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

Loss in the Battle and from Wounds—Fatality of the locked Jaw—Treatment of it—Some Ships more subject to it than others—Different from other Cases of Tetanus—It is not cured by the Removal of the Part—It may come on after the Part is cured—Effect of Climate in producing it—Accidents from the Wind of a Ball—Accidents from the Explosion of Gunpowder—Means of preventing them—General Observations on Sores and Wounds.

Though surgery was not properly in my department, yet, having had a fair opportunity of collecting facts concerning this branch of practice, I thought it my duty to pay some attention to it.

The whole number of men wounded in the actions of April, 1782, amounted to eight hundred and ten.

Of these, sixty died on board before the end of the month, five in the course of the following month, and two in June.

There were ninety-seven wounded men sent to the hospital at Port Royal, of whom there had died twenty-one when the fleet left Jamaica on the 17th of July.

So that the whole loss of men in the battles of April, and their consequences, is as follows:

Killed outright266
Died of their wounds on board67
Died of their wounds at the hospital21
Total354

Of those who died on board, fifteen[124] were carried off with the Symptoms of the locked jaw; but of those sent to the hospital, only one. The reason that so few in proportion were affected with it in the hospital may have been, that none of the wounded were landed till near the end of the third week after the principal action. The danger of this symptom was then, in a great measure, past, though I have known it to take place in every period from the second or third day till the fourth week.

Only three men in the whole fleet recovered from this alarming complaint; and as it is interesting to know every thing relating to so desperate a symptom, I shall give a short account of each.

The first was a seaman of the Montagu, who had his thigh wounded by a splinter which carried away part of the integuments and membrana adiposa, and lacerated in a small degree the vastus externus muscle. The wound did extremely well till the 23d day, when the jaw became almost entirely fixed, and the whole muscles of the wounded side were thrown into frequent spasms. Mr. Young, the surgeon, who was always anxious and assiduous in his duty, consulted with me, and we had immediate recourse to the warm bath, which gave a degree of instantaneous relief, and was repeated twice a day for half an hour. He was sensibly better every time; in nine days was entirely free of the symptom, and continued afterwards to do well. The only other means taken for this man’s recovery, besides what were used with the other wounded men, were from three to five grains of opium, which he took every day, in divided doses.

The next was a seaman of thirty years of age, belonging to the Magnificent, who had the humerus broken and shattered by a splinter which entered the deltoid muscle. Several large portions of bone were extracted, and the artery was laid bare on the inside. On the fifth day there came on a large ichorous discharge, with a low quick pulse and depressed spirits, and the jaws began to close, with pain and stricture on both sides about the articulation of the lower jaw. He had every day since the accident taken half an ounce of Peruvian bark, combined with opium or rhubarb, according as it made him loose or costive. This was continued, and the part externally was kept constantly moist all round with volatile liniment, to which a fourth part of tinctura thebaica was added. Next day the jaw was almost entirely fixed, so that it was with difficulty that a little wine and water could be introduced with a spoon. Mr. Harris, the surgeon, now wisely determining to do something vigorous in this unpromising situation, beat up twelve ounces of opium moistened to the consistence of a cataplasm with the thebaic tincture, and applied one half to each side of the jaw. The patient this day swallowed a pint of the bark decoction with half an ounce of nitre, and took a diaphoretic draught of twenty drops of thebaic tincture and thirty of antimonial wine. He had also the smoke of tobacco thrown up his nostrils.

On the third day after the attack he could open his mouth half an inch. The cataplasms were taken off, beat up afresh with the tincture, and applied anew. The bark and other medicines were continued. On the fourth day the stricture and pain of the jaw went entirely off, but the cataplasm and volatile liniment were applied for three days longer. The wound produced a laudable discharge, every symptom became favourable, and he continued to recover.

The only other person who recovered from this symptom was a man in the Bedford. Several died of it on board of this ship; and as the same means of relief were skilfully employed in all the cases by Mr. Wickes, the surgeon, the success seemed owing more to something favourable in the man’s constitution, than any thing peculiar in the treatment, which consisted in the administration of the warm bath, opium and camphor, with mercurial friction on the jaw.

This accident affected some ships remarkably more than others, particularly the Barfleur and Bedford, though their wounds had nothing peculiar, nor were in a greater proportion than in the rest of the fleet. Four were carried off by it in each of these ships. It has formerly been observed, that great ships acquire peculiar habits, or dispositions, which incline the constitutions of the men to one disease more than another. This complaint took a run in some particular ships last year also after the battle of the Chesapeak; and I have known it prevail in some particular hospitals more than others. In the present instance, it may have been owing either to something peculiar in the constitution, or air of the ships; or we can conceive it to be owing to some sort of nervous sympathy, just as the epilepsy[125] has been known to spread from one boy to another, at a school, in consequence of imitation, dread, horror, or some such delicate nervous or mental affection. We have in yawning an example of a spasmodic affection spreading from one person to another. If this is the case in the locked jaw, those affected by it should be removed from the presence of the other wounded men, lest the idea of the sufferings of others should be so fixed in their mind, or so impress them with the fear of the like, as to invite the attack of the same complaint.

Though the locked jaw, in consequence of wounds, resembles frequently in its symptoms the tetanus which arises without any external accident, yet there are many cases of the former which differ materially from the violent symptoms of the other, as described by authors. In most cases of the locked jaw from wounds the spasms are not so general, so violent, nor attended with such exquisite pain. It sometimes happens that the convulsive twitchings are even accompanied with a sort of pleasure, as in the case of a lieutenant of the Montagu, whose case was related to me by Mr. Young, the surgeon of that ship, a man of skill and observation in his profession, and upon whose fidelity and accuracy I could perfectly rely. This officer had been wounded in the elbow at the battle of St. Christopher’s by a splinter, whereby the capsular ligament of the joint was injured. On the ninth day, symptoms of the locked jaw came on, and soon after the whole muscles of the wounded side were affected with frequent convulsive twitchings, which, as he himself said, afforded a pleasant sensation, exciting laughing like an agreeable titillation. He died on the fourth day after it came on, and had no pain to the last.

