Medicine at sea

[Misson]

Now here's something we hope you'll really like.

"It was only want of being busied in some Action that made them [the men who stayed on Captain Swan's ship while they were at Mindanao] so uneasie; therefore they consented to what [Captain] Teal proposed [mutiny, basically, leaving everyone on shore behind while those on the ship sailed away under Captain Teal], and immediately all that were aboard bound themselves by Oath to turn Captain Swan out, and to conceal this Design from those that were ashore, until the Ship was under Sail; which would have been presently, if the surgeon and his Mate had been aboard; but they were both ashore, and they thought it no Prudence to go to Sea, without a Surgeon: Therefore the next Morning they sent ashore one John Cooksworthy, to hasten off either the Surgeon or his Mate, by pretending that one of the Men in the Night broke his leg by falling in the Hold. The Surgeon told him that he intended to come aboard the next Day with the Captain [swan], and would not come before, but sent his Mate, Herman Coppinger...

But to proceed, Herman Coppinger provided to go aboard; and the next Day, being the time appointed for Captain Swan and all his men to meet aboard, I went aboard with him, neither of us distrusted what was designing by those aboard, till we came thither. then we found it was only a Trick to get the Surgeon off [the land and onto the ship]..." (Dampier, p. 253-4)

Can't you just feel the smugness rays?

[Mission]

Well, I found a period reference to leeches in Richard Wiseman's surgical manual, Severall Chirurgical Treaties.

"One of [the Scottish Army at Dunbar [1650] wounded in the chest] cought a very great proportion daily of thin Matter, of a brown colour and rank smell. None but this died under my hands; the rest after some while retiring to their homes, where (as I have often heard them say) their Leeches performed great Cures, by virtue of some Plants which they gave internally, and which with Fats they made Basalms [aromatic oily or resinous plant products thought to heal wounds or reduce pain] of. Yet I believe this man died tabid [wasted, emaciated]." (Wiseman, p. 436)

Wiseman seems to be discounting it as a folk cure, suggesting it didn't work in this case at least. So far, he has never mentioned leeching other than here, and he has mentioned bleeding and scarifying (making multiple incisions for bleeding) many times which continues to make me suspect leeches were not widely used at this time by medical practitioners.

[Rev.Sam]

Back to the notion of Cauterization, if we can?

Is this just a hollywood notion, or do you think gunpowder would be used for a quick pinch, to superheat and close?

[blackjohn]

Lurid tales that remind me of the time I had a great job reading the official history of the Medical Corps in the European Theater and making maps to go along with the text.

Never make the mistake of thinking a manure pile is good cover...

[Mission]

Back to the notion of Cauterization, if we can?

Is this just a hollywood notion, or do you think gunpowder would be used for a quick pinch, to superheat and close?

I haven't found any mention of that in the 20 odd books on period surgery and sailing I've read to date. There was a problem with having open fires shipboard (to heat actual cautery tools), particularly during battles and rough weather. So I suppose it could remotely be possible. Still, there is evidence that cauterization wasn't as widely used during the GAoP as it was before it, so the question may be mostly irrelevant anyhow. Also note that during the preceding era when cautery was more widely used, the idea that gunpowder was poisonous was very hotly debated in the surgical manuals, suggesting to me that they would most likely not even consider treating a wound with it.

However, I was just watching They Call Me Trinity and they did it there, so I can at least say it was true in spaghetti westerns.

[Mission]

Still, there is evidence that cauterization wasn't as widely used during the GAoP as it was before it, so the question may be mostly irrelevant anyhow.

Or maybe there was more than I have been led to believe so far in my reading. I thought this was interesting; these quotes are excerpted from the section on amputation in Richard Wiseman's book Of Wounds, Of Gunshot Wounds, Of Fractures and Luxations:

"At Sea they sit or lie [during amputation], I never took much notice which; nor do I remember I had ever any body to hold them; but with the help of my [surgeon's] Mates, and some one or two that belonged to the Hold, I went on with my work. At Sterling I made an Amputation on above the knee and had as little help; besides my Servants, there was only a Sea-Chirurgion assisting me. We stopt the Flux of blood by actual Cautery, and the Wound digested and cured without any ill accident." (Wiseman, p. 452)

"That done [the bone of the limb being amputated cut], you are at liberty, whether you will cauterize the Vessels by a Button-Cautery [For an example, see part # 11M on this page], or a Ligature [silk strand used to tie arteries] stop the Bleeding, or by Agglutination [adhering the wound edges together]. The use of Chalcanthum [Copper sulfate, used to chemically cauterize] I do not approve. To apply Escharoticks [mild caustics] to the ends of the Nerves and Tendons newly incised, causes great pain, weakens the Part, and makes way for Gangrene; it not being likely you can so apply them to the Artery, but that you must burn the Parts about, which are, as I said, the Nerves & c." (Wiseman, p. 452-3)

"But in the heat of Fight it will be necessary to have your actual Cautery always ready, so that will secure the bleeding Arteries in a moment, and fortifie the Part against future Putrefaction: they required after Cauterization no such strict Bandage as that thereby you need to fear interception of the Spirits. When we cauterize the Artery, we do then touch the end of the Bone, it hastening the Exfoliation [casting off necrotic bone matter]." (Wiseman, p. 453)

I wonder how he set up the fire for the button cautery? I wonder how he directed something that big only to the artery and didn't "burn the Parts about"?

