violent in the island of St. Thomas, Princess island, and Fernando Po. In St. Helena, foreigners enjoy good health. At the Cape of Good Hope, the settlements are fruitful, pleasant and healthy. Passing these, Ave come to the large island of Madagascar, Avhere, during the rains, which continue from NoA^ember till March, this island is very unhealthy, particularly the Bay of St. Augustine and Fort Dauphin, the tAvo places Avhere ships commonly anchor. The same may be said of Mascarenhas, Mauritius, and the barren island of Diego Reys. As to the eastern shores of Africa, Ave shall only remark, that Mozambique is reckoned unhealthy ; the country of Quiola much more so ; but the city oi Maradoxa and Melinda are said to be tolerably free from disease. East Indies. In all parts of the East Indies, situated near large SAvamps, and the banks of muddy rivers and stagnant Avaters, mortal diseases are very prevalent. " The English have four presidentships or govern- ments namely, Madras, Bengal, Bombay, and Ben- cTolTn Formerly, Madras was the most healthy of these but latterly it is least so, with the exception of Bencoolen, Avhich has always been the most sickly. 15 178 SICKLY SEASONS IN THE EAST INDIES. Bengal is very sickly during the rainy season, Avhich commences in June and continues till October ; the remainder of the year is healthy. Calcutta, belong- ing to this presidentship, built literally on a sAvamp, on the east side of the Hoogly, and surrounded to this moment by immense lakes at a feAv miles distant, has, by the draining of that part of the city inhabited by Europeans, become as healthy as any country of the same latitude on earth. There are several other places in this Aacinity that seem to have been made healthy by being cleared, as Fultah, Barrackpore, Serampore, Chandernagore, Chinsurah. But other places continue sickly." Bombay is more healthy than Bengal, and in gene- ral the Avhole coast of Malabar is tolerably exempt from disease. The same may be said of Surat and Tellicherry on the same coast. The rains begin in May or June, and last four months. Manilla, in the island of Laconia, is remarkable for its healthiness. Tranquebar, a Danish settlement, is likeAvise healthy. Pondicherry, the capital of the French in India, is far from being unhealthy. The same may be said of Goa, the residence of the Por- tuguese viceroy in India. Batavia, the capital of the Dutch dominions, is annually subject to a fatal and consuming sickness. The rains begin in June, and sickness in July. The diseases which rage during the wet season, and for some time after it, in the unhealthy parts of India, are malignant and bilious fevers. Foreigners espe- cially such as live intemperately, are also subject to fluxes and to an inflammation of the liver. This last is almost pecuhar to India, and principally to the Coro- mandel coast. The diseases of the hver are generally preceded by fever, difficult breathing, and violent pain in the right side. The fevers of Bengal are attended with violent bilious symptoms. Genuine ideopathic inflammation of the liver is ten times more prevalent on the coast of Coromandel than ON CHOICE OF CLIMATES, ETC. 179 on the plains of Bengal; whilst on the other hand intermitting and remitting fevers are ten times more frequent in the latter place. This is attributed to the greater heat, being ten degrees higher on the Coro- mandel coast. ON CHOICE OF CLIMATE, AS A REMEDY FOR CONSUMP- TION, AVITH DIRECTIONS TO PATIENTS IN THEIR TRIAL OF IT. Change of climate stands at the head of remedies for consumption in its first stage, and as a palliative in its second stage. Not that any climate possesses spe- cific virtues in this disease, for statistics of health and mortality show that there is no immunity from con- sumption in any quarter of the globe. But some cli- mates are more salutary, to Aveak and irritable lungs, than others; and experience shows that persons dwell- ing in northern latitudes, may, generally, under the advice of a physician, and with dhections hoAV to profit by its advantages, and avoid its disadvantages, derive great benefit from a change to a milder chmate, during the Avinter season. My purpose is to give a compara- tive vieAV of some of the usual places of resort. The climate of the Northern and Middle States varies so httle in respect to latitude, and temperature in mid-Avinter, that a removal from one place to another Avould promise little benefit; less, in fact, on such considerations, than some favored positions compared Avith others do in the same state. South Carolina and Georgia hold a middle rank betAveen NeAv England and Cuba, and have proved highly beneficial to patients from the North, who labored under chronic bronchitis, and bleeding from the lungs, and also in cases of incipient consumption. I have rarely if ever, been disappointed in finding the inva- lids I have sent to those places, benefited by the change Aside from the favorable change of atmos- 180 ON CHOICE OF CLIAIATE pheric temperature, there is a satisfaction to the patient in knoAving that the facility of communication Avith those places, enables him often to hear from home, and to return by land, if desirable, at any moment. Farther south, the most eligible place is St. Augustine, which is resorted to by great numbers from the North, and in most cases, Avith decided advantage. The accommo- dations for invalids are not so good as may be desirable, but they are undergoing considerable improvement, and all necessary comforts are obtained at a reasonable price. Occasionally there are sudden changes of tem- perature, and even severe frosts, Avhich require more care and circumspection on the part of invalids, than are requisite in any of the West India islands ; less so, however, than Carolina or Georgia. The West Indies are resorted to during the Avinter season, by invalids from all parts of the United States, partly on account of their intertropical and equable heat, and partly on account of the frequent intercourse kept up with those places for purposes of trade. In the disordered state of the respiratory organs, Avhich I have mentioned, and in more advanced stages of con- sumption, they generally prove beneficial. Some of them, however, are more eligible than others. Jamaica, from its size, differs from others, in presenting more variety of climate and scenery. Of all the small islands, St. Kitts, for its high, and Barbadoes, for its Ioav land, are deserving of preference. A change of residence from one island to another is, perhaps, better than re- maining stationary, affording as it does the advantages of sailing, and variety and novelty of scene. Santa Cruz has the advantage of English society and customs, and is often selected by invalids from the northern and middle States. The thermometer ranges betAveen 76° and 84° during the Avinter, and usually stands at 80°. The island being very small, its air is oceanic and re- freshing, showers are frequent, Avinds gentle and grate- ful ; and exposure to air pleasurable by day and night. The water is not always pure in this and many of the AS A REAIEDY FOR CONSUMPTION. 181 islands, rain-water being the chief supply. Milk is scarce and dear; but tropical fruits are delicious and abundant. Cuba is, hoAvever, the more general place of resort for persons laboring under pulmonary diseases. The country around Matanzas is thronged by invalids dur- ing the Avinter months. Many of the permanent resi- dents are either American or English, as are also the families and servants in many of the hotels and board- ing-houses. The climate is mild and equable during the Avinter, but is occasionally visited by a chill from the north. A strong desire to render all the service in my poAver to invalids, in pursuit of health in this region, hi the Avay of general as Avell as professional advice, has led me to obtain from a physician of high emi- nence, Dr. John D. Fisher, of Boston, such information as AA-ill interest and benefit them, from the time they decide on going to Cuba, till their return. I may add, that Dr. Fisher is particularly skilled in pulmonary diseases ; and having just returned from Cuba, Avhich he visited, for the recovery of his OAvn health, is preem- inently qualified to give advice. " The results of my investigations, in relation to the influence Avhich a permanent or a temporary residence in Cuba has on pulmonary consumption, lead me to form a favorable opinion of the remedial agency of the climate of that island in this serious disease. " The Aveather in Cuba from November to May, is uniform in its temperature, and is usually characterized by a pleasant and healthful degree of dryness. It is this, denominated the dry season, which proves particu- larly agreeable and beneficial to consumptive invalids. " The rainy season, comprising the period from May to October, is rather too debilitating and Avarm to be agreeable to persons of a tuberculous habit; and yet those who have resided in the island for years in suc- cession, do not consider the rainy season calculated to undermine the general health, or to exert an unfavorable influence on tuberculous lungs. 