Boys will be boys

Howard Wallace

Howard Wallace

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My son and his friend (12 & 13) were down at the local stream this evening, preparing for a night of primitive camping. They had an ancient “Old Hickory” knife they were using to cut reeds for a bed. When not in use it was stuck into the dirt, blade up. It didn’t take long for a bare foot to find the blade.

The cut was about 2” long, 1/4” deep, on the instep of the sole of the foot. No nerves or tendons cut. My son’s friend got to demonstrate his machisimo as we rinsed it out with isopropyl alcohol.

So they’re sleeping at my place this evening, instead of down at the stream. Of course, there was a reading assignment and an oral report. --Bradford Angier, The Art and Science of Taking to the Woods, Chapter 28, Making Camp Accident Proof—

The sole of the foot??? I’ve never seen a knife cut there before.
 
Speaking of a good instructional read for young boys and girls(if I ever have a daughter, no way am I gonna raise her to be some man-serving wallflower), has anybody heard of "Handbook for American Boys", or something like that? I don't have an author, but it was written some time in the 19th-early 20th century. It was real cool. Had rules for sports, camping and hunting advice, different projects like slingbows and building sailboats, ways to get into mischief, just a lot of cool stuff.

I ran into this way back when, in the library at tradeschool. Actauly, I think I'll check Amazon for this thing...
 
Sounds like the boy was lucky, he could have easily lacerated a tendon in his foot.

Good idea about the book report, too. They won't forget this anytime soon.

Oh, BTW, never irrigate a wound with alcohol, it causes damage to the tissue around the cut. Irrigate it with regular water. You can even use soapy water to clean a minor wound and then rinse the soap off. Works as well or better than alcohol and doesn't cause the pain/damage.

Applying an over the counter antibacterial ointment such as bacitracin is also good for minor wounds. If the wound needs stitches just bandage it up and they will clean it out at the ER.



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~Greg~


 
Kodiack's advise about IPOH is good if you are near an ER or med help...however, if not near help it is a good idea to irrigate with IPOH.
The tissue damage is caused by dehydration, generally 1-2 cell layers in depth. If an infection sets in, exotoxins and lysozymes are released damaging far more than the few cell layers damaged by the alcohol and the potential for septicemia is far greater.

Always take a small bottle of IPOH when out backpacking, camping etc
 
Thanks for the advice Greg. You are absolutely correct regarding irrigating a wound with alcohol. I was unwise to post that particular detail. If the incision were deeper or I had doubts about its healing properly I would have used a dilute Betadine solution and then rinsed with water.

My unorthodox approach is to treat the spirit as well as the body. In this case I had a young man with a minor incision on his foot, due to a stupid practice. He was in good spirits, laughing and joking about his misfortune. An alcohol rinse is generally a more memorable experience than a dilute Betadine rinse. We did put on an antibiotic ointment after the rinse. I didn’t mention that detail, nor the fact that I used several small bandaids to hold the edges of the wound closed, nor that the entire wound was then covered with a guaze bandage.

He will be going in on Tuesday for a Tetanus shot. I described it to him in order to prepare him. (Is that a 12” or 13” needle they use these days?
wink.gif
)

I have also found castor oil to have profound medicinal value in cases of this nature, but the only stuff I can find in the pharmacy has all the flavor removed. Does anyone know where I can get the good stuff?

Now I’m in trouble. I hope Doc Welch or the EMT’s on the board don’t see this, or I may have to take on the nation’s medical establishment.

In all seriousness, if I was dealing with a scared child, or if the wound had been of a more serious nature, the treatment would have been quite different.

 
The last tetanus shot I received was not nearly as bad as the ones I remember from my childhood. Either I'm getting used to them or they have changed procedure.
 
Thanks for the info, DC. I just took my first biology class, a 500 level radiation biophysics class. I had to get a biological dictionary so I could understand all the big words you guys (and gals) use. It helped me to understand your post. Isn’t osmosis neat?

Paul, I figure when the young lad comes back and tells me that the shot wasn’t so bad after all, I get to segue into how bad they were when I was a kid. You know - the barefoot walk through the snow to the doc’s office, the sandpaper pad they used to dull the needle, etc..
 
The early editions of the Boy Scout manual were titled Handbook for Boys. They're wonderful. I have one from the 1940s -- it's full of information about real wilderness camping. The current editions are ... well, I'll just say I find reading them about as exciting as watching the grass grow.

