How deadly should infected wounds be, on average?

[Michael Thayne]

Originally Posted by KarlKost

Egyptians used honey but also rotted bread to treat infections, which they didnt know that had penicilin but that they knew it healed.

Could honey and rotted bread confer a similar bonus to at least TL6 antibiotics? (ie Penicilin basically)

I looked into this a bit as part of this thread and when penicillin was discovered scientists put a bunch of effort into figuring out which mold strains worked best, and how to get an effective mass-production setup going. To model the low-tech version, I would give +1, maybe +2, when applied to a wound, and nothing when taken orally—"penicillin" is more properly "penicillins", a family of compounds, some of which can survive passing through the stomach but most of which can't.

[Fred Brackin]

Originally Posted by Michael Thayne

To model the low-tech version, I would give +1, maybe +2, when applied to a wound, a

Also note that the appropriate section of Low Tech has a wide array of herbal medicines for treating a wide array of conditions. They all give a +1.

If you think this combo "should" be better than the average herbal that could justify the +2.

[hal]

Some time back, I purchased a copy of the Merck Manual with an eye towards trying to find a way to quantify diseases, medical symptoms etc - for use with GURPS.

It was then (Before GURPS 4e came out) that I found a way to emulate diseases for use with GURPS.

I treated it as a two phase approach:

Step 1) Catching the disease
Step 2) determining the end result of the Disease

If you know statistically, how many people would succumb to the disease in general, and you treated the average person of HT as your baseline - then being able to determine for instance, that only 20% of the population will contract the disease, then you know that a failure rate of 20% means a success rate of 80%. Statistically speaking, 80% is closer to a roll of 12 than it is to a roll of 12. 12 is 74.1% while 13 is 83.8%. Consequently, for a normal healty individual of HT 10, he/she would require a saving roll of a 13 to avoid catching said disease. Oddly enough, that works out to a HT+3 saving roll.

If roughly 10% of all who contract that disease die, then we know we need a saving roll that is successful 90% of the time, or a 14. Thus, we know that once you contract the disease, you require a secondary saving roll of HT+4.

But here is the fun thing. If a person suffers from a fever, in theory, they could find that their IQ value drops significantly, as their ability to concentrate drops. Someonw who suffers from a given disease may find that their energy levels are depleted, suggesting a form of Unfit or Very Unfit. If the progression of the disease can cause a loss of appetite or perhaps causes them to vomit excessively to the extent that they become dehydrated - well, GURPS has rules for that right.

You could for instance, determine that if a given number of people contract a disease, that in a very small range of infected, it leads to death. In another range - it could lead to blindness, and for the rest of those who are infected, othing bad happens. Find out how many of those have nothing results, and treat that as "for those who succeed on the second roll after infection, nothing significant happens". Failure of that HT target roll by X means that blindness occurs. Those who failed their HT saving roll on the second roll by X+Y, die.

Now - as a GM, you're going to research your diseases right? ;)

Find a few diseases where the symptoms are VERY simillar to non-deadly situations. When you roll for their diagnosis rolls, tell them the symptoms.

If you're REALLY sadistic as GM, roll 2d6 for your player, and let them roll 1d6 up front. If they have a skill 12, and they roll a 6 on 1d6, they're not going t be sure that the die roll for diagnosis is successfull or not, but with 12-6 (what they rolled on 1d6) their 2d6 roll has to be equal to or lower than 6. They're likely going to be worried that they likely didn't succeed. They will even worry that you may have rolled a crit failure and be lying to them.

The point is - if you take the time to do the research, codify it, write it down etc - then give them some of the notes saying "This disease has symptoms X, Y, and Z" and then you tell them "your patient has symptoms X and Z" - they may well conclude that their patient has disease of whatchamaycallit - right?

But there is the thing. Some symptoms are going to be based on other issues, even genetic conditions instead of outright diseases. Had I been born even 20 years earlier, I'd have been dead in less than a year after birth. It was a function of genetics (on a low level) and a few years after my birth, women were given a simple treatment to avoid having their children die courtesy of blood factors present when a mother has rh negative blood and the father has rh positive.

