- "Shallya give us thin priests and fat doctors."
- —A fat priest doesn’t give enough to the poor, and a thin doctor isn’t very successful at healing patients.[1d]
In a world rife with war, disease, and perilous adventure, characters often find themselves in need of medical attention. Luckily, those who follow the careers of Barber-Surgeon, Student, and Physician can provide such service. These lucky purveyors of the healing arts are in return thankful for the current state of affairs in the Empire, in that they are given the opportunity to explore an exciting and lucrative occupation! With an eager hand and humble heart do we therefore present a summary of the current state of Medicine in the Empire.[1a]
- "According to Gaelen."
- —Medicinal saying for 'Undeniably true'.[1d]
The beginnings of medicine in the Empire and indeed the Old World are generally attributed to the works of the High Elf Gaelen. In the years following the foundation of Sigmar’s Empire, scholars and scribes transcribed many great Elven works in order to build the first great library of Altdorf. The most comprehensive guide to herbs and their healing properties of that time is today known as the Book of Gaelen due to its most commonly cited source. Of course, all the originals have been lost, and who knows how those first translators—and the countless since—may have perverted the true Elven wisdom or excised the contributions of other great scholars. Yet the book remains authoritative, not least because of its Elven pedigree, and few are the Physicians who do not keep a modern printing on their shelves, almost as if it were a badge of office.[1a]
During the first millennium of the Empire, the Elven texts were expanded upon by hundreds and thousands of classical scholars. The classification of herbs and ailments was collated into a Byzantine hierarchical system, most famously collected into the gigantic Principia Herbologium, but no scholar truly extended beyond the principles of those original texts. These focused on observing a patient’s colour, temperature and temperament, and then treating him with the appropriate tincture, powder or salve. The “Gaelenic” philosophy, as it eventually became known, likens the human body to a seedling, needing only the right balance of nutrients to grow strong. This mindset was the core of all Imperial medicine until two events changed the Empire forever.[1a]
In 1111 IC, the Black Plague struck, and at the same time the Undead arose in the land of Sylvania. In the shadow of these threats, faith in medicine waned: men as strong as oxen and taking popular herbal remedies could yet be struck down by an unstoppable, invisible killer, and might rise again the next night to become an altogether different type of danger. Any and all diseases were seen as the work of Chaos, which could only be treated with cleansing fire. Doctors who sought to cure rather than burn were likewise condemned, and the field of medicine entered a great dark age.[1a]
At the same time the Necromancers were rising to power, every day performing darker and more perverted explorations into the nature of flesh. For the first time, the temple of the body was thrown open, and as these dark sorcerers made it their unholy playground, they also learned a great deal about anatomy. Much of it they (thankfully) took to their graves, but some of it was preserved and passed on, thus producing the greatest leap forward in medicine since Gaelen. Works such as The Flayed Man and The Creeping Flesh date from this era, and are among the most prized of all medical works—and the most suppressed.[1b]
Necromantic studies were the keepers of medical knowledge for over 500 years until another great tragedy sparked a new look at medicine. In 1786, the Red Pox appeared throughout Tilea, claiming men and animals alike. This more mundane disease, striking in a more enlightened age, prompted the rising population of academics to ponder disease more as a natural phenomenon than as the taint of Chaos. They began to look to animals to learn more about the human form; although any sort of human dissection was still taboo, animal carcasses were perfectly acceptable. The human body began to be appreciated anew as a great nexus of flesh, bone, organs and vessels, each of which could be examined and treated separately.[1b]
Soon after came the Tilean renaissance, and the works of Leonardo of Miragliano brought a new appreciation for engineering. From this arose a new paradigm of thought, one in conflict with Gaelen's theories and the practices that stemmed from them. Where Gaelen saw the body as sacred and inviolate, to be nurtured as a whole, never cut apart, the ‘Mechanicals’ saw the body as nothing more than a giant machine made of many cogs; to throw open such a machine was as natural as examining the workings of a clock or millwheel, and to cut and amputate as natural as tightening a screw. Of course, many doctors could see elements of truth in both sides, and today there are very few that will never perform amputations, or refuse to see the value in holistic theories. There remain some, however, for whom the question is one of morality and even faith, and every student inherits one or the other stance from his tutor or college. As a result, the Gaelenic / Mechanical split continues to characterise modern medicine.[1b]
The Cutting Edge
- "Verena for rulers, but Gaelen for riches."
