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Mortality?

Hi,

Not sure if this is a late suggestion but I just thought of it as I was watching a documentary.
How will mortality rate be managed in this game? Because I know that living in Neolithic times was hazardous and life was short sometimes.
Are there going to be like random deaths, like maybe child birth deaths, accidents, animal attacks, infant mortality? Because very few people lived to be old during these times. Kind of a dark topic. But I think it’s real and could possibly be a a curveball when we’re playing the game.

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Infant mortality and maternal mortality were indeed “high” by our standards. I have read figures as high as 2 in 5 children not surviving birth or their first year and (if I recall) something like 1 in five women not surviving their first pregnancy. I will try and find those figures.

The average lifespan of a Neolithic person is usually quoted as being around 20-25 years, but this average comes from a full look at all mortality, including the vastly higher than average infant mortality. The average life space vastly increases for children who have survived their first 5 years.

I’ll post some of those numbers when I find the research I used in my own works.

One of the major problems complicating nearly everything was infection. When I hired a doctor recently to provide me with technically accurate descriptions of wounds suffered by neolithic combatants, he constantly pointed out how deadly the infections would be.

For example, an arrow wound to the arm where the arrow was fully removed, cleaned with modern tools and the wounds sewn might be effectively “healed” in 3 weeks to a month (6-8 months until the arm was fully mobile, not counting permanent loss of the range movement). Without the modern steps, an infection would likely occur and have a good chance of killing the person. If they survived that, at least 2 months would be needed for the wound the close.

I was amazed how much longer recovery times were (which is why I hired the doc for accuracy lol)

I can post some of those wound questions/answers if it helps.

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Yeah that’s one of the great things about even basic armour (you’d be amazed at how much difference a few layers of bundled cloth can make, especially when you consider offensive weapons would have mostly, with a few exceptions for exceptionally wealthy people, been made of stone) it can turn a major laceration into a broken bone, and a broken bone (as long as it’s not an open fracture) is much less susceptible to infection than a laceration.

I also wonder how much knowledge there was of wound care, in later periods some doctors would keep their tools dirty as a form of advertising. “Who would you rather see that doctor with a clean apron and tools that look like they’ve never been used before or that one over there who clearly has seen several patients today already?” seems mad but if you don’t know how important sterilization is to wound care then it might be a sensible way of looking at things.

And yeah Lotus you are right, I’ve seen statistics that taut 20-30 years life expectancy right up until the early modern period with “life was brutal, harsh and short” even in sources that should know better. Almost universally they are neglecting to factor out the high infant mortality rates that skew the overall average downwards. I also seem to recall that Hunter-Gatherer life styles where generally healthier than Farmer economies both due to nutritional factors and the toll that a dedicated farming life takes on the body when compared to semi-nomadic hunting and gathering, though I’ve never seen a decent comparison of average lifespans between the two.

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The wound recovery times in secondary closure can even be a lot longer, depending on the surface area that is damaged. In modern times, complex open abdominal wounds following e.g. complicated surgery may take up to roughly 6 months to fully close.

The chances of infection are certainly present, but can be greatly limited with good wound management. And even in modern day wound management, the mainstay of it consists of no more than water, gauss, and something non-adhesive. This practise has changed very little since the days of the Egyptians.

Primary closure of wounds is most certainly faster, however, also that does not require modern tools. Once again, irrigation of the wound is key. Beyond that, some form of thread and needle is all that’s needed. This too, was already practised by the egyptians with the first physical suture dating back to around 1000 BC and the first reports of this practice dating back to roughly 3000 BC or so.

In case of infection, then yes, survival was greatly limited. However, it has not been till the discovery of penicillin in 1928 that we could successfully counter infection. Before that, there were some prophylactic measures in place however, e.g. honey dressing on wounds. The hydrogen peroxide within does have an antibacterial effect. And its use too is known to have date back to at least the Egyptians.

It is a shame that there is no written text to go by to indicate whether this knowledge / application was available dating back even further.

However, do not underestimate the basic principles of wound healing and its simplicity. In modern medicine it may quickly look as if if approached in those times by far a majority of people were likely to have died, but this is far more likely a misconception. Better yet, slowly we are letting go of the extreme conditions under which wound care is given in emergency departments in the western world.

