Thoughts On Alorian Medicine

Discussion in 'Roleplay Discussion' started by Ocularum, Sep 5, 2021.

  1. Ocularum

    Ocularum Scott Supremium

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    Table of Contents
    1. Preface
    2. Theory Overview

    2.1 Anatomy
    2.2 Mental Illness
    2.3 Disease Prevention
    2.4 Sanitation

    2.4.1 Regalia’s Pipes
    2.5 A Doctor’s Repertoire
    2.5.1 Tools
    2.5.2 Procedures
    3. Prosthetics
    3.1 Clockwork Biotech
    3.2 Clockwork Prostheses
    3.3 Traditional Prostheses
    4. Types of Healing
    4.1 Interactions Between Healing Types
    4.2 Alchemy and Herbalism
    4.3 Sorcery and Magic
    5. Roleplay Resources
    5.1 Dos and Don’ts
    5.2 Emote Examples

    5.2.1 PuffyPigeon’s Examples
    5.2.2 IreliaRamora’s Examples
    5.3 Abilities

    Preface
    Please ignore image errors or incorrect in-text citations. Things have been shuffled around and resized to preserve readability and not dwarf the surrounding text. Some topics were covered by request, and whatever this is does not cover abilities and how good they may or may not be. Thank @PuffyPigeon and @IreliaRamora for contributing their thoughts and roleplay experience.

    Theory Overview

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    Early ideas on medicine and psychology may be considered backwards by today’s standards, but those ideas are perfectly acceptable in Aloria with the exclusion of things like humors and the four temperaments (HydraLana, “School of Medicine”). However, Alorian doctors would have an understanding of the circulatory system, the nervous system (including some cranial nerves), parts of the eye, diagnosis by observing patients and examining their pulse and bodily fluids, and knowing the brain is the center of intellect and reason. This is the foundation of Galenic medicine, named after Greek physician Galen. At this stage in history philosophy and medicine were intrinsically linked, leading to physical ailments and moral virtue being almost one and the same (Wasson).

    Although, not all knowledge was good or correct by our current understanding. Galen, despite his contributions to the medical field and philosophy, also believed in miasma theory (or miasmatic theory) which is a medical theory that claims diseases and illnesses stem from bad air, which itself originated from rotting organic matter. Contaminated water, vapors, and poor hygienic conditions all were contributors to miasma, and passed not from person to person but from the environment itself. Regalia’s plumbing and sanitary systems could be attributed to belief in miasma theory. It would not be until the end of the real world 19th century that the opposing germ theory would take hold. While it is possible that Alorian doctors are toying with contagion theory, miasma theory is the much more attractive alternative to invisible pathogens or organisms that cause disease, which would make contagion and “germ” theory a form of quackery equivalent to believing Aloria is flat.

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    Although microscopes exist in lore, their rarity and expensiveness, combined with no existing industry for it, means that it will be a while yet before microbiology and studying bacteria begins (BetaInsomnia). There has however been in-character examination using microscopes by the defunct Steigenfrit Institute. You can read about their experiment here.

    Anatomy

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    (Johannes de Ketham. Fasiculo de medicina. (Veinice, 1495).

    Continuing on the topic of extensive study and observation, autopsy makes up the foundation of anatomy and medical practice. Altalar schools are known to test medical theories on slaves and animals alike (HydraLana, “School of Medicine”). In surgical literature there exists the Wound Man, a diagram that puts injury and illness on display in order to bring awareness to the human form and treatment (Hartnell).

    Mental Illness

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    Mental illness in Aloria should not have a one-to-one relationship with reality, largely because it is a sensitive and often uncomfortable topic, and because this universe is an amalgam of fantasy and real world elements. Some illnesses go by other names in lore, but are comparable to real mental disorders and diseases. Knight’s Syndrome for example is characterized by sufferers reliving their traumatic experiences and having strong emotional reactions to things that trigger those experiences (HydraLana, “School of Avant”).

    In other words, Knight’s Syndrome could be a form of post-traumatic stress disorder (PTSD), and this is the approach that should be taken when considering how mental illness, disease, and genetic disorders fit into this universe. Trauma is often used as a lazy plot device, so do not take this explanation as an excuse to do horrible things to your characters. Representations of things real people experience is important, but something that should be done carefully.

