Observations on the Diseases of Seamen

by Sir Gilbert Blane

The next cause that was mentioned of the long continuation of fluxes, was a lienteric state of the bowels. This consists in a great irritability of the whole alimentary canal, whereby all the ingesta are transmitted so fast, that there is no time for assimilation. Liquid aliment, such as broth, is particularly subject to this inconvenience. There are few cases of long-protracted fluxes in the West Indies, without this symptom in some degree.

The remedies that are here found of most service are such as counteract irritability or relaxation. It is in cases where this is the prevalent symptom that opium may be most freely used. Frequent and small doses of the compound officinals, such as theriaca, pulvis e bolo compositus, or diascordium, have been found of service. Though the relaxation would seem here to indicate the Peruvian bark, yet I have hardly ever known it employed in any form in this or any other stage of the disease, without being hurtful. But there are other bitters not only safe but useful in restoring the tone of the bowels; of this kind are simaruba, quassia, and chamomile flowers. The first has been reckoned a specific in this sort of flux; but though its powers are undeniable, it will be found frequently to fail[117]. I have also used, with advantage, a tincture of gentian and cinnamon in Port wine. Something aromatic has a good effect when added to the bitter, being adapted to prevent or obviate flatulence, which is a common and troublesome symptom in this complaint.

That class of remedies which may be called pure astringents, might seem at first sight well calculated for cases of this kind. Of this sort are the terra Japonica and extractum campechense; but though I have seen evident benefit from this last, there are few cases in which such medicines are found by experience to be of material service. Where the cause consists in simple relaxation, they will effect a cure; but it more frequently happens that the disease is kept up by a vitiated state of the secretions, or a depraved action of the bowels.

The absorbent earths are a more useful remedy in this form of the disease. They have, perhaps, a restringent effect independent of their power of absorbing acid. It is certain, however, that great part of their use consists in the destruction of acid, which is very apt to be generated in that depraved state of digestion which takes place in advanced fluxes, particularly in this lienteric state of the bowels. In the early and acute state the vegetable purgatives, such as cream of tartar, tamarinds, and manna, are proper; but in this advanced stage they are hurtful by the acidity and flatulence which they produce, and both the food and medicines should be so calculated as to avert and correct those inconveniencies. There is something in vegetable acids extremely unfriendly to a weak state of the bowels in general, tending to bring on spasmodic gripings, and preventing a healthy digestion and assimilation, as we know in the case of heartburn, and of those who make use of vinegar to check corpulency, by preventing the formation of blood. Vegetable acids, however, are admissible where there is a redundancy of bile, or where the excrements are putrid; and Dr. Zimmerman recommends tamarinds as a useful medicine in what he calls the putrid dysentery.

Lime water has been recommended in old flaxes, and I tried it in several cases; but, except in one, I could not perceive any benefit from it.

Absorbents may very properly be combined in prescription with some of the compound-officinal opiates, and a medicine will thereby be formed, which will have at once the advantage of an anodyne, a bitter, an astringent, a carminative, and absorbent. As these earths have little or no taste, they may also be added, with propriety, to the common drink, as in the form of the chalk julep, or decoctum album. It may be thought that here and elsewhere I have not been so particular as I ought to be concerning the forms and doses of medicines; but circumstances, such as age, constitution, and symptoms, make these, in a great measure, discretionary; and any one who is sufficiently conversant with physic to be entrusted with the charge of the sick, will have sufficient judgement to vary his practice accordingly. It has, therefore been my object rather to give the general principles of treatment than the particular forms of medicines.

A proper regulation of diet, as well as medicine, is of the utmost consequence in this disease. A free indulgence of animal food is pernicious, particularly in the first stage of it. In the chronic state, a moderate use of it is allowable, and in the lienteric state it answers better in a solid form than that of broth, which is apt to gripe and to run quickly through the bowels. The best general articles of diet are farinaceous bodies; and these are greatly improved by being toasted brown before they are used. It was observed, in a former part of this work, that the flux was supposed to have been prevented, in the fleet commanded by Sir Charles Saunders, by throwing burnt biscuit into the water used by the crews of the ships. It is a good practice to put a well-burnt toast into all that the patient drinks, and toasted bread, or panada made of toasted bread or biscuit, is one of the best articles of diet. Brackish water ought to be avoided, as it ruffles the bowels when in so delicate a state. Fermented liquors are improper, except when the disease is advanced, and where weakness and relaxation are the prevailing symptoms. Malt liquor will hardly ever agree, on account of its acidity and flatulence. Of wines, Port is to be preferred as the most strengthening; Madeira as the least subject to acidity; and, for the common men, no drink of the fermented kind is safer than a moderate quantity of spirits diluted with water.

Warm clothing is of the utmost consequence in this disease, and external warmth of the abdomen tends greatly to sooth the bowels. I have seen good effects from a warm gum plaster constantly worn on that part. Though cold is in general hurtful and unsafe, I have nevertheless known the sailors, who, by their habits of life, are commonly heedless, bathe in the sea when labouring under what they call the white flux, without any bad effects.

It sometimes happens that this disease baffles every effort both of medicine and diet, so that a change of climate becomes the only resource.

The last cause of habitual flux that was mentioned was the retention of scybala, which keep up the irritation and tenesmus. It is very natural to neglect purgative medicines when there seems already to be too great a discharge by the bowels; but there is this inconvenience from omitting them for a length of time, that those hard lumps of feces, called scybala, are apt to collect in the cæcum and cells of the colon, as I have seen upon inspecting the dead bodies; and the fibres of the intestines being weakened, their natural strength is not sufficient to expel them without being stimulated by a purgative. It is therefore necessary to give some evacuant medicine from time to time, even though there should be no griping nor any marks of acrimony in the intestines. Rhubarb is allowed to be one of the best medicines for this purpose; and I have also known a combination of salts and sena have a good effect after a long neglect of purgative medicines. It is probable, from the durable effects produced, that these do not operate merely by the expulsion of scybala; and we can conceive that they may be of service by the removal of certain depraved fluid secretions, or that they may stimulate the vessels to a more healthy action and a more natural secretion. Be this as it will, experience teaches that in all fluxes it is of advantage to interpose from time to time some purgative medicine.