Research of less-than-desirable topics (wounds, wound complications, etc.)
February 23, 2020 at 10:08 pm #107137February 27, 2020 at 5:12 pm #107489
DOGGON IT I ACCIDENTALLY DELETED MY PREVIOUS ANSWER, HERE WE GO AGAIN.
So as a nursing student and an amateur scholar of medieval history, I can speak a little into this. The appearance of the wound depends on the stage of infection and what caused the wound in the first place: [Laceration (a cut)? Puncture? Burn? Pressure ulcer? Crush cut (blunt trauma coupled with breaking the skin)?]
I’ll assume the wound you’re thinking about isn’t a pressure ulcer caused by sitting too long, but probably either a deep cut or a wide puncture (sword / arrow / knife, etc.). The infection is going to most likely stem from invading bacteria or fungus infiltrating the local site of the wound. In just about any infected wound, the area around is going to appear red and swollen and most likely feel hot to the touch; this is the body’s natural immune reaction to foreign bodies (germs) getting in under your skin. Phagocytosis is going to result in the creation of a lot of extra pus as the immune system’s local white blood cells tries to eat the bacteria plus any infected tissues, then commit suicide and turn into that lovely goopy yellow-white puree, destroying whatever they ate. Certain bacterial, fungal, and amoebic infections can cause the pus to change colors, from green to bright yellow to brown, as well as texture, from creamy to that of anchovy paste. This will be the most visible sign of internal infection in an open wound. Furthermore, the wound is going to absolutely reek. Here your imagination is going to have to suffice, as I personally can’t smell; imagine the rankest, dankest smell you can. The smell of an infected wound is the smell of active, rapid decay.
While eventually pus will be drained away, it can accumulate faster than the body can get purge it through the lymphatic system, resulting in local swelling into pimples; if they’re big enough or causing pain, you can lance them. In addition, on the exposed surfaces of the wound (the inside of the cut) you’re going to see ‘slough’ or necrotic (dead) tissue (often has a leathery, crusty texture).
Apart from pus, some infections (e.g., funguses like athlete’s foot) do produce fruiting bodies – patches of bright coloration, depending on the fungus or mold – you may see white, green, yellow, or blue. Dead skin on more superficial wounds will appear bright white-yellow if it’s wet, or yellow and crusty if it’s been left too dry. A cut or puncture will feature slough especially on the bottom and sides of the wound, while the upper portion may or may not show pinkish raw tissue as a sign of regeneration, depending on whether the infection or the immune system is winning.
Uncontrolled, the infection will generally spread radially until it reaches a capillary or an artery, at which point you’re going to see inflammation and pus build-up spreading systemically through the bloodstream. This would be the streaking you’re referring to, and this is a sign that things are going very, very, very badly.
If the infection gets into the bloodstream and you don’t have modern antibiotics or some kind of magic, you’re most likely toast. While medieval surgeons were far more knowledgeable than we give them credit for, using mandrake root for an anesthetic and honey, arsenic, and alcohol for antiseptics and tourniquets to staunch bleeding during emergency amputations, antibiotics simply didn’t exist in those times. The best they could do with any sort of systemic infection was to give you whatever herbal remedies they thought might help (which might also kill you) and administer last rites. If initial infection was not prevented, the only thing that could save you was your own natural immune system and prayer.
Let me know if this was helpful or too long.
Non nobis Domine, sed nomini, Tuo da gloriam.February 27, 2020 at 9:48 pm #107511Anonymous
Well that was incredibly informative!! Bravo! I almost threw up but it was so worth it.
So wait…. They used arsenic?!?
I might have about twenty other questions for you as well.February 27, 2020 at 11:15 pm #107514
@the-inkspiller YOU ARE AMAZING AND ARE MY FAVORITE PERSON RIGHT NOW THANK YOU SO MUCH and I have deleted long posts before on accident and it’s awful I’m so sorry XD
Ok so I’m not even kidding when I say that what I just read was a heck ton more useful and extensive than what Google gave me thankyouthankyouthankyou!!!! No, that was not too long, and yes, incredibly helpful!