So - not all health issues are diseases. Sometimes, a person is simply fated to die due to medical reasons unrelated to anything but bad luck. Heart conditions that will lead to a heart attack, accidents in surgical processes that can cause scarring on organs leading to "openings' closing up and causing renal failures down the road. But that's neither here nor there. Unless you want your game to become a sort of HOUSE MD style campaign - this level of detail will cause people's eyes to glaze over at the table.

C&S (Chivalry and Sorcery) had events for a region such as plague - that could put the fear of GOD into the players for their characters. Knowing that you get two saving rolls to avoid losing your character to one of the four horsemen - is far superior to dealing with only a single saving roll (in my opinion). If a disease has noticable effects - maybe the characters will seek out such temporary solutions while pursuing a long term one.

And by far? One of my favorite houserules I used was a simple, but effective one...

Your character suffers a penalty equal to half the worst wound your character took in combat - until it heals entirely. Chronic pain is the worst! If a player character suffered a wound of 8 points, they will suffer from pain valued at -4, then -3, then -2, and then -1 until they finally heal. If they want to avoid the penalty to their stats, they'll likely seek out pain killers. If their character gets hooked on pain killers, they will have to try and do what it takes to kick the habit if possible.

In one of my cyberpunk campaigns a while back, one player wanted to have subdermal armor installed. HE was told that they peel his skin off, insert the subdermal armor on, hit his body with massive infusions of stem cells to help reconnect neural connections. It was described as being placed in a vat of boiling water and being kept there - that roughly 1 in 5 people become addicted to pain killers, or otherwise another 1 in 5 suffer from mental issues acquired from excessive pain. Player rolled an 18 on a HT saving roll to avoid addiction, and sweated bullets as he tried to kick the pain killer addiction once he went active in public (yeah, he was getting pain killers in excess of what was prescribed).

In any event - medical issues CAN help drive drama for the players and the stories told at the table. A monthly HT saving roll with minor failures indicating minor issues can be fun -= temporarily inflicting loss of fatigue as if from lack of sleep, or perhaps giving a player Unfit for two weeks, constant bathroom issues etc - can help drive the story. A crit failure can mean something more serious (I'd go with a confirmed Crit failure for really serious stuff). But - that's all depending on the story you want to tell.

[Pursuivant]

Originally Posted by hal

Some time back, I purchased a copy of the Merck Manual with an eye towards trying to find a way to quantify diseases, medical symptoms etc - for use with GURPS.

There are thousands of diseases so that seems like an impossible task. Kudos for attempting an ambitious project.

Originally Posted by hal

It was then (Before GURPS 4e came out) that I found a way to emulate diseases for use with GURPS.

The third step to make a disease, toxin, or similar problem useful from a gaming point of view is to define who can get it, how common it is, and where is it most commonly found (in terms of populations or geography).

You also need to model route of transmission and ease of transmission, the infamous R0 value, modeled using GURPS stats. Something like Leprosy might have an R0 of HT+4 to resist (requires lots of contact), a disease like measles might have an R0 of HT-6 (i.e., easy to catch, even with minimal contact).

Originally Posted by hal

But here is the fun thing. If a person suffers from a fever, in theory, they could find that their IQ value drops significantly, as their ability to concentrate drops.

I modeled disease symptoms as new Afflictions. For example, Mild Tinnitus gives -1 to Hearing rolls, Severe Tinnitus might give -4. Mild fever might give -10% to ST, -1 to FP, and -1 to HT rolls to resist Heat, Severe Fever might give -30% to ST, -3 to FP, -2 to IQ, and -3 to HT rolls to resist Heat.

Modeling symptoms as Afflictions not only makes it easier to create novel versions of the Affliction advantage, but also allows disease symptoms to be standardized. For example, a typical flu might give you Mild Fever, Nausea, and Mild Pain.

Originally Posted by hal

So - not all health issues are diseases. Sometimes, a person is simply fated to die due to medical reasons unrelated to anything but bad luck.

