Medical knowledge in a prehistoric world

Marian Perera · Aug 17, 2017

I don't know if this thread is in the wrong forum or if anyone will be able to help, but I'd really like some ideas on this topic.

The premise of the story I'm working on is that a century ago, thousands of people from our world and time were taken to a prehistoric world and abandoned there. As a result, they had modern knowledge without much, if any, modern technology (only what they carried with them). Their descendants have the skills and information that was passed down to them, but their lives are extremely hardscrabble.

My MC is a doctor, and at one point he's questioned on his training. I don't know how to succinctly describe what he knows, or should know. Basic surgery? Infection control? Medicine, like everything else in their lives, is stripped down to the essentials. For instance, he's aware of X-rays because one of the things his ancestors brought with them was a medical textbook, but of course he can't hope to perform one of those.

Help! Any thoughts?

GeorgeK · Aug 17, 2017

It depends on what part of the world the training came from. Lister was in the late 1800's. So if you are talking about early 1900's they'd know about antisepsis. They'd have the basics of germ theory, reasonable wound care, even surgery including rubber gloves and ether based anesthesiology. Mostly what they'd lack is antibiotics and modern medications. They'd know of the early sources of some medicines that have their roots in herbology like willow bark (aspirin) Foxglove (digitalis)

Most general surgery (MD level) text books include a chapter or two on the history of medicine. Sabiston had a nice section on that. You might pick up an outdated copy somewhere cheap or find one in a library

less than 10$

https://www.amazon.com/gp/product/0721634923/?tag=absowrit-20

Marian Perera · Aug 17, 2017

GeorgeK said:
It depends on what part of the world the training came from. Lister was in the late 1800's. So if you are talking about early 1900's they'd know about antisepsis.

Oh no, the people are all from 2015, and though they're from different parts of our 2015 world, they're all middle class or upper class. So most of them were quite well educated.

They'd have the basics of germ theory, reasonable wound care, even surgery including rubber gloves and ether based anesthesiology.

Wound care, that's a good specific to include. Thank you!

I might also mention ether based anesthesiology because they've built a crude chemical laboratory.

Mostly what they'd lack is antibiotics and modern medications.

And modern equipment.

They'd know of the early sources of some medicines that have their roots in herbology like willow bark (aspirin) Foxglove (digitalis)

Thanks, great details!

Orianna2000 · Aug 17, 2017

They might be able to produce antibiotics. In the time traveling Outlander books, the MC, a doctor from the 1960s, creates primitive batches of penicillin in the 1760s by growing mold cultures on bread and then refining them. I've no idea how easy or difficult this would be, but it's worth looking into.

benbenberi · Aug 17, 2017

If the first generation of transportees immediately wrote down everything they knew about modern medicine, biology, chemistry, engineering & other science & technology, there's a chance their descendants a century+ later might have access to a good understanding of those knowledge domains, bootstrapped what they could in a low-tech environment, & created functional workarounds for other things, e.g. develop a basic herbal pharmacology using local available plants and no elaborate manufacturing base.

If the first comers did NOT write EVERYTHING down, and create a good system to transmit their knowledge & expertise, within a generation or two the knowledge will be lost or quickly filtered into myth, magic & the-custom-of-our-people. Medical knowledge will become folklore & tradition. Good medical practice will become repetitive ritual -- it may by chance incorporate all the steps needed to achieve a good result but, without a sound understanding of the underlying principles, it will also be too rigid to allow deliberate change (all the steps in a ritual are important, & no one knows which ones are actually contributing what to the outcome) and yet subject to the inevitable changes that always happen when people do things "the way they've always done them," aka "playing telephone".

Under even the best circumstances they'll be in a lot worse shape coming from 2015 than they probably would have been coming from 1915, because medicine has become so thoroughly technologized that many trained professionals would have a lot of trouble practicing medicine without any of their customary tools & infrastructure. And the technology of modern medicine, from surgery to pharma to diagnostics, is the very highest of modern high tech & couldn't possibly be recreated from scratch in even rudimentary form from a baseline of no tech at all.

blacbird · Aug 17, 2017

Marian Perera said:
Oh no, the people are all from 2015, and though they're from different parts of our 2015 world, they're all middle class or upper class. So most of them were quite well educated.

I'm confused. In your OP you say "a century ago, thousands of people from our world and time were taken to a prehistoric world and abandoned there."

If they are from 2015, how could they have been transported a century ago?

caw

Cyia · Aug 17, 2017

Even without antibiotics, they might be able to manage antibacterials, like wild honey. Willow bark for pain and inflammation reduction with wounds, spider webs for fevers, etc. Chemistry could come in handy, as could bone-setting.