15* 182 ON CHOICE OF CLIMATE " In ansAver, therefore, to your inquiry, ' under Avhat chcumstances Avould it be desirable to send consump- tive individuals to Cuba,' I Avould say, that I Avould recommend tAvo classes of phthisical invalids to visit that island on account of their health. The first class would be those aa-Iio, in consequence of an hereditary taint, are predisposed to the disease, and avIio had shoAvn symptoms of the existence of crude tubercles in the lungs ; and the second class Avould be those who have tuberculous deposits in the lungs, Avhich tuber- cles may have advanced to the state of softening — provided this state should be confined to one lung, while the other lung is comparatively free from the disease; and provided also that the general tone and functions of the digestive and other organs of the body are healthy. " Individuals of the first class, by taking up their residence in Cuba, before the disease has advanced beyond the state mentioned, and by observing, in the most rigid manner, the laAvs of health, may live and enjoy a comfortable degree of health there, even to an advanced period of life. They should engage in some active business, Avhich would require them to be much in the open air, and to take constant and pleasant physical exercise. " In selecting a residence in the city or in the country, they should be particular in securing a dry and healthy one ; and, under all circumstances, they should guard themselves against the effects of a change of the weather from hot to cold, and against the debilitating and ener- vating influences of the summer and rainy season. " This season is much less favorable to the safety of the phthisical invahd, than the other portion of the year ; and, in consequence of its depressing influence on the vital powers, it is recommended that the invalid should, as often as every tAvo or three years, spend the summer months in a northern climate ; by doing which the system regains its accustomed tone and vigor, and is prepared to withstand, for a lengthened period, the enfeebling AS A REMEDY FOR CONSUMPTION. 183 influences of intertropical climate. I became acquaint- ed Avith many individuals of this class, during my stay in Cuba, Avho had resided in the island many years, and avIio enjoyed a firmer state of health at that time than they had for a long period previous to their leav- ing the United States. " With respect to the second class of consumptive patients Avho may Avith advantage visit Cuba, or those in Avhose lungs tubercles not only exist, but are in the commencing process of softening, I Avould remark, that they should arrive in the island in November, or after the rainy season is passed, and remain until May; during which period they will experience and enjoy all the advantages of a uniform temperature of sum- mer heat. This season is usually characterized by a dry atmosphere, and a range of temperature from 74° to 82°. The heat, Avhich otherwise would be often- times oppressive, is tempered by the trade Avinds or sea breezes, Avhich blow in a gentle gale from the east constantly during the day. These, which are most agreeable in their effects on the system, sometimes change suddenly from the east into the north, and then SAveep over the island, causing the mercury to fall rather suddenly in the thermometer as low as 68° or 65°. This change in the temperature, and the peculiar chilliness of these 'Northers' are seriously felt by the inhabitants, and particularly by invalids, and ren- der a change of clothing and even a fire necessary. These winds are the only chcumstances which render a winter's residence in Cuba at all disagreeable ; and as they are of short duration, then unpleasant effects can be and should be guarded against by those whose lungs are invaded by tubercles, whether in a primary or a secondary degree. The class of patients now under consideration, on arriving in Cuba, should not remain long at the place of debarkation, but should seek some boarding place in the country, where they can have the advantage of pure air, pleasant scenery, and constant exercise on horseback. They should 184 ON CHOICE OF CLIMATE make it a rule to rise at an early hour and ride some miles every morning, taking care to return home be- fore the heat of the sun becomes too oppressive. From ten o'clock in the morning, until five in the after- noon, they Avill find it more agreeable to remain within their cool apartments, reading, Avriting, or engaged in some pleasant amusements which require gentle exercise of body. After five o'clock, they can exercise again by riding or Avalking until evening. As it is important that the patient should have his mind constantly and pleasantly occupied, so that he shall even forget that he is an invalid, I Avould advise him to engage in some agreeable pursuits, that may divert his attention from his malady; and especially Avould I advise that he should not associate Avith those Avho, like himself, visit the island on account of pulmonary complaints. It is too frequently the case, that consumptive patients in Cuba resort in numbers to a feAv boarding establish- ments. It Avould be much better for them if they would not thus associate. For being together, and hav- ing nothing to occupy their minds during many hours in the day, they are naturally prone to converse on the subject of their maladies, and oftentimes imagine that they are rapidly passing to the grave. This very thought has an influence in depressing the vital pow- ers, and in hurrying on the disorder to a more serious stage. Patients of the class I am now speaking of, should, therefore, if possible, often pass from one place to another, and remain but a short time at one boarding house. In thus moving about the island, they will necessarily be much in the open air, and take the very kind of exercise which is the most bene- ficial. Then minds will also be occupied by agreea- ble and interesting objects, and their general health promoted. These consumptive patients should make their arrangements to leave the island in the month of May. Those from New England should proceed from Cuba to some southern port, and travel leisurely, and not reach home till the middle or last of June, or AS A REMEDY FOR CONSUMPTION. 185 until the east winds are over, and summer is fairly commenced. In Avhat I have said respecting the classes of consumptive persons avIio may be recom- mended to visit Cuba, you Avill observe, that it is of great importance to the patient that the exact patho- logical state of his disease should be determined. Many, very many persons, are sent to the island who are in the last stages of the disease, and Avhose lives are shortened rather than prolonged by leaving home. No patient, whose lungs are more seriously diseased than has been indicated, should leave his home and friends ; and no medical man can be justified in re- commending him to do so. EUROPE. The climate of the south of Europe, has for ages been associated in the minds of medical men with re- hef for pulmonary diseases. Marseilles, Montpelier, Hyeres, and Toulon, Avere formerly the resort of the afflicted. But these places, says a distinguished wri- ter, (Sweetser,) are all liable to cold dry Avinds from the north and north-west. Hyeres, situated nine miles east of Toulon, being sheltered from these winds by a range of hills, is preferable to the others. The place is often selected by the invalids of France, but the advantages of its climate are inferior to those of manv other places, and would scarcely justify a voy- age to it from America or England. D' Nice, in Piedmont, enjoys a mild Avarm climate, but for many patients it is too exhilarating and exciting. A lofty range of mountains shelters it from the north wind, but during the early spring it is unsafe on ac- count of the chilling north-east and east winds. Ihe atmosphere is generally clear and somewhat