Plague in Dungeons and Dragons can be an epic event in your campaign. It gives you the opportunity to create a critically important crisis in your adventurer’s realm that involves no villain at all. Now don’t get me wrong. I love villains. After all…..I am one. But sometimes you just need a change of pace. And a devastating plague can be just the ticket for high adventure.

This looks like the bring out your dead cart from Monty Python

Someone has to find a cure for this plague right? Or it is going to burn through the population of the land like wildfire. The cities will be overflowing with bodies to be collected. The temples and hospitals (if there are such things in your campaign) will be overflowing with the sick and the dying and the dead. Some heroes will be needed to go out into the wild and bring back the necessary components to create a cure. Some rare herbs or plants will likely be needed. Perhaps that crazy old witch that lives out in the dark forest may have some answers. Or maybe that sage or oracle that lives up on the highest mountain may know of a cure.

These people are not having a good time

Disease In 1st Edition AD&D

Plague itself is not technically mentioned in the 1st Edition Dungeon Master Guide. Instead pages 13-15 cover a range of potential infections and diseases that were common to the middle ages. This segment gives a table that covers occurrence and severity of certain potential conditions. Each of these conditions has a very small description of each.

Disease in 5th Edition D&D

Plague is specifically mentioned in the 5th Edition Dungeon Master Guide. Pages 256-257 of the DMG covers diseases and gives some suggestions for types that might be encountered in the game. One of those types is called Sewer Plague which sounds a lot like the Black Death that burned through Europe during the Middle Ages.

This hospital is overrun with plague victims

Plague in Dungeons and Dragons

Whatever edition of this game that you choose to play a plague can be one of the biggest potential crisis that can occur. In some ways it might be bigger than almost any villain. Something will have to be done or the kingdom or realm is going to collapse. It gives a Dungeon Master lots of options for questing for a cure.

As for which type of Plague to use it really does not matter how accurately you describe it. The people who live in a middle ages type realm are going to see it as the scariest thing in their lives to this point. Their friends and neighbors are dying. Their king or government will appear to have lost all control of it. They will become desperate for help. Some may blame things on witchcraft and be looking for scapegoats.

Even the mechanics of your disease are not really that important. What is important is that people are dying from it in huge numbers and a mere cure disease spell seems to be totally ineffective to stop it. This sets the adventurers up to do something truly heroic. They can save everyone. No one else can!

These people are screwed. One dude on the left appears to be pulling his hair out.

Go back up to the top of this post. Check out the dude on the left in the picture. Notice that torch in his hand? I wonder what he plans on doing with that? Desperate people do desperate things. In a big medieval city that could have disastrous consequences. Especially if someone decides that fire will purify the city.

What Plague Should You Use?

Well. Since everyone is familiar with the Black Plague….. it will do as well as any. Or some variation of it. Rats are a common problem in big cities even in a fantasy realm. They are a common disease carrier. And they are everywhere to be found. Why not use them again? But…you could make the plague a part of a curse instead. Perhaps the city offended some gypsies that were passing through? Or maybe they angered some dark wizard that used to live in town. Or perhaps that old hag that lives down river from the town is tired of the tanner’s chemicals floating towards her home…..

In any event. Pick something. Make it fatal and painful and widely spread. Make sure that new people are coming down with it in large numbers. And then set the table for your adventurers to solve the problem by going on a heroic journey to find the cure. This could easily be a low level or a high level adventure.

Plague in Dungeons and Dragons is a rarely used villain. But it is a good one. It is an indiscriminate killer. And your players may enjoy it as a change of pace.