Your biggest problem is going to be that the chemical composition of the planet and the air is going to be vastly different in a prehistoric setting. Your people are all going to be high on oxygen.

benbenberi · Aug 17, 2017

blacbird said:
I'm confused. In your OP you say "a century ago, thousands of people from our world and time were taken to a prehistoric world and abandoned there."

If they are from 2015, how could they have been transported a century ago?

I think what they mean is that people from 2015 are transported to the prehistoric world, and a century has passed in the prehistoric world since that happened. (So presumably it would now be 2115 in the world the original people came from, but we're not there anymore.)

Marian Perera · Aug 17, 2017

blacbird said:
I'm confused. In your OP you say "a century ago, thousands of people from our world and time were taken to a prehistoric world and abandoned there."

If they are from 2015, how could they have been transported a century ago?

They're from 2015, and it's now 2115.

ETA : Cross-posted with benbenberi!

Marian Perera · Aug 17, 2017

Cyia said:
Your biggest problem is going to be that the chemical composition of the planet and the air is going to be vastly different in a prehistoric setting. Your people are all going to be high on oxygen.

Well, I said "a prehistoric world" because it seemed quicker and easier than saying "a continent with a few signs of destroyed nonhuman civilization but nothing industrial that the people could use, lots of uncultivated land and wild animals".

The story's a paranormal/fantasy, though, so even if it was actually a prehistoric world, I could tweak the atmosphere.

WeaselFire · Aug 17, 2017

Marian Perera said:
They're from 2015, and it's now 2115.

Then they're a century behind the times? In a world that resembles pre-history but does have some kind of history?

Medical training could be anything. If he's a licensed physician in 2015, he'll have all the basics plus whatever specialty you give him. Probably not going to be doing a MRI if there is no MRI tech with their scanner just hanging around, but he'd know all the basic medical knowledge any MD graduating school and having completed internship would. When asked where he got his training, he'd likely answer with the school he graduated from and the hospitals or clinics he's worked in.

I think what you're really looking for is survivalist medicine or bushcraft medicine. What can be done with things found in nature.

Jeff

Marian Perera · Aug 18, 2017

WeaselFire said:
Then they're a century behind the times? In a world that resembles pre-history but does have some kind of history?

Assuming they ever returned to Earth, yes, they'd be way behind the times in terms of how much they know. The world they're in right now does have a history of its own, but that history doesn't involve any scientific knowledge or discoveries.

Medical training could be anything. If he's a licensed physician in 2015, he'll have all the basics plus whatever specialty you give him.

Not quite. The doctors who were part of the original population in 2015 are all dead now, since the story starts a hundred years after humans' arrival in the prehistoric world. It's now 2115 there. So although my character is what his community considers a doctor, he's not licensed by any regulatory body as we know them. Human society in the prehistoric world isn't that advanced.

I think what you're really looking for is survivalist medicine or bushcraft medicine. What can be done with things found in nature.

That's right, but I was just wondering what the best way was to phrase it. I just wrote the scene where he quickly describes his qualifications and I had him say that he's most familiar with basic surgery, wound care and obstetrics (all of which are needed for the plot). Wondering if there's anything else I should add. I thought about vaccinations too, because if Jenner did that with cowpox it shouldn't be too difficult.

Marian Perera · Aug 18, 2017

benbenberi said:
If the first generation of transportees immediately wrote down everything they knew about modern medicine, biology, chemistry, engineering & other science & technology, there's a chance their descendants a century+ later might have access to a good understanding of those knowledge domains, bootstrapped what they could in a low-tech environment, & created functional workarounds for other things, e.g. develop a basic herbal pharmacology using local available plants and no elaborate manufacturing base.

This is great. I hadn't thought about it in so much depth, and it gives me ideas for the doctor's backstory. Especially since, a hundred years later, people live in small settlements across the land, it's even more important for medical knowledge to be preserved and passed down accurately rather than leaving each town or village to develop its own.

So I'm thinking that a couple of doctors in the original generation had the foresight to, as you said, record everything they knew. With no guarantees that they would ever return to their own world, they would also need a structured, formalized way of training their successors.

If the first comers did NOT write EVERYTHING down, and create a good system to transmit their knowledge & expertise, within a generation or two the knowledge will be lost or quickly filtered into myth, magic & the-custom-of-our-people. Medical knowledge will become folklore & tradition. Good medical practice will become repetitive ritual -- it may by chance incorporate all the steps needed to achieve a good result but, without a sound understanding of the underlying principles, it will also be too rigid to allow deliberate change (all the steps in a ritual are important, & no one knows which ones are actually contributing what to the outcome) and yet subject to the inevitable changes that always happen when people do things "the way they've always done them," aka "playing telephone".

