I n the last section, we talked about illnesses like body lice and diarrheal sickness, which typically result from bad sanitation and hygiene. Numerous additional bacterial, viral, and parasite illnesses can be just as harmful but may not necessarily be related to sanitation and hygiene. For instance, anyone can develop appendicitis, regardless of their cleanliness or the surroundings at their retreat. A single ingrown hair can cause an abscess or boil.
It's amazing how well our bodies can fight off illness. No organ is immune to infections, though, so a good doctor must be able to identify and treat these ailments early on. We review some of the more typical ones you might encounter in this section.
Abdominal pain may be caused by several infections, some of which can be treated medically and others surgically. Appendicitis is a reasonably frequent condition that could be fatal in a long-term survival scenario, especially for young people. Approximately 8 out of every 100 people will develop appendicitis (appendix inflammation).
Anyone can get appendicitis, but persons under forty are more prone to get it. The appendix is a 2-4 inch long segment of tubular, worm-shaped tissue that attaches to the intestine in the bottom right side of the abdomen. This structure has a pouch-like interior that opens to the big intestine. The appendix's function is uncertain; however, one idea holds that it is an example of a "vestigial" organ, meaning that it is a no longer-useful relic from our evolutionary past.
When the appendix is obstructed, or bacteria are transferred from other parts of the body, problems might occur. The appendix may become infected or inflamed due to the bacteria's growth, or it may even become pus-filled. The appendix may rupture and discharge infectious material into the abdominal cavity if the issue is not handled. This leads to peritonitis, which can spread across the entire abdomen and become very serious. Before the invention of antibiotics, infections frequently resulted in death.
After 12 to 24 hours, appendicitis progresses from a vague soreness near the belly button to the lower right quadrant of the abdomen. About two-thirds of the way down from the belly button to the top of the right pelvic bone is this region, sometimes known as "McBurney's Point."
Other likely symptoms may include the following:
Patients may struggle to use their legs since doing so causes their abdominal muscles to contract. Other common sign and symptom of appendicitis is fever, nausea, and vomiting.
Press down on the lower right abdomen to make the diagnosis. It will probably hurt your patient. What is referred to as "rebound tenderness" may indicate a potential ruptured appendix. In this situation, pressing down will hurt, but taking your hand away will hurt far more.
From the moment you make the diagnosis, the patient should only be allowed modest amounts of clear liquids. Although surgical removal of the appendix is curative in this case, it would be challenging to perform without access to contemporary medical equipment.
If contemporary surgical care is not available, your sole option may be to give the patient oral antibiotics to treat an early infection. Naturally, intravenous medicines like cefoxitin work better than oral antibiotics like cephalexin (veterinary equivalent: Fish Flex). In studies conducted in the United Kingdom, early (uncomplicated) cases of appendicitis were treated with some success by intravenous antibiotics.
If intravenous antibiotics or surgical intervention are not possible, a combination of ciprofloxacin (veterinary equivalent: Fish Cin) and metronidazole (Fish Zole) is an alternative. It can also be used by people who are allergic to penicillin. Even though recovery is likely gradual, if therapy is started early enough or the body has built a wall around the infection, recovery may still be feasible.
Is it possible to have surgery when general anesthesia is not an option? Most procedures cannot be done without putting the patient's life in danger. However, surgeons in impoverished nations have performed appendectomies under local anesthetic.
You must be confident that you have an inflamed appendix before considering surgery to treat the condition. Sometimes, various medical conditions appear with overlapping symptoms, so you'll need to perform detective work to tell one from the other. Making the "differential diagnosis" is what this is known as.
The following conditions are just a few of the many that might mimic appendicitis.
Tubal Pregnancy
A tubal pregnancy should be ruled out in females of reproductive age. One of every 125 pregnancies experiences this problem. In this circumstance, a fertilized egg implants in the fallopian tube rather than the uterine wall, which is where it should be. It expands in this narrow canal until its size causes the tube to explode. This frequently results in pain and internal bleeding; a tubal pregnancy was frequently fatal in the past.
Instead of an infection, blood is the cause of the pain in this instance. Have some pregnancy tests in your medical supplies if your family or survival group includes women of childbearing age. Till proven otherwise, a woman with a missing period, a positive pregnancy test, and excruciating pain on one side of the lower abdomen are tubal pregnant.
