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Putting The Fear Back Into Disease

by Mike Bourke

In most roleplaying campaigns, diseases aren't all that scary. The prevalence of Healing magics (or their technological equivalent) leaves characters blase about the dangers posed. Some referees are inclined to ignore diseases because they pose no real threat to the PCs. The obvious solution, if this is seen as a problem, is to make the diseases themselves more dangerous and more common. But there is a fine line here that is easy to cross.

One of the reasons for this attitude is because GMs are reluctant to inflict Disease and Illnesses on the players. The game is about the characters overcoming challenges, not lying helplessly on sickbeds. Making diseases more dangerous runs the risk of deeply upsetting the players - and without them, there is no game.

I would contend that making Diseases more dangerous as a Secondary threat can seriously ramp up the drama of a situation, however; the character rising from his sickbed to confront the Goblin Horde, in a condition far removed from his best, for example. So we need to make diseases more dangerous without overly increasing the chance of a character dying from the illness. It has to be a hampering factor, and perhaps a serious one, but not likely to be ultimately deadly.

This is easier than most referees would expect. PCs, by their nature, are going to be exceptional individuals, and that alone will make them more likely to be amongst the survivors of any non-arbitrary illness. They are far more likely - practically certain, in fact - to have access to some sort of healing magic or technology, and may well have significant skills in the healing arts. All these facts suggest that PCs are more likely to survive even if Disease is made scarier.

The key words there are "non-arbitrary". There have to be clear game mechanics that take into account an individual's capabilities - his stats and saves - and thereby give PCs the edge. There have to be clear rules for the effect that a skilled Healer can have on the course of the illness. And there have to be clear descriptions of how magic/technology plays into both of the above.

The following rules were written for my D&D 3rd Ed campaign. All references given are to the 3.5 edition core rules. At the same time, they are fairly generic and systemless; most systems will have some characteristic that is the equivalent of D&D's "Con", for example, and most will have some game mechanic that is equivalent to a Fortitude saving roll. Conversion to any other system should be no more difficult than a table of equivalent terms.

Part 1: The normal progression of Disease and it's effects

1A: Exposure:

When they first come into contact with a disease, characters usually get a saving roll to avoid contracting the illness. If they fail, they will begin to fall ill, and immediately enter the Incubation Period. The DCs for some of the worst diseases known to exist are shown in the DMG, p292. Other illnesses have a base DC of 20 - d12 + a virulence rating (see below). It is common for diseases to have a standard modifier ranging from +2 to -8 to this result.

1B: Incubation Stage:

Characters who are infected by disease may not show symptoms for some time. This interval is known as the incubation period. During the latter part of the incubation period, the illness may be contagious even though apparently healthy, depending on the nature of the disease.

1C: Active Stage:

Following the incubation period, the disease becomes Active. This is when characters first discover that they are ill. Some diseases leave the character contagious for the whole of this phase, in others it is half the duration or less. During the Active period, characters must attempt to resist the effects of the disease by making a Fort Saving throw. If the roll fails, the disease progresses.

Damage from disease comes in two forms - hit point loss and characteristic loss (usually temporary). The daily hit point loss, in order of increasing deadliness, is (1) d4-3, (2) d3-2, (3) 0, (4) d2-1, (5) d3-1, (6) d4-1, (7) d2+1, (8) d3+1, (9) d4+1, or (10) d3+2 points for every two character levels or part thereof. For common diseases (no stat loss), roll 1d10 to determine the strain number of the disease, also known as it's virulence. The DC for saving rolls against a given strain of a DC is 20 - d12 (rolled once for the disease, not once per exposure) + this virulence rating. For uncommon diseases, roll a d12, and if the result is 3 or higher, subtract two. There is thus a greater chance that the disease's HP component will be much less significant than the disease's exceptional effects.

HP losses are sustained regardless of the success or failure of the characters saving roll (but a success halves any actual loss of hit points). If this amount is less than zero, the character may recover the indicated number of hit points if the damage was caused by the disease. Hit point damage cannot be healed at all on any day in which a disease progresses except as indicated above.

