About

Wounds, anatomy and healing: how the game models the body

In this game an injury is never just lost hit points; it is a particular wound, to a particular layer, of a particular part. Here is how that works, and a little about the real tissues behind it.

In the game: bodies made of layers

Dwarf Fortress models a body as a collection of parts, each made of layers of tissue. A blow to an arm might bruise the skin, cut the fat, tear the muscle or break the bone, each with different consequences. The official wiki's wound page describes injuries as happening to limbs and organs through the environment or fighting, graded from no recorded wound, through minor damage and impaired function, to a part that has lost function entirely, is broken, or is missing altogether.

Modern versions go further than skin, fat, muscle and bone. The same page explains that when a tendon, a ligament or a motor nerve is severed, the part can lose its function, and that damage to sensory nerves removes pain from that part. It also distinguishes wounds that only tear skin, which bleed little and scar lightly, from wounds that tear deeper layers, which bleed more and scar more heavily.

Why some wounds never go away

Because the game tracks tissues individually, some injuries are permanent. The official page says plainly that some wounds will never heal: missing limbs, nerves that no longer function, blindness and similar injuries stay with a dwarf for the rest of their life. Other injuries simply take time, and a badly hurt dwarf can spend a long while in bed.

In the game: the fortress hospital

A fortress with no hospital is one where every injury is a slow disaster. The official wiki's health care page describes a hospital as a zone where wounded dwarves rest and receive care, stocked with supplies such as thread, cloth, splints, plaster and soap.

The same page explains that doctors are dwarves assigned to one or more of the doctoring jobs, diagnosis, surgery and setting bones, or all three, and that they work under a chief medical dwarf, an appointed official. A doctor works on a patient only after a diagnostician has decided what the patient needs, so a fortress without anyone doing diagnosis leaves its wounded lying in bed indefinitely. Cleaning, suturing and dressing wounds are handled as well, and the page notes that infected wounds typically come from a lack of soap, poor access to water for cleaning, delays in care or plain bad luck.

So a working hospital needs beds, water close by for cleaning (a well is ideal, as the water page explains), soap and cloth in stock, and dwarves assigned to diagnose. Neglect any of these and you find out after a siege, when the soldiers come home.

The real anatomy behind it

This section is general information about anatomy, not medical advice.

Tendons and ligaments

Wikipedia's article on the tendon describes it as a tough band of dense fibrous connective tissue that connects muscle to bone, transmitting the force of muscle contraction to the skeleton, and notes that tendons, like ligaments, are made of collagen. Wikipedia's article on the ligament describes ligaments as fibrous connective tissue connecting bones to other bones. MedlinePlus puts the difference simply on its sprains and strains page: a sprain is a stretched or torn ligament, and a strain is a stretched or torn muscle or tendon. Its tendinitis page describes tendons as flexible bands of tissue that help muscles move bones.

Fractures

Broken bones are the other staple of the game's hospital. MedlinePlus's page on fractures defines a fracture as a break in a bone, and notes that a stress fracture is a small break often caused by overuse.

The stages of wound healing

MedlinePlus's article on how wounds heal describes it in stages: bleeding and clotting, then a scab; a period in which the area becomes slightly swollen and tender while the immune system works; then tissue growth and rebuilding, with collagen forming the foundation for new tissue; and finally a scar that gradually strengthens. Wikipedia's article on wound healing names four broadly similar phases: blood clotting, inflammation, tissue growth and tissue remodelling.

An active field of research

How tendons, ligaments and bones mend after injury is an active area of study, and research reviews make interesting reading for anyone curious about how much is still being worked out. A 2022 review in Frontiers in Cell and Developmental Biology compares how tendons develop with how they repair after injury, and describes tendon injury as common and difficult to manage, with both processes still not fully understood. A 2010 review of functional tissue engineering of ligament healing discusses the biology of normal and healing ligaments and explains that healing responses differ between ligaments and tendons, with knee ligaments as its focus. A review of fracture-healing physiology in the Journal of Orthopaedic Research describes the physiology of fracture healing, with particular attention to fractures whose healing is delayed or does not complete. These are research literature, cited only as examples of what is being studied.

Long sessions at the keyboard

One more connection between the game and the body is on your side of the screen: people play it for hours at a time. Wikipedia's article on repetitive strain injury describes it as an injury to part of the musculoskeletal or nervous system caused by repetitive use, vibration, compression or long periods in a fixed position. MedlinePlus's page on carpal tunnel syndrome describes it as a group of problems including numbness, tingling, weakness or pain in the wrist or hand that happens when a nerve in the wrist becomes squeezed.

A comfortable setup makes long sessions more pleasant. OSHA's ergonomics overview describes ergonomics as fitting a job to a person. For a player, that means a chair and desk at heights that suit you, a keyboard and mouse you can reach without stretching, a screen at a comfortable distance, and regular breaks to stand up, move about and rest your hands.

If you notice pain, numbness or tingling in your hands or wrists that lasts, keeps coming back or gets worse, that is a reason to see a health care provider rather than to play through it. MedlinePlus's carpal tunnel syndrome page is a sensible place to start reading, and NIAMS's overview of sports injuries notes that overuse problems are not limited to athletes and can develop gradually over time.

For how the game's creatures are defined, down to their tissues, see modding.