dry. The thermometer during the coldest months seldom falls save at night, to the freezing point; and the mean temperature of winter is about 48°. It has long been much frequented by the English, who are sulfa- 186 ON CHOICE OF CLIMATE ciently numerous in Avinter to form a society by them- selves. They reside mostly in the rear of the city, in a part more sheltered by the hills. They informed me, Avhen I visited the city in 1820, that this part is decidedly better for invalids. < Genoa, Leghorn, and Florence, are inferior to Nice, as a Avinter residence for those Avho suffer from pulmonary affections. They hoAvever, abound in ob- jects of interest to travellers, particularly Florence, and afford agreeable and cheap accommodations. A feAv weeks' residence late in the spring may prove ad- vantageous. * Pisa is a pleasant city, situated on the Arno, Avhich divides it into two nearly equal parts. The streets are mostly wide and straight, and handsomely paved. The two most beautiful of them are the Lung, and Arno, Avhich are broad, quiet, and clean, extending along the curved and handsome quays, on one side bounded by the river and guarded by a Avail breast high, on the other lined by fine ranges of lofty build- ings. Silence and serenity are the striking charac- teristics of this city, and its scenery is soft and varied. There are many noble structures, beside the leaning tOAver, to denote its former grandeur, when it Avas the capital of a great republic, and the residence oi a hundred and fifty thousand inhabitants. It has a large English society, a botanic garden, university, exten- sive library, observatory, and museum of natural his- tory. Pisa has long had the reputation of possessing, for consumptive patients, one of the most favorable climates in Italy. Its climate is genial, but rather op- pressive and damp. It is softer than that of Nice, but not so Avarm; less soft, but less oppressive than that of Rome. For invalids Avho are almost confined to the house, or Avhose power of taking exercise is much limited, Pisa offers advantages over both Rome and Nice, or any other place probably in the south of Europe ; and from Avhat I saAV during a visit there, I should prefer it to any other in a majority of cases. AS A REMEDY FOR CONSUMPTION. 187 Living is cheap, and the hotels and lodging houses are very comfortable. The northern bank of the river enjoys a milder temperature during the cold sea- son than the opposite side, and should be preferred by the invalid. Rome. The climate of Rome is mild and soft, but rather relaxing and oppressive ; in its physical quali- ties, Sir James Clark considers it one of the best in Italy. One peculiarity of it, deserving notice, is the stillness of its atmosphere ; high winds being of rare occurrence. To an invalid Avho is anxious for tran- quillity, and takes an interest in the fine arts and in Roman history, no place can be compared Avith Rome. The quiet and solemn majesty that pervades the city, the melancholy grandeur of its ruins, the pomp and solemnity of papal processions, all have, as it were, a sedative and tranquillizing efiect on the mind of an invalid. Consumption in its early stages is generally benefited by this climate, especially in mid-Avinter, and it occurs less frequently here than in most other cities in the south of Europe, and is remarkably chronic in its course. It is also peculiarly favorable for chronic bronchitis. The Avater is very pure, milk abundant, and all the necessaries and comforts of life are easily and cheaply procured. The pleasantest lodgings are in the Piazza di Spagna, or someAvhere in its immediate vicinity. -Naples, for those in health, or laboring under slight debility, and who require mental amusement and re- creation more than a mild and equable climate, is a delightful residence, but for consumptives it should certainly not be chosen for a Avinter abode. High winds prevail there more than at Rome, and those coming from the sea are at certain seasons keen and chilling. I found during a residence of summer months that it is cooler and more equable, excepting when the sirocco wind from Africa prevails, than Rome, or almost any other Italian city. This is owing to the coohng breeze from the West, which draws in- to the bay. 188 ON CHOICE OF CLIMATE, ' Malta is not considered a good winter residence for consumptive patients. THE WESTERN ISLANDS. If required to state Avhat place of residence appears, on the Avhole, best suited for pulmonary complaints, I should, from all I have been able to gather, decide in favor of Madeira. The mildness of the whiter and coolness of the summer, and slight difference of tem- perature betAveen day and night, render it the most salubrious climate of the northern hemisphere ; ' and there is no place ' says Sir James Clark, ' on the con- tinent of Europe, Avhere the pulmonary invalid could reside Avith so much advantage during the whole year.' The same author thinks, that ' Avere the ac- commodations for strangers equal at Teneriffe, and the means of communication betAveen it and Madeira more frequent, many invalids might benefit greatly by passing the Avinter partly at Funchal in Madeira, and partly at Santa Cruz in Teneriffe, Avhich is about four degrees further south.' The Azores, situated five degrees further north, and further removed from any continent, enjoys a climate more purely oceanic, mild, humid, and equable, and better suited for bronchitis than even Madeira. i- Comparing Madeira Avith the Canaries, and Azores, we find a gradual transition from the humid, soft, and equable chmate of the Azores, to that of arid and rocky Teneriffe, where the want of rain during the greater part of the year, renders much of the island dry and sterile. Madeira presents an intermediate climate betAveen the two, and has the advantage of a cooler summer than either. They all abound in trop- ical fruits and vegetables, of all kinds, in eggs and foAvls, and in all the necessary comforts that an inva- lid requires. There is good English society, and fre- quent communication betAveen them and both the con- tinents. CONCLUDING REMARKS. 189 CONCLUDING REMARKS. • I have ever felt sensibly the Aveight of responsibility that a physician incurs in deciding on the propriety and expediency of a sea-voyage, and change of cli- mate, in cases of threatened consumption. On the one hand it seems like banishing the sufferer from home and kindred for an uncertain boon ; and on the other it may prove a fatal error to dissuade from a trial of perhaps the only remedy that could benefit. There are also many other chcumstances to be weighed beside the actual condition of the lungs. Ample pecuniary means, the feehngs and habits of the individual, the sex, taste for travelling, and for mental improvement, condition and attractions of home, and a variety of other considerations are to be taken into account. Granting all these to be favora- ble, Avhat are the period and circumstances in Avhich benefit may be expected ? I ansAver, that when the symptoms have but recently begun to declare them- selves, and are slight, some trifling, not very marked disturbance of respiration, commencing emaciation, some cough, bleeding from the lungs, there is a rea- sonable hope of benefit, even though there be some purulent expectoration' Life may be protracted, and a repetition every Avinter may carry the patient along through the period of life most susceptible to con- firmed consumption. Again, if percussion and au- scultation show that the disease is limited to but a small portion of the lungs, then change of climate, and the saihng or journeying, one or both, necessary in effecting it, may assist the constitution to bear up under such limited disease, and prevent its farther in- crease Furthermore, Avhen the disease is manifestly chronic in its nature, even though the disorganization of the lungs be further advanced, the subject would orobablv be rendered more comfortable, and live longer, in a mild and equable climate, than in one 16 190 CONCLUDING REMARKS. more severe and variable. Finally, change of scene and the buoyancy of hope, inspired by the prospect of travelling, will have a salutary influence, independ- ently of a mere change of temperature, and this should induce the patient to change his residence often, Avhile absent from home temporarily at least, rather than to continue in the same city. " Travelling itself should be so conducted by the in- valid, that neither his mind or body be overwrought. The former should be amused