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How do!

Hopefully an interesting one, as I don’t think it’s a topic the background has ever really gone into a huge amount of depth in. And as the title suggests, I’m looking to explore the state of medicine within the Imperium.

First and foremost, I’m going to argue that whilst wildly unevenly distributed, even the basic level of medicine available in Hive Cities (and so presumably Industrialised Worlds) is surprisingly good. The existence of bionics at all levels of society is my main evidence for this. Not only because bionics and cybernetics are inherently sophisticated by our standards, but by existing they strongly imply a good success rate at people surviving horrific injuries in the first place. So there must be a fairly widespread knowledge of First Aid, surgery etc, arguably surpassing our own on Industrial/Hive Worlds. After all, in order to fit someone with a bionic/cybernetic organ, you need to be able to replace the existing organ (or remnant thereof) and install the new, without your opponent dying from Not Having That Organ In Place.

Looking to the top tier, Rejuvanaut treatments (which seems to be a catch all term, rather than a specific process) can extend the human life by centuries, so that’s all but a miracle cure for death. And it’s noted within the Cain novels that it’s sophisticated enough for Nobles to freeze their physically apparent age at an age of their choice. But mentioning nobility? Rejuvenaut is clearly reserved for the Upper Echelons Only. And not necessarily through scarcity.

I think its important to note that gangs that we see in things like Necromunda are the "cream" of the bottom end of society in the Underhive; so many Hivers likely have to endure far worse without bionics or medical care.

That said the general base level does appear fairly high in general. That said I think its offset by living in a society that has probably zero concept of health and safety; no workplace unions*; no concern of lifespan; no concern over worker retention and generally has no fear of being sued by an injured employee.

Ergo you've got a mix of quite advanced medical coverage, coupled to the most grim interpretation of Industrial Age work practice and worker treatment.


So chances are many, esp in the lower classes, are living with a lot of injuries and long term medical issues created by their workplace and environment. Medical care will cover some, but I suspect many in the working classes live painful lives.
Middle classes will have it better with easier access to reliable medical care and some safer lines of work and then the upper classes have it so good they can be rejuve treatments and the works


*besides the Cult to the Four Armed Emperor

I think bionics may be more common place because there’s basically negative elf’n’safety.

Not necessarily ‘why it’s better than the arm that got horribly squashed and mangled and burned and acided then stuff up an Ambull’s bum for some reason” bionics. But base level “this will allow you to continue with the menial task that is your life” bionics. Essentially slightly fancy prosthesis, like a wooden peg leg with very basic shock absorption.

I mean, Servitors are super common place, and the conversion process involves pretty advanced bionics, albeit very likely repeatedly recycled host after host.

Which come to think of it is very much a thing for regular bionics, which may, depending on how dark you want to go, may be worth more to the Factorum than the workers themselves. Something bought in decades, possibly centuries ago, and held in stock until someone has suffered a relevant squelching.

We also see at least some workers in inherently hazardous areas receive standardised “enhancements”, including bionic lungs, implanted rebreathers etc. and someone has to pay for that kit and the implantation thereof.

But, moving away from “man Imperial Bionics are surprisingly interesting as a topic!” and focus that, in the Guard at least? There are soldiers surviving the sort of horrific injuries to require bionics with sufficient regularity that even a Field Medic must be surprisingly adept at their craft.

That to me is interesting because they’re not carrying the spares around with them on the field. So whatever their training encompasses, they’re able to stabilise a patient that has met one of the many, many grisly injuries until the battle is over, and more intense medical care can be arranged. And for somewhat lesser injuries, they’re able to patch the soldier up and get them back on the line, seemingly in minutes.

That’s…remarkable. And given Guardsmen aren’t exactly given elite training? Suggestive of quite impressive tools and technology at their disposal.

If anyone else has had the arguable pleasure of seeing Jason X? I’m thinking things like the sealant used on the Stoner’s arm when it gets lopped off. Open the pack, slap it on the wound, and it forms a heremetic seal, keeping bacteria out and sealing the wound in the short to mid-term.

I think it's important to remember that the Admech can literally implant you with advanced medical knowledge by shoving a data-stack in your head. And they probably don't even consider that to be advanced technology (compared to, say, making Space Marines or turning someone into a servitor). So prevalence of advanced medical skill/knowledge being common place should be surprising.

