Image by Gerhard G. from Pixabay, shadow added by Mike

A Post In Two Parts

This is a post in two parts. The first is the traditional blog carnival roundup; the carnival has now moved on to a new host. Turnout for July was disappointing, though, so that wouldn’t be enough to reward readers for taking the trouble to check in.

So I was already contemplating backing it up with something additional – the second part. And when I thought of a post that could dovetail with the subject of the carnival being rounded up, one last shot as it were, I couldn’t resist.

And then, as is my usual practice, I started to plan out the content, and discovered that there was an awful lot that had to be incorporated. In fact, there were no less than 86 entries (including the one above) in my heading/subheading list.

That’s a lot – so many that I’m not especially confident of getting everything done before deadline. And, if I don’t, this will then become a post in two parts in the more traditional sense, as well! I already know the perfect ‘split’ point… but let’s hope I avoid needing it. In that spirit, let’s get started…

Blog Carnival Roundup

Counting this one, there were 6 posts offered in response to my challenge – and one attempt that didn’t seem to make it in time – and five of the six were by me, here at Campaign Mastery.

They were (starting with the welcome outlier):

Plastic Polyhedra – On Loot and Lifestyle – Tom writes about the conversion of static piles of loot (boring) into wealth that can be used to trigger or incite adventures or simply act as a vehicle to deliver adventures to the party. Lots of ideas here for the taking, especially in a Fantasy Campaign (but not irrelevant to a modern one, just replace ‘loot’ with the word ‘paycheck’).

Campaign Mastery – A Wealth Of Characters – After the kickoff post for the blog carnival, I offer another technique of creating NPCs on the fly after dismissing the concept of an accumulated library of old NPCs.

Campaign Mastery – The Power Of Blur – I detail how I use ‘blur’ in image compositing, and then use the technique as a metaphor for avoiding the trap of providing ‘A Wealth of Specifics’ instead of generalizing to the impressions that a character has. Which led me to the Basketball Gorilla optical Illusion, which I then applied to PCs in an RPG. And as a bonus, you get a floral Dalek!

Campaign Mastery – A Wealth Of Suspects and the lessons they teach – A new RPG Campaign Structure for implementing self-contained Agatha-Christie-style adventures leads into an example of constructing adventures from the middle out. I then abstract the process into some general principles.

Campaign Mastery – A Wealth Of Stylistic Factors – How do you give each campaign its own unique style? After defining ‘a style’ in RPG terms, and listing the many contributing factors that coalesce to create one, I offer four examples of how to customize D&D for (a) High Fantasy, (b) Science Fiction, (c) a Mystery-oriented campaign (in two distinct varieties), and (d) a Politics-oriented campaign, before wrapping up with some final advice on how to use an established Style to your advantage..

Campaign Mastery – A Wealth Of Ailments – The article below, a final celebration of the diversity of the topic!

The blog carnival has now moved on to Of Dice And Dragons and the subject of The Gamer’s Notebook. Best of luck, Scot!

A Wealth Of Ailments

An episode of M*A*S*H inspired this post – I forget which, but it dealt with the limitations of Doctors and healers in general. And that happened to connect with a Quora group dealing with D&D in my head, and well, here we are. I started with a question, inspired by those sources, and that’s the right place for you to start, too.

Is Curing too easy in D&D?

Even though this article is clearly going to be D&D-oriented, many RPGs will face similar issues and questions. In an effort to avoid answering the question for just a little longer, let’s briefly consider that.