[Capn Bob]

Just as a side note, as a flintknapper, I've found that a bit of cornstarch helps clot blood very fast. This is a useful little bit of knowledge, since, as a flintknapper, I regularly bleed for my art. Bandaids are standard in any knapper's toolkit.

[Jony Winter]

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

That's interesting. I also know that bee propolis (the stuff they use to build their hives) is also used

for medical purposis. Bee products are quite wonderful. I personally take bee pollen as a

diet suppliment (although it seems like it is getting harder to find locally).

[Mission]

"A Commander at Sea, valiantly fighting in the midst of the Enemie's Fleet, had his Leg fractured by the fall of his Mizzen top-mast, it breaking his Leg transverse near the Ancle, the edge of the Bone thrusting out through the Skin. He not suffering the Bone then presently to be set while it was warm, afterwards, when it was swelled and stiff, it did not yield to Extension [restoration to it's normal position usually by pulling], but became painful and inflamed. After some few days he was brought to London, and I was sent to him. He was of an ill Habit of body, subject to the Gout and Dystenterie; and the Fracture being accompanied with great Defluxion [a great deal of discharge from inflammation] was not in a condition to admit of Extension. Therefore, according to Fallopius [Gabriel Fallopio (1523-62) anatomist and surgeon] and Hippocrates, before cited by me in the Treatise, I proposed to his Chirurgeon to proceed by Lenients [soothing medicines], to mitigate Pain, Inflammation&c. and by Bandage to hinder Defluxion. Which we did; and his Chirurgeon continued that method a few days, by which the Accidents were remitted.

When we met again, finding the Patient in ease, we took off the Dressings, and agreed to make Extension, and reduce the Fracture. The Patient was of a dry tough Body [humourally speaking, probably Choleric], and the Member yielded difficultly to the Stretch: upon which consideration we satisfied our selves with a moderate Extension, doubting that upon a more forcible one ill Accidents might follow, (as an Inflammation presently did.) We drest it up as a compound Fracture: and after some days dressing a Callus thrust forth, and united the Bones. That Callus being confirmed and dried, we hasten'd the Exfoliation [casting off outer surfaces, in the form of putrid ‘leaves’ on scales] of the foul Bone by a little Ægyptiacum [detergent ointment said to be of Egyptian origin, containing verdigris (copper acetates), honey and vinegar] and pulv. myrrhæ [resinous gum Myrhh, used as a tincture] dissolved in spir. vini [spirit of wine], applied hot upon an armed Probe. Thus the Bone was exfoliated, and the Ulcer cured by the ordinary Intentions in such cases. Yet the inward leaning of the Bone continued a weakness in the Member a long time, as is usual where the Fracture hath not been timely or well reduced. To remedy this, I caused a Bar of Steel to be fixed in his Shoe with joints, and by a Bracer of Cloath to be laced on, or tied with Ribbons on the outside of the Leg; by which it was marvellously strengthened." (Wiseman, p. 475)

This next is another case, no less interesting.

"...taking off the Dressings [of a broken shin], we saw the Bone distorted, the lower Stitches broken, and the Wound of an ill aspect, as it were tending to Mortification; also the Bone thrust out so far, that there was no hopes of its being any more reduced by a new Extension. Upon which consideration we resolved to saw off the end of it: and to that purpose having prepared all things ready, we cut out the remaining Stitches, and turned the Foot on one Side towards the Small of the leg, thrusting the Bone more out; the one sawing the end off, while the other with a Spatula defended the Tendonous flesh underneath from being wounded by the Saw [That's gotta hurt!]. That done we cleansed the Wound from the Saw-dust, as also from the Shivers of little Bones which we had not discovered in our first dressing, they laying pricking the Periofleum [a membrane that conveys blood to the bones], between the fractured Bones and Membranes, by which those sad Accidents had been hastened. The Wound thus cleansed, we turned the Foot right into its natural place, there being no need of Extension: which being done, we scarified [made several small cuts to] the Lips of the Wound, and washt them cum spir, vini [with spirit of wine], with a little Ægyptiac, dissolved in it, and applied to the ends of the Bones Pledgits [compresses of absorbent material, often lint] dipt in the same, and prest out. We also drest the rest of the Wound cum unguent basilic [unguent of basil], with a little ol. terebinth [turpentine - used as an antiseptic and to create the formation of pus in wounds], warm, and applied a Mixture of an Emplastrum Paracels, [A plaster soaked in mixture of turpentine, honey and egg yolk - named for the physician Paracelsus], and diachalcit. [oil, litharge and vitriol used as a astringent and detergent] over the Wound and Parts about, and then a Compress and Bandage over that, as in Compound Fractures.

