Medicine at sea

[Red Cat Jenny]

Ok well with all the slashing and shooting and such, did pirates stitch thir wounds? I would imagine they could have sustained some more serious gashes with all the close fighting.. How would they treat this? It seems with not much fresh watter and no antibiotics there must have been methods, I'm trying to imagine surviving through all the elements of life at sea..

[Story]

You mean the olde ways, like flushing wounds with fresh urine or letting maggots clean them out by eating the dead flesh?

[Red Cat Jenny]

eww eww ewwwww! I was rather hoping for pouring alchohol or some herbal thing..ouch!

[Zephaniah W Nash]

Careful, maggots are making something of a comeback in debridement (the removal of necrotic flesh).

In animal treatment...

And in humans...

[Capt. Sterling]

Careful, maggots are making something of a comeback in debridement (the removal of necrotic flesh).

And the leeche as well!

[Zephaniah W Nash]

True that, Capt. Sterling, particularly for use in the re-attachment of severed parts.

What I wonder -- and to bring this back to a more historical-type thread -- is if anything resembling the modern ick-factor would have been involved. It seems to me -- and this is pure speculation, of course -- it wouldn't have been viewed as... well... disgusting as it would to people today.

Firstly, it would have been more common. We now have such a mental picture of medicine as clean and shiny and antiseptic, which folks wouldn't have had at the time.

Secondly, particularly with maggots, it would be better than the alternative. I mean, even my modern mind would look at it this way: some nasty little crawlies wiggling around in that wound, or have the limb hacked off with no antisthetic... Bring on the maggots!

What I do wonder is how difficult it might be to get the right kind of maggots at sea. Unlike leeches, they do have a tendency to turn into flies...

[Red Cat Jenny]

Ugh..while glad I've not set down t' breakfast yet.. You make an excellent point about perspective then vs now.

I have oft wondered at medicine through the ages and how brutal and ghastly it was compared to as you say "modern antiseptic conditions"

If you have ever read about the pioneers in America and the explorers in other countries -as well as sailors and pirates.. I would say these were extrodinary men/women to survive not only the elements (cold, dampness, heat), but health issues as well as the treatments which may have done more damage than good.

My theory is that life, the air, etc was a lot healthier then giving them a better head start and that modern day people with their host of diagnoses and problems are handicapped simply by living in a polluted environment.

I read a lot about many things and came across an article reminding you that everything in your house and car give off all sorts of nasty fumes etc (vinyl chloride etc) Just because you don't see/smell a thing doesn't mean it isn't there. Not to get off topic-I am trying to make a point ..

Consider (at least in the US) how they push soaking everything in your house with Febreeze. Your skin will absorb such things as well as your lungs etc. And while they may be FDA approved, consider the cumulative effect! I am no environmental radical or health nut. (Hell I smoke and drink and stay up too late- Pirate!) But I lived on a spit of land only 2 miles N to S on the southern shore of LI where the wind blew off the open ocean almost constantly. The house I lived in wa built in 1925 and not much about it had been changed (save for lead paint and new pipes) I never felt healthier with all that fresh air. Moved back to the land locked burbs with the bug spray, fertilizer, car exhaust and it sucks (in a word) I can't wait to move back to the Ocean!

So with simpler foods and less chemicals I guess maybe people had a stouter state of health and recovery as long as they avoided the major diseases.

[Story]

Careful, maggots are making something of a comeback in debridement (the removal of necrotic flesh).

.[/url]

The Fresh Urine flush is also taught in some survival courses.

Note the 2,000 year old use of Honey as a treatment for wounds being 'rediscovered'.

http://www.worldwidewounds.com/2001/novemb...ical-agent.html

Key Points

1.

Honey is a traditional topical treatment for infected wounds. It can be effective on antibiotic-resistant strains of bacteria.

2.

Honey is produced from many different floral sources and its antibacterial activity varies with origin and processing. Honey selected for clinical use should be evaluated on the basis of antibacterial activity levels determined by laboratory testing.

3.

The antibacterial properties of honey include the release of low levels of hydrogen peroxide. Some honeys have an additional phytochemical antibacterial component.

4.

Many authors support the use of honey in infected wounds and some suggest its prophylactic use on the wounds of patients susceptible to MRSA and other antibiotic-resistant bacteria.