Bradford Angier's books are great too. Some of the medical information in them is out of date, though.

Some books about mountain climbing have good medical information. The trouble with first aid manuals is they only tell you how to do "first aid" assuming you'll rush the patient to a hospital as soon as you get the bleeding under control and the fractures splinted, and when you're in the wilderness that isn't always possible.

Beware of any medical information more than a very few years old. It's not long since the books were recommending procedures we now know to be extremely destructive, such as amputing frostbitten toes and using a tourniquet to stop bleeding.`

-Cougar Allen :{)
 
Cougar, you raise an interesting point about the obsolete information in the old books. It seems that every time I go back to refresh my first aid training the orthodox methods have changed. I think today more people are paralyzed by fear of doing the wrong thing than are actually doing harm by improper treatments. That is one reason some people will drive by an accident without rendering assistance.

Medical knowledge is always progressing. Any individual has to work with the knowledge they have at the time. The much derided arrogance of physicians is a useful attribute when faced with the incomprehensible mysteries of the human body. I doubt that there are any physicians who don’t understand how little they know about our bodies. Nevertheless, it is very worthwhile to refine our knowledge.

A few years ago my panicked wife summoned me to a party at my neighbor’s. A young man was choking on a piece of goat meat. Someone had tried the Heimlich maneuver but it hadn’t worked. I also gave some stomach thrusts, which had no effect. Then I turned the young man around and gave him some sharp blows between the shoulder blades, a technique that is no longer recommended in my first aid classes. The blows dislodged the meat, and the first thing the young fellow said was "Don’t hit me again." Then he cried and thanked me profusely. I could have loaded him in a car and taken him to the hospital after the stomach thrusts failed. But it was a 20 minute drive to the nearest paved road, and another 30 minutes after that to the hospital. This illustrates both your and DC’s points about the assumption of prompt attention by a physician in much of the first aid training.

Snickersnee, You and Cougar have convinced me that I’ll have to look for some of those old manuals. It sounds like I might be missing out on some fun. I have an old kids science book from the 50’s. One of the experiments is creating a carbon-arc furnace from a flowerpot, old carbon rods from batteries, an electrical cord, and a variable resistor made of fishing weights suspended in saltwater. I can think of about 10 different ways to hurt myself with that one.
 
A quick little heads up. If by any chance you can lay hands on some Dermabond, this stuff is great. It is like surgical quality super-glue. The only bad part is that it is for straight, even-edged cuts. Also, Steri-Strips and some benzoatine(?) are really handy for those moments that make you go....."DOH!!!!!". Later


See know why my signature is what it is?

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Yes it's sharp!!!! Now go get the first-aid kit!!!
 
Howard;

Yup. Back when I was cutting my teeth in bladesmithing, I ran across a furncae-in-a-flowerpot in an old set of Popular Mechanics Encyclopedia.

The idea I has was to cast blades in one piece and hollow them out Chris Reeve style. Came up with that on my own, hadn't heard of or become a fan of Mr. Reeve yet. Well, I plugged it in, and it blew out a fuse and exploded. I never figured out why.

One of the cool things I read in that book was about cutting a switch of willow and sharpening one end. Then you stick an apple on the sharpened end and whip it, that sends the apple sailing. The author then started talking about how you could get your friends together, have the one with the weapon stand one block over from a house and sling apples at it while the other kids form a line and correct his fire like artillery spotters! I KNEW I had something good in my hands after reading that chapter!
 
Snickersnee,

Did you put some kind of resistance in series with your arcing rods? The book I referred to suggested tying your wires to lead fishing weights, suspending the weights in a container of saltwater, and varying the resistance by varying the separation of the weights. I never had the guts to try it. You're more courageous than I am, plugging something like that into the wall outlet. Although when we made a little DC motor in grade school I went home and made a bigger model, and instead of using batteries I used an electrical cord. My motor created essentially a short circuit. When I plugged it in it also blew the house fuses, but not before causing multiple little explosions in the electrical cord, and filling my room with smoke.

We used a variation of the apple trick as kids. We used horsetails (the plant) and threaded them on sticks. Fun stuff.

Maybe it's time for a new modern book. How about "The Naughty Boy's and Girl's Book?" Do you think my lawyer would approve?


[This message has been edited by Howard Wallace (edited 03 June 1999).]
 