Note that half of the hit point losses are "virtual" and do not affect a character's chances of surviving combat.

Temporary Stat Losses In The Active Stage:

Most diseases do no more than inflict hit point damage, which is debilitating enough, but there are a number of especially-feared varieties that also cause temporary loss of characteristics; these are specified in the DMG, p292. Especially deadly are diseases that cause Con loss; this not only reduces the characters Hit Point reserves, but also his Fort save, ie his ability to resist further Con losses. Each day, the character recovers 1 point of ability score damage even while the disease is in progress; this may permit the character to hold his own against the disease.

If the character rests for the majority of the day and avoids strenuous activity, they receive a +2 circumstantial bonus to their Fort save for the day. "Home remedies" have a 50% chance of adding d6-3 to the character's saving throw to resist the disease on each day they are administered. If they do not have this effect, they have no effect. They can thus produce miraculous recoveries - or catastrophic failures. Nevertheless, most patients persist with them, as they have nothing better available.

If, in the active phase, the character runs out of any given characteristic, or loses all his hit points, the character dies. The body may continue to be contagious even after death.

Assuming that the disease does not kill the character first, there are two ways to exit the active stage: Relief and Convalescence.

1D: Relief:

This occurs in gradual stages. Each time that the character succeeds in his saving roll to avoid a worsening of his condition, the character rolls 1d6 and adds his Con modifier. These results accumulate until the total exceeds the sum of the DC of the disease plus 20, minus it's virulence (if it causes characteristic loss); or 20 plus 3 x (10-virulence). In both cases, the more dangerous the disease, the shorter the active phase; diseases which kill their hosts tend to become quickly extinct or to evolve into more moderate forms. When the accumulated total exceeds this target, the character has survived the disease, and the patient enters the Recovery Stage of the disease.

1E: Convalescence:

The alternative is to wait for the disease to run its course. Roll a number of d6 equal to 12-virulence. Use the lower of the total, or the maximum - the total. For common diseases (no stat losses), subtract the character's Con bonus; for uncommon diseases (potential stat losses), add the DC of the disease and subtract the character's Con bonus. The result (minimum 1) is the minimum number of days that the disease will remain in the active stage. Each day that a victim suffers no stat losses (HP don't count) takes one off this total. Note that Con losses may increase this value. If the victim suffers a stat loss on the final day, roll again as though the disease had just entered the active stage.

1F: Recovery Phase

Eventually, the character will either die or will enter the recovery phase. In this phase, characters recover (Con Bonus) hit points loss from the disease for every d6+6 hours of uninterrupted rest, in addition to their usual hit point recovery. Characters are no longer infectious, if they were previously.

For every 2 days the disease was active, the character suffers a -1 on any attempt to resist infection with a different illness; it is not uncommon for a character to struggle through a terrible disease, surviving only to have insufficient strength to fight off a relatively minor illness. This weakness reduces by one per day, as does any temporary characteristic loss. If the weakness exceeds the characteristic loss, however, the character must make one final Fort save or suffer a permanent loss of 1 in the characteristic affected (save twice if the disease affects two characteristics).

There is a base 50% chance that the character will suffer permanent scarring or marking as a result of the illness; this may or may not be visible when the character is clothed. This results in a permanent d4 charisma loss. For every point of Charisma lost, however, the character receives a +2 bonus to his intimidate skill. Most diseases have a modifier to this chance, up or down. In general, diseases which result from wounds leave only a visible scar at the source of the wound, but there are exceptions.

Stat damage is recovered the sequence Int, Char, Wis, Con, Agil, Str. In other words, the character's mental faculties are the first to return, then they start to look better, then their judgment clears, their general health then improves, then they begin to feel more spry and lastly, their strength returns. Note that few if any diseases affect ALL these characteristics!

