Medicine at sea

[Daniel]

The part on amputation is excellent, Mission. My new novel has an amputation scene, which I can now rewrite much more realistically with the help of that extract from Moyle. I blush to admit that I had assumed that the saw was used to cut the flesh as well as the bone.

What was the difference between the dismembering knife and the catling? When I look up "catling" on line it says it's a double edged knife used for amputation, but the reference to using the back of the catling to remove the periostrum suggests a single-edged blade.

I see there is no reference to searing the wound (thank goodness! A physician friend of mine says that searing is deleterious), nor to changing the dressing. Do you know anything about that?

[Mission]

Well, you can thank Moyle for the description; I just copied it. (It was one of the better ones I've seen, though. This is why I am sometimes puzzled by the fascination with John Woodall as the leading light in describing period sea surgery. He was the first, but Moyle makes things so much more plain and clear.)

The impression I have is that cauterization was not widely used with amputation. I don't believe any period amputation description I've read recommends cauterization as the primary treatment. Most authors seem to wince in their prose when they even have to bring it up. However, one must always keep in mind that books were written by the cream of the surgical crop (usually surgeons to the king it seems to me) and there were literally hundreds of times more surgeons out there practicing than writing. So you could probably have found someone or other who believed in cauterization as part of the treatment. It would most likely have been used for stopping uncontrolled arterial bleeding, even though they new about using ligatures.

Somewhere I read that someone thought the fastest treatment was to dip the amputated limb in hot tar. I have NEVER found anything close to substantiation for this though. It actually sounds like a quick and dirty solution that a carpenter came up with. When there was no surgeon and someone was wounded at sea, someone had to fill in. The captain or the carpenter were the second and third choices. The captain because he might keep a surgical book in his collection and the carpenter because he had tools that could be used in a pinch. But this is pure conjecture on my part.

The primary knife used to make the first cut is usually called a Capital or Amputation knife. Woodall refers to it as a dismembering knife. The Catlin (or "interosseous knife"; Woodall calls it a 'catlinge' or 'catling' as the mood strikes him) is a straight, two sided knife used to cut the materials between the tibia and the fibia when amputating a leg and between the radius and ulna when amputating an arm. As for tool names, I wouldn't get too hung up on them; different authors sometimes called the same things by different names. Too bad you can't see my kit or I'd show you the differences and you could just describe them. Pictures aren't quite as good, but for reference:

Amputation/Capital Knife

Catlin

(Note: this is a 19th c. Catlin, but they hadn't changed a great deal from the 17th/18th c. The handle would not have been made of ebony like this one - probably wood or ivory or some other material.)

[Daniel]

Yay, pictures! Exactly what I was hoping for. Thank you very much, Mission.

Am I correct in thinking that that amputation knife is sharpened only on the concave side?

Also, I forgot to ask before: Moyle mentions using "broad Tape" to make a ligature before amputating. Would this tape have been made from linen? It wouldn't have been sticky, would it?

[Mission]

Yes, the amputation knife is sharp on the inside - it makes good sense when you think about the shape of an arm and a leg. :)

I am not yet sure what they mean when they refer to tape. In fact, I have been most curious about this. I suspect it is just a piece of broad, flat cloth. It is basically being used as a tourniquet as he describes it. Hm. While looking for more info, I found a reference to cautery in amputation in Richard Wiseman's book, so I have to take back that previous comment. (I'm afraid I've forgotten more than I remember at this point.)