As such, cleaning wounds with pure hydrogen peroxide which was once thought to be beneficial due to its antibacterial properties is now known to actually be harmful to the wound healing, due to its cytotoxic effects as well. The step back to sterile saline was taken. But more and more studies are now showing that even sterile saline is no better than regular tap water.

Then there are the sterile fields created on emergency departments in the closure of traumatic wounds. Also in this case, there is no evidence to support it has any additive value. On the contrary, there is evidence to show it’s just as effective to abstain from using a sterile field. The same goes for dressing gauss, this too does not have to be sterile, clean is all that is needed.

Lastly, prophylactic antibiotics remain subject of debate. And there is an increasing body of evidence to support the notion to refrain from prescribing prophylactic antibiotics in numerous forms of traumatic wounds.

So as such, even in modern medicine us MD’s are getting back to basic. In a certain way adhering to principles already known to have been practised around 3000 - 5000 years ago. With the exception of modern sterilization of the surgical tools. However, when clean tools were used the outcome of historical medicine in treatment of traumatic wounds is unlikely to have been poor. It is known however that not in all times clean tools were used, as @Dernwine points out as well. I am not certain how that stance was during the ancient Egyptian times.

Death during childbirth or shortly after during the first months of life, as well as maternal death, certainly would have been high compared to today’s standards. There is little to no statistics on this from ancient times, but there is data from the 1600’s. A timeframe in which maternal mortality rates were roughly 1000 - 1500 per 100.000 childbirths, equating to a rough 1 - 1.5% chance of death during childbirth per pregnancy. The actual odds were greater for first time pregnancies, and smaller for multiparous women.

Infant mortality rates were extreme by today’s standards during the same time period, estimated to be at roughly 30% mortality within the first year of life. These figures have been reported in excess of over 50%.

There are also positives to the time period the game is set to take place in however. There have been no recordings of the plague in this time period. Diseases such as cholera also have not been recorded to have been present in ancient times.

Influenza on the other hand is with relative certainty known to have been present. Tuberculosis and smallpox are also known to have been around during the neolithic ages. The frequency of disease outbreaks though is estimated to have been low, however with if it did occur possibly having devastating consequences.

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From what I’ve always been told (not a subject I’ve ever studied in any depth beyond some very basic epidemiology while Gritrock was going on) a lot of modern diseases such as TB and Smallpox are actually diseases that target livestock (cows, pigs etc) and at some point made the jump from them to us due to the close proximity over the course of generations humans had with their livestock. (I also believe that I read something about ancient Cholera outbreaks taking place somewhere… I need to see if I can find it).

Anyway yeah, imagine outbreaks in small communities with no natural immunity to a new disease that had made the leap from animal to human and only the most rudimentary healthcare. It must have been devastating, similar, though probably on a much smaller scale since they didn’t all hit at once, as when the Europeans brought our plagues to America.

This was indeed the consensus up to a few years ago, where newer studies have identified genetic material of TB and smallpox dating back further than the domestication of the animals. The likely answer as to why is contemplated to simply be hunt. Not only living together with those infected, but coming in close proximity and even ingesting infected meat does pose a risk. Although e.g. TB is primarily spread airborne, it has a very low rate of transmission through ingestion as well.

See also the following article for the subset genotyping, setting a common ancestor to current TB at roughly 15.000 - 20.000 BC: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC23284/
And if you can get your hands on a copy, the article by Kapur et al in the journal of Infectious disease, ‘Is Mycobacterium tuberculosis 15,000 years old?’

This, too this date, remains an interesting one. Not so much the notion of us carrying a vast array of disease to the new world, but much rather, why was so little or possibly even nothing brought back (even syphilis is questionable on as to whether it was truly brought back from the new world or not, scientific debate is not out on this subject yet)?

Animal domestication is often attributed to this, however pre-columbian South America also had their own animal domestication. The muscovy duck, guinea pigs, llamas and alpacas.

Why Europe was not hit equally hard by e.g. a llama flu (does not even exist beyond the realms of The Sims and Tropico), remains interesting.

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I was always told that it was, as you mentioned, down to the fact that European-Asian civilisation had a much wider array of domesticated animals, and kept many more of them in much closer proximity to people. But as you’ve clearly shown the little reading I’ve done on the subject is out of date :).