The great work was now, how to support the Foot, and keep it even with the rest of the Leg, there being so great a distance between them without any Bone. But we having placed the Leg upon a quilted Pillow, laid him again in his Bed, and fitted it with a Wainscot-case [frame of superior, foreign, oak timber], where it was kept steady and equal, and lay conveniently for our daily dressing him. This done, we committed him to the care of his Friends to keep him there quiet, and ordered him cordial Juleps [sweetened alcoholic drinks] &c. After some hours we let him blood again. From this time his Pains lessened, and his Fever and other ill Symptoms went off as the wood digested." (Wiseman, p. 476-7)

[Mission]

I have done considerable research on medical practices of this period. I have found out that as far as to cauterize wounds goes only the most unskilled and uneducated would have used this as a method of stopping the flow of blood. In 1545 Pare' published his magnum opus on surgery which clearly stated that to cauterize was counter productive in that it cause excessive pain, retarded healing and caused what could be called collateral damage to surrounding tissue.

Indeed. Here is an excerpt from Paré's account (he actually talks a great deal about this in his book, refuting another book that had been printed at the time):

“Now I had read in John de Vigo that wounds made by Gunshot were venenate or poisoned, and that by reason of the Gunpouder; Wherefore for their cure, it was expedient to burne or cauterize them with oyle of Elders [made by boiling Elder flowers with olive oil] scalding hot, with a little Treacle (Footnote 2: i.e. theriacs, or antidotes to poison) mixed therewith. But for that I gave no no great credite neither to the author, nor remedy, because I knew that causitckes could not be powred into wounds, without excessive paine… I observed and saw that all of [the army surgeons he worked with] used that method of dressing which Vigo prescribes; and that they filled as full

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as they could the wounds made by Gunshot with Tents [rolls of absorbent material, often medicated to keep a wound open] and pledgets [compresses of absorbent material, often lint] dipped in this scalding Oyle, at the first dressings; which encouraged me to doe the like to those, who came to be dressed of me. It chanced on a time, that by reason of the multitude that were hurt, I wanted [because he ran out of] this Oyle. Now because there were some few left to be dressed, I was forced, that I might seeme to want nothing, and that I might not leave them undrest, to apply a digestive [substance to promote healthy pus formation] made of the yolke of an egge, oyle of Roses, and Tupentine. I could not sleepe all that night, for I was troubled in minde, and the dressing of the precedent day, (which I judged unfit) troubled my thoughts; and I feared that the next day I should finde them dead, or at the point of death by the pyson of the wound, whom I had not dressed with the scalding oyle. Therefore I rose early in the morning, I visited my patients and beyound expectation, I found such as I had dressed with a digestive onely, free from vehemencie of paine to have a good rest, and that their wounds were not inflamed, nor tumifyed [swollen]; but on the contrary the others that were burnt with the scalding oyle were feaverish, tormented with much paine, and the parts about their wounds were swolne. When I had many times tryed this in divers others, I thought thus much, that neither I nor any other should ever cauterize any wounded with Gun-shot.” (Paré, p. 137-8)

[Mission]

Here's something I'm certain you'll all enjoy. I'm planning to do an example of this one at PiP next year. Anyone want to volunteer to be the patient?

http://www.markck.com/pages/Piracy/Surgeon_Pgs/Proced_Trepanning.htm

Thus much of the Glyster Sirring.” (Woodall, p. 18-20)

[Mission]

I thought this was pretty interesting:

"“For every body that is blasted, or strken with lighning, doth cast forth or breathe out an unholsome, stinking or sulphureous smell, so that the birdes or fowles of the ayre, nor dogges will not once touch it, much lesse prey or feede on it: the part that was sticken often times sound, and without any wound, but if you search it well, you shall finde the bones under the skinne to be bruised, broken or shivered in peeces.

But if the lightening hath pierced into the body, which making a wound therein (according to the judgement of Pliny) the wounded part is farre colder than all the rest of the body. For lightning driveth the most thinne and fiery ayre before it, and striketh it into the body with great violence, by the force whereof the heate that was in the part is soone dispersed, wasted and consumed. Lightening doth alwayes leave some impression or signe of some fire either by ustion [burning] or blacknesse: for no lightning is without fire.

Moreover whereas all other living creatures when they are striken with lightening fall on the contrary side, onely man falleth on the affected side, if hee be not turned with violence toward the coast or region from whence the lightening came.