Questions: How long after the infection reaches the bloodstream will you die if left untreated? Will amputating (in my character’s case, the arm) do any good, if done before the infection gets up further than the arm? You mention mandrake root for anesthetic… what extent of pain does that keep you from feeling? Shallow knife cut? Broken bone? Just a bruise? The pus in the bloodstream… does it block bloodflow? And can it be kinda stringy-ish? So like, could someone (conjuring up a bit of a gory image here, my bad) conceivably pull it out of some of the larger veins? Can you give me an example of something that would result in a crush cut?
Also, here’s what happened to my character. I’ll have a couple follow-up questions…
Scenario: Character has broken arm. Uses a poultice on it (meant to dull a bit of the pain) and is allergic to some of the herbs used. The reaction she has to them is her skin kinda being eaten away (think like acid-ish) in a small spot (about two by two inches) and resulting in an open wound that’s not much worse than the skin scraped off in the spot. Then that gets infected. On top of her broken arm.
How much pain is she in? How clearly should she be thinking? What is the best thing that a healer can do for her at this point/ can she be saved / is it worth trying to save her if there’s a slight possibility? (The setting of my story is medieval-ish, and this particular healer has a very limited use of magic. It’s complicated, so let’s just assume no magic, but plenty of herbs and things available.)
I think I had a couple more questions but I forgot them lol. I’ll remember later. But thank you again!! 😀 😀 😀
@deeprun Yup, they used to use arsenic lol. Kinda counterproductive if you ask me XD
“Enough! Be quiet! I can’t hear myself think! I can’t hear my teeth chatter!"February 28, 2020 at 12:18 am #107519Naiya Dyani@naiya-dyani
Have you guys ever thought about how awful it would be to live back then. . . heck, I get super anxious just going to the dermatologist these days. XD
Hearts are like matter--they can be beaten down, torn, and burned, but they cannot be destroyed.February 28, 2020 at 1:39 am #107526
Realized I glossed over your poison question and thought I might give it a brief whirl. Long-term effects depend on the nature of the poison. Neurotoxins (like say, the venom of many snakes and spiders) which attack the nervous system may lead to rheumatism, loss of sensation, weakness, and even permanent paralysis around the site of the original bite.
Some snake venoms are instead cytotoxins, attacking the victim’s cells instead of hijacking / paralyzing the nervous system. Of this group, some specifically attack the muscles of the heart, causing fibrillation (irregular heartbeat) or heart paralysis – and most likely a heart attack to one degree or another. Any heart attack whether caused by poison or your own poor life choices is going to leave lasting scars on the heart from dead muscles (which died due to lack of oxygenated blood because the heart stopped pumping). This could easily fill in for chronic heart pain like you described (also called angina) which would in fact flare up under strenuous activity (in which you stress the heart beyond its limited ability to keep up with your body’s demands, so it overexerts itself).
So, yeah! Maybe he was bitten by a black mamba and survived! Somehow! 😀
Non nobis Domine, sed nomini, Tuo da gloriam.February 28, 2020 at 2:05 am #107527
Glad to help! Hit me up with questions any time, both of you!
DOGGONIT THE WEBSITE DELETED IT AGAIN AFTER I PRESSED SUBMIT. OKAY.
HERE WE GO AGAIN.
From the top:
1) You might live for a week or two at most. Feasting on your oxygen rich blood and spreading to all your vital organs – death is almost assured without antibiotics, and quite likely even with them.
2) Amputation might save her life if they notice her wound looking gnarly before she starts experiencing systemic symptoms (chills, fever, shallow, rapid breathing and rapid, ineffective heart beat).
3) Mandrake root (part of the nightshade family) would put you right out. It’s not the kind of anesthetic where you can still function; you’ll be asleep for the duration of its effect, but you’ll be feeling pain once you wake up. Using mandrake root excessively can cause cessation of breathing, which you might imagine is a pretty bad thing. If your character needs to be up and doing things or having important conversations, opium or good-old fashioned alcohol are probably your best bets.
4) Pus does not typically gather in the bloodstream, but in lymph nodes and local to the infection site; bloodflow is obstructed by the destruction of red blood cells (eaten by the bacteria), toxins created by the bacteria in the process of eating your body, as well as toxins produced to defend the bacteria from your immune system.