Diverticulitis
In contrast to appendicitis, diverticulitis typically affects elderly adults. Diverticula are tiny pouches that mimic the inner tube of a vintage vehicle tire and are found in the big bowel. Similar to how the appendix can become clogged, these sites could help also. Although the symptoms of diverticulitis are remarkably similar, most people will report pain in the lower left quadrant as opposed to the right.
Pelvic discomfort can also be a symptom of other inflammatory bowel diseases, including Crohn's disease or ulcerative colitis. Steroids are frequently used to treat them, although surgery may also be necessary.
Inflammatory Pelvic Disease
Some of the symptoms of an inflamed appendix may be imitated by a female pelvic infection, which STIs like gonorrhea or chlamydia frequently bring on. This condition is referred to as "pelvic inflammatory disease" (PID). However, these individuals typically have pain on both sides of the lower abdomen, fever, and occasionally a foul vaginal discharge.
Internal female anatomy may suffer significant harm from pelvic inflammatory disease. As the body tries to heal, scarring can occasionally result in infertility and ongoing discomfort. The best way to treat serious pelvic infections in women is with antibiotics like doxycycline, sometimes in conjunction with metronidazole twice daily for a week. Treating your sexual partners well is a wonderful idea.
Ovarian Cysts
Large or burst ovarian cysts or other female pelvic conditions may also hurt or bleed when they are present. An ovarian cyst is a collection of fluid inside of an ovary that is walled off. Many develop from egg follicles, while some tumors are benign or, less frequently, malignant.
Most cysts hurt when they rupture. Internal bleeding, severe irritation of the abdominal lining, or both can result from a rupture. Ovarian cysts can sometimes disappear independently, but a ruptured cyst actively bleeding will need to be surgically removed. Given that the pain is localized in the same area, a ruptured cyst on the right side may present as appendicitis.
Without modern diagnostic tools, it will be difficult to determine if abdominal discomfort is due to appendicitis or another condition. Despite this, we must keep in mind that medical professionals can only make a diagnosis based on bodily signs and symptoms in the past.
Body waste is also expelled through the urinary tract and bowels. The kidneys, ureters, bladder, and urethra are all urinary system parts. In essence, it serves as the body's plumbing.
Most women have had a urinary tract infection at some point in their life (UTI). The urethra, the tube that drains the bladder, is frequently impacted by a bladder infection (cystitis). Escherichia coli (E. coli), the most prevalent bacteria, is one of many that could cause this infection. The male urethra is considerably longer, even though males are not immune to bladder infections. Bacteria, therefore, have a harder time getting to the bladder.
Sexual activity can spread some urinary illnesses, including gonorrhea. Dysuria, or painful urination, is fairly prevalent in men, although most women simply report a yellowish vaginal discharge.
Although painful urination is not unusual in cystitis, frequent urination is the most typical symptom. Some individuals perceive a hesitant or sudden urge to urinate (referred to as "hesitancy" or "urgency") in the urine stream. A bladder infection may spread to the kidneys if not treated, infecting those organs (pyelonephritis). The following signs may appear in your patient once a kidney infection has taken hold:
It will be required to use antibiotics in this situation. If the infection is left untreated, it could turn into sepsis, a disease in which the kidneys allow the infection to enter the bloodstream. These patients may exhibit shock-related symptoms such as rapid breathing, low blood pressure, fever and chills, confusion, or unconsciousness.
A big part of reducing the likelihood of this issue is prevention medicine. People at high risk, particularly women, must adhere to fundamental hygiene practices. Standard guidelines include urinating immediately after a sexual encounter and wiping from front to back after urinating or defecating. Additionally, never put it off whenever there is a strong urge to urinate.
The key to avoiding bladder problems is maintaining an adequate hydration intake. To cleanse your system, think about using natural diuretics (substances that enhance urine production).