If a man bee striken with lightening while he is asleepe, hee will be found with eyes open; contrarywise, if hee be striken while hee is awake, his eyes will be closed (as Plinie writeth.) Philip Commines writeth that those bodyes that are stricken with lightning are not subject to corruption as others are.” (Paré, p. 208)

[Mission]

Oh, boy! I was doing a training today at Michigan State University and they have a public land grant. Long story short, they have to let the public have at their electronic database collection. They have access to both the Early English Books Online and Gale Eighteenth Century Collections Online. I am filling up my 8g memory stick with some great stuff.

The Experienced Chirurgion by John Moyle, De recta sanguinis missione by John White, Thomas Sydenham's complete works, John Atkins' The navy surgeon, Thomas Bonham's The chyrugians closet, R. Butler's An Essay on Blood-Letting and that's only about half of it. It's like striking the mother load. I may never start writing at this rate...

[Mission]

LadyBrower asked me to recommend books on period surgery and, naturally, the answer is my book, when it comes out in, say, 2017. Failing that, I thought I'd list some the books that I've found most interesting and informative.

#1 John Woodall's The surgions mate - The holy grail of ship's surgeon books (although it is hard to read because of the spelling and language as well as being hard to get). Contains a great deal of detail once you puzzle it out, although much of it is on medicines, which I do not find audiences appreciate as much as info on surgeries and surgical tools. But it may just be me.

#2 John Moyle's Chirurgus Marinus: or, the Sea-Chuirurgion - Perhaps not quite as thorough (or confusing) as Woodall, but much easier to read and comprehend and with most of the info you would want anyhow.

#3 John Kirkup's The Evolution of Surgical Instruments; An Illustrated History from Ancient Time to the Twentieth Century - outstanding book on antique tools of the medical trade.

#4 John Keevil's Medicine and the Navy 1200-1900: Volume II – 1640-1714 - an excellent review of the history of sea surgery and sea surgeons from the annals of the English Navy

There are literally dozens more like those, but those are the best I've read so far.

For contemporary books (which are easier to both find and read):

#5 Zachary B. Friedenberg's Medicine Under Sail - good overall description of sea surgery, although it goes past the GAoP. Best of the modern books on sea surgery IMHO.

#6 Emily Cockayne's Hubbub: Filth, Noise, and Stench in England, 1600-1770 - a wonderfully evocative modern book that will give you new insight in to just how horrible conditions were during period.

#7 Guy Williams' The Age of Agony - another wonderfully shocking modern book about period procedures.

Again, there are many more, but that is probably way more than most re-enactors will ever want to read. You can also search the posts in the medicine threads here in Twill which will give you a bunch more references if you're dedicated to finding period surgical stuff. Among the better ones:

Ships surgeons; Some Period Surgical Procedures; Some of the Surgeon's Tools; On Making a Medicine Chest; Plagues, Viruses and Diseases; Let's talk dental hygiene; The "barber" in Barber-Surgeon; Medicine in General; Surgical Instruments, Procedures and Whatnot.

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Be forewarned that several of the books in the first part of the list are hard to find, expensive and/or hard to read. Even recent reproductions of period references (there have been several within the past 50 years or so) are quite expensive - often costing a hundred dollars or more.

If you really want period references, the most affordable way to go is through a university library's database subscriptions to obtain pdf copies. You need a library that has access to the database "Early English Books Online" to get Woodall. If they have access to the the database "English Short Title Catalog" you will find a ton of terrific resources there as well. University libraries often have a guest researcher computer or public access computers which you can use. I recommend calling ahead to see if they have the databases and if there's a way for you to get on their system. (Reference librarians are often invaluable in helping you with these sorts of things.) Also, be sure to bring a memory stick so's you can copy the resources you want. Note that I've found that most small private colleges and community colleges do not have access to this database. So consider starting with the large universities near you and always call before going.

Also, for general info on a period sailor's life (including medical bits and pieces as observed at the time), I suggest the thread A sailors normal day? which contains several excellent references.

[LadyBrower]

Thank you very much!! I will go on the hunt... =)

[Mission]

Here's a nice descriptive one:

“In our Sea-fights oftentimes a Buttock, the Brawn of the Thigh, the Calf of the Leg, are torn off by Chain-shot and Splinters. All these are contused Wounds, and look black, and do often deceive the unexperienced Chirurgeon, he taking them by their aspect to be gangrened, and by dressing them as Mortifications with Ægyptiac. and spir. vini, doth certainly sphacelate them; and those persons die miserably afflicted.