and pleasantly excited, but not fatigued. ' Italy, in a particular manner, so abounds in objects awakening the most eager curi- osity, and interesting associations, that there is constant hazard of undue mental and physical exertion. Con- stant sight-seeing is wearing to those in health, and much more so to the invalid, and may unfit the body for quiet rest at night. The exercise of the body too should be pleasantly exciting, but never exhausting, and not suffered to encroach on the usual hours of sleep.' The churches of Italy, with the exception of St. Peter's, are cold and damp, and should be avoided. " Flannel should be Avorn next the skin, and thick soled shoes, or Avhat is better, shoes AA'ith false soles of cork. The patient should always have an overcoat at hand. He should avoid lofty mountains and the damps of evening—subsist on a light and nutritious diet — should take breakfast previous to setting out in the morning, and bread and milk, or macaroni and fruit at noon, and a plain meal about sunset, and not take a hearty one just before sleep. If only a predis- position to consumption exist, solid animal food, and the light Avines, if they agree with the patient, may be taken in moderation. But when symptoms of con- sumption are manifest, and especially if there exists any inflammatory tendency, both Avine and solid ani- mal food should in most cases be avoided. The best vehicle for travelling is one's OAvn carriage, by Avhich the routes, stopping places, periods of travelling and rest, may be adjusted to the patient's strength and CONCLUDING REMARKS. 191 convenience. The diligence travels all night, and at a very slow pace ; the vettura is still more objection- able. * It Avill be advisable to change the conveyance by land to Avater, as often as convenient. " Pulmonary invalids should bear in mind the advan- tages of sailing over those of land travelling. The vicissitudes of heat and cold are less during the twen- ty-four hours, the rolling of the vessel produces a sedative effect upon the pulse and lessens inflamma- tion, the fumes of tar emanating from the seams and cordage of the ship, acting upon the secretions in the lungs, improves the expectoration, various kinds of bodily and mental excitement are excluded; and on the Avhole, so far as my observation has extended, pa- tients, if not annoyed by sea sickness, will hi a majority of cases, find themselves benefited during then out- ward bound passage. . " Invalids who go to tropical climates during the Avin- ter should in most cases, return during the summer season They should not return direct to New Eng- land, till after the month of May; they Avould do bet- ter to land at a southern port and approach the north gradually. I have known many persons complain of increased cough, and sometimes have bleeding at the lungs the moment they arrived on soundings, it pre- vious to the first of June." APPENDIX. Table of Aveights and measures employed in medi- cine. A pound, lb. j An ounce, § A drachm, 3 A scruple, B The gallon, The pint, The fluid ounce, The fluid drachm, contains ■> xij vnj xx contains * 12 ounces, § 8 drachms, 5 3 scruples, 9 20 grams, gr ' eight pints, sixteen ounces, eight drachms, sixty drops. When medicines are directed in the quantities of a table-spoonful and a tea-spoonful, it is to be under- stood that the spoons are of middling size, the former equaUing about half a fluid ounce, and the latter a fluid drachm. Sixty drops of water, one hundred drops of spirits and tinctures, and one hundred and twenty of alcohol, are equal to a drachm by measure. The doses, prescribed in this book, are intended for male adults. Boys from fourteen to eighteen are to take only three fourths the quantity ; from ten to thir- teen or fourteen, one half only. MEDICINE CHESTS. There is no part of the supplies of a merchant ves- sel in Avhich such Avant of system exists, as in the medicine chest. The laAv of the United States, re- quiring a chest to every vessel over a certain size, is APPENDIX. 193 so indefinite, that betAveen the parsimony of OAvners and the imposition of apothecaries, the intention of the laAv is quite as much evaded as it would be, if the ocean were pointed at by the commander, Avhen called upon to exhibit his medicine chest, merely because a sailor occasinally uses salt water as a medicine. It is true that there is a medicine chest on board each ves- sel over a certain size, and that there are medicines in it, and this ansAvers all the requirements of the haw. But let a physician, Avho is acquainted Avith the medi- cal wants of seamen, examine the chest, and he will report that bulky articles of trifling cost occupy most of the room, to the exclusion of other articles, absolutely necessary in case of sickness. The reason offered for this, when the apothecary is not afraid of offending his customers by giving it, is, that owners, from being in the habit of obtaining chests for certain sums, are unwilling to give more at the suggestion oi an apothecary; and that it is necessary for the chest to exhibit large quantities of medicine in order to give satisfaction. It would, however, be inconsistent with the fair and humane character of American merchants, to Avithhold their consent to any improvement sug- gested by a disinterested person, acquainted with nau- tical diseases. . , f But the impositions most to be complained oi are practised by foreign apothecaries, who not only put up w^ong proportions and unnecessary kinds, but cheat in the price and quality of the articles. To correct such abuses and make medicine chests the seaports of the United States. It ijhowever - be -coUec f "j"^ SS?:££5£ shtld'be f deducts from this price of from five to ten per cent. 16* CONTENTS OF A MEDICINE CHEST. PROPORTIONS ACCORDING TO THE NUMBER OF PERSONS IN A SHIP, AND THE FAIR PRICE OF EACH MEDICINE. From lb' to 4U men. From 8 to J 6 men. Less than 8 men.. NO. NAMES. 11). oz. $ cts. lb. oz. $ cts. lb. oz. $ cts. DOSES INTERNALLY GIVEN. 1 Alum. 4 (j 2 4 1 3 4 grs. of powder, made into a pill. r 30 to 40 drops, 3 or 4 times a day, in fe- 2 Antimonial Wine. 8 30 8 30 4 17 ) vers and inflammations; atea-spoonfal ( every 15 minutes as an emetic. 3 Balsam Copaiva. 8 60 8 60 4 40 20 drops on sugar or water. 4 Balsam of Life. (Turling-ton's.) Blister Plaster. (In roll.) } 8 68 8 68 4 40 do. do. 5 C 55 3 30 2 20 (i Blue Pill. (In mass.) 4 35 2 20 1 12 One pill for syphilis ; four as a cathartic. 7 Blue Vitriol. h 4 h 4 h 4 ( As an emetic in case of swallowed poi- 8 Calomel Pills, 2ors. each ~) \ son, 15 grs. in a glass of water. No. 200, 100,1=0. (Tin > 1 50 80 70 1 or 2 morning and evening, in syphilis. box.) J 1 20 i 20 to 30 grs. for a cathartic in malignant 9 Calomel. 20 1 h 12 ) fevers, and cholera of India, and the 10 Calomel and Jalap, lf> grs. of each, mixed Nos. 40, 25, 10. \ 50 33 20 ( West Indies, and Africa. 11 Camomile Flowers. Box. 8 30 4 17 2 10 12 Castor Oil. 1 30 8 20 6 15 One to three table-spoonsful. 13 Camphor. 1 50 8 30 6 25 A tea-spoonful. 14 Caustic. i 25 i 25 i 25 15 Cream of Tartar. (In ll 30 8 17 4 10 ( A tea-spoonful or two in water or mo- 1 box.) ) j lasses. 16jDover's Powders, (made into pills,) 4 grs. each.) I 1 25 70 30 r 1 pill in fever, and for coughs and coltte, 5 and 2 or 3 in rheumatism, every four 1 Nos. 230, 115, GO. 1 J ( hours. NOTES AND DIRECTIONS CONCERNING EACH MEDICINE. No. 1 Is chiefly useful externally to stop bleeding, and for fungous ulcers j for gargles; for sore throat, by dissolving a tea-spoonful in a tumb ler of water. Internally, in obstinate diarrhoea, in pills. Useful in lung fever and pleurisy, coughs, colds and levers ; uiven four or five times a day, in half teaspoonful dose. As an emetic, in dose of a tea-spoonful every 15 minutes, till it operates. When exhausted, the phial may be replenished with 10 grains of tartar emetic, and half a pint of hot water, which will he of equal strength with ilie wine. Balsam Copaiva, given chiefly for gonorrhoea, and gleet ; dose 20 drops, three times a day, dropped on the surface of a glass of water, or into sugar. It is good in piles. Is of trifling value in old coughs; is worse than useless in cuts, and ought to be left out of the chest. Useful in local pains and inflammations, particularly about the lungs, may be spread on cloth or leather, very thin, and applied near the pait affected, and allowed to remain twelve hours. Useful in biliary obstructions, especially after having had bilious fevers in tropical climates. Also in syphilis, morning