1G: The Immunity Stage:

When the character has recovered all the stat losses he can, and at least half of any hit point damage, and his chance of reinfection is less than his Con Bonus, he no longer needs to remain convalescent and will continue to heal through normal rest. This is called the Immunity Stage and it persists even after the character has achieved all the recovery that he's going to make.

There is a chance that the character is left immune to either that strain of the disease, or to all strains of the disease. This chance is 15 minus the higher of the following: the disease's save DC, or it's strain virulence number. The character rolls a d8 and a d12; if both are higher than the target, the character has complete immunity to this disease thereafter, regardless of it's strain, unless it is inflicted by a spell. If only the d6 is higher than the target, then the character acquires immunity to this particular strain of the disease. If only the d12 is higher, then the character has acquired a resistance to this particular strain, and receives +2 to all saves against it in the future. These rolls should be made as soon as the character enters the Recovery stage as they impact the consequences of failed Healing attempts during the Recovery Stage.

1H: Carriers:

In a few very rare cases (a result of 200 on 2d%), someone exposed to the disease may become a Carrier. For them, the disease will never enter the Active Phase; they remain perpetually infectious.

Part 2: Fever

Fevers are a common indication of the battle between the patient and the disease that is ongoing throughout the Active Phase. The level of Fever experienced is determined as follows:

  1. Initial: ¼(2d8)+1- ½(Virulence), minimum 0, in degrees.

    This gives a range of 0-4½ degrees of fever as shown on the table below and an average of a shade under 0.95°. There is better than a 46% chance that the patient will experience no fever initially. If there is no fever, there will still be other symptoms - aches & pains, chills, palpitations, numbness of limbs, spots before the eyes, sores or rashes of different colors, bleeding from nose, ears, eyes, mouth, or elsewhere, itching, swellings, shallowness of breath, diarrhea ... the list goes on and on. In general, each disease has specific symptoms.

    2d8: Virulence
    1 2 3 4 5 6 7 8 9 10
    1 0.5 0 0 0 0 0 0 0 0 0
    3 1.25 0.75 0.25 0 0 0 0 0 0 0
    4 1.5 1 0.5 0 0 0 0 0 0 0
    5 1.75 1.25 0.75 0.25 0 0 0 0 0 0
    6 2 1.5 1 0.5 0 0 0 0 0 0
    7 2.25 1.75 1.25 0.75 0.25 0 0 0 0 0
    8 2.5 2 1.5 1 0.5 0 0 0 0 0
    9 2.75 2.25 1.75 1.25 0.75 0.25 0 0 0 0
    10 3 2.5 2 1.5 1 0.5 0 0 0 0
    11 3.25 2.75 2.25 1.75 1.25 0.75 0.25 0 0 0
    12 3.5 3 2.5 2 1.5 1 0.5 0 0 0
    13 3.75 3.25 2.75 2.25 1.75 1.25 0.75 0.25 0 0
    14 4 3.5 3 2.5 2 1.5 1 0.5 0 0
    15 4.25 3.75 3.25 2.75 2.25 1.75 1.25 0.75 0.25 0
    16 4.5 4 3.5 3 2.5 2 1.5 1 0.5 0
  2. Ongoing: +¼ a degree per point of non-fever stat loss;

    +¼ a degree per failed fort save;

    +¼ a degree for every 10 points of HP loss.

    This can add a maximum of another 15 degrees of fever to that shown (assuming that the character lives long enough). For the record, the highest recorded human body temperature from fever is 115.7°F - and the patient survived, leaving the hospital fully recovered after 24 days (but that was in 1980, with modern technology). Note that substituting a healer's roll for the Fort save does not prevent the rise in fever (refer Healing, below).

  3. Recovery: -½ a degree for each stat point recovered;

    -¼ a degree for every 10 points of HP loss.

    Initial fever halves in 24 hours, halves again in the next 24, and so on (round any result of less than ¼ of a degree to zero).