Another set of books I have found to be fun and entertaining are the Professional Guide's Manuals I & II. They were written for the North Star Guide Association by George and Jacques Herter. They are full of woods skills for professional woodsmen. An example of the tips is "Do not run over porcupines dead or alive with a car or truck." All joking aside there are some very good chapters with good information.

Cheers,

ts

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"Cet animal est tres mechant;quand on l'attaque il se defend."("This animal is very mischievous: when it is attacked it defends itself")
 
Primitive camping? Please excuse my suburban naivete, but isn't camping something involving an eddie bauer catalog full of "adventure gear" to go hiking at the local "nature center"? Primitive is I guess when you go do this outside of KOA or some sort of hillbilly looney activity like that. Seriously, guys, as a suburban guy who would love to find the time to do such an activity, but feels that it is just to hard to lug two cases of beer with a two day supply of ice down the trail without a car, I am proud of you for teaching your kids such things. Anyone wanna teach a thirty five year old this stuff? I am thirty now and will be having my midlife crisis soon. Sweetie, the dear lass, has explained that it will not be dealt with in the fashion of a girlfriend and red sports car, as so many other lucky souls do
 
Parker,

If you really want to get back to the stone age try books by Larry Dean Olson or Tom Brown. Metal knives, who needs them when you have a perfectly chippable rock? I think both those authors are still teaching classes in primitive living, if you want to hang out with some other rich guys going through midlife crises.

As to the kids, they pick that stuff up on their own. The kid who got hurt had a full outfit of gear for his night's camping. Here's the list.

1 - slingshot. Homemade out of a forked stick, surgical tubing, and old shoe leather.
2 - knife. Old butcher type, 7 inch blade, from second hand store. No sheath. (Now it has a sheath made from a plastic milk carton and duct tape, post accident.)

BMWGS80

I'm going to have to hit the bookstores. I have two cookbooks by George Herter, and they're great. Now I have to find the guide books.

 
Howard, mine used a clothes iron plugged into a disembodied electrical socket. Killed the iron too!

I think doing a book like that would be great! Give the kids something to do besides drive byes!
 
For even more 'look, ma, no hands!' ideas, try http://www.linsaybks.com
They offer two catalogs. Secrets has everything from Tesla coils to whiskey stills. I even ordered a book on how to build a carbon arc torch (you can get the rods out of heavy duty alkaline batteries).

The other catalog deals exclusively with metal work.

I got a farily fast response on the one order I made and I placed that with snail mail.

------------------
Joshua
But doom'd and devoted by vassal and lord.
MacGregor has still both his heart and his sword!
-MacGregor's Gathering, Sir Walter Scott
 
DC; sorry, cara mia, but you are dead wrong on this one.

Using isopropanol or similar chemicals on a wound is extremely harmful, would qualify as malpractice if done by a medical practitioner. I would be glad to testify against you in court if you did it to one of my patients.

Howard, I also believe in treating both the spirit and the body. To do so by inflicting needless pain, intentionally, is abhorrent. Frankly, I would have reported you to Child Protective Services. The general golden rule in medicine is that you and the patient are on the same side. To do something punative is NOT being on the same side.

Now, with this out of my system, let me explain about the dangers of plantar (sole of the foot) injuries. First of all, unlike the hapless lad in question, they tend to be punctures. This takes a bunch of nasty things down under the skin where you can't wash them out. The worse cases are where a kid is wearing tennis shoes, and a small plug of the inner sole of the shoe gets under the skin. This is usually loaded with pseudomonas, a tough bug to treat.

We routinely numbed up and explored and vigorously irrigated plantar p.w.'s. Even so, there was a high infection rate. Pseudomonas still often requires IV antibiotics.

One rarely sees damage to significant structures on the sole of the foot; i.e. the concerns about tenon laceration is vastly different from the hand, where it is seen routinely, as opposed to the foot, where tendon damage is rarely seen.

This is due to the plantar fat pad, the 'cushion' of the foot. It protects the tendons from most injuries. It also makes extremely frustrating the search for foreign bodies. I had to, on more than one occasion,
resort to fluoroscopy to remove needles from the foot.

