How would I handle writing this like missing limbs, wheelchair users, conjoined twins, serious burns, and hearing issues in a fictional/ medieval-fantasy setting were surgeries, prosthetics and other modern technologies are not available? I want my stories to have a lot of disabled and disfigured characters while also not falling into harmful tropes and stereotypes(motivations being solely about being disabled or the villain is evil because their disfigured etc.) but I’m not sure what my limits are when it comes to a specific time period we’re technology is extremely limited.
In advance: this is a very long post.
The thing about disabilities is that they exist whether you have the technology for them or not. And the thing about surgeries and prosthetics is that they are very, very, very old.
Pretty much all the information in this ask is from Wikipedia, by the way. When it's not, I'll give you a link.
The oldest known amputation is 31,000 years old, and the next oldest known one is 7,000 years ago. 7,000 years ago is like 6000 BC, well before the medieval era, even if we're using medieval to mean the very very start of it in 500 CE. 6000 BC is, well, 6500 years before 500 CE. People were doing surgeries in Ancient Greece and Ancient India and Ancient Egypt and Ancient China. Were they less successful, on average, than modern surgeries? Yeah, definitely, considering infection risks and germ theory if nothing else at all. But surgery existed, and "surgeon" was an established title and job by the medieval era. A lot of technology is older than you think.
And in the same way, people with serious burns, missing limbs, and hearing loss have existed for a very long time.
I'll start with hearing loss because its inclusion in this ask surprised me the most. This doesn't affect someone's lifespan, and it doesn't require any technology to live with. Sign languages develop wherever deaf people are, because people want and need to communicate with each other, and if not that then things like pen and paper or drawing symbols. Some people today with different degrees of hearing loss & deafness exist without ever putting on a hearing aid or cochlear implant.
As to conjoined twins, they are very rare. Half are stillborn, a third of non-stillborn twins die shortly after birth. They have better survival rates today than in the past. And even then, there are reports of conjoined twins who are either older children or even adults, for a very long time. Here is a link to a paper called "The 3,000-year history of conjoined twins."
Chang and Eng Bunker (1811-1874) would likely have been successfully separated today, but they existed as conjoined twins in their time died at age 63. Earlier still, Lazarus and Joannes Baptista Collaredo (1617- at least 1646) were a case of conjoined heterophagus twins; Joannes Baptista was a parasitic twin and much smaller than Lazarus, and reportedly could not speak or move his body parts independently. But they still both lived until at least age 29. Older still, the oldest mention we have I think, Augustine of Hippo in 415 CE mentions what was likely conjoined twins. So they can exist.
When it comes to missing limbs, they don't have to affect lifespan. They can, but they don't have to. Missing limbs can be congenital, and congenital amputees don't necessarily need a prosthetic. Today, most upper limb amputees, congenital or not, straight up don't use a prosthetic. And limb differences exist regardless of if prosthetics do.
Even then, prosthetics are very, very old. The first one that we know of for a limb is around 1000 BC in Ancient Egypt. Pliny the Elder, born in 23 or 24 CE, talks about a prosthetic hand. The Capua Leg is from around 300 BC, and for a time was the oldest known limb prosthetic. For a non-directly-real example, how many pirates in movies have you seen with peg legs and hook hands? That's because people using both of those things have existed for a long time. François Le Clerc (died in 1563) was a privateer who had a peg leg. François de la Noue (1531-1591) was a captain who had his arm amputated and then had an arm prosthetic with a hook. (Big century for guys named François and prosthetics I guess lol.) Götz von Berlichingen (1480-1562) had two different prosthetics for the hand he got traumatically amputated.
Which goes into the point: survivable amputations are very old. Some are like von Berlichingen, and are lost in an accident, which the person survives. But some are surgical, like de La Noue above; his arm was injured by bullets and amputated later. Celsus described one as far back as in the 1st century. I mean, I'm sure they were miserable, what with no anesthesia, but they existed, and people lived. (Maybe your fantasy world has magical anesthesia?) Here is a paper called "On some paleopathological examples of amputation and the implications for healthcare in 13th-17th century Lithuania," which in the abstract alone mentions specifically that one skeleton showed signs of healing.
Wheelchairs are also very old, by the way. They aren't exactly like our wheelchairs today, but the first ones we know of are around 525 CE. Other things, wheelchair-adjacent but not quite, were used before that. I mean, as long as people who cannot walk have existed, they have needed to move to other places for whatever reason. Wheels getting involved is the easiest way to get that done.
Last but not least, burns. These are related to amputations, because a severe enough burn – 3rd degree or 4th degree – needs surgery as treatment so you don't die, and amputation is surgery. And, like mentioned above, surgeries, specifically amputations, have existed for a very long time.
If your world has magic, why can't this extend to burn care and amputation as well? I don't mean completely healing a 4th degree burn that goes right to the bone, especially because 4th degree burns just don't heal, there's not enough left, but perhaps magic helps prevent infection to nearby sites, or, again, works as painkiller when it comes to an amputation or promotes faster healing of the amputation itself.
But either way, if you survive a burn, even with significant functional impairment afterwards, then you are already alive, and you might make use of things we've mentioned above like prosthetics or wheelchairs.
Sure, if a technology isn't there then it isn't there. We don't have Leg Regrowing Technology, meaning some people who used to have legs and lost them don't still have legs. But that doesn't mean we don't have any way at all whatsoever to support said people, and the same can be said of any era.
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