And yet we also know that a lot of the Ad mech approach to technology is a case of "This is the STL - it tells us how to do the thing - we don't know how the thing actually works and to try and understand it is blasphemy unless you're a top ranking magos".

So on one hand you might have a high level of access to informatoin; on the other the information itself might not be as indepth as we'd study in modern medication.


Ergo some of it might literally be at the level of "Person has X problem, use Y354 pill to cure. If you don't have Y354 pill, person will die".


Which then brings in the other aspect, supplies. We clearly see that different tiers of society have different levels of treatment so we can infer that different resources are accessible to different tiers and also different quantities of resources.

That’s a fair point. And it’s not restricted to the Ad Mech either. Source here is “House of Chains” for Necromunda.

Essentially, Vat Born members of House Goliath are, well, Vat Born. That is they’re artificially created, and matured in Vats, emerging at a post-puberty stage, if not fully adult. And the knowledge they’ll need for the job they’re to do is implanted via Data Slug.


Automatically Appended Next Post:
Sorry, Overread was posting as I was posting.

But that is also another good point. At best? I think we can fairly comfortably conclude that whilst medical knowledge isn’t necessarily great? Medical Technology (even a bandage is a form of technology at the end of the day) is impressive enough that you don’t need to properly understand why what you just did work, or what you just stuffed up their fundament did to make their head magically regrow. Sadly no prizes for spotting my obvious hyperbole in this post.

We love chopping off limbs and replacing them with perfect iron augmetics, folks.

Firstly, I am pretty confident that the medical knowledge of medicaes on more advanced worlds and especially biologis adepts is going to be superior to that of today's doctors, although it may be couched in religious phrasing in a way modern medicine generally is not. Partly this is just because they live and work for much longer and can accrue a level of personal experience unavailable to humanity today. But we also see plenty of references that suggest the Imperium does have a pretty good grasp of the human body, such as the medicaes that treat Eisenhorn.

That said, I suspect that bionics, being derived from STC tech intended for colonists, have some degree of self-implantation technology that makes them easier to fit. The biggest issue with cybernetics today is the nerve interface, where the correct neurones need to be wired up at a microscopic level, yet underhive rogue docs can implant these things in a slum.

Bionics are also very durable- there are a number of instances were the implants are inherited by a child when the parent dies. They are almost certainly more valuable than many of the humans attached to them. Bionics do seem to be commonplace amongst the working class on industrialised worlds- Necromunda is one example, but the bionics on models in the Chaos cultists and poxwalker kits also support this.

Generally GW doesn't write biology very well. I speak from the perspective of a modern real life doctor.

In its fiction, as others have mentioned, we see examples of things like rejuvenation therapies that can extend lifespan and halt apparent aging (albeit with eventual limits and at apparent high monetary cost), and the ready use of bionics. On other hand, descriptions of actual medical facilities and medics in fiction seem a reversion to the mad scientist or butcher of the 19th or early 20th centuries, with things like blood stained aprons and blood spattered walls, leaky intravenous lines, and other things that would be completely unacceptably below standards of care today.

Also, the prevalence of extensive scarring especially facial scarring suggests a lack of care about restoration of appearance or careful suturing and wound closure that would result in cleaner healing. That kind of scarring would be unacceptable for most modern surgeons. Visually I know the idea of such scars is to hearken back to things like the duel scars of academic fencing, and a visual cue about how "tough" the scar holder is. The existence of puckering and scarring around implant sites also suggests relatively brutal implantation and lack of care with meshing with the surrounding tissue. We see from artwork this kind of scarring occurring even in those that you would think have the money and resources to avoid it such as nobility, Inquisitors, or Space Marines.

In short, it seems the Imperium does not care about nice cosmetic appearance when it comes to its medical/surgical care, or in fact wants to achieve the opposite: a brutal, tough, grotesque image

I think it helps sell the crudeness and gothic grim dark of the setting.

Certainly some people CAN afford very high end surgeries that would beat what modern medication can achieve - down to almost no scarring and everything.


However it seems that hte masses are treated more like rough/cheap machines. Repairs and fixes are slapped on quickly and leave marks. Even the bionics are not as high tech as the Imperium could make in terms of design, aesthetics and function.

It's a hodgepodge and that's why I think its like the Mechanicus understanding of technology. They've a bunch of medical tools and they can use them to save people and keep them going; but they really don't understand what they are doing.