The locked jaw from accident differs also from other cases of tetanus, in respect to its cure; for the latter has been successfully treated by cold bathing, as is related by Dr Wright[126] and Dr. Cochrane[127]; but it is acknowledged by the latter that this treatment did not answer when the complaint proceeded from a wound.

It is to be remarked, that the locked jaw did not take place in those cases in which the wounds had a foul and gangrenous appearance more than others; for those that digested and cicatrized favourably, were equally apt to be affected by it; and though amputations are most liable to this symptom, the slightest injuries, even a scratch, will sometimes bring it on.

It would be difficult, therefore, to establish any particular treatment that would tend to prevent accidents of this kind; but Mr. Bassan, surgeon of the Arrogant, one of the line-of-battle ships engaged on the 12th of April, mixed laudanum with the dressings of all the wounds, and no locked jaw occurred.

In the Bedford there occurred a curious circumstance concerning this complaint. In one of the cases that proved fatal, the symptoms did not come on till the wound was so far healed that all dressing had been laid aside.

Mr. Wood, surgeon of the hospital at Jamaica, informed me, that in cases of the locked jaw from injuries to small members, such as fingers, he had tried the effect of amputating the part after the symptoms had come on, but without any effect in putting a stop to them.

Would it not appear, from the two last mentioned facts, that this symptom is not kept up, nor even takes place in the first instance, from an immediate present irritation, but that the constitution comes to be so modified, or receives such an impulse, as it were, that the complaint runs its course independent of the presence of that stimulus which excites it?

It would be difficult to assign a satisfactory reason why this accident is more frequent in hot than in cold climates. The effect of external heat upon the living body is not to raise its temperature even when the heat of the air exceeds that of the body[128]; so that we are to seek for the effects of it in some of those affections peculiar to animal life. And as the outward temperature of the air does not affect the general mass of the body, all the effects produced by it must depend on impressions made on the external surface of the body and lungs; and the skin, which may be considered as a large expanded tissue of nervous fibres endowed with universal sympathy and great sensibility, affects every organ and every function of the body, according to the state of the air in contact with it, whether cold or hot, moist or dry, pure or vitiated. This sympathetic sensibility of the skin is chiefly affected by the state of the perspiring pores on its surface; for it is only when these are open that the impression of the air on the skin produces catarrhs, rheumatisms, and internal inflammations in cold climates; and the external temperature in hot climates being such as to keep the pores almost always open, this seems to be a principal reason of that universal irritability prevailing there, and of the general sympathy that prevails between every part, particularly as connected with the organs of perspiration[129]. This readiness of one part to be affected by another in hot climates is well illustrated by the sudden translation of certain diseases. I have seen, for instance, a catarrh cease, and be converted, as it were, into a diarrhœa, and this as quickly disappearing, a pain in the foot would arise, like an attack of the gout. All this would happen in the space of a few hours.

But, in cold climates, wounds are by no means exempt from the locked jaw; for it sometimes occurs in England, where I have seen it even in the winter season[130].

Since my return to England I have received some new and useful information on this subject in conversing with Dr. Warren, physician to the King; and as any observations derived from so much acknowledged skill and sagacity must be valuable, I shall here relate what he was so kind as to communicate to me.

This eminent physician, in attending a case in which he was nearly interested, and in which his endeavours were rewarded with success, found the greatest benefit from opium and the warm bath. The opium was given in the form of tincture, in moderate, but pretty frequent, doses. The bath was composed of milk and water, and the addition of milk was, no doubt, an improvement; for there is something in this as well as oil extremely soothing to the human nerves. Dr. Warren had intended to make trial of a bath of oil in case this had failed. He mentioned the following observation, with regard to the external application of oil, which could only have been suggested by that anxious attention that was paid to the case. It was found, that the uneasiness arising from the spasm was allayed by constantly drawing a feather wetted with oil over the temples, which had an evident effect in lulling the pain and spasm; for when this operation was left off, there was an immediate recurrence of these symptoms[131].

It would appear, therefore, from this as well as the former cases, that opium and the warm bath are the only remedies yet known which are of service in this complaint, and much will depend on the judicious management of them. The method of administering the opium, recommended by Dr. Warren, seems to be the most judicious, especially in constitutions not habituated to this medicine.

There is a certain medium in giving opium, by which its best effects are obtained, for in an under dose it will produce disturbance instead of rest; and when it is given in large quantities it frequently defeats the very end for which it is given, by throwing the body into convulsions which terminate in death. The rule for judging of the proper limits of this dose is, by its effect in inducing that stupor or insensibility which renders the senses incapable of irritation; for in this, as well as in every other case of disease, the cure seems ultimately to be the work of nature, the effect of medicine being only a secondary operation, by which it removes some obstacle to the natural efforts of the constitution. Though a dose of opium greater than ordinary is required to produce this insensibility in cases of spasm, and though the constitution in that situation will bear more, yet even here it may be given to excess; and by beginning with small quantities, and giving it in frequent rather than large doses, the constitution will thereby be better reconciled to it, and it will also with more convenience admit of that gradual increase which is peculiarly necessary with this medicine. These ideas were suggested to me by Dr. Warren; and it may be farther added, in recommendation of his method, that the liquid form is preferable to the solid, as the effects of it will sooner be seen, and a better judgement can be formed how far it is proper to push it.

Great attention is also necessary in regulating the heat of the bath; for if it is not sufficiently warm, it will not have the effect of producing a due relaxation; and if it should be too hot, it will stimulate too much, and will have the farther inconvenience of making the patient very faint in a short time. It cannot be well regulated without a thermometer, and 93° upon Fahrenheit’s scale is perhaps the best temperature. I have kept a patient in a bath of that heat for six hours, which he could not have endured for half an hour had the heat been three or four degrees higher.