    Rather than a character having depression, social anxiety, PTSD, or an unnecessarily tragic backstory, they may instead be suffering from an imbalance of something, an improper diet, or a recognized phenomena or other term that. Alorian doctors have the means and tools to recognize patterns and changes in behavior, but not necessarily their actual origins or treatments for these disorders. Grief, negative environmental factors such as miasma or poor living conditions, and more could be the cause of mental instability, but not the why. In history, the why was sometimes demonic, or originating from sin and bad deeds.

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    It should be said that sometimes these descriptions were purposeful in order to paint groups of people in negative lights, citing their problematic viewpoints as demonic or madness to undermine them. These “demonic” origins were also overstated as the primary medieval understanding of mental illness, which was again based on ideas proliferated by Galen, who believed mental illnesses “had either physical or mental causes that included fear, shock, alcoholism, head injuries, adolescence, and changes in menstruation.” (Bridley and Lee.) Despite this “the ordinary man attributed ‘mental and spiritual illnesses... as much to overwork, overeating and overindulgence in sexual activity as to climatic conditions, magic, spells and demonic possession.’” (Neugebauer)

    Disease Prevention

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    Fire, quarantine, and plagues are common in roleplay, and surprisingly present in lore. The current Blight is technically not a plague, but for the purposes of discussing quarantine methods and medical theory it will be treated as such. The Blight has seen nobles close their borders, trades of infected goods denied, and a godawful amount of fire. All of these things have been employed against people in history to varying degrees of success, but these tactics stemmed from desperation and a desire not to become ill rather than an understanding of germs and microbes. Even the Black Plague was thought to be caused by bad air (miasma).

    Sanitation
    Contrary to popular belief, people in the Middle Ages were not all living in squalor and filth. Regalia is no exception to this, making use of plumbing systems and sewers built on the ruins of far older civilizations. There are a number of bathhouses in Regalia as well, and to my knowledge no dangerous outbreaks or closures that would disincline people from their use. Bathing in streams or other bodies of water would likely be popular, but the canals are known to house all kinds of nasty things.

    A good hygiene regime promoted good health, and good health stemmed the tides of disease and illness in communities. To that end people were advised to wash their hands and face daily and frequently wash their linens, as well take care of their hair so as to not catch lice (“The Medieval Hygiene Guide: Top Tips For Combating Grime In The Middle Ages - HistoryExtra”).

    Regalia’s Pipes
    Regalia’s plumbing comes from somewhere, and that somewhere is pipes. These pipes could be made up of lead, copper, or possibly even blacksteel. Lead runs the risk of lead poisoning over time, an illness that is not properly identified in Aloria. Copper on the other hand is prevalent in other places and disciplines and seems the more likely candidate. Copper also possesses resistance to corrosion, and antimicrobial properties that would not be known at this time. Blacksteel piping is a recent invention, but might exist in newer sections of the Holy City, or districts and neighborhoods where the Vladno congregate.

    A Doctor’s Repertoire
    A doctor’s knowledge is their saving grace and the tools they use to perform their duties are just as important.

    Tools

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    Images from the Wellcome Collection.

    Starting off with some misconceptions:

    1. Stainless Steel does not exist and also possesses no inherent antimicrobial properties.
    2. Steel has a durability that iron does not, but no other real benefits in terms of lore description (LumosJared). Iron is perfectly serviceable for tools.
    3. Steel is just as susceptible to corrosion as iron (because it’s an alloy containing iron, and does not possess the same properties as stainless steel), but proper care for tools makes this almost a non-issue (Corrosionpedia).
    The absolute pinnacle of tools is regular steel because the “Sancella of Union has a monopoly on the highest grade Steel” (LumosJared). In future years it would likely be carbon steel then stainless steel. For now, other materials are either too heavy, too expensive, or too ridiculous to be used in the medical profession. Tools themselves are incredibly varied and tailored to suit the operation being performed. Physicians however had far fewer tools at their disposal than surgeons did.

    Alorian doctors have access to the Cryostim, an injection and extraction device. Cryostims “are usually out of the price of a commoner, but most clinics will carry one or two Cryostims for medical use.” (LumosJared and HydraLana).

    Procedures
    There are countless more procedures than those listed here, but this is to give you an idea of ones that might be done at this time.

    As bloodletting was mostly employed as a means to balance humors, it likely would not be a treatment used by Alorian doctors.