Abstract

Honey is an ancient remedy for the treatment of infected wounds, which has recently been 'rediscovered' by the medical profession, particularly where conventional modern therapeutic agents are failing. There are now many published reports describing the effectiveness of honey in rapidly clearing infection from wounds, with no adverse effects to slow the healing process; there is also some evidence to suggest that honey may actively promote healing. In laboratory studies, it has been shown to have an antimicrobial action against a broad spectrum of bacteria and fungi. However, further research is needed to optimise the effective use of this agent in clinical practice.

Introduction

Honey was used to treat infected wounds as long ago as 2000 years before bacteria were discovered to be the cause of infection. In c.50 AD, Dioscorides described honey as being "good for all rotten and hollow ulcers" [1]. More recently, honey has been reported to have an inhibitory effect to around 60 species of bacteria including aerobes and anaerobes, gram-positives and gram-negatives [2]. An antifungal action has also been observed for some yeasts and species of Aspergillus and Penicillium [2], as well as all the common dermatophytes [3]. The current prevalence of antibiotic-resistant microbial species has led to a re-evaluation of the therapeutic use of ancient remedies, including honey[4].

Honey Remedy Could Save Limbs

By Brandon Keim

WIRED

01:00 AM Oct, 11, 2006

When Jennifer Eddy first saw an ulcer on the left foot of her patient, an elderly diabetic man, it was pink and quarter-sized. Fourteen months later, drug-resistant bacteria had made it an unrecognizable black mess.

Doctors tried everything they knew -- and failed. After five hospitalizations, four surgeries and regimens of antibiotics, the man had lost two toes. Doctors wanted to remove his entire foot.

"He preferred death to amputation, and everybody agreed he was going to die if he didn't get an amputation," said Eddy, a professor at the University of Wisconsin School of Medicine and Public Health.

With standard techniques exhausted, Eddy turned to a treatment used by ancient Sumerian physicians, touted in the Talmud and praised by Hippocrates: honey. Eddy dressed the wounds in honey-soaked gauze. In just two weeks, her patient's ulcers started to heal. Pink flesh replaced black. A year later, he could walk again.

see Wired.com for the rest of that article.

[Story]

If it's a matter of life and death, you'll get over 'icky factory' pretty quick.

Some reading for you:

http://www.nmm.ac.uk/server/show/conWebDoc.138

http://www.mic.ki.se/West.html#West4

(The modern period/1601 - and 18th century categories in particular)

[Zephaniah W Nash]

Flushing out a wound with urine might not be a horrible treatment, as well.

Urine, in general, is a sterile substance (unless there is some disease of the urinary tract, of course) although it is full of some toxins -- that's one of the main purposes of urinating, to remove toxins. Although, and I think I would want to discuss with a doctor before trying it, those toxins could very well be some that are not dangerous if they get into the bloodstream directly, as in being used to flush out or wash a wound.

Considering the state of "fresh" water at sea, I'm thinking the urine may well be much cleaner to clean a wound with, if there is nothing else available.

And considering Red Cat's post, not only is it very possible that the environment was generally healthier (although, onboard ship, the conditions might easily be as bad or worse as average conditions today), the people just tended to be healthier overall -- at least from a purely physical standpoint. Those who work harder physically and are therefore in better physical shape, tend to have a better chance of surviving wounds. Overall life expectancy is much lower (when you also factor in such things as lack of good nutrition, etc.), but the survival rates concerning such things as wounds is often better.

Additionally, when considering wounds, most modern treatments (apart from antiseptics and antibiotics to help prevent/treat infection) are, in effect, making one comfortable until the body can heal its' own wounds. In some cases, that's the same with disease, as well. An overall healthier body will heal that damage faster than a less healthy one.

[jessie k.]

Urine, in general, is a sterile substance

Sterile only immediately after it leaves the body, though.

[Red Cat Jenny]

Didn'y think sea water was so unsterile? My dad used to tell me if you had a minor abrasion the salt water would help heal it, which it seemed to when we went to the beach with the various scrapes you aquire as a kid. Granted no major injuries, but still it seemed to work.

In a separate post here I am attaching some info, some outdates the GaOP but it's quite interesting.

----------

[Zephaniah W Nash]

I considered the use of seawater as well, for cleaning/flushing out wounds if nothing else. I seem to recall having heard somewhere that, depending on where or perhaps where that seawater came from, it could be chock full of pretty nasty infectious agents. Purely anecdotal, though, old-wife tale sort of thing.