I think a great example is the replacement foot from the Fallout TV show that is airing right now. It munches the guy's leg and bolts on without any instruction or guide. Anyone can do it with very basic training, but its crude, rough and function, but not ideal. The machinery/equipment is superior to the skills of the operator.


Of course the great part of this is talking about the lower ranks of society and the military.

The upper reaches can clearly achieve very high standards

Iracundus wrote:
Generally GW doesn't write biology very well. I speak from the perspective of a modern real life doctor.

In its fiction, as others have mentioned, we see examples of things like rejuvenation therapies that can extend lifespan and halt apparent aging (albeit with eventual limits and at apparent high monetary cost), and the ready use of bionics. On other hand, descriptions of actual medical facilities and medics in fiction seem a reversion to the mad scientist or butcher of the 19th or early 20th centuries, with things like blood stained aprons and blood spattered walls, leaky intravenous lines, and other things that would be completely unacceptably below standards of care today.

Also, the prevalence of extensive scarring especially facial scarring suggests a lack of care about restoration of appearance or careful suturing and wound closure that would result in cleaner healing. That kind of scarring would be unacceptable for most modern surgeons. Visually I know the idea of such scars is to hearken back to things like the duel scars of academic fencing, and a visual cue about how "tough" the scar holder is. The existence of puckering and scarring around implant sites also suggests relatively brutal implantation and lack of care with meshing with the surrounding tissue. We see from artwork this kind of scarring occurring even in those that you would think have the money and resources to avoid it such as nobility, Inquisitors, or Space Marines.

In short, it seems the Imperium does not care about nice cosmetic appearance when it comes to its medical/surgical care, or in fact wants to achieve the opposite: a brutal, tough, grotesque image

Random ponder off your post?

In the modern day, we understand the importance of surgical cleanliness. Scrubbing the hands, iodine, facemasks and all that pop culture goodness which gives an idea of, but by no means accurately represents what actually happens.

Grubby, blood and other stained aprons in 40K by comparison seems crude. But, can we entirely rule out that in-universe common antiseptics/counterseptics are advanced to the point that they’re now so effective that a quick skoosh of that good stuff on hands and equipment is just as good, if not superior to, modern sterilisation techniques? Where grubby and ostensibly dirty doesn’t necessarily preclude sterile?

Interesting topic, for once I lack enough insight to post replies but on the one hand, its nice to read about, and on the other... whose ready to speculate on tau, eldar docs and medicine within the eye of terror

 Mad Doc Grotsnik wrote:

Iracundus wrote:
Generally GW doesn't write biology very well. I speak from the perspective of a modern real life doctor.

In its fiction, as others have mentioned, we see examples of things like rejuvenation therapies that can extend lifespan and halt apparent aging (albeit with eventual limits and at apparent high monetary cost), and the ready use of bionics. On other hand, descriptions of actual medical facilities and medics in fiction seem a reversion to the mad scientist or butcher of the 19th or early 20th centuries, with things like blood stained aprons and blood spattered walls, leaky intravenous lines, and other things that would be completely unacceptably below standards of care today.

Also, the prevalence of extensive scarring especially facial scarring suggests a lack of care about restoration of appearance or careful suturing and wound closure that would result in cleaner healing. That kind of scarring would be unacceptable for most modern surgeons. Visually I know the idea of such scars is to hearken back to things like the duel scars of academic fencing, and a visual cue about how "tough" the scar holder is. The existence of puckering and scarring around implant sites also suggests relatively brutal implantation and lack of care with meshing with the surrounding tissue. We see from artwork this kind of scarring occurring even in those that you would think have the money and resources to avoid it such as nobility, Inquisitors, or Space Marines.

In short, it seems the Imperium does not care about nice cosmetic appearance when it comes to its medical/surgical care, or in fact wants to achieve the opposite: a brutal, tough, grotesque image

Random ponder off your post?

In the modern day, we understand the importance of surgical cleanliness. Scrubbing the hands, iodine, facemasks and all that pop culture goodness which gives an idea of, but by no means accurately represents what actually happens.

Grubby, blood and other stained aprons in 40K by comparison seems crude. But, can we entirely rule out that in-universe common antiseptics/counterseptics are advanced to the point that they’re now so effective that a quick skoosh of that good stuff on hands and equipment is just as good, if not superior to, modern sterilisation techniques? Where grubby and ostensibly dirty doesn’t necessarily preclude sterile?

