Medical advice

 

In what seems like a hundred years ago, when I arrived to do a single-handed GP locum in Tongue on the north coast of Scotland, I asked the soon-to-be-going-on holiday GP what in particular I needed to know — "fish hooks and midge bites" he replied: "To get a fish hook out of the skin, often on the face, get some pliers and cut the shank so you can then pull out the barbed end forwards as it were, and then the tail end backwards. Do not — repeat not — try and pull the whole thing out backwards!" And: "For itchy midge bites, antihistamine cream and smear it on" (he had a very large tub of the stuff). Mind you midges are seldom, if ever a problem at anchor, provided you don't anchor in summer on a calm night right under trees.

 

Emergency care:

 

For a real emergency in Scotland, dial 999 if you are in mobile range. For less urgent things phone, phone 111 for NHS 24 where you will get appropriate advice (but sometimes they do take their time to answer). Of course, at sea and out of mobile range, there is the ever-helpful coastguard on channel 16.

 

Medicine chest:

 

For doing your own thing, stock your medicine chest, which should be in a watertight box of some sort, with: 

-  Pain killers (paracetamol, aspirin, Brufen/ibuprofen)

-  Anti sea-sickness medication (anti-emetics) — discuss with your local

pharmacist, particularly if you are on other medications

-  Triangular bandage

-  Crepe bandages

-  Melolin dressings

-  Micropore tape

-  Waterproof elastoplast

-  Cotton wool

-  Gauze swabs

-  Steristrips to hold minor cuts together

-  Glue for bigger cuts

-  Electrolyte solution for oral rehydration

-  Antihistamine cream

-  Sunblock and lipblock (yes, even in Scotland)

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Cuts at sea are common and don't heal well if exposed to salt water every day. To minimise the risk of infection, wash the wound in fresh water and protect as best as possible with plasters/micropore etc. Also if you have the know-how, suturing (or a steristrip) makes a cut waterproof and less prone to infection.

 

More challenging problems:

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Think about a urinary catheter and lubricating jelly for the prostatic older male crew. I have heard of situations where this would have been helpful, and there was a doctor on board who would have known how to use a catheter if it had been available.

 

How much minor surgery you want to do is up to you, but if you are competent take, if you can get hold of them: some sutures, local anaesthetic, syringes and green needles, artery forceps, scalpels, tweezers which have many other uses, and scissors (as well as the boat scissors). I wouldn't try a general anaesthetic if I were you, but the more adventurous doctor, nurse or paramedic could take a face-mask and oropharyngeal tube maybe. A battery-powered cardiac defibrillator might be reassuring for the older crew (available from Amazon I believe).

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Seasickness

 

Mal de mer, also known as seasickness, is a vile problem for some, never a problem for others. As with all medical disorders, this must be partly nature (your mum had it) and partly nurture (your mum vomiting up gave you ideas of doing the same, helped along by over-anxious parents). It can be avoided by sticking to the canals, but that is a bit dull. So what to do?

   

- On deck, wrap up well to keep warm and dry, and wear gloves in any weather likely to be a problem. Look at the horizon, steer the boat.

- Do not go down below when at sea if at all possible. If you do then quickly lie down on a warm and comfortable berth as near the centre of the boat and as low down as possible, close your eyes and go to sleep.

- Take any preventive medication (stugeron, scopaderm patches or whatever) an hour before you set off, certainly well before you are likely to feel sick, but beware drowsiness.

- Do not expect to be sick (tricky), look at the horizon, keep warm and dry, take the helm.

- Some people find dry biscuits help, or rusk-like things (Bath Olivers if you are posh), others swear by ginger (neat, or in biscuits, or as a drink).

- Keep hydrated.

- If you are apprehensive, say about leaving the harbour, this will make seasickness worse.

 

If you do get sick:

   

- Go down below, lie down, get warm, use a bucket, go to sleep if you possibly can, and pray for landfall.

- Don't get dehydrated, take frequent small sips of what you fancy (other than alcohol).

- Vomit over the lee-side please (that is the downhill side).

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And don't feel embarrassed if you are sick, even Nelson and R T McMullen, who was one of  the toughest Corinthian sailors, suffered: “No amount of motion on deck affects me, but battened down below with the charts and books, bending over the table, and clinging to it for support in a small vessel sailing 7 knots in the trough of a heavy sea, is a position that would severely try the arch-enemy himself, even without the additional discomfort of wet clothes, and privations of all sorts that poor mortals have to endure”. (Down Channel, 1893).

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Our own boat record is 22 sicks amongst the three crew between Stromness and Westray, largely due to swell and not enough wind. But the sun was shining, recovery as ever was quick once we reached land, and we are all still sailing. I myself do occasionally feel sick, once rather surprisingly just downstream of Tower Bridge with all the chop from the tourist boats dashing here and there.

 

If you fall overboard:

 

To conserve heat, cross your arms across your chest and tuck your knees up under your chin (much easier if you're wearing a lifejacket, which you should be). If you're with two or more others, then huddle together in a circle facing inwards so that the sides of your bodies are close together to conserve heat (may not work in rough seas because you could just crash into each other).

 

Medicine has clearly moved on from the late 17th century when Martin Martin wrote about the Hebridean cure for "faintness of spirits". The patient was laid face up on an anvil when "the smith takes a big hammer in both hands, and making his face all grimace, he approaches the patient; and then drawing his hammer from the ground, as if he designed to hit him with his full strength on the forehead, he ends in a feint, else he would be sure to cure the patient of all disease; but the smith....has a dexterity of managing the hammer with discretion; though at the same time he must do it so as to strike terror in the patient; and this. they say, has always the desired effect". If this is really true, then the diagnosis might have been what we would now call 'functional', in other words there are symptoms but no recognisable disease. Some would think the patient is malingering but mostly the view is that the patient is not, and that in some way the unconscious mind has persuaded the conscious mind that the symptoms are real. Indeed, to the patient they are indeed very real. This 17th century treatment was what some would label as 'a kick up the backside', and may still be favoured by ignorant and unsympathetic doctors.

 

(Thanks to GP-daughter Margaret for her help with this page, she knows much more about these issues than a retired neurologist like me)