Some Period Surgical Procedures

[Graydog]

I think it supports that for battle casualties, if you can survive long enough to make it into the hands of a physician, they (that be the physician) will not actively try to kill you for your own (or a capturing party’s) good.

Thank you for adding to my information base on this tangent interest of mine. However, I don’t want to hijack the subject of this excellent thread and I will leave off with any further discussion on battlefield mercy killings

-Greydog

Edited October 30, 2008 by Graydog

[Mission]

Thank you for adding to my information base on this tangent interest of mine. However, I don’t want to hijack the subject of this excellent thread and I will leave off with any further discussion on battlefield mercy killings

I don't mind; I don't know if anyone else does. (To be honest, I don't know if anyone else even reads my long posts in this thread. ) I was thinking about the other soldiers killing their wounded fellows and I recalled why it said they did that - it was to prevent the wounded men from falling into the hands of the enemy. So even that is arguably not so much of a wound-oriented or pain-reducing mercy killing. (I just wish I could remember where I read that. Trouble is, I read several sources at once and until I enter them into my notes later, so I can't always keep them straight. Even worse, that bit doesn't fall directly into my area of interest, so I probably didn't highlight it for future copying.)

Here's one about a fracture caused by a splinters in battle. Splinters from cannonballs were far more likely to cause wounds than the actual ball was, although this does not appear to be widely understood by most people and certainly by most movie-makers. It also highlights one of the most frightening dangers in many sailor's minds. (See if you recognize it.) In addition, it contains some wonderful detail points about a sailor's weapons (Sashes!) and how a make-shift hospital bed was made. (This is not the first time I have come across this method, although this account is more detailed in explaining how the bed was built.) Also note the comment about seamen and wine near the end.

"In the heat of Fight at Sea, amongst the many wounded men that were put down into the Hold to me, one of them had his right Arm extreamly shattered about two Fingers breadth, on the outside above the Elbow, by a great Splinter. I ought to have cut off the mans Arm presently: but a sudden cry that our Ship was on fire put me in such disorder, that I rather thought of saving my self than dressing my Patients. I hastily clapt a Dressing upon the Wound, and rouled it up, leaving his Arm in his other Hand to support it, and endeavoured to get up out of the Hold as the others did, verily believing I should never dress him nor any of them more. But our men bravely quitted themselves of the Fire-ship by cutting the Sprit-sail Tackle off with their short Hatchets, (which they wore during Fight sticking in their Sashes.) So we were freed of the Fire, and by our hoisting up the Top-sails got clear of our Enemy, and I returned to my work. But I was at a loss what to do with

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this man who lay not far off complaining of his Arm. I would have cut it off instantly with a Razour (for the Bone being shattered, there needed no Saw. [the splinter shattered his bone!], but the man would not suffer me to meddle with his Arm, he crying, it was already drest.

The Fight being over, and we gotten into the next Port, I caused this Mariners Bed to be set up: (which was four pieces of Wood nailed together and corded, and a Bears Skin laid upon it, and fastened between two Guns to the Carriages:) upon this I saw him placed; and having ordered his Arm to be laid so that I might the better come to dress it, I sent for dressings, and laid them orderly upon a small Pillow well stuft and quilted in the middle. Upon this Pillow I first laid a soft double linen Cloth, next to that three Ligatures [ties for the bandage in this case], then a Pastboard wet in Vinegar, to make it more soft and pliant; to encompass the fractured Member, which I cut from each end to the middle into three Binders [broad bandages - Wiseman appears to be referring to the ligatures]: Over this lay my Defensative (medicine to prevent bad humours from gathering at a wound) spread on a thick Cloth, of such a breadth and length as to take in the whole Arm. Dressings thus laid upon the Pillow, I cut off the other [dressing] from his fractured Arm, and placed the Pillow with these Dressings close by his side; so that I saw his Arm laid as I designed upon my Restrictive [a bandage used to bind wounds tightly] and his Hand upon his Breast. Then putting my Fingers into his Wound, I pulled out first a piece of Splinter an inch thick and thereabouts, more or less; then Rag and Bones, great and small; I left not the least Shiver [fragment]. When I had so cleared the Wound of all the extraneous bodies and loose Bones, I was amazed to feel what a void space there was between the ends of the Bones. But I proceeded, and cut off the lacerated Lips [of the wound], which were of no use, and drest up the ends of the Bones with a couple of Dossils [plugs of lint] dipt in spir. vini [rectified spirits distilled from wine; alcohol] and Merc. præcipitat. [white mercurial precipitate, used for dressing ulcers. Good old mercury!], with some little ol. terebinth. [oil of turpentine, used widely to cleanse wounds and stem bleeding], spread upon Dossils, an empl. diachalcith. malaxt with ol. murt. & olivar. immatur. and a little acetum [a plaster of oil, litharge and copper salts kneaded with hydrocholorine and olive oil pressed from young olives - this is my best interpretation, anyhow] bringing my restrictive Emplaster, which lay under the Arm, over the whole Arm, from the Arm-pit to the Elbow and close round about, only leaving a space to dress the Wound.

