Amputating a finger - minimal treatment - and travel afterward (fantasy - sort of Tudor era type)

Jaymz Connelly

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In the fantasy story I am currently working on I have a human MC (a prince) who has been taken captive by (not very nice) elves. The elf king is quite a shit and decides he's going to send the MC back to his family piece by piece. He starts by cutting off the baby finger of the MC. (I plan to have other elves there to hold the other fingers out of the way while this happens.)

The MC receives minimal treatment (i.e. it gets wrapped only enough so he doesn't drip blood on the floor while being taken back to his room).

What I want is for the wound to not bleed horrendously, but it doesn't exactly heal either. It stays wrapped in the bandage which is not changed. Within a day or so, the MC will be rescued (before the elf king can cut his hand off) and will travel with the person who frees him. I'd like for the MC to develop an infection that progressively becomes worse so that within about two weeks, he's going to need some treatment or he'll die. Also, the MC will be ingesting a couple of berries that will make him violently ill. The companion gave them to him to ensure he was not taken to have his hand cut off that day. He was given the antidote to the berries once they're free of the city, but I'd imagine he'd still be rather shaky and not feeling too well)

I have a couple of questions with regards to this. Firstly, is this plausible? The person travelling with the MC has little to no healing ability or first aid (he's much better at killing people). He knows to clean the wound and bandage it with clean material, but that's about it. Secondly, the MC and his companion are travelling by horseback. Ideally I would like to have the MC stay on his horse for as long as possible. The MC is a very experienced rider, although he's never ridden that particular horse before the escape. I'm assuming the infection would make him feverish and possibly delirious and/or hallucinating eventually and the hand would likely be very painful/throbbing. And thirdly, once the MC can no longer sit his horse, how will the companion transport him to the closest manor house (within a day to day and a half of the MC not being able to ride unaided). The companion doesn't know the manor house is there, he's just trying to get help from somewhere and that is the first place he saw. They've been avoiding people as they travel because the MC is ashamed and embarrassed that he wasn't able to prevent the amputation - he's certain his brother would have escaped uninjured.

Eventually the MC will need magical healing to cleanse the infection and save the hand - but that's not an issue. I'm good with the magic bits, it's just the realistic injury and travel details that I'm not so good with. (My only experience with horses is a week of riding in high school, and then a trail ride on my honeymoon (where the rotten horse damn near killed my knee trying to get through the gate but stay as far away from the camel in the next field as possible))

Given that it's fantasy and I can pretty much do what I want with the story, I still would like to have the injury and travel be as realistic as possible.

I did spend the last three days reading every horse and medical thread in Research that I thought might have any information I could use - but nothing quite answered my questions.

Any and all help/advice would be greatly appreciated.
 

MaeZe

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Yes, it's plausible. The blood vessels in a finger are small enough one can stop the bleeding with a bit of pressure.

It would heal like an open wound that needs to fill in with connective tissue (scar tissue). With modern medicine we'd stretch the skin over the end of the stump and close the wound.

Not everyone died from every infection before antibiotics. People often survived limb amputation.

As for fever, you can have it either way. Not all finger amputations are going to result in sepsis, but some might.
 
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Alsikepike

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I think this situation is entirely within the realm of possibility. Not changing a bandage, (especially one that isn't clean or dry) can certainly lead to gangrene if left completely untreated. But, by the time someone starts to develop the symptoms you're referring to, it might already be too late. Emergency amputation would definitely be needed in your time period, as gangrene can spread quickly. Not to mention, there'd be a horrid smell emanating from the wound and a lot of swelling that would be readily apparent and too distressing to just ignore.

Also, it's unlikely you'd be able to save the hand with the timeframe you're working with, as no magic is gonna save a hand that would be mostly-dead flesh by the time they pair arrive. Although, there might be a workaround for this. If the Elf King cuts the Prince's pinky off at the second or third knuckle (the first knuckle being the one at the base of the finger) it might give the main character more time to work with, especially if he ties a band around what's left of his finger to cut off the blood supply and slow the infection. Maybe his savior notices how bad the infection is getting and offers to cut the rest off to prevent any more infection, but the Prince hesitates, (as anyone would) and denies how bad the infection really is. His savior obviously needs to keep the Prince alive, (preferably with his extremities mostly intact) so they compromise and put the band on his finger instead. Even with all of this though, two weeks is cutting things quite close, even with suspension of disbelief. If there's any way to cut the travel time down, I suggest you do it.

