Disease and Despair – the healing-resistant nightmare
Another filler article today, I’m afraid. By skipping half the things I was supposed to do over the weekend I finally got my sleep schedule back to something approaching my standards of normality. One of the things skipped was preliminary work on the next part of the New Beginnings series, leaving me with just enough doubt about getting it done in time that I decided to go for something that could be put together in a little less time…
Disease In Battle: A Historical Review
Throughout most of history, disease has been a very scary thing to contemplate. Analysis of the Iliad and other documents of the period show that at that time, arrow wounds carried a mortality rate of 42%, slingshot wounds 67%, spear wounds 80%, and sword wounds 100%. No need to hack away at your foe until he fell – one good hit, then incapacitate and move on. Or knock down for a second-line soldier to administer the coup-de-grace while you – presumably the better combatant – dealt with the next in line.
During the Mexican War (1845–1848) and the Spanish-American War (1898) disease-related deaths outnumbered battle-related deaths by seven to one. Most casualties and deaths in the American Civil War were the result of non-combat-related disease. For every three soldiers killed in battle, five more died of disease.
It’s also worth noting that until far more modern times than those, the most frequent battlefield treatment offered (whether the patient wanted it or not) was amputation, which was thought to at least provide a clean wound for treatment. Napoleon’s surgeon, Dominique-Jean Larrey, could reportedly perform 200 surgeries a day, or one every 7.2 minutes. Hip and shoulder joint amputations apparently took 15 seconds and 11 seconds, respectively. When assessing the casualty rates from Napoleonic-era conflicts, one should bear in mind that this treatment carried a 70% increase in survival rate – divide the number of wounded by 1.7 to get the number who would have died without such treatment and subtract from the historic wounded rate to get the number of additional casualties that would have resulted.
Given the field conditions, even a small scratch from an incidental source could easily become infected, taking men out of combat without their ever having even seen the enemy.
In RPGs, however…
Disease in most RPGs isn’t all that scary. All but a handful are easily cured with a low-level spell in D&D, for example.
In a way, that’s understandable; death by disease is not a very heroic exit, and the fear engendered by disease at a realistic impact level would eliminate the swashbuckling elements of a game. So one can understand why such a “cure” spell was introduced and made so accessible.
This undermines the realism of the game world for the sake of adventuring, and I have no complaint with that in general. However, at no point is there any suggestion of the impact that this would have when applied to anyone more than adventurers. It would restructure an entire society.
Families back then were large, because there were high mortality rates and higher infant mortality rates. People had six or seven children because only one or two might survive to adulthood, completely ignoring the gender-discrimination issues of the time – and that doesn’t take into account children who don’t survive infancy. The true birth rate, with that factored in, might have been as high as ten on average.
That’s a lot of mouths to feed, sapping income and prosperity from the life of the couple. It produces drastic overcrowding and consequently raises the rate of disease by aiding its spread. It’s easy to see, under such conditions, how the Black Death could be so widespread and devastating.
The Black Death Shows The Way
And yet, the Black Death had a transformative effect on society (though some might suggest that it merely accelerated an already-existing trend). By wiping out so much of the population – 30-60% of the European Population of the time according to Wikipedia – it made manpower so scarce that people could demand the freedom to move from place to place practicing a specialty, rather than being tied to a single block of land that wasn’t even theirs in most cases. People could afford the time to specialize, and grow skilled, and become a professional middle class. So significant were the consequences that Wikipedia has a separate article on the subject.
Imagine how different things would have been if the local parish Priest were able to cure one or two people every day, and the population knew it. Death becomes the result of not being able to reach a healer in time. Birth rates would never have reached the levels that were historically recorded in our world; the average of the modern day, 2.5 children, would have been far more likely. That means that there would not have been enough manpower to maintain the feudal system of government, exactly as was the case following the black death; and that freemen and a professional middle-class would be an economically-significant factor, if not a dominant one.
