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In a fantasy game, I'd like to make less use of magic healing - making it something special (magical even ;) ) - and instead have the characters see doctors/surgeons, often leaving them a little worse for wear.

How can I keep a doctor/surgeon character setting-appropriate?

And how can I deal with characters who want to learn medieval medicine?

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I think this question needs to be system specific. – anon186 Oct 29 '10 at 13:30
The question could be more specific as to technology level, but there is no need for it to be system specific. – aramis Oct 29 '10 at 17:06

Several things to keep in mind about real medieval medicine:

  1. No Sterilization - infection was rampant
  2. very few specialists - mostly wisewomen and barbers. A genuine surgeon was bloody rare. A Medical Doctor was in fact extremely rare, and in many places, a criminal!
  3. Very little of actual systemic issues known.
  4. Lots of herbal remedies merely mask symptoms; a few actually work on problems.
  5. No scientific research of note.
  6. Few effective anesthetics.
  7. Most didn't believe animal studies relevant - veterinary care was often in fact better!

The issue of specialists is important: Romans had surgeons and also healers, and some priests who did healings. Surgeons/Chiurgeons/Chirurgeons basically cauterized wounds and set limbs. Healers treated systemic disorders with herbal and chemical remedies, but generally avoided blood. Priests used potions and prayers, as did some wisewomen.

Post-Roman, the research was all but killed off; prohibitions on human vivisection, dissection, and autopsy, coupled with the loss of many medical texts, resulted in what little knowledge had been accrued being generally lost. Without vivisection and/or dissection and/or autopsy, little was known about the internals, and less about their operation. Further, given the choice between the later, better, Roman book by a noted hardline Christian Era pagan, and the pre-Christian era scholar who was known to have it wrong by the later Romans, typically, the earlier source was the one used.

Without anesthesia, and without sterilization, the risks of infection were immense. Honey-based salves and poultices were used, and known to work, but why wasn't. (Honey is naturally antibiotic.) Leaching of swellings would reduce them, but provided another infection route. Amputation risked contamination with incompatible blood types, as well as infection.

Cauterization was the common mode of cleaning wounds. It was rather effective, but extremely painful and often did damage all its own in addition.

Surgery was oft prohibited inside towns, due to noise and stench.

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Note that it is generally the surgeon that was considered a criminal not a doctor. The difference is that surgery involved cutting into the human body which can be a problem in different culture. – RS Conley Oct 29 '10 at 12:48
Actually, the concept of "Doctor" originally had nothing to do with medicine; it's a scholarly title. Doctors of medicine don't start in any number until the renaissance. Post-Roman scholarly pursuit of medicine begins in earnest in the Duello period, tho in muslim held lands, practical surgery. And it's not until the 1800's when most physicians also had doctorates. Medicine as science starts again in the late 19th C, with the regulation of the industry in most western nations. – aramis Oct 29 '10 at 17:04
You could flip it to reflect the state of Arabic medicine at the time which was actually very good. They also actively studied it. – David Rickman Jul 21 '11 at 20:28

For a fantastic resource on the science of medicine, herbalism, and churgery in the 13th century, I recommend Art and Academe by Atlas Games for their Ars Magica game.

It details the humors, injury, illness, and the steps necessary to fix them without involving many game-specific rules outside of certain sections. it is easily generalizable to any game system.

To keep a doctor appropriate, first separate the practice of medicine from churgery. Bone-setters are much less prestigious than Doctores, and they treat completely different things. Churgeons treat broken bones, injuries, and obvious wounds (that take months or longer to heal if they're bad.) Doctors treat diseases, do medicine, and otherwise balance the humors.

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Burning Wheel is a fantasy game with a gritty system for wounds, treatment, and healing. Combat in Burning Wheel isn't outright deadly, but combat has a good chance of giving you a debilitating injury.

There are different ranges for wounds. The severity of the wound for a character depends on their stats; the same attack could be a Light wound for some and a Superficial wound for others. Injuries stack and cause die penalties. When the sum of the die penalties brings any stat to 0 or lower, they're down.

Superficial and Light wounds will heal themselves over the course of a few hours to a day, even on a failed Health test, without medical attention. Wounds more severe require medical attention before the Health test can be made to recover. Medical attention includes skills like Herbalism, Field Dressing, and Surgery, with different obstacles depending on which skill and the wound severity.

Untreated or poorly treated wounds can also bleed out to more severe wounds or leave permanent die penalties or, in the case of Mortal Wounds, death. After treatment, a Health test determines (on success) how long it takes to recover or (on failure) more permanent die penalties or death. Healing times are based on severity, with ranges like 2-12 weeks, 1-3 months, 2-6 months, and up to 24 months for a Mortal Wound.

