Is there a Doctor/Historian in the house?

possiblerobot

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Okay, I've got some really specific and slightly strange questions about medicine, history, and the history of medicine. For context, I'm writing a dieselpunk/fantasy novel set towards the end of World War Two (around 1943-'45), and these are the questions I have:
1. What sort of medical equipment and medicine is needed to keep someone in a medically induced coma, and how long is it safe to keep someone like this?
2. Would the German government have this sort of equipment available to them at this time?
3.This one is kind of complicated. I want to have the MC be a sort of super soldier, but I also want to have some basis in reality. So if you could help me figure out how far I could go to make him "Super" before resorting to magic, it would be appreciated.
 

King Neptune

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It probably would have been possible to keep someone in a medically induced coma with drugs and a ventilator, both of which were available in that time. I don't know how long they could have kept someone in such a state, but the heart would not behave well for too long a time, bt several days would have worked. People were kept on ventilators for extended periods..

You will have to define "super" for this purpose, and then you will be able to ask how to get someone into that condition.
 

MaeZe

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You should be asking nurses not just doctors. :tongue

It's not likely. Possible if you want to stretch the truth a bit, the reader might not know or care.

The History of anesthesia is a good place to start. While chloroform, nitrous oxide and ether were used in the 1800s, and anesthesia was commonly used, the science was not all that advanced by the 1940s.

They did not have the skills and continuous monitoring equipment available to sustain an unconscious state for more than a few hours without killing the patient.

Negative pressure ventilators were common through the 1950s. Those are the tank type where your whole body except the head are exposed to external pressure alternating positive and negative to mechanically ventilate the chest. We had positive pressure ventilators by the early 1900s and they were being used in the OR and ICU by the late 1940s

But there's a big step between being able to breathe for an unconscious person and maintaining a person in a coma for any length of time.

To keep a person in a coma for an extended period of time you have to regulate the administration of the drug, monitor the heart and blood pressure continually and breathe for the patient continually, which also might mean monitoring the blood gasses (patient's oxygen and CO2 levels). Mechanical ventilation has additional problem in that it is hard on the trachea and lungs. And unless you are going to feed the patient with a stomach tube or IV, you can't feed the person. Total parenteral nutrition was not available in the time frame you are writing in so that leaves a tube into the stomach. It's why people on permanent ventilation get tracheostomies.
First-Generation ICU Ventilators

Ventilators designed for positive-pressure invasive ventilation became available in the 1940s and 1950s. Figure 11 shows some of the early models. The key distinguishing feature of these early invasive ventilators was that they provided only volume-control ventilation (Table 1). Patient-triggered ventilation was not possible with these first-generation ICU ventilators.11,12 However, the range of sophistication of these ventilators was quite large.

Also for long term ventilation you have the issue of suctioning the mucus out that we normally swallow. And infection is likely in the 40s. Penicillin was only discovered in the 30s and mass produced in the 40s. But it was still very new.

I'd suggest you could do it if it were absolutely necessary for the story, but don't dive in blindly if you choose to go that route.
 
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possiblerobot

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You will have to define "super" for this purpose, and then you will be able to ask how to get someone into that condition.

I mean "super" as in, how far past what a normal person's abilities could I push him realistically before I have to rely on magic. For example, if I took a picked a random soldier out of the United States Army and kept them in an environment where they could be safely monitored by doctors, what could he be able to achieve if given drugs to enhance their performance, what would they be able to achieve if they kept up the same or similar exercise routine they had as a soldier? And what type of drugs would be used? I'm using drugs here because they're the closest thing I can think of that can be an analogue for being enhanced by magic.
 

Duncan J Macdonald

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I mean "super" as in, how far past what a normal person's abilities could I push him realistically before I have to rely on magic. For example, if I took a picked a random soldier out of the United States Army and kept them in an environment where they could be safely monitored by doctors, what could he be able to achieve if given drugs to enhance their performance, what would they be able to achieve if they kept up the same or similar exercise routine they had as a soldier? And what type of drugs would be used? I'm using drugs here because they're the closest thing I can think of that can be an analogue for being enhanced by magic.

It seems to me you are trying to recreate the Captain America origin story. That world used a 'special compound' and a roomful of handwavium electronics to give Steve Rogers his physique (which I note he does nothing to maintain).

From a layman's point of view, about the best that could be done at that time would be a Charles Atlas type regimen . Add a few doctors specializing in vitamins and have the soldier work out more than the 15 minutes a day that Atlas asked for.
 

possiblerobot

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It seems to me you are trying to recreate the Captain America origin story. That world used a 'special compound' and a roomful of handwavium electronics to give Steve Rogers his physique (which I note he does nothing to maintain).
No, not exactly. I was going to have him given some drugs to help improve his abilities, but I was thinking most of his strength would be given through the way the people in charge of building him used magic. I just wanted a baseline for what a human would need magic for, and what could be given through "mundane" training regiments and maybe drugs.
 

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I don't know anything about the medical technology, but toward the end of the war the Germans were so short of everything that they didn't have enough morphine for their wounded soldiers. Or so the weeping German doctor told the wounded POWs.
 