Note that the trend towards professionalism has produced the modern army, which considers itself a professional force, well-trained and well-equipped – though the conscript army remained a factor until after the Vietnam War, so some additional “kick” would be required to produce such a shift in military thinking. In our world, it was the combination of economic downsizing and the unpopularity of the military as a profession following the Vietnam conflict; in an RPG game world, I would suggest that the presence of adventurers who could kick the tails of an entire squad of less-qualified individuals, and the presence of outlandish monsters that frequently required special training and tactics that would force this same transition to occur.
That means that the game environment of the typical D&D/Pathfinder game would be a curious blend of the feudal, the reformation and the age of steam, and the 1980s. It only takes a few key breakthroughs in mechanical engineering by this new professional class to produce Steampunk!
Putting The Fear Back Into Disease
In 2007 or 2008 – some three-hundred-plus issues of Roleplaying Tips ago – I offered Johnn an article, “Putting The Fear Back Into Disease” which sought to redress the balance, to put some fear of disease back into the system without undermining things to such an extent that adventurers would be reduced to timidity. While dying from disease is not all that heroic, overcoming the odds despite a disease is even more heroic. I also wanted to give GMs the ability to control the extent to which a professional middle-class could rewrite the social landscape, so that the traditional Heroic Fantasy environment continued to make sense.
I’m not going to recapitulate that article here – you can read it in the Roleplaying Tips archives through the link above. But I was thinking about it this morning, and came up with a chain of speculation that makes for interesting reading. Specifically, what would happen in a game if a Healing Resistant Disease were to arise?
If the principles of my article were in place within a campaign, the effects would be relatively minimal – a plague scare along the lines of the social practices instituted during the Black Death (hence my links to those articles on Wikipedia). This would be a population used to the notion that not every priest could solve every problem, so it would be bad, but not cataclysmic.
Things would not be so rosy in a game world without such a balancing element…
The Healing-Resistant Disease
The natural first assumption would be that the resulting plague was the work of some inimical force – a Devil or Demon or Dark God – whose influence the local priest was unable to overcome. It would also be assumed that this was strictly a local problem, so the township would be sealed and urgent messages sent to higher up the the Theological Power Structure. Meanwhile a witch-hunt – both literal and figurative – would commence in the affected towns.
The results would be akin to the fear – and the manifestations of that fear – that gripped the township of Salem, New England, in the 17th century (Salem Witch Trials). Anyone who was newly-arrived would be suspect. Anyone who had performed acts that the local clergy held to be unsavory would be suspect. Allegations would be made by members of the public against neighbors who they didn’t like or mistrusted. Populations would turn to adventurers – both current and retired – to root out the cause.
At first, people would isolate themselves from outside contact as much as possible. Anyone suspected of harboring the disease would be shunned. Con men would begin selling miracle cures and preventatives – but woe betide any that didn’t got caught when their “cures” failed.
At that center of higher religious authority, a disturbing pattern would begin to emerge, one that would quickly show that this was not a local problem, that it was more widespread. Several townships were affected, and there might be several regions affected, though geographically separated. An urgent mission would be sent to one or more of the affected townships to bring stronger theological “muscle” to bear. In some cases, this might even be successful; eventually, though, one of these higher-level clerics would fall ill of the disease, and public panic would reach a whole new level.
Almost-forgotten superstitions and prejudices of all kinds would make a resurgence. Social Order would begin to collapse as people turned into lynch mobs and pitched battles erupted in the streets. Anyone suspected of harboring the disease would now be more than shunned – their homes would be burned while armed men prevented anyone from leaving, in a desperate attempt to quell the disease.
In the meantime, there would be cases where people had fled through whatever quarantine was in place, and some of those would spread the disease to new population centers.
From Local to Regional
It would probably be around this time that the first reports of the plague would reach the highest levels of civil authority. The most likely route by which this news would travel would be a series of messages from the mid-level theological authorities, who would report to the heads of their Churches or High Temples or whatever the equivalent is in this particular game world. The increasing urgency of these reports would mean that the first traveled slowly through channels, with each subsequent one cutting more and more quickly through the layers of bureaucracy, in effect “catching up” with the earlier messages.