"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 [Actual Cautery is using heated steel instruments to cauterize; potential cautery is using chemicals to cauterize], and the Wound digested and cured without any ill accident. Yet where we have convenience to proceed more formally, we always place the Patient to our most advantage, where he may be held firm, and in a clear light, and so that our Assitents may come better about us. The Member is to be supported by some one, whilst another standeth behind the Patient, and draweth up the Skin and Musculous flesh. Then make your Ligature two fingers breadth or thereabout in the sound Part; so that if you amputate in case of Mortification, you may be sure to quit your self of it. This Ligature is omitted by many of our Chirurgeons here in the City, they only making a turn with a Tape, pinning it on as a marker to circumcide by: And in stead of the Ligature I propose, they make a Gripe [grip], which Gripe is commonly made by some assistent who hath strength to do it. Indeed this is good, where a shattered Member is to be cut off, to smooth the Stump; in which case there is no great fear of Bleeding. But in Amputations it seems to me to be very inconvenient: For I never yet saw any man so gripe, but that still the Artery bled with a greater force than was allowable; yea, when Mr Woodall griped, who was so applauded, and in truth made for the work. It being so, in what a huddle is the stump then dressed? But suppose the uneasie posture and the long griping tires the Griper, or that his Hand be crampt the while, what condition is the Patient then in? Whereas by this ancient way of Ligature the Vessels are secured from Bleeding, the Member benumbed, and the Flesh held steady, ready to receive the impression of your crooked Knife [Capital or Amputation Knife], (or Razour, which I have often amputated with.) This Ligature made, the Assistent strengthens it, whilst he draw up the Musculous flesh. In the mean time the Operatour, with a sharp crooked Knife, by a turn with his hand cuts the Flesh off round to the Bone; then with the back of it he scrapes the Periosteum from the Bone; if there be two Bones, then with a dividing Knife [or Catlin] he separates the fleshy Membrane from them. The Bones freed of the Periosteum, Guide proposes a linen Cloath, and Hildanus a kind of Purse, to be brought over the upper divided Flesh, to pull it upward, and make more way for the Saw. But I think that needless. The Flesh divided, the Parts separate enough of themselves, besides the Assistent’s pulling up of the musculous Flesh and Skin is sufficient. That done [the bone of the limb being amputated cut], you are at liberty, whether you will cauterize the Vessels by a Button-Cautery, or a Ligature [fabric strand used to tie arteries] stop the Bleeding, or

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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." (Richard Wiseman, Severall Chirurgical Treaties, p. 452-3)

[Mission]

I'm reading Albucasis, who is actually a 10th c. Arabic physician who is cited by several of the period authors because his text was used in the education of surgeons. So you have to take this as a possibility for use at sea rather than evidence of something that was absolutely done.

Caveats aside, I couldn't resist posting this. For all you migraine suffers, I present a solution. (Don't try this at home.)

“CHAPTER THREE. On the extraction of the temporal arteries.

When a man has a chronic migraine or acute catarrh, on account of acrid humidities and heat in the temporal muscles, or a violent chronic headache, or the like, and has been treated with various medical treatments without success, we have sometimes in these diseases tried extraction of arteries from the temples or cauterization of them, already described. The manner of extraction is for the patient to shave the temporal hair; then you press upon the artery appearing on the temple; for it will be manif3est to you by its pulsation, and is rarely invisible save in a few people or on account of severe cold. But if it not plain to you then let the patient bind his neck [footnote 1: read ‘head;] with the end of his garment; then do you rub the place with a piece of cloth or foment with hot water, till the artery is obvious to you; then take a scalpel shaped thus (fig. 42); then with it gently scrape away the skin till you come to the artery, then stick a hook in it and draw it upward till you extract it from the skin and free it all round with the membranes that are beneath it. But if the artery be think, twist it with the tip of the hook and cut out enough of it for the two ends to be well separated from another and

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contract so that no haemorrhage occurs; for if it is not divided and cut it will not let blood flow at all. Then let blood, from six to three ounces.