In terms of transporting the Prince after he can't ride, the best option I can think of is to have the two characters ride one of the horses. Of course, this is easier with bigger breeds of horse, but it's doable. Difficult and uncomfortable, but doable. If the Prince is still healthy enough to sit up, he can just sit behind his escort and put his arms around his escort's waist. If he's not able to sit up, he can always ride in front of his escort, with the escort sitting further back on the saddle with his arms keeping the Prince steady while also holding the reins. Worst case scenario, the Prince can always be draped over the horse and secured to the saddle in front of his escort. Again, not easy, but doable. It should definitely be attempted with a bigger horse who's used to such things though, as you can imagine a horse'll be a little upset that it's load just doubled in weight.

I'd say your scenario is definitely possible overall. Go for it. It shouldn't be too hard to iron out the kinks if you make sure to acknowledge the problems.
 
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Jaymz Connelly

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Yes, it's plausible. The blood vessels in a finger are small enough one can stop the bleeding with a bit of pressure.

It would heal like an open wound that needs to fill in with connective tissue (scar tissue). With modern medicine we'd stretch the skin over the end of the stump and close the wound.

Not everyone died from every infection before antibiotics. People often survived limb amputation.

As for fever, you can have it either way. Not all finger amputations are going to result in sepsis, but some might.

Excellent! Thank you.
 

Jaymz Connelly

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I think this situation is entirely within the realm of possibility. Not changing a bandage, (especially one that isn't clean or dry) will certainly lead to gangrene if left completely untreated. But, by the time someone starts to develop the symptoms you're referring to, it may already be too late. Emergency amputation would definitely be needed, as gangrene can spread quickly. Not to mention, there'd be a horrid smell emanating from the wound and a lot of swelling that would be readily apparent and too distressing to just ignore.

Also, it's unlikely you'd be able to save the hand with the timeframe you're working with, as no magic is gonna save a hand that would be mostly-dead flesh by the time they pair arrive. Although, there might be a workaround for this. If the Elf King cuts the Prince's pinky off at the second or third knuckle (the first knuckle being the one at the base of the finger) it might give the main character more time to work with, especially if he ties a band around what's left of his finger to cut off the blood supply and slow the infection. Maybe his savior notices how bad the infection is getting and offers to cut the rest off to prevent any more infection, but the Prince hesitates, (as anyone would) and denies how bad the infection really is. His savior obviously needs to keep the Prince alive, (preferably with his extremities mostly intact) so they compromise and put the band on his finger instead. Even with all of this though, two weeks is cutting things quite close, even with suspension of disbelief. If there's any way to cut the travel time down, I suggest you do it.

In terms of transporting the Prince after he can't ride, the best option I can think of is to have the two characters ride one of the horses. Of course, this is easier with bigger breeds of horse, but it's doable. Difficult and uncomfortable, but doable. If the Prince is still healthy enough to sit up, he can just sit behind his escort and put his arms around his waist. If he's not able to sit up, he can always ride in front of his escort, with the escort sitting further back on the saddle with his arms keeping the Prince steady while also holding the reins. Worst case scenario, the Prince can always be draped over the horse and secured to the saddle in front of his escort. Again, not easy, but doable. It should definitely be attempted with a bigger horse who's used to such things though, as you can imagine a horse'll be a little upset that it's load just doubled in weight.

I'd say your scenario is definitely possible overall. Go for it. It shouldn't be too hard to iron out the kinks if you make sure to acknowledge the problems.

Hmm, what about if the MC somehow managed to change the dressing himself before he was rescued, maybe with a torn piece of his smock (undergarment)? He'd have some water in his room that he could possible use to clean the injury site as much as possible. This of course, is assuming that he wasn't being totally consumed with pain and unable to think clearly, I guess. I definitely don't want him to get gangrene, but it's important for plot purposes that he become extremely feverish and in danger of dying without fast, magical healing. I could have the elf king cut it at the second knuckle. If, when the MC is pretty much out of it due to fever and infection, the companion decided to chop off what was left of the MC's finger in an effort to slow the infection, would that then allow for the extra time needed?