2A: Fever Effects:

For every quarter-degree of fever above a body temperature of 100°F, the character suffers -1 temporary INT loss in addition to any damage actually caused by the disease. The character may add ¼ of his Con bonus to this threshold. Thus a character of Con 3 (bonus -5) will begin losing INT almost as soon as he develops a fever - his threshold is 100-1.25=98.75°F, and his normal body temperature is 98.6°F ±1.1°. A character with a con of 18 (Bonus +5) on the other hand, would not begin to suffer debilitating levels of fever until his body temperature reached 101.25°, and these effects would not produce noticeable INT loss for another quarter-degree of fever, ie 101.5°. Most people experience substantially diminished capacities while experiencing 3 degrees of fever, so this makes a big difference!

Temporary INT loss through fever also produces temporary WIS loss. For the first six INT, this is 1 Wis for every 2 INT; for the next 4 INT, it's 1-for-1; thereafter it's 1½ for each point of temporary INT loss.

2B: Coma:

When a character's INT reaches an effective value of zero, he enters a Coma. Thereafter, he loses Con instead of INT at the rates described previously. Note that this reduces his capacity to cope with fever, and so his body temperature goes racing up. Similarly, when the character can no longer lose WIS, he begins losing STR and DEX (alternate between the two). While stat losses from fever cannot kill a character, they can so deplete him that stat loss from the disease can do so, and quite quickly. Furthermore, while in modern times we can artificially maintain comatose patients indefinitely, this is not an ability known in the character's era. While water can be provided by placing a wet cloth in the mouth, at the risk of choking the victim, food cannot, and most coma victims will starve to death (see Starvation, p304, DMG) very quickly, especially given Con losses and HP losses due to the fever and the disease.

At the end of each day spent in a coma, a character must make a Will Save to come out of the Coma. The DC of this save is 15, +1 for every two days in a comatose state. Given that comas are caused by Fever, which saps the basis of the save, this is a difficult roll for most characters to succeed in. Even if prevented from starvation through some magical means, a character can survive the entire disease process and still have failed this saving roll; it might be days, weeks, months, or even years before they awaken. The longest Coma on record was over 37 years - and the victim did not survive.

If the character makes his save exactly, he is considered to have spent the day slipping in and out of a coma, ie flirting with danger.

2C: Breaking A Fever:

Clearly, a fever can be just as dangerous to the character as the disease itself. The "easiest" way to break the fever and thus negate or avoid that danger is by externally reducing the body's temperature - every hit point of cold damage reduces the fever by ¼ of a degree.

The danger of doing so is that severe cold affects the limbs more substantially than the core body, and frostbite can claim toes, fingers, feet, hands, or even whole limbs. Refer "Cold Dangers" (DMG p302). While the character suffers only half of the actual damage which would normally be inflicted, in their weakened state this may be more than they can cope with. Until the late 1950s, opinion was fairly evenly divided in the medical community as to whether it was better to try and break a fever or to sustain a patient and let the fever run it's course. Improvements in technology over the 20 years following that date slowly led to the dominance of the "break" treatment. In a middle-ages or pseudo-medieval culture, they had no choice but to do what they could to break the fever, and as quickly as possible. However, in such a world, ice baths and the like were much harder to come by during the winter months. It was often necessary to send the patient to a location permanently snowcapped, ie high in the mountains - and if they would not survive the trip, there was little that could be done.

A damp cloth placed over the victim's forehead brings a ½-degree reduction in fever within 1 hour; it must be refreshed hourly to maintain this improvement. Immersion in a bath of room-temperature water brings a ½ degree reduction in the first half hour, another ½ degree in the following hour, and a further half-degree in the following hour-and-a-half. The water must be replaced every hour. Ice baths are considered "Cold Weather" and the character is considered unprotected. The character must make a Fort Save (DC 15, +1 per previous check for cold damage) or suffer 1d6 subdual damage (which does not heal until the character ceases to be exposed). This 1d6 produces ¼-¾ degrees of fever reduction and inflicts 1-3 points of actual damage to the character from the cold. Furthermore, even if the character makes his save - something that is often made more difficult by the disease's ongoing effects - he receives the same benefit +25%, round up to the nearest quarter-degree, as they would have in room-temperature water. Over 2½ hours, even if the character makes his saves, he will therefore have a reduction in fever of a full two degrees.

