Art & Academe Chapter Four: Medicine

Medicine is the science by which the dispositions of the human body are known so that whatever is necessary is removed or healed by it, in order that health should be preserved; or, if absent, recovered. — The Canon of Medicine by Avicenna

The Academic Ability of Medicine is concerned with the human body: how it works, what disrupts its working, and how such disruptions can be prevented and cured. This chapter begins by describing the anatomy and physiology of the body, as accepted by the scholars of Mythic Europe — Christian, Jewish, and Islamic alike. Key concepts in this subject are the three faculties or spirits that infuse the body. The natural faculty is the nutritive force of the body, which nourishes the tissues and the organs to extend life. The constituent parts of the natural faculty are the four humors, which vary in proportion according to the individual’s natural inclination. The balance of humors gives a person her complexion, which encapsulates her physiognomy, physiology, and personality. The sensitive faculty is the force of movement and sensation, giving the body the power to perceive the world about it and react to it. The sensitive faculty is also the vehicle of the mind: it orders the input of the sensory organs; stores images in the memory; and manipulates them in the imagination. The vital faculty is the spark of life itself. Without the vital faculty, the organs would not accept nutrition or respond to movements.

After describing the nature of the human body, this chapter discusses how the delicate balance of humors and faculties can be altered or disrupted, and what effects they have on health in terms of injury, malformations, and disease.

The final section of this chapter discusses the physician himself, and includes new and extended rules for the Abilities of Medicine and Chirurgy. It also details the vital role of the apothecary in the medical arts, and presents background and ideas for players wishing to play a medical-based character.

The Natural Faculty

The natural, or vegetative, faculty is present in every living part of the human body. It is distributed by the veins, mixed in with the blood and the other humors. The principle organ of the natural faculty is the liver, in which the faculty arises from the food passed to it by the stomach and intestines. The purpose of the natural faculty is twofold: the first is nutritive, concerned with the welfare and preservation of the individual; the second is reproductive, focusing on the propagation of the human race.

The natural faculty is assisted by the four forces inherent to it. When the natural spirit reaches the tissues, the appetitive force causes the nutritive humors in the veins to be absorbed by the organs according to their need. The retentive force causes the material that is drawn in to be held in position during the time in which the digestive force is engaged in transforming the natural faculty of the humors into another substance. The expulsive force exists to rid the body of the waste products of the digestive process.

The natural faculty is formed from chyle, the porridge-like pulp that is a result of the digestion of food. The chyle is drawn from the stomach to the liver by the appetitive force, and is subjected further to the digestive force, changing it into the natural faculty. Some of the natural faculty is distributed to other organs via the veins, and is transformed further into the four humors, and into cambion and sperma. Cambion can be formed anywhere in the body, and it is transformed further into flesh and fat, as well as other fluids of the body such as breast milk. Cambion cannot be used to make most of the other tissues of the body, such as bones, veins, arteries, and nerves, but it can repair these tissues if they are damaged.

Sperma is formed only in the generative organs, and fulfills the reproductive function of the natural faculty. Sperma is the root material from which the tissues of the body derive, but this can only occur when male and female sperma come together to form an embryo, in a manner which can be compared to the making of cheese. The male sperma is equivalent to the clotting agent of milk, and the female sperma is equivalent to the coagulum of milk. A woman’s womb has seven compartments; if male sperma clots the female sperma in one of the warmer right-hand compartments then a male child is engendered. The cooler lefthand compartments produce female children; where as the single central compartment on occasion produces a hermaphrodite. Multiple births occur when the male sperma enters more than one compartment.

During pregnancy, the embryo is nourished with the menstrual blood of the woman, which is filled with her natural faculty. One portion of this blood is changed into the substance of sperma, and used to make bone, nerves, and all the organs. Another portion of the woman’s blood becomes cambion and forms the flesh and fat that fills up the spaces between the organs. A third portion of the menstrual blood is waste matter, and is expelled with the infant at birth. Sperma continues to be produced by the infant, allowing it to continue to grow and make more bones and so forth, until he reaches the age of puberty, at which point production of new sperma occurs only in the generative organs, and subsequent growth is only through the production of flesh and fat from cambion.

Babies of Hermes Hermetic Ritual magic can create sperma as well as cambion, because it can restore lost limbs as well as create a whole corpse. However, magi have not been successful in repeating the act of reproduction in the laboratory, joining male and female sperma to form an embryo and thence a baby. Story Seed: The True Homunculus A maga claims to have created a true homunculus, by combining spermae from “donors” in a vat, and cooking it for nine months; she then brings the infant to maturity rapidly. Her vat-grown creature has life, and she sees this as an end to recruiting grogs, servants, and possibly apprentices. Will these creatures have minds and souls; and if so, whose? How widely will her Lab Texts spread before it is discovered that the bodies are inhabited by demons, faeries, or the spirits of the dead? Story Seed: A Bitter Harvest A natural magician has been “harvesting” pre-adolescent children for their sperma in an attempt to make a crude Longevity Ritual. He is likely to kidnap children possessing remarkable powers — such as apprentices — and has attracted the attention of a demon who greatly desires him to succeed.

The Four Humors

A humor is a bodily fluid in which the natural faculty lies, and is the source of one of the four forces. There are four humors: the hot and moist parts of the natural faculty form the blood, hot and dry parts make up the choler, the cold and moist parts constitute the phlegm, and the cold and dry parts make melancholy. Healthy or “good” humor has the capacity to be transformed into actual bodily substance, either by itself or in combination with something else. The residue from this transformation is called a “superfluity,” an unhealthy or bad humor. The body expels these bad humors to maintain proper health.

The fluid carried in the veins is predominantly blood, but in its healthy state it also contains various proportions of the other three humors, as well the superfluities being carried to their various organs of excretion. In a sick person, the veins also contain morbid or putrid humors, which are a result of excessive or insufficient digestion.

The Reality of the Humors In Mythic Europe, the description of anatomy, physiology, and complexion presented in this chapter is correct. While all the details might not be fully known to the general populace, and specific points are still debated by academics, the overall view of medicine detailed here is the truth. The humors really do run the body; there are no cells, no proteins, no DNA. Diseases are caused by disruptions in the balance of humors; rather than by bacteria or viruses, diseases are caused by inappropriate diet, bad smells, and unfavorable stars. Parasites are a symptom of disease, not a cause of it, and so on.

Blood

Blood, or the sanguineous humor, is formed in the liver. In nature it is hot and moist, and thus corresponds to the element of air. In its natural form it is red in color, has no unpleasant odor, and is salty to taste. Its main function is nutritive; blood is the raw product from which nourishment is derived by the tissues under the auspices of the natural faculty. As such, it strengthens the digestive force.

Choler

Choler, yellow or red bile, or the bilious humor, is formed in the gallbladder. In nature it is both hot and dry, and thus akin to the element of fire. It is light in texture and pungent in smell, and has a sour or acrid taste. It provides the appetitive force to the natural faculty, and also nourishes those organs that are hot in nature. Its presence in the veins thins the blood so that it may pass through the finest of tubes.

Melancholy

Melancholy, black bile, or the atrabilious humor, is formed in the spleen. It is cold and dry, and related to the element of earth. In its healthy state, melancholy is a dark sediment, bitter to the taste. It endows the body with stamina, strength and density, and nourishes those organs and tissues that are hard and dry in nature, such as the bones. Melancholy imbues the natural spirit with its retentive force.

Phlegm

Phlegm or the serous humor, is formed in the pituitary gland in the head. Its nature is to be both cold and moist, and so it is most akin to the element of water. Healthy phlegm is white or colorless, and is sweet in nature. It nourishes the organs and tissues of a cold temperament, and moistens the joints, tissues, and organs needed for movement. Phlegm is the source of the expulsive force of the natural faculty.

Correspondences of the Humors

Humor	Force	Age	Season	Element	Quality	Opposition
Choler	Digestive	Childhood	Spring	Air	Moisture with Heat	Melancholy
Choler	Appetitive	Adolescence	Summer	Fire	Heat with Dryness	Phlegm
Melancholy	Retentive	Adulthood	Autumn	Earth	Dryness with Cold	Blood
Phlegm	Expulsive	Old Age	Winter	Water	Cold with Moisture	Choler

The Organs and the Concoctions

The substance of a body is composed of tissues; some derived from sperma (bone, cartilage, nerves, tendons, ligaments, arteries, veins, and membranes) and some from cambion (flesh and fat). These tissues are grouped into organs, which carry out the functions of the three faculties. Each organ has its own temperament. For example, the skin is neither hot, cold, dry, or moist, but in perfect balance; muscles are relatively hotter and yet only slightly moister than the skin; bone is extremely cold and very dry.

The most important organs of the body are those that play a leading role in one of the four concoctions. A concoction is the process through which the non-natural substances (see the Non-Naturals, below) are converted into the three faculties. The first concoction turns food into chyle in the stomach. The waste products are the feces, which are excreted through the intestine. The second concoction takes place in the liver, turning the chyle into natural faculty, which is then differentiated into the four humors in their respective organs. The waste product of this concoction is urine, which is excreted by the kidneys. The third concoction is where air, drawn in through the lungs, is mixed with natural faculty in the heart and converted into vital faculty, then distributed to the body via the arteries. The waste product is the exhaled air. The third concoction also combines the input of the sense organs with the natural faculty to form the sensitive faculty in the brain. The waste products are tears, mucus, and earwax, which are expelled through the eyes, nostrils, and ears. The sensitive faculty is distributed in the nerves. The fourth concoction takes place in the tissues, and turns the humors (primarily blood) into cambion and sperma. The waste products of this concoction are excreted by the skin as sweat, hair, and nails. Cambion is used to grow flesh and fat, sperma is the base substance of an embryo.

The principal organs, therefore, are the stomach, the liver, the heart, and the brain, where these concoctions take place. The secondary organs are those that either bring the raw substance of a concoction to the principle organ (mouth, lungs, sense organs), those that are the destination of the concocted substance (spleen, gallbladder, pituitary, generative organs), or the receptacles of the waste products (kidneys, intestines, skin). There are also auxiliary organs that distribute the faculties (veins, arteries, and nerves for the natural, vital, and sensitive faculties respectively).

The Vital Faculty

The vital faculty provides the body with life. Without the presence of the vital faculty, the organs of the body would cease to function. They would not grow or repair themselves with the natural faculty, nor would the sensitive faculty (see below) be able to cause them to have sensation or movement. The vital faculty is very much the “breath of life.”

The beating of the heart draws into itself fresh air (by way of the lungs) and the natural faculty (by way of the veins), and concocts from these two substances the vital faculty. It is then distributed throughout the body by the arteries; and it is because they contain the vital faculty that the arteries, unlike the veins, pulse with life-giving power. In the young the vital faculty is strong, but the body is capable of making only so much, and it is burned vigorously in youth, steadily in adulthood, and feebly in old age. Excessive heat brought about by exercise (see Exercise and Rest, below) causes the vital faculty to disperse, as do some poisons, resulting in exhaustion and weakness. Starved of vital faculty, the body gasps for air in a desperate attempt to manufacture more, resulting in increased respiration and a higher pulse to distribute the reserves to the aching muscles. Unless there is an ongoing problem, however, strength will return to the body with rest, food, and good air. The old, with less vital faculty in the first instance, consequentially tire more easily.

The Vital Faculty and Hermetic Limits Affecting the vital faculty is beyond the power of Hermetic magic. Consequently, Hermetic magic is unable to restore fatigue, reverse the effects of old age, or bring life to a corpse. Because of this, some magi view the vital faculty as a function of the soul (and thus protected by the Limit of the Divine), although philosophers past and present deny such a link since the vital faculty is a physical quantity, unlike the soul. Nevertheless, the Breath of Life granted to Adam and his descendants is clearly identified with the vital faculty, and thus the province of God Himself. Consequently, only a few Hermetic researchers investigate extending Hermetic theory to the vital faculty, for most believe it is a hopeless cause. Story Seed: Breath of Life A magus is attempting to use variants of The Gift of Vigor to transfer vital faculty from a living being into a dead one; after all, bodily energy such as fatigue is a function of the vital faculty. He has achieved varying measures of success, and has restored life to a limb for a few moments. He connects his successes to specific characters of corpses he used, and is always seeking for more subject material of that type. Unfortunately, there appears to be a large number of the correct type near (or within) the players’ covenant.

The Sensitive Faculty

The sensitive or animal faculty arises in the brain as a concoction of the natural faculty, nourished with the species of sight, hearing, smell, and the inputs from the other sense organs. The sensitive faculty is distributed to the body via the hollow nerves, and grants the body the volition to sense and move; the actual power to sense and move is supplied by the vital faculty. In this respect, the sensitive faculty is the warrior, the craftsman, or the scribe, but the vital faculty is the sword, the tool, or the quill. For this reason, the sensitive faculty is sometimes called the vehicle of the soul.

Imbued with vital spirit, the brain takes in the sensory species derived from its sense organs and concocts from them the sensitive spirit, which is then distributed in the nerves. The waste product of the formation of the sensitive spirit is expelled through the sense organs, as mucus from the nostrils, wax from the ears, and tears from the eyes. The sensitive faculty has ten senses or wits; five outward (vision, touch, smell, hearing, and taste) and five inward (cognition, common sense, estimation, memory, and imagination). The outward wits gather sensory species with which to nourish the sensitive faculty, and enable the soul to perceive the world around it. The five inner wits enable the soul to act on the information gathered by the outer wits, and together they constitute the human mind. It is not the business of a physician to need to understand the mind, for it plays only a small role in the preservation of health. Instead, the mind is the province of the philosopher, and more details on the inner wits can be found in Chapter Three: Philosophiae.