The first would describe a regional problem, and the suspected supernatural origins, and report the dispatch of a higher-level cleric to investigate. The second, rather more urgent, would follow close on the heels of the first, reporting that the problem was even more widespread than first thought. A third would report confirmation that the disease was supernatural in nature and/or origin, and the fourth that the local authorities were losing control of the situation. A fifth, from an entirely separate region, would mirror the first, as the early cases of the second wave were reported.
All this would land on the desk of whoever was the ultimate social authority in one bombshell. What happens next depends on the personality and especially the decisiveness of that authority. The correct action is a series of edicts that minimize travel, turn out the army to blockade infected regions, control the passage of essential supplies, etc, but these edicts will either be draconian in nature or almost-certainly ineffective (although it depicts a plague in slightly more-advanced stage, and lacks the impact of healing magic, several chapters of Demon Lord Of Karanda, the third volume of The Mallorean by David Eddings (available from this link shows the sort of ruthless decision-making needed – and spells out the consequences of not doing so with only slight exaggeration; the character doing the spelling-out is trying to persuade the authority in question, after all! The fourth volume, Sorceress Of Darshiva, describes the policies that actually succeed in bringing the spread of the plague under control, and so is also worth reading).
Let’s assume decisiveness, because anything less is a total disaster. In fact, a failure to respond adequately to the crisis is more than enough reason for anyone who wants to supplant the current rule with their won to advance their plans, potentially muddying the waters with a civil war on top of everything else. So let’s not go down that particular road.
Inevitably, the army on blockade duty will catch the disease, at least at some point. More importantly, rumors will be swirling by this time, and desertion will be rife. The enforcement of discipline will be a major secondary problem, and the harsh lessons necessary will be quite enough to contaminate the ruler’s reputation for many years to come, no matter how generous, fair, likable, just, and even-handed his reputation may have been before the crisis – a tertiary problem. If there were no groups plotting to overthrow the throne before the crisis, there will be many such groups for decades afterwards.
The results are clearly a nation in crisis. Anyone who thinks that the prejudices and paranoia unleashed will simply fade away once the immediate problem is resolved is peddling moonbeams; the society will take quite a long time to heal, and it won’t happen without strenuous effort by appropriate groups. Region-by-region, the subjects of superstition and prejudice will be different, and frequently fueled by proximity. A century or more of social progress can be wiped away in weeks, and not be recovered for decades or even generations.
A scary premise, no? But, if you want to make things really scary, have one of the Gods come down with the Plague…
Campaign Integration
There are two ways that this premise can be integrated into the campaign – either on top of whatever the PCs are going to be doing anyway, as an additional handicap, or as a stand-alone problem for them to solve, possibly interrupting or disrupting whatever they were doing.
I would suggest that the key to making this decision lies in the true origins of the disease. If the PCs enemy can be reasonably attributed as the cause, and may well therefore be in possession of a cure, then it becomes just an escalation in the existing conflict between them. If the enemy is not plausibly the cause, or you don’t want him/her/it/them to be the cause for whatever reason (including consistency of characterization), the plotline is one to be inserted. This gives you an opportunity to show a completely different side of that enemy – to quote a Klingon proverb from the (original series) Star Trek episode “Day Of The Dove”, “Only a fool fights in a burning house”. There are no enemies so evil as those who set aside their animosity and work with someone in common cause – only to resume exactly where they left off when the crisis is over, because this shows that they have a choice in their morality and have deliberately chosen the “Dark Side”.
Once you know the origin of the disease, you can decide what the PCs are going to be able to do about it. Even if the disease is not unnatural, but is simply something that’s been dormant for centuries – perhaps a leftover from a war long ago – there has to be something. Perhaps a specially-modified cure spell that only acts on this disease can be dug up from somewhere, if nothing else.