This gave strength to the weak Member, and was designed to prevent the Influx [of humours] from above. Just under this Emplaster lay a Splenium [medicated linen cloth, folded over three or four times to support the fracture]. To answer that I applied three more, one on each side, and another above: Which four were of such a size, that they, lying a little off from one another, encompassed the Arm. They were spread lightly with a little Cerote [a paste of sorts] made of axungia and Wax [wax combined with grease], to make them adhere where I placed them.

Then I brought the Bandage which lay under the Splenium, with three heads at each end. The lowermost of these took in the lower part of the Arm, from the Elbow upwards, with part of the Fracture, and was fastened on the exterior part of the Arm. This prest the Sanies [a thin fetid pus mixed with serum or blood, discharged by wounds] from the neather part of the Arm to the Wound, and hindred the lapse of Matter that way. The middlemost was made to press Matter out of the Wound, and keep the Lips down. The uppermost served to restrain the Influx, as I said, and pressed that Matter out which was already in the Part. This Bandage was made with great moderation, and so fastened, that it might be loosened without trouble to the Patient. [Note again the concern for the comfort of the patient by Wiseman.] Then I brought the wet Pastboard close to the sides, and cut another piece to answer it, which I wetted in aceto [vinegar], and by the three Ligatures under made them fast, but without disturbance to the Patient. If it could not have

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been so put on, I should have forborn the use of them, the Cure of these Wounds consisting in the easie Dressing and quiet Position, without which you will not cure one of them. The Pastboard as it dried, stiffened, and retained its shape, preserving the Fracture in the position I left it, and that with a very slack Bandage. Thus I finished the first dressing, leaving my Patient in much ease. He slept pretty well that night, and was the next day as well as I could expect. he was let blood the second day, and kept to a spare Diet: but we allowed Wine as a Cordial to all our Patients.

The third day I drest him again, took off the upper Pastboard, and loosened the head of the main Bandage; also I took off that Splenium which was over the Wound, and raising up the Emplaster from the Wound, took out many Dossils, found it warm and well disposed, and drest it up quick with my Suppuratives [medicine promoting the discharge of pus] hot, and an Emplaster as before. I stirred not the Restrictive, but made now a Compress more particularly for the Wound, purposing not to remove the two outermost heads of the main Bandage, unless it were sometime to give a little breathing to the Member. But the middle I opened as often as I thought fit, to dress the Wound. The other two had short Splenia to make the Bandage equal. But i was not then satisfied how the space between the fractured ends of the main Bone could be supplied with Callus [hard bony tissue developing around the end of a fractured bone]. My Patient was easier than any of my other with fractured Wounds. When it came to my turn to be visited by my Brother Chirurgeons of our Squadron, they did not dislike the Wound, nor my way of dressing, (for we being used to see one another's Patients, had all much one way of dressing: ) But they laught at the excuse I made for not cutting off his Arm, and doubted I should yet be forced to do it. But I kept my Patient flat on his Back, and that after a while was his greatest pain; For the Wound was well digested, and the bruised Flesh separated, I renewed the Dressings, taking all the old ones off, and fomented the member with warm Water, to give a breathing to it; then applied a Catagmatick Emplaster [medicated plaster for treating fractures], drest the Wound with mundificat. Paracelsi [cleansing mixture of turpentine, honey and egg yolk - named for the physician Paracelsus] or such like, and bound up the Member as at first, and so continued my way of Dressing as I saw cause, putting into the Wound only a Dossil or Tent [roll of absorbent material, often medicated to keep a wound open] made upon a Skewer soft and hollow, to give way to the Wound to incarn [form tissue inside the wound - I watched my finger do this after cutting it with a table saw. It looks like clear gooey, gelatinous stuff sitting in a wound, but it becomes flesh when left alone. It's really quite cool what our bodies can do.]; I scarce using any Injection, but by gentle Compression assisting Nature, who seldom faileth in supplying the lost Substance in Wounds, if we disturb her not by improper Applications.