Maybe...but all the scarring still suggests a general disdain for cosmesis and a brutal approach to surgery. While that might be understandable for trauma surgery on the battlefield, it is harder to explain for elective stuff like bionic implants, unless this goes back to the Imperium's religion and elevation of suffering as a virtue: "The Emperor suffers so we suffer too and cannot be vain in caring about appearances."

In all it's best not to think too much whenever GW or Black Library authors try to write about biology and medicine. I remember being bothered by one of ADB's Night Lord books where a character had raised intracranial pressure and they were talking about how eventually his brain would herniate through his eye socket, whereas in reality the laws of physics would mean the pressure would force the brain to herniate through the largest opening with the least resistance which would have been down through the foramen magnum into the neck (which is what occurs in real life cases, and is known as tonsillar herniation, downward cerebellar herniation, transforaminal herniation, or "coning", resulting in death).

Iracundus wrote:
Generally GW doesn't write biology very well. I speak from the perspective of a modern real life doctor.

In fairness, most people don't write biology well, arguably including many doctors Doctors tend to have an overly-pragmatic understanding of biology that is very practical for treating patients but can lead to some interpretations of science that are unrecognisable to biologists working in that field. One of my colleagues spends a lot of time talking to immunologists, and they find the oncology interpretation of immunotherapy to be quite bizarre.

In its fiction, as others have mentioned, we see examples of things like rejuvenation therapies that can extend lifespan and halt apparent aging (albeit with eventual limits and at apparent high monetary cost), and the ready use of bionics. On other hand, descriptions of actual medical facilities and medics in fiction seem a reversion to the mad scientist or butcher of the 19th or early 20th centuries, with things like blood stained aprons and blood spattered walls, leaky intravenous lines, and other things that would be completely unacceptably below standards of care today.

As MDG points out, Imperial "counterseptics" seem to be sufficiently amazing that they rarely have to worry about infections. Still not a great look if the medicae is just dumping counterseptics over the blood stains instead of finding a mop though...

Having said that, outside of some Marines (who often have some weird internal cultures in the Apothecarion), underhives,and overwhelmed field hospitals, how many examples of medicaes do we have? For me, the impression from more peaceful areas is that medicae facilities are clean and sanitary. Poor conditions in an overwhelmed field hospital isn't surprising though- I suspect you could find similar conditions in Gaza, for example.

Also, the prevalence of extensive scarring especially facial scarring suggests a lack of care about restoration of appearance or careful suturing and wound closure that would result in cleaner healing. That kind of scarring would be unacceptable for most modern surgeons. Visually I know the idea of such scars is to hearken back to things like the duel scars of academic fencing, and a visual cue about how "tough" the scar holder is. The existence of puckering and scarring around implant sites also suggests relatively brutal implantation and lack of care with meshing with the surrounding tissue. We see from artwork this kind of scarring occurring even in those that you would think have the money and resources to avoid it such as nobility, Inquisitors, or Space Marines.

In short, it seems the Imperium does not care about nice cosmetic appearance when it comes to its medical/surgical care, or in fact wants to achieve the opposite: a brutal, tough, grotesque image

The Imperium can do it if it wants- there are examples of high-end augmetics that are completely disguised to the casual observer, such as an entire bionic limb with implanted weapon being indistinguishable from a natural limb until it deployed. I think you are right with the theory that the Imperium either doesn't care or aesthetically favours scarring in many settings.

Re. Marines specifically- they supposedly scar exceptionally quickly. A bad cosmetic outcome is probably to be expected if they are always generating hypertrophic scars.

For Marines and I dare say a fair few, but not necessarily all, Guard Regiments and Hive Gangs, the scarring may be a source of pride. Something to show how tough they are, a warrior’s mark of survivorship and that.

Not that that in itself precludes the scars existing due to enthusiastic amateur incompetence of course!

I’d also wager that for any mook on an Imperial World, life is sufficiently rough enough that one’s overall appearance just doesn’t matter.

I do wonder what teeth are like among the citizenry of a Hive World. My understanding of the real world historically, at least in what is now the UK, is until sugar really became a thing in the diet, and after decently milled flour became widely available, the teeth of the poor were in surprisingly good nick. Less acids eating away at the plaque, and softer staple foods also giving them an easier time.

