Modernly Medieval Medicine

Part 2 of Series "Medicine, Malaise, Herbs & Healing"

Now with a disease on the loose, thanks to Part 1 of this series all about magically mutated disease outbreaks, the next thing we need to look at is how would the party go about investigating that. What ways could the disease be investigated, broken down, examined, etc in order to find out what is truly going on. Once the answer has been found we then also need a way for the party to create some sort of treatment for this disease. All of that is obviously going to need some rules and framework built up for the PCs to go hog wild in.  For the purposes of this particular post we will just be looking at the mundane and the medieval scientific side of medicine. I promise a post about magical healing is a part of this series but for now lets just jump in.

To get some good insight into what we have to work with in terms of medieval medicine here are a few sources that I tend to pull alot from - CrashCourse, Vlogs of Knowledge, Library of Congress, The MET, The British Library, Charaka Samhita, Neijing Suwen, Hippocratic Corpus, US National Library of Medicine, Canon of Medicine, The Trotula and probably lots more whose names and links just escape me. For medicine within a TTRPG system we look to - actually all I found when I tried to source things were people talking about how underwhelming and underpowered the Medicine skill was so as far as that nothing really helpful. I have found quite a few sources chatting away about the diseases themselves and how they play out (see Part 1 for some of those), but not the treatments so guess I'm claiming the spot on that then. BUT the part of the Medicine skill we will be focusing on today is the tiny part of the single sentence that says it can be used to 'diagnose an illness' is linkable so enjoy. For some added fun I'll probably be mashing in some things from Briar's Book (Circle of Magic #4) and the entire world that Tamora Pierce (I love you so much thank you for creating beyond fantastical books) has built because it shows a great example of what we are going for here in a way that gives legs to our soon to be framework.

So to get us started lets take a look at what IRL techniques at the time they had to research diseases for our medieval times. For the most part autopsies were still illegal and you got into alot of trouble for performing one. Towards the later part of this era special cases were made for educational purposes on criminals in a gallery style setting. Those pictures are honestly super creepy to me so go google them yourself if you are interested. Most things knowledge about sickness were therefore just from observation and commonly accepted medical texts created from the observations of others. This often lead to contradicting theories based off of the principle medical ideology they were using and wildly wrong assumptions. For the most part most ideologies were based off of the idea of things in the body that when they became out of balance created sicknesses and diseases. Pretty much research just didn't exist the focus instead was on treating the observable symptoms, so real life isn't much help to us here at least in this time period.

When it comes to modern medicine one of the most difficult things that you can do is research diseases. I mean like really ya'll it makes me dizzy reading up on some of this stuff. The biggest problem being that how you go about it can change drastically depending on the circumstances of the outbreak, the disease and even or policy of the location the outbreak is taking place in. To kind of help gloss over things without going into some sort of the thesis paper that I am by no means qualified to make I'm going to give a rather generic breakdown of what would be considered the most base typical procedures you might see during an outbreak of a new disease or disease mutation.

In our modern time data is a huge plus to any sort of research, this of course still holds true. Information on who is getting sick, where the sick have been (live, work, shop, etc), lifestyles, environmental factors (water, food, air) and just about any data point you can think of. The problem for us is the sheer amount of data that places like the CDC gather for such outbreaks you really and truly need a computer to crunch through. Outside of information we of course have samples that can be tested. Samples from the sick would include things like blood, stool, and saliva while samples from the environment might include soil, water, food, rodents/wildlife. This isn't to say possible samples are limited to these just that these are often time some of the most useful. These are also factors we will be focusing on for our system. To finish off our kind of research cycle for modern times is alot of tandem lifting between identification and testing. Researchers use patterns from the data and the samples to try and identify where the disease came from and how it spreads, as well as its structure. Alot of the particulars of the testing aspect are beyond me as I did after all take both of my degrees in a decidedly not biological direction. The bits that are important to us though is that cycle of both identifying and testing working hand in hand.

It is also important to not that in today's time we also have a system in place set up just for dealing with and containing outbreaks. There are protocols for quarantine, protocols for gathering and handling samples, protocols for handling and caring for the infected, protocols for testing cures, and protocols for administrating those cures. Unfortunately these aren't a standard set all across the board on everything BUT we can get some nice overviews of simple version we can later incorporate into our framework.

Since these are our two ends of the scale we will try and find a cozy spot in between that is useful to our players while still fitting into the world we have built up. More on that in a minute, but first we need to talk about the elephant in the room. That's right, magic. Not only are we dealing with a disease tainted by magic we also have magic available to us to try and suss things out.