Many of these conditions can be handwaved as low HT score or as effects of failed Aging rolls. Most of the rest can be handled using existing disads (e.g., Terminally Ill or Maintenance).

A successful Diagnosis skill roll will determine generally what's going on (e.g., "it's a heart problem"). Roll vs. Diagnosis -1 to -10 (usually no more than -4) to figure out exactly what's going on ("It's cardiomyopathy due to Borrelia burgdorferi infection, you've got Lyme disease.") Bonuses for equipment and medical TL definitely apply here. Bonuses for Assistants might apply.

In a cinematic game, Taking Extra Time helps, since that represents running all sorts of tests (that nobody has to pay for and which require no lab time or space whatsoever - because Hollywood) and lots of grossly unprofessional drama as the medical team works for a diagnosis.

Then roll vs. Physician or Surgery with the MoS/MoF for the Diagnosis skill, plus any relevant mods to treat the problem if a cure exists.

[QUOTE=hal;2439791]Knowing that you get two saving rolls to avoid losing your character to one of the four horsemen - is far superior to dealing with only a single saving roll (in my opinion).

"Save or die" mechanics suck, even if they're realistic. You always need to give players a sense that they have some way to solve the problem. "Fred's got Ebola Zaire, but we can still save him if we can just [fill in the blank]."

Disease, like other lethal hazards, also has to be something the GM warns the players about in advance. ("This campaign will use realistic radiation and disease rules. Consider taking Resistant (Disease) as an advantage." "The Warren of the Rat Fiends is a noted source of pestilence, take suitable precautions.") Players are generally OK with having bad stuff happen to their characters if they knew it was a possibility and accepted the risks.

As a campaign thing, really nasty diseases or epidemics should happen to Other People, at least to start. Make the plague the enemy, with PCs struggling to discover the source, end the plague, and save as many victims as possible. Ramp up tension by having the PCs start to get sick, so their lives are directly on the line while their powers diminish as the disease progresses.

[Varyon]

Originally Posted by Pursuivant

"Save or die" mechanics suck, even if they're realistic. You always need to give players a sense that they have some way to solve the problem. "Fred's got Ebola Zaire, but we can still save him if we can just [fill in the blank]."

Agreed, although one thing you can do here is have the GM roll in secret on the "survival" roll, then have death occur at a later time based on MoF (the higher the MoF, the shorter the time before the character expires). Certain treatments might give a retroactive bonus to the check, extending how long the character is alive... until you get high enough that the retroactive bonuses actually push the character into "Actually, you succeeded" territory, in which case the character survives and recovers. For automatic failure results, I'd say treat a roll of 17 as MoF 5 (or +5 to MoF if modified HT was less than 16), a roll of 18 as MoF 10 (or +10 to MoF if modified HT was less than 16), and if you reach "Actually, you succeeded" territory, give the character one reroll, at the original difficulty; success means they kick the disease, failure (any failure) means they can't get better than MoF 1 and thus will die (but it'll take a bit).

Still a lot of work for the GM, but potentially rewarding.

[KarlKost]

Originally Posted by Michael Thayne

I looked into this a bit as part of this thread and when penicillin was discovered scientists put a bunch of effort into figuring out which mold strains worked best, and how to get an effective mass-production setup going. To model the low-tech version, I would give +1, maybe +2, when applied to a wound, and nothing when taken orally—"penicillin" is more properly "penicillins", a family of compounds, some of which can survive passing through the stomach but most of which can't.

I gotta tell you thou, I had an ugly moto accident upon which I almost lost my leg. I stayed in the hospital for a bit more than a month, because I was waiting to do surgery, the doctors said they couldnt do it because I had generalized infections over my leg, and thus they couldnt operate my bones - the surgery involved making a hole in my tibia bone and put a titanium stick in the middle of it, replacing my marrow with it (yes, Im a Ciborg, thou they forgot to get me some ST+3 modules), but doing so while infection was so grave would incur a high risk of spreading the infection to the inside of my bones. But regardless how many antibiotics they gave me, the infection showed no signs of improvement - instead, it were slowly getting worse.

