Fighting Infection in the Field

[Clinton Ohlers]

In Ryan's recent podcast with Scott Williamson, Scott mentioned a serious infection he developed on the trail due to an ingrown toe.

Because of this, I want to pass on a very simple (and lightweight) method of fighting infection I learned from a doctor when I was a child, and which I suspect goes back to the days before routine dependence on antibiotics.

Immersion of the affected body part in very hot (clean) water can help reduce an infection and often bring it down entirely.

The method is simply to soak the body part (most commonly a hand or foot) in water as hot as you can stand. (Not so hot as to actually damage your skin, of course.) On a small infection, you can do this for half an hour twice a day. For more progressed infections, I’ve had success doing so for an hour or longer to bring the infection down. You can also add antibiotic soap to the water if you have it.

I’ve used this method as recently as January of this year while in Florida when a splinter in heel of my hand caused swelling with inflammation and pus in a single day. (Infections can hit fast in the sunshine state.) This method was also used back around the 1910s on my grandmother, who as a little girl had an infection that had spread up her arm.

That said, I’m a doctor of history, not of medicine. So, I don’t know things like how what the limits of this treatments effectiveness are relative to very serious infections. I don’t know anything about the physiology of why this works. Nor am I trying to imply this would have worked in Scott’s case. I simply don’t know. I’ve also never had need to do this while actually on the trail.

Rather, this is simply a very useful option that deserves to be common knowledge.

As it is, I suspect this simple, easy (although a bit painful), and effective treatment method is becoming more and more overlooked in our era of antibiotics. For example, while my parent’s doctor also recommends the value of soaking, when I’ve asked friends of mine who are medical students, none of them have heard of it. (In fact, they are often skeptical.) So, to check up the accuracy of this, you may need to consult an older physician.

[Douglas Frick]

Good point. Epsom salt added to very hot water is also effective in fighting infection. Not a lightweight item to keep in a first aid kit, but easy enough to find in town.

[paul johnson]

an old standby is sphagnum moss which contains iodine.

yes, iodine causes some tissue damage (as does most other ointments, salves, liquids, etc, which are commonly used for simple injuries) which can slow healing.

when the choice is infection in the field or some extra time to heal, my choice is fight the infection.

[paul johnson]

>>"I don’t know anything about the physiology of why this works"

Clinton,

simply, heat is the modality that you're using to attempt to disinfect by immersing. you are, in a sense, producing a localized "fever", of sorts.

bacteria have some trouble at higher than normal temps, which is why your body produces a fever to fight infection (of course, fevers can become counter-productive and life threatening if they are allowed to go too high). there is a classic experiment to demonstrate the benefits of fever in a 30+ yr old issue of the Journal of American Microbiology – fascinating reading at the time. i remember the article well, but won't go into details unless requested.

[Anonymous]

This original post, particularly, and also the follow-up posts are received with much thanks and as something good to know. I hope folks continue to add to this thread. A few years ago a buddy fell gashing his shin on rocks. Another partner had some medical training in the army and had some topical stuff and a bandage to apply. We then debated as the days wore on as to what follow-up treatment would be best. We concluded changing the bandage would only expose the injured buddy to more germs and left the original bandage on. We learned on the our return that injured buddy had a serious infection in the wound and his doctor said that the wound could have been effectively field treated with daily cleansing and reapplication of a clean bandage. As it turned out the doctor was able to successfully treat the infection which could have been prevented altogether with proper field procedures.

[Christie Ogden]

Prevention is the most important thing. Clip nails short before leaving on a trip.

If you do get an injury, keeping it clean and dressed is going to make a world of difference. Soaking it every evening and putting a clean bandage on will make it heal faster.

Often I will leave a bandage off the injured area for part of the day, so it can be exposed to the air.

[Michael Mangold]

A trick I learned in correctional medicine for infected ingrown toenails is to add an antibacterial soap (such as Dial) to the hot water. I've never tested this in the field but it works in the jails.

[Brian James]

My friend's Dad's friend (got that?) died last year at 45. He cut his finger on a doorknob. He had no other health problems and was fit and active. He was dead in 3 weeks of sepsis; nobody could believe it.

Stuff to think about; especially for those of us who tend to beat our hands or feet up in our day-to-day lives.

[Clinton Ohlers]

PJ, thanks for the analysis. I dropped what you said by one of the med school friends I mentioned (also a former hiking partner and now an anesthesiologist). I brought the soaking method up with him again and your explanation of why it works. He agreed it made sense.

Also, your point about bacteria’s vulnerability to heat would explain why when I've seen the method prescribed, the use of antibiotic soap or, alternatively, Epson salts, is merely secondary and optional, though good to do.

As an aside, Doug, I once made an Epson-salt compact that I placed over four puncture wounds when a cat that bit rather deeply into my arm. I did so immediately and no infection developed at all.

Brian, sorry about your friend's dad.

[Joshua Burt]

The efficacy of soaking was explained to me as an effect of concentration gradients. Adding epsom salts, or just salt, to the water causes fluid to move from the wound into the soak, from an area of high solute to low solute (science people, my terminology correct?). This "draws out" the infection. Adding antibacterial soap or tincture of iodine would be bonus.

[Ed Huesers]

I've been using a drawing salve on anything that looks like it can get infected or is infected, including ingrown toenails. It is "Ichthammol Ointment 20%" and manufatured by Goldine Laboratories in Miami. I purchased it at Wallgreens from the pharmacy, they didn't stock it on the shelves but no prescription was needed.
The old 1 oz. tube I had for more than twenty years said it had juniper tar in it and I could smell it. The new stuff just states some chemicals, I suppose they figured out what chemical the juniper tar had in it that made it work.
I hardly ever use it but it is always in my medical kit.

[Clinton Ohlers]

>>bacteria have some trouble at higher than normal temps, which is why your body produces a fever to fight infection

PJ and all,

About microbes and heat–I just ran across this in Peter Stark's The Last Breath, in his chapter on cerebral malaria.

When confronted with infection, he writes, the body will "try to cook the invading parasites to death." White blood cells release proteins that set off a series of chemical reactions causing the hypothalamus to "dial its temperature up to a higher setting"

And, here's an interesting form of remedy:

He adds, "The malaria parasite floating about in the blood is so effective at inducing these fevers that in the 1920s, before the advent of penicillin, blood infected with Plasmodium falciparum [cerebral malaria] parasites was injected straight into the frontal lobes of syphilis patients. The resulting 'therapeutic malaria' fever proved effective in killing off the syphilis bacteria in 80 percent of the cases, though the malaria parasite itself survived the fevers and had to be treated separately."

–CO

[EndoftheTrail]

Curious — in lieu of heating water, would washing the would with clean water, dabbing on some Purell and patching with a band aid — say twice a day — do the trick as well???

[Clinton Ohlers]

Ben,

That might help as a preventative and to keep the area clean. Although, once an infection starts it's another ballgame.

–CO

[Ed Huesers]

I've done my share of soaking with hot water alone and with epsom salts and it works great when you have the time. But, I find that if I soak my feet in the morning and put in a good day, my feet are past due for another soaking.
When I'm on the move, the drawing salve I mentioned before is my choice. I dress the area once in the morning and again at night. I don't wash the area, I just wipe off any mess and dig out any mess that might be along the edge of the nail.
Any infection I've ever had has been cleared up in three days even with walking every day.
I normally put the salve on before I get an infection when I get a road rash type of abrasion from rock with lichen on it. That lichen can get a nasty infection going in a few hours but the salve will prevent the infection and will have it healed in a few days.
Never know though, next year's Yellowstone trip may put me close to a hotspring in a time of need.

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