Emdees

[RandyT0001]

[CLUNK!]
The sound of me throwing my sabot into the machinery.
I wanted to get an idea how others treat emdees in their MP setting so I included a poll. Choose one. It's a public poll. Below are explanations of the choices.

1. General practice doctors (or dentists) without any specialization (before 20th Century)
   
   
2. General practice doctors with a small level of specialization (1900s)
   (dentistry, internal medicine, OB/GYN, general surgeon)
   
   
3. General practice doctors with a modest level of specialization (1930s)
   (anesthesiology, dentistry, gastroenterology, general surgeon, internal medicine, neurology, OB/GYN, optometry, pediatrics, pharmacology, radiology, and urology)
   (The minimal level of specialization of doctors brought into the future by the Rich Five [3rd ed.]. This is also the minimal level of specialization taught by the University in the KFS for 3rd ed. IMO)
   
   
4. General practice doctors with a diverse level of specialization (1960s)
   (anesthesiology, cardiology, cardiovascular surgery, dermatology, dentistry, gastroenterology, general surgeon, internal medicine, neurology, neurosurgery, OB/GYN, optometry, orthopedic surgeon, oral and maxillofacial surgery, pediatrics, pathology, pharmacology, radiology, and urology)
   (The minimal level of specialization of doctors brought into the future by the Rich Five [4th ed.]. This is also the minimal level of specialization taught by the University in the KFS for 4th ed. IMO)
   
   
5. General pratice doctors with a widespread level of specialization (1980s)
   (allergy/ immunology, anesthesiology, cardiology, cardiovascular surgery, dermatology, dentistry, endocrinology, gastroenterology, general surgeon, infectious disease, internal medicine, nephrology, neurology, neurosurgery, OB/GYN, ophthalmology, optometry, orthopedic surgeon, oral and maxillofacial surgery, pathology, pediatrics, pharmacology, plastic surgery, psychiatry, pulmonology, radiology, rheumatology, and urology)
   (The types of doctors the Rich Five [3rd ed.] were accustomed to visit and IMO would have brought with them into the future.)
   
   
6. General practice doctors with an extreme level of specialization (2000+)
   (allergy/ immunology, anesthesiology, cardiology, cardiovascular surgery, dermatology, dentistry, endocrinology, gastroenterology, general surgeon, infectious disease, internal medicine, nephrology, neurology, neurosurgery, OB/GYN, ophthalmology, optometry, orthopedic surgeon, oral and maxillofacial surgery, otorhinolaryngology, pathology, pediatrics, pharmacology, plastic surgery, podiatry, psychiatry, pulmonology, radiology, rheumatology, surgical oncology, thoracic surgery, transplant surgery, urology and vascular surgery)
   (The types of doctors the Rich Five [4th ed.] were accustomed to visit and IMO would have brought with them into the future.)
   
   
7. Emdees are basically witchdoctors, faithhealers and herbalists, not scientists.

[stormlion1]

I like to think there is some degree of passing down knowledge from one Emdee to another. A former Dentist trains another Dentist and then he passes that down. They might look at other specializations to see how that affects there own but will not practice it in any way. I do see there being a sort of generalist Emdee running around as well and them being very common but they are jack of all trades and are more good for minor things spread across the board than anything serious. Might patch up a bullet wound, but not extract the bullet if its in too deep. That sort of thing.

[kato13]

Since my general world is 1860-1900 tech I feel a majority of the country would fall in that area.

Some areas might reach as high as the 1960s but that would be very rare (KFS capital).

[Project_Sardonicus]

There was a great documentary on the BBC about life in Tibet under China. Who after occupying the country had made some efforts to put services in place, to try and keep the people sweet and not revolting.

One of them was Drs, so most medium sized towns and villages got one or more trained as a sort of GP if rather less skilled and more generalised then you'd expect.

I think this would be what the level of medical skills an emdee would have.

A lot of basic stuff from hygenically removing gallstones and appendixes, under anaesthetic and in sanitary conditions or even taking out cataracts.

Not to mention even more basic stuff like antibiotics.

Basically the standard medical treatments that were around at the end of world war2. In a low tech future these skills would be like magic and highly prized. I mean the winter you didn't have an emdee and everyone in your village got a virus death toll could be a couple of dozen. The next year you've got an emdee the death toll drops to a couple of old folks.

I think emdees would end up having a strict rule of never getting involved, a kind of super Hippocratic oath.
Whilst even the craziest tribes would spare them.

Also with their medical skills a team could go undercover as emdees if they need to travel incognito.

[ArmySGT.]

I don't think anyone of them would be skilled enough that a pre-War person would call them Doctor.

Without formal schooling, that some things would not be passed along because these can't be done without a laboratory.

Say a 25% loss in knowledge per generation.

Not to say an Emdee doesn't have a valuable skill set. Probably exceptional at trauma care and patient care. Diagnosis though, not so much. Cultures can't be sent to a lab, and medicines brought from the pharmacy.

An Emdee can remove a bullet in a relatively minor wound, surely. A critical wound with lots of internal bleeding, no.

An Emdee can probably get away with some minor surgeries because this person is aware of the need for a sterile wound. So probably an appendix. As long as ether and isopropyl alcohol are available.

An Emdee could set and if available even plaster a simple fracture. A compound fracture or shattered limb means amputation. Without X-rays or the formal training to read one if it was available.

An Emdee has probably become a fine herbalist, and in some cases a very limited chemist (distillation or emulsion). So while whatever it is may help you, atleast it won't kill you.

Then it also depends on how literate that Emdee is.......... To what level can that person read? Can you give them a text and expect them to absorb much?

A travelling Emdee is probably very limited (immediate trauma care) while one in a village or small town has better resources and improvised equipment.