    Trepanning on the other hand is life-saving, and was frequently used to reduce pressure in the skull after traumatic injury.

    Maggot Therapy is exactly what it sounds like.

    Lithotomy, a procedure for removing bladder stones.

    Prosthetics
    Prosthetics is the surgical or dental specialty concerned with the design, construction, and fitting of prostheses. Prostheses (plural) are an artificial device to replace or augment a missing or impaired part of the body (Merriam Webster). In lore there are a few examples of this, ranging from the fantastical in the case of Artifacts, to the “mundane.”

    Clockwork Biotech

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    Clockwork Biotech “bleeds”, grants the user a sense of touch, and is altogether an effective replacement for limbs lost (MonMarty, et al.). There are hardly any comparisons that can be drawn between Clockwork Biotech and prostheses of different real world periods, so it stands alone. You can read more about them here.

    Clockwork Prostheses
    Clockwork Biotech’s fragile cousin. These are perhaps the hand-crank prostheses seen in earlier years of MassiveCraft that shattered at the first sign of combat or with a good whack. Modern prostheses are about at this stage (though are less primitive and more expensive than prostheses of different eras), where the user controls the prosthesis with what remaining movement they have in their replaced limb. In advanced cases these replacements might even respond to nerve impulses, but that is more Clockwork Biotech’s purview.

    Traditional Prostheses
    The pegleg or the hooked hand—both are what immediately come to mind as antiquated artificial limbs. These traditional Prostheses may make use of straps to keep them in a set position, or be manually adjusted to complete everyday tasks.

    Types of Healing
    Interactions Between Healing Types
    Both alchemists and medical doctors have a distrust of magic, and this is reflected by mages having a dislike for alchemy and its products intended to reduce magical abilities (HydraLana, “School of Alchemy”). Magic is seen as a shortcut to natural healing and alchemy is seen by mages as a cheap imitation of their power, and while at one point the role of healer was interchangeable, alchemists and doctors are now distinct (HydraLana, “School of Medicine”). So, what does this mean? It means that doctors are not alchemists and alchemists are not doctors; sorcerers are not doctors but could wield Sorcery and Magic to handle magical ailments; and alchemists are neither doctors or sorcerers, but may be associated with herbalism, hailing back to their roots as tribal healers.

    There are schools of medicine in Altalar and Songaskian territories that focus on magic to heal, but studies of magical healing lack the knowledge gained from traditional doctoral studies. What use is there in learning how to set a broken arm when magic could be used to align the bones and so on (HydraLana, “School of Medicine”). This further reinforces the idea that sorcerers aren’t doctors, but they can be healers.

    Sorcery and Magic

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    Traditional medicine and alchemy are more accepted forms of healing. It was not until relatively recently that sorcerers, mages, and their magic were viewed in anything other than a negative light because for centuries Ailor and Asha alike were subject to enslavement and harsh treatment by the Allorn Empire until their fall. This in combination with Ailor’s most prominent religious views have created an environment where sorcerers and mages are scrutinized and use of their powers legislated against, though the noose has slackened due to the Emperor’s decrees and a need to coexist and make use of everyone within the Empire.

    Alchemy and Herbalism

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    With alchemy now being relatively freeform, it is possible to make use of the flora on the wiki in ways that were not possible before. Alchemy also has unique concoctions that mimic real world medicines, notably the Ground Cahal Tooth Potion and the Ash of Cielothar Hair Potion, which function as Hormone Replacement Therapy (HRT). The list of ingredients from the alchemy page has been expanded on and includes flora that could be of use. You can view that list on this spreadsheet.

    Roleplay Resources
    Dos and Don’ts

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    Emote Examples

    PuffyPigeon’s Examples


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    PuffyPigeon: Then afterward, there's usually chatter. If it's not busy, I stick with them for some good ol' doctor's recommendation and slice-of-life roleplay.

    Scott (Ocularum): This is a perfect example of what medics should be doing, and illustrates the correct way to include Abilities in emotes.

    IreliaRamora’s Examples

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    IreliaRamora: It's never a bad idea to explain what an item does—especially if it's an alchemy or specially treated medical item.

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    IreliaRamora: You can ask the patient what route they want to go, whether they want to stay awake or fall asleep for certain procedures! In this case, I wasn't aware of the necessity for major surgery at the time, but knocking the patient out was the right move anyways!