So after a bit more than a month I told the doctor that I couldnt take it anymore staying in the hospital, that I had to go home and I didnt even care if I lost my leg (it wasnt improving anyway).

So I went home, but stayed with my grandparents, becaused I needed somebody to take care of me, I couldnt even get up from bed not even to go to the bathroom.

My granfather was raised in a different time and in a different place. He used to say he lived basically as an indigenous (no, he wasnt, but he lived in the middle of the woods). He was a skilled hunter, tracker and woodsman. And he was also a healer.

He immediatly cut of all my antibiotics and prepared a oinment to pass on my wounds (like he used to say, if it's wet, keep it dry, if it's dry, keep it wet), and an extract made of ginkgo biloba.

I kid you not, my infection got healed with my grandpa's herbs and skilled hands in 5 days, while the doctors and antibiotics injected directly in my veins could not do it in over a month; the wounds were not fully healed of course, but the infection was GONE.

So, as someone who has experienced first hand the effectiveness of herbal medicine, I tell you that it is badly underestimated by pretty much everybody. Herbal medicine can be MORE, much more effective than pharma

[mlangsdorf]

Originally Posted by mlangsdorf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1281639/ says that at London hospitals in the 1850s, the survival rate for surgical amputations was around 60%. That's a bad case for surviving an infection: non-sterile operating and recovery environments, no anti-biotics, but some attempts at post-operation care. Though I'm not really sure how much difference the care made.

If you're looking for a harsh realism game, infected wounds should probably do 1 HP/day, resisted at some HT penalty sufficient to kill about 40% of the HT 10 population - I don't know what that number is.

So I wrote a terrible Python program - because all my Python programs are terrible - to do a Monte Carlo simulation of the issue. On a population of 36,000 infectees with HP 10, HT 10, and 6-11 points of initial injury (to simulate a possibly traumatic amputation), 59% of them survived an infection if the resistance penalty was -5. Here's the histograms for the date of getting cured and the date of death:

URVIVORS cured by day
1-7: 8561 (23.78%)
8-14: 6617 (18.38%)
15-21: 3062 (8.51%)
22-28: 1519 (4.22%)
29-35: 685 (1.90%)
36-42: 336 (0.93%)
43-49: 222 (0.62%)
50-56: 159 (0.44%)
57-63: 40 (0.11%)
64-70: 5 (0.01%)
71-77: 1 (0.00%)

VICTIMS claimed by day
8-14: 6370 (17.69%)
15-21: 4215 (11.71%)
22-28: 2529 (7.03%)
29-35: 807 (2.24%)
36-42: 513 (1.43%)
43-49: 12 (0.03%)
50-56: 127 (0.35%)
57-63: 188 (0.52%)
64-70: 30 (0.08%)
71-77: 2 (0.01%)

The default rules (with no HT penalty) results in 99.96% survival rate, and most infectees recovering within the first 4 days, which is what I would expect.

Changing the range of HT and HP to 8 and 13 for each doesn't particularly change the results for the -5 resistance rolls, but bifurcates the pools: survivors usually have HT 11+ and the dead have HT 10 or less. On average, of course.

[KarlKost]

Originally Posted by mlangsdorf

So I wrote a terrible Python program - because all my Python programs are terrible - to do a Monte Carlo simulation of the issue. On a population of 36,000 infectees with HP 10, HT 10, and 6-11 points of initial injury (to simulate a possibly traumatic amputation), 59% of them survived an infection if the resistance penalty was -5. Here's the histograms for the date of getting cured and the date of death:

URVIVORS cured by day
1-7: 8561 (23.78%)
8-14: 6617 (18.38%)
15-21: 3062 (8.51%)
22-28: 1519 (4.22%)
29-35: 685 (1.90%)
36-42: 336 (0.93%)
43-49: 222 (0.62%)
50-56: 159 (0.44%)
57-63: 40 (0.11%)
64-70: 5 (0.01%)
71-77: 1 (0.00%)

VICTIMS claimed by day
8-14: 6370 (17.69%)
15-21: 4215 (11.71%)
22-28: 2529 (7.03%)
29-35: 807 (2.24%)
36-42: 513 (1.43%)
43-49: 12 (0.03%)
50-56: 127 (0.35%)
57-63: 188 (0.52%)
64-70: 30 (0.08%)
71-77: 2 (0.01%)

The default rules (with no HT penalty) results in 99.96% survival rate, and most infectees recovering within the first 4 days, which is what I would expect.

