Dragonmarks: Modern Medicine

Could there be a pandemic in Eberron? A plague spread by the Children of Winter, or a bioweapon created by the nosomantic chiurgeons of House Jorasco? How does disease even work in a world where lesser restoration can remove any disease? Given events in our world, these things are on my mind and I thought I’d tackle them with a series of articles. This post will take a quick look at medicine in the Five Nations; a follow-up article will explore the role of disease and plagues in campaigns.

HEALTH AND HEALING

Fifth edition presents a largely abstract view of health. As I’ve mentioned before, hit points are a very nebulous concept—a blend of actual physical health and luck, skill, or willpower. A character can regain hit points by spending hit dice during a short rest, and is fully restored after a long rest. When you use the Medicine skill, all you need to do is role a die. But remember that when we play D&D, we are building a story together. The rules provide a foundation for that story, but it’s up to the DM and players to add the details. MECHANICALLY you’re as good as new after a long rest, and you don’t have to do anything other than hang out for eight hours to get that benefit. But if there’s a character with the Medicine skill in your party, you might tell the story of how that character worked to patch you up during that long rest—how they had to stitch up a particularly deep wound, how they gave you a shot of Irian-infused water to keep you on your feet or rubbed a Mabaran salve on your arm to numb the pain. When someone uses the Medicine skill or an herablism kit, they or the DM can DESCRIBE them as using medical tools or techniques, even if all the PLAYER does is roll a die. The point is that the rules keep things simple; we don’t WANT player characters to spend a long time sitting on the sidelines recovering from a sprained ankle or a broken rib. But you can DESCRIBE that process of recovery in as much detail as you want.

Also, remember that in fifth edition the rules that apply to player characters don’t necessarily apply to NPCs! YOU may recover fully after a long rest, because you’re the protagonist of the story; you’re the hero in the action movie who keeps pushing on after enduring ridiculous amounts of damage. But the DM can say that an NPC takes longer to recover from a serious wound—that a city guard will need days of bedrest to recover after being dropped to zero hit points, even if they were stabilized and healed. Player characters are remarkable. We can highlight this by showing that other people DO need more time to recuperate than player characters… or their particularly remarkable opponents.

JORASCO SERVICESR

In the Five Nations, most people rely on House Jorasco for medical services. As I’ve discussed in previous articles, priests in most temples and churches aren’t spellcasters; they provide spiritual guidance, not spellcasting services. So the Jorasco healing house serves the common role of a clinic or hospital in our world. Villages or communities that don’t have a dedicated healing house will still usually have a Jorasco-trained healer, whether it’s an heir of the house or someone who learned their skills from the Healer’s Guild.

Page 10 of Rising From The Last War lists the services you can obtain from House Jorasco. The first two are tied to the Medicine skill: Minor nonmagical care or major nonmagical care. This ties back to the idea that just because PLAYER CHARACTERS don’t have to deal with sprains, concussions, broken bones, and such, these things still exist in the world! Likewise, most people rely on nonmagical treatment for diseases. Lesser restoration provides an instant cure, but the 50 gp cost is beyond the reach of most commoners. But again: there’s nothing wrong with nonmagical care. The skill is called MEDICINE; it reflects the use of medicines and medical techniques—setting broken bones, disinfecting wounds, treating fevers, and on and on. Again, most player characters never need these things; but the common people do, and Jorasco provides these services.

Then we get to magical services. Lesser restoration costs 50 gp; remove curse is 75 gp; greater restoration is 150 gp. Who provides these services? What does this help actually look like? Here again, player characters are remarkable. The typical Jorasco healer isn’t a cleric; they’re a magewright. Per page 318 of Rising From The Last War, a magewright casts lesser restoration as a ritual that takes an hour and that requires “additional material components” that cost up to 40 gp. MECHANICALLY this is a “ritual that requires components.” But this is where the idea of arcane science enters the picture. I don’t see a Jorasco healer as sitting next to you chanting for that hour, and then POOF you’re healed. In my opinion, the “ritual” reflects medical work. They may be using divining rods and Irian salves instead of CAT scans and antibiotics, but they are starting with a foundation of mundane skill and then ADDING magic to accelerate the effects and perform healing that is impossible with skill alone. You can have the Jorasco chiurgeon shouting “I need a Lamannian rod and 5 cc’s of Mabaran moss, STAT!” as they work to break your curse or cure your disease. Likewise, the spell uses “40 gp of additional components”—but those components might be ENTIRELY DIFFERENT depending on WHAT they are treating. So: mechanically, a Jorasco healer can cure cackle fever or sewer plague by casting lesser restoration. But how they cure these two different diseases might LOOK entirely different. And once you accept the idea that different diseases require different components to treat them, you have the possibility that a Jorasco house could run out of the components needed to cure a specific disease! Now, refined Eberron shards can take the place of any costly component, and this can help with an outbreak; but if you’re in an isolated village, residuum could be harder to find than Mabaran moss. To be clear, this isn’t a concern for player characters. When your cleric casts lesser restoration it’s NOT a ritual and doesn’t require components… but again, that’s because player characters are remarkable!

