Santharian Development

Santharian World Development => Miscellaneous => Topic started by: Kelancey the Green on 03 July 2012, 22:41:56



Title: Bleeding Wounds
Post by: Kelancey the Green on 03 July 2012, 22:41:56
I would ask to add this to the already-existing entry "Pain Remedies, Blood Loss Management and Infection Cures" by Seeker.
Please steer me in the correct way to post this.


EXSANGUINATION, BLEEDING WOUNDS
Overview
Exsanguination means to lose blood such that the sanguine constituent collapses, blood does not course to all parts of the body, and, in the extreme, the victim dies from losing blood.  As explained in detail by Sage Aurora Damall in her treatise On Cuts and their Treatments (http://www.santharia.com/medicine/cuts_treatment.htm), the risk of exsanguination is dependent of the gravity of the injury sustained.  Most healers will gain expertise in treating these injuries in times of conflict, as field chirurgeons and Dalorins retained by fighting units attend wounded soldiers on the battlefield soon after an injury occurs.

Symptoms and Effects
Blood loss most often is not painful; indeed, a wounded person may lapse into stupor, thence into death, without any complaint aside from lethargy and slowing of their thought process.  Some signs and symptoms that healers show be vigilant of include nausea, dry mouth and nose, sunken eyes, pallor around the lips and fingertips, absence of production of urine, shallow and weak heart throbs, and rapid breathing.  This last effect is likely a result of the phlegm attempting to compensate for the impending collapse of the sanguine constituent, a final effort to recompose the constitution of the ailing individual.

Incidence, Causes
Again, the reader is requested to refer to Sage Damall's treatise On Cuts and their Treatments (http://www.santharia.com/medicine/cuts_treatment.htm) for a thorough examination of the causes of seeping wounds.

Diagnosis
In assessing exsanguinating wounds, a healer can never be too careful.  All bleeding wounds have at least one escape or outlet for the sanguine; one must gauge both the diameter and the depth of the wound. Take care to look for exit wounds as well, particularly if the victim suffered a deep penetrating wound or received an arrow or other projectile wound.  Look for fragments of the projectile inside the wound.  
  • If an arrow has penetrated the chest or belly, but has not completely gone through to the other side of the chest or belly wall, the healer must forcefully push the arrow through the nearest exit point.  Take care when doing so to mentally visualize the internal anatomy, and make great effort to minimize the damage you will cause by shoving the arrow through to the other side.
  • If an arrow has penetrated an arm or leg, but not travelled clear through the extremity, one must first mentally visualize the anatomy before proceeding.  First think through which method of extraction, pushing it through or pulling it out, will minimize the damage to the arm or leg.  If you cannot avoid severing a blood vessel, leave the arrow in its place and allow a chirurgeon to extract the arrow--he or she is better equipped to stanch the rapid hemorrhage from a major vessel.
  • If an arrow has penetrated the head, mouth or eye, a chirurgeon must be allowed to pull the arrow out.  Never push an arrow through to the other side of a head or eye wound.  Again, the most common cause of death in an arrowshot victim is not the arrow itself, but the massive blood loss caused by the healer who extracts the arrow.  You have to be prepared to immediately plug the entrance and exit wounds you cause.

If you see that a hollow organ has been opened by the puncture wound, the victim needs to be attended by a chirurgeon immediately lest catastrophic spillage of bodily constituents occur.  It is well established as fact that bile and choler both cause burns if they are spilled outside of their respective cavities, and either will greatly complicate wound healing.  Mixing of bodily constituents--such as introducing bile or choler into the blood vessels--is almost universally fatal.  A healer would be wise to follow these practices if a hollow organ--stomach, gut, spleen, or any other--is even suspected of rupture:
  • Wash your hands thoroughly.  Too often, we healers are the greatest source of harm to our infirmed victims who depend on our care.
  • Wash the wound thoroughly, and preferably wash the entire victim from head to toe.  This includes pouring some mild, dilute solution of water and/or astringent to any deep wound.  Painful as this may be to irrigate a deep wound with soapy water, this may also save the person's life.
  • Yahrle ointment has binding properties that may stave off contagion for a while, and may help injured organs to repair themselves.  Bladeleaf gel has been purported to have a similar effect, but this is not well-studied, at least not by this author.  Odea moss has at least the binding properties, but not the capacity to hold out contagion and spillage of bodily constituents the way the first 2 compounds do.
  • One may consider applying either yahrle ointment or bladeleaf gel to the punctured organ, but this is not a final, definitive treatment.  This will buy you time until you can deliver the victim into the care of the chirurgeon who will thread and knot the wounds closed.