Complexion

The proportion in which the humors are blended differs from one man to another, and constitutes his complexio or complexion. Every being has an innate complexion, which is determined by his horoscopes on the days he was conceived and born. This complexion varies according to the individual’s age, sex, geographic region, and even by the time of year. In principle, complexion is a physically perceptible quality, discerned by inspection, interview, and touch, and accounts for mental, social, and physiological stereotypes of individuals. The determination of a patient’s complexion is a vital first step for any physician, for sickness is most often caused by a perturbation in the natural balance of an individual’s humors, and successful therapy revolves around restoring that balance to the individual.

The four basic complexions are sanguine, choleric, melancholic, and phlegmatic. Each has its own physical characteristics such as stature, build, hair quantity and color; physiological characteristics such as color and consistency of excreta, speed and strength of pulse; and mental characteristics such as emotional states and types of dreams (see the nearby inserts). However, usually a person consists of more than one complexion, displaying the characteristics of two, or occasionally three, although one (called the principal complexion) is likely to dominate. It is unlikely to find a person in whom the active quality (hot or cold) features twice, therefore one does not find sanguine and choleric temperaments mixing (both hot) or melancholic and phlegmatic temperaments mixing (both cold), but this still leaves four basic complexions, eight compound complexions, and the possibility of a minor aspect of a third complexion in each of these latter eight.

Complexion and Personality

Complexion does not merely affect physical appearance; in fact, personality is a much bigger clue to the principle humor than morphology. There are both positive and negative sides to each complexion, and just as few people are pure representatives of a single complexion, not all persons with the same principle complexion will act alike. The stereotypes for each complexion can be linked to the stages of growth. The extreme sanguine personality is like that of a child, friendly and playful, but also petulant and easily lead. The extreme choleric is a surly adolescent, with powerful passions making him brave and seeking his independence, but also proud and uncaring. The melancholic complexion finds its extreme in the adult or parent stage of life; such a person is loyal and nurturing, but often believes that he knows best. Finally, the phlegmatic is akin to an old man, filled with wisdom and calm from a lifetime’s experience, but also weary of the world’s cares and fearful of approaching senility and death.

In common with their link to the four elements and the macrocosm, behavior is considered to vary with the season. Thus, the sanguine complexion is most prominent in the spring, and even the most determined melancholic can experience joy when his blood rises with the sap in this season. Choleric behaviors dominate in the summer, and it is no surprise to find that most wars are fought when the element of fire is ruling the human body. Melancholy takes over in the autumn, and with the cold weather looming, pessimism and depression is inevitable. Finally, the phlegmatic complexion waxes in winter.

Physical Qualities of the Four Complexions

Characteristic	Sanguine	Choleric	Melancholic	Phlegmatic
Stature	tall	tall	short	short
Build	fleshy	lean	lean	fat
Hair	plentiful, dark	plentiful, curly red or blond	parse, straight brown	sparse, flaxen
Pulse	great & full	swift & strong	slow & strong	slow & shallow
Appetite	good	weak	good	weak
Digestion	quick	quick	slow	slow
Urine	thick & yellow	thin & yellow	thin & pale	thick & pale
Skin Temperature	hot & moist	hot & dry	cold & dry	cold & moist
Skin Texture	smooth & soft	rough	rough & hard	smooth
Dreams	childish	warlike	emotional	fearful

Personality Traits for the Four Complexions

Sanguine: Hopeful, Friendly, Amorous, Compassionate, Temperate, Restless, Weak-Willed, Obnoxious, Insecure, Self-Obsessed, Lustful, Gluttonous Choleric: Self-Reliant, Optimistic, Courageous, Decisive, Determined, Domineering, Proud, Hot-Tempered, Angry, Prejudiced, Cruel Melancholic: Caring, Loyal, Sensitive, Altruistic, Creative, Idealistic, Generous, Just, Pessimistic, Pompous, Vengeful, Touchy, Unsociable, Envious Phlegmatic: Calm, Dependable, Contemplative, Easy Going, Peaceful, Loyal, Prudent, Lazy, Fearful, Stubborn, Paranoid, Selfish, Avaricious

Complexional Magic The Art of Mentem is the means through which Hermetic magi manipulate the emotional state of a person, and physician-magi have linked it to the provocation of one of the five non-natural states (see Non-Naturals, Emotional States, below). Thus Panic of the Trembling Heart invokes the state of timor, Rising Ire promotes ira, and Weight of a Thousand Hells invokes profound tristitia, and similar spells exist for laetitia and gaudium. A more subtle approach would be to affect the complexion directly, and thus temporarily change or control the personality of the target, which would be an application of the Art of Corpus. This requires a Minor Breakthrough in Hermetic Theory (See Houses of Hermes: True Lineages, pages 26–30). An unintended side effect of such research might be that the spells also induce the symptoms of disease, since they cause a temporary humoral imbalance in their targets.

States of Ill-Health

Deviations from good health (or eucrasia) are brought about through the non-naturals and the contra-naturals. Non-naturals are those things that can affect the complexion from the outside and which can cause temporary changes to humoral balance, and thus prevent or induce disease (or dyscrasia). The contra-naturals, unlike the non-naturals, have no useful function within the body, and cause only harm.

The ill health caused by the non-naturals and contra-naturals is divided by physicians into three categories. First are injuries, or “breaks in continuity” (solutio continuitatis), which are treated by chirurgeons. These are almost always of external cause. Second are the malformations (mala compositio), which are the result of improper growth, or deficiencies in form or structure. Finally, diseases or complexional imbalance (mala complexio) result from either internal or external causes, and are treated by practitioners of medicine who understand the vagaries of the human body.

The Non-Naturals

The non-naturals are those classes of things that are external to the body, but which are essential for the correct operation of a living thing: air, food and drink, exercise and rest, sleep and waking, repletion, excretion, emotions, and sensory species. The body digests the non-naturals into the humors and the faculties, and the quality and quantity of their supply is the most important factor in maintaining good health. Their absence consequentially results in deprivation, and eventually death.

Air and Climate

The air is the author of life, for it is the substance from which the vital spirit is concocted. Air is principally cold and moist, but it can become hot and moist in sunshine. Air which is gross, thick, or cloudy, and rarely moved by the wind, is putrid and depresses the vital faculty, leaving the body tired and the wits dulled. Pure and clean air, such as that found at the top of mountains or at sea, makes for nimble bodies and quick wits. The turn of the seasons and the geographical climate also affect the balance of the humors within a person.

Diet

Food and drink is the ultimate source of the natural faculty, so the correct diet is essential for the avoidance of disease. Certain foods, such as bread, chicken, mutton, and the flesh of calves and young goats are good and wholesome in general, for they are neither too hard nor too soft, too heavy nor too light, and avoid excess excrement. Other foods promote the production of humors through their heat, coldness, dryness, or moisture.

It is essential not only to eat the right foods but also in the right quantity. Eating too much makes the body dull, heavy, and weary due to an excess of humors, and these can stop up the passages through the body through which the three faculties pass. A person should principally eat those foods that counteract her dominant humor, and avoid an excess of food that promotes it. A typical prescription from a physician might suggest that a phlegmatic person eat lightly, since fasting counteracts his natural coldness and moisture, and avoid milk, fish, apples, and other cold and moist foods. Instead, he should eat venison with carrots, leeks, and garlic, with some wine.

As an individual’s complexion waxes and wanes with his age, the diet that promotes good health in that individual also changes. Thus a youth should avoid both hot and dry foods so as not to excessively inflame the choler, but as he becomes an adult he can take drier foodstuffs — but still eschew the hot—as his complexion changes to be more melancholic. Likewise, the changing of the season should induce gradual changes in diet to account for the climate.

Exercise and Rest

Exercise stirs up heat and sets the blood and choler in motion. It therefore engenders healthy appetite and digestion. Excessive exercise is harmful because the heat also causes the body to dry, which means that it becomes weary and suffers from excessive digestion.

Repose also strengthens the body because it stirs up the phlegm and melancholy, encouraging the expulsion of waste. Excessive idleness makes the body moist, and then cold, bringing a dullness to the mind and the senses, and insufficient digestion.

Exercise can be labor due to one’s profession, or that undertaken for recreation. Recreational exercise undertaken to benefit the health should be performed under the guidance of a physician (see Regimens, below) since the type of exercise must be appropriate to a person’s complexion. It is important to exercise all parts of the body, even the vision (by inspecting minute objects), hearing (by listening to faint sounds), and voice (by singing and shouting).

Forms of Exercise Strenuous Exercise: wrestling, boxing, quick marching, running, jumping over an object higher than one foot, javelin-throwing, pleth-running (running back and forth, shortening the distance each time), shadow-combat, exercise with a leather bag, long jumping, play with a large ball, play with a small ball on horseback, stone-throwing, lifting heavy weights, leaping with a weight on the shoulders Mild Exercise: swaying or swinging to and fro, standing in small boats, being carried in a stretcher or carriage, clapping hands alternatively before and behind, standing on tip-toes, swimming, friction (massage) Qualities of Common Foods Heating & Moistening Foods: mead, egg yolk, fresh bread, soft cheese, butter, shellfish, chicken, veal, lamb, asparagus, turnip, chickpeas, beans, olive oil, figs, raisins, dates, nuts, oats Cooling & Drying Foods: beef, mutton, lentils, citrons, quinces, capers, olives Cooling & Moistening Foods: milk, egg white, cottage cheese, fish, spinach, lettuce, cucumber, pears, apples, berry fruits, barley, ale Heating & Drying Foods: old bread, hard cheese, onions, leeks, garlic, artichokes, cabbage, carrot, parsnip, fennel, venison, hare, wine

Sleep and Wakefulness

Sleep is caused when the natural faculty rises to the brain and is condensed by the coldness of that organ into a humor that blocks the nerves and puts a temporary end to movement and the stimulation of the senses. This humor is digested by the brain during sleep, and once it is all gone, the person wakes. Thus, after excessive food there is a surfeit of natural faculty, which causes drowsiness. Melancholic people tend to retain the humor of the brain, and thus are prone to more sleep.

Sleep in general promotes heat and moistness, and aids digestion, counteracting the drying and cooling effect of exercise; however, too much sleep promotes excessive moisture. Conversely, insufficient sleep causes dryness; and is not recommended for those of a melancholic or choleric complexion.

Retention and Evacuation of Waste

The over-long retention of the waste products of the body (feces, urine, sweat, menstrual blood, and semen) will lead to disease. If the expulsive force is too weak, or the retentive force too strong, then these waste matters can be reabsorbed by another part of the body and instigate disease. The end result is a plethora of quality (see Symptoms of Disease, below), which is harmful to the natural balance of humors.

Emotional States

Strong emotions can have just as much impact on the health as other, more physical aspects of living. While complexion (see above) determines the general emotional temperament of an individual, excessive emotional states can counteract natural temperament or exacerbate disease. There are five emotional states that can originate not from complexion but from sources external to the body, such as from the mind or the soul, or from exercise, food, and so forth:

Gaudium (joy, bliss) is beneficial to all complexions for it is a perfect balance of the humors;
Laetitia (delight, love) inflames the blood and promotes moisture;
Tristitia (sorrow, gloom) promotes melancholy and dryness;
Ira (anger, hatred) is hot and infects the choler;
Timor (fear, worry, jealousy) produces phlegm and coldness.

A healthy amount of sexual intercourse, within the sanctity of marriage, leads to gaudium, as well as performing the vital function of evacuation. However, indulgence in excess sexual intercourse causes laetitia, and also induces dryness because of excessive evacuation.

Sensory Species

The five outer wits (taste, touch, smell, hearing, and vision) are gathered by the sense organs and concocted into the sensitive faculty. However, even the experiences of the sense organs can cause humors to move or strengthen. A physician will sometimes prescribe certain sounds or sights to a patient in his care, or else instruct him to avoid them. For example, a person recovering from a wound must not stir the blood, and so should avoid moistening sensory species such as bright colors.