How does the Mark of Healing factor into this? The simple answer is that most magewrights with the Healer specialty are assumed to be halflings with the Mark of Healing; they are able to master this specialty because they have the mark, and they are channeling the powers of the mark any time they cast their rituals. This is the same as the concept that you could play a Jorasco Life cleric who presents their healing magic as being drawn from their mark as opposed to religious faith. So they ARE using the mark to heal; it’s just that this uses standard magewright mechanics.

All of these same principles apply to the other services that Jorasco offers. Remove curse can be presented as a sort of magical infection. It’s not that the Jorasco healer mumbles for an hour and the curse stops; it’s that they perform a sort of mystical surgery, literally carving the curse out of your aura. While the RULES say remove curse never fails when cast on a player character, it’s still possible that it doesn’t always work on NPCs and that it’s normally potentially dangerous! Note that greater restoration is a 5th level spell—beyond the standard wide magic available in the Five Nations—and that Rising notes that only Jorasco’s finest healers can perform the ritual.

And finally, there’s raise dead. This is supposed to be a rare service, something available only at the finest Jorasco houses. This is typically tied to a focus item, the altar of resurrection. But there’s a number of points that have been spread out across various sourcebooks. The first is the idea that again, while Raise Dead always works on PLAYER CHARACTERS, it’s NOT reliable for NPCs! First of all, memory starts to fade as soon as a soul reaches Dolurrh. Someone has to CHOOSE to return to life… and if they’ve spend too much time in Dolurrh, they may no longer remember why they want to return. Even if they wish to return, sometimes the spell just doesn’t work. Sometimes it can restore life but draw the wrong soul back into the body. Or it may summon a number of hostile ghosts while leaving the corpse dead… or draw a marut that seeks to destroy the would-be healer. This is why wealthy people AREN’T automatically raised immediately after death; because for most people it simply isn’t a valid argument. What we’ve said is that IF a Jorasco house has the ability to raise the dead, they will always cast augury before raise dead… and if the proposed resurrection draws a result of woe, they will refuse to take the case. Essentially, raise dead is a tool that lets us bring player characters and crucial villains back from the dead; but it’s not a service for everyone! This is a topic I’ve discussed in more detail before: this article explores resurrection and alternatives to death, while this article considers the idea that you could add a personal price to resurrection beyond the components of the spell.

WHAT ABOUT FAITH HEALING?

As I’ve said: in the Five Nations, people don’t go to temples to be healed, they go to hospitals. But what about places like Thrane, where divine magic is more widespread? Or the Eldeen Reaches, where there’s more of an emphasis on primal magic than on the industrial magic of House Jorasco?

The Wayfinder’s Guide to Eberron discusses the idea of adepts, divine or primal counterparts to arcane magewrights. Page 127 of Rising notes that “divine adepts provide important services.” There still ARE Jorasco houses in Thrane, it’s simply that divine magic IS more widespread. You still wouldn’t go to the temple and ask the priest to cure you, but there are clinics tied to the Church of the Silver Flame where adepts can heal you. Such clinics can also be found in other nations, typically tied to adepts of Olladra; in the Eldeen Reaches, there are druidic adepts—often called gleaners—who may be able to perform healing rituals. The magic of an adept LOOKS different than that of a magewright; a Silver Flame adept will chant while they treat you, while seeking to excise malign influences with blades of light. But a critical point is that mechanically there’s no difference between an adept and a magewright, which means that this healing still takes an hour to perform and still costs the adept 40 gp. The components may be DIFFERENT than those used by the arcane magewright, but the point is that magically healing generally can’t be offered for free because it’s not free for the caster. In the Eldeen Reaches, it’s not that a druid spends 40 gp to buy components; it’s that the ritual consumes rare roots and herbs (likely charged with the essence of Lamannia or Irian) that would have such a value if they had to buy them. Usually people rely on the Medicine skill because magic has a price.