• Cyberpunk – How long does it take to recover from receiving a new implant? Is it like being fitted a modern prosthetic which needs to be followed with months of physical therapy? Because tying a PC down for that long seems undesirable – but any short-cutting of the process opens the door to a suitably-revised version of the question.
• Superheroes – when you have only a limited number of players, as was the case when my early superhero campaign was underway (for many years, it had only two players), anything that takes one out for a significant length of in-game time is undesirable. So I came up with the idea of a “Regen Tank” (retconned to be a nanotechnology), stolen directly from various sci-fi sources. And ever since, I’ve had to struggle with the equivalent question of just how effective or ineffective it was.
• In general, you don’t want PCs sidelined when their players are present and willing. Having a PC whose player is absent come down with some Dreaded Lurgy, on the other hand, can be a great way of justifying the absence or effective absence of their characters, enabling the game to go on.
• Contrariwise, some game systems try hard for gritty realism, and an appropriate simulation of sicknesses is part of that grit. But the general principle conflicts with that – so they have this question at their heart, too.

All of which demonstrates that this topic is bigger and more significant than the intellectual exercise that it seemed initially. So, let’s give it some serious consideration.

The Argument for Wound Cures

Let’s be clear, I’m not talking about the ubiquity of “Cure Wound” spells and potions. Nicks and wounds are a natural consequence of fantasy adventuring, and the absence of healing for such would have a stultifying effect. I looked into this specific issue indirectly in my series “All Wounds Are Not Alike” which considered the impact of a number of variations on standard Healing. But there are secondary considerations arising from that question – common access to quick healing means that infections are going to be a lot less common, for example, and that means that limbs will need amputating less frequently, and that means that prosthetics will have less impetus to improve and will be comparatively primitive.

No, this article is asking whether or not healing for sicknesses and illnesses beyond the normal scope of Cure Wound spells is too easy and too effective.

Lesser Specific Spells

I once played in a game in which the GM rated all diseases on a one-to-five scale. Double the rating and subtract one and you got the spell level of any spell designed to deal with that specific illness. I’ve shamelessly appropriated the concept for my own use, as you will find out later in the article.

Let’s unpack that a little.

One-star diseases

2 × 1 – 1 = 1 – so curable with a 1st level spell, i.e. by a 1st level cleric.

Two-star diseases

2 × 2 – 1 = 3 – so curable with a 3rd level spell, which requires a cleric of 5th level.

What’s the survival rate of adventurers in your world?

If it’s 90% (unlikely) then there will be 0.9×0.9×0.9×0.9 = 0.6561 clerics of that level for every 1st-level cleric out there.

I once calculated, using the treasure progressions in the 3.x DMG that the rate should be about 14%. 0.14 × 0.14 × 0.14 × 0.14 = 0.00038416 5th level clerics for every 1st level – or 2603 1st level clerics to get one 5th level cleric.

One-in-three tends to be a fairly happy medium. That gives 81 first level clerics for every fifth level cleric.

If one-in-250 people are clerics – enough that anywhere with that population or more will have at least one 1st level cleric – those survival rates give population levels for a fifth level cleric as 381, and 650,750, and 20,250 respectively.

It doesn’t matter how you get to those targets – five villages of 2000 and twenty hamlets of 513 people each is enough to contain a 5th level cleric, if your target is 20,250. With an average separation of maybe 25 miles, maybe 30 miles, that’s a circular region of around 100-115 miles diameter (25 localities, sqr root, over pi, times 25 or 30, times 2 to get diameter).

Why those separations? Because that’s roughly how far you can travel in a day on foot. Double that if traveling by horse, multiply it by three for a forced march, quadruple it if you are changing mounts regularly, and multiply it by 5 if you are traveling in a wagon pulled by at least four horses (reduced by 1 for every 500 lbs of freight being carried).

So the ‘happy medium’ means that a cure for a two-star disease is only a day or two away.

Three-Star Diseases

2 × 3 – 1 = 5 – so curable with a 5th level spell, which requires a cleric of 9th level.

Again working on the ‘happy medium’ numbers, that gives 3^4 5th level clerics for every 9th level cleric – that’s 81 to one (again) and 81×81 = 6,561 1st level clerics for every 9th level cleric.

If one-in-250 people are clerics – enough that anywhere with that population or more will have at least one 1st level cleric – those survival rates give population levels for a ninth level cleric as 1,640,250. There might be a dozen of them in a country the size of medieval France. Weeks of travel are indicated in order to get to one.