Effects of the Non-Naturals Any excess of a source of heat, cold, dryness, or moisture has a detrimental effect on the body. Excess hot non-naturals enhance the attractive force, promoting gluttony and thirst, and cause excess humors. Excess cold non-naturals affect the expulsive force, resulting in insufficient nutrition and weakness. Excess moist non-naturals putrefy through corrupt digestion. Excess dry nonnaturals augment the retentive force and pollute the body with waste humors. Causes of Moisture Climate: outward moisture, south & west winds, bathing (especially after a meal), spring, western nations Diet: excessive food, moistening food & drink Exercise: moderate rest Sleep: excessive sleep (especially in the day) Evacuation: retention of excretia Emotions: sanguine emotions, laetitia Sensory Species: bright colors, joyful music Causes of Heat Climate: outward heat (the sun, fires, hot baths), south & east winds, summer, southern nations Diet: fasting, hot foods & drinks Exercise: moderate exercise, light massage Sleep: moderate sleep Evacuation: no causes Emotions: choleric emotions, ira Sensory Species: discordant sounds (e.g. braying trumpets, clashing of cymbals), the sight of violence & rapidly moving objects (e.g. twirling flags) Causes of Cold Climate: external cold, west & north winds, excessive heat such as very hot air, thermal waters & prolonged moderate heat that relaxes the body too much, winter, northern nations Diet: excessive food, cooling foods & drinks Exercise: excessive exercise or repose Sleep: wakefulness Evacuation: excessive retention of excretions Emotions: phlegmatic emotions, timor Sensory Species: the sight of gentle motion (e.g. flowing water & waves), fluttering or tinkling sounds Causes of Dryness Climate: north & east winds, external cold (which congeals humors and obstructs moistening nutrients), excessive heat, autumn, eastern nations Diet: fasting, drying foods & drink Exercise: strenuous exercise Sleep: excessive wakefulness Evacuation: violent evacuations (including sexual intercourse) Emotions: melancholy emotions, tristitia Sensory Species: muted colors, mournful sounds

The Contra-Naturals

Contra-naturals are wholly harmful to the body. Contra-natural things include those things that do direct damage to the flesh, such as sharp edges, heavy objects, and the like. Poisons, fire, and corrosives are also included in the category of contra-naturals; as are vermin (see Chapter Three: Philosophiae, Natural Philosophy) which spontaneously generate from putrid humors or dead flesh.

Celestial influences cause putrefaction of the environment. This process is not readily discernable, but airs corrupted by inauspicious astrological circumstances are the cause of most epidemic diseases. The malign influence of Mars promotes diseases of the choler, whereas Venus disrupts the phlegm. Melancholy is polluted through unfavorable conjunctions of Saturn, and Jupiter can pollute the blood. The remaining three planets affect the faculties directly; the moon causes changes to the natural faculty, the sun to the vital faculty, and Mercury to the sensitive faculty.

Finally, one must also include supernatural agencies within the contra-naturals; certain beings from all four Realms have the power to cause injury, malformation, or disease in those who become the objects of their displeasure.

Injury

Euphemistically called “breaks in continuity” by the medical professions, an injury is anything that inflicts a wound upon a character. All injuries are treated using the Chirurgy Ability; Medicine can assist by protecting against infection, but in general it is ill-suited to the treatment of injury. Most wounds are external, such as being hit with an object intended to damage, but internal injuries are also possible. Internal injuries can be just as serious as external ones; while to outward appearances there is no apparent damage, the wounded organ is meanwhile leaking humors into parts of the body where they are not appropriate.

Light wounds usually affect just the flesh, but the location and type of a more serious wound can affect the consequence or treatment of that wound. Troupes may decide, in the interest of added realism, to determine the location and form of any Medium, Heavy, and Incapacitating wounds inflicted on or by their characters. Location should be divided up between the head, torso, abdomen, and limbs; but the distribution of wounds to these locations depends on circumstance. In battle with a skilled opponent, wounds to the belly or head are perhaps more likely, but an attack by an animal will concentrate on the lower half of the body, and a fall down a mountainside is equally likely to affect any of these locations.

Once the location has been determined, the actual form of the injury depends on the source of the damage. Wounds can basically be caused by crushing, piercing, slashing, or burns and scalds.

Optional Rule: Lasting Consequences of Serious Damage As described in this section, an Incapacitating wound is a significant punishment to the body, and might result in loss of the afflicted limb, or the acquisition of other Flaws. Troupes who want to add a level of added peril can simulate such crushing wounds in the following manner: When an Incapacitating wound is dealt, the player should immediately make a Stamina roll, against an Ease Factor of 6. If this roll fails, then there is a lasting complication to the wound that the character has suffered, in the form of a Minor Flaw — see Surgical Intervention for examples. Of course, a character who avoids the loss of a limb from the injury itself may face losing it through surgical intervention if the wound worsens (see Surgery, below).

Crushing Damage

Crushing damage is caused by bludgeoning weapons such as staffs and hammers, but also by falling or being underneath heavy objects when they fall, and by being trampled by large animals. Using blades against a heavily armored opponent is also more likely to cause crushing than slashing wounds. A fractured bone has cracked but not snapped, whereas a broken bone has snapped entirely, often with the sharp ends protruding from the skin. A crushed organ is bleeding internally, and its function in the body is wholly suspended, perhaps causing disease.

Medium Wounds: fractured long bones (e.g. arm, leg); broken small bones (e.g. hand, foot); fractured ribs; bruised secondary organs (kidneys, genitalia, intestines)

Heavy Wounds: broken long bones; broken ribs; fractured skull; bruised principal organs (liver, heart); crushed secondary organs

Incapacitating & Fatal Wounds: broken ribs that penetrate the lungs or heart; smashed skull; destroyed secondary organs; crushed principal organs

Piercing Damage

Piercing damage is delivered by sharp objects pushed into the body, particularly spears, arrows, and so forth, but also by the horns and teeth of animals, and by falling onto sharp objects such as stakes at the bottom of a pit. A pierced organ has been damaged superficially, whereas a punctured organ has been damaged to its core.

Medium Wounds: Punctured muscle group; pierced secondary organ

Heavy Wounds: Punctured secondary organ, chest cavity, or abdomen; pierced principal organ or eye

Incapacitating & Fatal Wounds: Punctured principal organ; destroyed secondary organ

Slashing Damage

Slashing damage is inflicted by edged weapons such as knives and swords, and also the claws of animals.

Medium Wounds: severed muscle group; substantial portion of skin removed; hand or foot maimed

Heavy Wounds: ligaments or tendons severed; secondary organ damaged; hand or foot severed; limb maimed

Incapacitating & Fatal Wounds: chest cavity or abdomen opened; primary organ damaged; secondary organ destroyed; limb severed

Burns and Scalds

Burns are caused by the direct application of a heat source such as a flame or a corrosive liquid, whereas scalds — usually less dangerous — are caused by indirect heat, such as touching a heated object or being covered in boiling liquid. Injuries caused by extreme cold or poison can also be considered to fall under this category.

Medium Wounds: skin burned away on a substantial fraction of a limb; local damage of a major muscle group; burning away of toes or fingers

Heavy Wounds: skin burned away on a substantial fraction of the torso; a major muscle group severely damaged; secondary organ damaged; hand or foot entirely consumed

Incapacitating & Fatal Wounds: skin burned away on a substantial fraction of body; principal organ damaged; secondary organ destroyed; limb entirely consumed

Malformations

A malformation is a disorder of structure, where a part or organ has undergone a change of form, either in its overall shape or in a part of it, such as to ducts, cavities, and surfaces. Malformations also include congenital errors such as dwarfism, or extra fingers and toes, and errors in growth such as rickets, varicose veins, ankylosis of the spine, fibrosis of the lungs, warts, and atrophy of the intestines. The size of a part might change, as in elephantiasis, or a wasting of the flesh as seen in the old. The category of malformations also includes dislocations, hernias, gross tremors of the limbs, gout, alopecia, baldness, vitiligo, sun-tan, body odor, pock marks, excessive fatness or thinness, and other consequences of growth, age, or a combination of the two.

Most malformations are represented in game terms as Flaws. Others, which spontaneously occur during life, are treated as the effects of aging. Malformations cannot be cured with either Medicine or Chirurgy.

Flaws Representing Malformations Minor: Afflicted Tongue, Arthritis, Disfigured, Fragile Constitution, Hunchback, Lame, Obese, Poor (Characteristic), Small Frame Major: Blind, Crippled, Deaf, Dwarf, Enfeebled, Mute

Disease

The immediate cause of most diseases is a shift in the complexional balance of the body, inducing a state called dyscrasia. This perturbation of complexion is usually in turn set off by harmful changes in the non-naturals or contra-naturals. Dyscrasia may be due to an excess of a healthy humor, or else an accumulation of morbid humors, both of which can cause the symptoms of a disease. If dyscrasia persists too long, then the disease can cause a corruption of the faculties: a disruption of the natural faculty causes wasting; a disruption of the sensitive faculty causes madness; and a disruption of the vital faculty results in death.

The treatment of diseases is almost exclusively the purview of the Medicine Ability, whose purpose is to maintain eucrasia (a state of good health). Some symptoms of a disease can be relieved through surgery, but only medical knowledge can assist the return to health. Diseases of the moist humors (blood and phlegm) are usually milder than those of the dry humors (choler and melancholy). Diseases of phlegm are usually chronic, whereas the other three tend towards acute disease.

Dyscrasia is most commonly caused by the non-naturals, particularly air and diet. Supernatural creatures seeking mischief might manipulate the non-naturals so as to encourage disease, but a more direct route is to curse the victim directly with dyscrasia. Demonic possession is a common cause of many diseases that directly affect the sensitive faculty, but some demons can also directly mimic diseases that occur naturally, making supernatural involvement harder to detect and treat.

Symptoms A plethora of quantity is a surfeit of healthy humors due to excessive appetitive force or defective digestive force. It is accompanied by excessive excretion of waste materials, and emotional disturbance corresponding to the humor in excess. In mild cases, malaise (a general feeling of discomfort or mild nausea) is felt during the season and in the climes associated with the excess humor. A plethora of quality is an accumulation of morbid humors due to the excessive actions of the retentive force or a deficient expulsive force. A plethora of quality causes nausea and the rejection of food, and will lead to other complaints caused by the predominant bad humor. A common result is the formation of apostemes (masses filled with corrupt humors) on or in the body. In extreme circumstances, cachexia (wasting) may set in, where the body is starved of natural faculty and starts to digest itself. An excess of normal blood leads to an abundance of the digestive force, which in turn can cook the other humors too strongly, causing them to putrefy. Abnormal blood has decomposed, becoming bitter or acrid, and too thin to nourish the organs. Symptoms: discharge of blood, continuous fever, syncope (fainting), ulcers, blood-filled aposteme, itching or stabbing pain, exhaustion, coma. An excess of healthy choler results in hunger and thirst as the appetitive force increases in abundance. Morbid choler is leek green in color and extremely toxic. Symptoms: jaundice, weak pulse, excessive thirst, tertian fever (reoccurs every third day), loss of feeling in the extremities, nausea and vomiting, quick exhaustion, seizing of joints, burning red pus-filled aposteme, throbbing or burning pain, hallucinations, dizziness. When there is an excess of healthy melancholy, there is a concomitant excess of the retentive force, resulting in slow digestion. Morbid melancholy coagulates in the body forming a hard mass that is difficult to shift due to its strong retentive power. Symptoms: constipation, quartan fever (reoccurs every fourth day), insomnia, hard, dry and dark aposteme, heavy crushing pain. Healthy phlegm makes things slippery; an excess of phlegmatic humor overstrengthens the expulsive force, causing incomplete digestion. Morbid phlegm is vitreous (glass-like in texture) or calcareous (chalky-white) and often causes obstructions. Symptoms: excessive salivation, discharge of mucus, flatulence, burping, hiccups, cough, abnormal gait due to accretion of vitreous phlegm, catarrh, diarrhea, dropsy (accumulation of fluid in an organ), dyspepsia (heartburn, acid reflux, halitosis), quotidian fever (occurs on alternate days, accompanied by chills), pleurisy (inflamed lungs and labored breathing), watery cysts, dull aching pain, seizing of muscles (tetany).

Describing a Disease

The game statistics of a disease are presented in a fashion similar to a spell. Each disease has a Severity that describes the type of wound suffered, and this Severity is modified by adding magnitudes for the interval, stable Ease Factor, and improvement Ease Factor.

Severity: Diseases can be Minor, Serious, Major, or Critical; each of these levels inflicts a different Disease Penalty. Severity is a measure of the overall impact of the disease on its victim, combining Disease Penalty with the ease in which the disease is caught and recovered from. The severity determines the ease with which it can be treated with medicine or magic. If the disease has a supernatural cause, then the level determines the minimum Might of the being that causes the disease, or the level of a spell needed to inflict it.

Interval: The time between Disease Recovery rolls — either Week, Month, Season, or Lifelong. For diseases with a Critical Penalty, the interval determines the time between Disease Recovery rolls once the patient has resolved his crisis (see below).

Stable Ease Factor: The Ease Factor needed on the Disease Recovery roll to prevent the disease from becoming more severe.

Improvement Ease Factor: The Ease Factor needed on the Disease Recovery roll to cause the disease to become less severe.

Make Your Own Plague

The rules presented here can be used by the storyguide to produce game statistics for a new disease, whether a real disease not listed here, or one of the storyguide’s invention. Magi with an interest in diseases can design a spell to cause a disease of their own, based on how it affects the humors and faculties of the body (see Medical Magic below for guidance on the spell levels needed to inflict a disease). Begin by deciding upon the symptoms of the disease, and how these translate into Disease Penalties or temporarily acquired Flaws. From here you can determine the level of the effect from its severity, interval, and stable and improvement Ease Factors. The medicinal components listed in a later section can be used as inspiration for planning the treatment of the disease, rather than relying simply on mechanics.