…

After extraction of the arteries the place must be packed with teased-out cotton wool, and on top of that must be put firm pads. And after loosening the ligature, dress with dry medicaments that encourage growth of flesh, and with bandages, until it heals. But if arterial bleeding hinders you in the course of your operation, hasten to stanch it either by cauterization or by filling the place with vitriol [footnote 2: probably the green vitriol, i.e., iron sulphate.], compressing it with your hand till the blood stays; or, if you have nothing of this kind by you, put your finger on it till the blood clots and rinse over the place till the flow dies down; then tie off as you should.” (Spink, M.S. and Lewis, G.L., Albucasis On Surgery and Instruments; A Definitive Edition of the Arabic Text with English Translation and Commentary, University of California Press, Berkley and Los Angeles, 1973, p. 178-80)

[Mission]

Millipedes as medicine! (This was taken as part of a cure for the King's Evil. King's Evil was a period name for tuberculous swelling of the lymph glands. It was called this because many people thought that it could be cured by the touch of royalty.)

"Millepedes should be washed, dried, and baked, then the Powder given in White Wine 3{scruples} twice a Day. Some infuse {ounce}i in a Pint, and take 2 or 3 Spoonfuls of the Expression, and some will swallow a Score at a time alive.” (Atkins, Navy Surgeon, p. 24)

Oh, and just for a fun, another bit from Atkins...

"How many Gret Men, (besides the Trustees,) have sollicited the Belief ot he Public to still stranger Things? * Apparitions, Witches, conversing with the Devil. That Women may conceive and bring forth Rabbits. A dead Man's Hand work powerfully in Cures. That Joshua has restored the Deaf Dumb and Blind." (Atkins, Navy Surgeon, p. 36)

Women may conceive and bring forth rabbits?

[jendobyns]

Millipedes as medicine! (This was taken as part of a cure for the King's Evil. King's Evil was a period name for tuberculous swelling of the lymph glands. It was called this because many people thought that it could be cured by the touch of royalty.)

"Millepedes should be washed, dried, and baked, then the Powder given in White Wine 3{scruples} twice a Day. Some infuse {ounce}i in a Pint, and take 2 or 3 Spoonfuls of the Expression, and some will swallow a Score at a time alive.” (Atkins, Navy Surgeon, p. 24)

Oh, and just for a fun, another bit from Atkins...

"How many Gret Men, (besides the Trustees,) have sollicited the Belief ot he Public to still stranger Things? * Apparitions, Witches, conversing with the Devil. That Women may conceive and bring forth Rabbits. A dead Man's Hand work powerfully in Cures. That Joshua has restored the Deaf Dumb and Blind." (Atkins, Navy Surgeon, p. 36)

Women may conceive and bring forth rabbits?

Sounds like there was a lack of understanding about fetal development by someone, and this could be some ignorant view of miscarriage, perhaps. Midwives would have been very much aware of the reality of such things, but the ignorant, or doctors who had not had the same experience as midwives, could go awry here.

[Daniel]

The King's Evil was also known as scrofula.

[Mission]

The King's Evil was also known as scrofula.

Yep. I gave the more widely used modern name for it. I actually don't plan to talk about it in my book since it doesn't appear in any of the sea-based surgical manuals as something they regularly treated. I mostly posted that for the rabbits.

[Calico Jack]

Sounds like there was a lack of understanding about fetal development by someone, and this could be some ignorant view of miscarriage, perhaps. Midwives would have been very much aware of the reality of such things, but the ignorant, or doctors who had not had the same experience as midwives, could go awry here.

Actually, it sounds like Mary Tofts, perhaps the most famous case of birthing rabbits, but not the only.

http://wellcomelibrary.blogspot.com/2009/03/extraordinary-delivery-of-rabbets-see.html

The Mary Tofts case is quite well known even today, and in this case is most assuredly a hoax [at least in its later stages]. The -type- of case, 'though, was well known enough even at the time to help create some of that fame that surrounded her.

[Mission]

I found this excerpt sort of interesting, if only because it appears that this surgeon must have kept or created crutches on board his ship.

