And Other References to Harry Nilsson

Eric Lis

Here in my workshop in Montreal, talk has once again turned to the hope of producing a 2nd edition of Insults & Injuries. I won't go into detail about it right this moment, as most of the decision-making is happening well above my level in the company, but my hope is that a good deal of exciting new content will make it in. Since "new stuff" is on my mind, allow me to invite you to join me as I draw up some rough notes for a disease never before covered in any role-playing game sourcebook to my knowledge: Lyme disease.

Lyme disease is a wonderful choice of for an illness to incorporate into your game. First off, Lyme disease is a condition which could very plausibly occur in a medieval fantasy setting. While Lyme disease itself has only really been recognized for about one hundred and fifty years and understood as a distinct disorder for less than half a century, there's decent descriptions of something that sounds like it was probably Lyme disease going back at least as far as the seventeenth or eighteenth centuries, and DNA from a five thousand year old mummy has shown signs that it was infected with the causative bacteria. Second, Lyme disease occurs in more or less the correct region of the world. Lyme disease has been reported in pretty much every country in the Northern hemisphere, but is particularly prevalent in the sorts of wooden regions which are so common in most European-influenced fantasy settings. Third, Lyme disease produces an interesting and unnerving array of symptoms, which means it can keep players guessing and off-balance as symptoms appear and disappear. Fourth, and not unimportantly, it's a disease that most of your players will have heard of, but probably aren't personally affected by and don't know much about, so if you choose to identify it with its common Western name then it'll capture their imaginations without so much risk of bringing up unfortunate memories. The downside to using Lyme disease is that it's a bloody complicated disorder; it has a lot of different potential manifestations and therefore could never realistically be broken down into the simple one or two Fortitude saves favoured by the two main SRDs. If you want to use Lyme disease in a game, it will take some effort, and most people don't like expending effort.

Lyme disease is a bacterial illness which is spread primarily by tick bites. In a fantasy game, this opens up a few different considerations for the disease. First and most obviously, any creature immune to infectious diseases is presumably immune to this one too. If it's spread by tick bites, a storyteller might reasonably rule that any creature with a natural armour bonus ism also immune to infection. Furthermore, since the disease is spread by an insect, any spells that affect insects could be used to increase or decrease the spread of an outbreak; Antilife Shell confers near 100% protection from infection, while any spell that controls insects could theoretically be used to weaponize it.

An infected creature goes through three stages of the disease. In the early phase, usually within the first month after infection, four out of five people will develop a red rash appears around the site of the bite that rapidly spreads outwards, often resulting in a sort of concentric ring or bulls-eye appearance. The remaining one in five infected people will have no outward signs that they now carry the infection.

The second phase of the infection can begin anywhere from days to months later. As the bacteria spread throughout the body, all sorts of different symptoms can appear. These range from the more common, such as flu-like weakness and widespread joint pain, to more rare manifestations, such as heart conduction problems potentially leading to death, or temporary paralysis of the facial muscles. In very rare cases, there are documented cases where Lyme disease appears to have caused memory loss and even psychosis.

In the third phase, the untreated illness enters a chronic state which can affect pretty well any system in the body. Identifying the disease at this stage can be difficult because it can cause such a wide array of symptoms, many of which are neurological and not usually associated with infections. The disease rarely reaches this stage in adventurers, most of whom will receive a Remove Disease spell long before, either due to earlier symptoms or for something else totally unrelated.

Treatment is Lyme disease is easy with magic and difficult without it. Lyme disease is instantly cured by Remove Disease, although a particularly nasty storyteller might rule that this spell only eliminates whatever bacteria are currently active at that moment, leaving a character open to developing symptoms again a few months later. If a creature makes it so far as to develop the third-stage disease and sustains permanent nerve damage, which typically manifests as ability drain, Restoration magic is needed to cure it. The disease tends to annoyingly be resistant to antibiotics, even if such specialized drugs are available in a campaign setting, and a creature will often have to take medications, with all their lovely accompanying side effects, for a month or more to eradicate the infection.

Perhaps the biggest challenge for the storyteller who wants to use Lyme disease in a game is deciding what to call it. Lyme disease is named after the region of the US where it was identified as a distinct disease, so this may not be an appropriate name in a fantasy world. The disease could certainly be known by the name of a region or city in the campaign setting, or else by the name of a healer associated with it. If the disease is identified as being the result of bug bites, its name might relate to that, or if it's named based on its symptoms, then the localized rash and subsequent weakness might easily lead to it being associated with vampires (which isn't entirely inappropriate, really). 

More than four years ago, Dr. Eris Lis, M.D., began writing a series of brilliant and informative posts on RPGs through the eyes of a medical professional, and this is the one that appeared here on June 15, 2014. Lis is a physician, gamer, and author of the Skirmisher Publishing LLC OGL sourcebook Insults & Injuries, which is also available for the Pathfinder RPG system