Stabbing and Recovery

I dunno about catgut, but as long as fire exists, there is cauterization. The word literally means "to burn with something hot." Perhaps if a major artery was severed and cauterization wasn't going to cut it, they might tie it off with something. It seems like that would only be in the case of the severing of an entire limb or something.

What body part are we talking about stabbing, here?

Tri-Injuring Prophet said:

My novel is based in an era comparable to our Renaissance. I heard they tied torn arteries with catskin ligaments, due to not having cauterisation, but am unsure as to the accuracy of this information.

The main question is if a person survived a stabbing, what would be the treatment for the victim, and his process of recovery?

Thanks in advance.

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I have just plowed thorugh a huge number of late Medieval and Renaissance medical sources. Some of the techniques were amazingly effective, considering the resources.

How bad do you want the character to be hurt? Dead? Minor wound? Lingering at death's door for months?

Tell us what the plot requires from the character and it's a lot easier to decide how to hurt and treat them.

A nick to either femoral artery would involve lots of blood, weakness, fainting, and almost death unless someone cauterizes it. This artery is about 1" wide, one on each inner thigh and easy to get to with a rapier through hose worn by the bravos (ala Romeo).

HeronW said:

A nick to either femoral artery would involve lots of blood, weakness, fainting, and almost death unless someone cauterizes it. This artery is about 1" wide, one on each inner thigh and easy to get to with a rapier through hose worn by the bravos (ala Romeo).

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An inch is much too large, that's more the size of the iliacs or even the distal aorta in a smallish adult. Cauterization is a burn. There is thermal denaturation all around the area. This realistically would cause a terrible infection to burn deep enough to stop the bleeding and would require coagulation of the femoral artery to stop the bleeding. If it worked it would almost certainly result in gangrene of the entire leg. Compression is the treatment of choice. Cauterization was mainly used during amputations.

If the character is supposed to be left for dead, a stab to the chest is a reasonable scenario. The attacker will easily assume that a lung is punctured and that the victim will shortly die when they lay there gasping in pain and the spot of red is steadily getting bigger on their shirt. If the blade slides along or just under the rib it can produce a big gash and a lot of blood without violating the actual chest cavity. It also is feasible that such a wound, particularly if made by a puncture or rapier type blade will clot off on its own. The victim passes out from the pain and wakes up an hour or so later weak from bloodloss but wiser for now knowing the attacker. The actual video is probably on the web somewhere of this actually happening. It was in an olympic fencing match (I believe it was 1980?). The tip broke off the Pole's weapon and the Soviets did not contest THAT point when their guy crumpled up like a piece of popping corn in reverse.

Tri-Injuring Prophet said:

I want him hurt bad enough to be thought dead by his assailant, who leaves. He's to spend several months in recovery, or as long as is needed for the injury that works best. He suffered shock during the attack and fell unconsciouss due to bloodloss.

Are these sources on the internet at all?

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Some of the sources are on the internet, but not always in English.

Ah .... a "sucking chest wound" from a stab to one lung would do it - his attacker would see and hear the burbling of blood and air and see the breathing difficulty and think it's fatal, character would be out cold from the pain briefly, and it's fixable with low-tech stuff provided he gets fairly prompt care from a knowledgable surgeon. It also has a recovery time of a couple of months.

What killed people in those days was the inability to safely open the chest, stitch up the major bleeders and close it up again ... if the stab wound missed large veins and arteries you could survive. And if you didn't succumb to infection.


http://en.wikipedia.org/wiki/Pneumothorax (explains the problem)

http://www.tpub.com/content/medical/14274/css/14274_201.htm
http://nv.essortment.com/chestinjuryfir_rmkl.htm

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First Aid:
1) Remove any clothing from the chest area.
2) Seal the wound with either your hand or an airtight non-porous material (oiled or waxed paper or other material)


3) While holding the airtight material over the wound wipe the blood from the surrounding skin. Apply tape to all sides of the material but leave one corner of the covering unsealed. This step allows trapped air to escape when exhaling and prevents air entry into the wound when inhaling.

Usually the vicitm is kept lying down, stabbed side down. May also be sitting up ... whatever gives the least distress. The danger is NOT blood loss, it's suffocation because the lungs stop working.

Pre-modern treatment of this kind of wound (1500's french army surgeon, Ambrose Pare, describes it in a ghastly mix of 1500s Latin and French)

Wound cleansing: red wine rinse to get the dirt out, followed by a dab of olive oil to keep things from getting crusty ... Pare seldom cauterized. Both the wine and the oil have anti-bacterial properties.