Q&A

Is the germ theory of disease known in Eberron? Or is there some truth to the humoral theory in a fantasy world where the four elements are more of a real thing than in our own? This would come into play in order to determine such behaviour as hand-washing and sterilisation of instruments or blood letting. For that matter, is there room for alternative medicines, rejecting that of Jorasco?

To answer the last question first, there’s DEFINITELY room for alternative theories and approaches to medicine. I expect that Riedra and Aerenal have dramatically different approaches to medicine. However, the crucial point is that MECHANICALLY this all works out to using the Medicine skill and to the benefits of resting. You can DESCRIBE it with exotic color, but at the end of the day it doesn’t MATTER if your healer is using Jorasco traditions or Riedran qi manipulation; the result is the same.

Going back to the first part of the question, this touches on an interesting point. Because it’s not simply whether the people of Eberron are familiar with germ theory, it’s the question of are most diseases in Eberron actually caused by germs? This is a world where werewolves, undead, and fiends are REAL THREATS. Lycanthropy isn’t caused by germs, and there could be any number of other diseases in Eberron that are actually cause by a mild form of demonic possession or by transmutation effects. There’s definitely a school of medicine that is based on the balance between planar influences, asserting that if you have a fever it’s because your Fernian influences are too high and you need to be treated with Risian ice… And in Eberron, that may be true. So there are germborne diseases in Eberron, but it’s not the ONLY form of disease out there and may not be the foundation of Jorasco treatment. I’ll talk more about kinds of diseases in the follow-up article, but the main point is, again, that this is somewhat cosmetic. Whether the disease is caused by a germ or an evil spirt, you counter it with rest, Medicine, or lesser restoration. These treatments are all tied to theories of medicine, but whichever theory you use, it will work according to the rules. Though you’re certainly free to say Bloodletting is a terrible principle that DOESN’T work, and while there are healers who perform bloodletting, they aren’t proficient in the Medicine skill and provide no actual benefits! Likewise, Jorasco potions of healing are reliable, but if you buy your healing potions from some unlicensed charlatan, you could find that all you’ve bought is snake oil. Trust that Jorasco logo!

Do the people of Eberron know how to prevent/treat scurvy or what it really is? 

This is similar to the preceding question, and could ultimately be asked about any disease from our world. But Eberron’s not our world. For all we know, the Ring of Siberys could radiate an aura of vitamin C, and it could be impossible to have a C deficiency in Eberron. There’s no rules for scurvy in 5E, and it’s never been mentioned as a problem in any sourcebook, so the default is that it’s not a problem—either because it’s been identified and people know how to deal with it, or because for some reason ((C-rays from the Ring of Siberys!) it’s just not an issue. I’ll talk about this more in the follow-up post, but the short form is that you need to decide what diseases you want to be threats, and ultimately what makes a good story. Personally, I don’t feel that players running out of oranges and catching scurvy is a story I want to tell, but that shouldn’t stop you from doing so!

If magewrights can carve a curse out of a person’s aura, was this ever suggested as a solution during the Lycanthropic Inquisition by Jorasco or the Silver Flame’s own minor healers?