They'll be travelling from the elven main city, out of that country and into the prince's country. I need to have them about halfway through the MC's country on their way to the royal city when they absolutely must stop. It's a pretty long way and I don't want to kill their horses. It's not the horse's fault the elf king is a dick.

Unfortunately, they're not going to have access to a bigger breed of horse for the escape. They'll have two horses that are similar to Arabians. (stolen from the elf royal stables) I was thinking they wouldn't be able to travel for too long if they both had to ride the same horse, although perhaps it would work if they regularly traded off since they'll have two horses. So, ride for a few miles (probably only at a walk, given the extra weight), then switch to the other horse, and so on.
 

Beanie5

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You could delay the infection starting for a couple of days and they were on the road, and then rapid onset. He could suck on the wound before then I belive saliva is a good antibiotic, and clean it too.
p.s. I LIKE MAGGOTS!
 
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Jaymz Connelly

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Maggots... ewww! *shudders* :flag:

I was thinking that the infection wouldn't take hold right away. I learned from speaking to a nurse for a different story a few years ago that it takes at least a few days for the bacteria to multiply enough to get observable symptoms with an infection. (yes, I'm always horrid to my MCs. :D)

My MC is not really the adventurous sort. I think this is probably the first time he's been so severely injured. Poor lad. (he's an adult about 20 years old) He's also got an inferiority complex, so he won't be willing to mention how much his injured hand is bothering him. With a bit of luck, they'll get close to being out of the elf country before it starts being a real issue.
 

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And thirdly, once the MC can no longer sit his horse, how will the companion transport him to the closest manor house (within a day to day and a half of the MC not being able to ride unaided).

If I were your MC's companion, I'd figure my best option would be to just tie him to his horse. How you tie him determines on the kind of tack your world has.

Tying him to the horse means no matter how bad the delusions get, he's not going anywhere the companion doesn't lead his horse (assuming the companion keeps hold of the lead rope). Also, this would be the quickest method of travel. Not only would the tying take not more than a couple minutes, their rate of travel would hardly suffer. A plus, if the elf king's minions are in hot pursuit.
 
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gambit924

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You could delay the infection starting for a couple of days and they were on the road, and then rapid onset. He could suck on the wound before then I belive saliva is a good antibiotic, and clean it too.
p.s. I LIKE MAGGOTS!

Haha! I love that, Beanie. I love maggots too. Which is a bit morbid, but...whatever, right? But sucking on it is probably not a good idea. Human mouths are not very clean. Best way to clean it is probably with alcohol. Or you could perhaps cauterize the wound. That's always interesting. Freaky and interesting.
 

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Evidence for the Health Claim

Dr. Nigel Benjamin, a clinical pharmacologist with St. Bartholomew's Hospital and the London School of Medicine and Dentistry, claims that licking wounds is as beneficial to humans as it is to animals. His research showed that when human saliva comes in contact with skin, nitrite—a natural component of saliva—breaks down into nitric oxide, a chemical compound that is effective in protecting cuts and scratches from unwanted bacteria.

getting a dog to lick it might be better though.:)

p.s. if you cauterize a wound without cleaning it ( properly )chances of infection go way up.
 
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gambit924

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Hmm, what about if the MC somehow managed to change the dressing himself before he was rescued, maybe with a torn piece of his smock (undergarment)? He'd have some water in his room that he could possible use to clean the injury site as much as possible. This of course, is assuming that he wasn't being totally consumed with pain and unable to think clearly, I guess. I definitely don't want him to get gangrene, but it's important for plot purposes that he become extremely feverish and in danger of dying without fast, magical healing. I could have the elf king cut it at the second knuckle. If, when the MC is pretty much out of it due to fever and infection, the companion decided to chop off what was left of the MC's finger in an effort to slow the infection, would that then allow for the extra time needed?

They'll be travelling from the elven main city, out of that country and into the prince's country. I need to have them about halfway through the MC's country on their way to the royal city when they absolutely must stop. It's a pretty long way and I don't want to kill their horses. It's not the horse's fault the elf king is a dick.

Unfortunately, they're not going to have access to a bigger breed of horse for the escape. They'll have two horses that are similar to Arabians. (stolen from the elf royal stables) I was thinking they wouldn't be able to travel for too long if they both had to ride the same horse, although perhaps it would work if they regularly traded off since they'll have two horses. So, ride for a few miles (probably only at a walk, given the extra weight), then switch to the other horse, and so on.