As soon as the cold damage inflicted becomes great enough that the character is no longer suffering from the effects of a fever, cold damage once again becomes 100% damaging. That means that it is very easy for the treatment to go too far, and (again given the character's weakened state) they can be in as much danger to life and limb from the treatment as from the disease.

The only alternative is an anti-pyretic medication. Like home remedies, these are hit-and-miss in effectiveness. There is a 30% chance that a "specific for fevers" will produce (3d4)/(2d4+1) degrees (round up) of fever reduction over a 24-hour period, a 15% chance of half this, and a 5% chance of double this. There may be side effects that accompany the "medication", this is a matter for the GM to decide.

Sidebar: Never Seen A Divided Die Roll Before?

This is something that I first encountered in a Dragon Magazine more than ten years ago and was quite taken by. It's a technique for making extremely high results unlikely but possible while biasing the results towards the low end of the scale, taking advantage of the dumbbell-shaped probability curve that results from multiple dice. You roll for each side of the fraction, do the division, and round according to the usual practices of your system. In this case, the top part of the fraction is 3d4, giving a minimum of 3, a maximum of 12, and an average of 7½. The bottom part is 2d4+1, which has a minimum result of 3, a maximum of 9, and an average of 6. With three numbers each, the shape of the final probability curve can be fairly easily visualized:

Min/Min: 3/3=1 Min/Ave: 3/6 = 0.5 Min/Max = 3/9 = 0.333
Ave/Min: 7½/3 = 2.5 Ave/Ave: 7½/6 = 1.25 Ave/Max = 7½/9 = 0.8333
Max/Min: 12/3 = 4 Max/Ave: 12/6 = 2 Max/Max = 12/9 = 1.3333

Since half the results are going to be less than the average/average value, there's a 50% chance of 1.25 or less, and therefore only a 50% chance of 1.25 to 4. What's more, it can be seen that most of those results are going to be less than 2.5. In fact, anything more than 2 is a pretty good result, only about 14.8% of results will be better than that - the equivalent of rolling 18 or better on a d20.

If there is enough interest, I might write an article on divided die rolls for a future Roleplaying Tips.

Part 3: Healing Disease:

Having access to a healer can make a significant difference to a sick character's chances of survival. Note that a character cannot be their own healer, but they usually try it anyway! Treat such attempts as though the character were using the Healing Skill Unskilled, ie roll twice and take the worse of the two results.

3A: Prophylaxis:

Prior to exposure, the healer can make a Healing roll against a DC of 30-(strain number) [refer "Active Stage" above]. If this roll succeeds, the character can add the margin of success as a bonus to any potential patients who may be exposed, provided that they have followed his advice concerning prophylaxis. He may add both this bonus and his Wisdom Bonus to his own saving roll to resist infection at the time of exposure provided that he has also followed this advice - but he must make this check every day that he is exposed to the disease, so sooner or later he will almost certainly fall victim unless he is extremely skilled.

3B: Incubation Stage:

If the healer begins treatment of an individual believed to have been exposed to a disease before the disease becomes active, he makes a Healing roll against a DC of 25-(strain number). The healer adds his margin of success or failure to the character's first Fort check to resist the effects of the disease when it enters its Active stage. In practice, it's easier to add this DC to the Fort DC required and add the healer's total roll to the save total generated by the patient.

3C: Active Stage:

If the patient is resting (as described in "Diseases without a Healer" (above)), the patient may substitute the healer's skill roll for his save if the result is higher. But the real benefits of Healing are only accessible when the patient makes his save without calling apon the Healer's skill, because the Healer can then turn his attention to undoing some of the actual damage being wrought by the disease without focusing on simply keeping the patient alive and medically-stable for another day.