“Example of a Fractured Thigh

I. In the Hard Winter, 1709, a Young Man of twenty Years of Age fractured his Thigh, by a Surging of the Cable, about four Fingers Breadth above the Knee. I reduced it, and proceeded in the Method before laid down; only instead of Junks, I infixed the Dressings with a Sheet of Pasteboard, (that came from above the Fracture to below the Calf,) placed the Leg and Thigh even, and in a Position easy to him, kept the Great Toe in a Line with his Knee, and carefully filled up the Vacuities at the Ancle and Ham with Compresses: I also bled him; and in the Evening gave the following composing Draught.

Rx. Aq. Theriac. Syr. de Mecon. a {ounce}s. Laud. Liq. g. xvj Aq. Hord. {ounce}ij. F. Haust.

The next Morning I found him easy beyond Expectation, (the best Sign of a good Reduction;) and as it is an Argument of the Dressings being well apply’d, and the

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Fracture in a right Order, so, after such Assurance, there seems little more required or wanting to Success.

This Case I submitted to the first Applications about three Weeks, only attending to keep the Limb in a due Order, and preserve a Conformity by a small daily Extension. In that Time he became able to walk about with Crutches, and soon after without. Which quick Cementation was to be attributed principally to the Patient’s Youth, and the Coldness of the Season.” (Atkins, Navy Surgeon, p. 59-60)

[Iron Jon]

Here's an old iron fleam set on eBay that they misnamed - antique old vet medical knife all chiselled rare 1700

[Mission]

Here's an old iron fleam set on eBay that they misnamed - antique old vet medical knife all chiselled rare 1700

Oooooh. Pretty...

It might actually be rightly named (although I don't know). Veternary fleams are very hard to discern from human fleams. Many of the fleams you can find on eBay are actually veterinary fleams because they were used on animals long after bleeding ceased to be a normal medical procedure for humans.

Too bad they want so much for it. Based on others I've seen, it should start for less than $100. (It might get to $350, being so ornate and having so many blades, but when you start that high on eBay many people are a afraid to bid.)

[PoD]

Italian early wrought iron Fleam for Bloodletting

An early Italian fleam for bloodletting, great design, all wrought iron, length 16 cm

http://www.fleaglass.com/index.php?a=2&b=1458

[Mission]

I've been considering having one of those made by a blacksmith for me since they're so simple. The problem is that I have several different kinds of fleams already which puts it pretty far down the "want" list. But it does look cool.

[PoD]

I've been considering having one of those made by a blacksmith for me since they're so simple. The problem is that I have several different kinds of fleams already which puts it pretty far down the "want" list. But it does look cool.

Yep as soon as I saw it I sent the picture to my blacksmith friend and he's knocking me one up in a couple of weeks. I'll post a pic once its done.

[Mission]

Here is an interesting account of a trepanation from John Atkins which resulted from a wound caused by a sliver. From my reading, slivers created by projectiles were some of the greatest dangers to seamen during battle (far greater than the projectiles themselves).

“Example II. John Usher

This Person was struck by a short splinter of Wood, in the Forepart of the Os Sincipitis: No Symptoms of a Fracture followed, but to Appearance, as well as ever he had been in his Life.

We dilated the Wound, in order to extract this Splinter with a Forceps, or other Instrument; but finding our Endeavours in vain, and not being able to judge at what Depth it stuck, or the Accident that it might ensue from leaving it in any Time, we thought proper next Day to apply the Trepan, and found an odd Circumstance after the Operation; for the first Table being removed, the inner appeared depressed to a pretty large Circumference.

The Operation was repeated through both Laminæ, and the deepest Part of the Depression, till the Splinter was brought away. We found no Extravasation; and dressed the Membrane Perforation, &c. in the Manner which has already been recited.

Fourteen or fifteen Days passed without any remarkable ill Symptom, and then the Patient was suddenly seized with a great Pain in the Head, soon followed with a Sopor, Stupidity, and Looseness: I blooded him, gave an easy Purge of Pul. Rhabar. Kept him to the white Decoction, and some volatile Smells; but about the twentieth Day, he was farther seized with a Palsey of his Tongue, and left Arm, and died in twenty-four Hours after.” (Atkins, Navy Surgeon, p. 89-90)

[Mission]

Here's a question for someone...what does he mean here by "a great Dog?" I couldn't find an immediately acceptable definition on Google, unless it refers to one of the carpenter's tools.