and evening, in doses of 3 or 4 grs. When taken as a cathartic, it should be followed soon after with other physic to assist its operation. Useful to touch old ulcers with ; a solution of it may be drawn into the nose when bleeding ; sometimes given as an emetic. May be taken night and morning, in cases of syphilis that absolutely require it. Most recent cases can be cured without mercury. In the fevers and fluxes of India, Western Africa, and the West Indies, large doses of 20 to 40 grains are given at the onset of the dis ease, and salivation is hastened by frequent small doses. Given when very strong cathartics are required, as in brain fever, and commencing jaundice. Useful in a recovery from fever, and in other cases of debility. Made like other herb teas. Several extra bottles of this should he taken on long voyages. A tin canister is safer at sea. The gum loses fast by evaporation. It is best to mix it in less spirit than will dissolve it, and replenish the bottle with spirit. It is a useful medicine in typhus fever, and for colics. This is chiefly used to touch chancres with. Cream of Tartar makes a cooling beverage in fevers ; useful laxative mixed with sulphur. Dose a tea-spoonful. Dover's Powder is very improperly omitted in many medicine chests. It is very useful in rheumatism, and severe colds and pleurisies, and in typhus fevers. Dose 1 pill, and for rheumatism 2 or 3 pills every four hours, and especially at bed-time. If desired, to give with calomel or camphor, the pill may be mashed into a powder. en TABLE CONTINUED , From In to 40 men. From 6 to 16 men. Li NO. NAMES. lb. pz. S cts. lb. oz. $ cts. lb. 17 Elixir Vitriol. (Glass stopper.) } 4 i 10 4 10 18'Flax-seed. (In box.) 3 40 2 25 1 10,'Gentian, in coarse pow- ^ der. (Box, or jar, or > 8 17 8 17 paper.) ) i 20 Gum Arabic. 4 17 2 10 21 Hartshorn, spirits of. 1 40 8 25 22 Ipecac, in emetics. 20 grs each. Nos. 24, 16, 10. according to the size ol the chest. } 60 40 23 Laudanum. 8 40 6 30 24 Muslard, 4 boxes, £ lb. each. 2 do. } 88 44 25 Nitre sal, powdered. 1 17 G 10 2C> Nitre, sweet spirits of 1 40 8 25 27|Ointinent, simple. 1 38 1 3d 2s,Ointment, Hasilicon. 1 33 1 33 2l>iOintment, Mercurial. 6 45 4 30 30 Opium. 1 \ 45 i 25 31 Paregoric. 1 38 8 25 CO OS than 8 men. pz. S cts. doses given internally. (j 8 to 10 drops in a gill of sugared water. 1e- ' j A table-spoonful to a quart of water for Jt) ( teas. \ A table-spoonful to a pint of hot water, j and boiled 20 minutes. The same as flaxseed. 20 10 drops in water. 18 The best emetic is half of an Ipecac, ' and half of a Tartar Emetic dose mixed. 30 to 80 or 100 drops. 1 5 to 10 grains in half a gill of water; in j fevers and scurvy, every 3 or 4 hours. j A tea-spoonful in a wine glass of water j in fevers. | Dose one to two grains, or one small ( sized pill. i A tea-spoonful to two or three in a j wine-glass of tea or water. NOTES AND DIRECTIONS. "lixir Vitriol is valuable in the decline of fever, and in typhus fever when the stomach can bear it. 10 grains of nitre added to 10 drops, is excellent in scurvy. A drop of it added to quinine and water, dissolves the former. The vitriol phial should have a ground glass stopper. 'lax seed, excellent in coughs, lung fever, gonorrhu'a, catar tieutiuu may be made into decoction like quassia ; is useful as a tonic ; steeped in spirit with orange peel, it makes a good bitter. !um Arabic, same as flax-seed tea in preparing and using. 21 Hartshorn mixed with sweet or sperm oil, and shaken, makes a good liniment for rheumatism; adding spirits of camphor, makes it opodeldoc. Ipecac is better as a common emetic than tartar emetic, but a mixture of the two is still belter. Useful in the beginning of all fevers, xcepting, perhaps, the yellow lever. .Mix in a gill of water, and take half at a time, waiting 20 minutes between. Laudanum may be replenished by an ounce of opium to a pint of spirit, and letting it steep 10 days. 24 I'here is great deception in mustard. Inquire for Underwood's superior. Nitie is useful in all fevers, and in some mtiamiiiations ; 10 grains dissolved in water, or half an even tea-spoonful; the same mixed with 10 drops of elixir vitriol or other acid is useful in scurvy. Spirits of Nitre, given in fevers and gonorrhoea, colds and dropsy. Made easily on board by melting spermaceti, olive oil, and beeswax together. Basilicon is like simple ointment, adding to it rosin. Mercurial ointment is apt to separate in hot wealher, which may be prevented by inverting the vessel every few days. Used to assist in raising mercurial action, the bulk of a nutmeg to be rubbed inside the thighs. Useful in pain, in toothache, but not in headache. In all severe colics it should be given freely at first. Useful in rheumatism. 31)Paregoric, mixed with an equal quantity of antimonial wine, is good in coughs and colds. TABLE CONTINUED NO 3x NAMES. From Hi t lb. oz. > 40 men. S cts. From 8 to It! men. lb. oz. ,«! cts. lb. | Pearl Barley. H 20 1 l(i h 33 Peppermint, essence of 1 38 8 23 34 j Quassia, rasped. (In box ] 8 17 0 15 or paper.) 5 35j Quinine. * 1 50 k 80 3(i Rhubarb, tincture of. l 40 8 22 37i Salts, Epsom. 2 18 2 18 1 38, Soda, supercarbonate of. 1 25 8 17 301 Squills, syrup of. 1 35 8 24 40 Strengthening Plaster. | (In roll.) } 8 25 G 20 411Sugar of Lead. 6 15 3 8 42, Sulphur, flower of. 1 20 1 20 43 Tartaric Acid. 2 1 25 1 G7 44 Tartar Emetic; in emetic, doses of G grains each, No. 50, 20, 12. \ 30 15 45 White Vitriol. 6 15 2 6 Total price. $18 09 $12 40 co GO ss than 8 men. oz. $ cts. DOSES GIVEN INTERNALLY. 10 1 A table spoonful to a quart of water, \ boiled an hour. 6 6 20 15 c A decoction is made by boiling a table-< spoonful in a pint of water. Dose 1 to (2 table-spoonsful. * 45 j As a common tonic, 1 to 2 grains. In / intermittents, 3 to 5 grains. 1 to 2 table spoonsful, as a cathartic. 10 1 to 2 table-spoonsful. 4 10 t Half a teaspuonful in a glass of cold \ water. G 20 A tea-spoonful in coughs and dropsy. 3 2 8 8 15 6 6 40 ( 2 to 3 grains mixed with jelly in long, } protracted diarrhoaa. 1 grain to an ( ounce of water for eye wash. Two to three tea-spoonsful in molasses. t Half a teaspoonful, with as much soda, } to make soda-water; the same quantity (in scurvy. 10 1 Half a dose, mixed with half a dose of ip-( ecac, is better than either of thein alone. 1 3 ( 10 to 15 grains as an emetic ; 6 grains as ) an eye-wash ; or 3 of this and 3 of lead ( in half a pint of water. $7 70 NOTES AND DIRECTIONS. No. 3-3 33 34 35 3G 37 38 39 40 41 42 43 44 45 I'earl Parley requires long boiling; it is useful in howe] complaints, fevers, coughs, and colds Is less ti^ed than formerly, and might be bit out of the chest. Uuass.a, like gentian, is a useful tonic to the whole system, and stomach in particular. 1'rcpared by boiling 15 or 20 minutes. asnoo,\sf,!ll',\f'w'o'f?,?!1 .YiT'8' lie T,"le i,,'t° PI",S of l Brilin each- U is I"''l'^e,l for taking by putting 20 grains into as many table- spoonstul oj walei in a phial, and adding -1 or 5 drops of elixir vitriol. A table-spoonful is a dose of J grain. Rhubarb, tincture of, is good in chronic diarrluea, in tea-spoonful doses. -Uierej^hould be at least 50 lbs. of salts, extra, on board whale ships, kept in a pail or box, to replenish the bottle. 'oda, snpercarhonate, is useful for acid stomach ; with equal quantity of taitaric acid, it makes soda powder Squills is nselul in coughs, hut its place might well be supplied by syrup or molasses, with sharp vinegar and the juice of strengthening plasters are useful in weakness of the hack. Lead, sometimes called acetate of lead, or sacharum saturni, is useful in bleeding at the lungs and the bowels ; dose 2 to 3 grains rolled into a pill with crumbs of bread ; applied externally in inflammations. ;ulpliur seful m piles, and in s divation ; also in itch ointments Useful in scurvy as a beverage ; with soda, it makes soda p .wders. lartar Emetic in j grain do-es in paper- , halt one with half a d ■ of ipi-c ic, makes ill • best d safest eniHlc. White \ itnol, 2 grains, with sugar of lead, 2 grains, and ti ounces of rain or soft water, makes a good wa.-h in inflammation of the eye, ana a good injection in ghonorrhcea. A tea-spoonful dissolved in half a pint of warm water is a good emetic for ejecting poison trom the stomach. It will also stop for a time alarming bleedings from the lungs, when other medicines fail. CO CO 200 APfEXDIX. INSTRUMENTS, UTENSILS, DRESSINGS, &c. ARTICLES PROPORTIONED TO THE NUMBER OF THE CREW. $ c. I $ c.