Context: fantasy novel in which a key character had just suffered massive burns on her legs and genitals in battle. (it was a mage-fire, conjured by my antag, an extremely powerful mage) My character's been rushed away to get treatment. Technology level is kinda like the middle ages, with some magic floating about. 1. What would be the first few basic things any doctor would do to stabilize her condition? And what sort of treatment would come after that? 2. What are some complications that the doctor might see as a likely consequence? 3. Can severe burns on the legs render someone disabled? Would her walking, balance, perhaps sexual function and/or bladder/bowel movements be affected? If yes, then to what extent? Will she ever naturally recover all her functions? 4. What sort of disfigurement are we talking about? 5. How long before she can realistic get up and be independent again? How long before she is fit for battle? This is a relatively brief part in my novel (1-2 scenes max before she probably gets healed completely by magic), but I'm trying to write a realistic aftermath to the attack. @GingerCoffee tagging you because I seem to remember you're a nurse practitioner.
the one thing I do know, (probably not helpful) is that the best immediate treatment (and I’ve ysed this technique on sunburn and on scalds/burns in a professional kitchen) is to flush the area with cold water and cover with cling film for at least four hours. This fools the body into thinking it’s not burned, and reduces blistering which reduces pain and scarring. Maybe your medical character knows this and can use something other than cling film, something plant based?
Firstly, if any honey is at hand, they would use that to treat the wound. If bleeding, daysies and yarrow can be used to disinfect and stop the bleeding. In medieval times, they were exceedingly good (better then we are today) at finding and fixing broken or features bones, dislocations, and other such injuries. However they had very poor concept of how to treat open wounds. Typically, salves would be made by a witch women (not what you are thinking, they were most like herbalists crossed with a wise woman) that included a number of medicine derived from plants or animals products (like kidney, bile, etc...). I've been burned severely before (gasoline fire) in the wild and had no access to painkillers. I was literally withering in pain for quite some time until I was dosed with painkillers. Getting drunk helped a lot with the pain, it is a horrible pain. Your character would literally be passing out, and even dying, from the pain alone. The worst part about burns is that they infect very quickly. Honey is very good at treating burns, but without honey, and disinfecting, coagulant and sealing salve, applyied liberally on the affected area will work. Your main issue with severe burns is pain and infection. The rest you can't do much about. You character will takes weeks before being able to move freely again and it will be days for a severe burn before the pain goes away. It scarring with be severe (still got my scars after 12 years since being burned, clear as day). I would conservatively say that three weeks with some magic juices to be necessary for her to be able to walk independently again. Consequences like how it affects sexual adder or whatever I do not know. To note, I am not a medical professional and this is purely based on my own experience and own research. Asking your doctor or a doctor friend may be a good idea and certainly s more accurate one
Thanks for the call out. First you have to decide what level of technology you are talking about here. When you say middle ages, I can't see a person with such wounds surviving. You're going to need medical knowledge or magic. Until modern medicine no one survived a large area of third degree burns. Skin and scar tissue don't grow back without skin grafts. First there is massive loss of fluids without skin. And second you have massive infection without skin. Figure out how you are going to address those two things and I can help you from there.
Yes, cool the burn as fast and as much as you can without introducing infection risk. And, no you aren't tricking the body. Cold arrests the damage from the burn which continues long after the source of the heat is removed.
For the middle ages, I think honey is an interesting option. It deserves more research as to whether it was used during those times but it makes sense to some extent.
Honey was the luxury option in those days. Realistically for any major burn wounds they would get as witchwoman to create a salve for other materials. The salve however did not always help. Sometimes you would get one made from actually beneficial plants, whilst others may make it from crushed worms or the intestinal lining of south migrating otters or some other superstitious or nonesensical option. As I said, they more or less guessed apwas a good or bad based on trial and error. There also was no set knowledge or book to take from or consult either. Either way it was likely going to result in a painful death as gingercoffee noted. In medieval times they where not overtly knowledgable about the effects of poor hygiene and cleaning in regards to wound care. So infection was fairly common and whilst the could treat it to some extent, it was not always successful and sometimes, based on the level of infection or size thereof, nothing could be done. naturally, some monks and scholars at the time believed it to be a work of god smiling down the undeserving. Naturally it is nonesense, but it shows to what level they thought of it as. They were typically very superstitious...
