Chapter 12 – Quotes and Final Comments

12.1 Quotes from “Lucifer’s Hammer”

Larry Niven and Jerry Pournelle, Little Brown and Company (UK), 1995. pg 610-612

I’ve included these quotes because one accurately describe a primitive medical technique, giving an example of how a life saving procedure such as cross matching blood can be done under primitive conditions and the second and third summarizes several key realities of a long term TEOTWAWKI situation. Obviously I do not recommend using this procedure.


When Maureen reached the hospital, Leonilla Malik took her and led her firmly into a front room.

“I came to help,” Maureen said. “But I wanted to talk to the wounded. One of the Tallifsen Boys was in my group and he-“.

“He’s dead.” Leonilla said. There was no emotion in her voice. “I could use some help. Did you ever use a microscope?”

“Not since college biology class”

“You don’t forget how” Leonilla said. “First I want a blood sample. Please sit down here.” She took a hypodermic needle from a pressure cooker. “My autoclave” she said. “Not very pretty but it works.”

Maureen had wondered what had happened to the pressure cookers from the ranch house. She winced as the needle went into her arm. It was dull. Leonilla drew out the blood sample and carefully squirted it into a test tube which had come from a child’s chemistry set.

The tube went into a sock: a piece of parachute cord was attached to the sock, and Leonilla used that to whirl the test tube around and around her head. “Centrifuging” she said. “I show you how to do this and then you can do some of the work. We need more help here in the lab”. She continued to swing the test tube.

“There”, she said. “We have separated the cells from the fluid. Now we draw off the fluid and wash the cells with saline.” She worked rapidly. “Here on the shelf we have cells and fluid from the patients who need blood. I will test yours against theirs.”

“Don’t you want to know my blood type?”, Maureen asked.

“Yes. In a moment. But I must make the tests anyway. I do not know the patients blood types and I have no way to find out, and this is more certain. It is merely very inconvenient.”

The room had been an office. The walls had been painted not long ago and were well scrubbed. The office table where Leonilla worked was formica, and very clean. “Now”, Leonilla said “I put samples of your cells into a sample of the patient’s serum, and the patient’s cells in yours, so, and we look in the microscope.”

The microscope had also come from a child’s collection. Someone had burned the local high school before Hardy had thought to send an expedition for its science equipment.

“This is very difficult to work with.” Leonilla said. “But it will work. You must be careful with the focus.” She peered into the microscope. “Ah, Rouleaux cells. You cannot be a donor for this patient. Look so that you will know.”

Maureen looked in the microscope. At first she saw nothing, but she worked the focus, the feel of it coming back to her fingers. ..Leonilla was right, she thought. You don’t really forget how. She remembered that you weren’t supposed to close close the other eye, but she did anyway. When the instrument was properly focused she saw blood cells. “You mean the little stacks like poker chips?”, she asked.

“Poker chips?”

“Like saucers-” “Yes. Those are Rouleaux formations. They indicate clumping. Now what is your blood type?”

“A” Maureen said.

“Good. I will mark that down. We must use these file cards one for every person. I note on your card that your blood clumps that of Jacob Vinge, and note the same on his card. Now we try yours with others.” She went through the same procedure again, and once more. “Ah. You can be a donor for Bill Darden. I will note that on your card and his.”


“We have no way to store whole blood, except as now – in the donor”.


“No, we must learn to live without penicillin.” She grimaced. “Which means a simple cut untreated can be a death sentence. People must be made to understand that. We cannot ignore hygiene and first aid. Wash all cuts.”


For a fictional account I recommend James Wesley Rawles “Patriots”. This contains accounts of survival medicine in practice (in addition much other excellent material) with detailed descriptions of several surgical procedures and childbirth in a post-collapse society. Although there is some dramatization to it I feel this accurately reflects some of the medical situations which will need to be faced.

12.2 Final Thoughts

These are some final thoughts about the medical situation post a severe TEOTWAWKI. I’ve included this just to stimulate some thoughts and discussions.

With no antibiotics there would be no treatment for bacterial infections, pneumonia and a cut would kill again, contagious diseases (including those sexually transmitted) would make a come back and high mortality rates would be associated with any surgery. Poor hygiene and disrupted water supplies would lead to an increase in diseases such as typhoid and cholera.

Without vaccines there would be a progressive return in infectious diseases such as polio, tetanus, whooping cough, diphtheria, mumps etc, especially among children. People suffering from chronic illnesses such as asthma, diabetes or epilepsy would be severely effected with many dying (especially insulin dependent diabetics). There would be no anesthetic agents resulting in a return to tortuous surgical procedures with the patient awake or if they were lucky drunk or stoned. The same would apply to painkillers, a broken leg would be agony and dying of cancer would be distressing for the patient and their family.

Without reliable oral contraceptives or condoms the pregnancy rate would rise and with it the maternal and neonatal death rates, woman would die during pregnancy and delivery again and premature babies would die. Women would still seek abortions and without proper instruments or antibiotics, death from septic abortion would be common again. In the absence of proper dental care teeth would rot and painful extractions would have to be performed. What limited medical supplies were available would have to be recycled, resulting in increases risks of hepatitis and HIV infection.


Any comments or suggestions welcomed. I plan to periodically update this FAQ with any recurring questions from misc.survivalism and also with any interesting things I come across.

Craig Ellis,

All views in this FAQ reflect only my opinions and is not to be considered in any way a professional opinion or advice.