Demons of Disease Demons that cause diseases do so through an infernal power (detailed below) which is a variety of Possession (see Realms of Power: the Infernal, pages 32–33). Minor demons can usually only possess one victim at a time, although more powerful demons may be capable of afflicting multiple victims with their disease. Diseased Possession, 2 or more points, Init +2, Mentem: If this power penetrates, the Might Points spent from the demon’s Might Pool enter the possessed creature and are tracked separately from its normal Might Pool. The demon must then spend one point of this Might per five points (or fraction) of the disease’s Severity to inflict its victim with the contagion; this Might expenditure does not cause another Penetration roll, but the victim receives a Disease Avoidance roll, which, if successful, immediately expels the demon. The symptoms of the demon’s disease manifest immediately. There is no incubation period, but otherwise it progresses like any other disease. If the demon has remaining Might points from its initial possession attempt, it can spend them on its other powers, including inflicting the disease again if its victim recovers. The demon must retain at least one point of Might in reserve to maintain possession of the victim, and cannot refresh the Might Points used to possess the victim from its usual Might Pool without another use of the Diseased Possession Power. If the demon is exorcised or destroyed with magic, the symptoms of the disease cease immediately, although any damage caused by the disease remains. Example: Grim is assailed by a Demon of Scrofula with an Infernal Might of 10. The demon possesses him with the minimum amount of Might to inflict the disease, which is 3 points (it needs 2 points to inflict this Severity 10 disease, plus one point to sustain the possession). Had Grim possessed Magic Resistance, this power would have a Penetration Total of –5 (the demon’s Might – (5 x Might Pool spent); see ArM5, page 191). The demon then spends 2 of these 3 Might Points to inflict him with scrofula, retaining the last Might Point to remain in possession of the grog. Scrofula has a Stable Ease Factor of 6, so if Grim can make a Disease Avoidance roll of this Ease Factor or greater, he can expel the demon immediately.

Contracting a Disease

To catch a disease, a character first has to be exposed to the source of dyscrasia that is listed in the description of the disease. The frequency with which characters are exposed to causes of humoral imbalance is left to the discretion of the storyguide. As a rough guide, a character moving into an unhealthy environment should roll once or twice in his first season, particularly if the environment is ill-suited to his temperament. Long-term residents contract diseases as a consequence of aging — an illness result on the Crisis roll (ArM5, page 170) may be represented by a disease instead.

To avoid contracting the disease, the character must add his Stamina to a stress die, and this total must exceed the Stable Ease Factor of the disease. Suffering from wounds makes one more susceptible to disease, so any Wound Penalty (but not Disease Penalty) is added to this roll, as is the Living Conditions Modifier of the character. A magus receives the Form Bonus from his knowledge of Corpus (ArM5, page 77).

Disease Avoidance Roll

Stamina + Living Conditions Modifier + (Corpus/5) + Wound Penalty + Stress Die

Ease Factor

Stable Ease Factor of the Disease

If this roll succeeds, the character has avoided the disease. If it fails, then he will start to suffer the effects once the incubation period of the disease has elapsed. The incubation period is normally less than half of the Interval, so a character with a disease with Interval Month will start to show symptoms a maximum of two weeks later. If the Disease Avoidance roll botches, then the disease is contracted, but it is one step more serious than usual; so, for example, a Major Disease becomes a Critical Disease.

Disease Progression and Recovery

Once the incubation period has elapsed, an infected character initially suffers the Disease Penalty listed in the description (see Disease Table, below). Disease Penalties are treated exactly the same as Wound Penalties, and are cumulative with them. Disease Penalty does not affect Disease Recovery; however, Wound Penalties penalize Disease Recovery rolls, and vice versa. Some diseases inflict the effects of Flaws; these maladies do not also inflict Disease Penalties unless indicated otherwise.

Once the specified Interval of the disease has elapsed, the character makes a Disease Recovery roll, which is analogous to the Wound Recovery roll except that the Ease Factors for remaining stable and improving vary according to the specifics of the disease, and do not change according to worsening or improvement. If a character fails to meet the Stable Ease Factor, then the disease level worsens by one. For example, a Minor Disease becomes a Serious Disease. If the character meets the Stable Ease Factor but not the Improvement Ease Factor his condition does not change, and he receives a +3 to the next Disease Recovery roll, which is cumulative until the disease improves or worsens. If the character equals or exceeds the Improvement Ease Factor, then the disease improves one disease stage. Once a character is at the Minor stage and gets an Improvement result on the Disease Recovery roll, then the disease is cured.

Each time a disease improves or worsens, the disease’s Severity changes (see Disease Table, below). This Severity is important in determining the success of medical cures.

Example: Garotillo (see below) is a Serious disease of Severity 9. Grim contracts the disease after failing a Stamina roll against an Ease Factor of 6 (the Stable Ease Factor of garotillo), and suffers the symptoms of the first stage: a fever, drowsiness, and mild pain, which amount to a –3 Disease Penalty. Since the disease has a Duration of Week, he receives his first Disease Recovery roll after seven days, which he fails. The Disease is now a Major disease of Severity 12, and he now has a –5 Disease Penalty. Fortunately for him, he achieves an Improvement result (12+) on his next three Disease Recovery rolls, and the disease improves to Serious (Severity 9), then Minor (Severity 6), until it is cured.

A disease with an interval of Lifelong can neither improve nor worsen without supernatural aid.

A character who does not rest when suffering a disease risks making it worse. Use the rules for Activities When Injured (ArM5, pages 178–179), substituting Disease Penalty for Wound Penalty. If the character is also wounded, Disease Penalties and Wound Penalties do not stack. For example, a character with a Light Wound (–1 Wound Penalty) and a Critical Disease (–5 Disease Penalty) risks worsening his disease if he travels all day without rest, but does not risk worsening his wound. Diseases that inflict only Flaws cannot be made worse in this manner.

Disease Recovery Roll

Stamina + Medicine* + (Corpus/5) + Wound Penalty + Recovery Modifiers (See Below) + Stress Die

Ease Factor

As Determined By the Disease

* See Treatment of Disease (below) for details of how Medicine can be used to affect Disease Recovery rolls.

Disease Table Disease Base Severity Disease Penalty Minor 6 –1 Serious 9 –3, or a Minor Flaw Major 12 –5, or a Major Flaw Critical 15 May not take any action Modifiers To Severity Circumstance Modifier Interval: Week 0 Interval: Month +1 Interval: Season +3 Interval: Lifelong +10 Stable Ease Factor: 4 –1 Stable Ease Factor: 6 0 Stable Ease Factor: 9 +1 Stable Ease Factor: 12 +3 Improvement Ease Factor: 10 –1 Improvement Ease Factor: 12 0 Improvement Ease Factor: 15 +1 Improvement Ease Factor: 18 +3

Crises

A character with a Critical disease is at a Crisis. Crises also occur when a less-severe disease worsens to the Critical stage due to failed Disease Recovery rolls. The player must make two Disease Recovery rolls each day (at sunrise and sunset) that the character remains in Crisis. On a total of 0 or less, the disease enters its terminal stage, and the character dies within a day. A result equal to or greater than the Stable Ease Factor of the disease improves the Crisis to a Major disease, and recovery then proceeds normally. Any other result means a somewhat worsened condition, and all subsequent Disease Recovery rolls are made at a cumulative –1 penalty until the character improves or dies. These are standard Disease Recovery rolls, and factors that help normal Disease Recovery rolls also helps these. A character who survives a crisis is permanently affected by his illness, and gains one aging point in an appropriate Characteristic. Unlike a Crisis brought about through Aging (ArM5, page 170), a disease Crisis does not affect (and is not affected by) a Longevity Ritual.

Calculating the Severity of a Disease

First decide on the Disease Penalty (Minor, Serious, Major, or Critical) inflicted by the malaise, and consult the Disease Table insert to obtain the base Severity of the disease. Adjust this according to the modifiers for Interval, Stable Ease Factor, and Improvement Ease Factor. Note that if the Interval is Lifelong, then it does not have an Improvement Ease Factor, and the Stable Ease Factor is only used for the Disease Avoidance roll. The Improvement Ease Factor must always be greater than the Stable Ease Factor.

Example: Erysipelas (see below) is a Minor disease, so has a base Severity of 6. The interval between Disease Recovery rolls for this disease is a Month, increasing the Severity by 1. The Stable Ease Factor is 6 (no adjustment) and the Improvement Ease Factor is 10 (–1), for a final Severity of 6.

Story Seed: A Bitter Disease A new disease has physicians stumped; its symptoms derive from an excess of choler, so it should respond to cooling and moistening medicinals, yet nothing tested so far has succeeded. The long hot summer has made the disease particularly prevalent, and the medical profession is searching for a cure. Hidden in a tome in the character’s library is a description of the disease and its cure — a rare swamp plant called bitter cane. Unfortunately, the only bitter cane in the area is the vis source of a particularly irascible magus called Aramin, who, as an expert in both Perdo and Corpus, may well be the author of the plague in the first place. Story Seed: Magical Contagion A magus with a serious grudge against another invents a disease-causing spell that inflicts a Hermetic Flaw. Using the spell outside of a Wizard’s War would constitute a High Crime (because it limits a magus’s magical power), but what happens if the disease proves to be contagious when used under a particularly inauspicious alignment of stars? A disease that restricts magic in some way could have profound effects on the future of the Order, and it would be in the interests of the characters to prevent the disease from spreading too far.

Some Common Diseases

The Ague

Major Phlegmatic Disease, Severity 14 Stable: 9, Improve 15, Interval: Week

Caused by bad air, particularly around sewage and tanneries (Non-Natural). This is the most severe type of this disease.

Symptoms: Continuous fever with chills.

Other types of the ague corrupt different humors, and are either Minor or Serious Diseases. As a choleric disease, the ague induces fever every fourth day; as a melancholic disease the fevers occur every third day; and as a sanguine disease the fever occurs every day.

Anal Fistula

Minor Melancholic Disease, Severity 5 Stable: 4, Improve: 10, Interval: Month

This unpleasant condition is caused by excessive retention of melancholy on the fundament; commonly resulting from sitting for long periods on horseback while wearing heavy armor (Non-Natural).

Symptoms: Hemorrhoids, mild pain and distraction, aposteme of melancholy and blood called a fistula that requires surgical removal (see Surgery).

Apoplexy

Critical Sanguine Disease, Severity 16 Stable: 6, Improve: 15, Interval: Week

This disease causes massive and immediate damage to the heart, which disrupts the vital faculty and causes immediate collapse. Apoplexy is caused by a malicious faerie and is sometimes called “elfshot.” Some other supernatural beings may also be capable of causing it (Contra-Natural).

Symptoms: Crushing pain to chest followed by immediate collapse and disease Crisis.

Bloody Flux

Serious Phlegmatic Disease, Severity 9 Stable: 6, Improve: 12, Interval: Week

The bloody flux is an excess of phlegm caused by living in cold, wet conditions (Non-Natural). It is common in towns and campaigning armies. This complaint can cause weakness or wasting if it continues for too long, as the body evacuates nourishment before it can be used.

Symptoms: Diarrhea, chills, cramps, a running nose, and bloody stools.

There are more severe versions of the bloody flux that have higher Stable and Improvement Ease Factors.

Chaudepysse

Minor Choleric Disease, Severity 9 Stable: 6, Improve: 12, Interval: Season

This disease is contracted by men who have commerce with unclean women (i.e. during their monthly flow), and is often called “the burning” due the pain of urination (Contra-Natural). It is notoriously difficult to cure and is most often treated by direct injection into the urethra of parsley, oil of roses and violets, and the milk of a mother nursing a manchild.

Symptoms: Pain, a discharge of blood from the male organs, excessive itching, rash. Continuous fever may follow, and if the disease becomes Major, sterility and impotence.

Childbed Fever

Major Sanguine Disease, Severity 11 Stable: 6, Improve: 10, Interval: Week

The act of giving birth causes swings in a woman’s balance of humors that make her vulnerable to the childbed fever demon (Contra-Natural). This demon attempts to enter the woman’s body as the baby leaves, so this disease can only be contracted by women who have just given birth.

Symptoms: Chills, fever, abdominal pain, nausea, and in terminal cases a rotting of the reproductive organs that can spread to the rest of the body. If there were birthing complications (prolonged labor, placenta retention, conception during menstruation, or a still-birth, for example) this is a Critical Disease rather than a Major one.

Coryza

Minor Phlegmatic Disease, Severity 4 Stable: 4, Improve: 10, Interval: Week

Coryza, or the common cold, is caused by a cold, damp environment such as that found in late autumn and winter (Non-Natural). The cold and wet conditions cause an excess of phlegm in the head.

Symptoms: Catarrh, unpleasant cough. If it worsens, a quotidian fever, inflammation of the lungs, extreme weariness (make Fatigue rolls for even light exercise).

Diabetes

Minor Sanguine Disease, Severity 14 Stable: 4, Improve: n/a, Interval: Lifelong Rich food and a gluttonous appetite can result in this disease, a result of the disruption of the digestion and thus a surfeit of nutrition (Non-Natural). The children of gluttonous parents occasionally suffer from this disease. It was named by Aretaeus the Cappadocian after the Greek word for a siphon, due to the excessive discharge of urine.

Symptoms: Instead of a Disease Penalty, causes fainting for a few minutes whenever a Fatigue roll (ArM5, page 178) is failed.

Erysipelas

Minor Choleric Disease, Severity 6 Stable: 6, Improve: 10, Interval: Month

Erysipelas is a disease of morbid choler due to excessive heat and dryness derived from inappropriate food for the character’s complexion (Non-Natural). It migrates to the skin to cause a maddening rash. People tend to avoid a sufferer of erysipelas because of his obvious symptoms of disease

Symptoms: Severe itching rash, most prominent on the extremities, but also on the face and arms. Can poison the blood if the disease worsens.

