A Ranger's Trauma Kit: Bandaging (Image Heavy)

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Elleth
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A Ranger's Trauma Kit: Bandaging (Image Heavy)

Post by Elleth »

Project Theory and Justification
Some of you may remember the thread touching on period-appropriate medical supplies we had a while back:

Medical Kits

While planning another project (soon to be written up in the MERS newsletter) I thought I might try the bandaging idea and see how it works -

presenting a traditional materials “trauma bandage” -
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Place in the Lore
So far as I can tell, there's not much specific information about bandaging in either Middle Earth canon or medieval material culture. We know bandages were used, and poultices were used, and they must have been carried somehow from time to time - but I admit a dedicated single-packed item like this is probably very much a "farby" anachronism.

On the other hand - the need for wound dressings (sometimes in a great hurry) is plain, and even without germ theory anyone would know that you don't want to cover a wound with filth and wet if you can help it- so given those constraints it's not I think impossible that some denizen of Eriador would come up with a similar idea. Ultimately though, I figured if my choice was this or modern kit - so why not use this?

How common could they have been?
Even torn from scrapped clothing I don't imagine these would be a trivial expense in a medieval context. Not terribly expensive true, but dear enough that they'd not be thoughtlessly wasted: in this respect they're not at all unlike modern dedicated trauma bandages and clotting agents.


Which is to say - I suspect if these bandage packs were found at all, they'd be found among those out in the wild, far from help and support, and with a reasonable expectation they might be wounded.

That is... Rangers.
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Re: A Ranger's Trauma Kit: Bandaging (Image Heavy)

Post by Elleth »

Construction Technique
As I mentioned in the original thread, the logic of the bandage is simple: wool absorbs fluid wonderfully, but it can stick to a wound and will leave fluff behind. Linen is less prone to stick or leave fluff, but it doesn't absorb particularly well.
Obvious answer - wrap a wool pad in linen!

I had scrap from an old linen smock I made once upon a time, and remainder pieces of a wool blanket - perfectly period materials recycling!
I stack three layers of scrap blanket on top of a strip of linen, then fold over the end and tack it down. I keep my stitches large and loose to avoid compressing the wool too much:

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I then take another strip, and stitch it down the same way to the opposite side, then sew across the bottom to make a pocket:
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Re: A Ranger's Trauma Kit: Bandaging (Image Heavy)

Post by Elleth »

Herbal Poultice

As long as we have a pocket - why not make a poultice of it? Some dried agents sewn into the bandage itself will likely quickly become soaked with the wound itself - if not a bit of irrigation will do the trick. Ready made treatment!
I made up a mix of yarrow, plantain, and calendula:
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DISCLAIMER
In earlier times I’d have added comfrey, but it’s my understanding that’s gotten some cautions thrown up in recent years, and not being experienced enough with herbal medicine yet to feel confident, I’m leaving that out. Also as Harper reminds us, yarrow is also a uterine stimulant and shouldn’t be used on a woman who is or may be bearing a child.)

Be smart, I am not a professional at this do your own research, yadda yadda. Disclaimer over. :)

Anyhow - I did two things with the mix. First I boiled the bandages a bit in the herbal mix. As soon as I poured the herbs in the pot, I realized I should have used a sachet, as the bits and pieces were troublesome to remove:
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Live and learn. Also, I didn’t boil for very long at all, as I was cautious about felting the wool. It doesn’t feel like I did any real damage for the couple minutes I had it in the boiling “tea” bath, but if I was really insistent about perfect sterility I’d find another way.

That said, if these ever get used they’ll be in unsterile woodland conditions anyhow: I’d not want to stuff them into deep punctures, but for bandaging up scrapes and such and I think they’d be fine in the short term.