“Example V.

A Concussion of the Brain. A young Lad standing in a Boat, under the Bow of the Ship, a great Dog accidentally fell from out of her, and brought his Head and the Boat’s Thwart (seat) together. He bled at the Ears and Nose, and kept doing so by Intervals for twenty-four hours; Speechless also, and insensible, yet no Wound or Appearance of Hurt through his whole Head.

I took away {ounce}xij. Of Blood immediately, had the Head shaved, and rubbed his Temples and Nostrils

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with an equal Mixture of Sp. Lavend. and Sp. Sal. Vol. Ol.

The next Day I blooded him again, applied a large Vesicatory to his Neck, and made contemperating Julap. But this he constantly regurgitated, as often as he attempted to swallow.

On the third Day, I repeated Venesection, injected a stimulating Enema, and towards Evening he spoke; which was the first Time from his receiving the Hurt.

We daily after this, found some Progression in the Recovery; but the Stupidity wearing off slowly, I cut him an Issue, and left him to the Use of Errhines [substances that promote running at the nose], and have Reason to think they were of no small Benefit.” (Atkins, Navy Surgeon, p. 92-3)

[MarkG]

Here's a question for someone...what does he mean here by "a great Dog?" I couldn't find an immediately acceptable definition on Google, unless it refers to one of the carpenter's tools.

“Example V.

A Concussion of the Brain. A young Lad standing in a Boat, under the Bow of the Ship, a great Dog accidentally fell from out of her, and brought his Head and the Boat’s Thwart (seat) together. He bled at the Ears and Nose, and kept doing so by Intervals for twenty-four hours; Speechless also, and insensible, yet no Wound or Appearance of Hurt through his whole Head.

I took away {ounce}xij. Of Blood immediately, had the Head shaved, and rubbed his Temples and Nostrils

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with an equal Mixture of Sp. Lavend. and Sp. Sal. Vol. Ol.

The next Day I blooded him again, applied a large Vesicatory to his Neck, and made contemperating Julap. But this he constantly regurgitated, as often as he attempted to swallow.

On the third Day, I repeated Venesection, injected a stimulating Enema, and towards Evening he spoke; which was the first Time from his receiving the Hurt.

We daily after this, found some Progression in the Recovery; but the Stupidity wearing off slowly, I cut him an Issue, and left him to the Use of Errhines [substances that promote running at the nose], and have Reason to think they were of no small Benefit.” (Atkins, Navy Surgeon, p. 92-3)

The ratchet or pawl on a windlass is called a dog. Some of those were large and heavy enough to cause damage when dropped from a height. I don't know why one would be loose. The were a vital part of the windlass. That's the only "dog" I know of on a ship. I checked definitions and didn't see any other likely meanings.

[Mission]

Ladies and gentleman, the scourge of sea medicine: the splinter. (No, it was not the bullet, not the cannon ball, not the sword...it was the splinter.)

“EXAMPLE III.

An Eye struck out by a Splinter making one Side of the Os Nasi and Spongiosi bare.

Alexander Henderson, in that grand Naval Fight of ours with the French off Malaga, 1703. had his left Eye struck out by a Splinter, making that Side of the Os Nasi and Spongiosi bare: and from which several little Splints of them were easily drawn away with the Forceps. I cut away the lacerated Teguments [pieces of skin, I think] in the Wounds, as far as they appeared to be insensible; drest it and the Bone immediately with equal Parts of Tinct. Myrrh. a Fomentation and Decoction warm’d; over that again Pledgets of Digestive, a Compress, and a double Fold of Linnen pinned down to retain all. Where one Side of the Os Nasi was perceived loose, stricter

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Bandage would have depressed and disfigur’d: Instead of which, I advised him to practice the Smoothing of it, with his Finger frequently, that it might fasten evenly.