Whereas if they be considered rightly, though they look like Flesh long hang’d in the Air, of a dry blackish colour, yet they have warmth, and by Lenients, as is prescribed in Simple Gun-shot Wounds, they would digest, separate their Sloughs, and incarn. But they are slow in Digestion, and require good Fomentations and Embrocations to cherish the native heat, which is much weakened by so great a loss of Substance. These require oleum terebinth. to be mixt with your Digestive: But you must have a care you do not inflame them and cause pain by adding too much of it: A Spoonful to six ounces of your Suppuratives is enough in the drest Habits. Your judgment will best direct you, and your Patient’s complaint: It being unreasonable to hope that Wounds can digest, while they are accompanied with much Pain.” (Wiseman, p. 428)

Glossary

Ægyptiac. - an oil-free mixture of copper acetate (verdigris), vinegar, and honey

Digest - healthy pus formation in a wound

Embrocate - To moisten and rub with liniment or lotion

Incarn - form tissue inside the wound

Lenients - soothing medications or applications

Oleum terebinth. - oil of turpentine - used as an antiseptic and to create the formation of pus in wounds

Slough - dead outer skin

Sphacelate - moritify or complete death of a part

Spir. vini - rectified spirit distilled from wine

Suppurate - to form and/or discharge pus

[Raphael Misson]

And now for some thoughts on bloodletting from the ancient master of venesection himself, Galen. (From the book Galen on Bloodletting by Peter Brain)

“Parts in the region of the throat and trachea which are much inflamed are greatly benefited at the beginning by venesection [opening a vein] at the elbow, but after the beginning by letting blood from the tongue; both the veins in it are cut. So too cutting the vein alongside the greater canthus [the place where the upper and lower eyelids meet] is good for the crusts on the eyes that remain after inflammations. Similarly when a vein in the forehead is cut, heaviness of the head and pains that have become chronic as a result of the plethos [an excess of blood] are usually noticeably relieved; but when they are starting, or are at their height, revulsion [diversion of blood from an affected part to a distant one] at the neck by means of a cupping glass relieves them, sometimes by itself, sometimes when used in combination with scarifications [making multiple small cuts to let blood from the skin]. The whole body should be evacuated in advance. In the same way pains in the back of the head, whether incipient or already established, are relieved by cutting the vein in the forehead. When fluxions [flows of humours] are beginning, one should preferably effect revulsion in combination with evacuation; but when, for instance, inflammatory conditions have gone on to induration [hardness], evacuate through the affected parts, or adjacent ones." (Brain, p. 94)

Edited July 26, 2009 by Raphael Misson

[Calico Jack]

Ah, Venesection. It has certainly led to some "colourful" engravings across the continent, such as those in Hans von Gersdorff's Feldtbüch der Wundartzney (printed in Strassburg, by H. Schotten, in 1528). A quick free look can be found at http://longstreet.typepad.com/thesciencebookstore/2008/04/maps-of-the-hum.html 'though a look through google can find many venesection diagrams in *.pdf format, suitable for reproduction to have laying around near your surgery.... [grins]

[Mission]

(Note: This is pretty tame for those of you who are weak of stomach. Chances are you've already stopped looking when I post to this thread, so I'm probably talking to no one here, but there you are. Where ever you are.)

Someone asked me about how fractures were handled during period and my basic response was 'pretty much like they are today. (Without casts which hadn't been invented yet and with humors, which is obviously out of date.)'

I've been reading a new old (very old) source and I thought he put it all together nicely. In fact, this is one of the better surgical treatises I've come across. So here's a long answer about treating fractures just for the joy of typing on my part. This happens to be the instructions for treating a broken arm, but to paraphrase the author, the arm is pretty representative of other limbs.

There is no necessity for much study, then, in order to set a broken arm, and in a word, any ordinary physician can perform it; but I am under the necessity of giving the longer directions on this subject because I know physicians who have the reputation of being skilled in giving the proper positions to the arm in binding it up, while in reality they are only showing their ignorance...

5. And these are the signs that the patient has been well treated and properly bandaged: if you ask him if the arm feels tight, and he says it does, but moderately so, and especially about the fracture; and this reply he should make all along, if the bandage be properly applied. And these are the symptoms of the bandaging being moderately tight; if for the first day and night he fancies that the tightness does not diminish, bur rather increases; and if on the next day there be soft swelling in the hand, for this is a sign of moderate compression, but at the end of the second day the compression should feel less, and on the third day the bandaging should appear loose. And if any of these symptoms be wanting, you may conclude that the bandaging is slacker than it should be; or if any of these symptoms be in excess, you may infer that the compression is more than moderate; and judging from these, you will apply the next bandages either slacker or tighter. Having removed the bandages on the third day, you must make extension [straighten the part] and adjust the fracture, and bind it up again; and if the first bandaging was moderately applied, the second bandaging should be made somewhat tighter. The heads of the bandages should be placed on the fractures as in the former case; for, by so doing, the humors will be forced from it to the seat of the fracture; it

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is of much importance that this should be properly understood. Thus than bandaging and compression should always commence at the seat of the fracture, and everything else should be conducted on the same principle, so that the farther you proceed from the fracture, the compression should always be the less. the bandages should never be actually loose, but should be smoothly put on.