The circumstance next in consequence, in the cure of this complaint, is the keeping up a moisture on the skin, and guarding the surface of the body from the access of the air. This is particularly necessary with regard to the part itself, which should be constantly enveloped in warm, anodyne, and emollient applications. The good effects of this is particularly exemplified in the case which recovered under the care of Mr. Harris, who gave the diaphoretic medicine, composed of antimonial wine and laudanum, and applied the anodyne cataplasm to the external fauces. It was remarked, that the locked jaw was most incident to those wounded men who lay in parts of the hospital where they were exposed to a current of air; and the cases of tetanus that most usually occur in the West Indies, independent of wounds, are those of slaves who fall asleep in the night-time in the open air.

Since the first edition of this work, there has appeared an Essay on the Locked Jaw by Dr. Rush, physician to the American army in the late war, in which he recommends, from his own observation, Peruvian bark, wine, and blisters, and to dress the wounds with mercurial ointment, in the cure of this complaint. From some trials I have since made of the bark in St. Thomas’s hospital, I have reason to think well of it as a remedy in this disease.

There is a singular species of accident to which engagements at sea are liable, the WIND OF A BALL, as it is called. If a cannon ball in its flight passes close to any part of the body, it renders it livid and numb for some time[132]. It is most dangerous when it approaches the stomach; and there was an instance of a man in the last battle, who, upon a ball passing close to his stomach, dropped down dead instantaneously, without the least visible marks of injury. Another, in consequence of a ball passing close to his belly, remained without sense or motion for some time, and a large livid tumor arose on the part, but he recovered. I attended a man at the hospital at Barbadoes, who had the buttons of his trowsers carried off by a cannon ball, without its having touched the body. The pubis was livid and swelled for some time after: he suffered exquisite pain from strangury, which seemed to proceed from a paralysis of the bladder, for he voided no water without a catheter for near three months, after which time he recovered. I know a brave young officer[133] in the army, who had his epaulette carried off by a cannon ball at Charlestown, in consequence of which the shoulder and adjacent parts of the neck were affected for some time. A like accident happened to a marine officer in one of the late engagements; but in neither of these was the head materially affected, nor is it so apt to be affected in this way as the stomach. I never knew death the consequence of the wind of a ball on the head; though an officer[134] in the Sultan, at the battle of Grenada, was so stunned by a shot passing near his temple, as to be insensible for some time, but he recovered entirely in a few hours[135].

The class of wounds most peculiar to a sea engagement are scorches from the accidental explosion of gunpowder; and in most of the campaigns in which I have served they have been very frequent and fatal. Few accidents, however, of this kind happened in the late engagements; so that we had but little experience of this sort of wounds in April, 1782. But on former occasions they were very frequent, and the best application to the burnt parts was found to be linseed oil, which some of the surgeons mixed with lime water, others with cerusse, and both compositions answered well. Opium was found of great use in alleviating pain and procuring rest, care being taken to guard against costiveness by the use of clysters. In the battles of 1780 and 1781, one-fourth part of the whole killed and wounded was from this sort of accident; but on the 9th and 12th of April, 1782, only two accidental explosions of gunpowder happened in the whole fleet, by one of which one life was lost, by the other, two. This difference was owing partly to greater experience and habits of caution acquired in the course of the war, and partly to certain improved methods in working the artillery introduced by Sir Charles Douglas, which, like all his other valuable improvements, tend to give facility and expedition, as well as to save the lives of men. The circumstances which tend to prevent explosions are, 1st, The wetting of the wads, which prevents their inflaming and blowing back when they fight the weather side of the ship; a circumstance which, without this precaution, gives occasion to a number of accidents by the burning parts catching the loose powder, or setting fire to the cartridges. 2dly, The use of goose-quill tubes and small priming boxes, made of tin, instead of the large horns formerly in use, whereby great quantities of powder were scattered about and exposed to accidental fire. 3dly, The use of locks, which was practised with great success in several ships, and was found to make the operation both more safe and more expeditious.

It frequently happens that men bleed to death before assistance can be procured, or lose so much blood as not to be able to go through an operation. In order to prevent this, it has been proposed, and on some occasions practised, to make each man carry about him a garter, or piece of rope-yarn, in order to bind up a limb in case of profuse bleeding. If it should be objected, that this, from its solemnity, may be apt to intimidate common men, officers at least should make use of some such precaution, especially as many of them, and those of the highest rank, are stationed on the quarter deck, which is one of the most exposed situations, and far removed from the cockpit, where the surgeon and his assistants are placed. This was the cause of the death of Captain Bayne, of the Alfred, who, having had his knee so shattered with a round shot, that it was necessary to amputate the limb, expired under the operation, in consequence of the weakness induced by loss of blood in carrying him so far. As the Admiral, on these occasions, allowed me the honour of being at his side, I carried in my pocket several tourniquets of a simple construction, in case accidents to any person on the quarter deck should have required their use.

It sometimes happens, however, that no hæmorrhage arises from a limb being carried off by a ball. The surgeon of the Fame related to me an instance of this, in which the thigh was cut through by a shot near its upper part, all except a little flesh and skin, and yet not the least hæmorrhage followed. This may have been owing to the limb being entirely severed, or nearly so, whereby the vessels contracted more easily than if they had been partially divided. All that was done for this man was to remove the limb, and to saw off the jagged end of the bone. He survived six days, still without bleeding, and died of the locked jaw.

I was informed by several of the surgeons, that the method of taking up the vessels by the tenaculum was found to answer extremely well; and many of them imagined that the locked jaw was not so apt to be brought on by this mode of operation as by that of the needle. But it is hardly to be attempted in time of action, for want of steadiness and a good light, and it was chiefly at the hospitals that this practice was found so successful.

Mr. Alanson’s method of amputation by a great retraction of the muscles, so that the fleshy parts shall meet over the bone and unite in the first intention, was attended with great success in the West Indies, particularly at the hospital at St. Lucia, under the care of Mr. Bulcock.