Finally - and this is the cool part I think - I poured some of the herbal mix into the "pocket" of the bandage, and sewed it closed. The bandage now is not only nicely absorbent, but will seep in some herbal goodness to aid quick wound healing:
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Re: A Ranger's Trauma Kit: Bandaging (Image Heavy)

Post by Elleth »

Storage

Here is where things may get a little farby. Reflecting on it, I think a more period solution might be separate strips of linen bandaging, wool scraps, and *maybe* either some sachets of the herbal mix ready to go or simply made into a tincture wash.
But lets proceed anyhow.

First I sewed a number of small linen bags from the same scrapped smock as I got the bandaging from:
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Then I treated each with wax - demo here.
Finally, after placing each bandage in a waxed bag, I folded the edge over twice, loosely sewed it shut, and folded it over once more to keep the threads in place:
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Note - I use an accordian fold when I stow the bandage rather than rolling it up: this I think makes it much easier to get to the pad portion and properly deploy the tails.
Also as you can see, the loose thread has a “pull cord” loop in one end: this idea is an adaptation from the feedbags we use for our livestock. While these bags use a slightly different method, the idea is the same: pull the string, open the bag.
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Last edited by Elleth on Sun Jul 24, 2016 12:16 am, edited 1 time in total.
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Re: A Ranger's Trauma Kit: Bandaging (Image Heavy)

Post by Elleth »

Bandages In Use:
And here we are out in the wild… the waxed bags are nicely resistant to water and grime - time will tell how well they preserve the contents.
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Pull the string, open the bag, and apply. The pad is placed on the affected site, then the tails are wrapped around the injury and tied to keep it in place. The “short” tail should be at least a foot or so long so you can hold it in one hand while wrapping with the other should you have to apply it to yourself.
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Conclusions:
First - what I'd do differently. As I noted, the most important change I think would be using a sachet for the boiling stage. I might next time cut rather than tear the linen strips, and possibly even whip-stitch the edges. It would be a lot more time intensive, but there's less chance that way for fluff or loose threads to get caught in a wound. I'd also probably add more length to get more material to wrap with. What I have is sufficient - but only barely. About twice as much would be much more secure, though of course more bulky.

Other than that, I'm feeling pretty good about the project: they're definitely very functional - it's not Celox and modern pressure bandages, but for any scrapes and cuts that didn't require immediate evacuation to the real world, I'd be very comfortable using them.

I confess I'm not looking forward to any opportunity to try them out for real though. :)
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Re: A Ranger's Trauma Kit: Bandaging (Image Heavy)

Post by Harper »

This is an interesting project. I like it. Well done.

That is a very potent combination of herbs you are using.

Yarrow was often called "Wound Wart." I remember the story that it was "discovered" by a Mystic/Holy Man about 150 years ago who said it was a sacred herb and, if you had it during "troubled times," it would ward off any type of plague or fever. It is an outstanding purifier. It removes impurities and makes you sweat them out. It is good for any number of conditions and is particularly good for women's issues. It has been called "a cure for all life's ills." Some instances in which yarrow should be avoided include (but are not limited to) the following:

-Avoid using during pregnancy. Yarrow may stimulate the uterus. But some midwives use it post-labor to help tone the uterus, reduce cramping and to avoid hemorrhaging.

-People taking medications that slow blood clotting (Anticoagulant / Antiplatelet drugs) and lithium should avoid taking yarrow.

-When used topically, some people can develop a rash from touching the fresh plant.

-Yarrow should be avoided by those with allergies to ragweed.

Yarrow has been called "Nature's Band Aid."


Plantain is great for drawing out particles/venom while being soothing. It is a very powerful blood purifier and can help greatly with snake bites. There is a legend in India which says that when a mongoose is bitten by the deadly cobra, he goes off into the forest to find an antidote to its venom--Plantain.The Anglo-Saxons considered it one of their "Nine Sacred Herbs." Every Ranger should have some (leaf or salve) in his/her haversack.

British folk medicine has a saying “Where there is Calendula, there is no need of a surgeon.” The idea was that Calendula would fight infection. It can make you drowsey if taken in sufficient quantiity. It would probably be safest to avoid using it during pregnancy/breast feeding.

