THE
MEDICAL EXAMINER.
AND
RECORD OF MEDICAL SCIENCE.
NEW SERIES. —NO. CV.—SEPTEMBER, 1853.
ORIGINAL COMMUNICATIONS.
On the Diseases and Injuries of Seamen. By G. R. B. Horner,
M. D., Surgeon U. S. Navy, Philadelphia.
In our preceding remarks we have spoken of the means of ob-
taining healthy and capable persons for sea service, and of the
best methods of keeping them efficient—many may be kept so—
but in spite of all precautions, some cases of disease or injury
will certainly occur among them, it matters not how small a crew
may be. When it is large, on a long voyage, we must expect a cor-
responding increase in the number of disabled. It has appeared,
then, that it might be useful for me to give an account of the
diseases and injuries I have met with at sea, and of the curative
means adopted, but chiefly of those which have been found the
most efficacious, without undertaking to give a learned treatise,
either on new or old remedies, and entering into a long disputa-
tion on the theory of the diseases, and the many modes of prac-
tice recommended since their first discovery. The reader likewise
must not be disappointed, if he should find omitted many of
the nice distinctions now made in their names, and which serve
to create confusion and obscurity rathei’ than to elucidate the
nature of diseases. Pedantic terms may sound melodiously, and
yet fail in sense and imparting knowledge either respecting the
manifold diseases to which the human race is liable, or the mul-
titude of remedies used for their cure. For this latter reason a
grand display of Latin prescriptions, setting forth long lists of
medicines, puzzling the writer as well as reader to remember well,
will be sedulously avoided—not only for this reason, but from my
want of belief in the efficacy of making such heterogeneous com-
pounds, and from my preferring simple remedies. After these pre-
. liminary remarks, I will observe, that although, as is well known,
seamen are subject to the same diseases and injuries as landsmen,
they are often modified by their peculiar mode of living. Sea-
men work, sleep, eat, drink, and dress differently from the
former. At sea this happens from necessity; on shore from
habit. The floating, peculiar structure of their ever-moving ha-
bitations, also produces changes in the disorders and injuries of
seamen, and hence we find them varying frequently according to
the class and state of their vessels, the general management of
these, and the weather or climate where they are ; yet, when any
one disease becomes epidemic in a ship, at the same time that it
commonly spreads with rapidity, from the crew being as it were
imprisoned together, and it not being possible to perfectly sepa-
rate the sick from the well, the type of the disease will be found
very much alike. This will be rendered greater by their similar-
ity of living, as respects food, drink, clothes, and other modifying
causes. From the impossibility of flight, when an infectious or
contagious complaint occurs in a vessel at sea, and far from
port, all in her, except a few who may be protected from the
disorder, know their liability to being attacked, and are not so
susceptible of being seized with a panic as people on shore,
and soon become accustomed to the danger, and resigned to
whatever fate awaits them. Familiarity, too, with dangers from
other causes blunts a sailor’s sense of fear, and though his
limited views into futurity should not make him a predestinarian,
he suffers whatever evil befalls him with singular resignation,
and meets death without fear. Hence I never knew this to
kill a sailor, nor one to be accused by his physician of having
died of fright. On the contrary, sailors bear disease with pa-
tience, meet death with philosophic complacence; and if they get
well, pursue their erratic occupations and dissolute amusements
with no apparent compunctions of conscience. Though they may-
read some of the numerous bibles distributed by societies in every
vessel, and attend divine worship with great decorum, they are
apt to do the first for pastime, and the last from the mechanical
effects of discipline. The sacred books being put down, the service
at an end, they become as reckless as ever, and think no more of
what has been read or heard. When death at last is impending,
they may take the medicines prescribed, from respect and obedi-
ence, but may care so little about it as to reject them, as I once
saw done by an old sailor named Michael Leopold, dying of
diarrhoea, caused by his being entrusted with a bottle of dissolved
tartar emetic prescribed by the surgeon for a chronically enlarged
testis. When he had been excessively prostrated, and the clammy
sweat of dissolution was upon him, he cried out that “he was
dying, and he was glad of it; take that brandy-toddy away,” said
he, “ I will have none of it, for when I wanted it you would not
give me any.” Thus the old man died without further medicinal
aid, and striking every person present with amazement at his re-
fusing what no sailor was ever before known to reject in any shape
whatever, for every one believes in the sovereign efficiency of
grog. Internally they think it possessed of wonderfully healing
powers—even greater than that of tar to any hurt, or of that
panacea brown soap and sugar for an application to all boils and
swellings, and external affections generally, whether the result of
disease or injury. Some of the most ordinary external disorders
to which seamen are liable are the former of every grade, from
the smallest boil to the most aggravated phlegmon, partaking
occasionally of a carbuncular character, involving all the tissues
of the skin, and resting on the investing fasciae of the muscles
beneath. When this occurred the local inflammation occasioned
great pain and febrile symptoms, the patient was unfit for duty,
had to be taken on the sick list, and to undergo regular treat-
ment.