Pus is usually more liquid than solid (even if it’s pretty gooey), so it would more likely leak or squirt rather than be pulled out with tweezers. Thank goodness. 😛
5) A crush cut might come from being hit with something like a spiked war-hammer, or a massive blunt object like a hundred pound bar of iron; it could also look like the aftermath of an open compound fracture, where the bruised flesh (which now looks like tenderized beef) is caused by the blunt force which broke the bone; the broken bone then acts as a blade, cutting through tissue and breaking the skin, potentially with externally visible bone. This is a very, very ugly wound, and it’ll likely look worse before it’s better.
Examining your character’s wound and infection:
1) The allergic reaction sounds a bit like a less terrifying, localized version of Toxic Endothelial Necrosis, where your entire skin system basically peels itself off your body, leaving you looking like a human piece of beef jerky.
2) The wound it leaves sounds similar to a second degree burn or a stage 2 / stage 3 pressure ulcer, depending on whether it’s only the skin that’s lost or any underlying fat tissue as well. The shallow nature of the wound will delay its progression to sepsis.
3) The area of the wound is going to hurt, a lot. It’s going to be red, swollen (probably a walnut sized lump), hot to the touch, possibly leaking pus mixed with slough and scabs constantly (together called exudate). She’ll probably have trouble concentrating in all that pain, but she’ll still be cognizant of reality.
4) However, if she’s reached septicemia (blood infection), she’s going to be running a high fever, chills, rapid breathing and heart rate potentially with fibrillations; low blood pressure, cold body, pale, clammy skin, nausea, vomiting, potentially diarrhea. With her body systems failing under the weight of infection, she’s going to be delirious and likely only lucid for certain periods of time (most likely when the fever is mitigated by external conditions, like a cool breeze at night, etc.)
5) Given a shallow wound like that, if the infection is caught before it goes septic, the healer might be able to save her by sterilizing the wound. A possible course of treatment might look like this:
6) Debride and drain the wound (remove all the slough and remove as much pus as possible), sterilize it with high purity spirits or a solution of arsenic emulsified in some other inactive ingredients like lard, alcohol, or bile (yes, that’s stomach acid), then pack the wound with a dressing composed of turpentine, honey, and spiderwebs, compressed under a tight dry bandage, or one soaked in brine (saltwater). Change the dressings daily and continue to cleanse and reapply the above remedies until the infection recedes. Bear in mind that any touching of the wound is going to hurt like a million bee stings, let alone pouring alcohol or spreading arsenic all over your exposed tissues. This might be a situation in which you use mandrake root for some nice sleepy time….
Hope this was helpful! Feel free to hit me up with any research questions, not just ones about medicine or wound care! I can always stand to learn more.
Non nobis Domine, sed nomini, Tuo da gloriam.February 28, 2020 at 10:21 am #107530
Is it weird that I’m enjoying this topic?
Gotta question for you. . .
One of my characters gets attacked and severely hurt by a Moonwolf (basically a werewolf) and the other character can’t do anything to help him.
How are some ways the wounds could get infected within twenty-four hours?
And how could it be treated in a realistic way?
“Tears sparkle like fallen stars, the world at our fingertips, We didn’t know, It wasn't happiness.February 28, 2020 at 12:15 pm #107535
*reads all that twice, grinning* Marvelous! Thank you!!
And hm… *reads your answer to the fourth from the top* Dadgummit! Gotta rewrite a scene… XD
*realizes I knew next to nothing about the amount of pain that one would be in under those circumstances* Heh. *goes off to rethink two to four chapters of my book*
Ok so here’s another question… Would you mind reading over a few of my chapters and seeing if what I’ve written is even close to being realistic, and giving me a bit of feedback on how I could make it more so? If not, that’s totally fine! But I just realized it’d be easier than trying to describe exactly what’s going on. (I think the max number of chapters would be like three or four. My average chapter length is 2000 words. Ish. Somewhere around that.)
@urwen-starial Not at all! XD …Well, authors are their own type of weird, so maybe it’d be weird to other people, but among us authors…? Nah.
“Enough! Be quiet! I can’t hear myself think! I can’t hear my teeth chatter!"February 28, 2020 at 12:16 pm #107536
@naiya-dyani Oh my word, I know right??! XD
“Enough! Be quiet! I can’t hear myself think! I can’t hear my teeth chatter!"February 28, 2020 at 12:24 pm #107537
@urwen-starial So, I’m no expert on wounds inflicted by lycanthropes (lol), but I can say a little bit about animal bites and scratches.