Very helpful! I'll see if I can work some of this into the story, especially since one of the main characters is a would-be historian.

Under even the best circumstances they'll be in a lot worse shape coming from 2015 than they probably would have been coming from 1915, because medicine has become so thoroughly technologized that many trained professionals would have a lot of trouble practicing medicine without any of their customary tools & infrastructure. And the technology of modern medicine, from surgery to pharma to diagnostics, is the very highest of modern high tech & couldn't possibly be recreated from scratch in even rudimentary form from a baseline of no tech at all.

You're right. I thought for a while about moving the date back.

The way the people are transported to the prehistoric world is, they're all passengers and crew on a cruise ship that travels into a thick mass of fog and emerges... nowhere on Earth. I figured this way, I'd have a large enough population (even after the inevitable deaths) that their descendants wouldn't have problems with inbreeding, plus it seemed a plausible way that thousands of people could quietly disappear at once with no one on land being any the wiser. Also, the cruise ship would carry enough supplies that they wouldn't all be starving within days of making landfall.

Which was one reason I set the landfall date as 2015. On the other hand, big ships made ocean crossings in the early 1900's.

But I also wanted societies in the prehistoric world to be diverse, not to mention as accepting as possible of different orientations, religions, etc. Of course, it's not like everyone's tolerant in our time, but I think there's at least more awareness of such differences now.

GeorgeK · Aug 18, 2017

Marian Perera said:
Oh no, the people are all from 2015, and though they're from different parts of our 2015 world, they're all middle class or upper class. So most of them were quite well educated. !

Ok that's a different scenario than I was envisioning. Your initial physicians then should have basically all the knowledge of a current physician in their respective specialty plus doctoral level knowledge of all the sciences covered in med school. Pretty much any modern surgery is then feasible short of things with special tech based devices. So, initially, nothing with scopes, nothing with radiologic imaging. There would be more diagnostic laparotomies (cut them open to see what's wrong and fix it then if possible) Ether is relatively easy to make and in the big scheme of things a very safe anesthetic but it has the side effects of a terrible headache and nausea upon awakening. They can have retching bad enough that they can rip open an abdominal wound if the surgeon didn't take that into account. Initially suture material would be an issue as well. From the medical standpoint one of your initially important people will be a microbiology lab tech. They generally only have an associate's degree but would more readily be able to identify a plated bacterial culture by sight and smell than the typical physician. That information will help the physicians to know how to treat the patient and more importantly be better able to guess how contagious something is. They are an underrated person in the current medical system because people assume that task is done by computers, when it isn't

It would be reasonable if you have a massive cruise ship that there should be some physicists, engineers and organic chemists which means that once they get the day to day stuff of living going they should be able to get metallurgy going, and glass blowing and plastics and pharmacology, maybe not for the current generation but probably by the second generation. Again, like those above have said, this assumes that the respective individuals survive long enough to pass on the information. Presumably in 2100's people have multiple electronic devices containing the sum of scientific knowledge. If I were in charge, those least fit for hunting, gathering, building would be set to task to transcribe that.

M Louise · Aug 18, 2017

Is it possible that one of the original 2015 party was a medic who had worked with an organization like Médecins Sans Frontières in the developing world? That means somebody would have been able to deal with the immediate medical crises facing the transported community in terms of immunology, parasitology, infectious diseases, pregnancy and childbirth. Modern humans dependent on antibiotics and medications would have compromised immune systems and how well they would cope would depend on adaptive skills, nutrition and micro-climates. Doctors might be replaced by midwives and herbalists over the course of a century.

Is the prehistoric environment friendly or inhospitable -- tropical jungles, a desert or Ice Age? Is there an ocean with a shoreline for seafood? Is there clean adequate water or must they dig artesian wells? What provision is made for newborn babies and the elderly? What do they need to teach one another about hunting and gathering, and what medical emergencies arise during injuries sustained on a hunt, or poisoning from unfamiliar species of plants or berries?