In six Weeks the Wound was incarned [skin had regrown in it], and healed; but soon gave Notice by a pricking Pain, Tenderness, and Tumor about it, that some Ossicles [small pieces of bone] or Exfoliation was further to be expected. The Cicatrix [scar covering the wound] being thin, I broke through it with my Probe, and enlarged with the Scissars, discharging a fœtid Matter.

A small Scale or two soon came away by the Wound; as did also another thro’ his Nose, (on blowing of it;) after this it healed, and continued firm.” (Atkins, Navy Surgeon, p. 142-3)

And another (which he calls a gunshot wound, but which is, in fact, a splinter caused by gunshot.)

“EXAMPLE V.

A large Gunshot Wound, and Loss of the Glutæi Muscles.

John Carter, had a Splinter in this Engagement, come close to his Groin, and in passing off carried half his Buttock away. We laid him by at present among our other Wounded, with a slight Astringent Application: Next Morning he was found in grievous Pain, the Wound very large, a great Part of the Glutæal Muscles on that Side being torn away, the Ossa Innominata [pelvic bone] bare in Part, and the whole, black, livid, and insensible externally. I made superficial Scarifications [a series of small incisions designed to allow blood/humors to be released] to the Wound now, and next Day applied three of four cauterizing Buttons [round-headed cauterizing tools], one after another, where the Insensibility or Colour led me to think a Mortification [area of dead or gangrenous skin] begun; and this without much Complaint from the Patient, filling the whole with thick Pledgets of Tow, dipped in U. Ægypt. hot.

In a Day or two, I had the Pleasure to see the Gangrene checked, signified by a red Circle round so much of the Lip [of the wound] as I had cauterized nigh, and is Nature’s Effort to separate the Eschar [scar tissue], the remaining Part that had been left undone, and now covered with stinking cadaverous Sloughs, I repeated the Cautery too, a little at a Time, for two or three Days, extracting now and then a Shiver of the Splinter and Bone, which I carefully look’d after at every Dressing.

When I had finished with the Cauterising necessary, I immediately dressed the whole Wound with Digestive [medicine designed to cause incarning, or growth of skin in a wound], used the Fomentation very warm, and half an Hour at least every Dressing wrapping a dry Stupe wrung from

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it, and a large Flannel-Roller round all: Inwardly the best nutritive Food we could get him, instead of the vulnerary [healing] Decoction.

In eight Days most of the Sloughs were separated, and in twelve all that little red Circle, or adjacent Inflammation vanished; but then the Largeness of the Wound gave such an Increase to the Discharge, that from a chearful Disposition he became remarkably weak and depressed, more so by a Looseness supervening, that very much abated the Hope of his Welfare.

I kept him to the white Decoction, and an Opiate every Night, which relieved a little; but to the Wound which I consider more essentially, (those being only the Dependencies of this,) there seemed two Intentions necessary; 1st, Was by all Means we could, to lessen the Discharge; and 2dly, to keep the Matter from insinuating among the Muscles above or below: It ouzing from all Parts on any Pressure as tho’ rotting.

Here the vulnerary Decoction came in Use, not to drink, but to dress him with, mixed half Brandy or Spirit warm; and is always my Method when the Eschars of any large Wound are separated, and Digestion obtained: increasing your Spirits, (and Astrictives [astringents] in the Decoction,) as you design to pursue more or less of this Intention. For here is the Caution again, if you are too sudden in the Check, you give Room for Tumors and Apostemations [wounds releasing pus] elsewhere; as was the very Case of this Man. I dressed him every Day as above; and to answer the second Intention, made Compresses from the Perinæum, the Buttock, and on every Side towards the Wound, giving his Position in the Cradle, as great a Tendency also as could be consistent with any Ease: The Quantity of Matter lessened presently, and only a thin Synovia [mucus or mucus-like fluid] from the Bottom of the Wound at the Bone, (common where the Tendons and Ligaments are torn;) but a large, painful, and discoloured Tumor, at the same Time, spread itself at the anterior Part of the Hip, down the Abdomen into the Inguen [juncture of the inner thigh and trunk of the body] and Scrotum.