It's strange to consider that the Imperium doesn't care about infection and yet at the same time NURGLE. You'd think even if you were trying to suppress information on Chaos, that you'd have the cleanest hospitals in the world to try and avoid giving any Nurgle element a chance to set root and fester.



I think one key is that a LOT of 40K (like honestly a lot of fantasy and sci fi) is written visually first. There's a visual story that the writers want to tell and that defines what we see, how things happen and why things happen within the setting.
This can often lead to a simple concept - a gothic, victorian style take on medical practice - resulting in a strange situation where you've a duality of super advanced understanding on one side; and almost barbaric practice on the other.

It does suggest that the technology is by then sufficiently advanced and widespread, that brutal and primitive methodology isn’t a detriment.

That whilst, yes neat and tidy incisions and amputations would still be preferred, they’re no longer necessary.


Automatically Appended Next Post:
We should also keep in mind that as most, if not all, Imperial technology is derived from the STC, what the STC actually represented.

And that’s a survival tool for the Frontier. All of man’s then existing scientific knowledge in a Magic Box, which at least some versions of wouldn’t just give you a blue print or manufacture the parts, but create the thing lock, stock and barrel.

That definitely suggests largely “plug and play” highly automated medical care. Stuff you just needed a bit of care, but not necessarily knowledge or skill to use correctly.

 Overread wrote:
It's strange to consider that the Imperium doesn't care about infection and yet at the same time NURGLE. You'd think even if you were trying to suppress information on Chaos, that you'd have the cleanest hospitals in the world to try and avoid giving any Nurgle element a chance to set root and fester.

Hygiene and healthcare for the masses? That would be...*gasp* socialist. Next you'll be preaching the overthrow of the nobility for mob rule, as if the common hive worker or agri world peasant could possibly vote in their own interests. Are you sure you're not a Genestealer cultist in disguise or a Sensei preaching liberation of the lower classes? /s

Spending on the masses and educating them about good healthcare practices is not something the Imperium does. Even Inquisitors tend to take the line that knowledge is dangerous and needs to be hoarded and kept away from the masses since even knowledge of Nurgle may lead to curiosity etc....

The other problem is Nurgle's disease are not purely organic and biological but some have a supernatural component, such as spreading by sound or carried by daemonic flies that can survive in the vacuum of space, meaning normal healthcare and hygiene helps but can only go so far. The Tau Shadowsun novel had such a thing happening to the Tau and they are definitely clean and hygienic. Nurgle's plagues in that story were held back by the faith of the Tau subject races in the Greater Good, showing that faith or other supernatural means are also necessary to fend off Nurgle.

Another thought - speed.

More delicate and intricate operations take much longer to perform. One thing we often see with at least the lower classes of the Imperial society is insane overpopulation. Couple that to a society that generally lacks any top down care for its population and you could end up with medical practice being quick because its overwhelmed.

You don't clean and take care and time with stiches because you've a waiting room overflowing down the street. Plus the person coming in only has 30mins before their next work-shift. So just saw off their arm; chuck it in the corner and bolt that new servo-arm on and get them pumped up on pain-killers and sent back to the factory FAST so you can get to sawing the next guy's leg off.





Of course there is another element too - visual bias. GW tells a story with everything and we are often seeing worlds at their worst in the Imperium. We don't see the pleasant peaceful agri worlds or paradise worlds and get as much insight into them because, honestly, they aren't doing much. Those worlds might well have high grade medical practice; good resources; good training and practice and might do medical wonders every day.

However unless Chaos or a Genestealer Cult or a Warpstorm are going to set madness into the place, we won't really see them save in passing in a story where we might otherwise focus more heavily on the darker parts of the story very quickly.


So we are always looking at the Underhive side of things; not the Spire side. The dark, gritty, nasty, twisted side. Where the doctor only cares about your credits; where the equipment is good but incomplete; where the building is already a rusting, half toppled ramshackle so who cares if there's blood on the operating table

Add in that life just isn’t as precious, and rough and ready is ruthless pragmatism manifesting.

 Overread wrote:
. We don't see the pleasant peaceful agri worlds or paradise worlds and get as much insight into them because, honestly, they aren't doing much. Those worlds might well have high grade medical practice; good resources; good training and practice and might do medical wonders every day.

However unless Chaos or a Genestealer Cult or a Warpstorm are going to set madness into the place, we won't really see them save in passing in a story where we might otherwise focus more heavily on the darker parts of the story very quickly.