If the MC meets the second character sometime after the infection sets in, then cutting off the rest of the finger would probably not help. The Second character would probably have to remove the hand or some of the arm at that point. It depends on when the to meet and how far along the infection has spread.

- - - Updated - - -

Evidence for the Health Claim

Dr. Nigel Benjamin, a clinical pharmacologist with St. Bartholomew's Hospital and the London School of Medicine and Dentistry, claims that licking wounds is as beneficial to humans as it is to animals. His research showed that when human saliva comes in contact with skin, nitrite—a natural component of saliva—breaks down into nitric oxide, a chemical compound that is effective in protecting cuts and scratches from unwanted bacteria.

getting a dog to lick it might be better though.:)

True. Thanks for the info, haha.
 
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gambit924

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Evidence for the Health Claim

Dr. Nigel Benjamin, a clinical pharmacologist with St. Bartholomew's Hospital and the London School of Medicine and Dentistry, claims that licking wounds is as beneficial to humans as it is to animals. His research showed that when human saliva comes in contact with skin, nitrite—a natural component of saliva—breaks down into nitric oxide, a chemical compound that is effective in protecting cuts and scratches from unwanted bacteria.

getting a dog to lick it might be better though.:)

True. Thanks for the info, haha. True about the cauterizing. Still, it's always an interesting and slightly gory way to go. Plus I thought you kind of liked gore, Beanie.
 

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MaeZe

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... I belive saliva is a good antibiotic, and clean it too.
p.s. I LIKE MAGGOTS!

Maggots can be used to debride a wound if they are the correct species that only eats necrotic tissue (some eat viable tissue, not so good).

As for licking one's wounds, we always say human bites carry a risk of infection but I'm conservative prescribing antibiotics for human bites and haven't seen an issue with that practice.

But I make sure to follow up with that patient because approximately 10%-15% of human bite wounds become infected owing to multiple factors. So at the first sign of infection I do write that script.

Licking Your Wounds: Scientists Isolate Compound In Human Saliva That Speeds Wound Healing
 

Jaymz Connelly

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If I were your MC's companion, I'd figure my best option would be to just tie him to his horse. How you tie him determines on the kind of tack your world has.

Tying him to the horse means no matter how bad the delusions get, he's not going anywhere the companion doesn't lead his horse (assuming the companion keeps hold of the lead rope). Also, this would be the quickest method of travel. Not only would the tying take not more than a couple minutes, their rate of travel would hardly suffer. A plus, if the elf king's minions are in hot pursuit.

It is definitely an option to tie him to his saddle. I just wasn't sure if he'd be able to stay upright. Thanks! Elf king's minions are not in pursuit, hence the 'leisurely' pace they've been travelling. Companion is a trained assassin and he kind of dropped the palace on the elf king and court as his parting gift. :D
 

Jaymz Connelly

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Haha! I love that, Beanie. I love maggots too. Which is a bit morbid, but...whatever, right? But sucking on it is probably not a good idea. Human mouths are not very clean. Best way to clean it is probably with alcohol. Or you could perhaps cauterize the wound. That's always interesting. Freaky and interesting.

All the threads I've read prior to posting my own said that cauterizing is not a good idea.
 

Jaymz Connelly

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If the MC meets the second character sometime after the infection sets in, then cutting off the rest of the finger would probably not help. The Second character would probably have to remove the hand or some of the arm at that point. It depends on when the to meet and how far along the infection has spread.

The second character is the one who rescues the MC from the elf king's palace. I don't want the MC to be so bad from the infection that he loses more than the finger.

Basic timeline of events is:
MC gets finger cut off and then returned to his locked and guarded room
(possibly cleans the injury and puts on a fresh bandage torn from his smock) - a day or two passes
SC (second character) gains access through unconventional means to MC's room, gives him berries to swallow that will make him ill. Tells him kingy is planning to cut his hand off that night.
MC eats berries - pukes on guard's shoe when they come to get him for the evening 'entertainment'. He's left alone in his room to recover or not.
SC comes after guard has left and gets MC out of room (again with unconventional means), they head out of the city as fast as MC can go.
Just outside of city they hear the 'boom' of the palace going up. SC won't let MC stop, hustles him along to where a friend has a campsite set up. Friend has the horses that were liberated earlier in the day. He can also possibly do some minor magic to slow any possible infection - if they think of that. MC and SC will leave at dawn on the elf king's horses, heading for the MC's home country.