Certainly. Under the rules of fifth edition, that’s EXACTLY how you treat lycanthropy: you cast remove curse, and if you’re doing it as a magewright ritual that means you’re performing just this sort of spiritual surgery. However, there’s a few factors here as regards the Silver Crusade…

  • Bear in mind that especially early on, I’m sure the templars DID cure people when they had the ability to do so. It simply wasn’t viable as an overall solution to the problem, based on resources, the number of lycanthropes, and the fact that you would have to capture and hold lycanthropes alive to do this—and especially in the early days of the Purge, the odds were stacked against the Templars. They didn’t have the luxury of trying to take most of their enemies alive; they were lucky if THEY could stay alive.
  • If you’re using magewrights or adepts, you need 60 gp worth of specialized components to cast that ritual. What are those components? Are they specialized to each type of lycanthropy (IE, you need to treat a wereboar with different herbs than a wererat), or general? It’s quite reasonable to say that when the Crusade began the templars didn’t have either full knowledge of proper treatment or that they simply didn’t have access to sufficient supplies of the appropriate components—and this was before the residuum revolution which lets you use refined dragonshards instead of any component.
  • Critically: Lycanthropy during the Purge was different from lycanthropy as it exists today. This is literally true, as the rules for curing lycanthropy in 3.5 rules are far more difficult that just casting remove curse. It either has to be done by a 12th level cleric within three days of the affliction (and 12th level clerics are VERY rare in Eberron) or it has to be attempted during a full moon… and the victim has to make a DC 20 Will save for it to work. Eberron gets a lot of full moons, but still, that’s a lot of time and resources for a ritual that has a very high chance of not working.

The simplest explanation for the change in the rules of lycanthropy is that lycanthropy itself has changed: that the power of the curse is now weaker than it was during the purge, because the influence of the overlord or daelkyr behind the surge has faded… or alternatively, because techniques for treating lycanthropy have advanced significantly over the last century. Either way, lycanthropy can now be effectively treated by a magewright performing remove curse; that doesn’t change the fact that it wasn’t a viable solution to the problem at the height of the purge.

That’s all for now! When time allows, I’ll write a follow-up article about using disease in an Eberron campaign, but my Patreon supporters will decide the topic of the next article. Until then, wash your hands!

34 thoughts on “Dragonmarks: Modern Medicine

  1. This might be more suitable for the follow-up article, but are there any mundane or magical diseases that were brought into existence by the Lady of the Plague that didn’t exist in Eberron previously?

    • There are definitely diseases created by the Lady of the Plague and by the daelkyr. But as you say, this is a subject for the follow-up article.

  2. Nice!

    i wonder what its like, studying medicine for all the various races….
    Sure many of them might look similar on the OUTside…but what about on the INside?

    I’m reminded of two tumblr posts, where thats brought up….although Eberron Elves are probably not Fungi, and i get the feeling they would be insulted if they were told they were a type of squirrel or cat.

    • It is a valid question. Just because elves, dwarves and gnomes all look generally human on the outside doesn’t mean that they couldn’t be wildly different on the inside. Elves have two hearts! Dwarves have hearts of stone! The critical point is that the RULES work the same regardless—you can use the Medicine skill on a human or elf with no penalty. So if Dwarves have gold in their blood as well as iron, Jorasco still knows how to deal with it.

      • Just because I find funny to mention it, The Order of the Stick explicitly says their dwarves have two livers. Which is why they can consume so much alcohol without getting drunk.

  3. As always fascinating details. I’ve long been interested in the history of medicine, and found the traditional method of simply healing plagues with magic narratively unsatisfying, given how big a role anything from everyday problems to major pandemics have played, and are indeed still playing, in the real world. Having special rituals for each disease (and no way to deal with some illnesses), as you describe it, is a great idea.

    I hope you and yours are fine. To everyone who reads this, be safe, and all the best.

    There are some questions, though some of them might be a bit too detailed:

    Is the germ theory of disease known in Eberron? Or is there some truth to the humoral theory in a fantasy world where the four elements are more of a real thing than in our own? This would come into play in order to determine such behaviour as hand-washing and sterilisation of instruments (needs germ-theory) or blood letting (makes sense only in the context of humoral theory; would go against Blood of Vol doctrines I assume). For that matter, is there room for alternative medicines, rejecting that of Jorasco?

    Is there a religious element to this – in the past, plagues were often seen as divine punishment? No god seems to directly fit this bill, or could it be attributed to the Devourer as an embodiment of the uncontrollable, destructive forces of nature? Does the Blood of Vol have any special ideas about this, given its focus on blood as a vital force, and the role blood plays in the humoral theory as well as in modern medicine. The Seekers use blood donations as a religious ritual, after all, though not, as far as we know, actual intravenal transfusion.

