Medical Resources

This guide is in no way meant to cover all of the possibilities for your character’s medical roleplay stories, as many other illnesses and injuries existed in the 19th century. This is only meant to help guide you on some of the most common symptoms you will experience for the illnesses or injuries your character may have faced during this era. Your doctor will help guide you through the roleplay with predominantly vocal cues in a “create your own adventure book” style. The questions may be presented as a statement such as: “I’m going to check your heartbeat now” and this would be your cue that the doctor is looking for a /me response from you, the patient, along the lines of “/me heartbeat is abnormally high”. For those of you that wish to be more specific, feel free. Your responses will dictate what we do for your characters in terms of treatment, so the choice is entirely up to you! The reason we address medical RP in this fashion is so the processes can be made as swiftly as possible, for streamers whose audiences may want to follow along, and so others nearby who may be watching can hear the interaction.

When a foreign object pierces the skin and creates a deep wound. This can be caused by a gunshot or a stabbing. A gunshot can also be a through and through, which means the bullet travels through the body causing more damage; or it can be lodged, where the bullet is either stuck in a bone or muscle. Penetrating wounds can result in arterial, venous, organ, nerve, muscle, bone, or tendon damage. Penetrating wounds are at higher risk of infection due to influences entering the body, especially if cleaned improperly.

• Bleeding is usually minor due to damaged capillaries unless an artery or vein has been punctured. You will not hemorrhage profusely without arterial damage.
• Intense, sharp pain at the site of the injury.
• Septic influences may leak into the peritoneal cavity (abdomen) if the stomach, liver, or intestines are punctured.
• Septic influences may leak into the retro-peritoneal cavity (lower back) if the kidneys are punctured.
• Cerebrospinal fluid may leak from a head wound if the cranium and dura mater (sac protecting the brain) are punctured.

When an impact with a dull, firm surface or object causes an injury to the body. A blunt force trauma injury can result in organ, nerve, bone, or tendon damage. If the trauma occurs on the head, it can result in a concussion, brain damage, or a brain hemorrhage (hemorrhagic stroke). Very rarely would it result in arterial damage unless the trauma is severe.

• Bruising
• Abrasion
• Pain
• Dull pain unless there is a fracture, then the pain may be sharp. If there is nerve damage, the pain may be shooting, tingling, or non-existent.
• If the blunt force trauma involves the head there are a few different issues that could potentially arise:
• Concussion
• Brain swelling
• Minor hemorrhage
• Hemorrhagic Apoplexy (stroke)
• Brain Damage

Can be caused by aneurysms, penetrating wounds, and rarely blunt force trauma. Arteries are high-pressure blood vessels that carry oxygenated blood to the body. Veins are low-pressure blood vessels that carry deoxygenated blood to the heart. Main arteries connect to arterial branches throughout the entire body. Veins connect to branches of smaller veins as well. If a main artery or vein is punctured, your character is at high risk without a tourniquet. Whereas a smaller branch may stop bleeding on its own after pressure is applied or with minimal.

• If a main artery or vein has been punctured, your character risks bleeding out within the following amount of times listed depending on severity. Arterial damage should also require a lot of downtime for your character.
• Carotid and Subclavian Arteries: 2-20 Minutes
• Inferior Vena Cava, Jugular and Subclavian Veins: 15-60 Minutes
• Aorta Artery and Heart: 1-2 Minutes if the heart doesn’t seal itself
• Brachial and Femoral Arteries: 5-60 Minutes
• Low Vitals:
• Low temperature
• Rapid and feeble pulse
• Low blood pressure
• Slow respiration
• Pale complexion and blue lips
• Dizziness
• Sweating
• Fatigue
• Nausea
• Cold Skin
• Weak, rapid pulse
• Shallow, rapid breathing
• Loss of Consciousness

Can be caused by penetrating wounds or blunt force trauma. The knowledge of how to heal in-depth injuries to the heart or brain does not yet exist, though suturing them, removing foreign objects, and aspirating or draining their protective sacs is common practice.

• Heart:
• Lungs:
• Stomach:
• Liver:
• Intestines:
• Kidneys:

Can be caused by poisons such as arsenic, cyanide, strychnine, belladonna, digitalis, oleander sage,or toxins, illness, or infection.

• Heart:
• Lungs:
• Stomach:
• Liver:
• Intestines:
• Kidneys:

Can be caused by penetrating wounds, blunt force trauma, burns, and illnesses like diabetes. It can heal over time on its own depending on the severity and cause, or it can require a surgery to resect, “graft”, or stretch the nerves. Diabetic neuropathy damage generally won’t heal, and will worsen overtime as we do not have Insulin.