The next taking off and renewing these dressings of this fractured member was occasioned some 16 or 17 days after, by a troublesome itching of the part, which was occasioned, I suppose, partly from his liberty in Diet, partly by the heat of the Weather, and want of Transpiration [evaporation of water/sweat]. [Mostly, itching is caused by healing, as anyone with a healing wound can attest.] Upon this account I took off the Dressings, bathed the member with Seawater, and drest him up with emplast. de lithargyro. [lead-based medicated plaster, which serves as a powerful astringent]. The Wound was about this time well incarned within, and the Lips beginning to cicatrize [heal by forming scar tissue] from their edges, I dressed them with Epuloticks [medicine promoting wound healing] as unguent. tutiæ, & c. [Tutty (zinc oxide) ointment, an astringent sort of paste] All this while I kept my Patient upon his Back, and renewed not the whole Dressing until I was again necessitated. One day coming from the Shoar, (where our Wounded men had liberty to lodge if they desired it, and were drest by us there,) I found this Patient with a heat all over his Body like an Erysipelas [fevered illness characterized by localised redness and swelling]: At which he was much affrighted. He had, it seems drank Wine too liberally with his Mates, (as they would most of them do, if they were any thing well.) Unless it rather proceeded from a generation of Callus, in which case it usually happens. I let him Blood, and dressing him as in an Erysipelas, finding his Arm pretty strong, and his Wound healed within, and in a fair way of cicatrizing, I raised him up, after he had lain about eight weeks. All which

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while I believe he never stirred his Arm from the time I first placed it, but only while I renewed the Dressings.; he being the most patient man in that respect I ever attended: and in truth, without that submission he could scarce have been cured.

There was in this Patient a strong Callus filling up the void place of the lost Bone at least two inches, with little or no shortening of the Arm: but the Joint of the Elbow was so stiff from the position it lay so long in, that he could not stretch that Joint whilst I knew him, which was until that Ship was cast away.

My memory will be much cried up, for remembring so many particulars in a Patient so many years since cured by me. But if you consider how remarkable a case it was, and in my Trade, there will be less wondring at the possibility of it." (Wiseman, p. 425-8]

[Graydog]

A rather amazing story and probably why it got written down. That indeed was a lucky fellow for many a reason.

Also very fascinating is the one line comment about sashes as you already have noted.

[Mission]

By George if Wiseman does just about come out and state it directly. He's talking about gunshot wounds to the throat and organs in the chest. I'll let him explain:

"Almost all these Wounds made by Gun-shot are mortal; but it is not consistent with Religion or Humanity, to leave such people without help: For sometimes we haply prolong the life of some of them, and now and then cure one." (Wiseman, p. 434)

Of course, this is just one surgeon, although my understanding is that he was most influential in his time.

And 'haply' is my favorite word of the moment. It means by chance or accident. I am going to use that in a sentence today just for fun.