The same had to be done in cases of less severity, and which
wrere attended with only local symptoms, either from their disa-
bling the affected parts, interfering with the proper use of the
limbs, or it not being possible, while the patients were perform-
ing duty, to treat them conveniently. In cases of all kinds,
these phlegmons, would not be regarded as of local origin only,
and in their treatment it was necessary to regulate the diet, for-
bid gross, crude, irritating ingesta, and to administer medicines in-
ternally to expel them, and restore the system to a healthy state.
Saline cathartics were sufficient, usually. Severe cases required
magnesia alone, or with epsom salts, or rhubarb, at the same
time warm linseed poultices were applied, until suppuration had
occurred, the phlegmons had came to a point, and then they
were lanced so freely as not only to disgorge the cysts, turn
out the hardened sloughs or cores in the centre, but to cause a
copious effusion of blood from the parts surrounding the cysts.
Afterwards, the poultices were renewed and reapplied until sup-
puration was complete, the parts had become soft and pale, and
the pain subsided. The poultices were then left off, and some
mild, soothing, astringent lotion used. A solution of the
acetate of lead, in the proportion of a half drachm to a half
pint of water, was commonly prescribed. Sometimes this lotion
was introduced into the poultices to soothe the skin, and prevent
a great extension of inflammation. Care was taken also to pro-
cure if possible flaxseed meal of good quality. In some places
this cannot be obtained, and at Gibraltar the best that could be
bought, instead of being soft, oily, and nearly white, was in
cakes, hard, dry, dark, and like sawdust. Such flaxseed meal is
said to be obtained from the seed after the oil has been entirely
abstracted by heat and pressure, and is unfit for poultices. Bet-
ter ones can be made of ship’s biscuit, steeped in boiling water,
and mingled with a little grease or oil, when sweet. If in
port, fresh bread, made into a mass with milk, may be more con-
venient, and make a better substitute for a good linseed poultice :
or one of mashed potatoes may be prescribed when bread is too
dear, or cannot be had. For some phlegmons likewise an ex-
cellent poultice may be made by pouring boiling water on the
inner bark of the red elm, after it has been cut or ground into
small pieces. When thus prepared it becomes very pultaceous,
soft, adhesive, and soothing.