So we are always looking at the Underhive side of things; not the Spire side. The dark, gritty, nasty, twisted side. Where the doctor only cares about your credits; where the equipment is good but incomplete; where the building is already a rusting, half toppled ramshackle so who cares if there's blood on the operating table

I think this is a really important point. The stories tend to either focus on desperate warzones or areas with high levels of poverty and deprivation. These are not places conducive to optimal healthcare in the modern day either. For example, polio outbreaks happened in Syria during the recent civil war, and healthcare has totally broken down in Gaza.

The glimpses we get of life on civilised worlds are, well, civilised. Healthcare seems as you would expect. The same seems to be true for field hospitals that are not being overwhelmed by casualties.

I would not be surprised to see many hive worlds having a form of universal healthcare (outside the underhive), but with a very dystopian calculus of utility costing. I can very well see an industrialised hive only offering the most cost-effective treatments that can return a worker back to the production line quickly, and possibly even having state-enforced cut-offs for turning hivers with serious diseases or illnesses into servitors or corpse starch if that is the most cost-effective approach to maximising their productivity. Some Mechanicus worlds will certainly use such abhorrent practices.

I think I have seen some references to worlds with some defree of universal healthcare, but cannot remember any off the top of my head. Of course, this would vary substantially from world to world and even between regions in worlds.

That’s true, but of course the nature of 40K is that it’s the main lens we’re given to see The Imperium through.

But we can look to persons surviving pretty serious injuries in such dire conditions, and from there assume that in more favourable conditions, Imperial Medicine might be near on miraculous compared to the 20th Century.

It seems the main drawback on bionics is they can only implant what they have in stock. And even within The Guard, that doesn’t mean it’s box fresh. If you lose an eye, you could get something really basic or really fancy for instance.

Thinking on Bionic Eyes? Ezekiel of the Dark Angels shows us that bionic replacement also isn’t necessarily “one and done”. Sure we’re talking about an Astartes here and all the privilege that comes with that status, but it shows bionics can be swapped out and upgraded.

Even for the rich and powerful like hive nobles or the example of Lord Admiral Ravensburg (hero of the Gothic War, leader of Battlefleet Gothic, and who was rumored to have a harem of mistresses living in his palatial quarters on board his flagship the Divine Right), their bionics are obvious mechanical. The other officers of the battleship if one looks in the BFG rulebook are similarly covered in obvious scars and mechanical bionics even though what we know of the Imperial Navy is that its officer corps are often from nobility. It's therefore not purely about street docs being rough and tumble surgery on the nearly expendable factory workers. I think the Imperium's culture values "looking tough" and bearing one's past injuries as a badge of honor and sacrifice.

There’s definitely warrior culture stuff going on, and taking pride in your scars.

But in terms of the general aesthetic of bionics? I can’t help but wonder if that’s largely informed by the Mechanicus and its peccadillos over the machine being superior to flesh, and so “why would we want the augmentics to blend in, being part machine is rad and everyone will be shiny and chrome”.

Iracundus wrote:
Even for the rich and powerful like hive nobles or the example of Lord Admiral Ravensburg (hero of the Gothic War, leader of Battlefleet Gothic, and who was rumored to have a harem of mistresses living in his palatial quarters on board his flagship the Divine Right), their bionics are obvious mechanical. The other officers of the battleship if one looks in the BFG rulebook are similarly covered in obvious scars and mechanical bionics even though what we know of the Imperial Navy is that its officer corps are often from nobility. It's therefore not purely about street docs being rough and tumble surgery on the nearly expendable factory workers. I think the Imperium's culture values "looking tough" and bearing one's past injuries as a badge of honor and sacrifice.

I think this is definitely true for the martial branches of the Imperium. For example, an Admiral can highlight their personal bravery by openly displaying the bionics and scars earned in boarding actions in their junior days.

For nobility in general, it clearly varies, and hidden augmetics are a thing. Inquisitors, Rogue Traders, and other individuals with power/powerful sponsors and a desire or need for discretion also sometimes have hidden augmetics.

There is also a middle ground I suspect. A bionic device available to a nobleperson is likely to be very high-grade and superior to the human organ it replaces. Openly showing these can be seen as a power move: "don't mess with me, my bionic eye can see right through you" vibes. Such individuals may still want a good cosmetic result with minimised scarring etc. but consider overt bionics to be cosmetically desirable. Herman von Strab has visible augmetics, but doesn't appear to have rough scaring around these, they are implanted with care. The Necromunda nobles and Rogue trader models also have various augmetics, but these also seem to lack bad scarring too.