...

6. When the third day arrives, that is to say, the seventh from the first dressing, if properly done, the swelling in the hand should be not very great; and the part which had been bandaged should be found more slender and less swelled at each time, and on the seventh day the swelling should be quite gone, and the broken bones should be more readily moved, and admit of being easily adjusted. And if these things be so, you should, after setting the fracture, apply the bandages so as to suit the splints, and a little more tight than formerly, unless there be more pain from the swelling in the hand. When you have applied the bandages, you must adjust the splints all around the limb, and secure them with strings [possibly linen strips - this is not clear to the person who interpreted this text from the original language] so loose as just to keep them in their place, without the application of the splints contributing at all to the compression of the arm. After this the pain and recovery should proceed as in the preceding periods of bandaging. But if, on the third day, the patient say that the bandaging is loose, you must then fasten the splints, especially at the fracture, but also elsewhere, whereever the bandaging is rather loose than tight. The splint should be thickest where the fracture protrudes, but it should not be much more so than elsewhere.

...

The splints should be adjusted anew every third day, in a very gentle manner, always keeping in mind that the object of the splints is to maintain the lower bandages in their place, and that they are not needed in order to contribute to compression.

7. If then, you see that the bones are properly adjusted by the first dressings, and that there is no troublesome pruritus [itching - those of you who have had casts may appreciate that one] in the part, nor any reason to suspect ulceration, you may allow the arm to remain bandaged in the splints until after the lapse of more than twenty days. The bones of the fore-arm generally get consolidated in thirty days altogether; but there is nothing precise in this matter, for one constitution differs from another.

...

And if, while the arm is bound up in the splints, you should at any time suspect that the bones do not lie properly, or if anything about the bandages annoys the patient, you should loose them at the middle of the time, or a little earlier and apply them again.

...

And in this simple plan of treatment it is necessary to attend also to the following directions, which some physicians pay little attention to, although, when improperly executed, they are capable of marring the whole process of bandaging: for if both the bones [of the arm] be broken, or the

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lower one only, and the patient who has got his arm bandaged keep it slung in a shawl, and that the shawl is particularly loose at the fracture, so that the arm is not properly suspended at this end or that, in this case the bone must necessarily be found to be distorted upwards; whereas, when both bones are thus broken, if the arm recline in the shawl at the wrist and elbow, but the rest of it be not kept up, the bone in this case will be distorted to the lower side. The greater part of the arm and wrist of the hand should therefore be equally suspended in a broad soft shawl." (Hippocrates, Of Fractures, Hippocratic Writings, Translated by Francis Adams, p. 76-8)

"19. The suspending of a fractured limb in a sling, the disposition of it, and the bandaging, all have for their object to preserve it in position...

20. It should be kept in mind that exercise strengthens, and inactivity wastes." (Hippocrates, On the Surgery, Hippocratic Writings, Translated by Francis Adams, p. 73)

Note: The books attributed to Hippocratic Corpus are estimated to have been written in the 4th century BC and compiled in the 3rd century BC...so not a lot has really changed over the millennia.

[Mission]

Some more from Hippocrates on treating a fractured arm that I thought was interesting.

You may be wondering why I am quoting Hippocrates, but many of the period surgical manuals do not describe certain treatments in great detail because the "ancient" authors had already done so. The GAoP was in the beginning/middle of the transition away from the "ancient" authors, but the elimination of things like bleeding were still more than a century away

Curiously, Hippocratic writings only recommended bleeding in a couple of cases - it appears to have been Galen who, many centuries later, expanded the role of bleeding in medicine. So some of the detailed explanations of treatment that might have been used during period were actually what Hippocrates and Galen recommended. Albucasis was another ancient author they seem to have liked, although I haven't read his works yet. (He's on the list.) I do know he was not a big fan of the "ancient authors" (Galen and Hippocrates among them) and apparently recommended other treatments. However, the period authors cheerfully embrace and call upon treatments mentioned by all three of these authors. Wiseman and Woodall occasionally quote them verbatim.

Naturally, the GAoP period medical authors were not totally unified on treatment methods. If fact, they sometimes argue with each other in their books - as do Hippocrates and, more particularly, Galen. Still, if you read the previous post and this one, you probably already sense that we still use some of the methods Hippocrates recommended today. Maybe that's why he's considered the father of medicine.