It may be remarked, that though all sores and wounds in the foot and leg are difficult of cure in a hot climate, I have observed, that, where the constitution is good, those in the thighs, arms, trunk, and head, are rather more easy of cure than in Europe, and that parts divided by incision very readily unite by the first intention. In reasoning upon this, it may be said, that as healing depends on a certain degree of vigour in the powers of life, this should not err either on the side of excess or defect. If it is too great, as in the case of a hale, plethoric constitution in a cold climate, too much inflammation is apt to be excited; and if too feeble, as happens in a hot climate, in the lower extremities, which are far removed from the source of life and circulation, the salutary effort is not strong enough to generate new organised parts. But in the trunk of the body, in such a climate, the powers of the animal œconomy are in that just medium which is most favourable to this operation of nature.

THE END.

APPENDIX
TO
PART III.

It has been suggested to me, that it would add to the utility of this Work to subjoin a list of the remedies best suited to the practice of physic at sea, with their quantities, and to give a set of formulas for the direction of young practitioners. I have accordingly made out a gross computation of the requisite quantities of the most useful and necessary articles of the Materia Medica, and also a few of the most commodious and simple forms of administering some of the most efficacious remedies for the most common diseases.

It is of consequence every where, but especially on board of a ship, to simplify practice, as much as possible, with regard to the number, the preparation, and the administration of medicines. Where a great number of compound medicines are given, it is extremely difficult to ascertain, by accurate and satisfactory observations, what are their real effects; and as there are not conveniences at sea for great pharmaceutical nicety, the plainest forms should be adhered to. And as all operations are rendered more practicable and easy by being reduced to a stated method, this is an additional inducement for studying plainness and simplicity in preparing and administering remedies. This uniformity is more attainable in the public service than in private practice; for in the former all the patients are of one sex, they are all adults, and they are generally of robust constitutions.

In the list hereto subjoined the articles are distinguished into PRINCIPAL and SECONDARY; and when a surgeon considers how limited his funds are, I hope he will not think that I have made a disproportionate assortment in reducing the number and quantities of the latter, my view in this having been that he may better afford an ample proportion of such medicines as are really efficacious and indispensable in the cure of diseases. It may be affirmed, without vanity or arrogance, that the printed list of articles with which the navy surgeons are enjoined to supply themselves is very injudicious considering the present improved state of the medical art; and it is of great importance that the due proportion of each article should be ascertained as nearly as possible, that no unnecessary expence may be incurred, and that the chest may not be encumbered with unnecessary articles.

There are no simple distilled waters in the following list, as they are very corruptible, and too bulky to carry to sea. Their place is supplied by a small quantity of oil of mint, which may be occasionally added to common water, in the proportion of a drop to an ounce. There are no tinctures inserted, except laudanum, the traumatic balsam, and compound spirit of lavender, as the surgeon, having a proper supply of spirit of wine or rum, may make them on board of the ship.

In the following list the surgical articles are not enumerated. There is a new article which I beg leave to recommend, as it has lately been found extremely useful, and is now used in large quantities in the hospitals in London. This is linseed meal for poultices. The surgeon should also be provided with a sufficient quantity of linseed oil, as it has been found to be one of the best ingredients in dressings for scorches. [See page 540.]

The quantity of each article is adapted to an hundred men for one year, so that a calculation can easily be made for any number of men, and for any length of time.

ASSORTMENT OF MEDICINES
TO BE
CARRIED TO SEA,
FOR
ONE HUNDRED MEN, FOR ONE YEAR.

PRINCIPAL ARTICLES.

Peruvian bark, ten pounds, and if the ship is destined for a hot climate, twenty pounds. This article should be provided by the Public. [See p. 359].—Calomel, two ounces and a half—a Emetic tartar, one ounce and a half—Ipecacoanha, four ounces—Opium, one ounce—b Purging salts, ten pounds—Senna leaves, two pounds.

SECONDARY ARTICLES.

Aloes, half an ounce—Ammoniacum, two ounces—Balsam of copaiva, three ounces—c Traumatic balsam, four ounces—Camphor, three ounces—Cantharides, one ounce—Capsicum, three drachms—Castor, an ounce and a half—Chamæmile flowers, or hops, two pounds—Cinnamon, an ounce—Prepared chalk, or oystershells, six ounces—Conserve of roses, half a pound—d Cordial confection, two ounces—e Cathartic extract, half an ounce—Extract of hemlock, three ounces—Extract of logwood, one ounce—Gentian, five ounces—Ginger, three ounces—Gum arabic, four ounces—Gum guaiacum, three ounces—Powder of jalap, one ounce and a half—f Laudanum, four ounces—Linseed, one pound—Magnesia, six ounces—Manna, eight ounces—Whole mustard seed, half a pound—Myrrh, four ounces—g Crude mercury, two ounces—

Names in the last Edition of the London Pharmacopœia.

a Antimonium tartarisatum.—b Either Glauber’s salts, natron vitriolatum, or sal catharticus amarus, magnesia vitriolata. Glauber’s salt answers better in a hot climate, being less deliquescent from the heat and moisture of the climate.—c Balsamum benzoes compositum.—d Confectio aromatica;—e Extractum colocynthidis compositum.—f Tinctura opii.—g Hydrargyrus.

a Corrosive sublimate, an ounce—Nitre, eight ounces—Oil of almonds, one pint—b Castor oil, half a pint—Linseed oil, three pints—Essential oil of mint, one ounce—c Jamaica pepper, four ounces—d Blistering plaster, ten pounds—Quaffia, eight ounces—Salt of hartshorn, two ounces—e Salt of steel, half an ounce—f Salt of wormwood, ten ounces—Castile sope, half a pound—Sarsaparilla, three pounds—Serpentary, four ounces—Spermaceti, four ounces—Rectified spirit of wine, one pint—g Weak spirit of vitriol, half a pint—h Volatile aromatic spirit, half a pint—i Spirit of Mindererus, two pints, or the volatile salt and vinegar may be kept separately, and added occasionally—Spirit of turpentine, four ounces—Dried squills, half an ounce—Flowers of sulphur, one pound—Golden sulphur of antimony, half an ounce—Cream of tartar, one pound—Vinegar, six pints—j White vitriol, six drachms—Wormwood, one pound—k Flowers of zinc, two drachms.