The Healer uses his Heal roll (if it also succeeds) to subtract one day from the duration of the active phase of the disease, or to heal 1d6 of the hit points of damage due to the disease, or to heal one additional point of characteristic loss (if any). These are in addition to any recovery the character achieves of his own accord. It is the Healer's prerogative to determine which is the more important use of his skill. Furthermore, the character will receive a +2 synergy bonus to his next Fort Save.

However, if the Healer fails his roll by ten or more, the duration of the active phase is extended by one day and the patient suffers 1d6 points of additional (actual) damage. This is the consequence of a medical practice that does more harm than good when used incorrectly, such as trepanning (drilling a hole in the skull) or the application of leeches. There are also any number of "preparations" which are supposedly curative of certain ailments, but which are either toxic or counterproductive. For example, blood thinning agents were often given to people who fainted frequently, because the theory was that this would help the blood travel through the body to where it was needed; but these frequently have the side effect of lowering blood pressure, making the victim more prone to faint. A little knowledge is a dangerous thing!

There is no such thing in D&D as the Hippocratic Oath!

3D: Treating A Fever:

As discussed above, there's probably not a lot that the Healer can do about a high fever. The one thing that he CAN do is what the patient would do himself, when the patient is no longer capable of doing so - maintaining ice baths, etc. This doesn't call for a healer, it calls for a nurse. However, a successful Healing or Herbalist roll will permit the character to select an antipyretic medication without the risk of side effects. This doesn't increase the chance of it doing any good, just reduces the chance of doing additional harm.

The other thing that a healer can do is monitor the patient's condition, and apply toweling soaked in warm water to the limbs (which must be suspended from a frame) to reduce the danger of frostbite when an ice bath is used. He can determine when the ice bath has done all the good it can, and discontinue the treatment before it becomes too dangerous. And he can (metaphorically) read these rules to assess the risk, as opposed to using whatever the prevailing "folk wisdom" of the campaign is.

3E: Coma:

There is even less that a healer can do about a coma. Even today, we're not entirely sure what one is and how you emerge from it; the best that can be done is keep the patient alive, and hope.

3F: Recovery Stage:

The Healer rolls his skill against a DC equal to 10 + (patient's stat loss) + (patient's HP loss / patient's level) + (penalty to resist other diseases).

On a critical success, the patient recovers 1 point of stat loss (even if this loss would otherwise have been permanent) AND the patient also receives both of the possible benefits of a regular success (below).

On a non-critical success, the Healer can choose to restore 1d6 of the patient's lost hit points, OR reduce the penalty to resist further illness while he is recovering by 1d6. (note that this cannot give a patient more HP than he started with, or confer a net bonus to resist disease).

On a failure, the Healer must divide the margin of failure into two halves as equally as possible. One half is additional hit point damage done to the patient (which may be enough to kill him if he was sufficiently weakened by the disease); the other is additional penalty to the patient's chance to avoid a secondary disease attack. Unless the patient acquired immunity to the disease from which he is recovering, this should be considered a relapse; roll immediately for "exposure", skip any incubation stage, and reduce the virulence by two steps (if possible).

On a critical failure, use dice implosion to determine the margin of failure and then apply the FULL amount to BOTH of the hazards described above. NB: through a quirk of game mechanics, it is possible for a sufficiently-skilled healer to have a critical failure that has no ill-effects. Where this is the case, the referee should roll d20 for each penalty effect. Something bad should ALWAYS happen on a critical failure.

3G: Immunity Stage:

Once the patient enters the Immunity Stage, even though he may not yet have fully recovered, Healing is no longer required and can no longer benefit the patient. There are no shortcuts through the final aftereffects (other than magic, which is discussed below).

3H: Carriers:

A character's status as a Carrier can never be altered by mundane Healing.