- —An epithet popular among university students, referring to the fact that while students of the law frequently rise to high station and public office, students of medicine tend to be wealthier.[1d]
In the recent centuries, the Mechanical outlook has become the default in Tilea and Estalia, not least thanks to the great artist Andreas Vesalius, whose book De Corporis Fabrica provides the most accurate paintings of the human body yet produced. Dissections, too, have become accepted in these decadent southern states. The Empire, however, still resists this practice, seeing it as a violation of the will of Morr: after death, a man must be placed in Morr's Garden as soon as possible, not be opened out and toyed with. Any act of human dissection is considered necromancy, and remains punishable by death. Elements within the University of Nuln publicly protest this ban; many others simply contravene the law in secret.[1b]
It is now widely accepted amongst the medical community that the frontiers of medicine cannot be expanded without examining the human body. This is so much the case that grave robbing is one of the most profitable criminal occupations to be found, with demand sky-high for the services of any ‘resurrection man’ strong enough to heft a shovel and brave enough to risk being burnt at the stake. A budding department in the generally regarded conservative University of Nuln now includes a dissection demonstration as part of its fifthyear curriculum (after swearing all the students to secrecy, of course). They require so many bodies that a criminal organisation known as the Resurrection Brotherhood has evolved and become very wealthy filling the demand. Led by a ruthless Halfling known as Bloody Jacob, the Brotherhood’s motto is “Dead before supper, delivered before breakfast.”[1b]
Grave robbing has its limits, however. Students of anatomy prefer their subjects to be as fresh, as complete, and as young as possible, so that they might glean the most information about healthy flesh. Some are not above hiring unscrupulous people to make sure that subjects become available. In the city of Marienburg, many poor travellers check into the Birkenhare Hostel, unaware that most of its patrons have their throats slit during their first night. Few miss these itinerant wanderers, and the upkeep on the hostel is paid by the very grateful Dean of the Marienburg Academy of Physicians.[1b]
Theories of Medicine
- "Every demon hates his brother."
- —A more poetic version of the medical adage that “like cures like”.[1d]
Whether Gaelenic or Mechanical in outlook, all medical scholarship is accompanied by a full grounding in Classical works, particularly the new field of Science. This field is dominated by a trinary model of the universe, dividing the world into the Realm of Law, containing the Gods and the Elves, the Realm of Chaos and all its dark threats, and the Realm of Man, where mortals are cursed to struggle between the two.[1b]
This underlying form of the universe is reflected in many aspects of the natural world: the warm healthy sun of the day is of the Realm of Law, and the dark, dangerous night belongs to Chaos, with dusk and dawn being the time of Man. Perhaps the greatest parallel, however, is in our political system, with the nobility and the church seen as part of the Realm of Law, chosen as they are by the Gods themselves. The world of the peasant and the beggar is of course tainted by Chaos, and the Realm of Man is linked to the growing middle class between.[1b][1c]
The trinary system also applies to the human body. The head and throat are considered akin to the Realm of Law, the heart, circulation and liver likened to the Realm of Man and the stomach, bowel and sexual organs associated with Chaos. Each area is also associated with an exhalation—one of the Three Fluids—the colour and composition of which is used for diagnosis. The throat is judged by the phlegm, the heart by the blood and the bowel by the faeces: if any of these are darkly coloured, the physician will know the area in question is afflicted. The darker the colour, the worse the sickness.[1c]
Rather than being purely academic, the trinary model and its social parallels has a constant effect on perceptions of illness and treatment. A bowel upset (like the Galloping Trots) in a peasant is seen as part of the natural order of things, and not requiring treatment, while any problems of the mind in a person of such station would be seen as a dire woe, and perhaps ascribed to Chaos-taint. Conversely, ailments of the brain are readily diagnosed in the wealthy or noble, sometimes even seen as their great curse, while stomach upsets in these worthies are blamed on some foolish contact with the unclean world of the poor. Other times, the association goes the other way: bleeding is a relatively safe, reliable and cheap treatment, and so has become the panacea of the busy craftsman or city-dweller, strengthening the association of the heart with this middle social stratum.[1c]