You could also soak the bandages in Colloidal Silver and let them dry. It is a powerful anti-biotic.

IMO, the number one herb for controlling bleeding would be Cayenne. Outside of the body, it stops blood flow while sterilizing the wound. Internally, it can control blood pressure and stop a heart attack. I always carry some with me in my Spice/Herb/Med kit. Unfortunately, it is from the New World (though there is also an African version of it)--so you might not find it appropriate in Arnor. It could however grow there in some parts. Perhaps it could have been obtained through trade or from Imladris.

Comfrey is still approved for external use. Big Pharma did a hit job on it years ago. I don't think that it killed anyone like their stuff does. I guess a 5,000 year track record isn't good enough. It is exellent for bone and tissue regeneration.

This is a little off topic, but with respect to skin sticking to bandages, I believe that the best treatment out there for burns is honey. It moistens the wound by reacting with fluids found there to produce a natural form of Hydrogen Peroxide. It also prevents infection. A Honey-based Comrey paste is even more effective. Another old trick is to cover whatever salve used with a Cabbage leaf prior to wrapping a bandage around the wound. Honey itself is kind of a "liquid bandage" which can be used to hold herbs in place on a wound. Remember, some people are allergic to bee products, so it is best to ask before using them.

I have writted rather extensively on these kinds of things on another site. I have been considering requesting a new heading called "Herb Lore" and reposting a lot of that stuff there. I think Rangers would have needed to know some of that kind of thing. But I am not sure that re-enactor types would be as interested.

What do you think? Is there enough interest here?


The preceding information was presented for educational purposes. It is not meant to diagnose, prescribe, treat, heal, cure, etc. Consult a physician for medical problems.

It's a damn shame I feel it necessary to even say this.
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Re: A Ranger's Trauma Kit: Bandaging (Image Heavy)

Post by SierraStrider »

I like the pads, Elleth. It strikes me as similar to a modern hemostatic dressing. And while it may be a bit farby, any situation where a small linen bandage wouldn't suffice is a situation where authenticity should take a hard backsteat to pragmatism. Any wound that would require a pad like this to staunch would be a real gusher, and would merit anything and everything you could throw at it, regardless of period documentation.

So, herbalism.

Harper, I'm certain we have the same goal here: looking out for people's health. And I completely understand your mistrust of "big pharma". After all, modern drugs have side effects, often dangerous ones. "Their stuff" can kill people when used incorrectly, and even some licensed doctors are a long way from perfect when it comes to understanding the risks of the medicine they employ.

That said, most of the problems with modern medicine are writ large in herbal, alternative, holistic, complimentary, and every other euphemism for "unregulated" medicine.

For example, the herbal remedies you buy at the store; A recent scientific analysis of herbal compounds sold at GNC, Wallgreens, Target and Walmart determined that 79% of them contained no trace of the herbs they were marketed as. And why should they? The companies who manufacture herbal remedies are not somehow more wholesome or more intrinsically honest than "big pharma" companies. They're both for-profit groups, the only difference being that the "alternative" manufacturers aren't subject to any regulation or oversight. This is a phenomenon I tend to think of as "Big Small": large corporations taking advantage of the perception that they're somehow counterculture underdogs, when really they're...well, large corporations, and every bit as subject to the drawbacks of market capitalism as their "mainstream" rivals. A great example is Monsanto: it's the poster child for faceless, titanic industrial evil, "Big Agra" incarnate--but in fact, it's smaller than Whole Foods.

But back to the topic at hand, these big alt-med companies might be rapacious fraudsters, but that doesn't actually imply anything about the discipline of herbal medicine. If you cultivate or collect your own herbs, that's fine, right?

In some cases, most likely. But one can more or less put medicinal herbs into two categories: The risky ones and the useless ones. Herbs are not safer than pills because they're "natural". Strychnine and hemlock are natural. They're not safe because they've been used for X-thousand years, either; bloodletting was so common a remedy that the archaic word for doctor, leech, is now associated only with a bloodsucking invertebrate they employed. And herbs are definitely not safer because they're unrefined.