    Do you have any details about the fiend of pestilence and filth worshipped by the Plaguebearer carrion tribe, and his influence on the world during his imprisonment? I tend to see it as something akin to Pazuzzu, commanding pestilential winds, though the Mesopotamian demon ended up being apotropaic.

    Are the Children of Winter simply looking to spread plagues to weed out the weak, or would it be possible for some of them to do so in a controlled fashion, to help people build up immunities by subjecting them to the worst they can bear? Would it be reasonable to assume that, while they spread plagues, they also help people prepare against them, so long as this is done by natural means?

    How did Karrnath react to the plagues that struck it in the first years of the Last War? Beyond raising undead soldiers, that is. Is there something that the central government could impose, or would it be up to the local warlord?

    Kind thanks, and be well.

    • I’ve added an answer to the germ theory question at the end of the article. The questions about the Children of Winter and the Plaguebearer overlord will both be part of the follow-up article.

    • I confess I couldn’t restrain a laugh when I saw what this “Dragonmark” was about. Great way to make the best of a bad situation. Thanks for that, Keith.

      As Syltorian above mentioned the four elements theory, or, generally speaking, asked about the state of medical knowledge, I’d be curious if you had some ideas to throw about what forensic medicine may look like in Eberron. Thanks by advance if you find time and inspiration for that.

      As a personal answer for the question regarding the entity worshiped by the Plaguebearers, in the campaign I’m currently running as a DM (#InMyEberron), it’s actually Zuggtmoy, the Lady of Rot and Decay, that I retrofitted as one of the non-canonically-named Overlords. Her prakhutu, Yibiyru, the Rancid Lady of Bitter Bile, is also pulling some strings behind some cells of the Children of Winter (see the “circle of spores” in the Guide to Ravnica). — But hush, don’t tell my players yet…

      • I’m also interested in what “mundane” forensics are known. While divination like Scrying (which the Mark of Shadow can produce), Locate Object (which the Mark of Finding can produce) and the like can out preform what we know (There’s also one RPGA module that points out Sending confirms the subject is alive, even if they can’t tell you anything of value), there’s presumably some mundane options out there if only due to supply issues (in the real world, crime labs are undersized for their work load and they can’t answer more minor crimes. The high number of unmarked inquisitive in Sharn alone suggests the Dragonmarked houses aren’t solving everything).

  4. If magewrights can carve a curse out of a person’s aura, was this ever suggested as a solution during the Lycanthropic Inquisition by Jorasco or the Silver Flame’s own minor healers? I know there’s several reasons this would be ineffective in actual practice but was the curse looked at as a thing which could be attended to or was it known from the start to be something considerably more difficult?

  5. In 3rd edition, as far as I can tell Regeneration is not an effect Jorasco can produce. This seems intentional since they aren’t capable of restoring Aejar’s arm (57+58 of Five Nations), and if any non-PC could afford the best services Jorasco has to offer, it’s King Boranel. Was there an out of universe reason to exclude that particular spell from their abilities?

    Do the people of Eberron know how to prevent/treat scurvy or what it really is? It seems like a simple thing, but it took US till 1753 just to figure out certain types of food cured it, and we didn’t figure out why that worked till 1912.

    Likewise, what’s Eberron’s understanding of microbiology? Does Eberron understand diseases are caused by microorganisms that can be destroyed by heat, chemicals or magic (Purify Food and Drink+Prestidigitation)? That boiling water makes it safe to drink is another thing we took FAR too long to figure out.

    • Under 3.5 rules, Regenerate was a 7th level spell. The wide magic of the Five Nations largely tops out at 3rd level, with effects of up to 5th level (teleport, raise dead) being POSSIBLE but very rare. 7th level spells like regenerate as simply beyond the scope of what Jorasco can provide; you’d have to go to Aerenal to get that sort of treatment.

      I just added an answer to the scurvy question at the end of the main post. I’ve also added an answer to the previous question that ties to the microbiology issue. An important thing to consider is that in Eberron, there may be many serious diseases that AREN’T caused by microorganisms, but are rather caused by planar influences, fiendish possession, etc, etc. So medical science is an interesting question, because it needs to incorporate both natural and supernatural threats… and as you note, it does have access to tools such as prestidigitation and purify spells that we don’t have.

