Freelance Traveller

by Robert O'Connor

From their very beginnings, intelligent beings have attempted to limit or even cure the various afflictions that fall upon them during their lifetimes.

The ability to recognise injurious agents and prevent or treat their ill-effects improves with increased technological capability.

Definitions

Diagnostics

The art or science of determining which disease processes are taking place in a patient.

Investigations

Laboratory, imaging or surgical tests used to confirm or challenge the provisional diagnosis.

Therapeutics

The art or science of treating disease. This is arbitrarily divided into 'medical' (use of pharmaceuticals) and 'surgical' (use of instruments).

Developments by Tech Level

TL 0. Knowledge is accumulated by trial and error and transmitted from family member to family member. Mysticism is inevitable. Apart from a few plant and animal-based remedies, there are no effective medical treatments. Surgery is restricted to splinting and bandaging.

TL 1. The development of agriculture permits towns and cities to arise, and further division of labour.

• The training and conduct of medical practitioners are regulated by authorities, either within the group (college/clerical hierarchy) or by the prevailing ruling structures.
• Theories of disease arise. Potential for competing schools of thought exists.
• Clinical diagnosis is quite sophisticated.
• Anatomical dissection begins.
• A large pharmacopoeia arises, but the utility of most agents is doubtful at best.
• Limited surgery develops : removing bladder stones or squares of skull to relieve raised intracranial pressure (trephining) are the pinnacle of technique at this stage. Setting of simple fractures, removal of superficial foreign bodies, draining boils and abscesses and suturing are commonplace.

TL 2. Key physiological concepts, such as the circulation of blood, are discovered.

• Anatomical knowledge improves, as does clinical diagnostic skills.
• The first tentative attempts are made at amputating limbs and transfusing blood. Survival rates are predictably low.
• Prosthetics are crude (eg. Tycho Brahe's nose or a wooden pegleg), but plastic surgery (skin flaps only) is possible.

TL 3. The discovery of the microscope reveals ubiquitous bacteria. Microscopic anatomy - histology and embryology - begin as sciences.

• The laws of heredity are deduced ; the beginnings of genetics.
• Sanitation (sewers, drains and clean water) is recognised as a vital health promoting device.
• Vaccination against certain diseases is experimented with. Success rates are highly variable.
• Surgical technique is hindered by inadequate pain relief, blood loss and post-operative infection. Abdominal surgery is possible, but rarely attempted because of these factors.

TL 4. Industrialisation accelerates rapidly, as does the development of chemistry and physics.

• Germ theories of disease are proposed. Physiology and pathology become important clinical sciences. Endocrinology develops. Thyroid extracts and insulin are used clinically, for example.
• Psychology and psychiatry arise.
• Certain volatile liquids are demonstrated to have anaesthetic effects (e.g., ether, chloroform).
• Antisepsis is employed in surgery, dramatically decreasing the incidence of post-op infection.
• Hypodermic needles are developed.
• Surgery's scope extends to abdominal and neurosurgical procedures.
• Laboratory investigations become well established (blood grouping, microbiology).
• The discovery of X-rays revolutionises diagnosis. Early radiotherapy is attempted.

TL 5. Attempts are made to treat the more disabling psychiatric disorders (e.g., insulin coma, electroshock therapy, psychoanalysis).

• The pharmacopoeia is expanded with the development of antibiotics, synthetic steroids and analgesics.
• The complexity of the immune system becomes apparent, as does the structure of DNA.
• Intravenous anaesthetic agents are developed, as are muscle relaxants. The 'anaesthetic triad' of anaesthesia, analgesia and muscle relaxation therefore becomes possible.
• Surgery on the heart is attempted, to correct congenital abnormalities and valvular disease.
• Disposable intravenous cannulae and catheters are developed, as are crude prosthetics (e.g., jointed plastic arms with hooks or claws).
• The damaging effects of radiation are recognised ; X-rays are used less frequently and more carefully!
• Mass immunisation for certain diseases is commonplace.

TL 6. Ultrasonography is developed and used clinically.

• Effective psychoactive drugs (antipsychotics, antidepressants and sedatives) are developed, but these are not without side-effects.
• The pharmacopoeia continues to improve.
• Invasive monitoring and telemetry techniques are developed.
• Acute care (coronary care and intensive care) units are formed.

TL 7. Transplant surgery (heart, kidney, skin, cornea), cardio-pulmonary bypass (heart-lung machines) and renal dialysis are developed.

• Reconstructive surgery is well-developed.
• The merging of the computer and X-ray machine yields the CT (computed tomography) scanner.
• Methods for manipulating the DNA of bacteria emerge ; biotechnology becomes a booming field.

TL 8. The scope of transplantation expands to include lung, liver, pancreas, bone marrow and segments of intestine.

• Laser and endoscopic surgery become commonplace.
• The first automated surgical assistants are developed towards the end of the period.
• Early anti-viral drugs are introduced, as is gene therapy for a few conditions.
• Nuclear magnetic resonance (MR) scanners are developed.
• 'Nuclear medicine' arises as a speciality with refinement in gamma cameras and radiopharmaceuticals.
• Improved computer processing power permits 3D reconstruction of X-ray, MR or ultrasound images.
• A spinoff from silicon chip technology enables blood analysers (haematology, biochemistry) to become hand sized.
• Recombinant viral vaccines (e.g., against hepatitis A and B) are developed.
• Cloning via nuclear transfer techniques is successfully demonstrated.
• Polymerase chain reaction or PCR techniques offer a way of detecting very small amounts of (biological) material.