[Graydog]

By George if Wiseman does just about come out and state it directly. He's talking about gunshot wounds to the throat and organs in the chest. I'll let him explain:

"Almost all these Wounds made by Gun-shot are mortal; but it is not consistent with Religion or Humanity, to leave such people without help: For sometimes we haply prolong the life of some of them, and now and then cure one." (Wiseman, p. 434)

Of course, this is just one surgeon, although my understanding is that he was most influential in his time.

And 'haply' is my favorite word of the moment. It means by chance or accident. I am going to use that in a sentence today just for fun.

This haply finding does be most informative.

Thank ye.

[Mission]

Post script: Thank God I stumbled across this book on Google Books about 2/3 of the way through typing this. It was very helpful in trying to discern the abbreviated Latin medicines.

What a splendid reference for what I'm doing! I'm typing in notes from Paré (and I have a lot of them) and using this wonderful book to figure out what is what when it comes to medicament. 'Aqua vitae' is a pretty common ingredient from several surgeons and I always thought it was just some sort of water. Well, it's not. It means 'Water of Life' aka. Brandy. That'll cure what ails ya!

[Mission]

I have seen reference in some of the recent books on surgery at sea to this particular story, but I didn't know it came from Wiseman. This'll make you appreciate modern medicine...

"In a Sea-fight an Irish Mariner having discharged his Gun, which was hony-combed [Why?], and loading it suddenly again, whilst he was ramming in a Cartridge, the Powder took fire, and shot the Rammer out of his hand, tearing the Palm of his hand, also some of his Thumb and Fingers. The Wound was not considerable, but the force of the Blow extinguished both sense and motion of the Member. I drest him up with our common Suppurative, (of which at such times we had great quantity ready,) and applied over all a common Restrictive, so rowled it up, there being then no time for Bleeding him. But after the Fight I let him blood, and a day or two after purged him, then fomented and embrocated the Member with ol. lumbric. cham. anethi, lilior, unguent. nervin, [oil prepared from earthworms, germander, dill, lily and salve for nerves] and such like, and did all that we Chirurgeons of the Squadron thought fitting; but without success.

One night after he was cured of his Wound, lying asleep in his Hammock, he was wakened by the wet he felt upon his Breast and Belly; and getting up to a Candle, he found the Dressing upon his Hand all bloody, as also the place whereon it lay. I being called took off his greazy Dressings, and found the Palm of his hand and fingers gnawed by Rats. They had eaten through the oiled Cloths, and had gnawed his Hand more, if he had not wakened by the trickling of his blood. [Recall that his hand was numb.] I drest his Wounds with Digestives to hasten Suppuration, supposing the discharge of Matter might contribute to his Recovery. After I had cured them, I made him a Fontanel in that Arm, and bathed the member frequently, also cupped and scarified it; and afterwards applied Plaisters of Pitch, to stir up a heat in the Members. He was a young man, and otherwise of a strong Constitution, and was not over-solicitous to have it cured, as designing to make some profit by it. To which purpose he took an opportunity of landing, and hastened away to Madrid: Where having gotten some reward for his service, he returned to the Navy, and had more use of his Arm."([Wiseman, p. 437-8)

Glossary

Cupped/Cupping - removing bad humors by making heating a small cup and placing it on the skin to form a vacuum as it cools. Over a wound, it will remove drainage/blood and bad humours

Digestive - medicine used to cause wounds to form pus

Embrocate - to moisten and rub with a liniment or lotion

Fontenel/Fontenell/Fontenelle - artificial ulcer made by incision or burning, which is maintained by the insertion of a foreign object with the goal of discharging deleterious humours

Foment - substance used as a warm, moist medicinal compress; a poultice

Plaister/Plaster - an adhesive bandage

Restrictive - a bandage used to bind wounds tightly

Scarify - Making several small incisions in an area to allow the discharge of blood and remove excess humours

Suppurative - medicine promoting the discharge of pus

[Dorian Lasseter]

A bit of pre-GAoP History today...

http://www.wired.com/science/discoveries/n.../dayintech_1114

Nov. 14, 1666: Watching a Transfusion, and Taking Notes

1666: Samuel Pepys, writing in his famous diary, records the first description of a blood transfusion.