Also, and I mean to make this clear. Whilst certainly their methods were not as successful as ours, they still worked for most of the time. A commonplace method for treating wounds in battlefields was the application of various salves, or otherwise to keep the area moist and wet. this was successful some of the times and simply because it was the medieval ages does not mean they did not know anything they were doing.
One medieval remedy I know of for minor burns was snail slime. Though while I can't find a primary source to verify this, there has been research done on how effective it would be and it actually works to an extent.
Thanks all for your replies! Skin graft is when you apply skin tissue to the burnt area and encourage it to grow, I think? What are cold arrests? My idea was a water mage would probably bathe the area in water. But beyond that I am not sure how my characters should treat the wound? How would you prevent infection? What would you dress the wound in? Honey and bandages? Something else? Cling film sounds like it'd really hurt... Would you have to cut off any dead, charred flesh? I want my characters to believe she's gonna die, and then they will go get my MC who heals people. What would be the first thing my MC would do to try and save her? Regrow skin? Replenish fluids? Could someone tell me more about what happens and why the damage continues long after the source of heat is gone? I will certainly be using magic to heal this character, so tech might not be an issue per se.
Just because the source of the heat is gone, that doesn't mean there isn't still heat in the wound. It's like just because you take a steak off the grill a little early, that doesn't mean it's not going to finish cooking if you set it aside to rest for 5 minutes. Carefully. If a person is suffering from serious burns, then suddenly applying a lot of cold to the area could put them into shock and kill them. Honey has great antiseptic properties, so that's not a bad idea. There's also a really awesome treatment that I don't think happened in the medieval time you mentioned, but I don't think would be anachronistic in a fantasy setting.
A bit OT but it backs you up somewhat: a couple of years ago, snail slime was the trendy "new" ingredient in anti- aging moisturizers. A lot of the product ads and literature mentioned its use in the Middle Ages.
maggots are usually the best, and have been the best, at removing dead of charred flesh for a very, very long times (babylonians and egyptians were recorded using maggots to cleans wounds as early as least 1000BC). The pain alone will make her want to die. That kind of pain is unbearable and continuous, no reprieve. Besides, it looks nasty and once blisters and infection set in (if it does) it will smell terrible. The risk of infection and the pain alone should convince your character that she's going to die.
@GingerCoffee https://www.nhs.uk/conditions/burns-and-scalds/treatment/ http://www.realfirstaid.co.uk/clingfilm/ We researched it as part of a first aid course, and it's what I used when I suffered a bad burn on my forearm from a gantry heat lamp - which has actually left not one single trace of a scar.
Even with that, I have an issue with "trick" as the etiology or means by which it works. I wasn't trying to make a big deal of it, only correcting the mechanism of action.
Sounds like you are going well past technology and full into fiction. How much detail are you planning on writing, especially if you are going to use magic in the end? As for priorities with large burns fluid resuscitation is first. The skin holds your fluids in. They pour out of 3rd degree burns. There's a bit more than just drinking water. Why not look it up? Preventing infection is the next priority and replacing the skin is the last. Pain is an issue through out the process but surprisingly there is less pain where the burns are full thickness until you start debriding and tissues are growing back. You would not want to be applying honey or snail slime to large areas of burned tissue, by the way. Perhaps a magic oil or something might help until the healer arrives.
Ma maybe trick is the wrong word. Fooled might be a better word. When you burn, the area is subjected to being dried out, your body flushes the area with moisture to compensate, which is how blisters form, blisters are what causes the pain and they harbour germs. I had to have a course of antibiotics after a burn that everyone suggested I not treat the way I had been taught to (as a first aider). The cling film keeps the moisture in and so the body doesn’t react by flooding the area, less blistering, less pain, quicker healing time, less scarring. Was a stupid steamed potato that got me. Upper arm, I could’ve cried like a baby when it happened.
@GingerCoffee - why is applying honey etc to a large burn area a bad idea? How do you prevent infection in the absence of antibiotics? I am mostly interested in basically having a few details to write regarding what my characters should expect. I can't write how they are attempting to save her and I can't write their failure to do so without knowing some basics like, just small bits like "We have tried XYZ already, it isn't working" or "Well on average X would happen and now all we can do is Y and hope for the best" or "She needs X but we only have Y so now we can expect Z". For the purposes of the scene, I don't need that many details, but I feel I need to personally get a good idea, or at least some idea, for me to be able to write it. Will look up water loss. Thanks @Necronox for the maggots suggestion!