But as you said, why no diseases where brought back, or perhaps more accurately, why there where no diseases to bring back, is interesting.

Better update on my earlier post.

While blunt force trauma to the head from a stone ax or a well-placed arrow to the heart might be immediately fatal, a significant percentage of the casualties during a Neolithic raid or battle would likely be the wounded. While we can suppose that the losing side of the battle would have their wounded dealt with violently and abruptly, the wounded from the winning side would face a rather bleak outlook, as well.

Without antibiotics, the ability to properly close wounds or remove foreign objects from within the body, aside from those which could be readily observed, infection would be the greatest danger to those who survived the initial wound. The risk of infection increases as a result of foreign material left within the wounds. Ironically, the warrior’s lack of significant clothing may have slightly decreased the likelihood of infection as clothing material is often embedded within wounds creating a breeding ground for bacteria.

If the warrior survived the initial trauma, they faced local infection, which may develop into fatal blood poisoning, sepsis. Often, limbs would be severed due to severe damage or perhaps to save the body. Even if they were lucky enough to survive infection without developing sepsis, they faced a prolonged healing process and potentially debilitating side effects. In prehistoric warfare, even a simple wound could be as fatal as a grievous one and the outcome was often grim.

=/

Infanticide :slight_smile: We know that is has existed in almost every pre-modern culture, in some more than in others. Finding piles of infant bones under Roman brothels is not uncommon, and we know that “weak” children were often exposed, given to nature, long before that, in both Rome and Greece. Just look at the myths of Herakles! The oldest sources of the Pagan Northmen in Iceland suggest similar practices there. On the other hand, I think I recall some ancient author being surprised that the Germanic tribes did not expose newborns…

The more knowledgeable members of the forums should correct me, but as I recall, the scientific community regards infanticide during Paleolithicum as a well established fact, and very common, as in several tens of percent of newborns. In a society without prophylactics, relying on being able to move quickly from place to place, carrying everything, including infants, and the access to resources drastically different from week to week, month to month… it is understandable, albeit horrifying to modern eyes… like the discussions on ritual sacrifices in another thread…

I would be surprised If this was commonplace, given the infant mortality rates and maternal mortality rates. It might have occurred in special cases, such as severe abnormalities.

Cauterizing would be a cool tech to learn from some knowledge that might help some of these!

I would also love to see the mortality generate knowledge as people try various methods to attempt to save others. A lot of herbs became religious icons due to medicinal properties and I would just love to see the birth of medicine in game.

Small fact on Neolithic medicine ^^ (Source)

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I grew up at Neandertal (where they first found bones of that human species), and visited the local museum a couple of times. One thing that struck me there was that health was indeed worse in settlements, compared to earlier hunter/gatherer camps (someone mentioned this before). For one reason, because of waste pollution, but also for new deseases like, for example, tooth decay (which first appeared among humans with a grain based diet). Also, tumors were apparently very common.

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I actually wrote a reenactment of two such procedure (in a narrative fashion). A tooth removal and a C-section (fatal to mother). Working with a doctor to ensure the medical parts were correct, I was shocked at the trauma a human would endure for even the simplest of procedures. Blood loss, shock and infection were probably the most lethal, but so much more could kill. =/

There’s also another aspect of medicine that could be linked to technology discovery: dogs licking the wounds for healing.

At least in some cases, medecine gods where associated to dogs, as this is the case for e.g. the Mesopotamian Ninisinna / Gula or the Greek Asclepius.

As I didn’t see it noted earlier in the thread, I think this was worth reporting it, as this may give a link between dog domestication => health improvement => higher life expectancy for the citizens => bigger town => happy player :slight_smile:

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I don’t know if this ever got addressed by the Developers, but I think it will be very important to show maternal and infant mortality within the game. I don’t mean necessarily showing it happening, but making the player aware that it happened.

Warriors are always glamorized, and their deaths cast as heroic acts, but the plight of women in the simple act of childbirth is often overlooked, even though it probably made up for a vast percentage of deaths under 25 years of age within the tribe.

In order for the player to appreciate the role of women in something so basic as the continuation of the tribes population, showing the actual rate at which they and their children died is a pretty effective method. With all that women have gone through, it seems important not to exclude or trivialize this key risk they took.

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