MENU 

Adapted from the original post: mini anatomy lesson – William's wound!  

 

 

Brief recap of the situation in episode 704: A woman who feels particularly uncomfortable. (A must incofortable woman)

 

William hastily crosses the Great Dismal Swamp. Surprised by a snake, his horse rears. William falls heavily and tumbles down a steep hill, hitting a branch that crashes deep into his right forearm.

 

As he has just torn off the branch of his arm, William sees Ian watching him. The latter sets out to treat the young man with the means at hand.

He releases the wound of several splinters with his knife and then pours very hot water on the wound to try to clean it and perhaps sterilize it and swaddle it in a piece of cloth.

William's wound
from a medical point of view

He then accompanied him to Dr. Denzel Hunter whose diagnosis was clear: it was necessary to amputate. He asks his sister Rachel to bring him a saw despite Ian and William's protests.

Fortunately, as Denzel presses on the arm with the idea of cutting it, pus oozes from the wound. He announces that the bile has been released and that the limb can be saved.

Much later, Williams shared his experience with his fellow soldiers.

 

"I wandered the gloomy Grand Marais for three days with a fever," he said. "Some... Indians found me and took me to a doctor. I almost died, and... (he lowered his eyebrows and cast a piercing glance at Zeb) – the doctor was about to cut off my arm, when the abscess burst and he cauterized it."  

 

Some time later, Rachel tells William that her scar has healed well. It looks like the star that guided the wise to the Child Jesus and suits him. In the book, she looks like a comet.

 

"The wound was still red and wrinkled, the skin around it was unpleasantly white and wet. However, it was undoubtedly a cure; The arm was no longer swollen and the sinister red streaks were gone. "Well," she said thoughtfully, "it's a beautiful scar, I think. Well knitted and rather pretty". 

 

Extracts from snow and ash.

Now that the recap is over, let's discuss the pathology of William's injury.

 

Was the accident plausible?

Yes. William is a tall man, who quickly descends the slope. All this weight with an outstretched arm allows this branch to plant very deeply.

 

Believe it or not, this question is covered by Newton's second law of motion which states that F = ma, in which the net force is equal to the mass multiplied by the acceleration due to gravity.

 

In clearer terms, the force with which William's outstretched arm struck the wooded point is equal to William's mass multiplied by the acceleration rolling downhill. This means that this force is more than enough to break the branch, break the skin, pierce the muscle and even fracture one or both bones of the forearm (radius and ulna)!

 

Poor William suffers from what pathologists have classified as a penetrating wound. This happens when a sharp object pierces the skin and creates a single opening in the tissues or body cavity. Obviously, there is an injury and the tissues in this case are the fleshy flexor muscles of his forearm. Our flexor forearm (palm side) houses eight muscles. The peak would probably have penetrated deep into 2-3 of these muscles. This means that any bacteria or other pathogens on the swampy branch would have penetrated deep into the tissues. That's why the wound became infected.

Ian unwraps William's arm and spies on a swollen, red, painful wound that will be warm to the touch. These are four of the cardinal signs of acute inflammation, the body's common response to injuries and infections.

Inflammation is announced by five cardinal signs, four of which were described 2,000 years ago by Celsius. These are: Redness, heat, swelling, pain and finally, loss of function.

Does William's wound have the five cardinal signs of acute inflammation? Well, yes, yes, it is! It is painful, swollen, red, warm and has lost normal use of the forearm.

 

Although Ian's intervention demonstrates his care and compassion, he has made many mistakes, having seen his aunt Claire intervene many times on wounds of this kind.

First, he should have cauterized the tip of his knife in the fire, or immersed it a little in boiling water (the one he heated to sprinkle it afterwards).

The insertion of the dirty tip certainly introduced multiple pathogens into the already infected wound! As for pouring boiling/hot water into the wound? It's not much help either and it must have been traumatic for William. It is better to let the water cool a little, then clean the wound with the "sterilized" liquid.

The amputation proposal is faithful to the writings of Diana Gabaldon.

 

"He had, he was told some time later, narrowly escaped the loss of his arm: Dr. Hunter had grabbed him and placed his amputation saw just above the wound, only to see the abscess that had formed underneath burst in his hand. Seeing this, the doctor hastily emptied the wound, filled it with garlic and comfrey, and prayed – successfully." 

 

The scene is chilling! Especially since any good doctor with training like Denzel's would not start sawing on the skin.

Saw teeth will tear and shred the skin and muscles, causing even more pain and morbidity for the patient. Instead, the practitioner must use an amputation knife to slice the flesh around the bone and then through the bone.

As horrible as it sounds, a capable practitioner could remove a limb very quickly in this way, thereby reducing the trauma to the victim.

Below is an example of a typical amputation knife and amputation saw from the time.

Finally, as Denzel exerts pressure on the limb, pus gushes from the deep abscess. After removing the pus, the wound was thoroughly cleaned and wrapped.

Pus is a thick yellowish or greenish opaque liquid produced in tissues infected with pyogenic bacteria such as Streptococcus or Staphylococcus (not all infections cause pus to form). Pus is formed by dead white blood cells, bacteria, tissue debris and serum.

 

The term pus derives from Latin and has been used since the 14th century. Again, since Denzel is a well-trained doctor, he probably would have used the term pus rather than bile.

Finally, consider William's scar when he tells his fellow soldiers about it.

 

Look," he said, pointing to the long comet-shaped scar on his forearm. "That's what happens when you have an abscess." 

Zeb and the doctor examined the scar, impressed. It was a shrapnel wound, he told them, caused by a tree struck by lightning. 

 

Congratulations to the makeup artists who knew how to make credible this slightly reddened, wrinkled and contracted scar as it should be.