Part 4: Cure Spells, Healing Spells, & other Magics:

4A: Exposure & Incubation Stage:

Healing magics work as usual on damage sustained. Any excess healing delays the onset of the Incubation Stage by 1 hour per "hit point" but this does NOT delay the onset of contagiousness. It is easy for characters of poor general health to become dependent apon healing potions and cure spells to delay the onset of a deadly disease; technically, this makes them carriers or plague-bearers - with all the social baggage that comes with the term. The relative ease with which "healing potions" (ie potions of Cure Light Wounds) can be brewed has been responsible for the outbreak of more than one epidemic when the healing potions have run out, and more than one town has been completely depopulated in days as a result. A protection from disease spell or potion taken prior to exposure can assist characters in avoiding infection.

4B: Active Stage:

Once a disease becomes active, the character receives only half the benefit normally received from Cure Wounds spells and Healing potions. The other half is used to repair damage caused to the disease by the body's attempts to fight it off. Since these attempts usually produce many of the disease symptoms, such as fever, the character may appear to worsen in condition as a result. This is expressed by applying the "healing" as a reduction in the character's accumulated progress toward the Recovery Stage (refer Relief and Convalescence (above)).

4C: Fever:

These types of magic can do nothing to help ease a fever other than helping to address the cause of the fever, as described in "Active Stage" above. However, the effects of Healing magic can be used to mitigate the damage caused by other treatments. There is an urgent need for a "Reduce Fever" spell, but so far no-one has been able to make one work. The best magical substitutes available at the moment are spells like Chill Metal. Endure Elements (heat) increases the sufferer's ability to resist the fever, increasing their threshold by 1¼ degrees as though the damage prevented was additional Con bonus.

4D: Coma:

Nor are there any spells of this type that can be used to bring a character out of a coma. Provided that the character's mental faculties have been restored from the effects of the fever that induced the coma, spells such as Telepathy may at least permit contact with the mind of the sufferer.

Important note: One theory as to the cause of a Coma is that it's a psychological escape from the memory of the pain and suffering. Another is that the character's mind is trapped in a maze of confused thoughts that they can't find their way out of. Another is that the character is locked into some self-contained loop of thought. (These are all greatly oversimplified, and are not the only theories). If any of these three are true in the Referee's campaign, Telepathy or similar might permit the awakening of the character. Whether or not this works, and HOW it works, are up to the Referee.

4E: Recovery Phase:

Once the character enters the Recovery phase, Healing potions and magics in general have their usual curative effects, and can accelerate the recovery phase remarkably. Once a character's HP damage is fully healed, any remaining Healing may be applied to temporary stat losses; divide the remaining HP of healing by the maximum result of the character's average hit die (ie if the character has only levels of Cleric, they would divide by 6, because a Cleric's hit die is a d6; if the character had 8 levels of Cleric and 4 level of fighter, they would use (8x6 + 4x10) / (8+4) = 88/12 = 7 1/3, rounds down to 7. The healing divided by this "hit maximum" is the number of points of temporary stat loss that are healed by the magic. These recoveries are handled in the usual sequence.

'Permanent' characteristic losses can only be recovered through the use of a Restoration spell, as can any Charisma loss that results from scarring. This does not remove the scars, but it does make them less angry and repellent. However, the character also loses any intimidation bonus due to the scars.

4F: Immunity Stage:

Healing magics have their normal effects during the immunity stage.

4G: Carriers:

A character's status as a Carrier cannot be altered by low-level Healing magics such as those found in potions and Cure Wounds spells; only Heal or Wish spells are powerful enough.


The measures detailed in this article are intended to tread a fine line between handicapping PCs and disabling them, while maintaining the mortal terror that disease can introduce amongst those less well-endowed. Certainly, these rules render disease a serious-enough problem that they will make PCs apprehensive whenever they meet a stranger, and certainly impact on the treatment strangers receive on entering a new town or village. They are more realistic without harming the fantastic nature of the game. And, because specifics are discussed for each stage of progression of a disease, it is easy for a referee to dial the danger level up or down to suit themselves.