Necessaries to be put in charge of the Purser, and served out to the Sick in place of the common sea provisions. [See page 358].

BARLEY, three hundred pounds—Eggs, greased and put in salt, twenty dozen—Extract of spruce, twelve pounds—Lemon juice clarified, and preserved by adding to it a small proportion of ardent spirits, five gallons—Raisins, fifty pounds—Rice, two hundred pounds—Coarse sugar, one hundred pounds—Sago, twenty pounds—Salep, ten pounds—Portable soup, fifty pounds—Tamarinds, ten pounds—Best white wine, three hundred gallons—Best red wine, one hundred gallons.

Names in the last Edition of the London Pharmacopœia.

a Hydrargyrus muriatus.—b Oleum ricini.—c Pimento.—d Emplastrum cantharidis.—e Ferrum vitriolatum.—f Kali præparatum.—g Acidum vitriolicum dilutum.—h Spiritus ammoniæ compositus.—i Aqua ammoniæ acetata.—j Zincum vitriolatum.—k Zincum calcinatum.

FORMULÆ QUÆDAM
MEDICAMENTORUM
IN MEDICINA FACIENDA APUD NAUTAS
ACCOMMODATIORES.

IN FEBRE CONTINUA.
PULVIS EMETICUS COMMUNIS.

℞. Pulveris radicis ipecacoanhæ grana decem, antimonii tartarisati grana duo, misce.

MISTURA CATHARTICA COMMUNIS.

℞. Foliorum fennæ uncias sex, aquæ ferventis libras sex. Macera donec pene refrixerit & adjice vel natri vitriolati vel magnesiæ vitriolatæ libram unam cum semisse. Dein cola & admisce tincturæ sennæ uncias octo. Dosis est ad uncias tres.—Interdum conducit adjicere singulis dosibus, vel pulpæ tamarindo um semunciam, vel mannæ semunciam, vel antimonii tartarisati semigranum, vel pulveris jalapìi grana decem.

ENEMA COMMUNE.

Aquæ marinæ tepidæ uncias duodecim.

POTUS COMMUNIS.

Decoctum hordei.—Conveniat adjicere singulis libris pro re natà, vel pulpæ tamarindorum unciam dimidiam, vel crystallorum tartari drachmam unam, vel nitri scrupulum unum, vel acidi vitriolici diluti guttas decem, vel succi limonum unciam unam, vel gummi arabici scrupulos duos, vel vini uncias quatuor, vel frustum panis tosti.

VINUM EMETICUM.

[136]℞. Antimonii tartarisati scrupulos duos, aquæ ferventis uncias duas, vini albi uncias octo. Solve antimonium in aquâ & adde vinum. Assumatur drachma una omni quadrante horæ, donec vel vomitus cieatur, vel alvus moveatur. Deinde assumatur semi-drachma sextâ quâque horâ.

PILULA FEBRIFUGA.

℞. Pulveris antimonialis, (Pharm. Lond.) vel pulveris febrifugi Dris. James drachmam unam, conservæ rosæ quantum latis sit. Simul contunde & divide in pilulas duodecim. Deglutiatur una quartâ vel sextâ quâque horâ.

MISTURA SALINA ET ANTIEMETICA.

℞. Kali præparati drachmam unam, succi limonum, vel aceti, vel acidi vitriolici quantum satis sit ad saturandum salem, aquæ puræ uncias sex. Bibatur tertia pars ter die.—Conducit pro re nata adjicere, vel pulveris antimonialis grana quinque, vel acidi vitriolici diluti guttas quinque, vel cretæ præparatæ scrupulum unum, vel aquæ menthæ semunciam.—Interdum conducit sumere hanc misturam statim postquam Kali & succus limonum mixta fuerit, scilicet in ipsâ ebullitione. Hoc imprimis utile est quando vomitus vel nausea molestus sit, & licet adhibere magnesiam vice Kali, & acetum vice succi limonum.

[137]PILULA DIAPHORETICA.

℞. Opii purificati grana duodecim, antimonii tartarisati grana sex, conservæ rosæ semi-drachmam, farinæ glycirrhizæ, vel tritici quantum satis sit. Contunde simul & divide in pilulas viginti quatuor. Devoretur una horâ somni. Interdum prosit dare unam bis die.

[138]MISTURA SEDATIVA.

℞. Misturæ camphoratæ uncias sex, tincturæ opii guttas viginti Misce. Bibatur tertia pars ter die.—Aliquando conducit admiscere singulis dosibus aquæ ammoniæ acetatæ drachmas tres, vel vini emetici guttas triginta.

[139]BOLUS SEDATIVUS.

℞. Confectionis aromaticæ scrupulum unum, opii purificati grani quartam partem, castorei Russici grana decem, tincturæ opii guttas quatuor. Misce. Assumatur sextâ quâque horâ.

BOLUS SERPENTARIÆ COMPOSITUS.

℞. Pulveris serpentariæ Virginianæ grana decem, camphoræ grana quatuor, confectionis aromaticæ quantum satis sit. Assumatur ter die.—Interdum conducit addere pulveris corticis Peruviani drachmam dimidiam, vel superbibere decocti corticis Peruviani uncias duas.

ELECTUARIUM AD CONVALESCENTES.

℞. Pulveris corticis Peruviani, florum chamæmeli, singulorum unciam unam, pulveris zinziberis scrupulos duos, syrupi quantum satis fit. Dosis est circiter drachma ter die.—Interdum adjiciantur vel rubiginis ferri drachmæ tres, vel pulveris terpentariæ Virginianæ drachmæ duæ.