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    IreliaRamora: This is where things get somewhat tricky. In modern medicine, it's simple to inflate a lung. However, in more medieval times, practices might be a bit different! I decided to google it to see if there was any history related to treatments for a collapsed lung. Searches like "History of collapsed lung treatment" or "Collapsed lung medieval times" ends up getting you on the right track, but sometimes it might take a few sources to find a solid reference.

    Always look for sources that reference around or before the 1000s if possible, or as close to the 200CE. That's a typical benchmark that I use based on OOC medical guidelines from the Medical Schools pages - Which cites medical prowess to be around the same level as the Greek philosopher Galen's practices. But! You can always improvise to a certain extent.

    Source: Thoracic Drainage

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    IreliaRamora: Any Afflicted individual infected with Vampirism or Cahalism will have their strength drained as they touch the water of the Sacrosankt. This prevents them from removing any part that touches the water as long as they are afflicted. Make sure to emote this if a struggle is occurring, or if someone is trying to prevent themselves from stepping in!

    The curing lore cites needing materials for this so flavor it up all you want! Candles, incense, paints and poultices made of special herbs... Feel free to flavor it any way you want! It's not mandatory to do this, but it makes for more interesting RP.

    Chanting, however, is the mandatory portion of curing. This is a ritual-like ceremony, and as such words do need to be spoken. If you would like, you could create your own verbal chant (If your character is a Unionist, this would fit well! A chant based on the God Empress Ness would be awesome!) Otherwise, you can simply emote that your character is chanting, and add some flair to it.

    Abilities
    Healing abilities are divided up mechanically. There is hardly any reason to pick the same abilities multiple times in part because of how stratified the roles of sorcerers, doctors, and alchemists are, and because even if it has different origins and mechanics associated with it the abilities do functionally the same thing. Refer to the Ability List when weighing the different types of abilities unless mechanics are explained on the page where that ability is listed.

    Clockwork point-buy has been omitted because “Clockwork will soon face a revision along the lines of Alchemy that will see the ability to buy Sorcery through Clockwork completely removed” (MonMarty).

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    A table showing types of healing abilities, available here.

    Citations

    Bridley, Alexis, and Lee W. Daffin. Essentials of Abnormal Psychology, Washington State University, 5 Jan. 2018, opentext.wsu.edu/abnormalpsychology/chapter/1-4-the-history-of-mental-illness/.

    Brill, Jason, et al. “The History of the Scalpel: From Flint to Zirconium-Coated Steel | The Bulletin.” The Bulletin, AmCollSurgeons, 1 Feb. 2018, https://bulletin.facs.org/2018/02/the-history-of-the-scalpel-from-flint-to-zirconium-coated-steel/.

    Hartnell, Jack (2017-06-29). "Wording the Wound Man". British Art Studies (6). doi:10.17658/issn.2058-5462/issue-06/jhartnell. ISSN 2058-5462.

    “How Does Rust Work? | HowStuffWorks.” HowStuffWorks, HowStuffWorks, 15 Aug. 2000, https://science.howstuffworks.com/question445.htm.

    HydraLana. “School of Alchemy.” School of Alchemy - MassiveCraft Wiki, wiki.massivecraft.com/School_of_Alchemy.

    HydraLana. “School of Avant - MassiveCraft Wiki.” MassiveCraft Wiki, https://wiki.massivecraft.com/School_of_Avant.

    HydraLana. “School of Medicine.” School of Medicine - MassiveCraft Wiki, wiki.massivecraft.com/School_of_Medicine.

    Kroll, J, and B Bachrach. “Sin and mental illness in the Middle Ages.” Psychological medicine vol. 14,3 (1984): 507-14. doi:10.1017/s0033291700015105

    LumosJared. “Steel.” MassiveCraft Wiki, https://wiki.massivecraft.com/Steel.

    LumosJared, and HydraLana. “Cryostim.” MassiveCraft Wiki, https://wiki.massivecraft.com/Cryostim.

    MonMarty, and OkaDoka. “Faith of Estel.” MassiveCraft Wiki, https://wiki.massivecraft.com/Faith_of_Estel#Ammu-Loa.

    MonMarty, and Eccetra. “Alchemy.” Alchemy - MassiveCraft Wiki, wiki.massivecraft.com/Alchemy.