With both the background of the plot and the end of the plot worked out, it remains only to determine (a) where the PCs first become aware of the situation, (b) how bad it is at that time, (c) how they are going to learn of the path to a solution, and (d) what is going to oppose them – because there will be opportunists out there who will do so!
For me, the critical questions are (c) and (d). How long is it likely to take for the PCs to find out about a potential solution, overcome whatever opposition they have to face (bearing in mind that movement may be restricted), obtain and distribute the cure? Then work backwards from the point of total collapse into anarchy, which is what happens when the army starts to desert to determine the situation when the PCs have to drop everything and focus on the emergency. That gives you a worst-case answer to (b) (though you can have things happening in the background before then, if you want, of which the PCs might be aware), and that in turn (in conjunction with what the PCs currently plan to be doing) gives you the answer to (a).
The other thing that you have to do is determine the profile of the disease. How contagious? What are the symptoms? How long before symptoms does a victim become contagious? How long after symptoms show does death usually occur, and in what percentage of the infected? Are bodies contagious after death? How is the disease spread? How long does the pathogen remain viable once removed from a suitable environment? Is Zoonosis possible – the spread from animals to humans? Can it also travel in the other direction? And, finally, how long can the disease remain dormant, in the soil or whatever?
Some of these answers are vital to understanding how the disease will spread, and what the timescales are. The longer the contagious phase before overt symptoms show, the more widely-spread the disease will be. The rate of contagion (how easy it is to catch the disease) indicates what percentage of the exposed population will come down with it. If both are high, the disease can be extremely widespread. One of the saving graces of AIDS was that the HIV virus fares very poorly once exposed to the environment; that is why it can only be spread by contact with an infected blood supply or other bodily fluid, which maintains that environment long enough for the disease to be transmitted.
The faster death occurs, the more quickly the disease will die out naturally. The most dangerous are those that permit a carrier to remain mobile for a long time, spreading the disease. The most successful diseases, and the ones that – in the long run – have killed the most people, are not the spectacular ones like the Black Death, or Ebola, but ones like Influenza. While there can be, and have been, massive lethal outbreaks of the latter (epidemics) they usually only kill a small percentage of the population at a time – year after year after year.
Each of the profile questions has a significant impact on the course of the disease, on how big the emergency will be, how quickly it will develop into a crisis, and how far it will spread. So think about the answers carefully, and craft them to create the disaster that you want to occur.
There is one final reference that I should point readers toward, in terms of this subject. Moreta: Dragonlady of Pern by Anne McCaffrey tells the story of a deadly plague that spreads across the planet, and of the desperate attempts to find a cure in time. While it’s not strictly necessary, it would probably help if the reader had read some of the other books in the Pern series, or at least consulted this Wikipedia page (and the pages it links to) to get the basic foundations.
A brief word on Heal
When I first started writing this, I thought that it might be necessary for the disease to resist “Heal” as well as “Cure Disease”. Further reflection has shown that it is not necessarily so; there are only going to be so many people who can cast it, and they can only cast it a small number of times a day, and the sheer logistics of bringing patient and healer together mean that many of those limited opportunities would be wasted, unless the disease was so widespread that the available treatments simply couldn’t keep up.
But this would bring about its own social disruptions. Consider: let’s say that ten people a day can be cured in this way, but 100 become infected. Who chooses the ten? and what do the other 90 think about those choices? And the people who don’t have it yet but who are being put at risk by the 90? And the friends and family of the 90? The slightest hint of favoritism or corruption and the temples – and hence, the “Heal” spells – would go up in smoke, destroyed by angry mobs. And there would be plenty of such hints, as those with influence and wealth seek to prioritize themselves, and those with power seek to justify favored treatment. Even if they are refused, there are sure to be those who will claim the healing was simply done in secret.
So, even if “Heal” does cure the plague, the results would be worse than if it did not!
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