Cure/Prevention
Healers are reminded here of the adage, "All bleeding stops," meaning that fast treatment of a seeping wound is critical, before collapse of the sanguine overcomes a victim.  If time permits, as judged by the healer attending a victim, then cleansing of a wound with mil'no sap or ormelin prior to surgical closure of a wound may help wounds to heal faster and more neatly.  Oil of the totit plant has a similar cleansing effect, though this may be more difficult to obtain than the first two.

Stitching materials are chosen according to the site and depth of injury.
  • For deep wounds of the abdomen and chest, this author recommends silkel thread on a curved metal needle, because the healer can put significant tension on the thread without fear that the thread or needle will break.
  • For wounds of muscles, Yuatu'way fiber, obtained from the totit plant, tied to a long straight or curved needle, is more appropriate, since the fibers will glide more easily and not pull or tear the muscles as might a tougher composite thread such as silkel thread.
  • For superficial wounds, scar formation is a threat to be avoided whenever possible.  Needles from the sepulchura cactus can be straight or curved, and do not tear skin the way metal needles do.  The silk of the lu'an moth is supple yet strong, and makes for good wound healing when used on skin gashes.
  • Conversely, in instances where scarring may be desirable to form a tight seal of a skin wound which will resist infection, wild tribes of Nybelmar and Aeruillin commonly use the Stone Myrmex to seal small cuts, drawing the edges of the wound together and then placing the insect’s head along the incision, whereupon the beast spits its defensive material, which hardens upon exposure to air. A single Myrmex can seal about a thumbnail’s width of cut before its supply becomes exhausted (indicated by an unwillingness to bite and a lax, drooping abdomen), and another insect must be chosen. The sealed cut resists infection, and the ‘stitches’ will hold up well under perspiration and water, but must be renewed every few days with the natural shedding and flaking of skin.
  • For wounds small enough that they do not require stitches, the webbing of the Santharian drape-silk spider binds wounds excellently, and is absorbed by the skin within 5 days.  The webbing may be matted and packed into a wound, or simply applied on the surface to keep out dirt and grime.
   
Stopping blood loss from a wound is more complicated than just putting in a few stitches.  Many wounds require aid from herbal preparations, either applied to the wound directly or imbibed to allow the whole body to recover from the loss of blood.  Some suggestions to this end are mentioned here:
  • Drinking 1 tot of ormelin within the first hour after sustaining a grievous wound, then a sip of ormelin before bed and at sunrise every day for a week, will bolster the sanguine after near-fatal injuries.
  • A potion obtained from the blue flowers of the arryi flower, or purple lantern, is purported to work just as well with smaller quantities than that needed of ormelin.  This potion is to be drunk within 6 hours of sustaining a fatal or near-fatal wound, also with the intent of fortifying the sanguine constituent.
  • Odea moss is relatively easy to obtain in most areas of southern Sarvonia.  When mixed with a drop of the victim's blood, the moss may be ground into a paste which is applied into and onto a bleeding wound. This stops the bleeding and helps the wound to close within a week or so.
  • Though silkel flowers may only be harvested one in every ten or twenty years, the paste made from these flowers is indispensible as a topical unguent to close bleeding wounds, often without any scarring.

