HERB - Wounds and Healing (long)

[Gaylin]

Isirith and all who asked about wounds and healing, I finally have had some
time to sit down and put stuff down into an e-mail. I hope this is what you
were looking for. If not, please ask me questions and I'll try to answer
them more to your liking as I can with what's in my peanut brain right
now. My apologies for any length issues. If you seem to miss some of this,
again, let me know and I'll see what I can do to help get you the original
info. If you find the info is too much beneath your knowledge, apologies
most profusely. The simple way seems best for explanation because the
medical terms, which I'm going to try to keep to a minimum, can be kind
of daunting. :)

Jasmine, Iasmin de Cordoba, iasmin at home.com or gwalli at ptc.com

PS: For those of you with more medical training than I, jump right in
and correct me, please. I'd hate to think I was disseminating information
that was incorrect. I'm always willing to learn more on this topic.

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How Wounds Heal

Let's take a little look at how wounds heal so that you can better understand
how medical treatments were intended to be used throughout history. When
you understand the nature of what the medical experts were trying to treat,
sometimes it helps you better understand why a particular substance was
used for treatment.

Wounds in humans are  repaired rather than rebuilt. This is important to
note because we can only repair wounded limbs, not regrow them. When
you're wounded, say from a large cut in the skin, the body has a special way
of fixing a wound using specialized tissue. The tissue is called "connective
tissue." Connective tissue is made up of two different kind of fibers and a
special goopy gel that bathes them (collagen fibers, elastic fibers, and
mucopolysaccharides, for the technically minded).

Now, within this tissue are a couple of cell types. One of them is small and
skinny and is called a "fibrolast." When your tissue gets injured, fibrolasts
immediately set to work to make the error right. Except for one problem:
wounds are messy. When you're wounded, blood gets where it's not supposed
to be, debris in the form of damaged or dead tissue ends up in the middle of
nowhere, and foreign material and bacteria end up invading the body like it
was a free buffet dinner line. Not a good thing and terribly frustrating for
the fibrolasts who are just trying to do their job of repairing you. Fibrolasts
are the good guys.

Because the fibrolasts seem to be getting the bum end of the deal, the body
has developed a few very elegant processes for various parts of the body that
help with the repair of wounds. First things first, a wound gets somewhat
inflamed. What the body is doing here is rushing extra workers to the scene
of the damage via blood. Blood cells contain the extra help in the 
form of white
blood cells. Protein to fight the bacteria arrives with the blood, and other
chemicals are brought with the blood as well. Each little piece has a different
job. White blood cells especially have differing types that do different jobs.
Some eat bacteria, some eat debris. White blood cells are the good guys too.

So at this point we have blood working on cleanup and fibrolasts working on
repair, except for one little problem: its not that easy to get rid of bacteria
in most cases. Bacteria are the bad guys. Sometimes they're very bad guys.
When fibrolasts are working, they are constantly having to rebuild tissue
bits. White blood cells constantly having to clean up against the 
tide of bacteria
that keeps destroying tissue. This battle is what we call an 
"infection" today. And
an infection can take pretty much two general courses. We all hope 
for the first
course which is minimal bacteria easily destroyed by white blood cells cleaning
up a wound and fibrolasts working their little hearts out to repair any damage.
The fibrolasts slowly rebuild the connective tissue and the goopy gel 
that bathes
it so that the gap of a wound is filled. The new tissue that the 
fibrolasts build is
called "granulation tissue because it looks bumpy under a microscope.

Here's where we'll take our first side trip into the history of 
wounds. The kind of
infection, cleanup, and repair work that I've just described, one in 
which there's
little trouble with infection and relatively easy rebuilding is 
called "healing by
first intention." The second course an infection can take is not so good. When
bacteria flares up and starts fighting, white blood cells are sent to 
clean them
up and get rid of them. When the bacteria wins, the white blood cells die. This
causes even more white blood cells to flood the area. This flood is 
called "pus"
a very normal, but sometimes annoying creamy white substance.

Have you ever heard people use the phrase "laudable pus" and wondered what
they meant? The fact that white blood cells die for a good cause, that they die
at the scene of a battle and they don't go back, is where the "laudable" phrase
comes from. In Latin is was usually "pus bonum et laudabile" or "good and
laudable pus." The formation of pus in modern medical terms is called
"suppuration." The fact that pus is created is not necessarily bad. 
Only bad pus
is bad. Good pus, the laudable pus that the ancient medical personnel praised,
was infinitely preferred and still is because it indicates that a 
wound is healing
well. Any pus that is not thick and creamy and relatively white means that the
bacteria in the wound is particularly strong or the body is having a difficult
time defending itself against the bacteria (because the body may already be
at a low, defensive point, say, from another illness).

So, we have a battle going on, and white blood cells are dying. In 
the process of dying
they release chemicals that they didn't have time to use up fighting 
bacteria. On
one hand this is bad because the chemicals actually cause a breakdown 
in the tissue
the fibrolasts are trying so hard to repair. But on the other hand, 
the release of
those chemicals is actually pretty good because it also destroys the 
dead and dying
tissue the bacteria wants to hide in. So when bacteria gets the upper 
hand before
a wound can be healed by the fibrolasts, we have the second course an infection
can take called "healing by second intention."

Okay, so we have wounds healing, whether by first or second intention, and the
end result of the healing is that a gap where the wound was is 
gradually filled up
by the aforementioned granulation tissue. That is, tissue and a nice, 
dried-up scab of
blood on top of open wounds. The scab protects the new, raw tissue 
until more skin
can grow to cover it. As the gap where of the wound is filled up, the 
edges of the
wound gradually pull together. This is called "contraction." During 
contraction,
new skin grows under the scab and the new tissue that the fibrolasts 
worked so hard
to put together is protected even further. Eventually, a whole lot of 
fibers are
created and most of the rest of the cells die off, leaving a scar, 
hopefully small.
The wound should now be healed.

I've glossed over a few items, such as what else can go wrong with wounds (e.g.
some other forms of inflammations, ulcers, excess tissue, or massive tissue
death). For the most part, however, the process of repair and cleanup of wounds
is fairly straightforward. Understanding the basic process will help you a bit
toward understanding why ancient and medieval doctors used the tools and
substances they used on wounds.

[written 8/31/00 by Iasmin de Cordoba (Gaylin Walli), iasmin at home.com]
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