    MonMarty, et al. “Clockwork.” MassiveCraft Wiki, https://wiki.massivecraft.com/Clockwork.

    Neugebauer, R. (1979). Medieval and Early Modern Theories of Mental Illness. Archives of General Psychiatry, 36(4), 477. doi:10.1001/archpsyc.1979.0178004

    “Science and Its Times: Understanding the Social Significance of Scientific Discovery.” Encyclopedia.com. 16 Aug. 2021 .” Encyclopedia.com, Encyclopedia.com, 27 Aug. 2021, www.encyclopedia.com/science/encyclopedias-almanacs-transcripts-and-maps/mental-illness-during-middle-ages.

    “Sorcery.” Sorcery - MassiveCraft Wiki, wiki.massivecraft.com/Sorcery.

    “The Medieval Hygiene Guide: Top Tips For Combating Grime In The Middle Ages - HistoryExtra.” HistoryExtra, HistoryExtra, 3 Mar. 2020, https://www.historyextra.com/period...washing-cleanliness-coronavirus-plague-covid/.

    Wasson, Donald L. “Galen.” World History Encyclopedia, World History Encyclopedia, 15 Oct. 2019, https://www.worldhistory.org/Galen/.

    Works Consulted
    “Ability List.” Ability List - MassiveCraft Wiki, wiki.massivecraft.com/Ability_List.

    Eccetra. “Experiment #2: Of Url Blood | The Steigenfrit Institute | MassiveCraft Forums.” MassiveCraft Forums, 6 Apr. 2020, https://forums.massivecraft.com/threads/experiment-2-of-url-blood-the-steigenfrit-institute.83050/.

    Conti, Andrea. “Quarantine through History.” PubMed Central (PMC), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7171380/.

    Ethics, Encyclopedia of Science, Technology,. “Galenic Medicine.” Encyclopedia.Com | Free Online Encyclopedia, Encyclopedia.com, 16 Aug. 2021, https://www.encyclopedia.com/science/encyclopedias-almanacs-transcripts-and-maps/galenic-medicine.

    Kannadan, Ajesh (2018) "History of the Miasma Theory of Disease," ESSAI: Vol. 16 , Article 18. Available at: https://dc.cod.edu/essai/vol16/iss1/18

    Stewart, Doug. “Galen - Biography, Facts and Pictures.” Famous Scientists - Biography, Facts and Pictures, FamousScientists.org, 22 Dec. 2014, https://www.famousscientists.org/galen/.

    “The History of Prosthetic Limbs | HowStuffWorks.” HowStuffWorks, HowStuffWorks, 25 June 2008, https://science.howstuffworks.com/prosthetic-limb1.htm.

    Other sources include trust me, bro and tickets. Thank BetaInsomnia and MonMarty for handling my questions.


    Why would you do this?
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  2. dimetros

    dimetros gross and small lizard

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    scott holy fuck
     
  3. GoodDreamer

    GoodDreamer The Regalian Nuke

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    You're amazing
     
  4. CrimsletMonarch

    CrimsletMonarch Priestess?? Dawn Songstress?? Emotional Wreck??

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    This is pretty good! I would say maybe Primal Reversal 2 could be added, but then, again I am unsure if it is really needed since this is already very in-depth.
     
  5. soggytoenails

    soggytoenails Roleplayer Premium

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    • Agree Agree x 2
  6. Ocularum

    Ocularum Scott Supremium

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    Meyer was whispering in my ear saying the same thing. I could have included every healing ability, but I avoided ones gained from afflictions or unavailable with point investment because I thought it'd be a little disingenuous. You want this healing ability there? Get infected and risk your business and livelihood, etc etc. I can still put them on the spreadsheet, though I might I list them separately.
     
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  7. Cipherition

    Cipherition Welcome to White Space.

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    immediately bookmarking this thank you so much
     
  8. NebulaePrimo

    NebulaePrimo Breizh... Premium

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    This is powerful and I will be using it for sure
     
  9. indyfan98

    indyfan98 I'm not narcissistic. I'm just better than you. Staff Member PR1
    1. Dread Empire Mage School AU

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    Also, a fun fact about history: doctors used to leave surgery for barbers to do. The doctors saw surgery as below them. The barbers would do amputations, tooth pulling, bullet or arrow removal, etc. The colors on a barbershop pole stand for blood (red), bandages (white), and I believe suds (blue).
     
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