The difference between medicine and poison is dosage. If I take a Tylenol or two, it can help my headache. If I take 10, it can shut down my liver and kill me. But I can stay safe quite easily, even with a relatively dangerous drug like Tylenol, because the dosage is right on the bottle. Meanwhile, the dosage of 'active' ingredient in an herb will vary based on the subspecies, the time of year it's harvested, the weather conditions during its cultivation, the soil composition, how it's stored, how it's prepared, and much else. Those fluctuations in dosage can be very, very relevant, too--the Romans used foxglove to treat heart disease, but the difference between an effective and lethal dose of digitalis is tiny.

Additionally, herbs rarely have just one active compound (at least, those that have any active compounds). This can be a problem, not only because (as in the case of Comfrey) the medicinal compound you want can come with a hearty dose of something else that's quite dangerous without any benefits, but because some safe and effective drugs become dangerous when interacting with others--and that can be difficult or impossible to account for when taking herbs that contain a plethora of bioactive compounds. This is one big reason that "it can't hurt" is an often dangerous falsehood when it comes to "complementary" or "holistic" medicine that combines alternative medicine with modern medicine. It often can hurt, in ways that may be counter-intuitive. For example, antioxidants are in vogue these days, and are often viewed as an avenue for preventing cancer. Unfortunately, this has lead some people to consume large doses of antioxidants in addition to their modern cancer treatments on the basis that 'it can't hurt'. The problem is that many chemotherapies use free radicals to target and destroy cancer cells, and of course, antioxidants neutralize free radicals, so the "complimentary" treatment ends up being entirely counterproductive.

There are problems with modern medicine as a practice rather than just an industry, but most of them are due to an inadequate focus on rigorous scientific methodology, something which herbalism lacks almost completely. Harper, you quote several adages and traditions in the above post, and while I'm sure those are intended to be illustrative rather than literal, they speak to a major red flag of herbalism; the origins of the discipline are firmly pre-scientific, from a time period where people thought the brain was an organ which served the sole purpose of cooling the blood, that diseases were caused by bad smells or evil spirits or an imbalance of nonexistant humors rather than microorganisms, and that field mice arose via abiogenisis from moldy straw. It's not to say that nothing they did was practical or effective in spite of their limited understanding, but "big pharma" has been using double-blind studies and placebo controlled trials to figure out which things those were for a century or more now. Instead of foxglove, we use synthetic digitalis, and almost no one ever dies from it (especially because of big-pharma-developed antibodies which can neutralize the toxin if someone does get too much). Instead of willow bark, we use aspirin, which is a lot easier to swallow. Dimethylguanide is one of the most prescribed drugs out there and was originally derived from compounds in Goat's Rue, but with the added benefit of being much less toxic. To paraphrase Tim Minchin, there's a word for alternative medicine that has been proven to be safe and effective: it's "Medicine".

I'm not into starting a flame war, here. Harper, I really appreciate that you don't try to hide the fact that these herbs have side-effects; it's a fact that all too many naturopaths try to conceal. That said, it's my opinion that any decisions people make regarding their health should be, to the greatest extent possible, science-based--not tradition-based, or lore-based--and based on a lot of research I've done herbalism just doesn't live up to that standard.
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Re: A Ranger's Trauma Kit: Bandaging (Image Heavy)

Post by Greg »

I have to say, SierraStrider, that you and I think similarly on this topic.

To be honest, I have very limited knowledge on the topic of Herbalism, but because it's so touch-and-go, I've spent little time researching it, and am only familiar with practical on-the-trail solutions for minor issues, such as using Jewelweed to help counteract Poison Ivy/Oak Rashes, and stinging nettles. Much like you, I worry that the hype over the usefulness of Herbs may be overstated by some capitalists, and so I tend to err on the side of caution with both modern ahd folklore-ish medicine.

