Diseases in D&D

Gestalt Gamer over at More Than Dice has a very excellent article about how to make diseases more potent in a campaign. But the thing that stuck with the most after reading his article was this line:

Never once have I played or DMed a game in which a character contracted a cold, a chronic illness, or suffered from a disease that couldn’t easily be removed with magic.

This, really got me thinking about disease in gaming, and in particular the lack of it.

The Real Medieval World Was Dominated By Disease

In the real world, medieval times was absolutely horrific with regards to disease. The average lifespan was just 30 largely because of disease being everywhere.

Poor sanitation hugely contributed to the spread of disease and a total lack of understanding of the nature of disease made most conditions incurable. Moreover, poor nutrition contributed to common diseases such as the flu having a much higher fatality rate than they do today.

Now, how much one wants his campaign to resemble the real world is a matter of taste. At the moment I am quite happy to have a game world that is clean, and as such disease is never more than the plot of a single adventure, not an issue that permeates the lives of every living thing in the world.

But what if you wanted a world with the feel of medieval times? What if you wanted disease to be a thing of mystery and a constant threat?

Make the Players Ignorant

I think the first thing you need to do is nullify the knowledge that players bring with them to the table. We live in a day and age where diseases aren’t really feared because we understand them too well. So you need to take that understanding away. The only way to do that is to change the underlying way that diseases work.

Forget about bacteria and viruses. Forget about malnutrition and cancer. A fantasy world needs a fantastic method for diseases. Either invent one of your own, or do some research on what people at the time thought caused diseases. One theory in Europe which could very easily translate into game play was Humorism.

Make Disease Omnipresent

Then, having taken away players knowledge, they need to be beat over the head with the idea that people are always sick and dying in this world. They need to see illness everywhere they go, and they need to see that people are both terrified by illness and unable to escape it.

As Gestalt Gamer points out, magical healing of diseases needs to be severely limited, either in availability or effectiveness. This could take the form of restricting spells, restricting the pool of casters, or just making Remove Disease and the like only affect conditions like Mummy Rot.

Finally, there needs to be a real chance each and every week that PCs will get ill. What that chance is and how ill a character might get would depend largely on how much of a focus you are wanting disease to be. But if you start every session with “OK everyone, time to see how sick you are.” players will come to really fear disease.

Disease Makes For a Gritty Campaign

I think introducing disease on this level makes for a far grittier campaign than I think my current group would like, so for now I am going to pass. But I could see great potential for this given the right players and atmosphere.

Have an opinion about this article? I love comments. Please feel welcome to leave your thoughts.