The treatment was to insert a tube into the wound to suction off the accumulated blood (legbone of fowl, boiled in vinegar to remove calcium and leave a cartilege tube) and air, then stitch the wound layers - the muscle layers, then the fatty tissue, then the skin (with freshly boiled catgut, horsehair or even silkworm gut ... all of these have to be boiled to make them soft enough to stitch with, which also minimizes infection risk), have the patient exhale as much as possible, and apply an air-tight dressing to prevent more air from infiltrating.

After the wound heals over, any air in the pleural cavity is slowly absorbed ... it takes a while, and the patient is bed-ridden and walking slowly.

Tsu Dho Nimh said:

Ah .... a "sucking chest wound" from a stab to one lung would do it - his attacker would see and hear the burbling of blood and air and see the breathing difficulty and think it's fatal,.

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And rightly so since a "sucking" chest wound is a Tension Pneumothorax, pretty much invariably fatal, not a garden variety pneumothorax which would only be mostly fatal.

GeorgeK said:

And rightly so since a "sucking" chest wound is a Tension Pneumothorax, pretty much invariably fatal, not a garden variety pneumothorax which would only be mostly fatal.

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Uh ... a sucking chest wound can turn into tension pneumothorax, but doesn't always do it. and tension pneumothorax is not invariably fatal.

http://www.nlm.nih.gov/medlineplus/ency/article/000089.htm covers traumatic pneumothorax, such as stabbings, impalement on your own ski poles, etc.

Tsu Dho Nimh said:

Uh ... a sucking chest wound can turn into tension pneumothorax, but doesn't always do it. and tension pneumothorax is not invariably fatal.

http://www.nlm.nih.gov/medlineplus/ency/article/000089.htm covers traumatic pneumothorax, such as stabbings, impalement on your own ski poles, etc.

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Lungs inflate because of the negative air pressure induced by the diaphragm and chest muscles. They do not inflate on their own, at all.
The "sucking" sound is external air being sucked into the chest cavity through the site of trauma. With each breath more is sucked in and with each breath there is a corresponding drop in the effective tidal volume and therefore perpetually and rapidly lowered arterial oxygen. Without someone to put an occlusive dressing on that hole, it will be a tension pneumothorax. (Unless it's a big enough hole that it can't maintain the pressure and then they'd be dead for other reasons) Untreated tension pneumothoroces are invariably fatal. I did trauma surgery for 2 years as an MD at a major regional trauma center. I don't remember anyone surviving who arrived with a tension pneumo, now developing one while at a hospital is another matter. "Hey, you medical students! don't pull that occlusive dressing off until the chest tray is in the room!" (Actually the chest tray is kept in the trauma room for just that reason) They were usually dead at the scene. The only survivors I remember were lucky enough to have had an experienced EMT arrive within minutes and stay with them through transport. If someone other than the patient hears the "sucking" then they are almost certainly going to die very soon without help and the patient is not likely going to have the breath to do it themselves and certainly are not going to pass out and wake up at all, let alone wake up and plug the hole. It also takes a fairly big defect to make a "sucking" chest wound since flesh tries to close over. The only way I would believe a story that used the term "sucking" chest wound and " left for dead" but the patient survived is if it was written up simply because the patient survived

Tsu,
I wonder if you're equating traumatic pneumo w/ tension pneumo. If so, jusyt an oopsie, they're not the same. George is right as the usual severity of tension pneumo. As a paramedic, I turned tension pneumo into simple pneumo by needling the chest--which is why he didn't have tension pneumo pt brought to the ER. No pm should be driving a tension pneumo pt around--the immediate field treatment is to decompress the chest, sometimes w/ a 14 g. needle (verr hard to come by in Tri's renaissance) or specialized device that's essentially a fancy needle and stiff cath w/ a flutter valve.

I presented the mechanism of injury for a traumatic pneumothorax, first aid, and a definitely possible treatment. Hippocrates was draining pleural fluid, BTW, and by Renaissance times they had the equivalent of 14-gauge needles (referred to as "quills") and a lot of stab wounds to practice on.

Ski patrol lives in fear of impalements - patrons landing on their poles, colliding with branch stubs, etc. - although it's fairly rare, and we practice the 3-sided dressing and the rest of the drill just in case.

Many variables control the outcome: size and shape of blade, angle of puncture (angled punctures have a tendency to self-seal because the tissues slide over the hole), location of wound, etc.