Anyhow, here is Hippocrates talking more about treatment of fractures:

“The following, then, is the most natural plan of setting the arm: having got a piece of wood a cubit of somewhat less in length, like the handles of spades, suspend it by means of a chain fastened to its extremities at both ends; and having seated the man on some high object, the arm is to be brought over, so that the armpit may rest on the piece of wood and the man can scarcely touch the seat, being almost suspended; then having brought another seat, and placed one or more feather pillows under the arm, so as to keep it a moderate height while it is bent at the right angle, the best plan it to put round the arm a broad and soft skin, or broad shawl, and to hang some great weight to it, so as to produce moderate extension; or otherwise, while the arm is in the position I have described, a strong man is to take hold of it at the elbow and pull it downward. But the physician standing erect, must perform the proper manipulation, having the one foot on some pretty high object, and adjusting the bone with the palms of his hands; and it will readily be adjusted, for the extension is good if properly applied.” (Hippocrates, Of Fractures, p. 78)

“The bone of the arm is generally consolidated in forty days. When these are past, the dressing is to be removed, and fewer and slacker bandages applied instead of it. The patient is to be kept on a stricter diet, and for a longer space of time than in the former case; and we must form our judgment of it from the swelling in the hand, looking also to the strength of the patient. This also should be known, that the arm is naturally inclined outward; to the side, therefore, the distortion usually takes place, if not properly treated; but indeed, all the other bones are usually distorted during treatment for fracture to that side to which they naturally incline. When, therefore, anything of this kind is suspected, the arm is to be encircled in a broad shawl, which is to be carried round the breast, and when the patient goes to rest, a compress of many folds, or some such thing, is to be folded and placed between the elbow and the side, for thus the bending of the bone will be rectified, but care must be taken lest it be inclined to much inwards.” (Hippocrates, Of Fractures, p. 78)

[Mission]

Ah, some nice imagery in this one:

“A portion of bone which protrudes should be sawn off for the following reasons: if it cannot be reduced, and if it appears that only a small piece is required in order that it may get back into its place; and if it occasions inconvenience and irritates any part of the flesh, and prevents the limb from being properly laid, and if, moreover, it be denuded of flesh, such a piece of bone should be taken off. With regard to the others, it is not of much consequence whether they be sawed off or not. For it should be known for certain, that such bones as are completely deprived of flesh, and have become dried, all separate completely. Those which are about to exfoliate should not be sawn off. Those that will separate completely must be judged of from the symptoms that have been laid down.” (Hippocrates, Of Fractures, p. 88)

[Mission]

Hmm. Now I seem to need a Depulsor and a Uvula-spoon...

"CHAP. XLIV

Of extraneous things got into the Throat.

If a Fish bone, or Pin, or the like small and sharp thing, be by accident got sticking in the Throat, (as often happens) you are with your Forceps to extract it.

But if it be a large bone or gristle, you are to thrust it down into the Stomach with your Depulsor; some have them of Silver, others of Steel, with

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a Button at the end, but that made of Whale-bone, smaller at one end than at the other, with a Spunge Buttom fastened to the smaller end, is best of all, for it bends as the Throat requires.

'Tis to be dip in Wine or Beer, and so put into the upper mouth of the Oesophagus, and and the bone thrust down with it.

By this means my self hath saved several that have been well near suffocated." (Moyle, John, Chirurgus Marinus: or, the Sea-Chuirurgion, p. 239-40)

"CHAP. XLV

Of violent Bleeding at Nose.

If the Nose happen to Bleed violently, it is from the thinness and sharpness of the Blood, and Erosion of the small Veins within the Os Cribrosum.

Many ways have been used to stop the Nose bleeding, and that which has stopt one has failed in another.

Some apply Cloths dipt in Acetum to the Privities [!], others put pieces of cold Iron to the Neck; some again

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make Ligature about the Joints [ligatures are pieces of fabric tied around a part to restrict flow], and others apply dorcels [dossil] of Cotten, dipt in restringent powder, into the Nostrils, with several other ways.

But the best way is to let blood immediately, and that in the inferior part, (if possible) as the Leg or Foot, for that surely makes revulsion [diversion of blood from an affected part to a distant one].

In the next place take Pulvis Troch. de terra Lemnia, (or powder of Vitriol Rom, which is just as good) and blow it up the Nostrils forcibly with your Uvula-spoon, and a little Dorcel or Lint sprinkled with the same, put lightly up the Nostrils.

But I have known, when all means has failed, that a quick Purge has done the Cure.

As that of Extract Rudii {scruple}ij. given in the time of bleeding, and excited to work as soon as possible, (but have a care you give nothing that may cause Vomiting.)

These things being done and over, you may give Laudinum gr. [grain?] iij. and expose the Patient to rest; or else Syr de moconio {ounce}j. in Aq. Papav. Comp. {ounce}iij. f. Haust. this composes and quiets the petulancy of the blood wonderfully." (Moyle, p. 240-1)

[Mission]

Amputation, from John Moyle's Chirurgus Marinis: or The Sea-Chirurgeon. He follows this with how the cure proceeds, which I have not typed in quite yet. Maybe I'll add it here.