History, Myth/Lore, et al.
The Gnorians, independent gnomes of the eastern Santharian coast, were the first civilization to explore medicinal herbs for bleeding wounds.  Of course, their renown for medicinal alchemy is well known throughout all Sarvonia.  This author has tried without much success to learn who among them is most prominent in healing alchemy; perhaps they prefer to remain anonymous to human researchers.

The Tenthinrhim "Youth tribe", or Wood Elves, was the first civilization to close bleeding wounds with needle and thread.  Kaierians in the field of battle had to devise a way for wounded warriors to press on in combat without succumbing to blood loss.  Among many other devices and skills they developed, they improvised a method of using silkel thread to tightly close wounds which would scar rather than fester.  This practice flourished over time, and was adopted by chirurgeons and healers alike in tending to victims with cuts and puncture wounds.

The Shendar tribe, having high sanitary standards, was the first civilization to minimize contagion by washing both healer and healing tools.  To the best of this author's ability to encounter, the practice goes back before recorded history in Uderza, though likely oral tradition has perpetuated this practice for many generations predating recorded history in that region of Caelereth.


Title: Re: Bleeding Wounds
Post by: Seeker on 04 July 2012, 11:41:42
I am working on how to integrate this.  Just wanted you to know this wasn't being ignored.

OK done! see below for the suggestions to make this fit with what we already have.


Title: Re: Bleeding Wounds
Post by: Seeker on 04 July 2012, 13:40:53
OK I spent quite a bit of time trying to get the information from both the internal bleeding and the exsanguination into the format we already have in the Blood Loss section of the Pain, Blood Loss, and Infection entry.  I had to remove some aspects as they were either duplicative or did not fit in this entry. Here is the section with everything combined.  I will suggest we add any additional stitching methods to the surgical procedures entry as we do not need to provide these two entries and the entry on cuts and treatments.


Blood-Loss Management.
What soldier, knight or warrior has not seen one of his kinsmen sustain a wound and subsequently bleed to death? Blood-loss, along with infection, is one of the major causes of death on the battlefield. In addition almost all surgeries involve blood, and the management of blood-loss is essential in the health of the patient. Many experiments have been performed on captured enemies to test the ability to manage or stop the flow of blood with varying results. As such, over the centuries a variety of methods for controlling the flow of blood have been developed. Many of these methods are being widely used in New-Santhala and in the more advanced military garrisons throughout Southern Sarvonia, with great success. Even some of the more barbaric tribes in Caelerath are beginning to see the value in the methods described. Blood loss is addressed as both internal blood loss and external blood loss.

INTERNAL BLEEDING

Internal bleeding may present a dire threat to the health and life of the victim, resulting from an array of causes, be they traumatic or idiopathic.  Ranging from an incidental bruise on the cheek to exsanguination and collapse of the sanguine constituent, the site of the bleeding is the key to the threat of the injury.  In life-threatening cases, prompt medical attention is needed to extirpate the outflow of blood and help restore the natural flow of sanguine.

Any significant amount of blood loss will produce fatigue, difficulty breathing, and weakening of the heart throbs.  Bleeding into certain sites, as in the belly, chest, and limbs, is almost universally heralded by a swelling or lancing sort of pain.  In other sites, this bleeding may be completely painless, as in bleeding within the head or gut.  In these latter instances, vigilance and high degree of suspicion of internal injury are advised to be made aware of the blood loss.

Injuries to the belly can contain a leak of up to 1 barrel, that is 30 mugs, of blood, with only the pain of injury and the tumescence of the belly to show any sign of internal blood loss.  Bleeding within the muscles of the arms and legs may contain as much as 3 mugs of blood in each limb.  Because of the limited space within the skull, intracranial bleeding is surviveable up to approximately 1 tot, thereafter giving way to stupor and death.  In most cases, even minor intracranial bleeding causes profuse vomiting and lethargy, sometimes accompanied by thrashing spells.