TL 9. Portable bacterial and viral analysers developed.

• Nerve refusion uses matrices of an inert substrate impregnated with cell signalling factors.
• Tissue culture technology allows organs to be regrown, facilitating transplant and reconstructive surgery. In vivo regrowth (e.g., regenerating digits) becomes possible, but is expensive and prolonged (requires hospital inpatient care). The artificial womb is a variant of these technologies.
• The first protein micromachines are developed as a result of advances in biotechnology and molecular computing. Stability and longevity problems restrict their use to the lab. However, rapid protein and DNA sequencing techniques become available.
• Homologous recombination - directed gene insertion - becomes possible with humans and other multicellular organisms. Prior to this, genes were inserted at random by the viral vector.
• The serendipitous development of fast drug spawns a new medical speciality : that of low metabolism and its disorders.
• Hibernation medicine's domain includes that of the newly discovered low berth (low-temperature vitrification and reanimation are demonstrated for the first time at this TL).
• Medical expert systems are incorporated in portable ICU level stretcher capsules built for retrieval/battlefield situations ; the first 'automeds'.
• Modern prosthetics and bionics become possible due to advancements in materials science, electrical and computer engineering.
• Organ assist devices exist for heart, lung, kidney and liver which are man-portable (separately).

TL 10. Growth quickening of tissue becomes possible. Malignant cells are destroyed by surveillance protein machines. These are also used in medical oncology.

• Broad spectrum vaccines become possible with nanotechnology. However, protection is conferred only for about a standard year, as the machines aren't stable and can't reproduce.
• The development of relatively efficient antiproton traps leads to the clinical use of antimatter for diagnostic imaging and radiotherapy. Antiproton CT requires much less radiation to get a better picture than X-ray based CT.
• 'Life support suits' are developed. These allow critically ill people some quality of life while awaiting transplant, say. Organ assist devices are plugged into the suit. The patient needs to be surgically installed into the suit.

TL 11. The pocket medical scanner is developed. Utilising advanced ultrasound and superconducting quantum interference device (SQUID) technology, it can determine heart rate from ECG ; measure cardiac output (volume of blood pumped per unit time) via Doppler ultrasound of the aortic root (probe must be placed on chest) ; and monitor other vital signs (blood pressure, blood oxygen saturation) and measure appropriate biochemical and haematological parameters with a multichannel arterial cannula (an IV line inserted into an artery).

• The medical computer is a medical scanner connected to an expert system - effectively a diagnostician in a box. A microbiology lab module is included with the computer but not the scanner.
• Improved understanding of the neurophysiology of vision leads to the development of artificial eyes.
• Low berth medicine is made much safer with the development of gravisonic refrigeration techniques. A related spinoff is the gravisonic scanner.
• Meson technology offers an alternative to antiproton CT in the form of the meson scanner.

TL 12. Synthetic vision, and advances in robotics lead to the development of modern automeds. Depending on legislation, automeds can perform functions from bandaging to resuscitation. Regardless, they are an invaluable tool for medical personnel.

• Psionic shields develop from an improved understanding of neurophysiology.
• Improvements in nanotechnology enable broad-spectrum 'vaccines' to be developed which enable recognition and neutralisation by the host's immune system of almost all infective agents, tumour cells and some toxic substances (the latter in low blood and tissue concentrations). Stability is still a problem : about five year's protection is conferred.
• Advances in materials science lead to the development of pseudo-biological prosthetics.

TL 13. Growth quickening technology peaks at a 100:1 quickening rate.

• Advanced regrowth techniques permit outpatient care. For limbs, limb buds are covered with a template insert which is shed when regrowth is complete.  Internal organs can only be regrown in this way if they are paired, (i.e. a functional original present) unless a portable life support system is used (heart/lung/liver/machine!), which are available, but EXPENSIVE.
• Newly dead persons can be revived with a combination of nanomachine based cell stabilisation and repair, aggressive nutrition and growth quickening. The only requirement is an intact brain and brainstem.
• Radiation poisoning (not acute brain syndrome) is amenable to treatment with repair machines, stem cell acceleration (in particular blood and gut lining) and surveillance nanites to eliminate malignant cells.
• Neural activity sensors are a refinement of psionic shield technology. They are large and very short ranged.

TL 14. Computer-brain interfaces are possible. At lower TLs, switches and other electrical devices are implantable, but nothing as complex as a computer. Implantable computers to exploit this breakthrough become available. It becomes possible to read memories and alter them as a result. However at this TL reading is non-selective and destructive, writing proves near-impossible.

• Genetic engineering (uplift of embryo, germ cell transmission of new characteristics i.e. Solomani work on cetaceans and primates).

TL 15. Brain transplants become possible, as does treatment of radiation-induced acute brain syndrome.

• Anagathics are developed. These are a combination of repair and surveillance nanites. Stability problems necessitate a course of tablets, injections, etc. (choose delivery system).

Beyond the common TLs....

TL 16. Crude memory transfer (non-destructive read)

TL 17. Immune system augmentation with 'active screen' nanomachines. Stability problem solved. Infection, poisoning, aging and malignancy are not possible.

• Selective memory erasure or alteration.

TL 18. Partial memory transfer (non-destructive)

TL 19. Biostasis :- no freezing or drugs : nanomachine induced metabolic arrest. Preservation time is a function of nanomachine failure or mutation rate.

• Advanced bioengineering :- living organisms can be directly reshaped with nano editing of their genome and growth acceleration.

TL 20. Minds can be transferred to computers or other sentients....

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