Four-Star Diseases

2 × 4 – 1 = 7, so curable with a 7th level spell, which needs a caster of 13th level.

Once again, there will be one of these for every 81 ninth level clerics, or 6,561 fifth level clerics, or 531,441 first level clerics at our ‘happy medium’ survival rate.

At our 1-in-250 clerical population rate, that’s one 14th level cleric for every 132,860,250 people. That’s close enough to the population of medieval western Europe. And that means months of travel to reach one.

Five-Star Diseases

2 × 5 – 1 = 9, so curable with a 9th level spell (which used to be as high as clerical spells went, once upon a time), so a 17th-level cleric.

With our standard assumptions, there’s basically a 1-in-81 chance that there will be one in the equivalent of Medieval Western Europe. That’s 1.2345679%. If the average lifespan of such is 80 years, that means that for each one that comes along, you have to wait another 6400 years for the next. Good luck with that.

The only solution is to look outside the prime material plane. If the population of each plane of existence is about 1/6th the “Western Europe” total – a fairly conservative estimate – then there will be one cleric capable of handling 5-star diseases every 13.5 planes. You could search for years or even decades without finding that one. (Of course, there will be one that you know about: the God who looks after healing).

These results are so relatable that the assumptions get a big tick, in my book.

The Medium-high-level Elephant In The Room

Sticking in the middle of this nice, orderly progression is the 6th level spell, Heal, which restores ten hit points (irrelevant) per level (okay, that’s more significant) and all diseases and mental conditions (oops).

For the progression to work, “Heal” and “Mass Heal” have to be watered down or neutered.

How ubiquitous, given our assumptions, would clerics be that can cast an unmodified Heal? We’re talking about an 11th level cleric. So there would be one for every 9 ninth level clerics. With an estimate of a dozen of the latter in a country like medieval France, we’re about at the point where there will be one Priest of the required ability in most major nations, probably in the capital city. He probably isn’t the head of the church – there’s too much admin and bureaucracy and politics involved in such positions to attract such a pious figure – but expect him to be the priest who looks after that head, and/or the head of state.

“I’ll Just Pop Down To The Temple”

It was long before encountering the 5-star system that these infamous words were first uttered in one of my campaigns. Because it was convenient at the time, and in that particular campaign, I let it slide and ignored the bigger issue. But I’ve seen (and occasionally played) in campaigns in which 6th level was the entry-level requirement for a priest in a major city or holy site. Usually, paradoxically, in campaigns with a far lower survival rate than the one-in-three-per-level “happy medium” used above.

And without watering “Heal” down, that makes Healing too common in my book, unless you’re prepared to spend quite a lot of time working out the implications for society, social order, economics, politics (etc) of such ubiquity.

To me, the results of the 5-star system sound about right. Trivial ailments get cured locally, sparing untold misery and boosting productivity significantly; more serious conditions have to be lived with, but can be cured if someone with sufficient wealth bankrolls your treatment; and still more serious conditions? The wealthy and elite may be spared them, but ordinary folk, not so much.

Others may feel that the 5-star interpretation offered makes healing too hard to access, while agreeing that the one-in-every-pot approach goes too far. It’s easy to choose a different set of assumptions and get a completely different answer. The indicated level of ubiquity for “Heal” may seem about right to them.

Are Diseases Too Weak in D&D?

Perhaps we should turn the problem on its head for a different perspective.

I like to think that the ubiquity of weak Healing was a factor in the creation of the magical diseases listed in the DMG.

Have you ever tried to use one of these? My experience is that they are too weak and too easily cured.

Of course, there’s good reason for this – being laid out by a disease isn’t heroic, and isn’t thrilling. It’s a different story for NPCs, runs the argument – it should be “one rule for the masses, and one rule for us”.

.There’s some merit in that perspective. PCs are generally considered exceptional specimens in most campaigns – that was one of the paradigm shifts that occurred between AD&D and third edition. Why shouldn’t they be spared the mundane worries of disease?

