After an hour and a half of climbing through dense thickets of maqui, blackberry, ferns and higueras - while dodging dive-bomb attacks from robin-sized hummingbirds - I finally neared my goal: the saddle of the 1,800-foot volcanic ridge named Selkirk's lookout. The place was Robinson Crusoe Island, 670 km west of Valparaiso, Chile, where Alexander Selkirk was marooned in 1704 and survived for four years in isolation before finally being rescued.
As every student of literature knows, Selkirk's survivor's spirit inspired Daniel Defoe to pen his enduring classic, Robinson Crusoe. Today, 278 years after first being published, readers - especially sailors - still marvel at this old-time seaman's ability to improvise.
I celebrated Selkirk's inventiveness by reading from Crusoe on 'his' mountaintop: "I have given up making boats of wood, which cost me too much time and effort. I have simply stretched goatskins over the solid framework of osier (willow)... Instead of an anchor, I have caged a large stone in a net I have woven. My hooks are curved nails shaped with a hammer… There is nothing that I have not done with my own hands…"
Creativity is the soul of improvisation and in situations where illness or injury threaten, it can save your life. There's no substitute for a well prepared medical kit and the skills to use it, but there will be times when even the best laid plans won't cover all circumstances. So let's take a look at how common items found aboard a typical ocean-going vessel can be utilized in a medical emergency. Many of these inno vative uses have been 'borrowed' from gurus of wilderness medicine - but as we all know, stealing from one source is plagiarism, while stealing from many is research.
GENERAL STUFF AROUND THE BOAT
"In the long run, all solutions are temporary, so go ahead and use duct tape." - Garrison Keillor
To make eyeglasses: If you're myopic (nearsighted) and your only pair of glasses goes overboard - you didn't bring a spare? You can improve your vision by simply taking a strip of duct tape, folding the sticky sides against themselves and making a number of pinholes that line up with your pupils. (Since poking yourself in the eye with a needle would only add to your misery, we suggest you measure your pupil-to-pupil distance ahead of time and make the pinholes before placing your new 'glasses' over your eyes. (A piece of cardboard can also be used.) You'll need to make quite a few holes, since pinhole glasses decrease illumination and peripheral vision - so experiment.
For strapping sprains and fractures, and for making splints: Your imagination is the only limitation to the ways you can build splints, straps, and supports out of duct tape and stiff materials such as leeboards, oars or paddles.
To make wound closure strips: Duct tape cut into thin strips (1/8" or 1/4") can be used to close large wounds (in lieu of butterfly bandages). To assure good adhesion to the skin you can use cyanoacrylate glue (Super Glue) along the wound edges. Be aware that some people are skin sensitive to duct tape.
For wound closure: In addition to the above, Super Glue is especially useful in small lacerations where there isn't a lot of tension on the wound (i.e. facial lacerations, cuts on the back of a hand, etc.). Technique: hold the edges of the wound together, apply a thin layer of glue over the entire wound (but not inside the wound); continue holding the wound closed for 60 seconds. Be careful not to get glue on your own fingers. Re-apply on a daily basis until the wound heals. Glue residue on the skin will disappear after a few days.
For tooth repair: Your dentist may hate you for it, but if worse comes to worst and you absolutely need to replace that lost filling or cap, this stuff will do it. See below (candle wax) for a very temporary alternative.
For abrasions on fingers: Ever been bothered by cracks and splits on fingertips from handling saltwater soaked lines? Daily application of a thin coat of glue to the cracks will prevent further pain and chafing.
For removal of 'foreign bodies' from the ears or nose: So maybe there's a three-year old on board who loves to put little 'things' up her nose or in her ear - things like beads or beans. Drop a dab of glue on the end of a toothpick and hold it against the foreign body. Wait a minute then pull. It's an ER trick I've used many times, and It works.
Lee Boards, oars, paddles
For splints: When used with duct tape, they can make excellent splints. When you add spare blocks and line, a traction splint can be made.
Candle wax (paraffin)
To make a dental cap: Melt the wax and immediately mix with a few strands of cotton. Then, while still soft, apply to the tooth to make a temporary dental cap. Bite down gently until hard. Usually lasts about 24 hours, after which the process must be repeated.
