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Old 06-30-2022, 10:32 PM   #31
KarlKost
 
Join Date: Mar 2017
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Default Re: How deadly should infected wounds be, on average?

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Originally Posted by Pursuivant View Post
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.
I did actually reaserched about the Ginko plant, and it truly is miraculous. I use it all the way up today, most of the time in favor of antibiotics - it IS better than anything you can buy at the drugstore. I'd say that whatever bonus antibiotics give, the ginko biloba plants give an extra +1 on top of those. It can be used even to treat cancer! Look it up on Google, it will blow your mind, it can be used for diabets, cancer, infections, healing, kidney problems, heart problems... Whatever kind of medical conditions you have, this magic plant can heal. You can make a paste out of it, you can drink it with your favorite vitamins... It truly is insanely miraculous.

By the way, my grandpa was a healer, and I trusted him MORE than I would ANY doctor. Im not just exaggerating or making things up, his healing skills truly were something that I wish I knew how to replicate. So, just by the things that I saw my grandparents do, I'd say that their basically almost tribal medicine was many times BETTER than our TL8 one. And Im no superstitious guy, Im the biggest materialist guy in the world, my grandparents didnt made magic or miracles, but they had a knowledge that modern doctors cant even conceive of. Their herbal skills were absolutely amazing - for example, I could choose to spend a week or two (or more) with the flu, taking useless medicine from the drugstore, or I could choose to take the herbal teas from my dear granny and get better in 2 - 3 days. Im not kidding brother, Im telling the absolute truth.

But yeah, all those herbs are native brazilian herbs (that mostly only older people know about), so indeed we DO have some potent herbs indeed. And their healing capabilities is something I have witnessed on several occasions (and so do to the big Pharna)
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Old 07-01-2022, 07:36 AM   #32
Varyon
 
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Default Re: How deadly should infected wounds be, on average?

Herbal remedies can indeed be useful. I wouldn't say that they should typically have a bonus compared to modern medicine, but I wouldn't object to the possibility of sometimes getting very close to - or even matching - the bonus for using modern medicine, for specific use-cases. They probably should be advantaged over common medicines if the infectious agent has developed resistance, however... at least so long as you're using the right treatment! That's for a more-or-less realistic campaign - for cinematic/fantasy campaigns, having herbal remedies be well beyond the best that modern medicine can offer is appropriate, and if you want to make Ginkgo biloba or similar into a sort of athelas-expy, go for it.
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Old 07-01-2022, 09:10 AM   #33
mlangsdorf
 
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Default Re: How deadly should infected wounds be, on average?

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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).
My Monte Carlo program says that a random population of 36,000 infectees with 10-12 HT and 10-13 HT and wounds of at least HP/2 has a 83% survival rate with the HT-5 resistance roll for an infection. Not perfect, but it's close to the historic data. Civil War amputees might have been even more wounded than that, which might decrease the survival rates.

Thanks for the additional data.
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Old 07-01-2022, 09:17 AM   #34
KarlKost
 
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Default Re: How deadly should infected wounds be, on average?

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Originally Posted by mlangsdorf View Post
My Monte Carlo program says that a random population of 36,000 infectees with 10-12 HT and 10-13 HT and wounds of at least HP/2 has a 83% survival rate with the HT-5 resistance roll for an infection. Not perfect, but it's close to the historic data. Civil War amputees might have been even more wounded than that, which might decrease the survival rates.

Thanks for the additional data.
I think that's a perfect rule then. The only thing to be careful however is constantly killing players, but for gritty games, it's fine perhaps.

On the other hand, min-maxers (ie players always) will be sure to pump up their HT
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Old 07-01-2022, 03:10 PM   #35
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Default Re: How deadly should infected wounds be, on average?

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I think that's a perfect rule then. The only thing to be careful however is constantly killing players, but for gritty games, it's fine perhaps.
Another thing to consider was quality of nursing care. Prior to the late 19th century (c. 1870s) hospitals, especially military field hospitals, were little more than hospices for the dying. For this reason, anyone who could possibly avoid hospitals did so.

Individualized nursing care could and did make a difference in patient survival, which is why wealthier people commonly hired private nurses.

In military settings, the Crimean War (c. 1855) and the U.S. Civil War saw the start of modern, professionalized military nursing. Since it was one of the few ways that respectable women could make a contribution to the war effort, military nurses were generally very smart, dedicated people.

