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DM Tips:Plague

Pestilence, plague, the harbinger of destruction. Fantasy games often omit disease, aside from mystical corruption such as a mummy's touch, but plague was an ever present problem for the medieval world. As a third level spell, cure disease is out of reach of the vast majority of the population, the rich may suffer far fewer losses in a magical world than would otherwise be the case, but for the teeming bulk of humanity disease is more likely to kill them than any war.

Disease can however be a discordant element in play, it cannot readily be fought, and it is ugly and unfair in its application. One does not however have to delve to deeply in the gory details to make use of plague in a game setting, and plague can be used to add flavor to games, create adventure opportunities, and, in a game of Birthright where players rule domains, give them a foe that may need to be solved by means other than brute force.

[top]Causes of Disease

Using modern understanding of biology, the following factors are common factors in encouraging the growth and spread of plague.
  • Concentrated populations to give disease a chance to spread before early victims recover.
  • Presence of mosquitoes and a long breeding period of warm moist weather
  • Filth, typically associated with cramped cities
  • Contaminated water, typically associated with stagnant water, cities.
  • Isolated populations to allow diseases to develop in one population group, and then spread to another wit no native immunity
  • Trade routes. Trade takes sickness from one area to another allowing diseases to spread and attack populations with no natural immunity.

As can be seen, isolated populations are unlikely to suffer overly from illness, put simply, even if one person is infected, the chances are good that they have little chance to infect others before dying or recovering if they live in a small isolated community. By contrast large cities offer disease the chance not merely for becoming endemic (always present in the population to some degree) but epidemic (a huge outbreak where a new strain of disease infects a section of the population, and proximity to potential victims is such that each victim infects several others before succumbing or recovering leading to significant amounts of the population to be infected within a short space of time).

To these causes of plagues in fantasy games can be added:
  • magical plagues deliberately spread by undead, wizards and other ne'er do wells.
  • wrath of the gods. Punishments inflicted by offended deities.
  • biological warfare. This was rare in RL history, however goblins, orogs and the like would have little qualms about biological warfare, and have themselves a famed resistance to illness. The Vos followers of Belinik would likely shun as cowardly any such methods of warfare, but Kriesha is far more practical, and sees winnowing out the weak through plague to be as natural as doing so through the cold of winter.

Other 'causes' that make sense to the medieval mindset include:
  • ungodliness, including heresy, sin, failure to tithe properly, etc, etc.
  • foul air, noxious odors, etc
  • curses from witches, sidhe, and other accursed beings.
  • rotten food (particularly meat) and tainted water (anything touched by an unclean social class, goblins, etc).

[top]Plague in the game

  • Low level. A quest could be to carry a villager on a pilgrimage to be healed at a shrine of Nesirie, or seek out the rare cure for a beloved artist known only by the druids of Rjurik.

  • Mid level. A quest could be to determine why a village has been cursed by plague, impose a quarantine upon the village, recover some ancient relic to heal the sick, hunt down the Shadow World Necromancer inflicting the plague on the village, or escort some elderly but fervent priest on one last mission of mercy, while fending off the priest's foes or political rivals.

  • High level, a major cholera epidemic can wipe out a city more surely than a goblin clan uprising, entire realms can be devastated by the black death, armies can be brought to their knees by typhus. Domain rulers may find plague the catastrophe that leaves them vulnerable to their foes, or that weakens a foe at an opportune moment. Foes may be detected whilst casting some ritual to bring a plague into being and need to be stopped, or some ancient ritual may need to discovered and performed to effect a cure, or perhaps a ruler must choose between trying to save a city, or sacrificing it through strict quarantine to serve the greater good.

[top]Infamous diseases

While there are innumerable types of disease, in a fantasy game there are only really a few - those which cause major epidemics. Minor colds, flu's and the like which cause short term debilitation are unlikely to interest most players.
Some of the major diseases are listed here, I have used Plague, Pox & Pestilence Edited by Kenneth F Kiple, published by Weidenfeld & Nicolson in 1997 as my main source, supplemented by Google searches, wikipedia, and my own prejudices to come up with the information here, all errors are, no doubt, mine, and may sometimes be deliberate.

[top]Rats and lice

Diseases that are (or can be) spread by rats and lice will quickly spread along trade routes where ships carry goods. They may however die out after the initial epidemic arising from a transfer from one area to another as the local rats in one area are killed off by the plague/local rats and the plague is incapable of long term habitation amongst the rats/lice of the new area.

