Observations on the Diseases of Seamen

by Sir Gilbert Blane

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.