Since Rasim's player is far too busy to write the truly epic textbook he laid out covering all aspects of medical practice on TI, I've been thinking about writing a smaller manual specifically to cover trauma care (wounds, etc.) since this is my Physician PC's area of expertise.
Mostly, I want to avoid the issue of inflation. Nobody really has a good sense as to where the limits lie in terms of thematic medical practice. So it's common that someone might use a technique that's too advanced for theme, but if other Physicians don't use it, they look like an idiot, and so soon you get this creep toward more and more sophisticated methods in order to just keep up. I've been guilty of this myself, and I think we need set in stone guidelines as to what is cutting-edge (haha) current treatment to stop the creep.
In writing a plan for a handbook on it, I realized I had a lot of questions about what would be considered truly thematic care, so I thought I'd post the outline and solicit comments from folks.
There are questions scattered through the text for things I'm particularly wanting input on (in italics), but please feel free to address other things as well, like stuff I've left out, etc.
Handbook of Traumatic Medical Practice
------I. General Wound Care------
- Cleaning wounds, the necessity of basic hygiene.
- A thematic description of infection ('corruption of the humors from outside influences') and the IC treatments to prevent it in brief summary.
- Bandaging procedures.
------II. Blunt Wounds------
- Bruising, the usefulness of leeches and an explanation of how they work.
IIa. Limb Fractures
- Most common types, various forms of casts, which are best for which wounds, how long to leave them in place.
- How to rebreak safely as possible.
IIb. Rib Fractures
- Should treatment involve wrapping ribs? Not beneficial in reality but often feels better, so I think it would probably be a standard treatment.
IIc. Skull Fractures
- Dangerous, no treatment except fitting skull back together. Metal fasteners in extreme cases, or is this out of theme? Drain swellings with leeches asap.
- Trepanation?
IId. Crushing Wounds
- Clean up blood, apply cold, be wary of tissue death that may require amputation
- I am assuming we would not have the knowledge for a fasciotomy (removing the fascia to take pressure off crushed tissue?) It depends on how much IC knowledge of anatomy, I think. A fasciotomy isn't very complex, but with infection being such a risk even considering we know of it ICly, perhaps we would never engage in any kind of deliberate surgical procedure? Really appreciate thoughts there.
------III. Slashing Wounds------
- Stitching, debridement, length of time to leave in sutures in various body parts, how to handle infection in a stitched wound
IIIa. Deep Cuts
- Mending arteries/veins? Do we do this? How do we handle organ damage - sew things together and pray?
IIIc. Severed Body Parts
- Pack in snow if possible, reattach if within 30 mins? Do we ever reattach stuff?
IIId. Puncture Wounds
- Stop bleeding
- Clean wound thoroughly
- Stitch if need be
- If punctured lung: release trapped air in body cavity periodically with needle and pray for the best, little else to be done?
IIId. Uncontrolled Bleeding
- Yarrow; other herbs we use for this?
- Cauterization if/when needed
------IV. Burn Wounds------
- Cool vinegar/alcohol poured over the burn
- Willowbark tea or floleaf for pain; mandrake if burns severe
- Gently apply burn salve
- Wrap in soft gauze
- Wash in cool liquid once a day, re-wrap
- Probably special humoral diet?
------V. Frostbite ------
TBD
------VI. Magical Wounds------
TBD
Handbook of Traumatic Medicine
We should talk on the mud. There's lots of good info out there on old medical practices (history of surgery on wiki is handy, there are some online copies of old books on wound men that are as well).
I think the big thing, for me, is when people start talking about infections/contagions in ways that indicate they really understand those processes. People didn't. Washing hands as standard practice is a recent thing. Etc.
Will try to post something on here over the weekend, though, even if I do catch you IG.
I think the big thing, for me, is when people start talking about infections/contagions in ways that indicate they really understand those processes. People didn't. Washing hands as standard practice is a recent thing. Etc.
Will try to post something on here over the weekend, though, even if I do catch you IG.
Yeah, for me, this is one area in which I'm less concerned about adhering perfectly to history and more about assembling a coherent and reasonable set of practices, especially considering the fact that on TI, treatment -works-. If we take some things from 1500 and some things from 900, that's A-OK by me so long as it all hangs together ICly.
Infection is probably the #1 biggie for getting it right. We need a 'theory' of it that encompasses everything known about it, complete with errors and a very limited range of treatments that make sense considering its humoral explanation.
Typically, my IC explanation has been that infection (which I call corruption of the humors) happens when some sort of outside agent is introduced into the humors and causes them to be fouled. This can be introduced into the wound when it's first incurred, or simply be the fault of bad, dirty air.
Hence astringent liquids like alcohol or vinegar are a good treatment, because when applied, they burn: fire is a cleansing force, and it's removing the outside agent. This is also why you must sterilize instruments, because they may carry filth from patient to patient.