The main component of treatment is aggressive fluid delivery. Drinking a lot of water will aid in the infection's removal by reducing the number of bacteria in the bladder or kidney. Warmth is calming when applied to the bladder region. Another important component of treatment is antibiotics (brand names and veterinary equivalents are in parenthesis):
• Sulfamethoxazole/trimethoprim (Bactrim, SeptraTM; veterinary equivalent: Bird Sulfa)
• Nitrofurantoin (MacrobidTM)
• Ampicillin (veterinary equivalent: Fish Cillin)
• Amoxicillin (Amoxil; veterinary equivalent: Fish Mox)
• Ciprofloxacin (CiproTM; veterinary equivalent: Fish Flox)
Phenazopyridine is an over-the-counter drug that stops the unpleasant urination associated with bladder infections. (Brand names include Azo, Pyridium, and UristatTM.) If your pee becomes reddish-orange, it's a transient pharmacological effect, so don't be frightened. It is believed that taking vitamin C supplements will lower the number of bacteria in the urine.
A few natural remedies for urinary tract infections are also available:
• Garlic or garlic oil (preferably in capsules)
• Echinacea extract or tea
• Goldenrod tea with 1–2 tablespoons of vinegar
• Uva ursi (1 tablet)
• Cranberry juice or tablets (1–3 pills)
• Alka-SeltzerTM in 2 ounces of warm water (poured directly over the urethra)
Use any of these remedies three times a day.
The liver is the largest internal organ in a person. Any disruption in this organ's function poses a threat because it is crucial to survival. The liver performs a variety of functions, including the following:
Production of bile to aid in digestion, removal of blood toxins including alcohol, storage of some vitamins and minerals, and production of amino acids (for protein synthesis)
• Keeping blood sugar levels within normal ranges;
• converting blood sugar into glycogen for storage;
• producing cholesterol;
• creating urea, the primary component of urine;
• processing old red blood cells;
• producing various hormones.
The term "hepatitis" refers to liver inflammation. This potentially fatal illness, which is primarily brought on by viruses, prevents the body from being able to digest toxins or carry out the other tasks mentioned above.
Hepatitis comes in many forms, typically identified by letters, such as hepatitis A, B, and C. Hepatitis can also develop due to negative medication and alcohol interactions.
Oral or fecal infection might potentially lead to hepatitis. As a result, we debated whether to include this here or in the last section on hygiene and sanitation. Because some types of liver damage, including those brought on by alcohol misuse, are not related to hygiene, I choose to include them here. Sexual contact can also spread hepatitis.
Jaundice, or the yellowing of the skin and eye whites, is a defining feature of hepatitis. Stools turn brownish, and urine darkens. The liver can expand or become painful to the touch right below the lowest rib on the right side of the abdomen. Additionally, there is an all-over itching that is experienced. Other symptoms include extreme exhaustion, weight loss, nausea, and occasionally fever. Hepatitis patients can occasionally have no symptoms at all and still transmit the disease to others.
An infected person's bowel motions contain the hepatitis A virus. A person gets a flu-like illness that can quickly turn serious when they consume food or drink tainted with the virus.
By coming into contact with infected blood, plasma, semen, or vaginal fluids, hepatitis B can be transmitted. The symptoms are typically identical to those of hepatitis A, despite the possibility that they could progress to "cirrhosis," a chronic disease that causes irreversible liver damage.
Nodules replace the liver's working cells in cirrhosis, which do not affect metabolism. Long-term alcohol and drug addiction can also lead to cirrhosis. Ascites, a buildup of fluid in the belly, varicose veins (enlarged veins, particularly in the stomach and esophagus), jaundice, and swollen ankles are all indications that you may have liver cirrhosis.
Globally, the hepatitis C virus has a persistent infection in over 200 million persons. It is a blood-borne virus that can be caught through hazardous sexual or medical behaviors, intravenous drug use, transfusion, or other means. Some of these people will eventually develop cirrhosis.
There won't be much you can do about this issue in a harsh environment than keeping your patient comfortable. However, most hepatitis cases are self-limited, meaning they will go away on their own in due course. Expect a minimum of 2 to 6 weeks of downtime. Hepatitis B is preventable with a vaccination.
You can, however, practice good preventive medicine by encouraging the following policies for your family or community:
• Wash hands after using the bathroom and before preparing food.
• Make sure children do not put objects in their mouths.
• Wash dishes with soap in hot water.