Tell you what, let’s set PCs aside for a moment and ask the question again, restricting applicability to NPCs – “Are diseases too weak in D&D?”

That comes down to campaign and style, but as a general rule, in my own experience, they aren’t so much too weak as too absent – until the GM notices, and then generally overcompensates..

Most campaigns seem to end toward the Utopian, with a bucolic village living in a golden age under threat from a dungeon-based nightmare of some kind.

The more experienced the GM, the more gritty and realistic the campaigns become (except when they deliberately take a lighter tone, so as to be able to focus on other game elements like politics). My Fumanor campaign’s world had its problems, but outside of those issues, citizens generally lived fairly well. Most had enough to eat, and could afford reasonable clothing. My Shards campaign was more Dickensian in approach, with such idyllic lives available only to the wealthy and connected – and to achieve that, I had to restrict the availability and effectiveness of Healing..

If Curing Is Hard, what is gained?

Aside from the health of the general citizenry taking a turn for the worse, that is. There are two different forms of this question, though – because we still have the open issue of whether or not different rules should apply for PCs. Perhaps, in the course of listing the impacts of ‘hard cures’, we can find an answer to that, as well, and get some idea of what those different rules (if any) should be.

Home Cures & ‘Popular Wisdom’

Where there’s sickness and a lack of expertise, home remedies and popular wisdom will provide ‘solutions’. As a general rule, these will either target symptoms, or will provide temporary relief, or will focus on whatever the common folk think is the cause of the illness – which rarely bears any resemblance to a scientific reality.

Of course, a strict scientific reality might have no relevance to a D&D campaign – that’s something else the DM has to think about. As a general rule, though, they have to be internally logical, and most GMs don’t have the time to invest in creating something that is both internally sound and not rooted in modern understanding of what was happening.

This means, of course, that players will understand the world far better than their characters are supposed to, and that can be a recurring problem for the GM. Taking that headache away is one of the major justifications for making that creative effort (the campaign immediately becoming more memorable and distinctive are two others).

Getting back to the point, home cures and ‘popular wisdom’ offer a pathway for the GM to explain (through an NPC) some of the underlying realities of the campaign (if accurate) or, at least, what the people of the game world think they are!

Cheap ‘Cures’ and other Snake Oil

If healing is plentiful, there’s no need for these, and con men will turn to other deceptions. And a source of color becomes much thinner on the ground.

Having an NPC taken in isn’t all that much fun, but it lets the PCs be ‘holier than thou’ or compassionate. Any example of the former is a natural invitation to the GM to teach the arrogant character a lesson. That kind of goes away if PCs are not (broadly speaking) as vulnerable to disease as the general public, because it removes any impetus on the part of the PC to buy.

Faith Healing and other Quackery

A more extreme example of the lengths that people will go to, in search of a cure. While exposing a PC to this level of shenanigans can be moderately entertaining, and a way to relieve the character of ready cash, it’s somehow unsatisfying unless part of a deliberate plot arc in which the PC discovers that he’s been hoodwinked and the Quacks get what’s coming to them in some form. Outside of that circumstance, it’s generally better if some NPC falls into the clutches of Faith Healers.

The reason is because the GM creates the faith and tenets of the Faith Healers, he is imposing those beliefs on the character. Even if the player is willing to take them on board, because they are someone else’s ideas, the player can struggle to integrate them into his character’s world-view; the whole thing can seem tacked-on and superficial. Results are often better if you get the player to design the Faith Healer and the nonsense that he represents, subject to GM approval – but that then raises the question of how skilled the player would be at doing so. Some of my players would struggle with such an assignment, I think, and I’ve got pretty good players.

This consequence actually argues (weakly) in favor of different rules for the two populations.

A Question of Medicine

If there’s less illness, or it’s easily cured, there’s a LOT less impetus for Medicine to develop. On top of that, consider how big the churches were as part of the social lives of Medieval Europe even without the ability to cure common ailments. If you grant them that capacity, how much stronger would their hold on the citizens become?