I'd like to stick with that approach because it's:
1) Kinda correct in some ways, but ultimately limited enough to feel thematic;
2) Arising naturally from humor theory
3) Allowing for enough logical treatment to RP recovering from infection if someone wants to go down that path - but also poor enough treatment to RP dying from it and frequently, as realistically happened with infections before antibiotics.
Infection is probably the #1 biggie for getting it right. We need a 'theory' of it that encompasses everything known about it, complete with errors and a very limited range of treatments that make sense considering its humoral explanation.
Typically, my IC explanation has been that infection (which I call corruption of the humors) happens when some sort of outside agent is introduced into the humors and causes them to be fouled. This can be introduced into the wound when it's first incurred, or simply be the fault of bad, dirty air.
Hence astringent liquids like alcohol or vinegar are a good treatment, because when applied, they burn: fire is a cleansing force, and it's removing the outside agent. This is also why you must sterilize instruments, because they may carry filth from patient to patient.
I'd like to stick with that approach because it's:
1) Kinda correct in some ways, but ultimately limited enough to feel thematic;
2) Arising naturally from humor theory
3) Allowing for enough logical treatment to RP recovering from infection if someone wants to go down that path - but also poor enough treatment to RP dying from it and frequently, as realistically happened with infections before antibiotics.
Just two comments - Davites worship a water god and use 'purification' and 'cleansing' rituals to combat magical taint and sin. In that vein, whereas I agree they'd know squat about bacteria, etc, it's not unlikely that they might wash their hands frequently or do so before embarking on important practices like surgery. Their soap probably isn't anti-bacterial though *cough*
The other thing that jumped out at me was trepanning, which my understanding is that it's an ancient practice previous to even Roman times, so I'd think it'd be okay. Ancient skeletons have been found that were trepanned, and more importantly, bone growth after the procedure implied the "patient" survived to heal somewhat.
The other thing that jumped out at me was trepanning, which my understanding is that it's an ancient practice previous to even Roman times, so I'd think it'd be okay. Ancient skeletons have been found that were trepanned, and more importantly, bone growth after the procedure implied the "patient" survived to heal somewhat.
1) Cleaning wounds and basic hygiene: Basic hygiene, for the reasons we have it, wouldn’t be known. Assumedly, people don’t want to smell, and we’ve got a water religion, so washing stuff with water or holy water would probably be good. Going with your interpretation of pus being corruption (it was recognized in Greek medicine, at least, as a good thing in a wound and a sign of healing, so they used to put bad stuff into wounds to irritate it to make pus develop if it didn’t), then they’d remove those humors. Commonly did understand that they want to keep something on the wound to keep it moist to promote healing (honey was popular, but herbal salves probably work), then wrap it in bandages. Very much a “wrap it and pray” type of operation. I’d think “if it starts to smell rotten” would be an indication something isn’t right and to have it looked at again. I don’t think ‘fire’ or burning liquids is the only way to cure infectious wounds. Maggots were used to eat away dead or corrupted flesh and are still used in medicine today. I could see a traumatic surgeon dumping some maggots on someone’s nasty look wound, wrapping them up until the maggots do their business, cleaning them out, doing whatever needs to be done, then wrapping the wound up. I like that better than alcohol or vinegar because it’s grosser. >.> But vinegar was kept in rooms to purify the air, so could just as easily be used for washing.
2) Bruising is a sign of too much blood in a certain area of the body. If there’s a reason for it, then it’s a direct response to injury to the body and humoral imbalance. If you just bruise easily, then you’re clearly sanguine. Leeches can drain the bruise directly if there is a bruise. To cure actual sanguine imbalance, then leeches would be placed on specific parts of the body to drain certain organs in other parts of the body (sort of like reflexology, but not confined to the feet). Blood-letting (just cutting the bruise) is just as useful and would probably be used in surgical situations over leeches. Leeches DO have proven medical qualities and are useful.
3) Plaster casts weren’t until the 1800s. Splints were most commonly used, with linen bandages wrapped around them. The bandages were normally treated with something to make them stiffer – Egyptians used embalming stuff (resins), Greeks used wax and resins. Middle ages got a bit more towards something that sounds like paper mache (animal fat, flour, egg whites, etc.) Artificial limbs started in the late middle ages. I normally look online for general “how long does a broken adult X take to heal” for healing times. They understood muscle atrophy and the need for exercise and being easy on those injuries. There are lots of information there about traditional bonesetters (goes a bit beyond this, they treated spinal problems and other things, too.)
4) Ribs: I like wrapping them or sticking people in support corsets, just to promote RP (need to buy PC made items). Bloodletting or leeches from proper places to try and balance the humors in that area, too.