• Avoid drinking or eating anything that may not be properly cooked or filtered.
A few “detoxifying” and anti-inflammatory herbal remedies may help support a liver inflicted with hepatitis. Some of these supplements include the following:
• Milk thistle
• Artichoke
• Dandelion
• Turmeric
• Licorice
• Red clover
• Green tea
These are not cures but may assist your other efforts by having a therapeutic effect.
There are also nutritional strategies that may help:
• Avoid fatty foods and alcohol.
• Increase zinc intake.
• Decrease protein intake.
• Improve hydration status, especially with herbal teas, vegetable broths, and diluted vegetable juices.
Athlete’s Foot
A fungus called an athlete's foot (tinea pedis) causes a skin illness. If left untreated, this ailment could become chronic and linger for years. It typically appears between the toes but can also appear on other regions of the feet or even the hands (often between fingers). It should be mentioned that this condition is contagious and can spread through damp surfaces, sharing of socks or shoes, or both.
Moist environments exacerbate any fungal infection.
Athletes who frequently have athlete's foot.
• Keep their feet wet for extended periods;
• Have a propensity to suffer cuts on their hands and feet;
• Perspire a lot.
Find the following to make the diagnosis:
Skin flaking between the fingers or toes.
Burning and itching in the injured areas.
Red skin.
Stained nails.
Fluid leakage from surfaces that have been repeatedly scratched.
Maintaining clean, dry feet may be sufficient to allow for delayed recovery from the condition if it is mild. However, the problem frequently has to be treated with topical antifungal ointments or powders, such as miconazole or clotrimazole.
Adding generous amounts of tea tree oil to a foot bath and soaking for around 20 minutes are two popular home treatments for athletes' feet. Apply a few drops to the troubled area after thoroughly drying the feet. Do this procedure twice daily. Between treatments, try to keep the area as dry as possible.
Ringworm
A fungal infection of the skin's surface is represented by ringworm. It frequently forms an elevated, itchy area that is darker on the outside. As a result, it could look like a clearly defined ring. Ringworm is unrelated to worms.
Ringworm will probably result in bald patches if it spreads to a region with hair. Scratching the spots repeatedly will result in scorching and oozing. The course of conventional and natural treatment is identical to that for athlete's foot:
• Try to keep your skin as dry as you can.
• Use drying powders or lotions or an antifungal (miconazole, clotrimazole).
• Keep clothing that is too tight off of inflamed skin.
• Wash typically.
• Everyday sheet washing.
Yeast Infections
Our body may be vulnerable to yeast, a one-celled fungus reproducing by budding off the parent, and viruses and bacteria. Certain types are naturally present in the human body, while others might harm it.
Fungal infections can be systemic or local, such as vaginal infections, ringworm, or "athlete's foot" (throughout the entire body). Intestinal fungal infections cause digestive problems in some persons. Numerous ailments have been linked to systemic fungal infections, but confirmed cases tend to predominantly affect the young, the elderly, and people with weakened immune systems.
Vaginal Yeast Infections
The exceedingly frequent condition known as monilia, or vaginal yeast infections, is not a sign of an STI. A lady with a yeast infection will experience an itchy vagina and a thick, cottage cheese-like discharge.
With short courses of over-the-counter creams or vaginal suppositories like MonistatTM (miconazole), this infection is frequently quickly healed but may return. Fluconazole (DiflucanTM), a prescription drug, may be used to treat resistant infections. If symptoms do not improve after three days, repeat the treatment.
Bacteria or protozoa bring on other non-yeast vaginal diseases, referred to as trichomoniasis and bacterial vaginosis. These are typically smelly and are treated with the oral prescription medication metronidazole, which functions as an antibiotic and an antiparasitic.
For treating mild vaginal infections, the time-tested vinegar and water douche, used once daily, is particularly successful.
Use a quart of water and one spoonful of vinegar to douche. Only apply this technique up till the patient feels better. Contrarily, women who frequently douche are more prone to develop yeast infections.
A helpful oral remedy can be acidophilus supplements in powder or tablet form. Yogurt and cranberry juice alters the pH of the vagina to a level that is unfriendly to yeast, making them beneficial meals for vaginal infections.