What might help is simply to look at what people in the developing world have done, especially when they rely on oral transmission of skills. Young people would be taught crucial skills of plant identification and some kind of writing materials would be developed (this again relates to the environment -- papyrus, bark, animal hides, rock art?). Fire would be crucial and this would enable cooking, sterilisation of wounds, cauterising, basic surgery. They would learn to brew beer and alcohol especially if the water was brackish but also because alcohol is a crude anaesthetic and disinfectant. The most sought-after and hard-to-get foodstuffs would be salt, fat and sugar. There would be wild honey, fat from insects if not animals. The honey could be fermented for mead and hives maintained. Grains from wild millet could be cultivated. Meat would be salted and preserved, pickled, dried in the wind. Nuts and roots would be stored to help the communities get through winters or drought.

If we look back at early histories of the semi-nomadic Khoi-San communities in southern Africa, the Inuit a couple of centuries ago, nomads in the Gobi desert, there is a great deal to learn from their survival skills. These were not unsophisticated communities, they adapted and made the most of the resources at hand. They developed aide-memoires in songs or counting games, lived close to the earth and knew how to track wildlife, how to tell time, how to work with seasonal planting. They had a cosmology that made sense to them in terms of explaining their worlds, a rich mythopoetic culture. How would deracinated moderns find themselves at home in a world so timeless and cyclical?

The 21st century arrivals would have had to learn and unlearn so much of what they thought they knew. What would they have been able to reinvent? Surgical procedures, obstetric innovations, pain relief for the dying?

Cyia · Aug 18, 2017

In addition to Doctors without Borders, anyone who was a field medic in an extreme environment should have some usable skills. Even a boy/girl scout with basic first-aid knowledge could make a version of the skills book they learn to earn their badge.

Take a look at the innovators - your daVinci's and your Ben Franklin's. See what they used to work around the limitations of their time to prove the theories and processes they knew would work, but really shouldn't have been able to manage.

benbenberi · Aug 18, 2017

I suspect that among your original 2015 people-on-a-boat, you may well find the ones who contribute the most usable skills to the new community are the hobbyists, not professionals. Most modern professions involve access to a lot of high-tech equipment and IT, and the practitioners may not have needed to develop low-tech skills or memorize relevant fact-sets. People who were field medics or did other work for NGOs in emergency-relief situations have probably learned coping skills and workarounds when resources are scarce, though techniques that require low-cost modern materials may be hard to replicate in a world without plastic sheeting, rubber hoses, etc. Serious survivalists, historical re creationists and artisanal crafters will have a lot of practical skills, though they're not the typical passengers on a luxury cruise. (Unless the original cruise was some sort of theme adventure that deliberately recruited people who usually don't take cruises. Maybe there was a floating sf con -- as we all know, AKICIF!)

Marian Perera · Aug 19, 2017

GeorgeK said:
There would be more diagnostic laparotomies (cut them open to see what's wrong and fix it then if possible)

Oh, that's another good specific to mention. The MC doesn't actually have to perform any surgery in the story, though he might have to deliver a baby, but this kind of technique could be something he's familiar with.

Ether is relatively easy to make and in the big scheme of things a very safe anesthetic but it has the side effects of a terrible headache and nausea upon awakening. They can have retching bad enough that they can rip open an abdominal wound if the surgeon didn't take that into account. Initially suture material would be an issue as well.

Like horsehair?

Thanks for the mention of ether. The story begins with the doctor driving a wagonload of medical supplies to a town, but I wasn't entirely sure what kinds of supplies those were, so I left it blank and kept writing. Now I can specify those supplies include alcohol (from a distillery) and ether.

From the medical standpoint one of your initially important people will be a microbiology lab tech. They generally only have an associate's degree but would more readily be able to identify a plated bacterial culture by sight and smell than the typical physician. That information will help the physicians to know how to treat the patient and more importantly be better able to guess how contagious something is. They are an underrated person in the current medical system because people assume that task is done by computers, when it isn't

You're not kidding. I have a master's in microbiology and I work as an MLT in a hospital. It's such a behind-the-scenes job that a lot of laypeople don't seem to know what we do.

It would be reasonable if you have a massive cruise ship that there should be some physicists, engineers and organic chemists which means that once they get the day to day stuff of living going they should be able to get metallurgy going, and glass blowing and plastics and pharmacology, maybe not for the current generation but probably by the second generation.

Yes, in the town he eventually ends up in, there's a glassworks. By now it's the third generation, so industries like those are well under way.

If I were in charge, those least fit for hunting, gathering, building would be set to task to transcribe that.

Good point. I might show that maintaining historical archives and handling communications (both involve a grasp of literacy, which is not at the same level for everyone) are done by people with physical disabilities in the here-and-now.

