Isn’t It Time for Thanksgiving?

  The days are getting shorter and the weather is becoming crisper. The World Series implies that baseball season is winding down. Football in all of its forms is in full swing. Somewhere in the midst of all this is the reminder that holidays are not too far away. We think of Halloween and Christmas and, oh yes, somewhere in there is Thanksgiving. Thanksgiving is often relegated to the few days off from work before the onslaught of the Christmas season and, at least in Alabama, serves as a reminder that the two major state universities will play football against each other the day after we gorge ourselves with food. Maybe we should re-evaluate our priorities. Isn’t it time we pause to give thanks for all that we have? I am not going to preach about being thankful for being in the greatest country in the world, despite its shortcomings. Instead, let us turn our attention to medicine and wound care.   Take yourself back in time and consider how wounds were once managed. The earliest record of wound treatment dates to the Egyptians in 3000 B.C. The Egyptians simply cleaned the wound and applied a mixture of honey, animal fat, and vegetable fiber as a dressing.^1,2 They had no knowledge of infection, bacteria, or even most diseases. Wounds were treated with wine, herbs, spices, rust, and many “unmentionable” things for centuries until the modern concepts of wound care were developed.³ Imagine yourself as a wound care provider in the ancient world faced with a wound that was said to have been caused by a chariot hitting the patient’s leg. Today we know this as a full-thickness wound with exposed muscle and tendon, but at the time you would have had no idea what those things were under the skin. There is some black tissue and dirt there, but what are you to do with that? With the knowledge you have, you pour water (is it clean water?) over the wound and apply some sort of dressing. Three days later the patient returns. The wound is draining what you heard someone call pus; the leg is very red and painful. Not knowing what else to do, you reapply the dressing. A few days later, as you wonder why the patient did not come back for his dressing to be changed, when you find out that he died. In the modern world this wound is easily treatable. Shouldn’t you consider giving thanks for your current wound care knowledge?   Wound care practiced in the 19th century is a bit closer to home. Imagine returning home from a trip and finding that the electricity to your freezer had been off for days. You can smell the odor from the front door and dread opening the freezer. Once the freezer door is open you are assaulted by an overwhelming stench of rotting meat. You quickly close the door and back away hoping you are not the one who is going to have to clean up that mess. Flash back to the mid-1800s and a Civil War hospital on either side of the conflict. That same rotting meat odor is what greets you when you walk through the door of the hospital, but you quickly realize that the rotting flesh causing the odor is attached to living people.⁴ No one else is there to “clean up this mess” but you, armed with very few, if any, of the wound care tools available to us today. Are you sure you shouldn’t be thankful for your current wound care knowledge and products?   Yes, we have come a long way in how we care for wounds. We know about tissues, cells, molecules, cytokines, growth factors, proteases, and even chromosomes and genes. We know about anatomy, debridement, anesthesia, infection, antibiotics, and dressings and bandages of all types. We have acquired so much knowledge that we laugh at the efforts of our predecessors. Here is where we should be careful. Without a doubt we have learned much more about wounds and their treatment than our forefathers, but before we become too smug about what we know, remember that we still have a long way to go. Imagine what wound care providers in the 22nd century will be saying about your wound care attempts.   When that Thursday in November comes along and you sit down with your family to eat and enjoy the day, I encourage you to be thankful for the current state of wound care.   I would suggest you also pray for advances in the near future that would make our current efforts seem like those of our forefathers. Wouldn’t that be the best thing for our patients? I think it is time for Thanksgiving, don’t you?

References

1. Brown H, ed. A Brief History of Wound Healing. Yardley, PA: Oxford Clinical Communications; 1998. 2. Halioua B, Ziskind B. Medicine in the Days of the Pharaohs. Cambridge, MA: Belknap Press of Harvard University Press; 2005. 3. Majno G. The Healing Hand: Man and Wound in the Ancient World. Cambridge, MA: Harvard University Press; 1991. 4. Adapted from Freemon FR. Gangrene and Glory: Medical Care During the American Civil War. Urbana and Chicago, IL: University of Illinois Press; 2001:13.