Similar treatment to the above proved best in many other
superficial affections, either of a local or general character, and
arising from idiopathic or symptomatic causes. Local treatment
was seldom alone adopted, and constitutional was never neglected
when there was reason to believe the local disorders were mere
signs of general ones, as was found in many eruptions, abscesses
formed in the cellular substance of the axillae, or about the lower
part of the rectum, or beneath and at the root of the finger nails,
constituting felons or whitlows. To these I have found seamen
as liable as seamstresses, and have no doubt of their arising often
in them from depraved digestion and bad diet, as well as local
injuries and too great use of their fingers. During my late
cruise, numerous cases of this kind happened at the same period
that phlegmons were prevalent; and in one day, there were three
admitted on the sick list for the former. A like treatment was
followed, and as soon as the poultices applied had induced sup-
puration, free incisions were made into the cavities formed, to
discharge their contents, prevent these from travelling beneath
the nails, tendons and fasciae, and producing caries of the bones,
as I have witnessed. In one instance, those of a middle finger
became so diseased, and caused such fungus in the joints and
soft parts as to oblige me to amputate it at its junction with the
metacarpal bone. From time to time similar abscesses were met
with in the feet, beneath the fasciae and tendons of the soles,
and were also cured by following the above practice of poulticing
first and then making free incisions. But one of the most re-
markable abscesses ever seen by me, was occasioned by a chronic
rheumatism in the left hip, buttock, and adjacent parts. The
person affected was a gigantic seaman, a blacksmith by trade, of
the name of Henry Fry, who got the above affection by expo-
sure in the Brandywine at New York in 1830. After he had
suffered considerably there and while she cruised, he returned to
the United States, and became armorer of the John Adams early
the next year. During her cruise in the Mediterranean, he suf-
fered greatly from pain in the parts—principally in the left hip
and buttock, extending along the course of the sciatic nerve ;
used friction with vol. liniment, and wore a Burgundy plaster on
the parts. Other local remedies were used, and in the middle
of January, 1833, he was taken on the sick list, being no longer
able to perform his duties. The skin over and about the left
trochanter major was of a dark brown color, and much indu-
rated. He was unable to stand, and limped; but both of the
inferior extremities were of natural size, and his general health
was good. Treatment: Low diet, a poultice to the indurated
parts, and a dose of calomel and jalap were directed. The next
day, 20 leeches were applied, and the poultice continued. On
t^e 18th, suppuration and ulceration had occurred; a fistulous
orifice was formed over the lower part of the trochanter, and a
probe was passed two inches and a half into the abscess. This
increased rapidly, extended upwards and backwards, until it in-
volved all the left buttock, and formed a number of other fistulae
above and below. One also broke out over the hip joint, and a
scrofulous affection of it, as well as a lumbar abscess, were sus-
pected. The purity of the pus discharged, its freedom from
flocculi, the general absence of the marks indicative of a scrofu-
lous diathesis, forbade such a conclusion ; and the treatment was
modified accordingly. It varied exceedingly, from the many
turns the disease took. Sometimes, he was only locally affected,
at others, he was feverish, and he was prescribed for according-
ly, both local and general remedies. He took a number of blue
pills, at intervals of one or more days ; doses of Epsom salts and
seidlitz powder, and rhubarb and magnesia in the morning ; and
had a solution of 5 grs. of the nitrate of silver in 3i of water, in-
jected into the abscess, to cause adhesion of its sides. A seton
passed through two of the fistulae, was used for the same pur-
pose, and efficiently; the latter were repeatedly scarified—
several incisions were made through the integuments, and final-
ly, one almost a foot long was extended vertically down the
buttock, to the back part of the trochanter, and in a line with
the former. The gash was an enormous and frightful one—the
parts divided were more than an inch thick”; and had I known,
before beginning, the extent of the abscess, I might have been
deterred from it; but having made an incision of three or more
inches, I did not reach the bottom of the abscess, and making
another quite as long with a like result, I at last had to make a
third one. Scraped lint was then laid in the abscess; the two
lips of the wound were united with adhesive strips ; a plaster of
simple cerate and a compress put over it; some wine, warm rice
water, a dose of laudanum, and friction with volatile liniment,
were prescribed, to ease pain, and bring on reaction ; for he had
become faint, and was covered with a clammy sweat, although he
had taken a dose of laudanum before the operation w’as begun.
After he had recovered from the immediate effects of it, the
general treatment was renewed. This consisted chiefly of a diet
drink made of sarsaparilla, sassafras and mezereon bark, and
extract of liquorice macerated in water, and made into a decoc-
tion. But many other remedies were used, to counteract the
untoward symptoms occurring from time to time—as fever,
diarrhoea, swelling of the abdomen on the left side, and acute
pain in different parts. Among these remedies were tartar
emetic conjoined with the effervescing draught, acetate of ammonia,
antimonial wine, tincture of opium, opium in substance, the sulphate
of morphia endermically applied after blistering, and by enemata.