When you have sufficient skilled nursing staff, you might get a +1 or better Quality bonus for wound recovery.

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Originally Posted by KarlKost View Post
On the other hand, min-maxers (ie players always) will be sure to pump up their HT
They don't already?

HT 12 is pretty much required for a first-line melee fighter in a low tech game, since it allows greater resistance to Stun and Knockdown, as well as greater FP scores. Hard to Kill and Hard to Subdue are the cheapskate versions of improved HT at 2 CP/lvl.

Historically, it's also realistic for successful explorers and fighters to have HT 12+ and possibly traits such as Resistant (Disease).
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Old 07-01-2022, 03:55 PM   #36
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Default Re: How deadly should infected wounds be, on average?

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Originally Posted by KarlKost View Post
On the other hand, min-maxers (ie players always) will be sure to pump up their HT
Pretty much any game with combat already heavily incentivizes that. I don't recall the last time I saw a PC with a HT below 11, and looking at DF, the average is 12.18 even if no-one invests in increasing HT.
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Old 07-01-2022, 06:47 PM   #37
KarlKost
 
Join Date: Mar 2017
Location: Brazil
Default Re: How deadly should infected wounds be, on average?

Quote:
Originally Posted by Pursuivant View Post
Another thing to consider was quality of nursing care. Prior to the late 19th century (c. 1870s) hospitals, especially military field hospitals, were little more than hospices for the dying. For this reason, anyone who could possibly avoid hospitals did so.

Individualized nursing care could and did make a difference in patient survival, which is why wealthier people commonly hired private nurses.

In military settings, the Crimean War (c. 1855) and the U.S. Civil War saw the start of modern, professionalized military nursing. Since it was one of the few ways that respectable women could make a contribution to the war effort, military nurses were generally very smart, dedicated people.

When you have sufficient skilled nursing staff, you might get a +1 or better Quality bonus for wound recovery.
Oh yes, good call. "Hospitals" were true slaughterhouses back in the day.

Im very thankful I've been borned in this enlightned era of ours (at least until we dont dive head in into WW3)


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Originally Posted by Pursuivant View Post
They don't already?

HT 12 is pretty much required for a first-line melee fighter in a low tech game, since it allows greater resistance to Stun and Knockdown, as well as greater FP scores. Hard to Kill and Hard to Subdue are the cheapskate versions of improved HT at 2 CP/lvl.

Historically, it's also realistic for successful explorers and fighters to have HT 12+ and possibly traits such as Resistant (Disease).
Yeah, I dont know what was I thinking. Of course players do it, that's the purpose of min-max after all, and players will always be CP squeezers
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Old 07-01-2022, 09:11 PM   #38
Inky
 
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Default Re: How deadly should infected wounds be, on average?

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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
I can believe that. From what I've heard, chemically, there's no reason why some herbal medicines wouldn't be at least as effective as synthetic ones. (After all, a lot of herbal medicines contain the same substances that are in the synthetic medicines). And some chemists believe they might actually be more effective, because of various minor substances present alongside the main one that might add to the effect. There've been some very impressive results in lab studies.

From what I've heard, the reason they're not used more often is more that the dose isn't reliable - the concentration of medicinal substances varies depending on the type of soil, the weather while the plant was growing, etc.. So using the same amount of the same plant won't always get you the same dose. You might get results as impressive as Karl's grandparents got, or you might get a weak mixture that's ineffective - or a mixture so strong it will poison you.

A lot of medicinal compounds do have distinctive tastes and/or smells, and though I've no source for this off-hand, it doesn't seem impossible that a really experienced expert could recognise, maybe by the smell, taste and/or colour, how strong a batch was and allow for that, to get the full effect every time.
In GURPS terms, that might translate to a critical success on a Pharmacy (Herb Lore) roll getting you a "Superior herbal extract" that was worth a +2 or even more. This is somewhat uncharted scientific territory, so how much of a bonus you could get might be up to the genre or the GM's taste.