The Falling Evil

Major Phlegmatic Disease, Severity 16 Stable: 6, Improve: 15, Interval: Season

Known by a large number of names (e.g. epilepsy, morbus caducus, morbus lunaticus), the “sacred disease” of Hippocrates is now known to be caused by demonic possession (Contra-Natural). The most common cure is to induce a quartan fever with medicinals that will dry up the moistness polluting the sensitive faculty. Trepanation (see Surgery) is occasionally recommended, but this is a dangerous procedure. The demons who cause the falling evil are weak, and this Major disease is easily resisted by those with a strong constitution; the demons usually strike following a debilitating blow to the head.

Symptoms: Rather than a Disease Penalty, this disease manifests as convulsions. Convulsions occur randomly and infrequently. For any given event, the storyguide should secretly roll a stress die; if the result is 9 or more then a convulsion will occur at some point during that event, as chosen by the storyguide. This spasm perturbs both sensation and movement, causing both to occur at random, leaving the character temporarily Incapacitated. He collapses to the ground and twitches. Every round he can make a Stamina roll against an Ease Factor of 9; success means that the convulsion ends, although he is reduced to the Dazed Fatigue level.

Febris Semitertiana

Major Choleric Disease, Severity 18 Stable: 12, Improve: 18, Interval: Week

This disease is truly fearful. It derives from water corrupted by the malign influence of Saturn and Mars (Contra-Natural). In the heat of summer, this disease can kill thousands.

Symptoms: Discharge of watery stools, crippling abdominal pain, raging fever, red rash all over the body.

Gangrene

Minor Sanguine Disease, Severity 8 Stable: 9, Improve: 15, Interval: Week

Evil spirits in an improperly cleaned wound cause putrefaction of the blood (Contra-Natural). Gangrene is the most common result of a botched Wound Recovery roll. The wound becomes a festering ulcer as the flesh is consumed by the morbid blood.

Symptoms: Continuous fever. The infected wound cannot improve until the gangrene is gone, but it can worsen. Surgical intervention (deep cautery or amputation; see Practice of Chirurgy, below) to prevent the gangrenous wound worsening is often the best option, because Wound Penalties affect Disease Recovery rolls and vice versa.

Garotillo

Serious Choleric Disease, Severity 9 Stable: 6, Improve: 12, Interval: Week

This disease is contracted through excessive exercise that dries the body and inflames the choler (Non-Natural). The disease is also known as morbus suffocans for its distinctive second stage, in which the disease spreads to the windpipe and causes death by gradual suffocation.

Symptoms: Tertian fever, mild pain in the throat, drowsiness, a white, livid, or black concretion of morbid humors at the back of the mouth. If this disease worsens to a Major Disease, the sufferer is in danger of suffocation if he ever fails a roll involving Stamina. Follow the rules for Deprivation (ArM5, page 180–181). For each Deprivation roll he also gets a Stamina + Concentration roll against an Ease Factor of 6; success means that he regains his breath.

Leprosy

Major Melancholic Disease, Severity 21 Stable: n/a, Improve: n/a, Interval: Lifelong

Medically, leprosy is an excess of black bile, and it is inflicted through the wrath of the Almighty as a punishment for unclean living (Contra-Natural). (See City and Gild, page 26, for the societal consequences of contracting leprosy.) There is no chance of avoiding catching leprosy — if God wills it, then the character is afflicted.

Symptoms: Skin damage, clawing of hands and feet, blindness, loss of sensation and paralysis in the limbs, and sometimes madness. The victim of leprosy gains the Leprosy Major Flaw. A leper has a permanent –2 modifier to her Living Condition Modifier and whenever she undergoes an Aging Crises (ArM5, page 170) the leper sustains a Heavy Wound in addition to any other result. Lepers cannot gain a positive reputation due to the pungent rotting smell that they emanate. As a lifelong disease, no Disease Recovery rolls are possible.

Leprosy, Hermetic

Critical Melancholic Disease, Severity 16 Stable: 6, Improve: 12, Interval: Month

Hermetic leprosy is caused by the Hermetic spells Curse of the Leprous Flesh and Curse of the Unportended Plague (ArM5, page 133; Contra-Natural). It conforms to everyone’s worst fears about true leprosy, manifesting as a rapid and hideous wasting disease accompanied by a pungent rotting smell.

Symptoms: Victim’s flesh rots off in a matter of weeks. If the victim survives the Disease Crisis, he will find it impossible to develop a positive reputation.

Story Seed: Hermetic Leprosy A physician who has experience with true leprosy has noticed this particularly virulent form of the disease, and has tracked it down to the covenant, which has a member who knows the appropriate spell. The physician has alerted the bishop to this clear evidence of the magus’ moral corruption. The characters must cope with the bishop’s response to these accusations.

Phimosis

Minor Choleric Disease, Severity 6 Stable: 6, Improve: 10, Interval: Month

A particular affliction of promiscuous men (but can be suffered by both sexes) caused by excess lust (Non-Natural). It is a painful and embarrassing disease, but usually clears up on its own with no lasting aftereffects.

Symptoms: Soft sores on the coital organs, which may become poisoned. A man who suffers a disease Crisis induced by phimosis is left impotent.

Phthisis

Major Phlegmatic Disease, Severity 17 Stable: 9, Improve: 18, Interval: Month

Phthisis pollutes the vital faculty with excessive phlegm. It is an epidemic disease, caught initially from foul air deriving from marsh water, and subsequently spreading from person to person through putrid breath (Contra-Natural). It is also known as consumption because it eats away at the flesh of its victims. Physicians recommend climatic therapy of sea voyages and high altitudes to rid the lungs of the putrid air, but few can afford the luxury of such treatment.

Symptoms: Hacking cough, shortness of breath, blood in the sputum, quoditian fever, and wasting; all of which amount to the Enfeebled Flaw.

Pneumonia

Serious Phlegmatic Disease, Severity 9 Stable: 6, Improve: 12, Interval: Week

This inflammation of the lungs is diagnosed by the presence of blood or choler in the sputum. It is caused by polluted air (Contra-Natural). Pneumonia has a tendency to exhibit a Crisis on the seventh day. Treatment is typically bleeding to reduce the excess fluid, and drying compresses applied to the chest.

Symptoms: Acute pain in the chest, quotidian fever. The afflicted character is also reduced to the Winded Fatigue level until he improves. At the Major stage of the disease, the victim suffers from the Enfeebled Flaw in place of the Disease Penalty.

Quinsy

Serious Phlegmatic Disease, Severity 9 Stable: 6, Improve: 10, Interval: Month

Quinsy is contracted from swallowing worms in one’s food, which live in the tonsils and cause them to swell (Contra-Natural). If the swelling gets so great that it threatens breathing, it is recommended that the tonsils should be surgically opened with a curved knife on a long stick, although some chirurgeons attempt to remove the tonsils entirely.

Symptoms: Pain localized in the back of the throat. Should it worsen to a Serious Disease, the Disease Penalty remains –1, but the character suffers from an Afflicted Tongue, and at the Major stage he becomes Mute.

Rabies

Serious Choleric Disease, Severity 13 Stable: 9, Improve: 18, Interval: Week

This dreadful disease is caused by the bite of a mad dog (Contra-Natural), which inflames the choler and dries the body. It is swift to affect its victim and difficult to treat due to the extreme mental disturbance of its sufferers. A physician must forcibly apply medicinals to the patient, and the involuntary convulsions mean that bed rest is impossible, even if tied down.

Symptoms: Raging thirst, extreme fear of water, violent convulsions. The mind of the sufferer is also affected, reduced to that of a furious beast. The sufferer foams at the mouth and attempts to bite all who come near, and he can transmit the disease in this fashion if the skin is broken.

Saint Anthony’s Fire

Minor Sanguine Disease, Severity 12 Stable: 6, Improve: 18, Interval: Season

Caused by an excess of blood due to possession by a minor demon in the victim’s intestines (Contra-Natural). Exorcizing the demon ends the disease, and the Order of the Hospitalers of St. Anthony specialize in such exorcisms.

Symptoms: Red rash, intestinal pain, visions, muscular spasms, and a burning sensation in the extremities. Eventually the limbs begin to rot. This disease is exceptionally hard to recover from due to the tenacity of the demon, and it typically worsens each season until the victim dies.

Scrofula

Serious Melancholic Disease, Severity 10 Stable: 6, Improve: 12, Interval: Month

An unpleasant disease caused by the cold dry winds of cities in Northern Europe, particularly those situated far from the sea (NonNatural). The excess of melancholy congests glands forming hideous lumps over the body. Also called struma and morbus regius (the King’s Evil) because the touch of the Kings of England or France is known to cure it.

Symptoms: Swelling of the glands all over the body, dull pain. If it progresses to a Major Disease, as well as worsening the Disease Penalty the glands — particularly those in the neck — swell to immense size, imposing the Disfigured Flaw. The swellings can be surgically removed once the disease is cured.

Stones

Serious Choleric or Phlegmatic Disease, Severity 11 Stable: 9, Improve: 15, Interval: Week

A coagulation of bile causes a hard stone to form in the gallbladder, while morbid vitreous phlegm is responsible for stones in the kidney and bladder. The coagulation occurs when either humor is in excess, such as through an inappropriate diet for one’s temperament (Non-Natural).

Symptoms: Acute abdominal pain, initially when passing water, but later continuously. Difficult to cure without Surgery.

Suffusio

Serious Melancholic Disease, Severity 11 Stable: 9, Improve: 12, Interval: Month

Suffusio is a congregation of humor between the lens and the pupil, obstructing sight, caused by the excessive absorption of harmful visual species (Contra-Natural). A surgical procedure called “couching” can expel the humor through the insertion of a thin needle beneath the lens.

Symptoms: Dimmed vision; rather than a Disease Penalty the sufferer acquires the Poor Eyesight Flaw until the disease is cured. A complication of the disease — called suffusio nigra or glaucosis — occurs if the disease worsens, resulting in the Blind Flaw. Suffusio cannot kill; a failed Disease crisis results in permanent blindness instead.

Tumor, Consumptive

Serious Sanguine and Melancholic Disease, Severity 10 Stable: 6, Improve: 12, Interval: Month

A consumptive tumor, or carcinoma, has a hard central mass with pointed projections that extend into an organ, which is why it is named after a crab (carcinos). It is a precipitate of blood and melancholy formed through insufficient evacuation (Non-Natural), and is the most dangerous tumor of all; it penetrates slowly into tissue but digests it as it goes, spreading its corrupting influence throughout the body. Surgery (see below) to remove the tumor is an option, but rarely meets with success due to the invasiveness of this cancer.

Symptoms: A hard mass, which causes stabbing pains in the affected organ. Rather than worsening in the usual way, every Disease Recovery roll that does not result in Improvement produces a new tumor in a different location; these secondary tumors begin as Minor diseases, and receive their own Disease Recovery rolls at a monthly interval. Only the first tumor can produce new ones; once it is cured or removed no new tumors will develop. Non-consumptive tumors are called oncoi (singular oncos). A cold tumor (Minor Disease) is formed from phlegm and melancholy, whereas a hot tumor (Serious Disease) is coagulated choler and melancholy. Both are slow to act, having an Interval: Season, but neither have the same ability to cause new tumors.

Variola

Serious Choleric Disease, Severity 11 Stable: 9, Improve: 15, Interval: Week

Variola, or small pox, is a disease caused by the accumulation of putrid choler in the skin due to inhaling polluted air in hot and dry conditions (Contra-Natural). It is highly contagious and disfiguring. Physicians recommend the eating of red food, and hanging red drapes around the bed of the patient to draw out the putrid choler from the skin.

Symptoms: Eruption of pus-filled pocks all over the skin, a tertian fever, pains in the back. Victims who suffer a disease Crisis and survive are often left blind, or horribly disfigured. The common name of small pox distinguishes this disease from other pox-causing diseases. Great pox, chicken pox (named after cicer, or chick peas, which the pocks resemble) and rubeola (measles) are all milder forms of this disease, and are all Minor rather than Serious illnesses.

Worms

Minor Sanguine Disease, Severity 9 Stable: 6, Improve: 12, Interval: Season

Worms spontaneously generate in congealed blood (see Chapter Three: Philosophiae, Worms). In a healthy person the worms disperse, but in the unhealthy they can overwhelm the body. Children are particularly susceptible as their bodily humors are intermingled with milk.

Symptoms: Wasting. However, those inflicted with worms are not immediately affected — they take no Disease Penalty. However, if after a season the disease worsens, the patient is afflicted with a Serious Disease.

Other Diseases

City and Guild (pages 25–28) provides more details for a number of diseases presented here (leprosy, the ague, St. Anthony’s fire, childbed fever, the bloody flux, and worms), as well as three other conditions that have not been converted to this system. Tarantism works in a manner wholly different to a disease, stemming as it does from a faerie curse. Abscesses are covered by the Deprivation rules (see ArM5, page 180). Finally, the black death is an infernal entity rather than a disease, which does not (yet) exist in Mythic Europe.

