Characters battle induced coma

Anything that gives him a whack in the head.

In a medieval setting, a mace would work well (so to speak).

Falling from a horse, hitting his head.

Any sort of significant blunt force injury to the head can send someone into a coma. As someone who works in this area though can I just offer up that you don't wake up from a coma all at once. It's like waking from a deep dream over the course of weeks to months, yes every coma is like that.

Massive blood loss leading to unconsciousness would also do that, eh?

Channy said:

Massive blood loss leading to unconsciousness would also do that, eh?

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It depends on the amount of blood loss. If someone looses enough blood that they pass out when the stand up or exert themselves, then no if the bleeding is stopped. If someone looses enough blood that they go into hypovolemic shock then yes, if they don't receive some sort of fluid replacement brain damage is a common side effect of massive blood loss.

I've got nuttin as to the question, but the thread title really, really needs an apostrophe and a hyphen.

Side query: how will they get fluids into him? If he can't drink, he'll be dead from dehydration in a week.

No idea if there was a medieval solution to this - you may already have sorted it, but it was my first "but why?" thought.

Good point on fluids.

If we were talking early 20th century (which we're obviously not) then funnel and rubber tube - that was how they force-fed suffragettes on hunger strike. Need a medieval version of the rubber tube.
Would also be interested to know if there are records of it actually being done.

The key part is to get the tube down to the stomach, not into the lung.

cornflake said:

I've got nuttin as to the question, but the thread title really, really needs an apostrophe and a hyphen.

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I came into this thread thinking I might recommend Connie Willis's Passage, it being the only book I know of where someone actually does battle a coma-like state.

skylark said:

Side query: how will they get fluids into him? If he can't drink, he'll be dead from dehydration in a week.

No idea if there was a medieval solution to this - you may already have sorted it, but it was my first "but why?" thought.

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With no peripheral or enteral access you don't get fluids into someone. I'm sure someone could try to get water down someone's throat, but that's asking for them to aspirate. Also you're being optimistic about dehydration. If they were in battle and losing fluid through sweat combined with any amount of significant blood loss they'd have two or three days at the most.

Someone did bring up the idea of a medieval NG or OG tube. While that's a good idea even if you know what you're doing it's difficult, and protocol is to verify with X-Ray. Weirdly it's super easy to get them in on neonates, but on adults it is incredibly dangerous if you don't have any way of verifying placement. One time I had a patient with an airway and on a ventilator. Even with a trach cuff in place I managed to get the NG tube past the trach and into the lung. The charge nurse tried, did the same thing and finally respiratory got it on their second try.

Medieval medicine was horrible. Honestly, if I was transported through time I'd refuse medical treatment if I was grievously wounded.

MDSchafer said:

It depends on the amount of blood loss. If someone looses enough blood that they pass out when the stand up or exert themselves, then no if the bleeding is stopped. If someone looses enough blood that they go into hypovolemic shock then yes, if they don't receive some sort of fluid replacement brain damage is a common side effect of massive blood loss.

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Aha, very helpful. In my own WIP I have a character who enters (not a coma, though) unconsciousness after receiving a gunshot wound and experiences massive blood loss. Their whole balance/coordination/stamina suffers until they get a moment to bandage the wound, but referencing a more technical term and requiring fluids will help make it more believable now.

In a medieval setting, if someone has a coma severe enough to last a week, they're dead. A coma that long almost certainly indicates a severe brain injury that's non-survivavable in a medieval context. If the coma is deep enough they can't drink water if a spout is put in their mouth*, they're dead of dehydration well before the week is up. If the initial injury included massive blood loss producing hypovolemic shock on top of a coma, they're probably dead within hours.

You may want to rethink the nature of the injury. A person may be gravely wounded & effectively non-communicative for an extended period without being comatose and without making their recovery in the absence of modern medicine completely implausible.


* I can't come up with reference to "invalid cups" like this before the 17-18c, but it's not impossible they might have existed earlier. The alternative way to get liquid into an unconscious person was by using a cloth teat similar to what babies were fed with - it only works if the patient can suck as well as swallow.

Poison maybe. There's a story about Genghis Khan getting nicked on the neck by a poison arrow and being out for a while. One of his generals sat with him and sucked the poison out of his wound. At one point he also had to sneak into an enemy camp for water. Not sure how long the episode lasted, but it seemed like at least a day. The fact that he had to go for water meant dehydration was probably visibly setting in.

Is this medieval historical fiction or a medieval-ish fantasy?

I’ve seen this done in fantasy numerous times (GRRM and Abercrombie both spring to mind) with some handwaving about healers and dripping honey water into the patient’s mouth to keep them alive so you could do the same.

If you’re going for historical realism then as benbenberi says I’m afraid your guy is just dead. Does he really have to be in a coma, or just too badly wounded to be up and about for a couple of weeks? There are plenty of ways to achieve that, if so.

Was discussing the "tap on the head" trope with my sister who is a doctor and works in neurosurgery the other day, and she listed some of the likely outcomes in terms of brain damage when you've had a blow on the head that cause maybe an hours blackout and the weeks of rehabilitation that often follow. For a week... Even today, with all the medical expertise there is, few people come out of that even relatively unharmed. We're talking all sorts of effects, and that is provided they somehow miraculously survive at all due to all the other problems mentioned with a medieval setting...

Henry VIII got a blow to his head during a joust and was out for almost an hour, IIRC (could be slightly less, could be slightly more). His recovery was pretty miraculous and rightly thought of as such by his contemporaries who had the context of 16th century experiences of blows to the head.

Quoting from this page (just googled very quickly) on traumatic brain injury:

Traumatic brain injury (TBI) can significantly affect many cognitive, physical, and psychological skills. Physical deficit can include ambulation, balance, coordination, fine motor skills, strength, and endurance. Cognitive deficits of language and communication, information processing, memory, and perceptual skills are common. Psychological status is also often altered.

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Note that this isn't necessarily talking about anything even near the brain damage associated with a week long coma.

benbenberi said:

You may want to rethink the nature of the injury. A person may be gravely wounded & effectively non-communicative for an extended period without being comatose and without making their recovery in the absence of modern medicine completely implausible.

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This.

I think we underestimate injury and how incapacitating it can be with pain, and shock and blood-loss, not to mention that that infection and fever not unusually followed. If you are going for realism, you should probably investigate your other options.

A common outcome of the kind of head-knocks that were common after battles from the neolithic through the renaissance is bleeding on the brain. If this was severe enough the patient would lose consciousness, seizure, and die.

The remedy--and people have been doing this for thousands of years--is trephination. About 20% of people who are trephined after losing consciousness (though not for a week; more like a couple of hours) make a "full" recovery, meaning no major cognitive or motor defects.