One Fifth

Eric Lis

Dr. Eric Lis is a physician, gamer, and author of the Skirmisher Publishing LLC sourcebook, Insults & Injuries.

One of the big news items of the past few weeks has been the release of 5th edition Dungeons & Dragons. My copy of the new Player's Handbook came in the mail a day or so after the release and I skimmed through it over the course of a few lazy hours and a few cups of tea. I won't go into detail here on what I generally think of the new rules and changes, because that isn't what anyone is here for. What I am in a position to comment on is the role that illness has within the game. While we're still waiting to see what the rules for diseases will be when the new DMG comes out, the Player's Handbook gives us one interesting thing to look at: the Contagion spell.

Contagion is an old favourite of mine. It's a nasty and versatile spell with a lot of different uses. In Insults & Injuries, we came up with a variant version of the spell which reflected its ability to cause more realistic illnesses, and while our version was far from perfect, I was always very proud of it. In fifth edition, the spell has undergone some meaningful changes. It been made much simpler, and in some respects it's become even more versatile. In 3rd edition, Contagion afflicted a creature with one of several possible diseases, but in essence, the spell was a quick and easy way to cause a little bit of ability score damage, which means that the spell was useful, but not particularly original. A small number of diseases had some sort of twist to the, such as the possibility of causing blindness or dealing damage to two ability scores instead of one. There was no great logic behind why you might be able to do 1d8 points of dexterity damage but only 1d4 points of constitution damage with the same spell. Two diseases were capable of damaging strength but none of them could affect charisma. Granted, to me, the spell's eccentricity and lack of internal consistency was actually one of its charms, because it's actually reflective of the ridiculous unpredictability of real sickness, but from a game mechanic view, it didn't make loads of sense.

In 5th edition, the spell is wholly different. Now, the afflicted creature contracts one of six possible diseases. Each diseases causes a target to have "disadvantage" on checks related to one of the six primary ability scores, meaning that for the duration of the illness, whenever the creature to make, say, a roll based of strength, they roll 2d20 and keep the lower result. While this isn't game breaking, it's potentially deadly and I think it really puts fear into a player's heart far more than a couple of points of dex damage. To make each disease a bit more interesting and individual, they all have a secondary effect: direct combat penalties, blindness, vulnerability to damage, confusion, or stunning. Contagion goes from being a straightforward ability-damaging spell to a highly versatile, highly variable, and highly debilitating weapon.

Contagion has had a few other changes made that are worth considering. In 3rd edition, Contagion could be cast by both divine and arcane spellcasters, although it was a 3rd level spell for divine casters and a 4th level spell for arcane casters. In 5th edition, Contagion is no longer found on the spell lists for wizards and sorcerers, and it's now a fifth level spell for clerics and druids. This change reflects just how powerful the game's designers seem to feel the new spell is. The decision to remove it from the basic arcane spell list reflects how spells that affect nature and the body's processes are much more clearly the domain of divine casters in 5th edition, but also serves simply to make Contagion a more obscure and less common spell. This makes sense to me, because to me, anything that inflicts horrific disease should be rare, so that it doesn't become commonplace and lose its ability to frighten players.

On a related note, it's interesting to see that although Contagion made it into the new PHB, it wasn't one of the spells included in the free version of the D&D basic rules posted online by Wizards of the Coast. On a further related note, the new list of official diseases isn't included in the free version of the DMG, so we'll still have to wait another month to see what sickness looks like in 5th edition. 

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 September 6, 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