[top]The Black Death

Transmission. Rats, lice.
Symptoms. 4 to 6 days after the first rat bite the first bubo's appear, dark blotches appear on the arms and thighs, turning into swellings in the groin and armpit that vary from the size of an egg to the size of an apple.
Effect: Within 10 days of infection up to 60% of the infected will die. In general 20-30% of the population of a reasonably populated province might be killed by the black death, with localized mortality rates of 40-50% of the entire population.
Lore. The Wrath of Azrai. Several times in history ships have spread this terrible disease after trading in Aduria during summer. The coming of the Wrath of Azrai is presaged by carpets of dead rats, mice and rabbits along docks and paths trodden by his enemy, Sera.

[top]Small Pox

Transmission. Rats, lice.
Symptoms. A few days after infection the person suffers a high fever and severe pain in their head back and muscles. After 2-5 days they get a rash of pimples and small pustules inside the mouth, throat on the tongue and mouth spreading to cover the face, and then all over the body.
Effect. Death rate 25 - 30%. Blindness, scarring or limb deformities in 5% of survivors.
Lore. Small pox has ravaged the Khinasi, Anuireans and Brecht many times, but is almost unknown in the Rjurik Highlands aside from brief outbreaks in the cities of the Tael Firth and similarly the disease is rare in Vosgaard where it is considered a punishment for shunning Laerme - smallpox is found in Vosgaard during high summer amongst those who keep to their winter skins and do not let light and fresh air into their homes


Transmission. Lice, ticks, rats, but also direct human:human contact.
Symptoms. High fever and a red rash of small spots for 1-2 weeks. Often causes drowsiness and stupor.
Typhus is most endemic when the population consists of people wearing a fair amount of clothing, without changing it, for a prolonged period, such as sailors, soldiers, prisoners and the like in cold or damp areas.
Effect: Typhus can obliterate substantial chunks of an army, infect as much as 10% of the population during an epidemic, the great Anuirean General Illeon is said to have marched near a hundred thousand soldiers into Vosgaard, within months less than a fifth of his force was able to fight, and as winter approached only two thousand of the army marched south, despite no significant battle having ever been fought. The Vos attributed the pestilence to the obliteration of Kriesha's temples by the General who admired Belinik's courage but scorned the winter witch and struck down her priestesses and smashed her altars wherever he could. Typhus is notably effective at killing not merely patients but doctors, over a quarter of doctors tending patients may die from it.
Lore. Kriesha's test, a disease of woe and misery that slaughters the weak and infirm, and those who huddle in their homes instead of daring the weather. In the Khinasi lands where cleanliness is considered sacred, typhus is almost unknown, amongst the relatively clean Brecht the disease occurs infrequently, and rarely kills more than 10% of those who contract it.

[top]Vitamin deficiencies

Vitamin deficiency is typically seen as a disease for the way it attacks the body, and seems to sweep communities at the same time. Deficiencies are however caused generally by poor diet (generally reliance on a single staple), and are thus common only amongst the poor (particularly of larger cities) and soldiers - in particular sailors. Because of the rarity with which these afflictions attack the rich, many may see them as proof of the superiority of the nobility, and nobles may be credited with curative powers over these diseases.

[top]Beri Beri

Transmission. Dietary ailment: lack of vitamin B: thiamine.
Effect. Less of strength and energy, swelling on the face and limbs, lack of feeling, sometimes to paralysis.
Lore. Also called the rice plague in Khinasi, where the poor often suffer from it. The disease mainly targets pregnant women and un-weaned children, but can also strike laborers and others who under take heavy physical labor for prolonged periods.


Transmission. Dietary ailment: lack of vitamin B: niacin & pyridoxine.
Effect. Tiredness but inability to sleep, nausea, diarrhea. This leads to 'sun-burned' skin which leads to symmetrical skin burns on the face, neck and hands. Mental side effects are not uncommon including dementia, anxiety, depression, amnesia, in extreme causes psychosis and suicidal feelings. Up to 70% fatality rate amongst those affected.
Cure. Milk, Meat, Eggs.
Lore. This disease infrequently affects peasants in Anuire and amongst the Khinasi. Some believe that the disease is caused by eating maize / polenta, but these common foodstuffs cannot be avoided by the poor who may have little else to eat, the innate superiority of the wealthy seems to make them immune to the disease.


Transmission. Dietary ailment: lack of vitamin A
Effect. Warped bones, hunched back, knock knees, deformed/enlarged hands, concave chest.
Lore. Known mainly in Vosgaard, northern Rjurik and the north of Brechtur. A pilgrimage to the temple of Rilni in Mairada is a sovereign cure. The Vosgaard call the disease bone-wrack, it strikes down cowardly children and spares hunters, accordingly its sufferers in Vosgaard are seen to have invited their fate.
Cure: Sunlight, cod-liver oil (traded by Zoloskaya, Merasaf and Min Dhousai mainly).


