Hygiene and Disease in Medieval Cities

[pwykersotz]

I was watching this video today, and it got me thinking. Do many of us use data like this to create our medieval cities? Or do we just assume a whitewashed version? Or do we bother to come up with magical explanations for why people would have realized this stuff? It certainly makes it understandable why the Clerics of the church would be in business if you just operate without a basic understanding of hygiene.


https://www.youtube.com/watch?v=cba7di0eL8I&list=PLhyKYa0YJ_5Aq7g4bil7bnGi0A8gTsawu&index=54

I myself tend to use a whitewashed version unless the campaign centers around it. Most of my stories are a more journeys of heroes rather than historical simulation. Still, I'm wondering if there's any value to be added by making society a bit less modern in mindset.

[Safety Sword]

In my experience, any time you try and use D&D to simulate anything, it turns out badly.

It works quite well as a role playing game though, I hear :smallwink:

[pwykersotz]

In my experience, any time you try and use D&D to simulate anything, it turns out badly.

It works quite well as a role playing game though, I hear :smallwink:

Hahaha, this is true.

There is an element though, a large one, of theme. A populace spread thin because disease ravages major towns to a net loss of life is also vulnerable to monster attacks. This could be a powerful campaign driver and an interesting mindset to roleplay. I'm not saying that we should draw up disease stats for cholera or anything, but given how hygiene changed the world, I do think it's worth considering. At least as an intellectual exercise.

[georgie_leech]

Worth noting that between magical disease that require curse removal to treat and diseases coming from swamps rather than cities, the miasma theory might actually hold true in D&D land. Nothing says D&D cities have to suffer the net negative natural growth the real life cities had.

[Safety Sword]

Hahaha, this is true.

There is an element though, a large one, of theme. A populace spread thin because disease ravages major towns to a net loss of life is also vulnerable to monster attacks. This could be a powerful campaign driver and an interesting mindset to roleplay. I'm not saying that we should draw up disease stats for cholera or anything, but given how hygiene changed the world, I do think it's worth considering. At least as an intellectual exercise.

The new spells "Summon Disinfectant" & "Conjure Ethanol" are going to get a workout.

"Leomund's Portable Steam Sterilizer"... I could go on... I won't.

[mgshamster]

I've thought about bringing in disease in to my settings many times. As a toxicologist, it's something I'm keenly aware of. (I've also wanted to make the poison rules more realistic).

However, it makes the game that much more complicated and it's very unheroic to simply die of disease. So I ignore it and handwave it away with the healing magic available. The only time I bring disease into the game is when it's used as a plot point for the PCs. Otherwise, it's ignored.

[Nicodiemus]

I soooo wanted to see "Leomund's Port-o-potty"

[mgshamster]

Worth noting that between magical disease that require curse removal to treat and diseases coming from swamps rather than cities, the miasma theory might actually hold true in D&D land. Nothing says D&D cities have to suffer the net negative natural growth the real life cities had.

One thing I've found fun to do is make many pseudoscientific theories of old be real. Maisma and homeopathic remedies can be fun to explore in fantasy.

[Fishybugs]

One thing I've found fun to do is make many pseudoscientific theories of old be real. Maisma and homeopathic remedies can be fun to explore in fantasy.

A potion vendor with a healing potion diluted to 1:10,000?

Talk about a rip-off. Oh, we were.

[georgie_leech]

A potion vendor with a healing potion diluted to 1:10,000?

Talk about a rip-off. Oh, we were.

I dunno, I could see a market for Assassins wanting a cure or antidote for those pesky healing potions. :smallbiggrin:

[Laserlight]

My campaign is set in AD 1600 Yucatan. I wanted the PCs to be able to explore ruined cities, and "population dropped 90% due to imported diseases and war" sounds like a plausible reason for those cities to have been deserted. So, disease is important--but primarily in the backstory. I haven't had them catch yellow fever or malaria.

Yet.