  6. Revivify is a 3rd level spell…but it’s obviously useless as a ritual, because the casting time is longer than the one minute limit. Does House Jorasco make scrolls of Revivify, and can magewrights use such scrolls? If so, do the elite of Eberron keep scrolls and the people who can use them close by in case of tragedy? Finally, are the problems with the soul returning minimized if a person is brought back within seconds of death (as the soul hasn’t had time to fully depart and start forgetting)?

    Reincarnation is far more rare, but how does that work in Eberron? Does the soul have the same difficulties returning. Also, what about Dragonmarks? I believe a previous sourcebook (Dragonmarked) said that someone reincarnated into a different race retains their dragonmark, but can’t pass it on to a child. Is that still true in 5E?

  7. These articles are just excellent. So much rich fodder for storytelling and world building. I will be sorry not to get to see you at Gamestorm, but I wanted to thank you for the best D&D setting. Recently returned to it now in 5e after having enjoyed it very much in 3.5 and as a GM and storyteller it is such a wellspring. Thanks.

  8. I recall Jorasco is mentioned to provide mental care in a few sources. How deep is their knowledge of psychology outside of that care? For example, would they be capable of analyzing a serial killer’s actions or making effective marketing campaigns?

  9. “I need a Lamannian rod and 5 cc’s of Mabaran moss, STAT!”

    Cubic centimeters? Doesn’t Eberron use imperial measures?

  10. This will probably seem bizarre or out of no where, but does Jorasco have a color scheme? Be it official or unofficial and more just a common theme?

    Would Jorasco considering experimenting in training Warforged medicine for battlefield treatment, due to their resilience and resistance to things like cloudkill?

    • Speaking only for how I’d approach it myself, there are a couple separate points:
      1) Warforged are free sentients under the Treaty of Thronehold, so I’m not sure ‘experiment’ quite fits here. The question is whether the Healers Guild would be interested in *recruiting* Warforged, which leads to…
      2) How insular is House Jorasco / the Healers Guild in your take on Eberron? In general, it’s implied that the Houses recruit outside their extended family to some extent, but there’s also some implication that Jorasco is a bit more extreme in their policies than most of the Houses.

      Basically, I think it’s fairly obvious that if the Healers Guild accepted applicants from outside the House, and in particular not just halflings they thought might be persuaded to marry into the House, *and* if there were interested Warforged applicants, I would think that the guild would certainly see their value in being able to operate where others cannot, and try to see them placed to such benefit. I’m not sure whether this would amount to something of any real scale under the current circumstances, though.

      In the stories I’m working with, Jorasco trends a little more extreme than what Keith usually articulates, but perhaps not as far as it could be. House members (including scions) are all required to join the Healer’s Guild and take the oath at the age of 25, and have to regularly meet their obligations to the Guild in some way even before this formality; yet there is some flexibility in how this is met, especially for unmarked scions, such as a student of Morgrave who contributes by way of research. A Jorasco clinic in Korranberg hires many Zil gnomes, but largely for menial jobs; it was a major departure from norms when one in particular was trusted enough by the owner to be hired to assist two of his younger children with administering the clinic when the rest of the immediate family was summoned away to assist with the Cyran refugee crisis after the Day of Mourning. In this particular take on Jorasco, I’d be disinclined to assume that the Healers Guild proactively recruits outside the House, but at the same time there might be particular exceptions here and there based on strings being pulled by influential house members. So I might consider a Warforged Field Medic associated with the Healers Guild as a PC concept, but I wouldn’t suggest the existence of an NPC squadron of warforged medics.

  11. Rereading this article reminded me of one of the most beautiful moments I’ve had in an Eberron campaign.

    It was the final showdown, and our rogue (my character’s girlfriend) had been kidnapped by the villain. The rest of us arrive on the scene … and the villain cuts her throat, leaving her dying and the rest of us in terror.
    I asked if my Archfey warlock could roll a regular Wisdom (Medicine) check to stabilize her but flavor it magically, and my DM said sure.
    My warlock summoned up all the courage in her tiny halfling body, and said, “I don’t know if our love counts as true, and it’s definitely not pure, but my magic is literally powered by fairy tales and I really hope this works!
    She leaned in and kissed her.
    I beat the DC by one.

    It’s heartwarming to know that the magical theory behind that was sound.

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