King Neptune

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I mean "super" as in, how far past what a normal person's abilities could I push him realistically before I have to rely on magic. For example, if I took a picked a random soldier out of the United States Army and kept them in an environment where they could be safely monitored by doctors, what could he be able to achieve if given drugs to enhance their performance, what would they be able to achieve if they kept up the same or similar exercise routine they had as a soldier? And what type of drugs would be used? I'm using drugs here because they're the closest thing I can think of that can be an analogue for being enhanced by magic.

The result would vary greatly from one individual to another, because body size, metabolism,and other factors are largely determined by genetics. You will have to define what "super" means, and then you can just make someone go there.
 

Deb Kinnard

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I was in ancillary medical practice from the late 70s through last October, and medically-induced coma was not a thing they did in the 70s, despite the availability of positive-pressure ventilation and better technology than the "iron lungs" polio victims ended up in, during the 50s. I once handled a record in which a young girl (10-12?) had been hit by a sanitation truck, did not survive, and was conscious the entire time she exsanguinated, due to the lack of medically-induced coma as a palliative for her extreme distress. It was very upsetting to read. This was in the late 70s or early 80s.
 

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I have read that during WW2 people who had a breakdown, especially ones working in high stress, highly important jobs like codebreaking at Bletchley, would be put to sleep for a week - as in drugged. Not in a coma, but relief from stress through prolonged sleep. Don't know any more details.
 

possiblerobot

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So, the way I'm understanding it, doctors of the time could induce a coma, or something similar, from around that time, but it would have been extremely rare during the time period, if used at all, and probably difficult someone in Germany due to heavy shortages of medical supplies. Am I getting this right?
 

King Neptune

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So, the way I'm understanding it, doctors of the time could induce a coma, or something similar, from around that time, but it would have been extremely rare during the time period, if used at all, and probably difficult someone in Germany due to heavy shortages of medical supplies. Am I getting this right?

I think that is a fair summary. You might also add that the coma would have to be brief, and the patient might die anyway.
 

Tsu Dho Nimh

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I was in ancillary medical practice from the late 70s through last October, and medically-induced coma was not a thing they did in the 70s, despite the availability of positive-pressure ventilation and better technology than the "iron lungs" polio victims ended up in, during the 50s.

I was a medical technologist in the 70s, 80s and 90s ... Yes, it was done. It was not easy, took lots of tests and monitoring, but you could do it for about a week. In a high-class trauma center.

I once handled a record in which a young girl (10-12?) had been hit by a sanitation truck, did not survive, and was conscious the entire time she exsanguinated, due to the lack of medically-induced coma as a palliative for her extreme distress. It was very upsetting to read. This was in the late 70s or early 80s.

Having seen people bleed out, she was not conscious for long.
 

Tsu Dho Nimh

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So, the way I'm understanding it, doctors of the time could induce a coma, or something similar, from around that time, but it would have been extremely rare during the time period, if used at all, and probably difficult someone in Germany due to heavy shortages of medical supplies. Am I getting this right?

Very difficult because of the necessity for keeping homeostasis, especially blood pH which is easy to screw up.

Also, they didn't have good enough IV nutrition to keep them alive.

Until the development of better anaesthetics to not muck with the chemical balance, and the ability to measure blood pH, even surgery had to be limited to what could be done before the anaesthetic killed the patient. Now some of the complex surgeries, like separating conjoined twins or extensive reconstruction, can take 12-18 hours with shifts of surgeons. And a lot of monitoring.
 

possiblerobot

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So it looks like I'm going to have to rely more on the magic and science fiction for this aspect than the history here, unless someone can come up with something that could cancel all of this out. So, I'd like to focus a bit more on the super soldier question. I'm looking into more of the performance enhancing drugs that were available during that time. Does anyone have any ideas of where I should start looking?
 

Tsu Dho Nimh

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Performance enhancing drugs ... methamphetamines. And caffeine. And more amphetamines.
And cocaine.

And then to come down off it and rest, barbiturates (veronal) and chloral hydrate.

Seriously, that's all they had. (checked my dad's old pharmacy books and that's about it for)
 

possiblerobot

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Seriously, that's all they had. (checked my dad's old pharmacy books and that's about it for)

*Frustrated sigh* It's like reality is trying to make my dug enhanced, magical super soldier completely unrealistic. However, you lot have been a huge help getting me a good idea of where to start with my MC. I can't thank you enough. Your help is eliminating my last reasons to procrastinate, which means I may actually get to starting this book sometime this century. Thank you all so much!
 
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Marlys

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Supposedly, the Nazis tested anabolic steroids to increase strength and aggression. Original source a Sports Illustrated article on the history of doping in sports, cited here.
 

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That's a pretty broad spectrum. Normally, there's a "limiter" that makes things hurt enough that we don't use our full strength, even when we think we're giving it our all. But when adrenaline and a life-or-death situation turn that limiter off--well, I've heard of a little woman lifting a car off a baby and seen a video of a larger guy lifting a helicopter off of its trapped pilot.