Symptoms of local infection will be initially indistinguishable from the usual immune reaction to an open wound for the first twenty four hours. The thing about animal attacks is that animals are already quite filthy: a scratch or a cut from animal claws can fill the wound with whatever packed dirt, bacteria, or fungus that just happens to be growing on that claw; a bite will spread a lot of saliva over the wound, which is absolutely loaded with parasites and bacteria and will quickly lead to infection unless the wound is cleaned. Aside from that, getting dirt in it or sneezing on it – just about anything can cause infection in a wound.
Immediate first aid once the danger has passed would consist of cleansing the wound with clean water, vinegar, or alcohol, then applying a tight bandage around the wound to stem bleeding and keep it covered from any further contamination by your local dirt. Oak sap and juiced oak gall (a sort of apple-like tumor created by the larva of certain wasps that next in oak trees) are known astringents – that is they cause local tissues / cells to contract, reducing bleeding from wounds and promoting regeneration of tissue (the wound will close back together – albeit slowly. Like days); these substances would be useful in the absence of the skills or supplies necessary for stitching the wound closed. Along the same lines, it was common in the medieval era to pack wounds with poultices / compounds of different known and rumored healing agents, including anything from honey (a known antiseptic), turpentine (also an antiseptic, if one poisonous to ingest), to clay (river clay is generally cleaner than dirt due to the purifying action of running water), ground shellfish (I really don’t know), and spiderwebs (natural astringent / ooagulant and antiseptic).
A tourniquet could also be applied to reduce bleeding, as long as it’s monitored to ensure the extremities (i.e., fingers) aren’t turning blue due to lack of blood.
Non nobis Domine, sed nomini, Tuo da gloriam.February 28, 2020 at 12:27 pm #107538
Thanks, that makes a lot of sense. Thanks again.
“Tears sparkle like fallen stars, the world at our fingertips, We didn’t know, It wasn't happiness.February 28, 2020 at 12:33 pm #107539
@anne_the_noob14 Sure! Give me a link and I’ll give it a read. I likely won’t be able to get to it tonight – I’m going to be on clinical rotations from 1 – 9 EST and I’ve little idea what to expect from the day. But send the link to your stuff, and if you don’t hear anything back from me, tag me tonight or tomorrow and bugger me until I get back to you. I’m a very forgetful person, so I won’t be bothered if you remind me to do something.
If you wouldn’t mind – you and all the other lovely people here – I have a story that could use some beta-reading. I say story, but it’s about 27k words, so more like a novella, which will eventually become a part of a novel. Part of the reason I’m such an Encyclopedia Edward right now is because I just wrote a scene in which a character received these same kinds of treatments for various wounds AND is fighting off an infection throughout the story, but I could use help looking at the story as a whole and seeing if it’s adequately weaving themes and motifs in and out; if the characters are compelling and interesting; if the action is followable; and if the ending is even remotely satisfying. 😛 Let me know if you’re interested and I’ll drop the link in my next post.
Non nobis Domine, sed nomini, Tuo da gloriam.February 28, 2020 at 12:38 pm #107540
I’m always willing to read stuff!
If you want me to, I’ll do it gladly, I’m not very busy this weekend. 🙂
“Tears sparkle like fallen stars, the world at our fingertips, We didn’t know, It wasn't happiness.February 28, 2020 at 12:48 pm #107543Anonymous
Story Embers has given me such grief with evaporating posts that I now copy everything of length before posting it. Take that technology.
Is there a word that describes a joyful revulsion? It’s thrilling to read such beautifully descriptive info on things I’ve tried in vain to research. Yet, I can only read in small chunks so I don’t vomit on the keyboard. It’s such a worthwhile trade-off. Take a hike Pinterest infographics, we’ve got the real deal.
I’d be very happy to read anything! I was going to actually see if you needed beta reading because I might… Well, I do have a list of half mangled characters from a medieval era that need someone with more expertise (and a stronger stomach) than myself. I’ve bashed them up but not sure how to pull them through! I’m also willing to trade artwork/character sketches in exchange for access to Encyclopedia Edward on medieval mayhem.
Arsenic… I’m still fixated on that.
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