And considering the sea-borne cloud of filth that would surround a becalmed ship, it would probably be a really bad idea in that situation.

But it's one of those things that got into my head, so I discounted the use of seawater without really considering it. If it is, in fact, true, then a minor abrasion would probably be fine, but a deep wound opening up muscle and/or veins/arteries would be a bad idea to expose to it.

Basically, I just don't know. Very possibly better than nothing at all, though.

And some interesting stuff in the other posted info there, Jenny.

[CrazyCholeBlack]

what about the practices that were used before GAoP like boiling oil etc? Would those still have been in use? I was just reading about the combo of turpintine, oil of rose & egg yolk on gunshot wounds. It dates back to the 16th century but would it have still been used later?

any good books on this subject? Where is the good Dr. when you need him?

[Coastie04]

Just my bit about being healthier in the old days. In one respect, yes. People were generally more physically fit (at least among the majority of seamen-officers and certain positions not necessarily so), the air was cleaner, and I'd even risk saying that many of the diseases were weaker before the widespread sterilization of things. On the other hand, there was no protective equipment such as rubber gloves back then, all sorts of chemicals being handled, and poorer nutrition. Lead based paint, tar, chemicals used to clean brass, etc. Many different things were used to keep the ship in good repair, as well as make her pretty. Plus, as has been mentioned earlier, some ships were just not kept clean. Part of that could be due to outside conditions (stuck in the doldrums, in port, etc.), and some could be internal factors (leadership, standard of cleanliness, availability of supplies, age of the vessel, etc.). Even today, I've been aboard fishing vessels that could pass a white glove inspection and some that I make sure my shots are up to date. So, live in those conditions for months on end and I doubt that you'd be any healthier than today. Back then, they didn't usually think about what would have health effects years down the line for the ordinary sailor. Today, we're more conscious of hazardous materials. Just my two cents worth.

Coastie

[CrazyCholeBlack]

found some interesting tidbits on the medicinal use of tobacco in this article. it covers everything until 1860, so just keep an eye on the dates. It's thankfully organized by general date.

Medicinal Use of Tobacco

[Sjöröveren]

This topic (History of Medicine) has been my primary area of interest for about 15 years, though only the last 3 years or so have been focused specifically on medical practice at sea.

There's so many postings that I want to put my 2 cents in on, that I'm going to quote each one individually. It's just faster and easier to do it that way.

[Sjöröveren]

Ok well with all the  slashing and shooting and such, did pirates stitch thir wounds? I would imagine they could have sustained some more serious gashes with all the close fighting.. How would they treat this? It seems with not much fresh watter and no antibiotics there must have been methods, I'm trying to imagine surviving through all the elements of life at sea..

Stitches were the most common method of closing a wound during GAoP. Cauterization, where the wound is closed via a red-hot instrument or boiling oil, was still in use, but in decline since the 16th Century.

Cleanliness aboard a ship ran the gamut from absolute filth to cleaner than the typical 21st Century home. National navies from England, France, the Netherlands and other northern European areas had a general reputation of cleanliness. The British Royal Navy began each day at sea with a thorough swabbing of decks, and did their best to keep the rest of the ship as clean as possible. Russian ships were considered to be the most cruel and vile ships afloat anywhere. Turkish and Moorish/Barbary ships also have a reputation for general filth. I read one account of Turkish sailors using the areas between the guns as both bunks and latrines. (Odd, since Muslims on land were and are called upon to keep clean as a tenet of faith.)

Pirates, I would imagine, are at the low end of cleanliness.

Sea water, of course, was limitless, but if the ship had been becalmed for more than a day or two, the sea around it quickly became an open sewer. Sometimes boats were lowered so the crew could row the ship into cleaner water.

There was no perceived need for sterilization at this time, because there was no knowledge of germs, thus no comprehension that microscopic critters were the cause of disease. Germ theory didn't come until 1867, with Dr. Joseph Lister's first publication on the subject. He was laughed at for a good number of years, until folks like Pasteur and Koch proved his point. It really wasn't until about 1900 that germ theory was pretty much universally accepted in the Western world.

But folks did realize that "bad water" or "foul air" made people sick. So they knew that general cleanliness was a good idea.