5) Trepanation, as Kin noted, was widely used historically and there’s evidence of bone regrowth, which means people survived for a while afterwards. Metal fastners would be too out of theme (long surgeries that are really bloody just aren't possible). Trepanation was used for mental illness, epilepsy, migraines, etc and was popular amongst the rich in Europe (rather, more of those bodies found on) so sounds like it could be elective. Evidence also shows it’s used for traumatic head wounds, to get shards of bone out to and to relieve pooling blood. Evidence from Europe indicates the infection rate was low and the survival rate for the procedure was high.
6) Crushing wounds: Clean that shit out with maggots, yo. Fasciotomy sounds like a no.
7) Deep cuts – cauterize the arteries or veins is possible. Not sure if it was done.
8) We do not reattach limbs. Not possible. This was only possible very recently historically. We can’t keep huge open blood wounds, there is no blood transfusion for lengthy surgeries. Something gets cut off, it gets cut off. Cauterize that shit pronto if you want to live.
9) Puncture wounds – clean it, stick some mumbo-jumbo honey shit on it, stitch it, cover it up, and pray.
10) Uncontrolled bleeding – cauterization ASAP. There are no blood transfusions. Blood loss is a death sentence. Cauterization was widely used – to stop blood loss, to cause irritation in one part of the body to balance humors in another part of the body, to remove tumors, etc.
I spent some time looking at:
http://archive.nlm.nih.gov/proj/ttp/fla ... etham.html
Which is a copy of a wound man (Traumatic medicine) book from the middle ages. When you hover over different parts of the text and images, it’ll pop up with text explaining it, and I’ll look through it to see if there are any fun nuggets to add to this.
2) Bruising is a sign of too much blood in a certain area of the body. If there’s a reason for it, then it’s a direct response to injury to the body and humoral imbalance. If you just bruise easily, then you’re clearly sanguine. Leeches can drain the bruise directly if there is a bruise. To cure actual sanguine imbalance, then leeches would be placed on specific parts of the body to drain certain organs in other parts of the body (sort of like reflexology, but not confined to the feet). Blood-letting (just cutting the bruise) is just as useful and would probably be used in surgical situations over leeches. Leeches DO have proven medical qualities and are useful.
3) Plaster casts weren’t until the 1800s. Splints were most commonly used, with linen bandages wrapped around them. The bandages were normally treated with something to make them stiffer – Egyptians used embalming stuff (resins), Greeks used wax and resins. Middle ages got a bit more towards something that sounds like paper mache (animal fat, flour, egg whites, etc.) Artificial limbs started in the late middle ages. I normally look online for general “how long does a broken adult X take to heal” for healing times. They understood muscle atrophy and the need for exercise and being easy on those injuries. There are lots of information there about traditional bonesetters (goes a bit beyond this, they treated spinal problems and other things, too.)
4) Ribs: I like wrapping them or sticking people in support corsets, just to promote RP (need to buy PC made items). Bloodletting or leeches from proper places to try and balance the humors in that area, too.
5) Trepanation, as Kin noted, was widely used historically and there’s evidence of bone regrowth, which means people survived for a while afterwards. Metal fastners would be too out of theme (long surgeries that are really bloody just aren't possible). Trepanation was used for mental illness, epilepsy, migraines, etc and was popular amongst the rich in Europe (rather, more of those bodies found on) so sounds like it could be elective. Evidence also shows it’s used for traumatic head wounds, to get shards of bone out to and to relieve pooling blood. Evidence from Europe indicates the infection rate was low and the survival rate for the procedure was high.
6) Crushing wounds: Clean that shit out with maggots, yo. Fasciotomy sounds like a no.
7) Deep cuts – cauterize the arteries or veins is possible. Not sure if it was done.
8) We do not reattach limbs. Not possible. This was only possible very recently historically. We can’t keep huge open blood wounds, there is no blood transfusion for lengthy surgeries. Something gets cut off, it gets cut off. Cauterize that shit pronto if you want to live.
9) Puncture wounds – clean it, stick some mumbo-jumbo honey shit on it, stitch it, cover it up, and pray.
10) Uncontrolled bleeding – cauterization ASAP. There are no blood transfusions. Blood loss is a death sentence. Cauterization was widely used – to stop blood loss, to cause irritation in one part of the body to balance humors in another part of the body, to remove tumors, etc.
I spent some time looking at:
http://archive.nlm.nih.gov/proj/ttp/fla ... etham.html
Which is a copy of a wound man (Traumatic medicine) book from the middle ages. When you hover over different parts of the text and images, it’ll pop up with text explaining it, and I’ll look through it to see if there are any fun nuggets to add to this.
Thanks for all the input! I really appreciate your work. Let me know if you want to be involved in writing the helpfiles that might come out of this, or anything like that?