To help us figure out what the halibut is going on here with magic there are a few things we need to discuss. Mainly the spells Detect Magic and Identify, I know that last one seems a bit odd given what we are talking about but stay with me. First our most powerful spell in our toolbox by default is Detect Magic as upon casting it you'll know the School of Magic that is corrupting the disease sample. Now we can get a little wonky when we have a disease with multiple Schools of Magic adding to its corruption. With auras that are tangled together it may be hard to suss out what all is going on especially considering that the disease sample being examined is probably very small at best. I'll talk more about that when we go over our framework of rules for research. Then because I know someone is going to try and use the standard Identify spell on this since we are talking about players here lets get something out of the way. Its not helpful. Its not a magic item like a tome or a sword. This magic is corrupting on an atomic level that doesn't give casting or buffing ability. It just destroys bodies and gives horrible symptoms to those infected. HOWEVER we will be creating a variant of the Identify spell that will help us out in our research.

Examined some IRL examples of how disease research is handled? Check. Examined some spells that the players might try? Check. Now lets get into what disease research in game will look like for us. We will try to keep the crunchy bits in the post light but there are several things we need to take care of. For this lets think of the research frame work in three broad terms - Finding the disease or the infected, Collecting samples, and running Testing to help identify aspects of the disease. Sounds good so far but lets remember we are working with mostly medieval instruments and magic, so we have some limitations. To help out with that we have a bit of homebrewing to do for a couple of spells, some items, and then of course the greater framework I keep mentioning.

To find sick people who are already showing symptoms will be easy. A simple matter of Perception and Investigation checks. You can even add Survival to try and track back infected people from where you found them to see if you find more infected, or unfortunate folks who might be infected. Alot of this part is going to be skill checks and RPing. You'll need to interview and talk to people both sick and healthy. This part is the first puzzle bit your players are going to encounter, so the longer they do this the easier finding signs will be. Especially once they get enough samples to start testing because they'll know the disease enough to more easily spot it. Those who know medicine can roll to examine people to see if they see signs or symptoms of the disease that have been discovered or observed. A heavy note taker in the group will be really useful for this as they can be the source for data that is used to start honing in on the source and patient zero.

We talked about it a bit in Part 1 about how easily some of these disease can be transmitted between creatures. Scarily easily if you remember. So how someone collects them could put them at great risk to catching the disease if its not gone about properly. Things like masks, gloves, and even magical protections are great ways to protect during collection. I am going to pull in some Circle of Magic knowledge here finally, I know you've been waiting for it. SPOLIERS blah blah blah blah SPOILERS. In the story the use a process of coating one's self in a kind of magic potion brew and a sort of magical steaming after coming in contact with samples. They also don magically protected clothing that is disposed off as they leave and the space is magically scrubbed again through a much more intense version of this steam/shower scrub. Magic is literally coating everything they work in with protection and containment magic. So it is highly suggested that the party take similar precautions. Depending on the size and wealth of the place infected they may have healers, casters, and clerics on hand able to provide the group with protective garments, containers, etc.

Now there are 4 main things we will be using to collect the samples that I'll talk about in a second. But I also want to mention the way these samples are stored for transportation and while waiting to be tested is important. Think about the diseases I gave as an example so many of them can be transmitted through contact with bodily fluids or contaminated objects. Again my suggestion is to have either a larger satchel or container that holds the separate samples heavily spelled, wrapping the samples in a protective substance or spell, or both. Heck maybe you as a DM want to create lore about something in particular for your campaign especially if you will be dealing with outbreaks often. I do want to point out that storage and transportation are important not just for not getting your fellow PCs sick during all of this but because if you cross contaminate your sample it might be useless or give you false information. I'll let the DM decide how to add that bit in cause everyone needs some fun creating rules.

Swab, cloth, vial and jar are the main ways we will use for collection.  Swabs and cloth you use to soak up a liquid of some kind - good for saliva, blood, etc. A cloth can also be used to wrap small physical samples like stool or a dead rodent. Vials and jars are more multi-purpose as they can be used for stool, soil, and larger physical samples or for larger amounts of liquid samples like blood. This isn't to say any of these are limited to just my examples for collection but please use the logic behind the examples. Think modern day crime scene investigation or how autopsies are run.

I might have mentioned that we would be creating a variant of the Identify spell to help things out, I don't know if you remember that it was so long ago. But here it is folxs - for the things we are identify the scale that they are at is minuscule compared to the things our normal Identify spell works superbly on. The concentration and training it would take to focus on something that small and try and suss out any kind of magic is going to take a deft and delicate touch. It would put an incredible amount of stress on an Arcane user and would therefore be limited in how often it could be used. There is also a chance that at that scale what you think you saw isn't actually what you saw, researchers get it wrong all the time. That is all a pretty nice lead up to the idea behind this variant so I want tease you with anticipation any longer.

Identify - Disease Variant

Must be proficient in medicine to use.