| Lancets. Penis Syringes. Bougies, small size. Gum Elastic Catheter. Clyster Syringe, 12 oz. Cotton Bandages, 12' feet long, 3 inches wide Patent Lint. Clean Rags. Cotton Batting, for' burns, and for dress- ings. Adhesive Plaster, spread Sheep skin, for plasters. Splints, for fractures. Tooth drawer. Curved Needles, and ' Waxed Threads. Scales and Weights. 1 Field Tourniquet. Spare phials, with corks. Spatula. Graduated Glass. Medicine Chest and Furniture. No. 2 2 3 2 1 4 oz. 1 lb. 1 lb. I yd No. 1 No. 5 No. 2 No. 4 3(i 50 3G No. 2 2 2 1 1 2 oz. h lb. 20 h lb. 3G h yd. 25 * 50 4 1,00 1 20 2 1,00 25 20 3 15 15 4,00 18 15 10 12 20 15 40 1,00 20 1,00 25 15 15 15 4,00 Medicines, 11,40 18,09 S20,4L» 10,20 13,46 No.l 1 2 1 02. i lb. I yd. i 2 25 13 25 12 12 10 20 2,00 $23,06 3,31 7,70 1,01 HOSPITAL STORES. Sago, 2 lbs.; Lemon Juice; Chloride of Lime, in a bucket, say 30 lbs., 20 lbs., 10 lbs., according to the size of vessel. Also, Wine; Tea; and Sugar; and Fowls. Also, Opodeldoc, 1 doz. bottles. APPENDIX. 201 PREPARATIONS OF MEDICINES AND DRINKS. DECOCTIONS, TEAS, GRUEL, &c. Decoction of Quassia. Take of quassia in powder one ounce, water one pint and a half. Put the quas- sia into a tin pot, and pour the water on it heated. Cover the vessel and boil for ten minutes. This decoction is given in all cases where a bitter tonic in considerable quantities is requisite. The dose is from two to four table-spoonsful. Decoction of Oak, Peruvian, and Cascarilla Bark. and of Nutgulls, may be made in the same manner. Barley-water. Take of pearl barley three table- spoonsful. First wash the barley from the mealy matter that adheres to it, with some cold water; then boil it a little with about half a pint of water, to ex- tract the coloring matter. Throw this away, and pin the barley thus purified into five pints of boiling Ava- ter ; which is to be boiled down to four pints and strained. This decoction is to be used freely, as a di- luting drink in fevers and inflammatory complaints. F'-'x-seef tea. Take of flax-seed or lin-seed, whole or powdered, two tal.le-spoon Jul. Water, three pints. Boll one hour and strain. This is an excellent drink, in cases of clap or oih,;r inflammation in the urinary passages, and also for coughs and other inflammations. It may be rendered agreeable by sugar and lemon- juice. Directions for making arrow-root, also wafer-gruel, from oal-meaf four, or Indian-meal. Take two large talh--.poon-.ful of either of the ni.ove articles. Waier, half a gallon. While the water is heating, rub the flour or meal, &c. in half a pint of cold water, adding a liltk at a time, then mix it with the hot water, stirring it at the same time, and boil fifteen minutes to hail an hour. 17 202 AIM'EXDI.V. Toast-water. This is made by sleeping slices of soft fresh bread in water, first toasting the bread till brown- ed thoroughlv, and then putting it into the walor while hot. When "soft bread cannot be had, the hard kind must answer. SOLUTIONS. Solution of Cream of Tartar. To an ounce of cream of tartar, pour one quart of hot water, to which add a little loaf sugar. This is an agreeable beverage in fevers and inflammations, and is a mild purgative. It may be rendered still more agreeable by the addition of a little orange peel. Lime-water. Take of quick-lime, half a pound, water, three pints, mix and cover the vessel for three hours, occasionally shaking it; then pour off the liquor and keep it in a vessel closely stopped. Its dose is from one-eighth to one-fourth of a pint. Solution of Alum, or Alum-wafer. Dissolve one drachm of aium in half a pint of water. Solution of Sugar of Lead, or Lead-water. Dissolve ten grains of sugar of lead in half a pint of water. This makes a good eye-water, and wash. Tar-wafer. Take of tar one pint, water one gal- lon. Boil them together fifteen minutes, frequently stirring them. Afterwards pour off the water for use. This is a valuable application lor the piles. MIXTURES. Cooling mixlure. Take of Epsom salts one ounce and a half, nitre twenty grains, tartar emetic three grains, mix in one pint of water. This is a cooling laxative or mild purgative, and may be given in doses of from one to three table-spoonsful, every hour ur two APPENDIX, 203 Vectoral or Cough mixture. Take of paregoric, two parts, syrup of squills and wine of antimony, of each, one part, mixed. This is an excellent mixture for a cough, and may be taken in doses of two tea- spoonsful on going to bed, accompanied by a large draught of flax-seed tea, or crust-water sweetened. (1/)alk mixture. Take of prepared chalk, or common chalk, finely powdered, two table-spoonsful, loaf sugar a table-spoonful, gum arabic in powder two table- spoonsful, water one pint, rub them well together till they resemble thick cream; add two tea-spoonsful of laudanum. Dose, a wine-glass every half hour in chol- era morbus. Effervescing mixture. Dissolve salts of tartar, half a tea-spoonful in two table-spoonsful of pure water. Then add lei non-juice, half a table-spoonful, and take it while it effervesces. This is valuable in some fevers. Dover's powders. This powder will be found al- ready prepared at the apothecaries' shops, where it should be put up in doses of fifteen grains each. It may be mixed and taken in warm tea. It is useful in some cases of fever, rheumatisms and other inflamma- tions. When taken, large draughts of warm tea or other diluting drinks should accompany it. Emetics, directions for taking. Mix the ipecac, or the tartar emetic powder in six table-spoonsful of warm water, and take three of them. A table-spoonful of the remainder is to be taken every ten minutes till vomiting is induced. After vomiting has commenced, warm water is to be drank freely after each operation. Should the vomiting continue too long, its operation may be turned downward by a draught of warm salt- waier. Should cramp of the stomach ensue, flannels dipped in hot water are to be applied over it, and twenty or thirty drops of laudanum given. Cathartics or Purges, directions for taking. Salts •204 APPENDIX. may be taken in dose of two table-spoonsfuls, dissolved ii half a pint of warm water. Castor Oil, in dose of two table-spoonsful. Calomel and Jalap may be mixed in syrup or mo- lasses in a table-spoon. Blistering Plaster. Spread the plaster nearly as thin as a wafer, on soli leather, four or five inches ■M|iiare, and apply to the side, neck or other part, prev- iously rubbing it with spirit or vinegar. After remain- ing on twelve hours, or till the blister is drawn, the water is to be let out, and a plaster of basilicon or of simple ointment applied. The blister plaster should be preserved for use a second or third time. CATAPLASMS OR POULTICES. Mustard Poultice. Take pounded bread, Avith a small proportion of pounded flax-seed, boil ten or fif- leen minutes, and spread it on rags nearly an inch thick, to cover the soles of the feet, then sprinkle on the powder of mustard-seed, and apply as warm as the patient can bear. Emollient j/ou/liee for sores and inflammations. Take of Indian meal, or pounded bread, and powder of flax- seed, or common flour equal parts, boil them logether, and spread the mixture more than half an inch thick on rags, and apply them warm. They should be re- newed every three or four hours. To preserve eggs at sea. Say about one hundred dozen. One bushel of stone lime, when slacked, one pound cream tartar, one quart of fine salt. Mix these with water until the mass comes to the consistency of thick cream, have your cask tight, cover the bottom of it with this material, and then place the eggs on the end, after having laid one tier, cover them with the mixture and place another tier. This will preserve APPENDIX. 