Old Shirts, Sweats
For dressings, slings and bandages:
Where sterility is not essential, tear up clean shirts for bandages. If sterility is important, such as in burn dressings, the cloth can be boiled and then dried in the sun or oven.
For use with poultices:
A poultice is something we don't see much anymore, but in certain circumstances can be extremely useful. For example, how many of you have ever had a mustard plaster applied to you? Now that medicinal plants are making a comeback (see below), it is useful to know how one would make a poultice. Crush the medicinal parts of the plant to a pulpy mass, apply to the affected skin area, and cover with a wet, warm cloth (shirt strips). You may mix this with flour or corn meal to make a sticky paste. If the plant has the potential to irritate the skin, smear the paste between layers of the cloth to prevent direct contact with skin.
Use as padding for splints.
Clothing made of Polartec®, Gortex® and similar fabrics make excellent padding for splints and dressings where there is a real possibility of the material getting wet. The natural 'wicking' effect of these materials tends to keep the skin beneath drier than if cotton is used.
STUFF FROM THE HEAD
Many uses: Safety pins have a variety of uses. However, as Dougal Robertson points out in his book, Survive the Savage Sea, they can get loose in a liferaft and raise all sorts of havoc with the inflatable tubes. Nevertheless, they can be indispensable for improvisations such as: popping blisters, making fishhooks (but real fishhooks work a hell of a lot better), removing splinters, when heated they can relieve a subungal hematoma (that painful black and blue area under your fingernail you get when you smash it with a winch handle), replacing lost screws in glasses, holding a sling together, poking holes in duct tape or cardboard to make eyeglasses (see above discussion of duct tape), holding dressings in place when you run out of tape, punching holes in a Zip Lock bag to make an irrigation device (use to irrigate wounds).
Nose-bleeds: The use of tampons for packing (with petroleum jelly or zinc oxide ointment) for nose-bleeds should be considered. OB brand 'slenders' are just the right size.
For lubricating dressings: Some dressings need to be 'non-stick'. The previous example of nasal packings is just one.
To shave areas of skin Irritated by jellyfish stings, sea cucumbers, sponges, fire coral or sea anemones.
Use diluted (1/4 strength) as a soak to jellyfish stings, sea cucumber skin irritations, sponge skin irritations, fire coral, or sea anemones stings.
STUFF FROM THE GALLEY
Fungal Infections (i.e. athlete's foot, 'crotch rot', ringworm, etc.): Can be used to make a poultice (see above) for fungal infections. It has also been recommended as a poultice suppository for fungal (yeast) vaginitis.
Bacterial infections: Of historical note, Louis Pasteur first described garlic's antibiotic properties back in 1858, and Albert Schweitzer used it for treatment of amoebic dysentery in his African clinics. It was used extensively as an antiseptic poultice to prevent gangrene in both world wars prior to the development of modem antibiotics. In an emergency it has been recommended for treatment of ulcerated wounds and other skin infections. Medical literature documents its effectiveness against staph, strep, E. coli, proteus, salmonella and K. pneumoniae.
Other uses: Good studies have shown that taking garlic orally on a regular basis lowers cholesterol levels in some individuals. In a cardiac emergency, it can even be used as a thrombolytic (like aspirin).
Seasickness: One of the most documented uses of ginger has been in the prevention and treatment of motion sickness. Recent studies have confirmed its usefulness in the treatment of the nausea of pregnancy as well. The general dose for treatment of nausea is 1 teaspoon of the grated raw root steeped in 4 ounces of hot water for 10 minutes. This can be taken every 30 minutes until the symptoms of motion sickness abate.
Gastrointestinal gas: While not really an emergency, there are times it would definitely be better for the whole boat if a particularly flatulent crew were to be encouraged to rid himself of his excess gas before going below in close quarters. Ginger has historically been used as a carminative (promotes elimination of GI gas.) I cannot personally attest to its effectiveness, but I plan to recommend it for at least one crew I've had the (dis)pleasure of sailing with.
