Wednesday, October 14, 2009

Ancient medicine and burn care

I'm doing a bunch of research about low-tech medical care for a "novel" I'm working on, because it annoys me when doctors in pre-industrial times are portrayed like medieval European barber/butchers, without sanitation or any real idea what they're doing.   The history of medical care is actually really interesting, because it's a story of increases in knowledge intermixed with periods of regression, and an obvious interaction between science, technology, and medicine.

Periodic bans on surgery and human dissection certainly haven't helped, and there has been a lot of trouble with blindly following experts who were wrong, from Hippocrates and Aristotle on down.  Maybe the most famous example, Galen came up with a lot of surgical techniques that really worked, but he also claimed that suppuration was an essential part of the healing process.

So what low-tech treatments really do work?  Meaning anything that doesn't require IVs, a chemistry lab, electricity, or powerful microscopes.  I'm specifically focusing on burns and chemical burns for plot purposes.

Most medical literature deals with low-tech treatments only in the contexts of first aid, before paramedics arrive, or disaster scenarios where there may not be enough medical personnel to provide adequate treatment.

(As a sidenote, I love the sort of passive-aggressive condescension in a lot of this medical literature:
"When a violent fire breaks out, there is an initial moment of psychological paralysis, generally followed by total incapacity for logical thought, and this leads to instinctive behavioural reactions whose one aim is to save oneself and all that is most dear, and reach safety. 6
This sequence of actions not infrequently serves only to worsen the extent of damage caused and to create an even more dramatic and tragic situation. In animals this may indeed be the only reaction possible, which is purely instinctive, but in man there is another option which at first sight may seem almost paradoxical: to keep calm and take rational decisions."

LOLOL  "The options are panic or keeping calm and making rational decisions", no shit you guys.  And this is from the 1990s!)

Anyway.  It seems likely that the most important low-tech first aid for first and second degree burns is cooling the burn with cool water.  The "ten-to-fifteen" rule states that you should cool the burn within 10-15 minutes by trickling cold water (10-15 Celsius) over the skin from 10-15cm for 10-15 minutes.  On the other hand, other sources say that soaking in water can be harmful, because it can cause hypothermia and hypoperfusion/ ischemia, especially in children.  Perhaps the important thing is to keep the rest of the patient dry, as the first one suggests.  I don't understand how flushing the burn with  cool water could possibly cause ischemia; Wikipedia says it takes "Localized extreme cold, such as by frostbite, ice, or improper Cold compression therapy".

Otherwise, it is important to monitor the lungs for extra damage and provide oxygen.  ( should find out if there are any simple ways to distill oxygen for use with damaged lungs.) You have to reduce direct contact between the burn and air, but usually not with tight bandages or fluffy cotton pads, because they can stick to the skin.  If the burn is large or severe, skin grafting may be necessary.

This is clearly a really complex subject.  I wish I had an actual book about it.

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