IN FEBRE INTERMITTENTE.

Adhibeantur in initio eadem medicamenta ac in initio febris continuæ. Deinde

Sumatur corticis Peruviani drachma una, secundâ vel tertiâ quâque horâ, vel etiam singulis horis, absente paraxysmo febrili.—Interdum confert dare singulas doses ex spiritûs vini tenuis (rum dicti) unciâ unâ.

Si cortex frustra adhibeatur fauste adhiberi possint medicamenta infra præscripta.

[140]℞. Zinci calcinati semi-drachmam, conservæ rosæ quantum satis fit. Contunde simul & divide in pilulas quindecim. Sumatur una ter die, augendo dosim si premerit morbus & si ferat ventriculus.

Vel,

℞. Zinci vitriolati grana duodecim aquæ puræ uncias tres Sumatur tertia pars ter die augendo dosim si opus fuerit & si ferat ventriculus.

Vel,

[141]℞. Tincturæ rhabarbari uncias duas, tincturæ sennæ drachmas sex. Misce. Sumatur paucas horas ante paroxysmum.

Vel,

[142]Cortice Peruviano frustra dato, aliquando conferat dare ægro quotidie, vel calomelanos, vel pilularum ex hydrargyro quantum & quamdiu sufficiat ad levem ciendum ptyalismum, & deinde instituere curam de integro cum cortice Peruviano.

Vel,

[143]Sumantur tincturæ opii guttæ viginti quinque, incipiente æstu. febrili, ex poculo potûs communis.

IN DIARRHŒA SIMPLICI.
BOLUS AD DIARRHOEAM.

℞. Cretæ præparatæ scrupulum unum, pulveris rhabarbari grana quindecim, pulveris corticis cinnamomi grana sex, opii purificati granum dimidium, tincturæ opii guttas quinque, syrupi quantum satis fit. Semel sumatur.

℞. Misturæ cretaceæ (Pharm. Lond.) cum duplici gummi arabico libram unam, tincturæ opii guttas decem. Absumatur totum partitis vicibus nychthemero, incipiendo duodecim horas post datum medicamentum novissime præscriptum.—Interdum adjiciatur tincturæ cinamomi uncia dimidia.

IN CHOLERA MORBO.

℞. Decocti hordei vel avenæ libras tres, pulveris gummi arabici unciam unam cum semisse, tincturæ opii guttas triginta. Hauriatur quam primum libra una, & deinde libra dimidia omni horâ usque ad levamen mali.—Si parabilis fuerit caro vitulina, vel pullus, jusculum tenue ex altero utro factum vice decocti supra dicti adhibeatur.

IN DYSENTERIA ACUTA.

Sumat æger quamprimum emeticum commune.

℞. Decocti hordei libras duas, salis cathartici unciam unam cum semisse, antimonii tartarisati grana duo. Misce. Hauriatur tepide primò libra dimidia, & deinde unciæ quatuor omni horâ donec alvus copiose & iteratim dejecerit.

℞. Pulveris ipecacoanhæ grana duodecim, conservæ rosæ quantum satis fit. Contunde simul & divide in pilulas duodecim. Sumatur una ter die. Si æger vehementer febricitârit satius erit dare ter die vini emetici drachmam unam ex cyatho amplo decocti hordei tepidi.

[144]℞. Pulveris ipecacoanhæ grana duo, pulveris opii purificati exsiccati granum unum, nitri grana octo. Misce. Sumatur horâ somni.

ENEMA EMOLLIENS.

℞. Amyli unciam dimidiam, aquæ puræ uncias decem. Coque ad idoneam spissitudinem.

Vel,

℞. Seminum lini drachmas sex, aquæ puræ uncias duodecim. Coque per quadrantem horæ & cola liquorem pro enemate.

ENEMA ANODYNUM.

℞. Enematis emollientis uncias quatuor, tincturæ opii guttas quadraginta. Misce.

IN DYSENTERIA CHRONICA.
BOLUS CATHARTICUS.

℞. Pulveris rhabarbari grana quindecim, calomelanos grana quinque, conservæ rosæ quantum satis fit ut fiat bolus. Mane sumendus, & repetendus post paucos dies si opus fuerit.—Vice hujus interdum conducat dare misturæ catharticæ communis uncias duas.

SOLUTIO CAMPECHENSIS.

℞. Extracti ligni Campechensis drachmam unam cum semisse, tincturæ cinamomi unciam unam. Tere simul & admisce aquæ puræ uncias quinque. Sumatur uncia una ter die.

DECOCTUM AMARUM.

℞. Corticis simaroubæ vel quassiæ drachmam unam, aquæ puræ libram unam cum semisse. Decoque ad libram unam. Absumatur totum quotidie tribus vicibus. Adjici possint singulis dosibus pro ratione symptomatum, vel cretæ præparatæ scrupulus unus, vel pulveris ipecacoanhæ granum unum, vel tincturæ cinamomi drachmæ duæ, vel tincturæ opii guttæ quinque.

[145]In casibus rebellibus confert illinere quotidie hypogastrium unguenti ex hydrargyro drachmâ dimidiâ.

Sit pro potu communi in hoc morbo aqua pura, frusto panis recens tosti adjecto, & pauxillo spiritus vini tenuis (rum dicti) admixto. Sit pro victu communi salab, vel farina tritici in pulmentum tenue ex aquâ purâ cocta.

IN INTESTINIS INFLAMMATIS.
[146]SOLUTIO SALIS CATHARTICI.

℞. Decocti hordei libram unam, magnesiæ vitriolatæ uncias duas. Misce ut fiat solutio. Bibatur, post sanguinis missionem, uncia una omni semihorâ donec alvus bis dejecerit.

Adhibeantur hypogastrio cucurbitulæ cruentæ, vel hirudines plures. Applicetur ibidem epispasticum satis amplum. Injiciatur enema cum oleo & pauxillo sale cathartico.