Best thing for would cleansing? I would mix a small dab of dishwashing detergent (this is optional) with Betadine solution in a 1 part Betadine solution, 9 parts water mixture. This avoids the cytotoxic effect of straight Betadine. If you happen to have some hydrogen peroxide, this works well also, the foam tends to flush out the debris. Of course you don't mix Iodine with peroxides, or you end up with the reduced form of Iodine, iodide (like in potassium iodide). This has no anti bacterial effect.

Best thing to carry? Betadine solution. Excellent wound cleanser as mentioned above, and also great water purification at 10 drops per liter.

To summarize: be very very careful and cautious about plantar injuries, especially puncture wounds. There is no such thing as a minor hand or foot laceration. Trust me on this, I have learned from hard experience.

Inflicting needless pain on a minor patient to teach him or her a lesson is child abuse. (I know, the kid was probably laughing his head off, and no real harm done, but there is a different climate present in the medical community today, so watch yourself, OK?)

Comments, criticisms, questions, and suggestions glady entertained.

Walter Welch, Diplomate, American Board of Emergency Medicine

 
Esteemed Moderator: If my response to Dr. Welch wanders too far off topic for this forum, I humbly request your correction.

Dr. Welch.

Thank you for your advice and for sharing your expertise. If your conscience or professional ethics dictate a report to CPS, please do so. We all have to live with ourselves. The name I post with is my real one, and the small town and state I live in are in my profile.

I understand that you, and much of society, do not share many aspects of my philosophy. Nevertheless, I also must live with myself, so I will continue to follow the dictates of truth and love as I understand them.

You are not the first of the orthodox to express abhorrence of my values, and I do not think you will be the last. Ten years ago I struck a professor in a UW graduate class speechless. She was lecturing on “dropout prevention programs” and I advanced the thesis that we did not need prevention programs, but dropout encouragement programs. That people in our schools that did not want to learn should be encouraged to leave, and an open door be ready to accept them again when they are ready to participate constructively without interfering with the education of others. This struck at the core of her beliefs, and all she could do was stammer that I should find another profession. I eventually graduated from that program, but not without causing a lot of consternation among the orthodox. I know from your posts that I can expect a more articulate and reasoned response from you than that poor professor was able to muster.

The reason for your revulsion lies in a fundamental difference in our values. I have thought a great deal about the topic of pain. The first time I was faced with this issue in relation to child rearing was when my son was an infant, and my family lived in a small house in the forest, heated by a wood stove. When my son reached the toddler stage the hot stove presented quite a hazard to him. My wife initially tried to warn him away from the stove, saying “no – no” when he approached. This approach had only limited success. After contemplating the problem and discussing it with my wife we allowed the toddler to investigate the hot stove and touch it with his finger. This caused an innocent baby pain, and he received a minor (no blistering) burn on his index finger. However, he never hurt himself again on the stove through his childhood.

You can probably see that I don’t share your abhorrence of inflicting “needless pain.” My children are familiar with corporal punishment, which is also “inflicting needless pain on a minor (patient) to teach him or her a lesson.” Note: I am not a medical practitioner, and as such have no patients. My basic goals are to help my children, and other children, to grow and develop. I believe excessive empathy without reason can and does impede their development.

This difference in basic values leads (from my point of view) to many of the poor and detrimental practices in orthodox medicine today. This difference is the fundamental reason that I and my family tend to avoid the medical fraternity whenever possible. My children have been delivered at home, partially because local hospitals were at that time running a > 30% C-section rate, presumably to avoid patient’s pain and maximize physician’s convenience.

Last week my wife suffered a miscarriage. She became dehydrated and under the advice of our midwife I took her into the ER, where they started her on an IV. The attending physician announced that he was going to give her a muscle relaxer, to make her feel more comfortable. After a short consultation with my wife we told him that he was not. He did later request to administer a drug to stimulate uterine contractions, which we consented to. Again, the desire of the physician to “be on the side” of the patient and “avoid needless pain” seemed to make him forget the physician’s primary directive, “above all, do no harm.”

I do sincerely thank you for informing me that putting alcohol on a small laceration is “extremely harmful.” This has not been my experience in treating many small wounds on myself and others, but I acknowledge that you have considerably more experience in this area than I. I understood that there was some dehydration of tissue that occurred, similar to what DC mentioned, but was not aware of the massive damage you implied. Could you, perchance, provide a reference accessible to a layman? It is certainly not my intention to cause damage to anyone.

Yours in heresy,

Howard Wallace


[This message has been edited by Howard Wallace (edited 10 June 1999).]
 
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