Healthcare and Hygiene In Adel

Cleanliness is a virtue for the Adelians, and the idea of being clean and feeling healthy because of it is one that is pervasive throughout their culture. They don’t suffer from backwards ideas about bathing or cleanliness, but they do have peculiar ideas about healthcare, as they are not a modern culture. Nonetheless, for the resources they have, Adelians have managed to combat a lot of disease, and to study avenues of treatment, and develop strange but mostly functional ways of caring for their ill. As with everything, it is a mix of religious superstition and characteristic Adelian pragmatism that led to this.

In this article we will look at disease control and treatment, as well as hygiene in Adel.

Adelian Hygiene

To the Adelians, only a clean body can house a clean soul. People bathe and clean themselves religiously, though some also enjoy relaxation or play in the water. Most Adelians (rural villagers) try to wash their hands, feet, face, ears, tails, hair and sensitive areas every day. Almost all villages are built near accessible water, so this purpose is not difficult to fulfill. Where possible, at least once or twice a week, Adelians wash their whole bodies and really rinse their hair out thoroughly. Villagers bathe using water, but those who can afford it wash with herb-laden, fragrant oils, considered a sanctified substance.

In villages, water is usually taken out of the nearby water source and used to fill a public pool, dug into the ground and lined with rocks and clay, or else villagers wash with buckets. They rarely wash in the river itself except on certain occasions. One can play in the water whenever there’s free time, but to actually bathe in it and cast off dirt into it is a serious occasion, as the Adelians believe that rivers and lakes can only hold so much filth at a time. In towns and cities there are public baths, often with four sections (unisex, female only, male only, and the nebulous “family”) for people to use as they want.

Dental hygiene is also important to the Adelians. Many use herbs and abrasives along with cloths or bristles to care for their teeth on a day to day basis. Bad teeth are pulled out. For some races, this is not problematic – Damakran can regrow their teeth all the time. Iomadi go through their teeth twice in their lives, but can then not replace them.

Adelians use a language based around hygiene to talk about disease and medicine. A disease is a “filth” or “taint” that has “sullied” the body, and it must be cleaned out with the proper substances and treatments. Cleanliness is an important part of Adelian medicine. A large part of medicinal practice for Adelians is to insure no more foulness is introduced into the person. Wounds and tools are cleaned, and there is a sense that “filth” can pass from one person to another, so contact with diseased persons is done in a careful fashion, and the Adelians have some concept of a quarantine. This has helped raise an awareness of infectious contagions, and helped the culture at large to remain healthier and more aware of sickness and its spread.

Most Adelian cities have running water, and some towns do as well. All towns and villages have traditions and means of disposing waste, and realize that proper care requires for waste to be managed properly. Villages use waste in the fields, and towns have latrines and then dispose of the waste in their own local fields, or sell it (cheaply) to any farmers nearby. Waste is never disposed of into the rivers, lakes or oceans, particularly since that upsets water spirits. Sometimes it is burnt or buried if nothing can be done with it, but by now they’ve gotten fairly efficient at using and getting rid of waste.

Common Remedies

Medicine is a practice of “cleaning” bodies and assuaging pains of the soul. The taint and incongruence introduced to the body differs – it could be wounds, illness, parasitic infection or even supernatural affliction. Real physicians in Adel have a wider assortment of tools for dealing with afflictions, but among the people there are some homebrewed remedies. Those villagers who volunteer to care for children and the sick are taught many folk techniques in case of injury and disease, that have been passed down since as far as any Adelian can remember. Some are more effective than others.

One common tactic for the improvised physician is to simply knock the ill person out for a while. Given time and care, the body may clean itself, but all throughout the soul is suffering. So by use of valerian root and other sedative tinctures, the patient is put to sleep and kept drowsy and dulled, to assuage their suffering and enforce a regime of bedrest. One can easily afford potions that induce a powerful drowsiness and deep sleep from any apothecary or even from general stores. Bedrest is a common first assault upon the afflicting malice, often paired with citruses and garlicky foods known to help sickly patients.

Herbal poultices are a common remedy. Many villagers have access to herbs and medicinal plants, and can make these patches and wrap the patient with them to treat wounds, inflamed areas and other surface injuries. This both protects the wound from the outside world, and helps introduce purifying substances into the body. Some people also believe that if properly prepared, the poultice’s mash of herbs and oils can seep into the skin and for example, cure headaches or stomach aches. It is debatable to what extent this works, but having a hot patch over your head can offer some headache relief.

Honey, citruses, cooking oils, vinegar, hot peppers, onions and garlic are often used to make restorative food dishes, usually in salads including light, leafy fare to convey the restorative substances into the body. Common lore holds that certain foods can rectify imbalances in a body – a body that is too hot can be given citruses (aligned with the element of water) to cool off. A body that is too cold can be given pepper or vinegar (aligned to fire) to warm up. Oils and onions are aligned with the Earth. Honey is given unto the element of Essence, or the soul. Honey is a very wonderful substance for Adelians.