I'll generally go with the things you've suggested, I think, though there are some small places still where we disagree. A lot of this comes from me only posting bullet points so far. I'll be posting the section on infection soon, since that seems contentious, to see if what I come up with feels reasonably appropriate for everyone.
Re: attachment - was definitely not thinking reattaching limbs. I guess I mean fingers/toes; but we probably don't attach those either, eh?
Evidently there's actually precedent for some remarkably complex surgeries in this time frame, so I think sewing veins/arteries together is not impossible - though I'll be recommending it in a VERY qualified fashion...
I'll generally go with the things you've suggested, I think, though there are some small places still where we disagree. A lot of this comes from me only posting bullet points so far. I'll be posting the section on infection soon, since that seems contentious, to see if what I come up with feels reasonably appropriate for everyone.
Re: attachment - was definitely not thinking reattaching limbs. I guess I mean fingers/toes; but we probably don't attach those either, eh?
Evidently there's actually precedent for some remarkably complex surgeries in this time frame, so I think sewing veins/arteries together is not impossible - though I'll be recommending it in a VERY qualified fashion...
Microsurgery wasn't until the late 1800s (I think that's what you're getting at with vein/artery replantation). Even things like reattaching fingers is very very modern (1960s). The first replantation of a brachial artery (reattaching or saving an arm) was in the 60s, too.
You're working with needles (that are hand made, not machine made, so they are big) and cat gut thread for sewing, and you don't have microscopes or anything to see things in much detail. I don't think anything on such a small detail was possible back in the time period we're talking about. Nevermind it'd be a mess - blood would be pouring out and there's no transfusions. I think they'd just cauterize and/or chop off and call it a day.
I don't mind doing research, but am not overly interested in making helpfiles, nor do I really think any of this needs to be helpfiles. Make a book, stick it in the library, and call it a day. People can go read the book. What's the purpose of IC books if we're going to have it all in helpfiles? It doesn't make sense to me. Don't think you should be making more work for yourself than necessary.
I already have a book out on herbalism and humors. Could expand on the later topic or do a general sort of medical book for everyday physician practice if folks want that.
You're working with needles (that are hand made, not machine made, so they are big) and cat gut thread for sewing, and you don't have microscopes or anything to see things in much detail. I don't think anything on such a small detail was possible back in the time period we're talking about. Nevermind it'd be a mess - blood would be pouring out and there's no transfusions. I think they'd just cauterize and/or chop off and call it a day.
I don't mind doing research, but am not overly interested in making helpfiles, nor do I really think any of this needs to be helpfiles. Make a book, stick it in the library, and call it a day. People can go read the book. What's the purpose of IC books if we're going to have it all in helpfiles? It doesn't make sense to me. Don't think you should be making more work for yourself than necessary.
I already have a book out on herbalism and humors. Could expand on the later topic or do a general sort of medical book for everyday physician practice if folks want that.
Okay, you've convinced me - I'll avoid any kind of rejoining of veins. (And reattaching fingers, too.)
The reason I want a helpfile is so that anybody who might be practicing medicine can just quickly glance it over and know what's thematic to RP. The book will still be worth reading because it'll have tons more detail.
If you don't wanna write anything up re: all this, that's totally fine by me - I just felt like you'd done enough work I wanted to offer the chance for QP.
Once new herbalism comes in I'd LOVE a book on treating various disorders/illness/diseases with herbalism. It'd be awesome if between your work and mine we end up with a few books that can serve as sort of 'medical canon' for physicians to reference.
The reason I want a helpfile is so that anybody who might be practicing medicine can just quickly glance it over and know what's thematic to RP. The book will still be worth reading because it'll have tons more detail.
If you don't wanna write anything up re: all this, that's totally fine by me - I just felt like you'd done enough work I wanted to offer the chance for QP.
Once new herbalism comes in I'd LOVE a book on treating various disorders/illness/diseases with herbalism. It'd be awesome if between your work and mine we end up with a few books that can serve as sort of 'medical canon' for physicians to reference.
Well, I've got my University book, that has two sections on herbalism, one on humors, and one on women's health issues. The herbalism thing is mostly non-code though, since that's not in. I suppose a code one would be useful when it is out in game.
I think a single helpfile is probably all that you'd need, like the ones for water so people know drinking water is a bad idea.
I don't think it'd make sense for Saf to make the book, but could probably make a larger one on humors and how to treat them and/or common complaints for regular physicians. Or something on Charalin medicine. What's the most useful?
I think a single helpfile is probably all that you'd need, like the ones for water so people know drinking water is a bad idea.
I don't think it'd make sense for Saf to make the book, but could probably make a larger one on humors and how to treat them and/or common complaints for regular physicians. Or something on Charalin medicine. What's the most useful?
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