I’ve used this premise in the past to justify a general prejudice against those “doubters and askers of impertinent questions”, mages, which I have always considered the “natural philosophers” of their realities. These are the people who try to understand the world; they might not be able to deny the metaphysical influence of the Gods, but they want to understand the “how” and “why”. And both undermine strict faith, and can contradict it, and the churches generally don’t like that.

In our own world, church bans against post mortem examinations held back anatomical knowledge for centuries, and that is the essential precursor of modern medicine.

It’s only a slight exaggeration to say that you can either have clerical healing or a knowledge of Medicine.

Of course, that makes books on anatomy rare, valuable – and forbidden. Great heat-soaks for excess player cash!

Hospitals & Other Institutions

If there are fewer sick, there is less need for somewhere to care for the sick. When was ‘the hospital’ invented? Well, hospitals in the modern sense were preceded by Sanitariums where sunlight (and sometimes salt water bathing) and rest were the most advanced cure on offer, coupled with treatments and primitive medicines that were generally just home remedies, when you got right down to it.

If healing is widespread but restricted in efficacy, as per the five-star system described, such institutions would still exist, but far more of their patients would be those with serious illnesses that could not be readily cured.

In the 18th century, people with serious illnesses (and especially those with mental complaints) were frequently exiled to such places and forgotten. Much the same happened prior to that time, though such care was rarer and more expensive, and hence more restricted; there were cases of people being walled up in a room of their home rather than letting them be seen in public, and often it was implied in conversation that the person had died – that being considered less shameful than that they had come down with this horrible disease, a punishment from God no doubt.

Earlier forms such institutional care were of greater variety; the fountain at Lourdes comes to mind, for example. Pilgrimages were sometimes organized to convey the ill to such curative locations. If you were lucky enough to attend a boarding institutions and recovered from whatever brought you there, it was not uncommon for you to be employed for the care of other sufferers; the concept of immunity was well understood even if the mechanics were not.

It takes very little imagination to translate these into fantasy-world equivalents, and you soon end up with a ‘golden age’ that has a rotten heart festering below the surface.

The Hidden Victims

There are thus three classes of hidden victim: those who have been institutionalized, those who have simply been locked away, and the families of those who have to live with them. These are traumatic episodes, and they have a significant impact on not only the primary sufferer but on those who surround them.

On an episode of Who Do You Think You Are that I caught up with a couple of days ago, an elderly relative of the subject was quoted as having said that they had never had any sense of paternal love or affection, or words to that effect. That’s the sort of impact that we’re talking about.

Plagues & Pandemics

I’ve actually discussed this point before, in Disease and Despair – the healing-resistant nightmare. An underlying assumption of that article was that healing was relatively widespread – certainly more than on the 1 in 3 model offered earlier.

It might be hard to have the proper perspective on this entire question because the world is currently suffering through a once-in-a-century pandemic – events that are near-certain to accelerate in frequency for a number of reasons.

The net impact on societies of Plagues and Pandemics can’t be over- or under-estimated. The one certainty is that there will be such effects, even if it is only through the loss of a particular individual, who then needs to be replaced by someone with more or less competence (but almost-certainly less experience) and with an entirely different style. They may also have a completely different private agenda, and/or a completely different set of allies and enemies.

Ripple effects alone could completely transform a Kingdom. The departed individual was either going to be more or less reactionary in preference and policy proposals than the throne actually implements; the vast likelihood (because that’s the way these things usually work) is that the replacement will fall on the other side of the scale. The Kingdom can thus go from enlightened and benevolent to strict and authoritarian, or vice versa, in extremely short order.

And that’s without the social impact of so many deaths, or the economic impact if one group is harder hit than the average, or the psychological impact of the fear that is likely to arise.

As I said, perspective is hard to come by when you’re in the middle of a pandemic. Study the Black Plague or the Influenza of 1918, or read Demon Lord Of Karanda, the third volume of the Mallorean, by David Eddings, or Moreta, Dragonlady of Pern by Anne McCaffrey, both which feature plagues / epidemics (links are to Amazon, I get a small commission if you buy).