On the 1st of June, three days after the operation, the dressings
were removed, the wound wTas cleansed of a large quantity of
clotted blood, and the bottom exposed. It was smooth, glossy
and forrod by the gluteal muscles chiefly, but it extended in
various directions under the integuments, and had several fistu-
lous outlets, one of which was on the posterior upper part of the
thigh. On the 4th, the dressings were again removed, and I
found that the lint had produced a healthy secretion of pus, and
that granulations were springing up on all sides; but on the
9th, so much irritation was caused by the former, that the wound
became inflamed, fever occurred, his pulse rose to 120 in the
minute, and so much pain was occasioned in the hip joint, that
the lint was taken out, and a neutral mixture, made of sup.-carb,
of soda and vinegar, mingled with 50 drops of laudanum, was ad-
ministered. The adhesive strips were renewed, as required;
the nitrate of silver was applied also, to heal the lips of the
wound; and after the fever had entirely subsided, to remove
debility,' he took the sulphate of quinia and diet drink. June
16th, the parietes of the abdomen anterior to the iliacus inter-
nus muscle, became tumid, and sore to the touch ; continued
afterward to swell, and were poulticed. Suppuration occurred ;
and on the 27th of August, I made an incision into the swelling,
and discharged a large amount of pus. Becoming more pros-
trated in the mean time, he was given an infusion of cinchona
gij., pulv. gentian gss., pulv. zingiber ^i., in lbs. ij. of boiling
water. Lead water was used, to remove excoriation caused by
the strips ; a seton was kept in two of the fistulse until their
cavities were nearly closed; and by these means and similar
ones, by the 12th of October, the wounds on the buttocks, as
well as the fistulse there, had perfectly healed, leaving a hand-
some cicatrix. Only one small fistula remained unhealed,
and but a small quantity of pus issued from it; he had perfect
use of the thigh; his general health had been restored, his
strength, appetite and spirits had returned, and a speedy restora-
tion to duty was anticipated.
This happy condition had been attained, although the ship
had been cruising from one end of the Mediterranean to the
other—had visited France, Greece, and Oporto—the whole sum-
mer conveying vessels through the Archipelago from Smyrna,and
was then on her voyage homeward. Most unluckily, however,
on the 2d of November, two days after she ran out of the straits
of Gibraltar, he was seized with a catarrhal fever, ascribed to
damp air on the Atlantic, and impelled before astrong Levanter,
or east wind, which had driven the vessel out of the Straits
against the rapid current making into them. A misty state of
the atmosphere prevailed in this part of that ocean, which is about
midway between the Straits and Madeira, and its ill effects I have
frequently observed. To relieve him, a half drachm of laudanum
and the same quantity of antimonial wine were given immediately,
and the next day he took the last named article with a half ounce
of spiritus mindereri every two hours. The sulphate of quinine
was then discontinued. The symptoms still became more un-
favorable, the fever continued, the fistula remaining in the left
groin, increased to double its size, the skin extending from the
former to the buttock became inflamed and erysipelatous, the
cuticle peeled off, the buttock swelled, ulceration began in the
cicatrices, after they had become livid and excoriated, and by
the 11th, nearly all the newly formed parts had sloughed away,
leaving a vast ulcer about three inches wide and about twelve long,
or the whole length of the great incision. In the mean time his
fever continued, the pulse was small and frequent, and his mind
flighty. Nevertheless we did not despair, but continued the
spiritus mindereri and antimonial wine, gave him hot marsh-
mallow tea; bathed his feet in hot water; put a leech on each
temple, and a lead water poultice to the inflamed parts. On
the 7th, the fever having left him, the mixture was stopped, the
poultice left off, an incision made into the upper part of the but-
tock, and a quantity of decomposed blood discharged. A plaster
of mercurial ointment was then put on the buttock, the edges of
the ulcer were brought together with adhesive plaster, and re-
tained by a compress and belt. Delirium continuing, a sinapism
was put to the nape of the neck, which relieved it; and to sustain
strength, he was again given the diet drink and compound infu-
sion of bark, wTith a fourth part of sherry wine in it. Great
attention, as during the whole previous treatment, was paid to
his regimen and general comfort. The mercurial ointment
proving too stimulating, was diluted with three parts of simple
cerate, and he soon began to recover. The sloughed parts
healed rapidly, the fistula, by aid of frequent scarification and
powdered cinchona, was filled up; and by continuing the above
medicines as long as needed, and giving the sulphate of quinine,
he still more improved. He also took a blue pill every other
night, a dose of powdered rhubarb and calcined magnesia on the
morning after for two days ; and by the middle of the following
January, the hip and buttocks were again perfectly healed.