205 eggs good a year. The cask should be imerted once in two or three Aveeks, to keep the yolk from settling doAvn so as to touch the shell. j\iilk, hoiv to preserve at sea. Provide a quantity of pint or quart bottles, (neAv ones are best,) they must be perfectly sweet and clean, and perfectly dry before they are used. Instead of draAving the milk from a coa\ into the pail, as usual, it is to be milked into the bottles. As soon as any of them are filled sufficiently they should be immediately corked Avith the best kind of neAv corks, in order to keep out the external air, and fastened tight Avith packthread or Avire. Then on the bottom of an iron or copper boiler spread a little straAv. on that lay a toav of the bottles, and some straAV betAA een, to prevent their breaking, and a layer of straw OArer them, to be covered Avith another layer of bottles, till the boiler is nearly filled, then fill with cold water,'and gradually apply' heat till it begins to boil, when the fire is to be AvithdraAvn. The bottles must remain undisturbed till quite cool, then taken out and packed in hampers with straw or saw-dust, and stowed in the coolest part of the ship. Milk thus preserved may cross the Atlantic and return as sweet as when first drawn from the cow. [N. E. Farmer, 1835. For making Spruce Beer. Take three gallons of waler, blood warm, l1, pint of molasses, 1 table-spoon of essence of spruce, 1 do. of ginger. Mix well to- gether, and add one gill of yeast. Let it stand over night and bottle it in the morning. To preserve cabbages, Sfc, fresh during a voyage. Cut. the cabbage so as to leave about two inches or more of the stem attached to it; after which scoop -out the pirn to about the depth of an inch, taking care not to wound or bruise the rind. Suspend the cab- br^-s bv means of a cord, tied round the stem, so thai that'portim of it from which the pith is taken, remain uppermost, Avhich regularly fill every morning with fiv»h water. By this simple method, cabbages, 17* •206 APPENDIX. eaulifloAvers, Sec, may be preserved fresh during a long voyage. CHLORIDE OF LIME. This disinfectant and purifier of both air and Avater, should be supplied for every vessel, large and small, more especially if destined to Avarm latitudes. Chloride of lime is a greyish white powder, varying in strength, and becoming moist by exposure 1o air. When very pure, it is nearly all soluble in Avater, and may be sprinkled upon the floor of any foul apart- ment, Avhen it will soon remove offensive smells arising from animal or vegetable putrefaction. The addition of a small quantity of diluted sulphuric acid will evolve -is virtues wilh double rapidity. To one gallon of Avater, add a pint of bleaching powder and an ounce of elixir vitriol, and it will be of a proper strength for correct- ing the putrid smells of apartments, and of animal putridity. The same effect will result without the acid, but will require more time. It is much used in privies, and docks, where the poAvder itself may be sprinkled. The solution may be sprinkled between the timbers in the hold of a ship, and on the berth- deck, on hammocks and in berths. Foul ulcers and wounds may have their dressings Avetted, and it may be sprinkled on the surface of a dead body which it is desirable to preserve on board for interment on shore, or some of the poAvder may be thrown into the coffin. It may be advantageously used for purifying offen- sive Avater, a property which makes it invaluable in long voyages. For this purpose, from one to two ounces of the powder may be mixed in sixty-five gal- lons of water. After the purification is efiected, the water must be exposed for some time to the air, and alloAved to settle before it is fit to drink. The best Avay to carry chloride of lime is in covered buckets. APPENDIX. 207 FUMIGATIONS. The forecastle and other lodging apartments of a merchant vessel should be fumigated as often as prac- ticable, and especially in hot climates. One of the most simple is the Vinegar Fumigation. Immerse a hot iron in vine- gar, at the same tune closing the hatches. Another. Sulphuric acid, or oil of vitriol, sal nitre, or saltpetre, of each one ounce. This quantity is sufficient for an apartment twenty feet square. The sulphuric acid is placed in a glass or china ves- sel, and the nitre gradually added : in order to have an abundant extrication of nitrous fumes, it is neces- sary to raise the temperature of the acid by means of a lamp, or bv placing it on hot sand. This air may be respired with perfect safety, and even Avith advantage in fevers ; it should therefore, al- Avays be preferred where the sick remain in the room. VACCINATION. Every captain bound on a long voyage, should see that his men are secured, before sailing, against small If he chooses, he can vaccinate them after leaving port but in taking virus Avith him for this purpose, he should remember that it will not keep on quill points at sea but a very few days. A piece of scab hermet- ically sealed in a glass bulb or very small phial may keep three months. Signs of vaccination having taken, will be apparent about the fifth day. 20S APPENDIX. THE LAW RELATING TO MEDICINE CHESTS. " Every \ressel of one hundred and fifty tons or upwards, navi- gated by ten or more persons in all, and bound on a voyage beyond the United States, and every vessel of seventy-five tons or up- wards, navigated by six or more persons in the whole, and bound from the United States to any port in the West Indies, is requir- ed to have a chest of medicines, put up by an apothecary of known reputation, and accompanied by directions for administering the same. The chest must also be examined at least once a year, and supplied with fresh medicines. "In case of dispute, the owner must prove the sufficiency of the medicine chest. It does not lie with the seaman to prove its insufficiency. " If a vessel has a suitable medicine chest on board, it would seem that the ship is not to be charged with the medicines and medical advice which a seaman may need. But the ship is still liable for the expenses of his nursing, care, diet, and lodging. Accordingly, if a seaman is put on shore at a hospital or else- where, for his cure, the ship is chargeable with so much of the expense as is incurred for nursing, care, diet, and lodging ; and unless the owner can specify the items of the charge, and show how much was for medical advice, and how much for other ex- penses, he must pay the whole. The seaman is to be cured, at the expense of the ship, of a sickness or injury sustained in the ship's service ; but if he contracts a disease by his own fault or vices, the ship is not chargeable. A sick seaman is entitled to proper nursing, lodging, and diet. If these cannot be had, or are not furnished on board the vessel, he is entitled to be taken on shore to a hospital, or to some place where these can be obtained. It is often attempted to be shown, that the seaman was put on shore at his own request. This is no defence. He is entitled to be put on shore if his disease requires it ; and it is seldom that proper care can be taken of a seaman on hoard ship. "If a seamar requires further medicines and medical advice than the chest and directions can give, and is not sent ashore, it would .-cm that th« ship ought to bear the expense ; but this poi. t has nf?ver been decided. If the medicine chest can furnish all he netfs, the sliip is exempted."— Dana's Seaman's Friend. INDEX. Abscess, how to open Acute Rheumatism Africa, diseases on the Western shore of Ague and fever .... Amputation . of the arm fingers and toes Anchorage in sickly ports to be changed Angina, or Quinsy Ankle, dislocation of ... Anthony's fire, St. ... Apoplexy ...... Application of leeches Arm, dislocation of ... amputation of ... bloodletting from fracture of ... Arteries, wounds of ... Ascites, or dropsy of the belly Asthma ...... Barley-water, how to make Beer . . ..... Bellyache, or colic .... Belly, diseases of • dropsy of . Bilious colic . fever . remittent fever Bite of snakes, vipers, &c. Bladder, inflammation of Bleeding, how to stop, in wounds at the nose how to perform in the arm how to perform in the foot Blister, directions for applying and dress Blood-letting • Blood, spitting of vomiting of Bloody urine • • . ■ flux. See Dysentena ing 210 CONTENTS. Bones, fractures of the nose the arm the clavicle or collar bone the lower jaw the elbow the fingers and hand the knee (palm bone) the leg ... the ribs the thigh Bowels, diseases of . : Bougies, how to introduce Brain, fever or inflammation of Bread. See Diet. Bread, how to provide yeast for Bronchitis, chronic Bruises or contusions ulcers from Bubo, venereal Burns and scalds Butter, how to preserve sweet Cabbages and Cauliflowers, to preserve at Catarrh or cold .... Catheter, how to introduce Chancre, venereal Chest, diseases of ... dropsy in Chilblains or frozen limbs Chloride of lime Cholera, Asiatic or Spasmodic Cholera Morbus ... Chordee ..... Chronic Bronchitis Rheumatism inflammation of the liver Clap...... Climate, choice of, in consumpiion Clothing, directions concerning Clysters, how to administer Cold or Catarrh Colic..... Collar bone, fracture of Consumption choice of climate in Contusions or bruises Contagion, means to prevent the spreadin Convulsions or epileptic fits g of CONTENTS. 211 Cough ........ Cramp of the stomach..... Coup de soleil, or stroke of the sun Croup........ Cuts........ Diarrhoea or looseness ..... from water of the Neva Diet, directions concerning Directions for preserving fresh meat for the prevention of disease among seamen Diseases on the Western shore of Africa the coast of England United States .... East Indies .... Mediterranean .... West Indies .... Diseases of hot climates, directions for preventing cold climates, directions for preventing the head ..... the throat ..... the chest ..... the belly ..... urinary organs and genitals limbs and large joints skin ...... fundament .... Dislocations of the lower jaw .... shoulder .... elbow .... palm-bone of the knee thigh..... knee-joint ankle..... fingers and toes Dress in warm climates ..... cold climates ..... Dressings for chancres. See Chancres buboes. See Buboes sores and ulcers .... blisters . Dropsy, general ....•• of the belly ..... chest ...... scrotum . . • Drowned persons, mean3 of recovering Dry bellyache ...... Dysenteria • • Dyspepsia or indigestion .... 65 190 44 51 121 81 82 152 153 161 170 169 163 177 169 164 161 149, 162 45 49 56 67 89 104 118 85 108 109 109 111 110 111 111 112 160 161 98 102 126 204 34 68 66 104 127 80 S2 36 212 CONTENTS. Earache ........ 49 Ezsi>, how to preserve at sea 204 Elhow, fracture of ...... 115 England, diseases on the coast of 169 Epilepsv........ 38 Ery-ipelas, or St. Anthony's fire ... 118 Eve inflammation of ..... 46 Falling down of the fundament 87 Feet, frozen....... 125 Fevers, intermittent or fever and ague 9 bilious remittent .... 12 low typhus or slow nervous 15 putrid, malignant, jail or ship 17 yellow ...... 22 acute or inflammatory 27 Fistula........ 87 Fingers, amputation of ..... 134 fractures of ..... 116 dislocation of ..... 112 Fits, epileptic....... 38 apoplectic ...... 40 Flax-seed tea, how to make .... 201 Fractures, general remarks on ... . 112 Fracture of the arm..... 114 nose ..... 113 clavicle or collar-bone 113 lower-jaw .... 113 elbow ..... 115 hand and fingers 116 knee, palm-bone of 118 leg...... 117 ribs ..... 114 thigh ..... 116 Fre«h meat, how to preserve 153 Fro-L-!>iUen limbs ...... 125 Fn.it in hot climates, bad effects of 144 Fumigation ....... 19, 146 Futni ration of ships ..... 207 Fundament, diseases of. See Piles, Fistula, and falling down of the fundament 87 Gleet ........ 96 Gonorrhoea ....... 93 Groin, rupture in, or Hernia .... 88 Guinea worm ...... 127 Gunshot wounds ...... 123 Gut*, diseases of ..... 74 Headache ....... 43 Head, fever of ..... 44 CONTENTS. Health, directions for preservation of Haemorrhoids, or piles Heart-burn ..... Heat, prickly .... Hernia or rupture .... Hospital stores .... Indigestion ..... Incised wounds .... Inflammation of the eye brain intestines or guts bladder liver lungs, or pleurisy kidneys stomach throat, or quinsy Inflammatory fever Intermittent fever Intestines, diseases of . inflammation of Introducing bougies the catheter Itch ..... Jaundice..... Jaw, locked, or tetanus fractured .... dislocated .... Knee, disjointed Kidneys, inflammation of Lacerations .... Laryngitis..... Law relating to Medicine Chests . Leeches or blood-suckers, how to apply Leg, fracture of .... Letting blood, directions for Limbs and joints, diseases of Limbs dislocated or disjointed fractured or broken frost bitten Lime juice, the importance of in long voyag Lime water, how to make Linseed tea, how to make Liver, disease of ... Looseness • Locked-jaw • • . Lumbago. See Rheumatism Lungs, inflammation of, or Pleurisy 18 214 CONTENTS. Lungs, consumption of ... Measles..... Meat, fresh, how to preserve Measures and Aveights, table of Mediterranean, diseases on the shores of . Medicine chest, contents and price of law relating to Medicines, directions for mixing and taking Milk, to preserve at sea Mercurial course. See Syphilis and Bubo Morbus, cholera..... Mumps ...... Nervous fever. See Typhus Nettle Rash..... Nose, bleeding from .... fracture of .... Operations ...... Ophthalmy, or sore eyes Palm-bone of the knee, dislocation of fracture of Paraphymosis ..... Penis, diseases of .... . Phthisis pulmonalis, or consumption Phvmosis ...... Piles ...... Pleurisy ..... Pneumonia ..... Poisons, swallowed .... Poisonous fish ..... Pox, small ...... venereal ..... Preservation from disease when wooding and Avatering of health of seamen Preparation of medicines Prevention of diseases in tropical climates cold and temperate climates Preventing the spreading of diseases in a creAv Putrid fever........ sore throat ....... Quinsy, or sore throat ...... Rash, nettle . ...... Ratio of mortality of British troops, in the British West India Islands ...... Ratio of mortality in the United Kingdom, Mediterranean, and in the African colonies .... Remittent fever ....... Resuscitation of drowned persons .... Rheumatism, acute ...... 58 43 153 192 169 194 208 192 205 102 75 51 15 120 47 113 129 46 111 118 101 93 58 100 85 56 56 128 129 42 98 143 136 201 140 148 145 17 54 49 120 167 17G 12 127 104 CONTENTS. Rheumatism chronic . . . Ribs, fracture of . . Running, or Clap .... Rupture, or Hernia .... Salt Avater, how to freshen Scalds and burns . . , Scalding of the urine . Scarlet fever .... Scrotum, dropsy in .... Scurvy ..... Seaports, different times of sickness in Seasons of sickness in different countries Sea sickness . . . . Serpent, bite of .... Sickly country, signs of . . . Signs of an unhealthy country Shoulder, dislocation of Skin, diseases of ... Sleeping on deck to be avoided Small pox ..... Snake, bite of..... Sore throat, or quinsy putrid .... Sores or ulcers .... Spitting of blood . Sprain ...... Stabs ...... Stomach, diseases of ... inflammation of pain of sour . St. Anthony's fire ... Stoppage of the urine Stroke of the sun . . • Strangury, or stoppage of urine . Stricture in the urinary passage Sun, stroke of • Suppression of urine Swelled testicle • Syphilis or venereal Table of Aveights and measures Testicles, SAvelled • Tetanus, or lockjaw . Thigh, fracture of Throat, diseases of . sore . . . ■ Thumb, dislocation of . Toes, dislocation of ... 216 CONTENTS. Toothache .... Tourniquet, how to apply Tumors, how to open Tympany, or windy dropsy Typhus fever, low Ulcers ...... Unhealthy country, signs of Unhealthiness, seasons of Urinary organs, diseases of Urine, stoppage of ... bloody, discharge of incontinency of Urethra or urinary passage, stricture of Vaccination .... Venereal disease or pox Venomous creatures, bites of Ventilation of ships Viper, bite of .... Vomiting of blood Vomiting from sea sickness and purging Water in the belly .... chest scrotum Water-gruel, how to make Water, how to purify how to correct its purgative quality salt, how to freshen ~ . Weights and measures West Indies, diseases of Wind colic Windy dropsy Worm, Guinea Wounds of arteries . bruises gunshot incised or cut Yeast, how preserved for sea Yellow fever Erratum. - From page 183 to page 191, was written by the author of the work, and not by Dr. Fisher, as the misplaced quotation marks would indicate. THE END. i 1% NATIONAL LIBRARY OF MEDICINE SNiDiasw jo Aavaan tvnouvn S / 8 i £01 -%^ national library of medicine NATIONAL LIBRARY OF MEDICINE p XX ! ^ 3NiDia3w jo Aavaan tvnouvn ^-#x! >S4x>. ^Ky/ | n; NATIONAL LIBRARY OF MEDICINE lMi>H 3NiDia3w jo Aavaan tvnouvn jNoiasw jo Aavaan tvnouvn NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE 3NiDia3w jo Aavaan tvnouvn ^x?% 3NIDIQ3W jo Aavaan tvnouvn r/i v-fs NATIONAL LIBRARY OF MEDICINE 3NIDIQ3W jo Aavaan tvnouvn 5- » f\ f ... ^.-^ NATIONAL LIBRARY OF MEDICINE ~/ ?• ° >r^}. ? yW 3NiDia3w jo Aavaan tvnouvn & Cr& <~~' <"" ° >TK_-' ' > g- / VC3 r zi x.Sx • x:yy 3 -:^. ,xh .; MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE V ~ W a : **Ls x X f yns ivnoiivn 3Ni3ia3w do Aavaan tvnouvn SNiDiasw do Aavaan TVNOUVN ! /> £& ■£ !-&y ^. V * "^ o X (EDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE 5 -' K~"^ -I "}iS" / ' $ .....3 1 v x'v^y I: Je-' •• 1 "'v IVNOIIVN 3NIDIQ3W dO AavaaiT TVNOUVN 3NIOIC13W dO AavaaiT TVNOUVN i: -&' x. / /s A 4 '' ' ^S";~^lf/ (EDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE I / ,1# i jjt-^X J> g- \,, fr}~^. 2- - --'x> _ ~*fa~y ^ x/ =f / " ' -\ o Aavaan tvnouvn snioiosw do Aavaan tvnouvn / -5 / a' -^ /~"ft ~° Ai) ""-■ ■'■ o" 0' J >^< - ! ^.^f | \, -£ ■. r/\T-' X • x '■-/.- u MEDICINE NATIONAL LIBRARY OF MEDICINE 6 v I <'% NATIONAL LIBRARY OF MEDICINE tf /. / V < 1 'V 0 J2- VNOIiVN 3NIDIQ3W dO AavaaiT TVNOUVN 3NIDI03W dO AavaaiT TVNOUVN ^^ IMAR3 1956 .- IV \ ^J; NLM032780686