Infections with oral yeast
Some infants and individuals may have a similar yeast infection in their mouth. White patches on the inside of the cheeks, the roof of the mouth, and other areas of the oral cavity are telltale signs of this infection, sometimes known as "thrush." Thrush can irritate the skin, and because the white patches are adhesive, they will bleed if removed. Nipple tissue can occasionally be impacted in breastfeeding mothers.
Conventional treatment for oral thrush includes taking liquid fluconazole (Diflucan) once a day for a week. Another antifungal, nystatin, can be administered topically to infected nipples four times per day for 5-7 days or is available as a "swish-and-swallow" formulation for oral thrush.
An infection could result from any soft tissue injury. Modern medicine simplifies treating infections brought on by small wounds or insect bites.
Even with the finest wound care, there is always a potential that an infection will develop. Infection of the soft tissues below the skin's surface is known as cellulitis. The dermis (you've seen this area when you scraped your knee as a youngster), subcutaneous fat, and muscle layers are the main layers of soft tissue underneath the epidermis.
The sheer quantity of burns, scratches, and cuts will make cellulitis one of the most common medical conditions, despite being preventable. Without medications, sepsis, a potentially fatal disease, can result from this infection because of how easily it can enter the bloodstream. Cuts, bites, blisters, and skin cracks can all serve as entrance points for bacteria that cause infections that, if left untreated, can result in sepsis. In an off-grid situation, we think that cellulitis will be the cause of a lot of otherwise avoidable deaths. The following conditions can result in cellulitis:
• Skin that is peeled or has cracks between the toes
• Poor blood flow, which includes varicose veins
• Accidents that result in a skin break
• Animal bites, human bites, and insect bites and stings
• Ulcers brought on by long-term conditions like diabetes
• Using steroids or other immune-compromising drugs
• Injuries from prior surgeries
• Using drugs intravenously
The following are cellulitis's symptoms and warning signs:
• Pain or discomfort near the infection
• Chills and a fever
• Exhaustion
• General discontent (malaise)
• Muscle pain (myalgia)
• Warmth in the infection's region
• Discharge of pus or hazy fluid from the infected site
• Redness that typically spreads to the torso
• Swelling in the infected site (causing a sensation of tightness)
• The noxious odor emanating from the infected site
Although cellulitis occasionally heals on its own, antibiotics are typically used in treatment. These come in oral, topical, and injectable forms. After a 10–14-day course of treatment with drugs from penicillin, erythromycin, or cephalosporin (Keflex) families, most cellulitis will get better and go away. Popular antibiotics include ampicillin and amoxicillin. Maintaining the extremities elevated is beneficial if cellulitis is present.
Ibuprofen (Advil) or acetaminophen (Tylenol) help ease discomfort. Soaks in warm water have been utilized for symptom treatment for a long time. The entire 10–14 days of antibiotics should be used to avoid any recurrences.
Abscesses (Boils)
An abscess is essentially a pus-filled pocket and is a type of cellulitis. Pus is the byproduct of your body's attempt to get rid of an infection; it is made up of inflammatory fluid, live and dead bacteria, and white and red blood cells.
It's possible that the abscess began in a "cyst," a hollow structure filled with fluid, if an infected wound or defective tooth were not the sources of the infection. Several different cyst forms can get infected and develop abscesses:
Sebaceous skin glands are concentrated on the face and trunk and are frequently connected to hair follicles.
Inclusion: When damage causes the skin's lining becomes stuck in deeper layers. Skin cell production and growth in inclusions are ongoing.
Pilonidal cysts are close to the tailbone and are prone to infection.
Antibiotics used to treat cellulitis have difficulty efficiently penetrating abscesses because they tend to wall off infections. It might be required to intervene.
A hole must be created for the evacuation of pus to treat an abscess. Applying warm, moist compresses to the area is the simplest technique to help with this. This will assist in bringing the infection to the skin's surface, where it will form a "head" and maybe spontaneously drain. The abscess is "ripened" in this manner. The abscess will change from stiff to soft, and the exit place will have a "whitehead" pimple.