Finally, by the 3d of February, notwithstanding the ship had
been at sea nearly the whole time,—had visited Mogadore, gone
to Madeira and Teneriffe, passed through the calm, hot latitudes
between that island and Liberia, spent several days at Monrovia,
thence crossed over to the West Indies, stopped a week at Mar-
tinique, and for a fortnight had been blown off the coast of the
United States by a cracking northwester, which raised a tre-
mendous sea, and greatly rocked her,—then all parts entirely
healed, he walked without help, and was then transferred to the
naval hospital at Norfolk. From that he was soon discharged,
well, applied some time afterwards, at the Philadelphia rendez-
vous, to reship, and being perfectly sound, was taken into service
again, to make the air resound with his sledge hammer and
anvil. Though not lame, as his progenitor, Vulcan, he strongly
reminded us of him, as his muscular arm and huge body heaved
up and down, and his heavy blows were laid on the red hot iron.
But I regret to add, that this valuable seaman died some years
afterwards, on board one of our national vessels, of dysentery,
contracted during his cruise in the East Indies.
Another instance of abscess of the left buttock, had occurred
in the same vessel, and in the person of the ship’s cook, a slen-
der, decrepid man of 45 years of age, who also had a- cataract
in the left eye and amaurosis of the right one; besides, was dis-
peptic and diabetic. As in the preceding case, the disease was
preceded by symptoms of sciatica, pain in the hip joint, and
swelling over the left sacro-sciatic notch. He was taken under
treatment, likewise, during the winter, was cupped, leeched several
times, blistered, poulticed, took blue mass repeatedly, magnesia,
&c. to work it off; had the blistered surface sprinkled nightly
with the acetate of morphia, and was given, besides the tonics
mentioned, an infusion of quassia. For the benefit of his eyes,
a seton was introduced and worn for weeks in the nape of his
neck. But five months after his admission on the list, and during
the following May, the abscess had perfectly formed, and being
about to ulcerate through the skin, was opened by a valvular
incision. About five ounces of flocculent, straw-colored pus,
were let out. It continued to flow for more than three weeks;
he became prostrated and hectical; and as the ship was
bound on a long cruise into the Atlantic, he was transferred to
the flag ship Brandywine. Of what became of him afterwards
I have never heard, and cannot give the result of his com-
plaint, but surmise it was a fatal one.
The following case of abscess of a different kind, was sent to
the John Adams from the Constellation frigate, to be carried
home. The person was J. D., a young, handsome, delicate
marine, who was said to have an affection of the urinary organs,
ascribed to a fall down a ladder. He had undergone little treat-
ment, and, according to his own account, taken only one dose of
medicine, a large one of calomel. Being of scrofulous habit,
this had salivated him, and caused soreness of the mouth, with
ulceration of the gums. He was then weak and hectical: and,
a day or two after he came on board the ship, was observed to
have a small swelling on the left side of the nose, and its bridge.
He stated, he had had the former broken when he was a boy,
and the venereal disease eightyears before. There was no other
evidence of this having any thing to do with his ill health, and
he was treated correspondingly, and for mercurialism.