Bleeding in the bowels may be silent or only mildly painful, perceived as either a gnawing or sharp lancing pain, and may persist undetected for up to months.  This type of bleeding may result in black, tarry stools, or, if the bleeding is lower down, bright red blood may issue forth into the toilet.  Some tumors can cause this type of bleeding, and early diagnosis is the key to treating these aggressive tumors.  The lungs and chest can hold a massive quantity of blood, up to 1 firkin in each lung.  However, such congestion can rapidly drown a person in their own blood, described by survivors as "air hunger", and thus this constitutes the most emergent case of internal bleeding.  Though no method of detection is universally effective, a simple concensus of healers suggests that probing an inflamed and reddened area with a hollow, wide-aperture stylet is the most direct way to finding the source of the bleeding.  In the case of bleeding into the lungs, chest, and belly, this may also be the optimal treatment, siphoning off the excess of sanguine until the balance of constituents returns.

Siphoning
Siphoning blood from a hollow cavity--chest, lungs, or belly--with a wide-aperture stylet is rapidly effective.  This usually requires multiple evacuations over a course of 3 to 10 days, performed at 6-hour intervals, or more frequently if the bleeding is severe.  Bleeding into the skull requires opening the skull with a trephine to allow the old blood to dehisce, and leaving the surgical wound open for no less than 3 days.  Careful application of wound cleansers, such as ormelin or the sap of the mil'no plant, will help stave off contagion in the days following surgical evacuation of the blood clot.

Draining
The quills of the riccio, or pricklepig in common speech, may be plucked, rinsed, and used as hollow needles for  draining blood from internal bleeding, or for administering herbal preparations to someone who is too ill to drink.  A small purse, from the washed-out intestine of an animal, is tightly knotted onto the base of one of these quills.  A dose of the preparation to be administered is suctioned up into the purse.  Then, the tip of the quill is inserted into a vein in an arm or leg, and the purse is squeezed, ejecting the medicine into the body to course through the blood.   Bleeding into the muscles of the chest wall or limbs is a simple matter of opening the skin and muscle and allowing the foul blood to drain.  The muscle and skin may be surgically sown shut just after drainage of the blood.  This author routinely relies on studious application of leeches to bring down bleeding at any site.  This method is more effective if the hemorrhage is superficial, as in a bruise or gash in the skin.

EXSANGUINATION, BLEEDING WOUNDS
Exsanguination means to lose blood such that the sanguine constituent collapses, blood does not course to all parts of the body, and, in the extreme, the victim dies from losing blood.  As explained in detail by Sage Aurora Damall in her treatise On Cuts and their Treatments, the risk of exsanguination is dependent of the gravity of the injury sustained.  Most healers will gain expertise in treating these injuries in times of conflict, as field chirurgeons and Dalorins retained by fighting units attend wounded soldiers on the battlefield soon after an injury occurs.

Blood loss most often is not painful; indeed, a wounded person may lapse into stupor, thence into death, without any complaint aside from lethargy and slowing of their thought process.  Some signs and symptoms that healers show be vigilant of include nausea, dry mouth and nose, sunken eyes, pallor around the lips and fingertips, absence of production of urine, shallow and weak heart throbs, and rapid breathing.  This last effect is likely a result of the phlegm attempting to compensate for the impending collapse of the sanguine constituent, a final effort to recompose the constitution of the ailing individual.  In assessing exsanguinating wounds, a healer can never be too careful.  All bleeding wounds have at least one escape or outlet for the sanguine; one must gauge both the diameter and the depth of the wound. Take care to look for exit wounds as well, particularly if the victim suffered a deep penetrating wound or received an arrow or other projectile wound.  Look for fragments of the projectile inside the wound. 