A well-equipped ship's Surgeon during GAoP would have various substances that he knew to aid in the healing process, such as Boric Acid, flowers of Sulphur, even the aforementioned honey. All have natural antibiotic or antiseptic properties. Many other preparations were alcohol based, so it wasn't the root or mineral in the medicine that aided healing, it was the alcohol. Surgeons also would sometimes splash a bit of alcohol over an incision site just before he began to cut. Not because he knew it would kill germs, but because the rapidly evaporating alcohol had a cooling effect on the skin, distracting the patient momentarily from the initial cut. Laudanum and other opiates were in use during GAoP, and would be used if available.

Oh, that's enough for this post. Let's see what else has been covered.

[Sjöröveren]

You mean the olde ways, like flushing wounds with fresh urine or letting maggots clean them out by eating the dead flesh?

I've heard of urine being used, but don't know much about it. Same with maggots. I know more about the contemporary uses of medicinal maggots than historical. I gotta research those two more....

[Sjöröveren]

eww eww ewwwww! I was rather hoping for pouring alchohol or some herbal thing..ouch!

I don't mean to single you out, Red Cat Jenny. Far from it. But you were the first to bring up something that's a bit a bone of contention for me. So, really, nothing personal, but...

the notion of "herbal" or "natural" medicine is entirely a modern one. These are words we use today to distiguish traditional forms of medicine from today's mainstream medicine. I am not criticizing herbal and natural medicine in the least. They are, in some specific areas, as good or better than much of current pharmaceuticals. But people in the past simply didn't use these terms. All medicine was natural, and the vast majority of pharmaceuticals were herbal (the rest being mineral or animal based). They didn't say "natural medicine" any more than we would say "natural e-mail" today. What other kind is there?

Sorry, but I've encountered other reenactors who stress that the medicine they practice (in character) are "all herbal and natural." I am tempted to point out that their ship's ropes, decks and sails all herbal and natural too.

[Red Cat Jenny]

Hey,I be glad ye found yer way t this post and look foreward t'whatever else ye post. Fascinatin stuff this...

I figured with all the opportunities to get burned, cut, scraped, slashed. stabbed, bitten and otherwise banged up during a life of piracy where you likely couldn't just "put in to port" and see a doctor without risking your neck, there would have to be some tried methods.

I imagine if the health of the crew couldn't be maintained to some degree so there was a consistent number of able men (or women-who knows?) then the ship wouldn't be too sucessful.

I know there was some apothecary available at the time and imagine they picked up some knowledge and methods from the natives they encountered as well. After all the island dwellers would have been living in danger as well from warring neighbors, wild animals and life in the rough and so must have also had methods they might have passed on.

If you have ever seen what a Bluefish can do to someones hand, you can imagine the risks in even a simple thing like dinner at times.

[Sjöröveren]

What I wonder -- and to bring this back to a more historical-type thread -- is if anything resembling the modern ick-factor would have been involved. It seems to me -- and this is pure speculation, of course -- it wouldn't have been viewed as... well... disgusting as it would to people today.

Firstly, it would have been more common. We now have such a mental picture of medicine as clean and shiny and antiseptic, which folks wouldn't have had at the time.

Secondly, particularly with maggots, it would be better than the alternative. I mean, even my modern mind would look at it this way: some nasty little crawlies wiggling around in that wound, or have the limb hacked off with no antisthetic... Bring on the maggots!

What I do wonder is how difficult it might be to get the right kind of maggots at sea. Unlike leeches, they do have a tendency to turn into flies...

Exactly! How many of you here have butchered a pig? Prepared the body of a family member for burial? Performed a bloodletting on a child, spouse or horse? Assisted in the delivery of a child, or calf/colt, etc.? All of these things were commonplace until 150 years ago or so. Add to that the fact that part of a seaman's job was killing other seamen. So helping the surgeon hold down your messmate while he saws his arm off, while certainly a serious situation, would not have much "gross out factor" aboard a ship.

(For the record, OK for the purpose of bragging, I've butchered a pig and assisted in delivering a stillborn calf. Both were really, really gross, but I kept my lunch. I even ate some of the pig. The calf we buried.)

Any surgeon, land or sea, would try to have a good supply of leeched whenever he could. Leeches were used most often to draw off "bad blood," i.e. dead and clotting blood beneath the skin. Think of a really bad bruise, the kind that turn all black and then yellow. Leeched sucked that stuff out. Not a great idea in hindsight, since the yellow stuff is hemoglobin, and part of your body's arsenal for repairing tissue damage. But you could see it, it looked bad and leeches got rid of it, so they used leeches.