• Level - 3rd
• Casting Time - 5 hours (ritual)
• Duration - Instantaneous
• School - Divination
• Range/Area - Touch
• Attack/Save - CON Save (based off of size of sample)
• Components - V, S, M (a pearl worth at least 100gp ground up, an owl feather, a sample)
• Damage/Effect - Detection

You choose on sample that you must touch throughout the casting of the spell. On a success you learn one school of magic affecting the sample, if any, and what it does. On a fail you know only if magic is affecting the sample. The sample and half of the ground pearl (50GP) is consumed upon casting. To determine the CON Save of the sample please see the chart below:

(when I say flask in this contents I mean like the thing we see healing potions come in like THIS)

Swab (a small bunch of cotton or similar material to soak up a sample): 18

Cloth (a square of cotton or similar material to soak up a sample): 15

Vial: 18

Half a Flask: 15

Full Flask: 12

Jar: 10

For our Detect spell the same DCs for the samples apply. However since you see all of the magic involved at once for every additional School of Magic in a single sample you'll need to roll an Arcane skill check to see if you can distinguish more then one of them from the rest. Do this for every sample size BUT the jar if it is more then halfway full of the same sample source. As an example if I was trying to Detect on a swab sample with 2 Schools of Magic corrupting it (first that would be a very bad day disease indeed oof) I would cast the spell, the DM would roll the CON save for the sample and if successful I would then need to 2 Arcane skill check. For the DC on those I'll let our happy little DMs decide but my suggestion is start with a DC 12 and add for each one you are trying to discern out of the mix after that.

Now that is the spell options we are giving are out of the way but what about those who have proficiency is the medicine skill and can't cast a 3rd level spell? Well there are a couple of times that could be helpful to them. One will be a spelled crystal disc that will help magnify aspects of the disease. The other will be a riskier burn test that has a possibility of instead of helping to identify releases the disease into the air possibly infecting those in the room.

Burn Test - a special candle is prepared layered to represent each School of Magic via a colored wax and a carved rune. A DM can call for a roll to see the skill with which the candle is made and augment the color distinction, uses available per candle, etc as seen fit. The candle takes 250GP to create and is consumed after 2 uses when created properly. A sample is held over the flame after it is lite and burned, the colored smoke released will then be of the color made to represent it on the candle during its creation. (See why distinct colors matter?) A burning sample has a 5% chance of releasing the disease into the air to infect those in the room on a fail CON Save of 12. The chance this happens raises by 5% and +2 to the CON Save for each size up the sample is from the swab.

Magnifying Crystal - Allows a non-magical aspect of the disease (a way it is transmitted, effects on the body, incubation, etc) to be relieved to someone proficient in medicine during a skill check. The aspect or degree of detail from that aspect gained is decided by the DM based on the skill check roll.

I'm going to be honest IRL treatments in the good old times of our Medieval history were not pretty. Alot of it involved bloodletting, sticking holes in skulls, drinking mercury and other such nonsense that makes most of the modern more sensible of us go WWWWWWWWWWHHHHHHHHHHHYY~! They believed that you were sick because you were out of balance, which is both horribly wrong and also right but not in the way they thought. To them it meant you needed to drain things to correct the ship back to the heading of being healthy. Also in a strange twist of things if that didn't work then in meant you needed to suffer for some greater purpose so maybe doing something that caused you to suffer might help your healing. Again all of this is a giant gloss over but there are plenty of things linked above and through other sources that you can read up on if interested.

The thing we are going to focus on rather then this creepy blood drain deal is that they had to use local plants to create medicines. We won't go into detail on HOW to create those medicines as that is another post in this series all to itself. But we will discuss its impact and use. Since things were source from nature what time of the year, how that season had been, and your location effected what was available people had to be very creative and find multiple things that provided the same benefits. We can see this in the fact that even today we say that ginger, rosemary, tumeric and green tea all help with inflammation to various degrees. Which means if we were making something for a patient to take who was experiencing gout symptoms these could all be things that we fell back from depending on the factors mentioned. It lends itself to alot of room for creativity, variety, and preference for solutions. However it also means that the amount of knowledge needed to treat using even something like ginger is crazy. A simple google search shows it can help with at least 11 things (please be wary of using such sources for IRL situations, always consult with a doctor, but in game situations we don't need to be so picky with). So someone would really have to focus on herbalism in order to gain proficiency in it, and would still definitely have room to continue learning and experimenting as they came across new things. Even strange things can be used, like harnessing a poisonous snake bite to target particular cells in the body that have gone off. (Inspiration from the fact that rattlesnake venom was used to create something that targets and kills cancer cells)

We've examined real life for what we can steal and twist from it. So what does creating a medicinal treatment for our corrupted and mutated diseases look like? Well alot like using the scientific method to create batches of possible treatments, test them on a sample, refine over and over again on progressively bigger and bigger samples before finally testing on a volunteer. I'm going to save the more detailed part of this bit for the Healing post in this series since we are in fact going long once again. The idea here is that learning about the disease and curing it isn't going to be a single encounter or a single session kind of deal. An outbreak will take alot of trial and error to start righting the ship, it is going to have alot of opportunity for curve balls. The disease might even mutate further and knock you back maybe just a peg or make you completely have to restart. Don't be afraid as a DM to really lean into things and make this a full story and experience.

With that little rambling over with, I’m JustKay your regular DM Dalliance on the web and I’ll see you next post.