[mmartin798]

This brings up an interesting aside. What of the humble druggist of the late 19th and early 20th century? These men brewed and cooked medicines in their stores, both on the direction of a doctor or as a treatment requested by a customer. Many of the remedies were for specific condition that were well described in the journals of the day. Would there be some high school or college chemistry teachers bringing back the trade after the war to fill in the doctor gap? Or even a pharmaceutical chemist who got pressed to make something for people, since labs are widely distributed it is likely some people of this level of skill and knowledge would survive. But as ArmySGT points out, the ability would start to decline without adequate support. There would be varying skill levels after 150 years, just as in emdees, from druggist selling valid remedies and others selling snake oil.
One thing I found interesting were the articles in the druggist trade journals from 1901 that had to warn the druggist about explosive mixtures that would sometimes get produced in their shops causing causalities amongst their members. Things like potassium chlorate and mercury fulminate among others.

[Project_Sardonicus]

In the world of tomorrow there definitely seems to be a few groups like the KFS who have mid 20th century tech; this would certainly include one would suspect a modest pharmaceutical factory and possibly a small hospital.

Once you leave out more sophisticated treatments a lot of medical treatment is relatively simple.

An interesting problem for emdees would be, if their source of drugs and medical schools are all in the cities of evil empires. How complicit are they in the nefarious actions of these regimes.

[Project_Sardonicus]

Originally Posted by mmartin798

This brings up an interesting aside. What of the humble druggist of the late 19th and early 20th century? These men brewed and cooked medicines in their stores, both on the direction of a doctor or as a treatment requested by a customer. Many of the remedies were for specific condition that were well described in the journals of the day. Would there be some high school or college chemistry teachers bringing back the trade after the war to fill in the doctor gap? Or even a pharmaceutical chemist who got pressed to make something for people, since labs are widely distributed it is likely some people of this level of skill and knowledge would survive. But as ArmySGT points out, the ability would start to decline without adequate support. There would be varying skill levels after 150 years, just as in emdees, from druggist selling valid remedies and others selling snake oil.
One thing I found interesting were the articles in the druggist trade journals from 1901 that had to warn the druggist about explosive mixtures that would sometimes get produced in their shops causing causalities amongst their members. Things like potassium chlorate and mercury fulminate among others.

Good point after 1945 or so, the medical community got antibiotics and all kinds of illnesses disapeared. These would be relatively to produce for one of these druggists.

[RandyT0001]

Looking up on wikipedia there are about 130 medical schools that confer a MD degree in the US (excluding PR). Not all of them are located in target cities. If 5% survived that means there are about 6 or 7 medical schools in the US. How advanced they are technologically depends on outside support by surrounding communities. Personally, I think they would try to maintain, at least, a 1930's level of health care, tech D (4th ed.). The encounter entry in the 4th ed. book (p220) specifies tech B-D for wandering emdees, including a possible portable generator (for a x-ray machine mounted in vehicle, etc.).

The KFS is a unique situation where the Rich 5 froze doctors and medical specialists. They also stored equipment and books. I find it hard to believe that the Rich 5 did not build a state of the art medical facility, including labs and feedstocks at their bunker to serve them and the 2000 for a few years. After the KFS was established one of the first building built in New Manhattan would be a teaching hospital to serve the Rich 5 and the 2000 and their descendents. The emdees trained at Bowling Green are normally general MDs and specialists from the 1900s level of technology. The best, brightest, most connected MDs recieve advanced medical training at the Hospital in New Manhattan. There are smaller, less capable hospitals in Louisville and some of the bigger towns, maybe a total of ten, at best.

Besides surviving medical schools there are Medical and Civial Affairs MP teams that might establish a medical school in a supportive community with sufficient technology.

[Project_Sardonicus]

Like a lot of things it's about reinventing the wheel.

If someone kept the books, then you don't need to reinvent antisepsis or antibiotics, anaethetics etc.

Similarly with maxim system automatic weapons or internal combustion engines.

The issue is far more about resources, material time etc.

So what I think you won't see is the actual 19th century, prescribing lead and opium pills because it seems right. Or blowing themselves up building experimental steam engines.

Rather it'll be KFS producing simple, heavy, reliable and ineficent internal combustion engines by hand. To produce a few cars or armoured vehicles straights out of the 1940s. Or emdees learning how to clean a room in a community and paint it in white emulsion, then disinfect so if they need to operate there's atleast some chance against sepsis.

[ArmySGT.]

It is not just nuclear war that brings the downfall of everything. East/West and every other player also unleashed Biowarfare weapons.

Where does one go when they are sick? To the hospital. So some of the highest incidence of death is healthcare workers (current events : Ebola outbreak).

The effects of plague are indiscriminate. A plague doesn't care if you pump gas or perform neurosurgery. The War is going to take a huge toll on every kind of medical practitioner. The surviving doctors are likely to be rural and General Practitioners. A teaching hospital is as likely to be over run by the sick and dieing as any urban hospital.

What can a teaching hospital do without electricity, drugs, x-ray film, supplies of sterile tools, laundry facilities, running water, or a sewer system.

It is not just about people, the interconnected infrastructure is broken down.
Major source of electrical power are destroyed (Hoover dam / Bonneville dam) or if missed offline because the technicians are to afraid to leave home or dead.

Only the largest of the largest survivor communities like Chicago could support people who produced nothing while learning something like medicine.

As for the Rich 5, I certainly endorse that they did freeze Doctors and Specialists among the families of the 2000 to care for them and the 2000. As a means of control, I doubt they accept anyone from outside the 2000 into medical school. At best, they produce paramedics that travel taking care of minor ills and low skilled nurses outside of the 2000. An educated populace is to difficult to control.