Marian Perera · Aug 19, 2017

M Louise said:
Is it possible that one of the original 2015 party was a medic who had worked with an organization like Médecins Sans Frontières in the developing world? That means somebody would have been able to deal with the immediate medical crises facing the transported community in terms of immunology, parasitology, infectious diseases, pregnancy and childbirth.

Thanks for the suggestion!

I'm also considering having the land itself subtly affect people's health (this is a paranormal) such that there are now no genetic conditions like Down's syndrome or cystic fibrosis. Maybe even no cancer, though all these go unnoticed because no one is carrying out surveys of the population's health. There are so many ways in this world for people to die that I like the idea of the land keeping them alive and healthy, like fattening up turkeys for Thanksgiving.

Doctors might be replaced by midwives and herbalists over the course of a century.

That's another reason my MC could volunteer to take a wagon of medical supplies to another town - to check that whoever's in charge of medical care in that town, it's not some half-trained amateur or superstitious crackpot.

Is the prehistoric environment friendly or inhospitable -- tropical jungles, a desert or Ice Age?

It's mostly temperate - deciduous forests and grasslands. Lots of mountains, though.

Is there an ocean with a shoreline for seafood?

Yes, plus several port towns and fishing villages. Just in case another ship from Earth ever appears.

The most sought-after and hard-to-get foodstuffs would be salt, fat and sugar. There would be wild honey, fat from insects if not animals. The honey could be fermented for mead and hives maintained. Grains from wild millet could be cultivated. Meat would be salted and preserved, pickled, dried in the wind. Nuts and roots would be stored to help the communities get through winters or drought.

That gives me some thoughts about what communities would use as trade goods.

They developed aide-memoires in songs or counting games...

I remember at the start of This Perfect Day, there was a children's song which began "Christ, Marx, Wood and Wei/Led us to this perfect day". It would be neat to have similar skipping rhymes which may now be garbled but which are an attempt to preserve as much of human history as possible - names of countries and cities or famous people.

Orianna2000 · Aug 20, 2017

Just as a side note, ether is highly flammable. And it's a gas, so without a proper delivery system, it's easy to accidentally inhale it yourself. There's a great bit in one of the later Outlander books where the MC (a doctor from the 1960s living in the 1760s) experiments with making her own ether for surgeries. It's been awhile since I read this particular book, so please forgive any errors, but at one point whatever she kept the ether in started to leak, so the gas crept along the floor, making everyone drowsy. And then, if I remember correctly, a stray candle flame ignited the ether and burned the house down. Or maybe that was a separate incident, I don't really recall for sure. The point being, it's dangerous stuff!

Marian Perera · Aug 20, 2017

Orianna2000 said:
Just as a side note, ether is highly flammable. And it's a gas

I checked Wikipedia, which says it's a liquid, albeit a highly volatile one.

Will bear in mind that it's dangerous, thanks! Transporting the medical supplies doesn't take up much of the story, just a page or two, so I don't think I'll need to go into detail as to how this is done safely.

Cyia · Aug 20, 2017

Not sure about the gaseous form, but ether was originally a liquid, administered by dropper onto a patient's face mask, continually during a procedure (the beginning of "anesthesiology" as a trade). You can see the dangerous of over-inhalation in The Cider House Rules; it's how Dr. Larch dies.

waylander · Aug 20, 2017

Diethyl ether is a liquid used as a solvent in chemistry labs, boiling point below 40C so easily removed.

Twick · Aug 23, 2017

Diethyl ether's definitely a liquid, but evaporates extremely quickly, so the vapour (rather than the "gas") will travel to ignition sources and cause flash fires.

Marian Perera · Aug 23, 2017

benbenberi said:
Medical knowledge will become folklore & tradition.

I reread Vonda N. McIntyre's Dreamsnake just to get an idea of what's been done with the "doctor in a dystopian world" premise, and while the book is still very enjoyable, it doesn't touch on this particular point. No matter where Snake (the main character in the novel) goes, people recognize and respect her as a professional healer who uses medical science, rather than her having to compete with the local herbalist or faith healer. It doesn't matter how remote the location, even ones where healers haven't been for years or decades. No alternative system of medicine has risen to fill the vacuum.

Of course, so much else goes on in the novel and it can't show everything, but I'm glad this is a potential problem for my world.

Medical knowledge in a prehistoric world

starting over

ever seeking

starting over

Freelance Writer

practical experience, FTW

Rewriting My Destiny

practical experience, FTW

starting over

starting over

Benefactor Member

starting over

starting over

ever seeking

Rewriting My Destiny

practical experience, FTW

starting over

starting over

Freelance Writer

starting over

Rewriting My Destiny

Who's going for a beer?

starting over