The Physicians

Medicine has enjoyed academic status since ancient times, and it is often hard to determine where medicine ends and natural philosophy begins, for the two are strongly intertwined. Without understanding the subtle interplay of the elements, the theory of medicine is difficult to comprehend sufficiently to put it to practical use. In particular, physiology and anatomy are based on theoretical understandings rather than direct observation.

Medicine has always been the province of the educated classes, and until recently — at least in Christian Europe — that meant the clergy. Up to the tenth century, the regular clergy (that is, the monks) were the only section of society who had regular access to medical texts written by famous physicians, and consequently they monopolized the ranks of the physicians. Recently there has been a shift in attitudes due to the rise of the various schools across Europe that teach medicine to anyone who can afford to attend. Still, the profession of the physician is still dominated by the clergy in the thirteenth century; two thirds of physicians who hold academic qualifications in medicine are in holy orders, and the majority of the rest are lay practitioners. Because of the recent proscriptions of the Church (see below), regular clergy are seriously under-represented in the physician class at this time, and only within the ranks of the new order of Dominician Friars is the academic study of medicine encouraged.

There is an informal hierarchy amongs those who trade in the health of others. At the top are the medici (singular medicus), those who have received academic training in the healing arts to whatever level. This includes both those who have studied medicine and those who have studied chirurgy in a formal sense; although those who make their living through the former are accorded greater status than the latter. At the bottom of the hierarchy of medical and surgical practitioners are the empirici (singular empiricus), a term used by educated practitioners in a derogatory manner to refer to those whose medical knowledge is acquired without formal education, and practiced through trial and error. Holding slightly more status than an empiricus are those who do not practice medicine, but instead specialize in the production of medicines for those who do; the profession of apothecary (see below) is a new one, but one that is very welcome to the medici who hitherto have had to make their own medicinals. The following sections describe each of these professions in turn, and offer guidance on the creation of characters from one of the healing professions.

Gilles de Corbeil

Characteristics: Int +2 (2), Per –1, Pre –1 (1), Com +1 (1), Str –3 (1), Sta –3, Dex –2 (1), Qik –3 (1) Size: 0 Age: 80 (Apparent Age 78, Born 1140) Decrepitude: 3 (3) Confidence Score: 3 (9 points) Virtues and Flaws: Magister in Medicina; Affinity with Medicine, Book Learner, Good Teacher, Physician of Salerno, Protection, Puissant Medicine; Ambitious, Enemies, Monastic Vows Personality Traits: Ambitious +3, Humanist +2, Kind-Hearted –1 Reputations: Medical Authority 5 (Academic), Physician to King of France 3 (Local) Combat: Dodge: Init –3, Attack n/a, Defense –3, Damage n/a Soak: –3 Fatigue Levels: OK, 0, –1, –3, –5, Unconscious Wound Penalties: –1 (1–5), –3 (6–10), –5 (11–15), Incapacitated (16–20), Dead (21+) Abilities: Artes Liberales 7 (grammar), Bargain 1 (supplies), Civil & Canon Law 3 (restrictions on physicians), Charm 3 (patrons), Chirurgy 4 (phlebotomy), Church Lore 3 (Benedictines), Etiquette 3 (French court), Folk Ken 3 (patients), French 5 (Norman), Guile 2 (to the dying), Italian 4 (Campania), Latin 6 (verse), Leadership 5 (physicians), Medicine 13+2 (regimens), Music 2 (hymns), Philosophiae 6 (moral philosophy), Profession: Apothecary 4 (febrifuges), Ride 3 (long distance), Teaching 8 (Medicine), Theology 4 (morality), University of Paris Lore 4 (Faculty of Medicine) Appearance: In his prime, Gilles was a tall man of phlegmatic complexion, with a noble mien and commanding presence. However, his remarkable age has ravaged his body, leaving him bent almost double from a spine fused by arthritis, with shaking hands and a bandy-legged gait. Nevertheless, his voice and his mind are still strong. Gilles de Corbeil, or Aegidius Corboliensis as he is known in Latin, is the archiater (chief physician) to King Philip Augustus of France. He was born in northern France in 1140, joined the Benedictine Order at Salerno, and trained under the great Petrus Musandinus. After receiving his doctorate he taught at Montpelier, but left there in acrimonious circumstances after feuding with the faculty, who resented his genius and sought to curtail his career. As a consequence, several masters of Montpelier have attempted to destroy his credibility, largely to no avail. Gilles has written copiously, including two famous summae on urine and the pulse which he composed in hexameter verse. He has researched some twenty formulae (see Chapter Five: Experimental Philosophy); mainly theriacs, but some inceptions for prognostical purposes. As the main channel though which Salernitan teaching has reached Parisian physicians, his contributions to his science cannot be underestimated. If your saga follows real history, Gilles will die in 1224; even the greatest physician of the era cannot escape old age forever.

The Medicus

The study of medicine in universities is far more common in southern Europe; as a subject of serious study, it has barely penetrated into the Kingdom of Germany or central Europe. This is a consequence of history as much as of interest, since the famed southern schools of Salerno, Cremona, Montpelier, and Bologna have greater access to the corpus of Arabic medical texts. Most teaching is between master and pupil, akin to a craft guild, even in a university setting.

The most prestigious medici are the graduates of a university’s faculty of medicine, the only type of physician who has any right to the title of doctor. However, a doctor may hold a degree other than one in medicine, and the term physicus is consistently applied to anyone with advanced education in both medicine and natural philosophy, and is also used to distinguish educated medics from educated chirurgeons. The highest accolade in the field of literate physicians is the title of Magister in medicina. Those who are called by the more general term of medicus may practice medicine or surgery (or both), but have no formal claim to the higher title. The majority of practicing physicians fall into this category; a medicus has typically studied medicine at university but it was not his specialty, and he graduated in a different subject or not at all.

Setting Up Business The skilled use of medicine is a lucrative business, and learned physicians are usually well off. Physicians may be employed exclusively by a rich individual, or else work for coin and see a wide rage of patients. Some cities, particularly in southern Europe (such as Bologna and Montpelier), require medici to buy licenses for the practice of medicine, and these licenses are dependent on a number of restrictions, such as a requirement to treat the poor for free. In these same cities, where lay medicine is more common, the study of medicine is often a family business and it is one of the few ways in which a person can improve his social standing. City & Guild presents rules for earning an income through a Craft or Profession Ability, and medici are no different. Physicians use (Intelligence + Medicine) to calculate Craft totals and labor points, whereas chirurgeons use (Dexterity + Chirurgy). Medicine and Chirurgy may be used in this fashion despite being neither Craft nor Profession Abilities. Businesses are rated in income brackets: Legendary (1000 Mythic Pounds per year), Greater (250 Mythic Pounds), Typical (100 Mythic Pounds), Lesser (40 Mythic Pounds), Minor (20 Mythic Pounds), and Trivial (10 Mythic Pounds). Among physicians, the highest income brackets (a Greater or Legendary income) are reserved for a magister in medicina, but most physicicans command a Typical source of income if they dwell in a city with a sufficiently wealthy client base. Physicians in small towns can generally only muster a Lesser income, and often did not graduate in medicine from a university. Graduates of Salerno are usually prized more highly, giving them an income one step higher than their peers. For a chirurgeon, the regular work of bloodletting and minor surgery usually only provides a Lesser to Typical income even in a city, but a chirurgeon who accompanies an army or lives in a war-torn region might command a better salary for himself and his staff. An empiricus is usually restricted to Lesser and Trivial incomes, particularly those who are forced to travel to obtain sufficient clients. Herbwives and midwives are treated similarly, but more often receive payment in kind rather than coin. The same system can be used for apothecaries; given that they are professional tradesmen, more detailed rules are provided in Pharmacy, below.

Formally Trained Physician Characters Anyone with Medicine 1 or greater may call himself a medicus; but a physicus from Western Europe must have the Clerk Social Status Virtue to be worthy of the title, indicating that he has studied at university. Those with both Clerk and a score in Medicine of 3 or more have probably graduated in medicine, and have the right to call themselves “doctor.” The Magister in Medicina Virtue (see below) grants the highest possible status in the field. Non-Christian physicians require analogous Virtues indicating a similar level of education. Medici who are well placed in noble society may find their business lucrative, either literally (represented by the Wealthy Virtue) or through the influence he has with his clientele (Social Contacts Virtue). Patronage from a nobleman might also offer the Protection Virtue or the Mentor Flaw. Medical skill can be enhanced with Virtues such as Affinity with Medicine, Cautious with Medicine, and Puissant Medicine. An educated chirurgeon has the same options, but should divide his experience points between Medicine and Chirurgy. Those who specialize in surgery only rarely achieve the same wealth and prestige of a medicus. Patronage usually comes from a nobleman or city that expects to go to war. A medical character in holy orders (possessing the Priest Social Status Virtue) is probably attached to a monastic house, but may have dispensation to administer medical advice beyond the walls of his community. A character of this type should not practice surgery or bloodletting for fear of disobeying the various statutes of canon law, although he may have the Chirurgy Ability purely for the treatment of wounds. An apothecary character is usually educated, although this is not essential. Most have the Gentleman Social Status Virtue, and may be Wealthy or the Heir to wealth, if the business is a family one. Social Contacts are helpful in obtaining rare ingredients from spiciers and other traders. Useful Abilities include Bargain, Profession: Merchant, and Artes Liberales. Apothecaries often know some Medicine, but local laws (particularly in southern Europe) may prevent them from treating patients. Many apothecaries dabble in experimental philosophy, particularly in the creation of theriacs (see Chapter Five: Experimental Philosophy, Pharmaceutical Theriacs). Female and Non-Christian Physicians Unlike many areas of academic pursuit, women can practice both surgery and medicine, and are limited to neither obstetrics or female patients as some might expect. Female medici are by no means common, for they are barred from entering most universities (Salerno being a noted exception), but training in medicine can stem from a private tutor or from one’s work in a hospital under a qualified physician. Despite the lack of formal education, women are not prevented by canon or civil law from ministering to patients, and about two in a hundred medici are women. Two famous recent examples are Trotula of Salerno and Abbess Hildegard of Bingen. Amongs the chirurgical professions women are far more common, particularly as nurses and midwives (see Practice of Chirurgy), but also as herbalists. Muslim practitioners of medicine are found in Christian communities in Iberia. Those parts of Spain under Muslim rule have formed centers of learning for Arabic physicians, and many of the Greek and Roman texts that the graduates of Europe rely on have entered the West after being translated from Arabic at Salerno and Cremona. Jewish physicians are found in Jewish communities, principally Iberia, parts of Italy, and southern France. In these regions over one third of all physicians are Jewish. Literate and learned Jewish medicine draws on both Jewish and non-Jewish lore, mainly transmitted through Arabic. In southern Europe, Jewish medici are in great demand amongs Christian patients, despite ecclesiastic and secular laws forbidding this. These laws were often modified, exempted, or ignored by the ruling classes.

The Chirurgeon

Chirurgy has had a less prestigious position than medicine since Galen and is not considered to be a valid subject of academic study. Chirurgy’s development has been greatly retarded due to various regulations forbidding human dissection. Indeed, chirurgy has long been merely an instrument of medicine — along with diet and medication — and the least of these instruments at that, resorted to only in extreme conditions when the patient is likely to die anyway. Within the last century the subject of chirurgy has achieved a great deal more respectability thanks to the hard work of several academics. A literate surgeon these days is accorded the same status as a medicus, and several universities offer degrees in chirurgy as well as medicine.

Despite this, chirurgy remains a craft. Scholars have systematized the subject, but there is no substitute for practice and experience. A theoretical understanding of how the body works is not necessary for the patching of wounds and the setting of bones, although the success of a chirurgical procedure can be enhanced by a knowledge of medicine. Medici can also benefit from acquiring the skills of a chirurgeon; bloodletting and cautery are important procedures for the establishment of good health, but these are applications of chirurgy rather than medicine, and there is a growing profession of barber-surgeons who assist medici in therapeutic surgical procedures. Chirurgeons are often attached to armies; indeed, some are required to accept such a posting by the authorities that grant them their licenses.

Physicians in Holy Orders

The ecclesiastical response to commercial medical practice and non-monastic education at universities was to forbid the participation of monks in such matters, enacted by a decree of the Council of Tours in 1163. The Fourth Lateran Council (1215) forbade clergy from cautery or surgical incision; and as a consequence surgeons, barber-surgeons, and barbers are usually from the laity. The regular clergy are not allowed to consult lay physicians, and a Papal decree expanded this prohibition in 1219, forbidding secular clergy from absenting themselves from their pastoral duties to study medicine or law.

The Church was suspicious that the medici put their patient’s physical health before his spiritual wellbeing, and their fees before either. The Fourth Lateran Council also obliged physicians to insist that patients summon a confessor before other treatment, and strictly forbade any medical treatment involving sinful means, such as prescriptions to eat meat on a fast day, or to engage in extra-marital sex.

Canon lawyers and theologians made the charging of modest fees for medical practice licit, enabling the medicus to cover his own expenses; but also imposed an obligation on him to provide a good service and to treat the poor for free.

The Apothecary

As medicine as a field of study became more prevalent in Mythic Europe from the tenth century onwards, its emphasis on the need to maintain or restore a humoral balance for good health — and the reliance of physicians on medicinals to do this — created a widespread demand for drugs and potions not readily available in the domestic herb garden. As the rapid dissemination of medical knowledge continued through the eleventh and twelfth centuries, simultaneous expansion of trade markets meant that a wide range of exotic new ingredients became available. These two things lead to the specialization of some tradesmen in the business of supplying medical and restorative preparations, and the profession of the apothecary was born.