Transmission. Dietary ailment: lack of vitamin C
Effect: After 3 months the person tires easily and becomes listless. After 5 months their skin becomes rough and dry. After 6-7 months they suffer hemorrhages in their legs and their wounds will not heal. After 7.5 months the gums soften, swell, and turn purple, old wounds re-open. Between 7 and 9.5 months Scurvy becomes lethal with a mortality rate of up to 96%.
Lore. The sailor's disease, certain to visit any ship that sets forth on a long voyage without paying respect to Nesirie. The crews of entire ships can be lost to this terror unless they regularly land to pay homage to Erik and ask him to assuage Nesirie's grief.


Neither wrath of the gods nor beast of fang or claw ever caused mankind so much suffering as these wretched bugs! Malikai el Adaba, 1275 MA
Mosquito's are flying insects that exist to hunt out men and women, feast on their blood and either infect the human with some disease carried in their saliva, or implant their eggs underneath the skin. No creation of Erik, these utterly foul and baneful pests are clearly the work of Azrai, his curse upon all Cerilia for his defeat. Kratos of Erik, 985 MR.


Transmission. Mosquito's
Symptoms. A freezing chill followed by high fever, exhaustion and massive sweating. This repeats itself every 2 or 3 days.
Effect: Malaria rarely kills adults, but it robs its victims of energy, their ability to enjoy life and make a living. Perhaps 2-3% of adults die, although mortality rates are higher amongst children, and the disease often causes miscarriages. Amongst native populations the most common sufferers are children under 5. The most severe outbreaks can see the death rate reach 20% of those infected, in a city as many as 10% of the population might die, while rural areas might suffer half the same total. The disease mostly affects warm (>15 degrees centigrade) moist areas, in particular swamps and coastlines. After someone has 'recovered' the disease can re-occur during following spring/autumns, even years after the first infection. When a Malaria outbreak precedes or coincides with another epidemic the combined fatality rate can be terrible due to Malaria's dehabilitating effects.
Lore. The Adurian plague that visits all visitors to Mieres. The plague is so infamous that most visitors leave Mieres before the end of summer, for catching Malaria in later summer and autumn is more likely to be fatal than the comparatively mild form in spring. Malaria is known in most lands which have warm swamps, but is unknown in the cold north. Although some would expect the Khinasi to be ridden by Malaria, the disease only appears to strike down the poor, this is ascribed by some sages to the practice of incense-burning by the wealthy to cleanse the air, which has the side benefit of driving off mosquito's.

[top](Adurian) Yellow Fever

Transmission. Mosquitoes, monkeys (jungle)
Symptoms. Jaundice, bleeding from the yes, nose, mouth, rectum and lesions, vomiting black blood, high fever, delerium, aches, exhaustion, agonizing pain.
3-16 day incubation period. Recovery often occurs 3-4 days after onset of symptoms. However after a further day after being 'cured' 1/4 of the sufferers go on to a more severe stage of the disease and up to half of these may die.
Effect. Typically 12-80% of the population will become ill, with mortality rates of up to 25%. In severe outbreaks as much as 50-80% of a city might be killed, often resulting in the city to be abandoned. The worst outbreaks require long periods of warm moist weather for the mosquitoes to breed and become infectious, and a critical mass of the human population to be infected so that the mosquitoes swiftly catch the disease from feeding and then spread it.
Note. The mosquitoes feed primarily during the night, accordingly day-visitors who sleep away from infected areas are unlikely to become infected.
Lore. This plague that first became known in its deadly form after obliterated the Anuirean nobility in the Basarji lands allowing El-Arrasi to first gain fame as a leader, and then use that fame to raise the entire nation in rebellion against the Anuirean Empire. The plague is also known as the Khinasi Flu. A fever called Avani's anger regularly sweeps the land and visits overly proud children with much weaker symptoms, this mild plague provides limited immunity to those born and raised along the Seare Sendoure, but every few decades the far more deadly form of the plague erupts leaving devastation in its wake. Some sages believe that Yellow Fever was epidemic in the north of Aduria shortly before the War of the Shadow, even claiming that the disease was the reason why historically the tribes of man had not colonized Cerilia, or that the disease delayed Azrai's march by decades allowing the tribes of Cerilia to grow in strength until they could defeat him, yellow fever is seen as holy by some sects based on these interpretations and seen as a cleansing agent of the gods which strikes down unbelievers.

[top]Air and water

Not all plagues need to be carried by insects, lice, rats and other vermin. Some are carried by the breath of Azrai alone, and spread amongst any who breathe the air or drink water touched by the God of Shadows.