Pepys (whose name is usually pronounced Peeps, or occasionally Peppis) was an able administrator for the Royal Navy, as well as a member of Parliament. But he is best remembered for his sprawling diary kept during the tumultuous mid-1600s, a time that saw such events as the Great Plague of London, the rise of Oliver Cromwell and the Great Fire of London in 1666. He also wrote extensively on the more mundane aspects of everyday life in Restoration England.

Pepys began writing his diary as a vanity project. According to a website dedicated to him, Pepys was proud of his achievements, and "writing down events involving him gave him great pleasure; re-reading them even more so."

His observations of the dog-to-dog transfusion were made barely four decades after English physician William Harvey declared that blood circulated through the body with the heart acting as the pump. Harvey actually rediscovered what had been discovered much earlier by Ibn al-Nafis, a 13th-century Arab physician.

Such was the ignorance of the circulatory system before Harvey that as Pope Innocent VIII lay dying in 1492, his physician suggested introducing fresh blood to the pontiff — orally. It didn't work.

The idea of replenishing or replacing blood through transfusion caught on shortly after Harvey's work became known. Physicians, notably Richard Lower, experimented widely using animals, devising instruments and studying ways to get around the problems of clotting. It was Lower who performed the first successful blood transfusion between dogs in 1665. Or partially successful: The donor dog bled to death.

Pepys observed pretty much the same thing a year later:

The experiment of transfusing the blood of one dog into another was made before the Society by Mr. King and Mr. Thomas Coxe upon a little mastiff and a spaniel with very good success, the former bleeding to death, and the latter receiving the blood of the other, and emitting so much of his own, as to make him capable of receiving that of the other.

This did give occasion to many pretty wishes, as of the blood of a Quaker to be let into an Archbishop, and such like; but, as Dr. Croone says, may, if it takes, be of mighty use to man's health, for the amending of bad blood by borrowing from a better body.

Within a year, both Lower and a French physician, Jean-Baptiste Denys, did just that, performing the first transfusions involving human subjects. In Denys' case, a 15-year-old boy received the blood of a sheep and somehow survived, probably because of the relatively little amount of blood used.

Owing to a complete absence of understanding regarding the importance of species and blood-type compatibility, subsequent human transfusions were only sporadically successful, and the benefits were dubious. Things only improved with the discovery of distinct blood types in the early 19th century.

The first successful transfusion using only human blood was performed in 1818 by British obstetrician James Blundell.

Other factors that eventually brought blood transfusion into the modern era, such as blood banking and the discovery of the Rhesus blood group system, occurred in the early to mid-20th century.

Edited November 14, 2008 by Dorian Lasseter

[Capt Thighbiter]

Mission - all cannon get honeycombed eventually. It is because black powder residue from firing is very corrosive and eats aways at metal. Even scrupulous cleaning can not get every last bit of residue out ( and I imagine life aboard shiip would prevent 'scrupulous cleaning). The corrosion is worst where the action takes place, back in the breach of the gun.

As the little pin holes get bigger and deeper, the barrel becomes less and less safe and more likely to burst. Honeycombing also holds glowing embers from the previous round and can ignite a new charge rammed home ( as it did in your story).

[Mission]

Ah! That's quite interesting. Thanks for clearing that up.

[Mission]

“But if the Wound [of the head] be with so great Contusion, that it casts off Slough, and leaves the Cranium much naked; through it be not fouled either by the Matter or Air, yet it will then be necessary to rasp it: for the Bone is naturally smooth and slippery, as if it were polished, and Flesh difficultly groweth upon it. Wherefore to hasten the Cure, you ought, by the authority of Galen and the most practical men, to rasp the Bone thin, till you see the bloud ready to come out of it: the Bone will thereby be the sooner supplied with materials for generation of Flesh.

