Medicine during the Golden Age of Piracy

[Salty Dog]

Drowning

At the beginning of the 18th century people were not taught to swim and most people, even mariners did not know how to swim. Artificial resuscitation was at its infancy with many experts arguing over the merits of the practice. If a sailor fell overboard and the ship was moving at any great speed, it was often thought rescue was impossible unless he managed to grab a line or some type of floatation device could be thrown to him (an empty cask or something else that might float). Falling overobard was almost certain death and it was only the most stout hearted sailor who did not fear going overboard.

What was known is that people could be brought back from the dead, so to speak after being submerged in water for an extended time; even as long as thirty minutes. It was also known that a person who had been placed under the water for even a very short time minute could seemingly recover completely only to die a few hours or even a couple days later because of the submersion.

The pathogenesis or what is happening in the body while a person is drowning is quite complex and beyond the scope of this article to be discussed in detail. This is because the reaction of a drowning victim will vary according to the victim, the environment, and the situation.
The following factors are just a few of the details that will impact on the drowning episode was the person washed overboard in violent storm or did he fall overboard in still water while drunk? Depending on the situation, the body will react differently and different reactions will take place in the body.

Did the person panic or did they remain calm

Did the person have a chance to hold their breath or did they immediately swallow large amounts of water?

In some instances of drowning the lungs may fill completely with water; in other cases very little water will be aspirated or breathed in.

Drowning in salt water can bring about different reactions or long term consequences than a fresh water submersions.

The factors and others lead to hypoxia, acidosis, and finally cardiac arrest.
Hypoxia: a shortage of oxygen in the body, specifically in the blood stream

Acidosis: an increased acidity of the blood plasma

Cardiac Arrest: Heart failure (heart attack)

[Salty Dog]

Most importantly for survivors of prolonged submersion is the linings of the lungs. The the lining of the lungs can be damaged during a submersion episode which can produce decreased lung capacity (an inability to take in oxygen) and if all the foreign fluid is not removed pneumonia can set in. In some instances of drowning, the stomach contents will be regurgitated and then breathed back into the lungs creating a new set of problems for the drowning victim.

So where does all this leave a drowning victim in the early 1700s? What kind of first aid was applied for a submersion victim 200 years before the concept of first aid existed? As mentioned, artificial resuscitation was in its infancy. Two methods were thought to be effective. One is very familiar to today’s lifeguards, mouth to mouth or mouth to nose resuscitation. The other method was to slip a tube of some sort down the trachea (breathing tube) and use a bellows to pump fresh air into the lungs (endotracheal tube).

Most trained doctors thought first method was inadequate because you were blowing used air into the lungs (and the stomach) and they discouraged its use while encouraging the trach tube and bellows. However, the second method involved a skilled physician who knew how to insert a tube into the trachea and also involved blowing air in with the bellows and then removing the bellows so the air could escape. In both cases, chest compression (that is, pressing on the external chest cavity in an attempt to start the heart) was not done. When you consider the tubes were not flexible and were not normally sanitized, you can see this method had many risks.

While bellows were carried on most ships where a fire was needed, they probably were not found on all ships or were not necessarily part of a sea surgeon’s medical chest, thus despite the thought that bellows were superior and tracheal tubes, most probably relied on mouth to mouth resuscitation.

The first step taken most people would have tried would have been to turn the person on their stomach and rub the back in an attempt to eject water from the lungs. Another method would be grabbing the person around the waist and repeatedly lifting the mid-section off the ground in an attempt to pump the water from the body. If the person seemed to be breathing after these attempts were made, a doctor would probably try to wake an unconscious victim by vigorous shaking. Despite the fact that mouth to mouth resuscitation was known before 1700, the above step would have probably been the only step taken by most sea faring men, especially pirates before 1700.

[Salty Dog]

After 1700, if these first steps failed, then mouth to mouth or mouth to nose resuscitation would be performed. This involved a man placing his mouth over the drowning victim’s mouth or nose and then blowing air into the lungs. This would often involve two rescuers with one man blowing into the mouth while another man pushed down on the stomach to prevent the air from entering the stomach. Depending on the damage done to the linings of the lungs during the submersion, this type of resuscitation can be quite effective. In order for resuscitation to occur the alveoli must still be functional. The alveoli are the final branchings of the respiratory tree and act as the primary gas exchange units of the lung. The gas-blood barrier between the alveolar space and the pulmonary capillaries is extremely thin, allowing for rapid gas exchange. They are easily damaged when water is aspirated into the lungs.

If the alveoli is damaged severely enough, no amount of resuscitation will be successful. In other cases a person will be resuscitated but because of damage to the alveoli they will never regain lung capacity and in still other case the damage to the alveoli will progress over time and eventually kill the victim.