An incision was made into the swelling—a half ounce of pus
discharged ; and the cavity being probed, the left nasal bone was
found rough and carious. He was put on a plain, nutritious
diet: took magnesia, to correct acidity of the stomach; had the
lunar caustic applied to the fungus, which sprung out of the
wound made on the nose. He took the sulphate of quinine, and
two diet drinks, of which the following was the principal. It
consisted of sarsaparilla,- §viij., lignum guaiaci, §ij., sassafras,
§iv., mezereon, 3ij., honey, gviij., and water, two gallons, which
was boiled down after maceration to two gallons. This decoction
was cooled, strained, and taken as required. In the second
case, the guaiacum and mezereon, which were too acrid and
stimulating, were left out, and senna leaves added. After this
decoction had been boiled down as the other, it was sweetened
with loaf sugar, and used in the manner as above. Three weeks
after he was taken on board, the alveolar processes of the upper
jaw were found carious, and the nasal process of the superior
maxillary bone, as well as the nasal, eventually became affected.
In the meanwhile the ship had got to Liberia, he had been more
prostrated by the heat of the climate, and was prescribed bathing
in cold sea water. By this treatment, he recruited, reached the
United States safely, and some time subsequently recovered his
health, with the loss of the bridge of his nose. This case is, I
consider, a very striking one of the positively poisonous effects
of mercury, and it proves the great impropriety of giving it with-
out regard to the constitution of patients. It moreover appears,
that it is given wrongfully in other than syphilitic cases, and
that its use should be avoided when other medicines can be as
well employed without such consequences. To show how use-
fully the preparations of mercury may be used, and yet prove in-
jurious, I will give the account of another case, that of Samuel
Mahoney, a young sailor of 22 years, tall, slender, and disposed
to disease of the lungs. He had been treated 18 months
previously for pleuro-pneumonia, and cured by means of V. S.,
nitrous powders of the common kind, containing calomel, thirty-
six leeches to the chest, the spiritus mindereri, and tart. emet.
blisters, the sulphate of morphia, and demulcent drinks. He was
readmitted for a tumor on the posterior face of the right ole-
cranon process, as large as a hen’s egg, and resembling a wen.
He stated, that three months before he had fallen on the elbow,
and the tumor had formed since then. As it was increasing
rapidly, it was cut off by an elliptical incision, and was discovered
to have been formed of a thick sac, containing a half ounce of
yellowish serum, a fibrous mass adhering to the internal surface
by tendinous bands. The base of the tumor adhered so closely
to the bone that it could not be perfectly detached. After the
incision, the edges of the wound were brought together with ad-
hesive strips, a compress of lint was applied over them, a paste-
board splint was put in front of the joint, and a roller passed
around the fore arm and it, to prevent flexion and the protrusion
of the naked olecranon through the wound. These things done,
he took a dose of Epsom salts and magnesia; and these medi-
cines having worked too actively, and with the bleeding caused
too much debility, he was given a dose of laudanum and tine, of
lavender. The dressing remained undisturbed for several days,
and was then removed. Every attention was paid him ; he was
kept on low diet, and at rest, and yet the wound became un-
healthy. Granulations sprung up, and it filled ; became fungous ;
projected a half inch above the lips; a number of large pustules
formed on the adjacent skin ; a solution of sugar of lead was
used as a wash for these, and the lunar caustic applied to the
fungus time after time, and as often as the dressing was removed.
Notwithstanding, the fungus continued to grow, and I determined
to try constitutional with local treatment. After the operations
had been done for more than a month, I prescribed blue mass,
five grains every other night, and powdered rhubarb, 9j, with
magnesia, ^j., the next morning, and the caustic was applied
occasionally. This treatment had a most happy effect. The
fungus quickly sank down, the edges of the wound approximated,
and, by the 10th of January, three weeks before the ship arrived
at home, a perfect cicatrix had formed, and the elbow was well.