Lost Limbs & Simple Replacements

I’ve touched on this already. So this heading serves as a simple reminder.

Disease as a Punishment

I’ve hinted at this already, too. Diseases were often viewed as punishments by the gods, or the work of devils and demons in the event that the sufferer was known to be pious.

Either a whole new set of rules gets applied because of the Divine origins, or Disease as a punishment is off the table if healing is widespread. And a significant tool of the forces of Darkness gets substantially weakened.

Torture

On the darker side, ubiquitous healing – even of the potion / Cure Light Wounds variety – can be used to enhance torture as an interrogation technique. Just anoint the wounds with a little of the potion to prevent death during questioning without diminishing the pain being inflicted and it becomes much harder to go too far.

Disease as a Weapon

While on the subject of darker thoughts: it was rare but not unheard of to use catapults to fling the bodies of those who had died of disease into enemy strongholds and castles during a siege in hopes of infecting those inside. It’s certainly quite a ruthless practice. Thankfully it loses effectiveness if healing is widespread, (depending on how virulent the disease is, of course).

The Magical Diseases

If healing is widespread, you are far more reliant on the Magical Diseases. And not only do I think they are not up to the job, there’s nowhere near enough variety amongst them.

They are also too knife-edge – nothing or plague, there’s no in-between. That’s because the natural diseases that should occupy that in-between spot are susceptible to Healing if that’s commonplace.

Too many GMs consider these from the perspective of a low-level character, which is when they can be quite foreboding – but that requires an encounter which is far beyond the capabilities of the PCs at the time. By the time you are of a high enough level to cope with a Night Hag, your susceptibility is markedly reduced, perhaps even non-existent.

Something that I’ve done on occasion in my campaigns is make these diseases immune to Clerical Healing – but susceptible to the Laying On Of Hands of a Paladin of a particular level.

Bottom line: if Healing is widespread, you are justified in making these diseases a LOT nastier. If it’s not, you are justified in making them a BIT nastier. If you adopt the ‘clerical resistance,’ you can leave them be because the treatment is far harder to come across and restricted in supply – and you can vary that supply by different settings of Paladin Level.

The Quest For A Cure

A major plotline gets taken off the table if Healing is too widely accessible – the quest for a cure. The victim on whose behalf you quest need not be a PC, though that adds impetus if it is. This can not only be a plotline in its own right, if you don’t know exactly what you’re looking for, it can be a driver of sub-plots. Another book by David Eddings, The Diamond Throne, is all about The Quest For A Cure (regardless of what it might say or suggest on the back cover – worst Blurb ever, at least on my copy!) – the link is to a compiled anthology of all three volumes in the Elenium, of which The Diamond Throne is only the first. My favorite is the last part, because of the political shenanigans, but don’t let that bias you!

PC Vulnerability

So the only arguments in favor of a different set of rules for PCs come down to Cure Wounds and a weak contribution that can be handled with a special case.

The more widespread healing is, the weaker any arguments in favor of the PCs being exceptional in this regard. Even the proposed distribution in the star-rating system discussion is enough to leave those arguments undented, whereas with the “6th level spell that can cure anything”, Heal, treatment is so easily accessed that almost ANY disease is nothing more than an inconvenience.

And that’s the Break Point between the two halves that I had in mind. While I have enough time left to make a start on the next sections, I don’t think I have anywhere near enough time to finish. So, next week, Take Two And Call Me Again will cover:

• Simple disease simulation rules
• How to create / document a disease, and
• Provide a quick review of about 45 diseases that I thought of off the top of my head, before wrapping up.

Hmm – that will make this Blog Carnival six weeks long, which I think (though I might be wrong) is a record….

984… 985…

I’m still looking for ideas on how to commemorate my 1000th post at Campaign Mastery. Fourteen to go (not counting next week’s post)!