Skulls & Shackles
The basic Pathfinder rules for diseases and poisons don’t necessarily mimic the progression of these afflictions in a believable way; a character with a few lesser restoration spells can simply ignore most diseases, and diseases and poisons that don’t affect your Constitution score can never kill you.
What’s more, because these afflictions tend to affect ability scores, their effects can be unrealistically powerful—a poison that damages Intelligence can take down any creature of animal intelligence, regardless of CR. The following optional system presents progression tracks for diseases and poisons that cause the victim’s situation to become increasingly worse.
PROGRESSION AND END STATES
When a victim fails his initial save and is afflicted with a disease or poison, he immediately gains the effects of the first step down that affliction’s progression track. For diseases, this is latent/carrier; for poisons, it’s usually weakened.
This replaces the affliction’s normal effects (such as ability damage and ability drain), though many afflictions still produce additional symptoms. At the GM’s discretion, truly deadly diseases and poisons might cause the victim to start further along the progression track than normal. All effects from disease and poison tracks are cumulative.
Most afflictions also have an end state—a point at which the disease or poison has progressed as far as it can. Once an affliction has reached its end state, the victim keeps all current effects (but doesn’t suffer further effects) and can no longer attempt saving throws to recover from the affliction.
By default, each disease and poison track has an end state of dead, but some afflictions have less severe end states, and others might progress only to a certain intermediate state at worst, allowing victims to continue attempting saves. In general, whenever a victim fails a saving throw against her affliction, she moves one step further down the progression track, gaining the effects of the next state and keeping all previous effects, until she reaches the end state.
If she’s afflicted with a disease, she moves one step back toward healthy whenever she fulfills the conditions in the disease’s Cure entry (usually by succeeding at one or more
saves). Once she reaches healthy, she is cured. Poisons work differently—fulfilling the cure condition removes a poison from the victim’s system, but she remains at the same step on the track and recovers gradually. (Treat a poison that has exhausted its duration in the same way.) For every day of bed rest (or 2 nights of normal rest), a victim recovers one step; this recovery is doubled as normal by Heal checks, and tenacious poisons might require a longer recovery period.
Usually, neutralize poison or remove disease immediately moves the victim to a healthy state on the respective track, and a heal spell will work for both. However, once the disease
or poison has reached its end state, only a more powerful spell such as miracle or wish can remove its effects.
Some diseases and poisons cause the same effects as a condition (such as sickened) or render characters paralyzed. Effects that modify or remove those conditions (such as
immunities) do not apply; only effects and immunities that help against diseases or poisons apply, as appropriate.
The disease track simulates the progression of a disease, starting with incubation. Ignore any onset entry for a disease; the victim attempts saving throws at a rate based on the
disease’s frequency. At the GM’s discretion, if the disease’s Cure entry does not allow a cure, the disease’s progression may be irreversible without the use of a heal spell, and even a successful remove disease only prevents further deterioration.
There are two different tracks: one for diseases that affect physical ability scores (such as bubonic plague or slimy doom), and one for those that affect mental ability scores (such as cackle fever or mindfire). Sample diseases can be found on page 140.
Physical Disease Track
Healthy — Latent/Carrier — Weakened — Impaired — Disabled — Bedridden — Comatose — Dead
Latent/Carrier: A character in this stage has the disease, and may pass it on if contagious, but suffers no ill effects.
Weakened: A character weakened by a physical disease suffers all the effects of the sickened and fatigued conditions.
Impaired: A character impaired by a physical disease also suffers the effects of the exhausted condition. Whenever he takes a standard action, he must succeed at a Fortitude save at the same DC as the disease’s DC or lose the action and gain the nauseated condition for 1 minute.
Disabled: A character disabled by a physical disease gains the disabled condition. If he takes a standard action, his hit points drop by 1 or to –1, whichever is worse.
Bedridden: A character rendered bedridden by a physical disease is awake and can converse, but he can’t stand on his own or take any standard or move actions.
Comatose: A character rendered comatose by physical disease is unconscious and feverish. He can’t be woken by any means as long as he remains in this state on the disease track.
Dead: The disease overcomes the body’s immune system, and the character dies. The corpse may be still be contagious, and some diseases may have unusual effects after the character dies.
Mental Disease Track
Healthy — Latent/Carrier — Weakened — Impaired — Befuddled — Deranged — Comatose — Dead
Latent/Carrier: A character in the latent stage has the disease, and may pass it on if contagious, but suffers no ill effects.
Weakened: A character weakened by a mental disease suffers all the effects of the shaken condition. The DCs of her spells and spell-like abilities decrease by 2. If she is a
spell-caster, she can no longer cast her highest level of spells.
Impaired: A character impaired by a mental disease no longer adds her mental ability score modifiers to the number of uses per day of pools (such as an arcane pool or a ki pool), abilities (such as channel and lay on hands), and bonus spells per day. Her DCs decrease by an additional 2. If she is a spell-caster, she can no longer cast her 2 highest levels of spells.
Befuddled: A character befuddled by a mental disease is losing her grasp on thought, reality, and self. She has a 50% chance each round to take no relevant action, instead babbling randomly, wandering off, or talking to unseen things.
Deranged: A character rendered deranged by a mental disease is almost entirely disconnected from reality. Her mind filters and twists all external stimuli into strange forms.
Comatose: A character rendered comatose by a mental disease has lost all grip on reality and entered an inner world of dreams. She can’t be woken by any means as long as she remains in this state on the disease track.
Dead: The disease has harmed the character’s brain beyond repair, killing her. The corpse may still be contagious, and some diseases may have unusual effects after the character dies.