It was now about a Month from his being wounded; and though this was a new Misfortune disheartening to our Patient, yet I did not think it equal to the Advantage we had in lessening the Discharge’ for he now daily

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recovered Strength and Spirit, the Wound incarning, and growing ruddy from all Sides. The Tumor indeed required Incision, (the Matter fluctuating under my Finger;) but I purposely omitted it for a Week, that my Patient had become heartier; and then opened and cured as in other Apostemations.

The Wound was nigh three Months in filling and cicatrizing [healing by scar formation], leaving a prodigious Scar, and great Lameness and Weakness on that Supporter, while I knew him, which was only the following Winter.” (Atkins, Navy Surgeon, p. 144-6)

[Mission]

Atkins gives a wonderful description of how the surgeon should prepare the Orlop deck and Cockpit for a battle, so I thought I'd repeat it here for those interested.

“Secondly, in War, the Surgeon always should have Boxes of Dressings ready, Turnikets, some Tents [roll of absorbent material, often medicated to keep a wound open], Pledgets [compresses of absorbent material, often lint], Buttons [Tow made in the form of a large button], and Dossils, in Sorts a great Number, without being armed; Rowlers [long rolled bandages], Compresses, Bandages, Ferulæ [ferule - strongly scented gum resin], Laminæ, of different Sizes; and when the Ship is preparing for Battle, to arm [thread] your Needles, to lay the Apparatus for Amputation particularly, and your Instruments in order, (as at p. 123.) the Ollop [Orlop Deck] and Cable Tiers are cleared and spread with Canvas, for receiving your wounded Men, the Cockpit separated for Operations and dressing them, whence they are to be removed.

That every Thing may be in the best Readiness on your Side for their Reception, tear up your old Ensign for present Use, mix up a Bason of Astringent, and have two or three of your Caps spread with it, a Pannikin of Ol. Tereb. [turpentine] with others of Digestive, and Spt. Vini [brandy], some Pledgets ready spread with this; a large Rowl of Cerate [a hard ointment or medicated paste consisting of lard or oil mixed with wax or resin] well malaxed [kneaded] with Tereb. Venet. to make it sticky; two Chests, and a round Stool, to rest your Wounded on for Operation, or Dressing; round the Stanchion fix some Boards for a Dresser, and covering with a Piece of Bunting, lay your Pocket Instruments, and such light Preparations as are of immediate Call, (but reserve the Bulk always in your Cabin, where they are likewise to lie in Order, and unmoved.) On each Side the Stanchion, and round you, place some large Lights, in Sticking-Iron Candlesticks, as taking least Room, and undisturbed by the Motions of the Ship; three or four moving ones also, and Snuffers.

Thus ready, the Surgeon is to consider, that Compound Fractures and Amputations will take up necessarily near the Whole of his Time. Flesh Wounds, especially by Great Guns or Splinters, are commonly large enough to discover any extraneous Body, to be extracted presently with your Fingers or Forceps; or if any Bits of Rag are suspected out of Sight, inject forcibly with Wine and Ol. Tereb. warm’d; if a Flux [flow] of Blood (very rare here) use the latter only, with Pledgets; concluding with one or two of those already armed

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with Digestive, or a Piece of Cerate, and a Bunting Rowler. But the other Cases plead strongly for Redress, and require abundance more of your Time to do it: The several Processes herein, I refer to what has been already said under those Heads; and shall only add here, that you are to be quick, as well as careful, in what Help you administer; for if the Action be warm, without Forethought, you will be in Confusion presently: And the Forecast lies in not suffering such wounded Men as can walk, and help themselves, to take up any Part of your Ollop, (especially that nearest you,) but move on to the Hold or Foreship; and those more helpless to be laid by your Assistants in their Stead, keeping your Cockpit as clear as possible. To all we must give Cordials at this Time; and Wine has, in my Opinion, the Preferences; because we are to quench Tirst, as well as refresh the Spirits.” (Atkins, Navy Surgeon, p. 148-9)