There was also rudimentary information regarding hypothermia or the loss of body heat, so the victim would probably be covered with blankets in an attempt to keep them warm so once a person appeared to be recovering they would probably be wrapped in blankets.

All sea going men knew that any time spent under the water could be deadly. Often for this reason, near drowning victims would be given rest or light duty for several days after the event even if they seemed alright.

[Salty Dog]

Gunshot wounds

Despite what you see in the movies, in the 18th century a gunshot wound to the chest or abdomen was almost always fatal. That is to say if the bullet made it through the fat layer and entered into the actual chest cavity or intestines.

From Tobias Smollett's book we get this exchange:

"the gentleman...asked what method of cure I would follow in wounds of the intestines. I repeated the method of care as it is prescribed by the best chirurgical writers, which he heard to an end, and then said with a supercilious smile, "So you think with such treatment the patient might recover?" I told him I saw nothing to make me think otherwise. "That may be," resumed he; "I won't answer for your foresight, but did you ever know a case of this kind succeed?" I acknowledged I did not, and was about to tell him I had never seen a wounded intestine; but he stopt me, by saying, with some precipitation, "Nor never will! I affirm that all wounds of the intestines, whether great or small, are mortal."

Unless the bullet could be seen or felt it was impossible to extract it. If the bullet had opened up the belly and exposed intestines, it was certain that peritonitis would follow. What was to follow was death. The only question was how long would death take and how much pain would the poor soul have to suffer. Surgery was not an option. About al the gun shot victim could do was pray and wait. On some occasions a bullet would lodge in the fatty tissue and work its way back out. In some cases no organ would be damaged and the person would go through life with a bullet lodged inside. however for most it was a slow lingering death from infection or internal bleeding.

Gun shots to the arm or leg could also prove fatal due to infection. Bullets had a nasty habit of pulling strands of filthy cloth into the body along with a note so sanitary bullet. most bullets were made of lead and often contained impurities. the act of firing the bullet from a pistol or musket did not as a common myth suggests, sanitize the bullet. They were dirty little balls of lead and would almost always lead to some kind of infection.

If the bullet hit a bone, amputation almost certainly followed. There was no way to set a bone that was shattered by a bullet, and the bone fragments were known to lead to infection. The only way to save the victims life was to take off the limb.

As for a gunshot that did not shatter a bone or injure organs, it was usually removed if the doctor could see it or feel it under the skin. Most doctors probed for bullets using their fingers. Once it was found they might use a bullet extractor or knife to cut out the bullet. Afterwards, the wound would be allowed to bleed in order to wash out any cloth and in hopes of preventing infection. Finally the wound would be sewn up, if necessary, and then bandaged.

[Salty Dog]

Splinter wounds

Before you email me and tell me Myth Busters proved that splinter wounds didn't happen please read the following historically documented cases of splinter wounds:

Dead and wounded littered the deck, cut down by cutlass slashes, gunshots, and flying wood splinters gouged from the deck and rails by the hail of bullets. Loyall leaned exhausted against an aft cannon, himself bleeding from a splinter wound.

-- (Historynet.com. American Civil War, the Bern Raid)
[Richard Dale]joined John Paul Jones's squadron as master's mate. Jones soon made him the first lieutenant of the Bonhomme Richard, and in that capacity he fought with distinction in the famous battle with the [HMS] Serapis, on 23 September 1779, and received a severe splinter wound (caused by large flying splinters of wood blasted out of the hull by enemy cannon shot).

-- (Biographies in Naval History, Commodore Richard Dale)
During the battle, the air was thick with an infinity of savage wood splinters sent flying by the impact of the cannon balls shot through the wooden bulwarks. Projectiles of every kind imbedded themselves into human flesh; the slaughter was appalling. We have some details of the wounds suffered by the Shannons. The purser, George Aldham, grape shot in the lower part of the abdomen (lived one hour);... Private Dan Neil (Marine), splinter wound in the breast, several sabre wounds, bayonet wound in the belly -- the list of these men and their awful wounds goes on and on. Upwards to a 100 men on both sides who died on account of this twelve minute battle, all with the same sort of dreadful wounds

--( History of Nova Scotia, Book #2: The Awakening. Part 5, The War Of 1812: Eastern Theatre. Ch. 12 - "The Shannon and the Chesapeake," Part 2.)

Bainbridge suffered two wounds during the fight. Early on a sniper's ball struck him in the hip; and, later, he sustained grievous splinter wounds when a cannonball shattered Constitution's wheel.