This cure strongly illustrated the utility of mercury ; but to show
what injury it at the same time did, I will state that, on the 17th
of the previous month, without any reason to suspect venereal
taint, the right inguinal glands began to swell; a bubo formed
and suppurated: twenty days afterwards a second one formed
in the same part; and five days subsequently a third one ap-
peared in the left groin, between the scrotum and thigh. The
latter bubo was indolent; the two first, on being poulticed, formed
a single large abscess, and the last of the two discharged its con-
tents through the incision of the first one. All of them were
obstinate, and resisted local and general remedies- The nitrate of
silver, Turner’s cerate, cathartics, blue mass, and Lisbon diet
drinks were of little service, and, in February, he was sent to the
naval hospital of Norfolk, the buboes having been still unhealed,
although his elbow remained sound. Hence, I was well pleased
with the action of the blue mass in this respect, but was dis-
pleased at the palpable effect it had had in developing a scrofu-
lous diathesis. Had the patient had chancres, or have been
known to have been exposed to syphilis, the buboes might have
been attributed to it; but neither was the fact; and his confine-
ment to the ship or her boats for at least a year, rendered it im-
possible for him to have been infected within that period, as
women were excluded from her.
A case of not less importance, if not of more, was that of a
seaman transferred to the John Adams, at Athens, in Sept. 1883,
from the flag-ship United States, which the year before had
arrived in the Mediterranean. This case was also attended with
enlargement of the inguinal glands, but he had in addition an
induration of some of the lymphatic ones of the neck ; one of the
parotids was swelled, and there was extensive ulceration of the
fauces, which had destroyed the right tonsil, and was attended
with inflammation and tumefaction. He had been affected for
nearly seven weeks, and nearly all his teeth were decayed. The
molars had suffered most, pus filled the hollows, the gums were
black, and a fistulous ulcer had penetrated the right side of the
velum pendulum palati. His voice was hoarse and guttural, and
deglutition difficult; the edges of the ulcers were thickened and
inflamed ; and, as he had had no venereal affection, was thin,
pale, and had stronger marks of being of a scrofulous diathesis,
his affection was considered to be of that nature ; though, so far
as I could learn, he had been treated only for an ordinary
ulcerated throat, and had been using a number of gargles ; among
which there were two of the sulphate of copper and nitrate of
silver.
Agreeably to my opinion of the scrofulous nature of his dis-
ease, an ointment of iodine, 3J-, basilicon, §j., was spread on a
rag, and directed to be applied over the right parotid gland twice
a day. He was also given a solution of iodine and hydriodide
of potash, in distilled water, and in the dose of twenty drops, four
times a day. The dose was gradually increased to forty drops,
and a strong solution of the nitrate of silver was applied twice a
day to the ulcers by means of a mop.
In spite of this treatment the ulceration continued, penetrating
the velum in another place, and then united the two parts to-
gether, so that it fell to the left side, and rested on the tongue.
A sulcus was formed in the roof the mouth, and the palatine bones
seemed to have been destroyed by caries. In the course of two
weeks, however, the parts had improved, and the ulcer on the
right side of the fauces had healed, though the velum on that
side was nearly obliterated, and the uvula was considerably in-
clined to the other. The disease, however, continued in other
parts, the fistula was detected in the right anterior half arch
five weeks after he came under my care, and the solution of the
nitrate of silver was reapplied by means of a hair-brush. This
fistula remaining stationary, was then laid open with a scalpel,
and bleeding very profusely, a solution of alum, in the tinct. of kino
was successfully applied as a styptic; a diet drink of a similar
kind to those mentioned was given. He took blue mass grs. x.
every other night, the caustic was reapplied as required, the
ulcers were scarified with a lancet repeatedly, and yet a month
later the fauces were more inflamed, and so continued until in
using the wash the half of what appeared to be the body of a
dead bread worm was extracted from the ulcer in the velum. In
a short time subsequently the throat became much less inflamed,
the internal remedies were continued, and a gurgle of sulph. of zinc
and sage tea used until it lost its good effect, and was then left off
for the caustic in solution and substance. To remove costiveness
several doses of cream tartar and sulphur in molases were given.
Under this treatment, varied as required by the condition of the
patient, his health was restored, the perforations in the palate
closed, and the other ulcerated parts nearly healed by the time of
his arrival in the United States. His transfer to the hospital
prevented me from effecting a perfect cure, and this was the
greater subject of regret as he had been under my care almost
five months.