IN ILEO, vel COLICA PICTONUM, vel morbo in regionibus æstuosis DRY BELLY ACHE dicto.

[147]PILULÆ CATHARTICO-ANODYNÆ.

℞. Extracti colocynthidis compositi drachmam dimidiam, opii granum unum & dimidium, olei menthæ guttam unam. Contunde in massam & divide in pilulas decem. Sint pro una dosi. Paucas post horas, si alvus non rite responderit, exhibeantur misturæ catharticæ unciæ duæ, vel[148] olei ricini uncia una, & repetantur ut opus fuerit.—Interdum in hoc malo divexat vomitus cui auxilio est, mistura antiemetica. Vide page 551.

Perfricetur hypogastrium oleo tepido.

Ineat æger in balneum tepefactum ad 93° therm. Fahren. per horam unam vel etiam diutius.

Denique suffletur in anum fumus nicotianæ.

Vel,

℞. Nicotianæ drachmas duas aquæ puræ ferventis libram unam.—Fiat infusum & cola pro enemate.

IN HÆMORRHÖIDE.
BOLUS HÆMORRHOIDALIS.

℞. Florum sulphuris drachmam dimidiam, conservaæ rosæ, vel pulpæ tamarindorum quantum satis fit. Assumatur bis die.

Si sanguinis ex ano profluentis magna fuerit vis, & præcipue si ex alto fonte effluxerit, valde proderit medicamentum infra præscriptum.

[149]℞. Olei lini recens expressi drachmas sex, tincturæ rhabarbari drachmas duas. Misce. Sumatur bis die.—Vice olei lini adhibere licet olei amygdalæ unciam dimidiam, cum mucilaginis gummi arabici drachmis duabus.

IN ALVO ASTRICTA.
PILULÆ LAXANTES.

℞. Aloes socotrinæ drachmam unam, syrupi quantum satis sit. Contunde & divide in pilulas viginti. Sumantur duæ pro re natâ.—Aliquando conducit adjicere vel pulveris zinzberis vel pulveris capsici grana quindecim, vel olei menthæ guttas decem.—Vice aloes licet adhibere extractum colocynthidis compositum.

ELECTUARIUM ECCOPROTICUM.

℞. Pulveris jalapii unciam dimidiam, pulpæ tamarindorum unciam unam, pulveris zinziberis semi-drachmam, syrupi melasses dicti quantum satis sit. Sumatur circiter drachma pro re natâ.—Interdum prosit adjicere crystallorum tartari drachmas duas.

IN CATARRHO.
LINCTUS.

℞. Conservæ rosæ unciam unam, mucilaginis gummi arabici unciam dimidiam, olei amygdalæ drachmas duas, succi limonis, vel acidi vitriolici quantum satis sit ad gratum saporem conciliandum. Misce. Sumatur pauxillum sæpius.—Interdum adjiciatur vel salis nitri drachma una, vel tincturæ opii guttæ decem.

Sit pro potu communi decoctum hordei in quo coquatur uvarum passarum uncia una, & sub finem cocturæ seminum lini drachmas duas pro singulis libris decocti.

Si febricitârit æger, sumantur mistura salina & pilula febrifuga ter die.

IN PLEURITIDE ET PERIPNEUMONIA.

℞. Decocti hordei libras duas, pulpæ tamarindorum quantum satis-fit ad gratum saporem, nitri drachmam unam. Misce. Hauriatur affatim pro potu communi. N. B. Si tamarindi moverint alvum sæpius quam semel aut bis die adhibeatur vice ejus syrupus melasses dictus.

Sumatur mistura salina & pilula febrifuga sextâ vel quartâ quâque horâ.

IN HÆMOPTÖE.

Hauriat æger infusi rosæ uncias tres quater die. Interdum adjiciatur vel tincturæ opii guttæ quatuor, vel nitri grana decem.

HAUSTUS OLEOSUS.

[150]℞. Olei amygdalini, aquæ menthæ simplicis singulorum unciam unam, manræ drachmas tres. Misce. Sumatur ter die. Sæpe conducit adjicere singulis dosibus tincturæ opii guttas quatuor vel quinque.

IN TUSSI ASTHMATICA.
PILULÆ PECTORALES.

[151]℞. Gummi ammoniaci drachmas tres, saponis Hispaniensis drachmas duas, pulveris radicis scillæ grana sex opii purificati grana tria, syrupi melasses dicti quantum satis sit. Contunde simul & divide in pilulas quadraginta octo. Sumantur quatuor bis die.

IN ASTHMATE A DIATHESI HYDROPICA PROVENIENTE.
PILULÆ SCILLITICÆ.

℞. Radicis scillæ aridæ grana duodecim, conservæ rosæ quantum satis sit. Contunde simul & divide in pilulas duodecim. Sumatur una vel duæ bis vel ter die.

Vel,
[152]HAUSTUS DIURETICUS.

℞. Aquæ puræ unciam unam & dimidiam, pulveris scillæ aridæ grana duo, tincturæ lavendulæ compositæ guttas trigintæ, kali præparati grana decem. Misce. Sumatur bis vel ter die.—Interdum adjicere liceat haustui vespertino tincturæ opii guttas viginti.

Vel,
BOLUS CÆRULEUS CUM SCILLA.

[153]℞. Pilularum ex hydrargyro grana quinque vel usque ad decem, pulveris radicis scillæ grana duo. Misce. Sumatur horâ decubitûs, per tres vel quatuor noctes consequentes.

IN RHEUMATISMO ACUTO.
MISTURA DIAPHORETICA.

℞. Aquæ puræ uncias tres, aquæ ammoniæ acetatæ unciam unam & dimidiam, pulveris antimonialis grana quindecim. Sumatur tertia pars ter die.—Interdum adjiciantur nitri grana quinque singulis dosibus.

Bibatur affatim decoctum hordei tepidum, cum nitri scrupulis duobus in singulis libris.

HAUSTUS SUDORIFICUS.