[RickAllison]

I dunno, I could see a market for Assassins wanting a cure or antidote for those pesky healing potions. :smallbiggrin:

I like the idea of making the party dwarf test out any concoctions :smallwink:

[bid]

One thing I've found fun to do is make many pseudoscientific theories of old be real. Maisma and homeopathic remedies can be fun to explore in fantasy.
4 humors, spontaneous generation, sympathetic connections.

[mgshamster]

4 humors, spontaneous generation, sympathetic connections.

Humors! That's what I was trying to think of and couldn't remember the name. I knew phlegm was in there; kept looking up miasmas and phlegm and was getting nowhere. Two different eras of medical thought.

[bid]

Two different eras of medical thought.
Miasma and humors both lasted from greek to 1800s.

1840s: https://en.wikipedia.org/wiki/Ignaz_Semmelweis#Discovery_of_cadaverous_poisoning

[mgshamster]

Miasma and humors both lasted from greek to 1800s.

1840s: https://en.wikipedia.org/wiki/Ignaz_Semmelweis#Discovery_of_cadaverous_poisoning

So it was! Look at that. Thanks for the correction.

[Mrmox42]

I have always used diseases and the general unclean state of human cities as a stable of my campaigns - but always as something that 'just is there' in the background. The players simply considers the unhealthy conditions to be 'normal', and are only reminded of them when they return from long journeys in the wilderness, when visiting those ultraclean elvish cities (yuck), or similar situations.
Sometimes major diseases break out and kill a lot of people, which courses major disorder, war, invasions and monsters to appear. And Thus: adventure hooks!

My campaigns are quite grim and gritty, but my players love it.

[MaxWilson]

I was watching this video today, and it got me thinking. Do many of us use data like this to create our medieval cities? Or do we just assume a whitewashed version? Or do we bother to come up with magical explanations for why people would have realized this stuff? It certainly makes it understandable why the Clerics of the church would be in business if you just operate without a basic understanding of hygiene.

I think D&D is better when you take advantage of the fantastic nature of the world to inflict some more... fantastic diseases. For example, I find this blog post inspirational: http://www.lastgaspgrimoire.com/does-this-look-infected/


After any encounter where you take a flesh wound, roll under your Constitution. If you fail you have contracted an Infection, which probably won’t slow you down too much but it’ll be really icky. If you roll an ultimate-fail 20 that’s not infected, you’ve gone and caught yourself a Disease.

Here's one of the diseases:


Fingers, fingers everywhere. They start as bony nubs but they emerge soon enough, calloused, without fingernails, twitching and catching on things.

Enough body horror and pretty soon Paladins and Lesser Restoration will become popular among your PCs, and among society in general. In fact you could make it a thing for each city and town to have diseased beggars with diseases pulled off that table, whom the Paladin can go and cure by laying on of hands.

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One thing I've found fun to do is make many pseudoscientific theories of old be real. Maisma and homeopathic remedies can be fun to explore in fantasy.

You simply must read this post then: http://hackslashmaster.blogspot.com/2015/10/on-doctors-craft.html

How to cure wounds without a paladin around:


3) The disease is spiritual, and as such, will continue to haunt you. The cure is deglove your own face and then to take the face of another and exchange them.
1: The disease isn't cured, because the face of the person you used was more wicked than yours.
2-3: The disease is cured, but the new face transplant doesn't hold, and you have no face. This causes you to lose 6 Charisma (minimum 3) and without eyelids or lips, your face dries out quite frequently. Your vision is clouded, everything is treated as if it is in dim light.
4-6: Success! it will take some time, however to get used to your new face.

[LordVonDerp]

Miasma and humors both lasted from greek to 1800s.

1840s: https://en.wikipedia.org/wiki/Ignaz_Semmelweis#Discovery_of_cadaverous_poisoning
Yeah, belief in the four humors killed George Washington.

[Daishain]

Even in a low magic setting, the magic that does exist provides an easy means of both determining safe hygienic practices and dealing with the fallout when they prove insufficient. Just going by RAW class features there are many low level means of curing diseases with a simple touch. Since the base classes don't come anywhere near representing all of the magic in the world, one can easily assume that someone dedicated to the practice of medicine in this world would have access to even more efficient means of treating patients, even if it is just as simple as a cantrip that with repeated use makes the symptoms survivable until the body deals with it on its own or a more powerful magic user is found. Since realistically every village of notable size is going to have a healer of some stripe, there are going to be few people in the world without access to such treatment.