Leeches were also used for bloodletting when the patient is too ill to sit upright. Slow but effective.

[Sjöröveren]

Ugh..while glad I've not set down t' breakfast yet.. You make an excellent point about perspective then vs now.

I have oft wondered at medicine through the ages and how brutal and ghastly it was compared to as you say "modern antiseptic conditions"

If you have ever read about the pioneers in America and the explorers in other countries -as well as sailors and pirates.. I would say these were extrodinary men/women to survive not only the elements (cold, dampness, heat), but health issues as well as the treatments which may have done more damage than good.

My theory is that life, the air, etc was a lot healthier then giving them a better head start and that modern day people with their host of diagnoses and problems are handicapped simply by living in a polluted environment.

I read a lot about many things and came across an article reminding you that everything in your house and car give off all sorts of nasty fumes etc (vinyl chloride etc) Just because you don't see/smell a thing doesn't mean it isn't there. Not to get off topic-I am trying to make a point ..

Consider (at least in the US) how they push soaking everything in your house with Febreeze. Your skin will absorb such things as well as your lungs etc. And while they may be FDA approved, consider the cumulative effect! I am no environmental radical or health nut. (Hell I smoke and drink and stay up too late- Pirate!) But I lived on a spit of land only 2 miles N to S on the southern shore of LI where the wind blew off the open ocean almost constantly. The house I lived in wa built in 1925 and not much about it had been changed (save for lead paint and new pipes) I never felt healthier with all that fresh air. Moved back to the land locked burbs with the bug spray, fertilizer, car exhaust and it sucks (in a word) I can't wait to move back to the Ocean!

So with simpler foods and less chemicals I guess maybe people had a stouter state of health and recovery as long as they avoided the major diseases.

The frontier, in general, was cleaner than the place you came from. Fresh air, clean water all waiting for people to ruin it. Which is what they did rather quickly, especially water. Most people didn't live on the pristine frontier. Most people lived on farms, in small villages or in cities.

Even on a farm on the frontier, little regard was paid to the relationship between your water supply and your farmyard. Wells tend to be dug in low areas, closer to the water table. Animals tend to feed on higher ground, where the grass grows better. So after every rain, a lot of that animal waste is going right into your well.

However, on long-established farms like in Europe, people didn't just go to the well, draw up the bucket and take a bit drink. Everyone knew well water would kill you, they just didn't know how it killed you. They did know that if you drank beer, cider, wine, whiskey, coffee or tea, you didn't get sick. They didn't know that the alcohol or the boiling was making the water safe, they just knew what worked.

In the villages and cities, the population density increased the health risks exponentially. Most people got their water from a common well, which helped spread water-borne diseases like dysentery, typhoid fever and cholera. Most cities used their streams and rivers as both water sources and sewers. Big cities like London, New York and Paris were unimaginably filthy by our standards. Sewage and animal carcasses in the street, garbage tossed out of doors to be eaten by feral pigs and dogs. A putrid hell-hole by any measure.

Air pollution didn't become a big problem until mid-19th century. More factories meant more coal-fueled boilers and more black smoke in the air. London had horrible air pollution problems until about 50 years ago when coal buring was banned.

So my opinion is, even with all the chemicals in use today, the environment is probably a bit better today than in the past. Maybe a break-even. Entirely different pollutants, but still a world full of danger. If you want to live in a world without pollutants, we all gotta do our bit, city and rural, rich and poor, east or west. If you need ideas, go see "an Inconvenient Truth" stay until the credits are done, and take notes. Lots of good ideas there.

[Sjöröveren]

Did I mention that I'm home sick today, and so I literally have nothing better to do than sit here and kvetch? So if you've had enough of me, feel free to go get a sandwich or walk around the block or something. But I'm staying here for awhile.

[jessie k.]

How many of you here have butchered a pig?

*raises her hand* :) Not really so gross.

What I do wonder is how difficult it might be to get the right kind of maggots at sea.

Didn't they find them in food stores, sometimes, along with the weevils? And even if they do turn into flies, the flies will lay eggs that turn into maggots. It's a vicious cycle. Still, imagine having to pick through your food to find maggots to put on your wounds...