Another model commonly used is the linking of each body part to one of the 20 astrological signs. Physicians who subscribe to this belief typically have a vast knowledge of astronomy, and determine both diagnoses and treatments based on the positions of the stars. A weakness felt under the sign of Mammit the Wise, for example, is surely caused by an imbalance in the brain, whereas a sore foot during the time of Cacklefax can no doubt be cured by stimulating the liver.[1c]
All medical models, however, eventually trace disease and sickness back to the taint of Chaos. It is, after all, the source of all failings and weakness, whether physical or spiritual, in mankind. Therefore, almost no medicine is done without at least lip service to the Gods, and both doctors and patients look to faith when medicine reaches its limits. Those who have chronic or seemingly incurable ailments may be advised to try extreme measures to gain the Gods’ favour, such as fasting, pilgrimages or flagellation. This is particularly common for those who have strong reason to blame their injuries on their own actions: lusty men with ‘Nurgy Nob’ have likely invited such things by their passionate inclinations and must turn to a life of celibacy; gravediggers with Tomb Rot have clearly come to the attention of the Fly Lord and must journey to a shrine to be cleansed.[1c]
- "A doctor for a diet, a surgeon for a cure."
- —Common saying among the lower classes referring to the fact that the treatments of physicians are typically longterm or ineffectual lifestyle requirements, while a surgeon takes a direct approach (lance the boil, cut out the infection, etc.), removing the problem.[1d]
Like most occupations in the Old World, both physicians and surgeons are grouped into guilds. The two careers are always separate, and the distinction is paramount—Sigmar help the person who insults a physician by confusing the two! However, a well-respected surgeon will enjoy wealth and social status much the same as a low-ranked doctor, and the layman may see little difference in their roles.[1c]
Physicians’ guilds are notoriously strict in membership so as to preserve the reputation of the profession. Women, Dwarfs, Halflings and foreigners are all typically prevented from joining, and the demand for university qualifications (which requires at least four years of study at an Imperially recognised medical college) typically excludes all but the very wealthy or noble-born. Of course, smaller towns may have less restrictive guilds, or may permit unlicensed physicians to practise. Surgeon guilds are much less exclusive, although they too know the importance of maintaining a reputation. Apprentices are thus rigorously trained, and in the aftermath of the war colleges of surgery have begun to spring up across the Empire as well.[1c]
A general distrust of doctors among the populace and the need to protect against contagious plagues has created a Byzantine system in relegating guild authority—and culpability. In many cities, the guilds are beholden to the mayor or council, and may not prescribe a cure or practice that is not first sanctioned by this body. Most famously, the Altdorf Guild of Physicians is officially known as the Physicians to the Crown. This patronage protects them against accusations of misconduct by the lower classes and allows them to directly advise the nation in times of crisis, but also means the Emperor has control over all their dealings. If a well-meaning Emperor reads one night that wearing a duck on one's head improves the mind, the doctors of Altdorf will be prescribing duck-wearing the next morning.[1c]
Meanwhile, apothecaries and herbalists operate independently of physicians. Some of these suppliers of mixtures and balms work in concert with physicians, particularly if a large profit can be made by each party. Others do whatever they can to discredit or contradict physicians and steal their patients, seeing them as book-blinded up jumps who show no respect for traditional remedies. Smaller communities often have midwives, wise women, druids, hermits, mages or miracle workers, all in various states of organisation and with various levels of ability and, indeed, mental stability.[1c]
Charlatans, lunatics and the incompetent thrive in such a crowded market, while ever more bizarre, outlandish and expensive cures abound. Small wonder many consider going to the doctor foolish and dangerous, and the few reliable doctors are treasured like gold by those who find them.[1c]