Observations on the Diseases of Seamen

by Sir Gilbert Blane

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.