This trade is encouraged in the main by the physicians, who are reluctant to undermine their professional status by indulging in commercial activities. Nevertheless, the relationship between doctor and apothecary is seen by cynical commentators as an unholy alliance designed to hoodwink the public into buying over-priced, adulterated, and largely useless decoctions. More worrying to the physician is the protection of his reputation, and many cities, particularly in southern Europe, have enacted laws under pressure from the medical profession preventing apothecaries from prescribing medicines on their own.

There is little doubt that the craft of the apothecary is a lucrative profession. The royal court of King Henry III of England spends over 1700 pounds of silver a year on exotic ingredients such as gum arabic, tragacanth, sandlewood, powdered gold, cumin, and so forth, all destined for the court-appointed apothecary. Most of these supplies are imported from overseas, along with large quantities of sugar, which is used both to make medicines palatable and as a medicine in its own right. Nevertheless, such expensive ingredients are not essential in the practice of pharmacy, and a skilled apothecary of more modest means can cull herbs from the local countryside — this is harder work, but requires less capital.

Profession Apothecary This Ability allows the character to identify, cultivate, and prepare common herbs, plants, and other ingredients for use in medicinal remedies. Any character without access to proper medicinal supplies makes all Medicine rolls at a penalty of –3, but with access to an apothecary this penalty is reduced (see Pharmacy, below). Specialties: finding ingredients, treating diseases, preparing poisons. (General)

The Empiricus

An empiricus is a character who specializes in one surgical (or more rarely medical) procedure. However, it is a derogatory term used by the literate medical profession, and these characters tend to refer to themselves as surgeons or medici. Empirici are usually traveling craftsmen, passing from town to town selling their skills to sufferers. This itinerancy is necessary to reach a wide enough market for their skills, but is also occasionally required in order to avoid confrontations with dissatisfied patients (or their surviving relatives). Typical specialties for these craftsmen are cataracts, hernias, the removal of bladder stones, and so forth. Only those who specialize in midwifery — which is almost exclusively the province of women empirici — tend to reside in a region, where their skills are highly sought after. A midwife occasionally has her thumbs surgically removed to make it easier to assist in childbirth, but this is a somewhat extreme measure.

To supplement his income, an empiricus often doubles as a peddler, bringing small items such as cheap jewelry, ribbons, and the like with him on his travels. Many sell “theriac,” a wonderful cure-all for any ailment, often claimed to be based on a secret family recipe. Some may actually sell real theriac (see Chapter Five: Experimental Philosophy, Theriacs), but most of the time it is just pondwater and grass.

A barber-surgeon is usually gainfully employed, and specializes in bloodletting to assist a resident medicus in maintaining the regimen of a community, particularly in a monastery where surgery is forbidden to the brothers.

Empiricus Characters An empiricus usually has the Surgical Empiricus Social Status (see below), and often have Virtues and Flaws such as Cautious with Chirurgy, Learn Chirurgy from Mistakes, and Famous (for their specialty). Such characters usually rely on a quick tongue and social Abilities to get them out of trouble should things go wrong. They may pick up Medicine on their journeys, but most lack this Ability, which is normally only available to the educated classes. Those specialized in bloodletting can normally find a job as a barber-surgeon, and take the Craftsman Social Status. In many cases the barber-surgeon has another job within the community as well, for only in large cities does this vocation have enough demand to keep him continuously employed. A midwife or herbwife is often eligible for the Wise One Social Status Virtue, although if suspected of being a witch the latter usually has the Outcast Flaw instead. Herbwives with the Herbalism Virtue (see below) are particularly beneficial to a community, and treated with respect, even if also feared. Such characters also rely on the Profession: Apothecary Ability to supply the raw materials of her craft. If a midwife has had her thumbs removed she effectively has the Palsied Hands Flaw; except in rolls involving childbirth, where she has a +2 bonus instead of the penalty.

The Herbwife

The herbwife — or herbman, although most are women — is the poor man’s answer to the apothecary. A far cry from the shops of the town stuffed with exotic ingredients, the home of the herbwife is festooned with the dried and otherwise preserved products of her garden, as well as of her frequent forays into the fields and woods for those ingredients she cannot cultivate. In most communities the herbwife is treated with respect, for as well as being the local midwife, her herb store maintains the health of the village. Occasionally she is treated with suspicion; while still relying on her wares, her clientele suspect her of being a poisoner or a witch.

New Virtues

Purifying Touch and Immunity The Lesser Purifying Touch Virtue (ArM5, page 44) grants the power to heal a specific disease that most people recover from on their own, or one which is not particularly serious. Any Minor or Serious disease can be chosen as the disease cured by this Virtue. The Greater Purifying Touch Virtue (ArM5, page 43) can potentially cure any disease regardless of Severity. The Greater Immunity Virtue (ArM5, page 43) can grant immunity to all diseases. However, the Lesser Immunity Virtue (ArM5, page 44) can only make a character resistant to one specific disease, and it must be a disease that could be affected by Lesser Purifying Touch.

Herbalism

Minor, General

The character is skilled in folk remedies and natural magic to the extent that she can cure diseases without formal training in Medicine. She instead has a unique General Ability — Herbalism — that substitutes for Medicine in all rolls and totals involving diagnosis, prognosis, and disease recovery. The herbalist can also create theriacs and medical ligatures (see Chapter Five: Experimental Philosophy). The character receives 50 experience points that can be put into Herbalism, Profession: Apothecary, and into formulae for theriacs. Herbalism is not Medicine however, and an academic would find her theories of health and disease wholly different from the accepted wisdom. Even if she can read, a herbalist cannot gain any experience in her Herbalism Ability from books on Medicine, and she cannot institute a regimen to promote good health without the Medicine Ability.

Physician of Salerno

Minor, General

The character has attended the famed School of Salerno, the pre-eminent source of medical learning. Not only does he carry the reputation of the school with him (granting a Reputation of Physician of Salerno 2), but he has also learned some unique medical procedures such as the preparation of anesthetics. This Virtue grants an additional 50 experience points to spend on Medicine, Philosophiae, and medical formulae (see Chapter Five: Experimental Philosophy). To take this Virtue, you must be able to take Academic Abilities.

Magister in Medicina

Major, Social Status

The character has achieved a doctorate in medicine from one of the medical schools of Europe (Salerno, Cremona, Montpellier, or Bologna), and completed his two years’ compulsory teaching. This Virtue offers the same benefits as Doctor in (Faculty) Virtue (see Chapter Seven: Universities). This Virtue is compatible with the Hermetic Magus, and Priest Virtues.

New Flaw

Surgical Empiricus

Minor, Social Status

You are a chirurgeon by trade, but have never received a wide grounding in the subject; rather your training has focused on only a single aspect of Chirurgy. Pick a type of surgery as your specialization in that Ability (couching cataracts, removal of stones, bone-setting, etc.). When performing this type of surgery, you get the usual +1 bonus to your roll, but when trying to employ any other application of Chirurgy, you must halve your score in Chirurgy due to your inexperience. It is likely that you travel to get enough clientele for your practice, but can usually earn a good living.

The Practice of Medicine

Recovery Modifiers Ars Magica Fifth Edition, pages 179-180, covers the basics of recovery from wounds and diseases. The rules presented in this chapter make the assumption that these rules apply to recovery in relatively healthy environments for the patient. However, it is not always possible to meet the ideal conditions of cleanliness, diet, and rest demanded for speedy recovery. For example, the inclusion of red meat in the diet and taking time to rest are luxuries that cannot be afforded by most peasants. The modifiers in the following table apply to all Chirurgy and Medicine rolls and totals, including Wound and Disease Recovery rolls. All modifiers are cumulative, and for each modifier that applies from this list the Chirurgy or Medicine roll receives one extra botch die. For example, a person who serves as his own chirurgeon while residing in a townhouse has a total of three botch dice for all his Wound Recovery rolls. Condition Mod Poor or unsanitary living conditions, e.g. barn or typical town house -1 Average conditions, e.g. a clean, warm room 0 Wealthy conditions or dedicated infirmary +1 Diet of a typical peasant –1 Diet of typical town person or covenfolk 0 Diet of typical noble or magus +1 Routinely active throughout healing period* –1 No chirurgical instruments (Chirurgy rolls only) –3 No medicinal herbs (Medicine rolls only) –3 Chirurgy or Medicine performed on self –3 * As much as the wounds or disease will allow without incurring extra Recovery rolls, e.g. traveling with a Light Wound.

The Ability of Medicine is primarily oriented toward establishing a preventative health regime in the physician’s clients, and in the curing of diseases in those who become sick. Medicine requires knowledge of the physiology and anatomy of the human body, and a philosophic understanding of the non-naturals so that they may be regulated to provide the optimum health tailored to individual needs. The working of a successful cure depends ultimately on the will of God, proximately on the knowledge and skill of the practitioner, but more immediately on the willingness of the patient to follow medical instructions, the healing power of nature, and external conditions he experiences while recovering.

Specialties for Medicine

Under the rules presented here, the following areas are suitable as specialties in the Medicine Ability: diagnosis, prognosis, therapy, regimens, theriac, a specific disease

Epidemiology and the Prognosis Total The rules provided in this chapter make diseases harder to cure. Rather than just adding Medicine to Disease Recovery rolls, the physician now has to have a sufficiently high Prognosis Total to have this effect. However, this reflects the grim truth of Mythic Europe — diseases are killers, but those who are rich enough to afford the services of a skilled physician are likely to survive. Consider the following: without access to a physician, over half the peasants in a typical village will die from a disease like pneumonia; and seven in a hundred will survive variola. However, with the assistance of a physician with Medicine 2, the chances of survival from these diseases are now almost 95% and 55% respectively. Medicine is very effective, and these rules are designed to maintain that efficacy, but limit its power to diseases within the capacity of the physician. It is now unlikely that a physician with a score of 2 can achieve a prognosis total large enough to cure variola, although pneumonia is possibly within his grasp. Magical Assistance to Disease Recovery Rolls Magical bonuses to Disease Recovery rolls can be provided by Creo Corpus spells or equivalent magics at the same levels as Wound Recovery rolls. Different spells are required for providing magical aid to Disease Recovery rolls and Wound Recovery rolls, for the healing process works in a different manner. These bonuses to disease recovery do not affect the Prognosis Total; they are additional to any benefit from Medicine. If a disease is caused by possession by a demon (or another supernatural entity), then magical attempts to provide a healing bonus (or cure the disease entirely) must penetrate the creature’s Might score to have any effect. Since possessing demons cannot normally be perceived, even with magic, they are not normally prone to destruction by spells like Demon’s Eternal Oblivion. Seasonal Activities As detailed in the following sections (Practice of Medicine, Practice of Chirurgy, Practice of the Apothecary), there are a number of seasonal activities involved in the care of patients that do not require the full attention of the medicus, and allow him to pursue other activities in that season. A character can do two different activities from the following list in a season, but the chosen activities can only include one of the asterisked items. If the activities chosen do not grant the medicus experience points, the character gains Exposure experience in an appropriate Ability. Provide palliative care for up to (Chirurgy) characters; Provide therapy for up to (Medicine) characters; Maintain a single regimen (regardless of the number of beneficiaries); Search for a specific medicinal ingredient for a month or less; Supervise up to (Leadership) infirmary staff (such as nurses); Practice either Medicine, Chirurgy, or Profession Apothecary;* Train another in Medicine, Chirurgy, or Profession Apothecary;* Gain labor points for maintaining a business.* The following activities take an entire season, and a character cannot perform any other activities in addition to them, other than gain Exposure experience: Palliative care for up to (5 x Chirurgy) characters; Therapy for up to (5 x Medicine) characters; Search for a specific medicinal ingredient for more than a month.

Treatment of Disease

In combating illness, medicine has three weapons: diet, medication, and surgery. A medicus employs one or more of these weapons to restore the balance of humors in his patient and return him to good health. While routine illnesses can be treated by anyone with medical knowledge, more serious diseases require a physician of substantial skill who is capable of bringing all three weapons of his art to bear. Diet — and other aspects of the environment — are the province of medicine, as is the knowledge of medicines (although their preparation requires the skills of an apothecary). Surgery is the craft of the chirurgeon, and is a skill that many medici lack. Correct diagnosis of the disease is essential — a physician needs not only to recognize the symptoms, but must understand how those symptoms are being produced by the state of dyscrasia if he is to bring the humors back into balance. He must then predict the course of the disease and plan his therapeutic strategy based on the tools available to him. Finally, the actual day-to-day therapy of the patient is what nurses him back to health.