If you see that a hollow organ has been opened by the puncture wound, the victim needs to be attended by a chirurgeon immediately lest catastrophic spillage of bodily constituents occur.  It is well established as fact that bile and choler both cause burns if they are spilled outside of their respective cavities, and either will greatly complicate wound healing.  Mixing of bodily constituents--such as introducing bile or choler into the blood vessels--is almost universally fatal.  Healers are reminded here of the adage, "All bleeding stops," meaning that fast treatment of a seeping wound is critical, before collapse of the sanguine overcomes a victim.  If time permits, as judged by the healer attending a victim, then cleansing of a wound with mil'no sap or ormelin prior to surgical closure of a wound may help wounds to heal faster and more neatly.  Oil of the totit plant has a similar cleansing effect, though this may be more difficult to obtain than the first two.  Stopping blood loss from a wound is more complicated than just putting in a few stitches.  Many wounds require aid from herbal preparations, either applied to the wound directly or imbibed to allow the whole body to recover from the loss of blood.  Some suggestions to this end are mentioned here:


Arryi Flower Potion ("Purple Lantern")
The arryi, or purple lantern, as it is mainly called in Aeruillin, is a flower which is encountered often by the Shendar when they travel through the Ajnuvic Grounds. Though found mostly in these grounds, as they have the ideal climate for its reproduction, the plant has been seen in other areas in Caelereth also, for example the Cr'cl'cey Mountains of Aeruillin. The plant has a very distinctive look, its long stems richly hung with many purple little flowers ("lanterns"). When an arryi dies in winter the flowers will turn blue, causing much awe amongst the Shendar, blue being of course their tribal colour. When an arryi flower perishes in the winter, the blossoms change from purple to blue. These blue flowers may be collected and dissolved into water to produce a medicinal preparation to stanch bleeding. Caution should be exercised to use only the blue flowers of the arryi which die in winter. The fertile flowers of the living arryi are purple, and these would prove fatal if ingested. The purple flower for which the arryi obtained its name may induce rapid, massive bleeding from multiple sites, which is almost impossible to stanch. The potion derived from the blue flowers of winter stop one from bleeding, causing the blood to clot very fast. The cold of winter turning the purple lantern to the frigid blue of death evokes the sound of Queprur's whisper chilling the land. This explains the efficacy of the potion of the blue arryi flower, the emboldened choler hardening the body against mortal wounds and freezing the outflow of blood. Found in Santharian province Truban northwest of Nirmenith Mountains, Ajnuvic Grounds, and in the mountains of Aeruillin. This potion is to be drunk within 6 hours of sustaining a fatal or near-fatal wound, also with the intent of fortifying the sanguine constituent.

Cauterization
A crude yet widely use method is the practice of cauterizing the wounded area. With this method the area in question is burned with a hot iron, boiling oil or a fire brand to close the vessels and stop the flow of blood. Advancements in cauterization have lead to the invention of a small L-shaped cauterization instrument consisting of a wooden handle a little longer than a palm span, with a metal rod coming out of the handle another palm span or so, bending at a right angle, and ending with a metal implement looking something like a tiny battleaxe head. When heated to searing hot over an open flame, this instrument is touched firmly but briefly to an open wound to burn (cauterize) bleeding vessels. This instrument is growing in popularity over the Sarvonian continent.

Clamping Vessels
A very advanced, yet rarely practiced, method of managing blood loss is tying off or clamping blood vessels. This procedure requires a more advanced knowledge of anatomy and requires proper technique and rare specialized clamping tools only found in New-Santhala. This method is utilized during surgical procedures and is said to be the cause of the increase success rate of surgeries over the past 50 years.
   
Magic Spells
Magic can also employed to manage blood-loss. While spellcasting to manage blood-loss is not common outside of the city of Ximax one can find it on occasion in New Santhala or on the field of a large battle. The spell Sanguinary Block is the most widely used magical spell address the loss of blood.