There are few reference within Tolkien to the uses of Herbs in healing or medicine, and they all (unless I've missed one) refer to a plant with extraordinary properties which, incidentally, does not exist in this age. Athelas is referenced directly, and the use of Cordials, which are herb-infused alcohols as restoratives or for other similar purposes, are the only two I've encountered. I carry a cordial I made myself, but I don't truly expect much from it in terms of function. It is there to be authentic, and if I'm in an enormous amount of pain and not in danger of bleeding out, I'll down the shot to dull the ache. That's about as far as it's going to ever go for me, and I feel confident and safe in knowing that I'm not going to put myself in a situation where I'll rely on a remedy whose function may have been exaggerated in the name of capitalism.

Elleth, those look like they were a really fun project...lots of thought went into that. I wouldn't hesitate to use one of those if I needed it. I typically just carry a single, small roll of modern gauze with me, which I wrap wounds with, and then overwrap with a long strip of linen that I carry. All the function without sacrificing safety or adding risk.
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Re: A Ranger's Trauma Kit: Bandaging (Image Heavy)

Post by SierraStrider »

Seems like a good philosophy, Greg. I'm sure Harper would agree with me that overprescription is a genuine problem in the medical industry, and that most people take drugs they don't need. I'm a big fan of listening to your body and trying to treat the root causes when you're feeling poorly rather than masking the symptoms with analgesics (most specifically for camping, if you have a headache, DRINK WATER).

We don't appear to have Jewelweed out here in the Sierra, but I saw this a while back and it seems like solid advice.

If I could recommend one first-aid supply that would be best for my fellow Rangers, it's soap. Period appropriate soap is just dandy, and in addition to helping prevent poison oak/ivy/sumac as mentioned above, it's probably just about the best thing for cleaning wounds. Iodine, betadine, hydrogen peroxide and alcohol are all pretty harsh on the tissue, and soap works just as well. Note that it's a good idea to thoroughly clean AROUND the wound, and to flush the wound with water, but try to keep soap out of the wound itself. Plus...it's soap. Tons of utilities other than medical. Just try to avoid getting it into bodies of water, because I believe it can stimulate algal blooms that mess with the ecosystem of the lake or stream.
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Re: A Ranger's Trauma Kit: Bandaging (Image Heavy)

Post by Elleth »

Thank you Harper - I was especially interested in hearing your opinion, since I'm just starting down the herbalism road. Regarding comfrey - my impression is that some people recommend not using it internally, external use on unbroken skin is okay... but I can't find a clear answer on open wounds. The honey/comfrey paste idea is intersting - I might have to try it. Is it just those two ingredients stirred together?

Cayenne - interesting. I'd always thought it was a vasodialator and INCREASE bleeding. It helps staunch it externally? That's wild.

Anyhow - yes I'd find an ongoing topic at least on the subject interesting, but I would also understand if the mods find it skirting too close to a liability issue. I'd hate to have the site owners in a pickle if someone read something on here and did something stupid.



Sierra - I absolutely get your point that dosage is hard to regulate, and herbal remedies can be a chancy thing.
One of the more pointed comments I've come across is -

"Oh? Herbal remedies are ineffective? Harmless? Would you like a glass of my poison ivy tea?"


*shudder*
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Re: A Ranger's Trauma Kit: Bandaging (Image Heavy)

Post by Greg »

I don't see a problem with the discussion. If we start getting more in-depth with these discussions and write-ups, we can always add an herbalism disclaimer to the user agreement.
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Re: A Ranger's Trauma Kit: Bandaging (Image Heavy)

Post by SierraStrider »

Elleth: Funny you mention poison ivy tea...I've known someone who did that--more or less. She put what was purported to be urushiol in her orange juice every morning to desensitize herself. The mechanism is scientifically plausible, but needless to say it's not recommended. A reaction to urushiol in the mouth and esophagus could have consequences ranging from unplesant to fatal.
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