“Now when part of a Limb is carried away, or the Bones so shattered that there is not hopes of saving the Mans life if it should be left on: This indicates Amputation, and there is no delaying of it.

Howbeit if you think it possible to be healed, it will redound more to

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your Credit to save it on then to take it off: ‘Tis true indeed, he is a good Surgeon that can take off a Limb dexterously; but he is a better that can save it one and heal it.

Now in Order to save this Mans Life, two main intentions immediately Offer.

To stop the Efflux of Blood, (for the Blood is the Life) and except that be stopt; the Man will immediately dye. And the other is to Amputate the Limb; for if that be left on, it will Gangreen, and Death will insue in a little time.

You are immediately to set this Man down on your Chest with the Limb you intend to Amputate along the Chest, (if it be the Leg) and the Part that is to be taken off over the end of the Chest. Let on e man be at the Patients back holding him, and another before him holding the upper part of the Limb; and a Third holding that Part that must be taken off.

This (with the Stockin ript off) must all be done in a moment, because the Man bleeds much.

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Then you are to make strong Ligature [something used to tie around a part to restrict flow] with broad Tape, three or four turns about the Limb, about three inches above the Place you intend to incise, (which if it be the Leg is usually about 4 inches below the Knee) if the Wound will permit; and whilst this is doing let him that has the Gripe [grip] haul up the Muscles tort [taught]; and then if it be the Leg, or the Cubit of the Arm that is wounded, you may make a second Ligature above the Joynt of the Knee or Elbow, which will restrain the Bleeding after you have let the other go. But when the wound is in the Thigh, or upper part of the Arm then this cannot be done, but you must be satisfied with one strong Ligation.

This done, (and the Man having had a Spoonful of Cordial to cherish him) you must with your dismembering Knife, take two large Slashes round the Part in the form of half rounds, and let one meet the other, as evenly as possible, and let them be deep enough.

Then with your Catling, divide the Flesh and Vessels about and between the Bones, and with the back of your

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Catling, remove the Periostrum [A tough membrane which covers a bone and is firmly attached to it] that it may not hinder the Saw, nor cause greater Torment in the Operation.

So Saw off the Bone at as few strokes as possible, and let him that holds the lower Part have a Care to hold steady least he break the Bone before the Saw is quite through.

When it is off, apply to the end of the Bone only a thick Pledgit of dry Tow [compress of absorbent linen], (or if the Pledgit were sprinkled with powder of Mirrh it were better). Sometimes I have taken the Cross stitch here, but oftener have done as well without it.

Then take your Buttons [linen tow made in the form of a large button], wet them in Acetum [vinegar]; (or aq. Stipica as in the Catalogue at No. 3 [#3 in Moyle’s recipes - I am not reprinting it here]) which is better) and arm them with your Restrictiva Maxima, as at No. 1. (some use the dry Pulv. Restring. Major. alone) apply these to the extremities of the great Vessels, and on them a Dismembring Pledgit, wet in the Acetum, and armed with the same Restrictive.

Let this Pledgit be just the breadth of the Stump; and let an Assistant hold

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it fast to, with the breadth of his hand.

Then let another Pledgit about an Inch broader than the former be well armed as the other, and apply it, but not the edges closed to as yet.

On this Apply a strong Cross Bolster as hard as possible and close the edges of the large Pledgit. And do you wish a single Rowler [bandage – strip of linen or other material] take four or five tort turns about the Part, and over the place where the Ligature was, so that the lower part of the Rowler may be even with the edge of the Stum.

Now some strip on a wet Bladder upon this, to save the upper Rowlers

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clean; but I have done the work as well without that.

But you must observe here, where Blood appears, and apply dry Buttons to such places, and so bring on another Bolster [pad]; and then with your double Head-rowler to make good Bandage, letting go your second Ligature (if you have one.)

This done lay the man so to pass as that his Stump may be as high (if not higher) than his Body, with a Pillow under it.

And let him be laid as far to the further part of your Platform as possible that some there may be room for others. For in some Fights I have had my Platform so full, as that I have not well known how to dispose of more.” (Moyle, p. 50-5)

[Mission]

“And let Enemas be injected when there is need, and open a Vein often, although a little at a time, to correct the blood, and keep off a Fever.” (Moyle, p. 84)

Well, that about covers it. I don't know why you guys think you need a surgeon.

[Mission]

See, here you could just get the carpenter:

“Sometimes a Finger, or a Toe, happens to be quasht to peeces, bone and all, so that there is no healing of it, but it must be taken off; or it will quickly Gangreen. In this Case (or if it be already Gangrened) you must place it even on the side of a Table, or some other board, and with your Exterpating Chizel and Mallet take it off at one stroke, and then Cure it as the Amputated Wound.” (Moyle, p. 95)

(In fact, the carpenter occasionally served in the role of the surgeon when there wasn't one aboard.)