[Mission]

Here's some interesting treatment for splinters (and other things in and under the skin) gone bad:

“Painful Corns, Fractures, Felons, Thorns, or Splints, running deep into the Ends of the Fingers, (under or on the Sides of the Nails) will often by their acute Pain, bring on sudden great Inflammation and Fluxion [flow of fluids]; sometimes rot the Bone without any Sign of a Mortification outwardly.

I have frequently on all these Occasions, taken off the Joints of Fingers and Toes, done at one Stroke with the Chissel, in the Joint of the second or third Phalanx, because less apt to splinter; and if there be a Caries [decay of the bone] stops there. Dressings after the first for stopping the Blood with warm Ol. Tereb. [turpentine] left on 24 or 36 Hours, must be Lint Pledgets [compress of absorbent material] out of a warm Digestive [substance to promote healthy pus formation in a wound], a little thick cross Cloth, a Rowler [rolled bandage] to keep it on, and a Flannel Cap over all; especially in cold Weather, to keep the Stump warm: The Wound that would never digest under that acuteness of Pain attending these Accidents under ill Habits, (and points out Malignancy,) quickly digests with this Alteration, and the Symptoms are relieved.

I have drawn away the Bone of the third Phalanx of the Finger, when bare, corrupted and loose, after these Accidents join’d perhaps to an ill Treatment; and seeing no Sign of a Mortification in the Wound, healed it up, finding the Finger, afterwards of more use, with such a Fungus, than if a Part had been extirpated [removed].” (Atkins, Navy Surgeon, p. 163)

[Grymm]

http://www.youtube.com/watch?v=Ez3BFGXR02A

[Mission]

"There was not much furniture in the midshipmen's mess. Nearly all had a table, not from any generosity of the Government, but because the table was wanted for the surgeons in their operations after battle." (John Masefield, Sea Life in Nelson's Time, p. 75-6)

I always wondered where the idea that the mess tables doubled as operating tables came from. (It's found in W.R. Thrower's dreadfully documented book on pirates.) Well now I know. Too bad it's so far post-golden age. (Yet another black mark on Thrower and his poor research.)

[Mission]

I occasionally get asked about the survival rate of sailors when people hear about the medical procedures and I say that I read somewhere that for capital operations (amputation, trepanation and similar high mortality operations) that it was about 50%. However, I found this info in Kevin Brown's book Poxed and Scurvied: The Story of Sickness and Health at Sea. It is from info on Nelson's ship in the early 1800s, but the surgical procedures remained fairly consistent from the 1500s through the mid/late 1800s with a few rare moments of medical progress, so I am comfortable quoting it. It should be noted that this would be an example of a ship with a captain who was very concerned about the health of his men and a surgical crew that was keen and fastidious. (So - the upper end of the scale as far as medical care goes.)

“On the way to Gibraltar, the Victory was caught in a storm; wounded men lying on the deck were rolled along the ship, those in hammocks were pitched against each other and the bulwarks, some were thrown down to the decks, and wounds were reopened. Yet the high survival rate of the casualties was remarkable and reflects and impressive quality of care by the surgeons. When the Victory was decommissioned in early January 1806, Beatty reported that nor more than six of the 102 convalescents had died, five on board and one in the hospital at Gibraltar and five who were transferred to the hospital ship Sussex. Remarkably, eight of the eleven amputees survived. Of the men who died after amputation, loss of blood was the cause of death for two of them and only the 22 year-old seaman William Smith died from infection after his leg was taken off at the thigh.” (Kevin Brown, p. 90)