Outside of Assassins (and not necessarily Clade Assassins), I’m not sure if I’ve read of bionics entirely blending in?

I know Cain covers his bionic fingers under his gloves, but said gloves are a pretty standard part of Commissarial garb. But having a bionic limb pass for flesh and blood? I can’t think of any immediate examples.

I bet you some slaanesh worshippers use them.

But yes its a good point that Bionics in the Imperium aren't built to be hidden. Off the shelf and even high end ones are just seen as normal. There's no attempt to blend or hide them into the body at all.

And they are so normalised that there's no social pressure there to hide them, so why not go all out with a fancy new bionic eye that stands out!

 Mad Doc Grotsnik wrote:
Outside of Assassins (and not necessarily Clade Assassins), I’m not sure if I’ve read of bionics entirely blending in?

I know Cain covers his bionic fingers under his gloves, but said gloves are a pretty standard part of Commissarial garb. But having a bionic limb pass for flesh and blood? I can’t think of any immediate examples.

There is an example in the Ravenor books of a person with a disguised augmetic arm that splits into a weapon system. I do recall other references to discrete augmetics in various settings. Usually they are used by people who want to hide their true capabilities or sometimes for servants to be more subtle.

Look at this and tell me the Imperium has healthcare!



I think the Darktide game does a great job of showing that your average citizen is a sickly wretch. Years of childhood malnourishment and pollution leading to a population of adults that look like drowned cats. I personally like the idea that the average height in the Imperium (especially on a hive world) is much closer to our underfed ancestors. So yes, there are facilities for quite advanced surgeries, but a huge gab for the more generic, massed health problems. No vitamins supplements, no generic antibiotics or chlorinated water sources.

And as others have mentioned these things aren't exactly what the BL authors focus their stories on. It's a little boring. No one wants to read the protagonist dyeing of diarrhea or their ten other siblings than didn't make past the age of five.

 Mad Doc Grotsnik wrote:
Outside of Assassins (and not necessarily Clade Assassins), I’m not sure if I’ve read of bionics entirely blending in?

I know Cain covers his bionic fingers under his gloves, but said gloves are a pretty standard part of Commissarial garb. But having a bionic limb pass for flesh and blood? I can’t think of any immediate examples.

Inquisitor Rime and his henchmen the Sirkles from the guant's ghosts novels Bloodpact and Salvation's reach all had extensive augmentics done to their faces and bodies, which at first glance are described as appearing natural, albeit falling into uncanny valley, but on closer examination were clearly artificial. so yes augmetics can be made to look real. said augmetic reconstruction is also described as being very expensive and hard to get, so presumably they'd not be common with the types of people most of the fiction focuses on (that being soldiers, gangers, and the like)

the Ghost's series also has a lot of examples of imperial medicine.. cleanliness rules are in fact obeyed, in fact in several novels the ways that Doctor's dorden and Curth deal with the tension of waiting for a battle to start cause trouble because they have to constantly rescrub to be ready for surgery. at the same time, their medicine tends to be, in the words of the TV show MASH, "meatball surgery".. their job is to keep the wounded from dying, with less focus on making it look nice later. though they have the knowledge for that too, at least in the more minor injuries. so they sterilize their tools and change smocks whenever they can, but sometimes they don't have time.something that sometimes bites them in the rear end when someone ends up with a bad post-op infection. we never see Dorden, Curth, or any of the others do the augmentic replacement work, it's implied that that gets done by doctors elsewhere, but even when the Ghosts are butting heads with command over deployments and the administratum overl ogistics, they never seem to have much trouble getting access to augmetic replacements. there are characters with replacement eyes, shoulders, voice boxes, hands, jaws, etc. perhaps Guant uses his commisarial authority to push paperwork through, but we never really see an injured trooper not get an augmetic to keep them fighting. given that in the commisar cain series we see something of the sort as well, and Cain doesn't have nearly the same pull as gaunt did, i'd guess that basic augmetics are fairly common for the Guard.

speaking of the Commisar cain series, when we do see medical centers in those, they seem to be fairly similar to the depictions in the Ghosts novels. even the space marine infirmary we get to see (in "emperor's finest") appears to be following medical sanitary practices.