Given that there are also highly practical reasons for efficient waste disposal (no one wants an otyugh to nest nearby), the people of the worlds we run are liable to be in a fairly strong position on this front

[pwykersotz]

Even in a low magic setting, the magic that does exist provides an easy means of both determining safe hygienic practices and dealing with the fallout when they prove insufficient. Just going by RAW class features there are many low level means of curing diseases with a simple touch. Since the base classes don't come anywhere near representing all of the magic in the world, one can easily assume that someone dedicated to the practice of medicine in this world would have access to even more efficient means of treating patients, even if it is just as simple as a cantrip that with repeated use makes the symptoms survivable until the body deals with it on its own or a more powerful magic user is found. Since realistically every village of notable size is going to have a healer of some stripe, there are going to be few people in the world without access to such treatment.

Given that there are also highly practical reasons for efficient waste disposal (no one wants an otyugh to nest nearby), the people of the worlds we run are liable to be in a fairly strong position on this front

Are there really methods for determining safe, hygienic practices? What in the books allows that? Detect Poison and Disease is great, but it's only within 30 feet, and it doesn't say it gives any insight into the source of the disease, merely finds its presence. And only a fully blown Priest can use Lesser Restoration, an Acolyte cannot. A medicine check is similarly limited. And given how long it took us and how effective the powerful servants of the gods are at curing disease, I'm not sure there would be even as much intellectual curiosity as we had in reality when investigating these things. I think it would be more likely that disease would be viewed as deific disfavor or the like.

As noted in the OP, I've never made disease a big thing in my campaign before, so by default I've run with those same expectations. The thing is, I've been considering that some richness to the world might be added with a few scattered medieval problems. I'm not talking about making every kingdom a cesspool or making the players make Con checks every day they drink water, but I am looking for an excuse to simulate something, not an excuse to avoid it.

MaxWilson, thank you for the resources, I don't have time to go through them today (I have a game to run), but I will shortly. :smallsmile:

And I do love the humors and miasma being real. I've always loved how D&D takes the outdated pseudoscience or explanations of how the universe works and made them reality.

[Daishain]

snip
There appear to be a few items of import you're discounting:

-by RAW. diseases can be easily cured by level 1 paladins, whose magic abilities are principally fueled by devotion rather than training, inborn talent, or even a connection to the gods. This fluff suggests that many people could adopt this one ability without a great deal of difficulty. The hedge doctor variant of lay on hands may be less efficient, but that isn't a notable problem.
-even if the above were not the case, the spells in the book do not cover even 1/100th of the magic in this world, and merely represent a small sample of the more common items used by adventuring types. A cantrip or ritual related to Spare the Dying which treats diseases (though does not cure, at least not immediately) is very easily within the realm of speculation
-Knowledgeable and benevolent beings exist which can be consulted on matters such as "how do we prevent X from spreading?", and are liable to tell people about this kind of thing even if none ask. At the same time spells exist which allow for information to be gleaned about most subjects. Whether or not the society is scientifically inquisitive matters little. The information is at their fingertips, and sooner or later they'll have reason to reach for it.

[Sigreid]

Well, seeing as how the point is fantasy, whether the streets run ripe with muck or not varies city to city and sometimes neighborhood to neighborhood as I tend to use that as a clue that you're going into the poorer/rougher part of town. The streets are filthy and miserable when the inhabitants are filthy, miserable and dangerous.

[MaxWilson]

There appear to be a few items of import you're discounting:

-by RAW. diseases can be easily cured by level 1 paladins, whose magic abilities are principally fueled by devotion rather than training, inborn talent, or even a connection to the gods. This fluff suggests that many people could adopt this one ability without a great deal of difficulty.

Or, it suggests that even a level 1 paladin is a remarkable individual of unusual purity and sincerity in his beliefs, who will make a great difference in the lives of a great many lepers even if he never slays any dragons.