[top]Tuberculosis / Consumption

Transmission. Person to person via coughing. Primarily in dirty, damp homes
Symptoms. Wasting away, blood from the nose/coughing.
Effect. In larger cities perhaps 20% of people suffer from TB during their lifetime, the disease is endemic, always present to some degree, but rarely causes epidemics unless living conditions become much worse. It is rare to unknown amongst nomads and dispersed rural populations.
Lore. Thought to be hereditary, the disease is found mainly in cities and it is said that living amongst Erik's people for a year and a day cures all cases and restores all lost flesh. The best cure for Tuberculosis is the touch of a king, failure to cure the disease is proof in some minds of proof of unworthiness to the crown. The disease is common in those who eat root vegetables (tubers) and thus likely caused by failure to properly thank Erik for providing such bounty to the poor.


Transmission. Water, especially shallow water. Generally spread by communal wells / pumps, or drinking/bathing in rivers contaminated by sewage.
Symptoms. Terrible diarrhea, extreme pain, spasms, bodies can twitch for hours after death.
Onset: In the shortest cases 1 hour from infection to symptoms, 2-3 hours to fatality. More normally 4-12 hours from first symptoms (diarrhea) to onset of more severe symptoms (spasms and pain) with death 18 hours to several days later.
Effect. Often 50-60% mortality in untreated victims, this can be cut to just 5% by adding sugar (glucose) to slightly salty water and giving it in copious quantities to the victim.
Lore. Nesirie's priests are said to hold a near sovereign cure for this deadly disease, and failure to pay her homage and welcome her priests is said to invite disaster amongst larger cities. The disease is said to be a creation of Kriesha, or perhaps the Orog god Torazan, for only the strong survive the intense pain.


Not everything that is thought of as a disease is in fact anything of the kind from a biological perspective. Here are some maladies that have been considered plagues by the natives of Cerilia.

[top]Ignis Scaer (Holy fire)

Nearly all the people of Cerilia depend on barley, rye, or wheat for much of their sustenance, and all know the disease known as holy fire. In moderate cases the disease causes convulsions, stronger cases can cause entire villages and even towns of people to run screaming and dancing in the streets and fields, for no apparent reason. Sometimes the disease causes life-threatening gangrene particularly when those affected hurt themselves whilst running from demons only they can see. Ignis Scaer affects both humans and livestock (particularly cattle) - anything that eats the grain (even cooked grains) is touched by the disease.

The druids of Rjurik brew a potent drink called kykeon from fermented herbs, mead, and barley touched by Ignis Scaer. The brew grants visions to the drinkers of a paradise sacred to Laerme and Erik, those less pure feel uninhibited instead and enjoy great revelry which is shrouded in secret.

The cause of both the plague and the druids potent brew (aside from the wormwood and mushrooms that also liven it up) is a fungus called ergot, best known for LSD which is derived from the hallucinogenic drugs that it makes to deter grazing animals from feeding on grass that it is infecting.

Ergot can easily be spread by someone knowledgeable about it - a pouch full of infected leaves will swiftly spread spores throughout a field if harvested at the right time. In addition to incapacitating the locals as a prelude to a raid, theft, etc, the delirium could easily cause a Matter of Justice or similar event if someone commits a crime, adultery, etc, etc while under the influence of the fungus.


Nothing saps the will of the Basarji like this seductive traitor, nothing more ably robbed of us of strength to withstand the mailed fist of Anuire, nor prostrates more at the feet of the Serpent. In Avani's name I outlaw it, let every root be torn from the ground, let every straining bulb be drowned in lime and salt and cast into the ocean! For all the pain that the poppy has taken from the world it has given suffering through apathy thrice over, let it be made utterly gone! El Arrasi, shortly before his assassination by the Sons of the Serpent.

Despite the loathing that the great El Arrasi held for Opium, it remains popular amongst the Khinasi, although the drug was brutally outlawed in Anuire for undermining order and distracting the peasants from their labors. Frowned upon in the lands of the Khinasi and generally illegal elsewhere, opium dens are places where weary Khinasi breathe in the smoke of forgetfulness and let the woes of the world pass them by.

Higher caste Khinasi generally shun patronizing these dens of iniquity and share pipes only with their closest friends and family in the privacy of their own homes.

Opium poppies are traded far and wide in the form of a tincture of dried poppy latex and alcohol called Nesirie's gift. This drug is the most potent pain-killer known to herbalists across Cerilia and is used by the wealthy to cure all manner of ills.

Opium can be used as a means for an illegal guild to spread influence, although outside of the Khinasi lands where the poppy can grow some trade route would be required. Opium is effective at subverting local officials and its (ab)use is infamously hard to stamp out as many governments have found.

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