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!