Bloodletting is a common technique of Adelian folk medicine (and advanced medicine) for certain injuries. The most common way is with leeches. Leeches are used to treat burns, arthritis and other bone pains and blood circulation and muscular problems. Leeches must be cleaned before use, soaked in plain water (anything else is thought to kill them). In some places, bloodletting is done with lancets, cutting open veins. This technique is falling out of favor, as more and more people realize it is the Leech that is important to the therapy, not the actual bloodletting. Still, some doctors may prescribe the lancet.

Maggot therapy is also used, particularly to eat necrotic tissue and disinfect wounds.

Advanced Medicine

To become a doctor requires a license, given by a physician’s or apothecary’s guild after an examination. Doctors pay dues to the guild in order to use their resources, including tools they can borrow and ingredients they can order. They can also compare notes on complex issues, and it is at the Guild where patients can easily call for a doctor to care for them. Every few years, the most popular doctors in the guild roster are selected as a council to share management of the guild.

Doctors are supplied with comparatively more uncommon remedies, including distilled chemicals and tonics, as well as surgical tools. The most common surgical procedure for Adelians is stitching. Adelians have become crazy about surgical stitching. Sometimes doctors have to refuse to stitch minor wounds just to save themselves time and supplies. The visit to the doctor, the cleaning patches applied to the wound, the stitching instruments, all seem very impressive. So Adelians who have access to doctors have of late found it trendy to visit the doctor and watch these impressive acts occur.

It is up to doctors to seek out craftsfolk to produce things like spectacles and canes for them to give to patients. Some doctors are versatile, however, and eventually learn to craft their own special aids for people.

Through their contact with scriptures from the Lost World, Adelians have learned of many medical procedures that are mildly discomforting for them. They are not sure how to feel about organ transplants for example. There is no established organ donation system, so for Adelians, they view the procedure as taking an organ from a living volunteer and transplanting it to someone. They can perform this procedure with a coin-toss chance of success for most organs. There’s some developments in the making of golem arms to replace amputated appendages, but it’s a nascent subject. More recently, and somewhat more interestingly, certain arcanists have managed to transplant organs from creatures like drakes and animals to people, usually eyes and ears (the deterioration of the senses has long been an inescapable malady for Adelians). These arts are still under evaluation and extremely rare, with the people able to perform these procedures currently a gifted few.

Reattaching limbs is very difficult for Adelian doctors, but they have rudimentary methods mending tendons and broken bones. They are painful and crude methods but they have a fairly good chance of working.

Adelians in larger towns and cities have contraceptive drugs, in liquid form. Some of these are herbally replicated in certain areas, but lack the efficacy of the alchemical version of the drug, which is more powerfully distilled. The natural remedy still leaves a chance open for impregnation, while the alchemical recipe is near perfect. There is no real stigma against using contraceptives.  Better to prevent having a child at all, than having a child that will be unwanted.

Child delivery is also often done by a doctor, if it can be helped. Otherwise, the village Guardian Spirit does it. Doctors have forceps that they use to more safely remove children from the mother. Village Spirits can use kinetic magic to attempt to ease the mother’s pain as well as remove the child. Midwifery is still practiced, and the men and women who practice it vouch for the safety and success of their time tested methods, but it is safe to say they are not as effective as a real doctor. Likewise, Doctors in Adel can perform abortions. To the Adelians, a child within the womb does not have its own soul – it shares the mother’s soul until it has been removed from the mother and breathed its first breath of essence-rich air. The abortion doctor is more concerned with the mother’s health and consequences to the mother, than with any philosophical issues about the child. Though individuals may oppose abortion, they do so of their own predilections, without institutional support.

Cost of Medicine

In rural villages, everything is said to belong to the Guardian Spirit of the village, and is shared among the villagers as necessary. When villagers become sick, the village is losing what that villager brought to them – the work he or she could do. Everyone has work they can do, even children get some tasks or errands. As such, people in villages are cared for and nursed without much thought to what resources are spent doing so. Every person wants to know he or she would be taken care of in a bad time, so he or she does what he or she can to care for others in times for vulnerability as well. After recovering, the patient will return to work, and usually tries to work harder to make up for lost time, or to show others his or her gratitude. Villagers care for outsiders as well, but not for free – someone without attachment to the village will have to work for them after recovery. This way they can pay back the time and resources spent caring for them, in the way a villager would do every day.

In towns and cities, medicine tends to cost coin. Most governments (Periterim is the exception) will cover the bill for necessary health costs – the patient just needs to run down to the government office in the town or city, and get a “sick stamp.” The stamp shows the willingness of the government to pay for the care. Sick Stamp patients, once fully recovered, are given “community service” errands in order to repay the government in useful work. Cleaning streets, painting the government office, delivering packages, doing paperwork, printing pamphlets, taking temporary assistantships to guard captains or military commanders, cooking in a communal kitchen, all kinds of minor work can pay for the Sick Stamp. People ashamed of using a Sick Stamp pay for the cost out of pocket, which can vary depending on the procedure. There are loan sharks who focus solely on covering other’s healthcare costs in order to leverage their debts against them in some way later.