Disease in Fantasy

And now was acknowledged the presence of the Red Death. He had come like a thief in the night. And one by one dropped the revellers in the blood-bedewed halls of their revel, and died each in the despairing posture of his fall. And the life of the ebony clock went out with that of the last of the gay. And the flames of the tripods expired. And Darkness and Decay and the Red Death held illimitable dominion over all. – Edgar Allan Poe, The Masque of the Red Death

I have an annoying cold today, which, along with an episode of Vikings, inspired tonight’s topic.

Most of us who enjoy the benefits of modern civilization cannot quite fathom the  impact that disease once had. Disease has done far more to hold the human population in check throughout history than war. Times of plague could shape an entire narrative in a Fantasy world, especially when superstition and the politics of ignorance come into play.

The black death is perhaps the most famous of ancient diseases. It is best know for ravaging Europe, peaking in ~1350, a brutal time that is well recorded, but current theories have it originating  in the east and travelling along the silk road, the great east-west trade route that loosely tied Europe, the Middle East. the Orient, and Africa together. It reduced the world population from ~450 million to 375 million or lower, with a fatality rate of 30% or more at this time. Other outbreaks were reported, including a period in the middle of the eighth century that may have been just as bad. These are just general figures, but we don’t need to be exact to see how such an occurrence could be the centerpiece of a work of fiction.

In men and women alike it first betrayed itself by the emergence of certain tumours in the groin or armpits, some of which grew as large as a common apple, others as an egg…From the two said parts of the body this deadly gavocciolo soon began to propagate and spread itself in all directions indifferently; after which the form of the malady began to change, black spots or livid making their appearance in many cases on the arm or the thigh or elsewhere, now few and large, now minute and numerous. As the gavocciolo had been and still was an infallible token of approaching death, such also were these spots on whomsoever they showed themselves. — The famous quotation from Giovanni Bocaccio’s Decameron about the symptoms of the black death.

The Black Death had several interesting consequences. Naturally fanatics bloomed in many areas that suffered, seeking to blame the spread of the disease on whatever local group most offended them, feeling that the disease must have a divine origin. While it is a sad comment on human fallibility that these acts became common, this sort of madness makes great fodder for stories. The plague his some nations much harder than others, greatly changing the balance of power. It also hit cities harder than rural areas, changing that balance as well.

Disease is underused in Fantasy. My favorite use of diseases in Fantasy, excluding diseases that make you awesome like vampirism or lycanthropy, and zombie based diseases, are found in the Elder Scrolls games, Morrowind especially. What I liked about these were the weird varieties of diseases that your character could encounter, each with its own symptoms and origins. Of course the fact that a simple potion or spell could rid you of most of them, made it less than arduous, but it was a nice touch. Many older tabletop RPGs had extensive lists of diseases, some of which could be the subjects of great quests to find cures.

Here are a few ideas to consider when using disease in a Fantasy setting:

  • What is the nature of your plague? Is the disease fatal, or just crippling in some way? Is it passed by fleas on rats, brought back by soldiers on crusade, or the result of the vicious spells of an insane cult? Is death quick or grim, blissful or horrific? In a way the disease is like a character in your work and should reflect the mood and themes you are trying to convey. The bubonic plague works much better for Grimdark than for a more pastoral fantasy.
  • How will people react to the disease? The emotional response of the characters to the disease is important to the story, and the attitude of groups and nations  to the disease is a key part of world building in a plague ridden setting. If fanatics lash out and blame, who will be there targets? If your world has visible, active Gods, what role do they and their priests play in the cycle of plague? What happens if the disease only targets elves? these are all rich considerations for story material.
  • How will the disease change how people live? If the population of the world dropped by half in a short period of time, things would change. Settlements and cities would shrink or be abandoned. Labour shortages could cause problems, but also create a rise in opportunity for those lucky enough to survive.
  • How will the disease alter the power structures? Some groups will use every opportunity that comes their way. If a kingdom is weakened by plague, another might decide to invade (which could, amusingly, increase the spread of the disease). A nation or guild might decide that keeping the cure to themselves is the key to power. Essentially you need to decide what changes the disease will bring to institutions as well as to individuals.
  • How will fantastic elements interact with the disease? How does the disease interact with magic in your world. If wizards hold the only cure they might become very popular and very powerful, but also make enemies. What happens if the disease interacts or changes magic somehow? The possibilities here are endless, but you should consider what effects the plague will have on the more unique and unesual elements of your world as well.
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