But if your Patient will not admit of Raspatories, then you ought to keep your Dossils [plugs of lint] close to the Lips of the Wound, and make your Exfoliation [casting off their outer surfaces] from the edges, that the found part may thrust off the rotten Bone. For neither Crabs-eyes, nor any Medicine inwardly prescribed, or Wine outward applied with Lint, or other Medicaments to the middle of a Bone, will signifie any thing to the Exfoliation of it: nay, the while you are so trifling, the Matter from the edges will rot the Bone underneath, and in continuance pierce through the first Table [the outer compact layer of bone of the skull], and run down between the two [inner and outer] Tables [of bone], thereby doing much mischief, and so will put you upon the use of the Terebra [a saw for perforating the skull]. After the Bone is scraped, you may dress them with Pledgits [compresses of absorbent material, often lint] dipt in liniment. Arce hot. If it require Digestion otherwise, apply them prest out of spir. Vini [spirit of wine], either simply, or such wherein hath been infused pulv. radic. ireos, aristoloch. peucedan. &c. [powdered roots of Iris, Aristolochia & Hog’s Fennel. I think.]” (Wiseman, p. 379)

[Raphael Misson]

"What I have written here plainly, touching meane and simple glisters; I would not be mistaken, as if I did it out of ignorance or disdaine of better medicines, for I were worse then foolish if I would reject, detract or disswade from the good use of decoction of hearbes, seedes, &c. with the additions of Electuaries, Laxative Sirupes and the like which I have in daily use at home upon each just occasion: yet many of the ancient Artists of worthy

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memory, which I could rehearse, have in former ages used for glisters only water and salt with oyle, and some others have added honey, and it is manifest that new milke alone is a good comfortable glister with the yolke of an egge, and a little course sugar added.

And you may also many times save a labor of giving a glister by a suppository, which is either to be made of a long peece of Allum scraped smooth, or of a candles end, or of a peece of hard sope, or of honey and salt sodden till it bee so hard that it will breake being colde, when being yet hot may be rowled & made up of the greatnesse of a finger, & administred: of any of these, I say, you may make a suppository as long and bigge as a finger or lesse, and thrust it up into Ano, & let the party keep this medicine one houre at the least in his body (if he possibly can.) Further note this generall rule concerning Glisters, let a Glister never exceede the quantity of one wine pint, let it rather want one quarter, especially when you give it to a costive body, or a ful body, he shal be much the abler & the willingler to keep it the just time. Further beware it be not too hot nor too colde, for the guts are tender parts, so hot as pisse new made, or a very little rather warmer is the true temper. But if you perceive the Intestinum rectum or Arse-gut, to bee excoriated or inflamed, in such a case use no salt nor salt broathes, nor strong Laxatives, as Euphorbium [an acrid resin made from the milky juice of Euphorbia [spurges] - a cactus-like plant. Valued for its drastic, purgative and emetic properties], Agaricum [agaric stiptic], Hiera Pigra [or Aloe Compositum - cinnamon, mace, asarum root, saffron and Lentiac, Socotrin aloes and honey mixed], Coloquintida [pulp of bitter apple], or the like. If you find the Langanum or Arse-gut to be clung, or hard stopped with excrement, you may put a small greasie or oily clout on the end of your glister-pipe only over the holes thereof, when you put it into the body, and thrust it into the head of the pipe then draw backe a little your hand and deliver in your medicine, and if you see cause, and that it will not easily deliver, force it somewhat. Also when your medicine is all in, and that you would draw out your instrument againe, doe it quickly, and let the party turne him on his backe, and he shall keepe the medicine in the better. In cases of excoriations or inflammations of the intrailes, in Glisters use

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Deere suet {ounce}ij. for one glister, and in want thereof, Axungia ovina vel porcina, I meane sheep or swines fat, and let the decoction whereof the glister is made, be onely of branne, and without any other addition, aud give now and then such a glister, I meane once a day, for two or three daies, after you may adde thereto some small astringent medicines, as Succus Acatiæ {ounce}j. or Gales {dram}ij. or Balustians {half ounce} or Myraboland, {dram}iij. even as you see cause, for these helpe to heal the guts well.” (John Woodall, The Surgions Mate, p. 189-91)

Edited August 31, 2009 by Raphael Misson