-- (Dictionary of American Naval Fighting Ships, Bainbridge)
I could go on but I don't have the time or patience to look up the numerous cases of people wounded and killed by splinter wounds. There are literally hundreds of documented cases of people receiving grievous and even mortal wounds from wood splinters during a naval engagements. As much as like Myth Busters, the historical evidence proves that splinter wounds did happen and they were known to be lethal. I'm sure not every cannon ball that hit a deck caused splinter wounds. I'm just as sure lethal splinters were produced. Multiple cannon shots were bound to weaken the structure and causing splits in the wood. Follow up shots could then dislodged large splinters and greater speed than if the wood had maintaine dit's solid integrity. Myth Busters experimented a six pound cannon ball. They mentioned it would be ten times more lethal that the three pound ball. The long nines, were the chaser guns on many fighting ships firing a nine pound ball. Ships-of-war were often armed with 24 and 32 pounders. Pirate sloops often were armed with anything from 4 to 12 pounders. A salvo of 12 pounders followed up four minutes later by a second salvo could very well produce lethal splinters simply because the integrity of the ship's hull had been compromised . The historical evidence is proof that it did happen. The inability for two TV personalities to replicate a naval battle is not sufficient to debunk the factual record of splinter occurences.

While it is open to debate if more sailors and/or pirates were killed by splinter wounds than solid cannon shot, the splintering of the decks and sides of ships was well known and was considered one of the benefits of using solid shot against sailing ships. After repeated shots, the sides of sailing ships could be beat up bad enough that large splinters, well over a foot long, could be dislodged and become lethal wooden missiles. Smaller less deadly splinters could take out eyes or cause serious lacerations. If the splinter broke off in the process of pulling them form a body, infection would almost certainly follow. Often the only way to remove some splinters was by cutting them out. If the splinter went deep into the abdomen, the only way to safely remove it was by trying to pull it out. This was not always possible. Deep splinters to the vital organs were a slow and painful death. I'm sure the men who suffered such wounds wished they would have been a myth!

[Salty Dog]

Infection & Mortification

It was important for both physician and surgeon to know the difference between infection and mortification. Infections could get better but mortified skin had to be removed. The most common way to remove mortified skin was through amputation when possible.

Today, we know that an infection is an invasion of a host by some foreign object. Typically this means inflammation caused by fungus, bacteria, or a virus but it can mean many other things. For instance, Colds are viral infections, athletes' foott is a fungal infection, and strep throat is a bacterial infection. Any numerous types of germs can cause wounds to become infected and in the 18th century almost all gun shot wounds would get infected to some degree. 18th Century doctors had no understanding of what caused infections. They did however know that wounds became infected. They referred to the discharge of an infection as laudable puss. Today, we know laudable puss as white blood cells in a wound fighting off an infection. In the 18th century this was considered a part of the healing process and in some ways it is. It is the body's attempt to fight off infection.

The puss was drained as part of the normal care of the wound. This was good in that they were also removing some of the infection but even draining the puss left it up to the body to fight off the infection. Laudable puss smelled foul but it did not smell like dead flesh. With luck the puss would eventually drain and the person would get better.

If the person did not get better, one of two things could happen. The infection could spread through the body via the circulatory system and the patient would die. Or the wound would mortify.

Mortification occurs when the wounded area no longer receives enough blood or air in order for the tissue to sustain itself. The most common term for mortification is gangrene. Gangrene (tissue death) is the rotting and decay of the flesh or body parts caused by infection or thrombosis or lack of blood flow. Typical sign of mortification is the stench of dead flesh, a blackening of the skin and painful swelling. The most common form of gangrene involving gun shot wounds or amputation was gas gangrene. Today we know it is caused by the clostridium perfringens bacteria. It spreads quickly and is still often fatal.

[Salty Dog]

Quackery

There is no doubt that by claiming quackery to be the Alternative medicine of the 18th Century, some people who practice by alternative therapies will be outraged. With that said, I will move on.

In some instance, just as today, Quacks actually did find useful remedies to health issues. However most quacks pedal ineffective medicines or therapies that had no positive effects and in some instances caused harm. One such Quack named Franz Mesmer used "magnetized rods" that were placed on the skin to cure all sorts of ills in 1734. Does this sound familiar? It should. 300 years later magnetic bracelets were being sold by the thousands despite no medical proof of actually working. Benjamin Franklin a man with a keen understanding of electricity was instrumental in debunking Mesmer's theory when it was first introduced.

Touching was a form of quackery in the 18th century. It was believed that royalty could cure disease simply by laying hands on an individual. Today the practice exist in the form of faith healers. While their are documented case of people being healed by such practice, there is no medical proof of being healed by simply by being touched. Even the Catholic Church dismisses the practice.

Other forms of quackery were more successful yet ignored by the medical profession. Today some of these quack remedies have proven to be beneficial and have been accepted as good medicine. For instance, the medicinal qualities of certain herbs are well founded today and vitamins are accepted necessary for good health.

Quacks were most successful at treating scabies which shows that even in the 18th century there were instances where the practitioners of alternative therapies were a step ahead of the established medical field. However for the most part quackery was dangerous, ill founded, and seen as the last hope of desperate patients who had no where else to turn.