Another possible explanation, of course, is that it was an infection that was actually caught in the hospital and was resistant to the standard antibiotics they use. In that case, the ginkgo biloba and so on would have been much more effective than those because those were new to it and it had no resistance. Thus the value of having lots of different options!
(Drug resistance is actually considered less likely with herbal remedies anyway, because, again, herbal remedies can contain lots of active compounds, making it harder to evolve a defence, while synthetic medicines usually have only one. This gets a lot of interest from scientists trying to develop new antibiotics).
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Old 07-01-2022, 11:28 PM   #39
KarlKost
 
Join Date: Mar 2017
Location: Brazil
Default Re: How deadly should infected wounds be, on average?

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Originally Posted by Inky View Post
I can believe that. From what I've heard, chemically, there's no reason why some herbal medicines wouldn't be at least as effective as synthetic ones. (After all, a lot of herbal medicines contain the same substances that are in the synthetic medicines). And some chemists believe they might actually be more effective, because of various minor substances present alongside the main one that might add to the effect. There've been some very impressive results in lab studies.

From what I've heard, the reason they're not used more often is more that the dose isn't reliable - the concentration of medicinal substances varies depending on the type of soil, the weather while the plant was growing, etc.. So using the same amount of the same plant won't always get you the same dose. You might get results as impressive as Karl's grandparents got, or you might get a weak mixture that's ineffective - or a mixture so strong it will poison you.

A lot of medicinal compounds do have distinctive tastes and/or smells, and though I've no source for this off-hand, it doesn't seem impossible that a really experienced expert could recognise, maybe by the smell, taste and/or colour, how strong a batch was and allow for that, to get the full effect every time.
In GURPS terms, that might translate to a critical success on a Pharmacy (Herb Lore) roll getting you a "Superior herbal extract" that was worth a +2 or even more. This is somewhat uncharted scientific territory, so how much of a bonus you could get might be up to the genre or the GM's taste.

Another possible explanation, of course, is that it was an infection that was actually caught in the hospital and was resistant to the standard antibiotics they use. In that case, the ginkgo biloba and so on would have been much more effective than those because those were new to it and it had no resistance. Thus the value of having lots of different options!
(Drug resistance is actually considered less likely with herbal remedies anyway, because, again, herbal remedies can contain lots of active compounds, making it harder to evolve a defence, while synthetic medicines usually have only one. This gets a lot of interest from scientists trying to develop new antibiotics).
Herbal medicine is also much more local. Penicilin is used over the entire globe. Amazonic herbs only in South America. In the Congo, they'll use herbs from the Congolese jungle. And son.

So indeed, bacteria resistance will probably be much less common for herbs used by small numbers of people on localized places than for something widespread over the globe.

Also, secondary active principles is very real, which is also why (at least here in Brazil where we have some particularly effictive herbs and teas and ways of using natural medicine) drugs will never be as effective as the plants. Some herbs contain hundreds or even thousands of substances that form secondary active principles that potencialize the overall effectiveness.

Oh yes, about the quantity, that's a thing too. G. biloba for example has a special way to have the part of the remedy extracted, you need to carefully remove the viscous substance that exists in the middle of the leafs - that can be used as is, and applied directly on the skin, or can be made into a juice for ingestion. Besides a potent healing for the skin, it can be used to heal ulcers, it can be used even as a food complement! It's rich in several minerals and vitamins; it can also be applied into the hair or skin for beauty treatments.
However, the leaves by themselves are toxic, so you have to take care to take the "good stuff" inside without sctraching the leaf
And my grandparents could indeed tell basically by instinct how to prepare those, how to have them in the proper dose; that's the difference between a skilled and proficient "herbalist" and someone that herd that something may be good. Granny and granpa new what they were doing, which is result of decades of experience, not just merely smashing plants togheter
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Old 07-13-2022, 03:21 PM   #40
Pmandrekar
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Default Re: How deadly should infected wounds be, on average?

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Very few players actually want realism, but if I was trying for something more realistic infection should vary with the size of the original wound.
Agreed, and how the wound was initially treated. There was an ancient bandage (Sumerian, maybe?) that generated a mild detergent and would have been much more effective at preventing realistic infection than bandages made from whatever sweaty fabric was sitting around.

Additionally, one of the ancient civilizations was using Copper surgery instruments, I think which resulted in a much lower infection rate than subsequent iron/metal surgery instruments.

Sometimes, even ancient peoples have had good technologies without realizing the underlying microbial reasons for disease. My undergrad degree was in (effectively) medical microbiology, and I was a scientific resource for GURPS Low-Tech, which is where some of this info is from.

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