Odea Moss Paste or Powder
In the gap between the Auturian Woods and the Tolonian Heath grows the odea moss, a deep green, very shiny, and incredibly slippery moss. While attached to its host the odea appears as tiny spheres. Once removed from its host plant, it starts to die a disgustingly slimy death. Appearing during the colder months of the year, the odea moss has been used by the Tethinrhim elves since it was discovered as a highly potent healing plant. Fresh odea moss is plucked from its host plant and mixed with a small quantity of blood from the victim. This forms a paste which is applied onto a wound. Alternatively, the moss may be removed and dried in the sun to form a powder. This powder, while not quite as potent as the fresh moss, still retains its property of mending wounds. Either fresh odea moss made into a paste, or dried odea powder, along with a drop of blood from the wounded, spread over a wound and left to be absorbed into the body, helps wound binding. This process should be repeated a number of times according to the severity of the wound. The odea moss does not need to be removed. Odea moss is rumored to be the creation of Nehtor (God of Healing) having witnessed the horrors and burns to the remainingTethinrhim elves when the Auturian Woods were burnt down in 806 b.S., assisting to help the elves to recover their strength. It is believed that odea moss appeals to the Foiroan constituent, coaxing the ichor to weave the fabric of the body into an intact tapestry of nature once again. Found in lower regions of Auturian Woods, Tolonian Heath, and rarely western side of Marcogg.

Ormelin ("Reberry Bush Juice")
The redberry is a common, medium-sized bush that can be found throughout most of Caelereth (with the exception of southern Nybelmar and Aeruillin). Each bush produces many small, tart, red berries, useful for cooking as well as being a primary ingredient of ormelin (orm conservation fluid). The fruit juice of redberries is one of the main ingredients inOrmelin (orm conservation fluid). The fluid is used as a cure-all elixir and significantly aids in the healing of wounds and blood-loss recovery as well as healing infection. Drinking 1 tot of ormelin within the first hour after sustaining a grievous wound, then a sip of ormelin before bed and at sunrise every day for a week, will bolster the sanguine after near-fatal injuries.

Silkel Flowers
Though silkel flowers may only be harvested one in every ten or twenty years, the paste made from these flowers is indispensible as a topical unguent to close bleeding wounds, often without any scarring.

Tourniquets
Tourniquets are often used to prevent blood loss immediately following an injury. The objective is to tie a supple material above a seeping wound preventing the flow of blood to the wound. However a tourniquet can also have the effect of killing the entire appendage and must be used with care.

Yahrle Ointment
Yahrle healing herb is also refered to as Meadow Hop, Military Herb or Staunchweed. It is found in the Aurora Fields, Heath of Jernais in Santharia, and Wilshirer Heath in Northern Sarvonia. The stem rises about 1 fore, and is angular and rough with spear shaped leaves. These leaves are one to one and a half palmspans long and 3 nailbreadths broad, growing out of the stem at the base, and have a feathery appearance. The leaves and stem of the yahrle give off a very pungent peppery smell. It flowers from late spring to early fall, with white or pale lilac blooms. The petals look like minute blades with flattened, loose heads. The whole plant is harvested, dried and made into an ointment. The ointment is applied to a wound to stop any bleeding. It is said by the elves that yahrle is one of the herbs dedicated to Cor, sometimes referred to as Cor's Nettle or Cor's Shadowing, and was used for divination in spells. It has also been used in folk superstitions to gain a vision of one's future husband or wife. It is speculated that Baveras smiles gently on those who use yahrle ointment, and this stanches the ebb of blood from a wound. 


Title: Re: Bleeding Wounds
Post by: Kelancey the Green on 05 July 2012, 00:42:39
 :clap2: :clap2:

Hooray Seeker! This looks wonderful! Just the right proportion of medicine and fantastical flavor. Thank you kindly for arranging the entry thus.

Can I do anything at this point to help put this up on the site, or are there any edits I need to go back and revise?


Title: Re: Bleeding Wounds
Post by: Seeker on 05 July 2012, 01:45:21
I feel it is ready, but if anybody wants a change or sees a mistake let me know and I will do it.  Otherwise we wait for the next weekend update.