• Numbness
• Tingling
• Sensitivity to touch
• Shooting pains around the injury site
• A complete loss of feeling in the area
• Oversensitivity to touch
• Muscle weakness
• Diabetic neuropathy:
• Skin ulcers
• Slow reflexes
• Bladder and digestive issues

Can be caused by strains, penetrating wounds, or burns. Straining a muscle can be due to an accident, overuse, or using a muscle incorrectly. Parts of muscle can be torn or ripped when a bullet, knife, or claws travel through them. Burns can damage the muscle enough to require resection of part of the muscle tissue if the appendage can be saved.

• Pain or tenderness ranging from mild to severe
• Redness or bruising
• Limited motion or no mobility
• Muscle spasms
• Inflammation
• Muscle weakness
• Burning of muscles can cause atrophy

Can be caused by penetrating wounds, blunt force trauma, illnesses, or infections. This can include lodged bullets, bone fragments, fractures, and bone splintering. A fracture can be anything from a hairline fracture to a compound fracture, meaning the bone breaks through the skin.

• Severe pain and tenderness which may worsen with movement
• Severe swelling
• Severe bruising
• Intense sharp pain when being touched or if it is a rib, inhaling
• Limited mobility or inability to move a limb or put weight on a leg
• Obvious deformity of the affected limb or a protruding bone if it is a compound fracture
• Bones that are infected cause more symptoms:
• Excessive sweating
• Fever and chills
• Nausea
• Weakness
• Redness and warmth at the site
• If there is an open wound, there may be pus

Can be caused by strains, sprains, penetrating wounds or blunt force trauma. Tendons that have completely separated require surgery to repair.

• Having felt a snap or pop at the affected area
• Severe and excruciating pain
• Immediate bruising
• Pain and tenderness that worsens with use
• A “crunchy” sound or feeling with tendon use
• Severe weakness
• Limited mobility or inability to move a limb or put weight on a leg
• Inflammation

Can be caused due to unremoved foreign objects, septic influences, bacteria, and unclean operating

• Pus or a yellow crust that forms over the wound
• A scab that is larger than the wound and is soft to the touch
• Redness and warmth at the site
• Pain
• Swollen nearby lymph gland
• Fever
• The wound isn’t healing properly
• Foul odor

Can be caused by bacteria entering the wound, a lack of blood flow in the area, or an illness such as arteriosclerosis, or diabetes.

• Changes in skin color ranging from gray, blue, purple, black, or red
• Swelling
• Blisters
• Sudden, severe pain followed by a feeling of numbness
• Foul-smelling discharge leaking from a sore
• Skin that feels cool or cold to the touch

Can be caused by head trauma. A doctor can check for brain swelling by introducing light to check for the pupils ability to contract. The more difficulty contracting, the more swelling.

• Headache or “pressure” in the head.
• Ringing in the ears
• Nausea or vomiting
• Fatigue
• Blurry or double vision
• Dizziness or balance issues
• Difficulty contracting pupils when light is introduced

The majority of snakes in North America are hemotoxic, excluding only 2 (coral and sea snake) which are neurotoxic. These 2 snakes do not exist in RDR. Most snake bites become infected along with the effects of the venom. Occasionally a snake will dry bite, meaning they won’t inject their venom, but an infection can still occur from the bacteria in their fangs.

• Puncture marks at the wound site
• Severe inflammation
• Redness or bruising
• Profuse sweating and salivation
• Blood clotting
• Severe pain at site
• Rapid heart rate
• Weak pulse
• Low blood pressure
• Labored breathing that may stop altogether
• Dizziness
• Numbness in mouth, tongue, scalp, feet, or bite area

The most common poisonings are Alcohol, Antimony, Arsenic, Belladonna, Blue Vitriol, Comfrey, Digitalis, Hemlock, Hydrocyanic Acid (Cyanide), Mushrooms, Opium, Strychnine, and Venom.

• Aconite
  • Nausea, violent vomiting and purging, vertigo, cold sweats, delirium, convulsions.
• Alcohol
  • Dizziness, confusion, stupor, aggression, pale face, noisy breathing, inability to walk or stand.
• Antimony
  • Severe vomiting, burning heat, stomach pains, violent purging, small frequent pulse, cramps, vertigo, fainting.
• Arsenic
  • Vomiting, stomach burning, excessive thirst, heat, stricture of the throat, diarrhea, slow and intermittent pulse, lethargy, convulsions, palsy.
• Belladonna
  • Dilated pupils, dimness of sight, stricture of the throat, nausea, vertigo, delirium, laughter, redness and swelling of the face, convulsions, general paralysis, insensibility.
• Blue Vitriol
  • Strong metallic taste, belching, violent vomiting and purging, griping pains, cramps in legs, frothing mouth, headache, giddiness, convulsions, insensibility.
• Corrosive Sublimate
  • Strong metallic taste, burning heat, constriction of throat, severe stomach and bowel pain, violent vomiting and purging, small, frequent and irregular pulse, cold and clammy skin, white and shriveled tongue, difficult respiration, fainting, convulsions, insensibility.
• Comfrey
• Digitalis
• Hemlock
  • Dimness of sight, vertigo, delirium, swelling of the abdomen, pain, vomiting, purging.
• Hydrocyanic Acid
  • Instant sensation of weight and pain in the head, nausea, quick pulse, insensibility, stupor, convulsions, slow and convulsive breathing.
• Mushrooms
• Opium
• Phosphorus
• Strychnine

Can be caused by exposure to fire, hot liquid, steam, metal, electrical currents, X-rays, sunlight, and chemicals such as strong acids, or lye. The severity depends on how much tissue has been affected by the burn. Although skin grafting was practiced, fourth degree burns over the majority of a limb were generally amputated. Burns can result in nerve, muscle, and tendon damage.

