Talk Like A Pirate

Eric Lis
When we were planning out Insults & Injuries, we had to pick and choose what diseases we wanted to include and what we decided to leave out for the time being. As it says in the book, the most obvious things that got left out were diarrhea and sexually transmitted infections... both of which are currently expected to make it into our follow-up project. There's another area of illness that got left out for a few different reasons: nutritional deficiencies. Looking back, this is an oversight I would have liked to have changed, because it feels like a real gap in the book. Nutritional disorders are probably a much better problem for people in a fantasy world than heart attacks, strokes, and other things that are problems for us who live long enough to suffer from them. In a fantasy world, a lot more kids suffer from rickets, a lot more people have to learn to live with goiters, and perhaps most famously, a lot more sailors die of scurvy.
Also known as: Pirate's mouth
Ages: Any
Description: Scurvy is one of those rare illnesses which are extremely deadly and extremely preventable, and its death toll depends entirely on one factor: how well a society understands nutrition. In societies which have not yet identified the pattern between health and the consumption of fruits and vegetables, scurvy is a poorly understood and much feared killer of men, but in societies with access to a few limes and lemons, scurvy is almost unknown.
Scurvy is a disease cause by a deficiency of vitamin C, an acid used by most living races to build collagen, the most abundant protein in the body. If collagen can't be properly synthesized, the body loses its ability to maintain the structural integrity of its bones, tendons, blood vessels, and pretty much everything else. When someone suffers from scurvy, symptoms first appear in tissues that suffer a lot of wear and tear and therefore normally have particularly high rates of healing, such as the skin and gums. A sufferer begins by feeling tired and listless, develops red spots on the skin ("petechiae") from broken blood vessels, and before long develops bleeding from their gums. If the disease continues, the sufferers develops pains over much of the body, their teeth begin to fall out, confusion sets in, and death follows.
Scurvy is a disease seen almost exclusively in humanoids and not in other animals. Most animals synthesize vitamin C in their bodies, and do not require it in their diet. Humans, elves, and the majority of other humanoids do not have this ability, and so can develop the illness.
Mechanics: For every month that a creature lives without access to fresh fruits (lemons, kiwis, berries), vegetables (carrots, potatoes, cabbage), or some animal products (live), it must succeed on a Fortitude save (DC 10). The DC of this check rises by 10 each month. The first time that a creature fails this save, it takes 1d4 points of Constitution damage; this ability damage cannot be healed with rest unless the creature's nutrition improves. With each subsequent failed save, the creature suffers one additional point of non-healing Constitution damage, and takes 1d4 points of hit point damage that cannot be healed with rest. After three failed saves, all hit point and ability damage suffered by the creature from any source heals at only one half the normal rate, rounded down.
Treatment: Lesser Restoration and Restoration treat ability damage sustained from scurvy, while any Cure spell repairs hit point damage sustained due to the disease.

Most societies with a sea-faring tradition have discovered various herbal remedies which seem to cure scurvy, but few if any societies understand why these herbs are effective. A Heal check (DC 10) stops progression of the disease and allows the sufferer to heal normally. At the DM's discretion, the DC of this check may be increased in a society where no such herbal remedies have yet been recorded. This heal check is curative only if appropriate materials (i.e., fruit) is available, and may not be possible on a ship at sea, in a lifeless desert, or under other particular circumstances. 

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 December 1, 2013. 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