Probably be a really bad idea to toss them in the nearest body of water, as they will most certainly get an infection and die. So your best bet would be to have a way to purify the water, and everything else that will be used in the treatment of their wounds. And if magic permitting, it won't take as long as it would under normal conditions. Just know that you should not use anything like snow or ice to treat the area, as ice crystals will form in the water of the blood only exacerbate the wound and make it feel like it is burning even more. IDK, good luck.
Honey is not an antibiotic whether people ages ago used it for a folk remedy or not. The reason microorganisms don't grow in honey is because of the severe osmolality. Water wants to move into the honey by osmosis to equalize the pressure. Fluid is pulled out of bacterial cells essentially sucking them dry. It's one thing to coat a small wound that has underlying skin intact. Bacteria would be hard-pressed to grow as long as the honey was thick enough. But on an area with full thickness burns it would suck fluid out of the body faster than it was leaking out on its own.
I doubt that people 500 years ago would have known this. Burns would mostly have been a result in death through infection most likely anyway. Another commonly practice solution to burns (as i stated above) was keeping the affected area soaked in various liquids. Some had a basis in their understanding of medicine at the time and revovled in keeping the wound clean of bacteria by the means of what we now call antiseptics (amongst others). For instance, it was common place to use woundwort (astringent), monkshood/Aconite/Wolfsbane/Mousebane (Antiseptic, poison, amongst others), henbane/Stinking Nightshade (Anesthetic), hemlock (Poison, used in light doses), Yarrow (Anesthetic, Coagulant), Merigold (antibacterial, antiviral) and belladonna/Nightshade (Many different uses: Anesthetic, Atropine can be extracted from this plant and used). I can provide a much better list of. The solution is mostly made with any of those plants and applied. However, sometimes other "remedies" would be given, and some of these were nothing more the supertitious solutions and prayer-beads-level 'medicine' and composes of ineffective or otherwise unnecessary or (now) discouraged practices and herbs (such as poisons or the wrong herb - like giving a diuretic to a cholera patient). Some others were somewhere between the two.
And how exactly do you replenish the body's water? I googled it briefly and got fluid resuscitation, but it just gives me long medical terms I have no idea about and doesn't tell me how you "resuscitate" water/fluid? And what would be the medieval equivalent, roughly? What would you dress the burn wound in? I obviously don't have cling film, or gauze. I am not sure about a bandage since wouldn't that adhere itself to the wound? Right now I'm thinking they'd drug her so she doesn't feel the pain. And then put something around the wound - some ointment made from herbs like Necronox suggested - and then cover it with something and hope for the best? I was skimming this article and guess what, some scientists apparently used to think you should actually press a hot iron to the burn wound, or put the wound near a naked flame, in order to "draw out" the heat. Like, WTF? That sounds like the most moronic theory anyone can have https://www.sciencedirect.com/science/article/pii/S1743919113001076
There is a few substances that cool their surroundings when on fire. I suppose it could work... never heard of it being done though. They would most likely 'dress' the wound in bandages. The main practice at the time, and the most commonly accepted, as the prevent the formation of blisters. Various people advocated this in different ways. the most commonly accepted was keeping the entire area under a liquid. Some others also used tightly wound bandages and other ideas. So it depends on your school of thought (in terms of medieval times). If you want bandages, they would most likely be made from linen. Sometimes they would be soaked in whatever you are treating the wounds with. They thought that bad smell caused infection (which is partially true) so often they scented those bandages with fragrances and sometimes will disinfectant. Similarly, these linens would be cleaned, perhaps even boiled to remove all the smells. They did not know it then as we do, but they 'sterilised' them first. But they thought of it terms of bad smells - now we understand it as bacteria and what not.
If I were writing a period piece and wanted some authenticity to the conditions of the time, I would go look for some good resources, there are many out there. Or one could just make stuff up, most readers would take it for granted those folk remedies were actually used or more importantly in fiction, the remedies were at least plausible. Beyond that, I'm not sure what your point is? I was asked why it was a bad idea to coat large burns in honey. I was not asked if it were a common practice in the middle ages.