Changing the range of HT and HP to 8 and 13 for each doesn't particularly change the results for the -5 resistance rolls, but bifurcates the pools: survivors usually have HT 11+ and the dead have HT 10 or less. On average, of course.

That's VERY interesting. I need something like that for my Realm Management (I need something to give me birth rates, fertility rates, age distribution and death rates month by month for my special highly modified Real Management game)

[Pursuivant]

Originally Posted by KarlKost

So, as someone who has experienced first hand the effectiveness of herbal medicine, I tell you that it is badly underestimated by pretty much everybody. Herbal medicine can be MORE, much more effective than pharma

Consider, however, the possibility that it was the change of environment as much as the change in treatment which saved you. Hospitals are notorious for harboring all sorts of nasty bacteria, most of which are increasingly resistant to standard antibiotic treatments.

Unless hospital staff are absolutely obsessive about sanitization and sterilization it's very easy for these infections to spread. Even simple things like having medical staff wash their hands properly before seeing each patient can make a difference.

That said, there are herbal and traditional remedies which work well as anti-bacterial and wound-healing agents (e.g., honey) and the Amazon and other tropical jungles are (or should be) the world's pharmacy. Everything from quinine to anti-cancer drugs have been derived from tropical plants. You definitely get a bonus to Pharmacy (Herbal) if you're operating in an environment where you have year-round access to high quality raw materials.

[Pursuivant]

Originally Posted by mlangsdorf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1281639/ says that at London hospitals in the 1850s, the survival rate for surgical amputations was around 60%. That's a bad case for surviving an infection: non-sterile operating and recovery environments, no anti-biotics, but some attempts at post-operation care. Though I'm not really sure how much difference the care made.

Also consider the sort of people who ended up in London hospitals in the mid-19th century - the poor and middle class people so sick or injured that they couldn't be treated at home.

These people might start off with low basic HT and ST (hence, HP) scores due to chronic disease (e.g., tuberculosis), chronic malnutrition, pervasive environmental hazards (e.g., coal dust and animal manure), and overwork.

On top of that, by the time they got to the hospital, they might have lost lots of blood or otherwise gotten their wounds infected.

By contrast, death rates for U.S. troops during the American Civil War due to amputation were about 26% (i.e., 74% survival rate).

Those statistics are based on mostly young men who were fit enough to pass a cursory medical exam, survive basic training (which often saw high numbers of recruits die due to infectious diseases or diseases of poor sanitation), and march to the battlefield. Very likely, at least HT 10 with the Fit advantage. Conditions by the time they got to the hospital would be much the same as a poor Londoner might face, however, - serious delays in treatment, bandaging with non-sterile bandages, injury sustained in a highly septic environment.

Amputation of an already infected limb was a likely death sentence - 92% fatality rate. Not only was there risk of sawing through infected tissue, spreading the infection, but infectious bacteria could be carried higher up the limb by bleeding or medical treatment. Additionally, the patient would already be in bad state due to the persistent infection and the surgeons would have to amputate a limb high above the infected area so that just healthy tissue remained - basically increasing the amount of HP damage inflicted to get a bonus to Surgery skill to avoid further infection.

https://www.pbs.org/mercy-street/blo...-war-hospital/

Surviving amputation also depended on how much of a limb had to be removed, ranging from about 10% mortality for amputations at the wrist to about 30% mortality for amputations at the shoulder.

https://www.civilwarmed.org/surgeons-call/amputation1/