• The severity of the burns are classified in degrees:
• First degree: Heat, pain, red inflamed skin, and small blisters
• Second degree: Severe pain, intense red inflamed skin, and large blisters
• Third degree: Damage to the top and underlying layers of tissue causing tissue disorganization with crust formation
• Fourth degree: Damage to all soft tissues down to the bone
• Issues breathing if there was smoke or chemical inhalation

Can be caused by exposure to freezing temperatures. Any part of the body can be affected, but frostbite generally affects the hands, feet, ears, nose, and lips. If a body part turns black or ashen, the part will need to be removed.

• Cold, prickling sensation
• Numbness
• Depending on the severity: red, white, blue, gray, purple, brown, or ashen skin.
• Blisters
• Death due to the cold was not yet known as “hypothermia” but the symptoms were known:
• Intense shivering
• Slurred speech
• Drowsiness and loss of coordination

This can be caused by infected wounds, pneumonia, urinary tract infections, meningitis, appendicitis, a severe tooth infection, or other infections that enter the blood.

• Low blood pressure
• Fever, but some people may have a body temperature lower than normal
• Rapid heart rate
• Lightheadedness
• Shortness of breath
• Confusion

50% Mortality rate

• High fever
• Chills
• Headache
• Stomach pain
• Bloating
• Constipation or Diarrhea
• Nausea and Vomiting
• Rash with small red dots

• Sudden onset fever
• Chills
• Severe headache
• Back pain
• General body aches
• Nausea
• Vomiting
• Fatigue and weakness

• Fever and influenza-like symptoms
• Shaking chills
• Headache
• Muscle aches
• Tiredness
• Nausea or vomiting
• Diarrhea
• Fast heart rate
• Mental confusion

Quarantine

• Fever and chills
• Headache
• Rapid breathing
• Body and muscle aches
• Rash
• Cough
• Nausea
• Vomiting

50% Mortality rate, Quarantine

• Thick gray-white coating that may cover the back of your throat, nose and tongue
• Fever
• Back pain
• Sore throat and neck
• Swollen glands in your neck
• Difficulty breathing and swallowing
• Muscle weakness and pains

(8 day incubation)

• Red, itchy rash that begins on the face and spreads to the trunk and limbs. They become filled with clear liquid, and when broken they form dark crusts.
• Headache
• Slight fever

Quarantine

• High fever and influenza-like symptoms
• Head and body aches
• Sometimes vomiting
• Red rash that appears on the body first
• Suppuration stage can cause the skin to smell bad, intense itching, and a swollen face

• High fever.
• Cough.
• Runny nose that precedes the eruption.
• Watery eyes.
• Rash that appears on the chest first, forehead, cheeks, then spreads downwards in 1-2 days.
• Eruption consists of minute pointed elevations that feel slightly rough, appearing in irregular crescent patches of dark red color.
• If it progresses further:
  • Light intolerance.
  • Deafness.

15-20% Mortality rate. Quarantine

• Very red, sore throat.
• Fever (101°F or higher) or chills.
• Whitish coating on the tongue early in the illness.
• “Strawberry” (red and bumpy) tongue.
• Red skin rash that has a sandpaper feel.
• Bright red skin in the creases of the underarm, elbow, and groin.
• Swollen glands in the neck.

• Fever, or feeling feverish/chills.
• Cough.
• Sore throat.
• Runny or stuffy nose.
• Muscle or body aches.
• Headaches.
• Fatigue.
• Some people may have vomiting and diarrhea

• Abdominal pain.
• Profuse watery diarrhea, often described as “rice-water stools”.
• Vomiting.
• Thirst.
• Leg cramps.
• Restlessness or irritability.
• Lethargy.
• Ashy pale skin.
• Coma.

(Curable in those that are healthy and young, highly contractible)

• Raised bump with a distinct black crusty ulcer in the center.
• Swollen nearby glands.
• Influenza-like symptoms.
• Fever.
• Headache.

(99% mortality rate, highly contractible)

• Fever
• Chills
• Chest and muscle pains.
• Shortness of breath.
• Confusion or dizziness.
• Cough.
• Headache.
• Profuse sweating.
• Body aches.
• Extreme exhaustion.