The Reality of Fantasy: Doctor, Doctor

This week, I’ve been discussing the reality of fantasy RPGs… just how things really were back then, so we don’t romanticize too much about “how great it would be”.

It was easy to die in olden times, and lack of a social safety net from the various churches was only part of the reason. There were a number of reasons why death was a more frequent visitor in the Middle Ages:

Most people lived in rather unsanitary surroundings. Thatch roofs were common in the countryside (where some 85-90 percent of the population lived) and while these piles of reed kept the rain out, they were also quite attractive to all manner of insects and small animals (like mice and rats). The wildlife in the roof carried germs and often deposited said microbes on the people or the food they ate.

There was no indoor plumbing, latrines were the norm. For those who didn’t want to wander out in the middle of the night to take care of business, there was a chamber pot. This device was often emptied not too far from the house in the morning. Such refuse was also unhealthy and tended to get into food or the water supply.

Back then, the saying “catch your death of cold” had real meaning. A case of pneumonia could be easily caught and would ruin your days permanently.

As the populations of towns and cities increased, these hygienic conditions got even, leading to a vast array of health problems. Medical knowledge was limited and, despite the efforts of medical practitioners and public and religious institutions to institute regulations, there wasn’t any such thing as an adequate health care system. Antibiotics hadn’t yet been invented and it was almost impossible to cure diseases without them.

Among the most feared diseases were smallpox, dysentery, spotted fever, syphilis measles, leprocy, typhus and especially the plague. During these times the fear of death was increased by the fact that the causes of the diseases were unknown; the illnesses were often thought to be caused by spirits, demons or the devil.

There were many myths and superstitions about health and hygiene as there still are today. People believed, for example, that disease was spread by bad odors. It was also assumed that diseases of the body resulted from sins of the soul. Many people sought relief from their ills through meditation, prayer, pilgrimages, and other nonmedical methods.

The body was generally viewed as a part of the universe. Four humors, or body fluids, were directly related to the four elements:

• fire=yellow bile or choler
• water=phlegm
• earth=black bile
• air=blood

These four humors had to be balanced. Too much of one was thought to cause a change in personality–for example, too much black bile could create melancholy.

Blood letting was a popular treatment for many diseases. Many diseases were thought to be caused by an excess of blood in the body and blood letting was seen as the obvious cure. When a large quantity of blood was required, the appropriate vein was cut. If only a small amount was needed, a leech would be used.

Diagnosis was also influenced by astrology. Medical charts informed physicians what not to do for people born under a certain start sign.

Blood letting was a common cure, which was used for many years after the medieval period. A patient’s vein was cut, or leeches allowed to drink blood from the affected part of the body.

Some operations were carried out, such as removing cataracts from the eyes, amputations and bone setting following a break. Attempts were made to use anaesthetics, but these could be fatal, as they often included poisons such as hemlock or deadly nightshade.

Various medical practitioners worked informally and were called upon when their services were required. These workers were generally unregulated and received no formal training. They included midwives, dentists and apothecaries.

And in the rare case of actually being able to fine one, surgeons had a very poor understanding of anesthetics and antiseptic techniques to keep wounds and incisions from infection – so you can imagine that it was not a pleasant time to be a patient – but if you valued your life, there was no choice. To relieve the pain, you submitted to more pain, and with any luck, you might get better.

Mental illness was also widespread during the Middle Ages. Injuries received to babies during the birthing process often led to brain trauma. Little could be done for these people, but there were no institutions for them and many were accepted into society. Others, however, would have crosses shaved into the backs of their heads, or be tied to pews in the church in hopes that mass would bring them relief.

This is why I am a strong believer in using illness and infection in-game. Think about it for a second – just how sterile are your sessions? Do those wounds fester with pus and bile? Do the PCs suffer from the flu?

If not – they should. Give ‘em a taste of how it “used to be”.