Bugs in ears: Ever awakened in the tropics with something buzzing and crawling around inside your ear? Here's a neat trick. Try pouring a few drops of non-heated cooking oil into the ear. A great study in the Annals of Emergency Medicine demonstrated it killed North American cockroaches in less than two minutes. Now you only have the problem of removing the corpse…
To preserve a lost tooth: A tooth that has been knocked out of the socket can be preserved for up to 24 hours in a small amount of cool, pasteurized whole milk.
Vinegar (5% acetic acid)
Marine animal stings: Apply to jellyfish stings, sea cucumber skin irritations, sponge skin irritations, fire coral, sea anemone stings. (Also consider meat tenderizer, isopropyl alcohol or urine.)
Eardrops for prevention and treatment of 'swimmer's ear': Mix the vinegar 1:1 with fresh water or isopropyl alcohol to prevent or treat otitis externa. Use after every dive.
Oil of Cloves
To numb a tooth: Soak a cotton pad and apply it directly to painful tooth, avoiding gums, lips or inside of cheeks.
To make temporary dental filling: Mix with zinc oxide powder
To numb tooth: Good local anesthetic for tooth pain. Apply directly to tooth.
To stop bleeding from gums or mouth wounds: Take a wet tea bag (not herbal teas) and place it directly against the bleeding site. Hold in place 10-15 minutes.
Also used widely in Great Britain to soothe minor burns and abrasions. Soak area with wet tea bag for ten minutes three times a day.
As a mild sedative or to soothe a tummy ache or to reduce gastric motility and secretions: Put 1 teabag in boiling water, steep for 5 minutes, may repeat 2 times in 30 minutes. Also a great treatment for infants suffering from restlessness and discomfort of teething (infant dosage 1/3 of adult).
As a burn dressing: It was in the mountains of Mexico that I first discovered this beneficial use of honey. A young girl had sustained a large second-degree burn to her back from falling into a cooking fire. Unfortunately we had run out of antibiotic ointments. Then a local healer suggested applying fresh honey. Within days the burns were healing, no infections developed and ultimately she had minimal scarring. Since then, medical studies have confirmed this therapeutic use of honey. (Also, see Oral Rehydration Solution below.)
Meat Tenderizer (unseasoned)
Marine animal stings: As an altemative to vinegar, use on jellyfish stings, sea cucumber skin irritations, sponge skin irritations, fire coral or sea anemone stings. Make a paste with water. Do not exceed 15 minutes application time.
Salt and Sugar
To make a rehydration drink: For treatment of dehydration where fluids have been lost because of heat illness, diarrhea or prolonged vomiting. Based on World Health Organization's ORS (Oral Rehydration Solution). 1 quart fresh water, 1 teaspoon salt, 1/2 teaspoon baking soda, 2 tablespoons sugar (or 1-2 tablespoons of honey). Alternate drinking with 1/2 to 1 quart of plain fresh water.
To shave skin areas of marine animal stings: After application of vinegar has been washed off, then make a paste of baking soda, apply it, and shave with a safety razor. (Also, see Oral Rehydration Solution above.)
Ultimately, improvisation is limited only by imagination. My list is merely a sample of what creative minds have come up with in the past. No doubt there are dozens of other common items which can be employed, and probably dozens of other innovative use for the items above.
Walking down the trail from Selkirk's lookout, I thought again about ol' Robinson Crusoe. It occurred to me that what he did to survive was well within the time-honored traditions of seafaring - the best sailors have never lacked the ability to solve problems in unique ways. Consider this quote from Horace Beck's Folklore and the Sea: "Aboard old-time sailing ships, a barrel full of urine was kept lashed to the foc's'le. Sailors used it to wash their clothes and hair. The one it bleached, and from the other it drove lice. Below decks the aroma was overpowered by more noxious smells, while topside it was blown off to leeward."
Thank God life at sea has now embraced the refinements of modern times.
- Kent Benedict, MD, FACEP
Ed. note: Doc Benedict has a list of credentials a mile long. Despite all his notable achievements In the field of medicine, though, there's almost nothing he'd rather do than go sailing offshore.
This story was originally published in the October 1997 issue of Latitude
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