If this doesn't occur naturally over a few days, you might need to perform an "incision and drainage" technique to break open the boil. Prick the skin above the abscess where it is most close to the surface with the tip of a scalpel (a number 11 blade works best). Your patient should receive instant relief from the pressure release, and the pus should flow easily.
Finally, thoroughly rinse and point the skin around the wound with triple antibiotic ointment. Wrap in a fresh bandage. Tea tree oil, raw honey, and lavender oil are substitutes for triple antibiotic ointment.
Dental abscesses may also benefit from incision and drainage, although it's possible that the surrounding teeth won't be saved. (In the dentistry section of this book, you can learn how to extract a tooth.)
Tetanus
The traditional position linked to tetanus
When we stepped on a rusty nail, the majority of us went to receive a tetanus vaccine as required, yet few of us truly understand what tetanus is or why it is harmful.
The bacterium Clostridium tetani is what causes tetanus, which is an infection. The bacteria creates spores, reproductive cells, or dormant bacteria in soil or animal waste. These spores can withstand temperature fluctuations and can survive for years.
There are just approximately 50 recorded cases of tetanus annually in the United States. However, there are more than 500,000 cases annually worldwide. The majority of casualties are located in underdeveloped nations with subpar immunization systems.
Tetanus infections typically happen after a person experiences a skin break. Skin is a crucial barrier against infection, and any crack in the defenses makes a person vulnerable to infection. The most frequent reason is a puncture wound of some kind, like a rusty nail or an insect or animal bite. This is because deep, narrow wounds provide less access to oxygen, which the tetanus bacterium dislikes. However, any wound that compromises the skin qualifies: The tetanus bacteria can enter the body through burns, crushed wounds, and lacerations.
Tetanus spores activate as full-fledged bacteria and multiply quickly when introduced into a wound. Tetanospasmin, a potent toxin released by the bacterium, causes harm to the sufferer. This poison selectively targets the muscle-supporting nerves.
Tetanospasmin binds to motor nerves, resulting in "misfires" that cause the affected areas to contract uncontrollably. The entire body may or may not be affected by this neurological injury. The patient can display the typical "lockjaw" symptom, in which the jaw muscle is tense. Any muscle group, including the respiratory musculature, is vulnerable to the toxin's effects and can become life-threatening if impacted.
Newborns and those over 65 appear to experience the most severe cases, and both groups of people are more likely to pass away from the illness. The mortality rate from widespread tetanus is 25–50%, higher in neonates.
You will be on the lookout for the following early symptoms:
• Sore muscles (especially near the site of injury)
• Weakness
• Irritability
• Difficulty swallowing
• Lockjaw
Initial symptoms may not present themselves for up to 2 weeks. As the disease progresses, you may see the following:
• Progressively worsening muscle spasms (may start locally and become generalized over time)
• Involuntary arching of the back (sometimes so strong that bones may break or dislocations may occur)
• Fever
• Respiratory distress
• High blood pressure
• Irregular heartbeats
First and foremost, the survival doctor needs to be aware that Tetanus is not communicable despite being an infectious condition. If you use a conventional hygienic approach and wear gloves, you can treat a tetanus victim safely. An irrigation syringe drains away debris after properly cleaning the wound with soap and water. This ought to restrict bacterial growth and hence lessen the production of toxins.
To eliminate the remaining germs in the system, you should provide antibiotics. It is reported to be effective to provide 500 mg of metronidazole (veterinary equivalent: Fish Zole) or 100 mg of doxycycline (veterinary equivalent: Bird Biotic) twice a day. The quicker you start antibiotic therapy, the fewer toxins your body will create. If you can administer it, intravenous rehydration is also beneficial. The patient will feel more at ease in a setting with dimmer lights and less noise.
Severe instances are treated with ventilators, tetanus antitoxin, and muscle relaxants or sedatives like ValiumTM (diazepam), but you are unlikely to have access to them. As a result, it is crucial to watch for the above-mentioned early signs in anyone who has received a wound.
Vaccination can help protect against tetanus. Booster shots are typically administered every ten years. Although the tetanus vaccine carries certain risks, severe side effects like seizures or brain damage happen less frequently than once in a million times. More frequently, milder side effects like fatigue, fever, nausea & vomiting, headache, and injection site irritation occur.