℞. Misturæ camphoratæ unciam unam & dimidiam, aquæ ammoniæ acetatæ unciam dimidiam, vini emetici guttas quadraginta, tincturæ opii guttas viginti. Misce. Sumatur horâ somni, vel etiam sæpius sed cum dimedia tinctura.

IN RHEUMATISMO CHRONICO.

℞. Tincturæ guaiaci volatilis drachmas duas. Sumatur ex cyatho potûs communis ter die. Vel sumatur gummi guaici semidrachma super bibendo haustum ex salis cornu cervi serupula aquæ unciis tribus.

℞. Pulveris ipecacoanhæ compositi (Pharm. Lond.) scrupulum unum. Sumatur hora somni alternis noctibus.

In casibus rebellibus pro remedio efficaci compertum est dare quotidie calomelanos granum unum vel grana duo.

IN HYDROPE.
PULVIS HYDRAGOGUS.

℞. Crystallorum tartari unciam dimidiam, pulveris jalapii grana quindecim, pulveris zinziberis grana quinque. Misce fiat pulvis, fumatur alternis diebus.

MISTURA DIURETICA.

℞. Infusi gentianæ uncias decem, spiritus vini tenuis uncias duas, kali præparati drachmam unam. Misce. Hauriamur unciæ tres bis die.[154]Vice infusi gentianæ licet adhibere infusum absynthii.

TINCTURA SCILLÆ. Pharm. Lond.

Sumatur drachma una bis die ex haustu potûs communis.

PILULA EX ELATERIO.

℞. Elaterii grana duodecim, syrupi quantum satis sit. Dividatur in pilulas sex. Sumatur una bis die.

[155]Ægro licet, imo prodest hoc morbo laboranti bibere ad libitum ex liquore aliquo siti extinguendæ accommodato, veluti aquâ hordei cum crystallis tartari.

IN ERYSIPELATE.

[156]℞. Pulveris corticis Peruviani drachmam unam. Sumatur omni horâ vel interpositis duabus vel tribus horis.

IN MORBO VENEREO.
1. IN GONORRHOEA.

Hauriatur ad libitum infusum lini, vel decoctum hordei cum gummi arabici drachmis sex in singulis libris.

Sumantur calomelanos grana duo quotidie per viginti circiter dies.

[157]℞. Aquæ puræ distillatæ uncias octo, hydrargyri muriati granum unum. Misce. Injiciatur pauxillum in urethram bis vel ter die.

IN GONORRHOEA BENIGNA.

℞. Balsami capaivæ drachmam unam, tincturæ lavendulæ compositæ guttas triginti. Misce. Sumatur bis die.

2. IN ULCUSCULIS.

In initio feliciter adhibetur causticum.

℞. Calomelanos drachmam dimidiam, conservæ rosæ quantum satis sit. Contunde in massam & divide in pilulas triginta. Sumatur una quotidie, vel interdum dimidia ter die, ut cieatur ptyalismus modicus. Perstet æger in usu medicamenti hujus per dies acto postquam sanata fuerint ulcuscula.

Pro medicamento topico, utile erit inspergere ulcusculum cum pulvere hydrargyri nitrati.

3. IN BUBONE.

Illinatur artus lateris affecti infra inguen cum unguenti ex hydrargyro drachmâ dimidiâ quotidie.

Si abierit bubo in ulcus mali moris omittatur pro tempore usus hydrargyri & sumatur quotidie [158]opii purificati granum unum primo semel, dein bis, denique ter die vel etiam sæpius, & pulveris corticis Peruviani drachma una ter quaterve die.—Interdum conducit sumere pulveris sarsæparillæ drachmas duas ter die, vel extracti cicutæ grana tria ter die, augendo paullatim usque ad grana decem.

4. IN VERA LUE, anginâ scilicet osteocopiis, exostosibus & defædatione cutis.

Illinantur membra quotidie cum unguenti ex hydrargyro drachmis duabus quotidie usque dum cieatur ptyalismus[159] per dies triginta ad minimum vel donec evanuerint symptomata.—Interdum vice litûs adhibere conveniat vel calomelanos granum unum ter die, vel pilularum ex hydrargyro grana quinque bis die, vel

℞. Hydrargyri muriati grana octo, spiritus vinosi tenuis libram unam. Fiat solutio, & sumatur uncia dimidia bis die. In ulceribus tonsillarum pernotabili est auxilio suffitum ex cinnabare in fauces inhalare semel vel bis quotidie.

Si ulcera mali moris exorta fuerint in quavis corporis parte, eadem, ut jam de bubone dictum est, fiant.

IN SCORBUTO MARINO.

Sumat æger quotidie succi limonum unciam unam ter quaterve die.

℞. Aquæ puræ paullulum tepefactæ congios triginta, syrupi melasses dicti libras sedecim pondere, extracti pini uncias octo pondere, spumæ vel fæcis cerevisiæ libras duas mensurâ. Misce & agita valide cum baculo, dein sinatur abire in fermentationem, ut fiat cerevisia, deinde servetur in vase clauso. Ut diutius servari potest, proderit admiscere spiritûs vini tenuis Gallici, vel qui rum dicitur, libras duas aut tres. Si infirma fuerint viscera adjicere juvabit vel lupuli vel summitatum absinthii vel quassiæ, vel zinziberis quantum satis sit. Hauriat æger libras duas quotidie.

℞. Farinæ avenaceæ libras tres, aquæ puræ congios quatuor. Misce. Macera donec liquor fiat acidulus, dein effunde dimidium & adjiciatur par copia aquæ puræ, & coque ad idoneam spissitudinem, ut cogatur in pulmentum. Sit pro victu assiduo cum vini & sacchari non purificati, vel syrupi melasses dicti quantum sufficiat ad gratum saporem conciliandum.

Ad alvum solvendam commode adhiberi potest electuarium eccoproticum cum crystallis tartari. Vid. p. 556.

THE END.