MC is trying to be stoic, so he won't be drawing attention to his hand as much as he can avoid it.
 

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Evidence for the Health Claim

Dr. Nigel Benjamin, a clinical pharmacologist with St. Bartholomew's Hospital and the London School of Medicine and Dentistry, claims that licking wounds is as beneficial to humans as it is to animals. His research showed that when human saliva comes in contact with skin, nitrite—a natural component of saliva—breaks down into nitric oxide, a chemical compound that is effective in protecting cuts and scratches from unwanted bacteria.

getting a dog to lick it might be better though.:)

p.s. if you cauterize a wound without cleaning it ( properly )chances of infection go way up.

And the very next paragraph in that piece quoted:

Despite the antibacterial agents found in saliva, many scientists caution against wound licking, arguing that such practice is neither safe nor health-promoting. Human saliva contains a wide variety of bacteria that are usually harmless in the mouth but can cause significant infection if introduced deep within an open wound. It is well known that the bite of a human can often be more serious than the bite of an animal (assuming the animal is free of rabies).

There's quite a bit more.
 

Jaymz Connelly

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Cauterizing coagulates blood and is used to stop wound bleeding in surgery. Not sure what you read about it.

I think the problem was, if it was done by someone who didn't know what they were doing, they could cause more damage than if they'd left the wound alone. I may be misremembering, though. This wouldn't be surgical cauterization, it'd be a knife heated over a campfire.
 

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The second character is the one who rescues the MC from the elf king's palace. I don't want the MC to be so bad from the infection that he loses more than the finger.

Basic timeline of events is:
MC gets finger cut off and then returned to his locked and guarded room
(possibly cleans the injury and puts on a fresh bandage torn from his smock) - a day or two passes
SC (second character) gains access through unconventional means to MC's room, gives him berries to swallow that will make him ill. Tells him kingy is planning to cut his hand off that night.
MC eats berries - pukes on guard's shoe when they come to get him for the evening 'entertainment'. He's left alone in his room to recover or not.
SC comes after guard has left and gets MC out of room (again with unconventional means), they head out of the city as fast as MC can go.
Just outside of city they hear the 'boom' of the palace going up. SC won't let MC stop, hustles him along to where a friend has a campsite set up. Friend has the horses that were liberated earlier in the day. He can also possibly do some minor magic to slow any possible infection - if they think of that. MC and SC will leave at dawn on the elf king's horses, heading for the MC's home country.

MC is trying to be stoic, so he won't be drawing attention to his hand as much as he can avoid it.

Okay, I see the timeline there. In the two days that MC is locked up before SC brings him the berries, is the MC continuing to tend to the wound (tearing off more bandages and cleaning it)? Given the timeline, the infection might be minimal, and the need to cut off more finger might not be necessary.
 

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I think the problem was, if it was done by someone who didn't know what they were doing, they could cause more damage than if they'd left the wound alone. I may be misremembering, though. This wouldn't be surgical cauterization, it'd be a knife heated over a campfire.

True. The healer would have to be very skilled in order to do this and not burn anything that does not necessarily need to be burned. Still, in some cases, it's better than the alternative.
 

Jaymz Connelly

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Okay, I see the timeline there. In the two days that MC is locked up before SC brings him the berries, is the MC continuing to tend to the wound (tearing off more bandages and cleaning it)? Given the timeline, the infection might be minimal, and the need to cut off more finger might not be necessary.

He might have to tear strips off the sheets on his bed to tend it more than once, but he could change the bandages more than once - as long as that means he'll still get the infection. I need him to have that infection and I need him to be close to death by the time he's healed.
 

Jaymz Connelly

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True. The healer would have to be very skilled in order to do this and not burn anything that does not necessarily need to be burned. Still, in some cases, it's better than the alternative.

And the SC is so not skilled. As I mentioned, he's much better at killing people than healing them. :D By the time they get to an actual healer, the infection is too bad. All cauterizing would do would be to inflict more pain on my poor MC. But that's okay. Like Baldrick, I have a cunning plan so that my MC will recover.