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Agreed, but a more detailed would be great! – SevenSidedDie Oct 29 '10 at 6:20
Added a bunch more detail and got voted down while writing it! Brilliant! – okeefe Oct 29 '10 at 13:51
Don't take it personally; some jerk serial down-voted all the answers but two and left no comments. – LeguRi Oct 29 '10 at 13:53
One thing worth noting about Burning Wheel is that playing a dedicated healer (even one without a big wound-making mace) is an entirely viable character, since the game is more about the troubles the healer cares about and less about being a cure-dispenser for fighty types. It's worth looking at the game just to see how it pulls that off. – SevenSidedDie Oct 29 '10 at 17:29

The most gamable treatment of herblore I've seen is Columbia Game's Herblore. The PDF can be found here. The print product is here. While written for Hârnmaster it is quite descriptive and adaptable for other rules system. I used it for original D&D and GURPS. One nice thing about this particular supplement is that it distinguishes between the raw plant and the potion that can be made from it. Both have effects in game terms. Some potions are made from a combination of plants.

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King Arthur Pendragon also has a usable system. An algorithm using physical stats (like Constitution) determines how many hit points per week are healed. Any serious wound, disease, significant blood loss, etc. requires a specialist to heal. They heal more often than not; but, the odds are not really that good. Permanent damage is commonplace.

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There was a supplement for Warhammer Fantasy Role Play 1ed. called Warhammer Grimoire, where an alcoholic surgeon is described, together with broader rules about healing and well, cutting off limbs. This was all pretty grim and gritty, dirty and not very efficient, but at the same pretty cool (don't get your self anesthetized, because you can wake up without some important parts of your body).

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May I ask, why was my answer down voted? I proposed a supplement with well described late medieval medic and his practice. What is wrong with this answer? – gruszczy Oct 29 '10 at 17:08
Someone just decided to down-vote every answer that mentioned a game supplement, looks like. It doesn't appear to be personal. – SevenSidedDie Oct 29 '10 at 17:19

To be honest, not a question I'd thought about much before, but I'll have a shot at it - call it my take on the concept. Surgery was generally avoided whenever possible. That gave infections a good shot at killing you, and from what I've read in a number of history texts, even minor injuries could lead to some pretty severe consequences. Surgery, sadly, tended to kill more people than it saved, and those it didn't kill sometimes wished they had died. Cauterization of wounds was common, which would ensure no healing would take place thereafter. Amputation was commonly used as a last resort (outside armies in a war, where it was used considerably sooner than that) which meant that gangrene could take hold, and by the time the victim finally plucked up enough courage for amputation, it was often too late. Remember, with a limb missing, you couldn't work in most jobs, which left relying on family or begging as options. So, surgery was a last option. Why? Because surgeons were prohibited, in most cultures, from cutting up bodies, living or dead. (For religious reasons, by and large) That meant that they were often working blind, so to speak. Add that to the fact that a successful surgeon often had little or no knowledge of (or interest in) hygiene and some wore their blood-soaked aprons to advertise their experience, and you can start to see why they were often referred to as butchers (and that pejorative is still used even today). If you wanted to find a surgeon who had some clues, you'd ask around to see who had the most surviving patients. Alternatively, and this was a good way for a character wanting to gain surgical experience, follow an army around. The surgeons there had a lot of experience in stopping bleeding, dealing with infection, and amputations. They may have erred on the side of safety, and performed amputation a little on the early side, but they had a lot of experience with what an untreated infection could do. As a character, you'd have a chance to explore anatomy that way, though unnecessary experimentation could lead to an early death at the hands of the friends of the dead, friends who were very handy with weapons.

Now, if you wanted to go for herbal cures, there were a number of options. Apothecaries existed who could provide you with what were believed to be efficacious cures for any number of conditions, and often were effective, although sometimes the side-effects were somewhat less appealing. Herbalists existed, and wise-women were often consulted (usually by women rather than men) about herbs that could cure any number of problems, especially ones that people tend not to talk about. This could easily be a character option, especially as it would encourage them to explore strange places, and search for knowledge.

So, slow healing via herbs (though faster than without them) and reduced infection chances, but with a number of side-effects. Fast healing via surgery (though with a risk, or certainty, of permanent damage) and ways to stop things that herbs can't touch (bleeding and such) but with increased chances of infection or the chance to append the nickname "Peg-leg" or "One-hand" to your name.

And wonderful role-playing options open up for characters who want to go into medicine. Searching for new herbs or combinations of herbs, old recipes for healing salves and potions, hunting down a healer who is rumored to have found a way to cure disease X, finding the missing ingredient for the salve you want to make, which can only be compounded while fresh -all good for herbalist types. Then there's the forbidden anatomy practice, grave-robbing to find appropriate bodies to experiment on, and the ever-present danger of the law/necromancers/other surgeons while doing so, escaping the vengeance of the family whose beloved father died on the operating table... ain't the life of a surgeon wonderful!

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I could see a few ways this could go. You could focus on herbalism, using the classic willow bark as aspirin, or moss to stop bleeding. They could fix up scrapes and bruises, and maybe even set a leg, but anything beyond that is going to be problematic.

And that's the best case scenario. You could also have a lot of odd theories about medicine -- humours, or different spirits.

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