Medical Magic

The same Creo Corpus guidelines that grant bonuses to Wound Recovery rolls can be used to create spells affecting Disease Recovery rolls, but a spell designed to assist the healing of wounds cannot be used to assist recovery from a disease. Under the rules presented here, some of the Corpus spells listed in Ars Magica Fifth Edition, pages 129–135, require clarifications as to how they act. Gentle Touch of the Purified Body: Instead of healing a Light Wound caused by disease, this spell uses the new guideline detailed below, and heals a Minor disease. Restoration of the Defiled Body: This spell can remove any Flaws that result from a disease. The Level 25 guideline is needed to negate the Flaws caused by surgery to save a Heavy or Incapacitating wound. The Physician’s Eye: The caster discovers which humors are out of balance, granting a +1 to his Prognosis roll. Revealed Flaws of the Mortal Flesh: This spell instantly diagnoses a disease (both cause and effect), and adds +3 to the Prognosis total if the follow-up treatment is designed by the character. Curse of the Leprous Flesh: This spell does not actually inflict leprosy (which is a Divine curse), but a disease very much like it (see Diseases, Hermetic Leprosy). This spell uses the modified Level 20 Perdo Corpus guideline detailed below, and similar spells can be designed to inflict other diseases. See Make Your Own Plagues, earlier, for details on how to make a magical disease. Incantation of the Milky Eyes: This spell inflicts a form of Suffusio (see Diseases). Curse of the Unportended Plague: See Curse of the Leprous Flesh, above. Rego Corpus spells can cause natural changes in the body humors, and thus mimic the symptoms of diseases; in a healthy person these spells need a duration to maintain their effects. Rego Corpus cannot inflict Disease Penalties, nor cause pain. New Creo Corpus Guidelines Level 15 Cure a Minor disease Level 20 Cure a Serious disease Level 25 Cure a Major disease Level 30 Cure a Critical disease Level 35 Cure any disease New Perdo Corpus Guidelines Level 5 Inflict a Minor or Serious disease with a maximum Severity 10 Level 10 Inflict a Minor, Serious, or Major disease with a with a maximum Severity 15 Level 20 Inflict any disease New Rego Corpus Guidelines Level 3 Invoke a minor symptom of a disease without creating any underlying malaise (e.g. rash, mild fever, cough) Level 5 Invoke a major symptom of a disease without creating any underlying malaise (e.g. vomiting, boils, paralysis) Gift of the Tortured Bowels Rego Corpus 10 R: Eye, D: Mom, T: Ind The target is inflicted with a sudden intestinal cramp, then immediately suffers a bout of diarrhea. Once the bowels are empty, there are no physical aftereffects. Medically inclined magi occasionally use this spell (and variants thereof) therapeutically, to purge the body of putrefied humors. (Base 5, +1 Eye)

Diagnosis and Prognosis

A physician diagnoses a disease initially from the external appearance of the patient and his narrative of the illness, although physicians are warned to not put too much faith in the patient’s description of his symptoms. Physical inspection involves a detailed analysis of the patient’s pulse, excreta, and most especially urine. The apparent obsession of a physician with urine has made the profession the butt of many jokes, and the distinctive round-bottomed urine flask is an almost universal symbol of the profession. The pre-eminence of urine is due to the fact that it is the waste product of the most important process in the body: the concoction of chyle into the four humors. It can therefore inform the physician of the humoral balance of the patient’s body better than any other symptom, from its hue, thickness, cloudiness, inclusion of solid matter, foaminess, smell, taste, and countless other physical cues. Books on Medicine devote many chapters to tabulating the meanings of these qualities, and the best have color charts indicating in pigment the various shades and their meaning. The next step in diagnosis is nearly always bloodletting, unless the patient is particularly weak. Not only is this the first stage of most therapy, but the inspection of the let blood can reveal the distribution of humors throughout the body and the state of their digestion into other products.

Prognosis is the prediction of the onset and course of a disease. It follows from the correct diagnosis of the symptoms and their cause, and involves the physician’s knowledge of how to combat those causes in his efforts to restore humoral balance. Much of medicine revolves around the prediction and management of crises, turning points in a disease when the body sheds humors, typically through a heavy sweat, vomiting, or diarrhea. Crises can be either good or bad, and strong or weak: a good and strong crisis results in the patient beginning to improve; a weak crisis (good or bad) results in no change; and a bad and strong crisis results in the disease worsening. Through prognostic astrology, a physician tries to predict the auspicious days upon which a crisis should occur, and then either delay or hasten the manifestation of the crisis so that it occurs on the right day. Prognostic astrology is covered by the Medicine Ability rather than Artes Liberales, but can only be applied to medical practices.

Correct diagnosis and successful prognosis are combined into a single total called the Prognosis Total, which is compared against the severity of the disease. If the Prognosis Total is greater than the severity of the disease, then the medicus has sufficient skill to plan therapy for his patient, who may add his doctor’s Medicine Ability to her Disease Recovery roll. If not, then the medicus is unable to treat this disease, and the patient must attempt to recover without the benefit of Medicine. Note that there is no die roll in the Prognosis Total — the medicus is either sufficiently skilled or he is not.

Prognosis Total

Intelligence + Medicine + Diet Modifier + Medication Modifier + Surgery Modifier

Ease Factor

Severity of Disease

Modifiers To Prognosis Total

Diet Modifier + Living Conditions Modifier

Medication Modifier + Profession: Apothecary (Maximum 3) Surgery Modifier + Chirurgy (Maximum 3)

To receive the benefit from medication and surgery, the medicus need not have the appropriate Abilities himself, but must have dedicated access to someone with those Abilities for the whole period of the healing process. The apothecary is required to prepare specific ingredients from his store of herbs, and mix them into medicinals for application to the patient. Note that without access to any medicinals, the Disease Recovery roll suffers a penalty as well as restricting the Prognosis Total (see Recovery Modifiers, above). A chirurgeon’s assistance is necessary for bloodletting, therapeutic cautery, and cupping (see Chirurgy, below).

If it is necessary to make a diagnosis without combining this with prognosis, then the physician should make a Perception + Medicine roll, with an Ease Factor determined by the storyguide depending on the rarity of the disease, where 6 represents an uncommon but not unusual complaint.

Therapy

Therapy is the day-to-day care of the patient, which is covered by Disease Recovery rolls. A physician can provide therapy to a number of patients at a time equal to his Medicine Ability without affecting his usual seasonal activities, and can care for a maximum of five times this number of patients by pushing himself to his limit (see Seasonal Activities, above). Physicians who work in hospitals can also coordinate a number of other physicians of lesser skill equal to his Leadership Ability, in addition to those patients under his direct supervision. These subordinates can provide therapy equal to their own Medicine Ability even if their Prognosis Total is insufficient, as long as their supervisor has a sufficient total to treat the disease.

If the physician is relying on an apothecary and/or a chirurgeon and loses that assistance partway through the treatment, the Prognosis Total must be recalculated immediately; if it is insufficient to achieve the Ease Factor, then the benefit from Medicine is lost from the Disease Recovery roll. Remember that as patients improve or worsen, the Severity of the disease changes. Each time a disease worsens, the Prognosis Total must exceed the new Severity to continue to provide benefit. Similarly, as a disease improves, the medicus may no longer need the assistance of his chirurgeon, whose time can be freed up to help others.

Disease Recovery Total

Stamina + Medicine* + Recovery Modifiers + Magical Aid + Stress Die

* Medicine may only be added if the Prognosis Total is sufficiently high; see Diagnosis and Prognosis

Prevention of Disease

The principle work of a physician — particularly one retained by a noble lord or at a covenant — is not to cure the diseases of his clients, but to prevent diseases affecting them in the first place. To this end, a physician will prescribe a tailor-made diet and regime of exercise and bloodletting appropriate to the individual based on his native temperament and the time of year. This recipe for living a healthy life is called a regimen, and its purpose is to control the effects of the non-naturals and so ensure eucrasia — that state of perfect balance of the humors that prolongs life and negates bodily suffering.

Once a client has been living under a regimen for one year, it begins to have an effect on health. A regimen requires no roll on behalf of the physician, although he must have a minimum Medicine score as indicated on the table below. Because regular bloodletting is a vital component to the regime of health, a regimen requires regular access to a chirurgeon with a Chirurgy score of at least 3; this may be the physician himself. Note that a regimen is a medical procedure and the chirurgeon lets blood according to the direction of the medicus; a chirurgeon cannot design a regimen without the Medicine Ability. All regimens are unique to the individual, and require constant attention from the physician, who makes small adjustments based on his regular inspection of the urine, feces, complexion, and dreams of his patients. Regular access to the patient by the physician is vital, but this amounts to a few hours each week, and does not substantially interfere with seasonal activities of either the patient or the physician (see Seasonal Activities).

Eucrasia is represented by a Living Conditions Modifier, which applies to Aging rolls and Disease Avoidance rolls, and assists in the Prognosis Total (see above). Every person has a base Living Condition Modifier based on his immediate environment and level of nutrition from his food (ArM5, page 170). Non-naturals such as air and climate are out of the control of the physician, but he can regulate quality of diet, exercise, and the other non-naturals through the regimen. The number of characters in the care of a physician determines the maximum effect of a regimen:

Clients = Physician’s (Medicine X 5)
Bonus To Living Conditions Modifier: +1
Minimum Medicine: 1

Clients = Physician’s Medicine
Bonus To Living Conditions Modifier: +2
Minimum Medicine: 4

Single Client
Bonus To Living Conditions Modifier: +3
Minimum Medicine: 7

Each physician can only manage a single regimen (that is, either a +1, +2, or +3 bonus) regardless of how many people are affected by it. The state of humoral balance that gives this bonus to health must be maintained at all times to receive the benefit, and it takes into account the non-naturals commonly influencing the character (see Effects of Non-Naturals, above). If eucrasia is lost, then it takes a whole year to re-establish. Eucrasia is lost if:

• The patient spends more than a month in a different environment;
• The patient neglects his regimen of diet for more than a month;
• The patient’s regular exercise changes for more than a month, which includes traveling and convalescing from any injury during this time;
• The patient has disrupted sleep patterns for more than a month, which includes conducting non-standard laboratory regimes (see Covenants, pages 107–109);
• The patient’s humors are significantly disturbed, which includes suffering from any disease, spending more than a day under the effects of a Corpus spell, or suffering a Wizard’s Twilight.

Regimens and Covenants Because a large component of a regimen is diet, promoting eucrasia can be expensive for the leaders of a community. In return for the general health of themselves and their people, the cost of living can double. In general, only wealthy covenants can afford to institute a regimen among its covenfolk. The Covenants book for Ars Magica Fifth Edition contains rules for the management of a covenant’s wealth; if employing these rules, the Inhabitant points (Covenants, page 63) for characters under a regimen are increased. Add up all the Inhabitant points for the characters under each regimen, and apply the following modifier, rounding all fractions up. 'Change in Living Conditions Modifier Multiplier to Inhabitant Pts. Increased to +1 x1.5 Increased to +2 x2 Increased to +3 or more x2.5 The cost applies to each step of improvement. For example, two companions of a covenant normally each have Living Conditions Modifier of 0, but they benefit from a regimen that raises this to +2. The companions now cost 18 Inhabitant points: a +1 bonus raised their combined cost from 6 to 9, and raising it further to +2 doubled this to 18. A magus who is part of the same regimen goes from +1 to +3, costing 25 Inhabitant points (5 Inhabitant points at +1, 10 Inhabitant points at +2, 25 Inhabitant points at +3). A regimen cannot be instituted if the covenant is applying Emergency Savings to their food budget (Covenants, page 69).

The Practice of Chirurgy

Chirurgy has long been considered the “poor brother” of medicine, and yet as a practical rather than an academic skill it is more accessible than the noble medicine; it is rare to find a village that does not have at least one person who knows the basics of this craft. The most commonly called upon chirurgical techniques require no booklearning, just common sense, and anyone who has studied the basics of the Ability can attempt to perform its procedures.

The Ability of Chirurgy covers a range of different practices. Suturing, bandaging, and the preparation and application of plasters, along with bone-setting, are used in the treatment of injuries. The practice of surgery specifically involves cutting (either incision or excision), and is used to treat minor complaints such as swellings and blemishes on the skin, right up to crisis surgery to save lives. Therapeutic uses of Chirurgy involve phlebotomy (bloodletting), cautery, and cupping. Finally, the skills of a midwife are part of Chirurgy. Any of these practices can be taken as a specialty of a character with the Chirurgy Ability. A chirurgeon is severely restricted if he does not have access to his instruments. Typically, a chirurgeon’s tool-bag contains some or all of the following: knives, razors, lancets, cautery irons, grasping tools, probes, needles, cannulae, trepanning tool, sutures, pads, and bandages. The lancet (a blade used for bloodletting) in particular is such a ubiquitous tool of the chirurgeon that it is often used as a symbol of the profession as a whole.

The following sections describe the practice of Chirurgy under four main topics: the therapeutic practices of phlebotomy and cautery; surgery, the treatment of wounds; and midwifery. The Recovery Modifiers mentioned in many of these formula can be found in the insert at the beginning of The Practice of Medicine (above).

Specialties for Chirurgy

Under the rules presented here, the following areas are suitable as specialties in the Chirurgy Ability: surgery, surgical intervention, first aid, palliative care, midwifery.

Phlebotomy and Cautery

Phlebotomy, or blood-letting, is the most frequently used tool of general therapy. All four humors are present in the veins and a build-up of even healthy humors can be detrimental to eucrasia. Worse, a failure to naturally expel bad humors can lead to putrefaction, but these bad humors can also be expelled through blood-letting. The practice of phlebotomy requires a certain amount of technical knowledge. Most commonly, blood is drawn from one of the veins in the arm, but other veins are opened for specific conditions; for example, melancholy is often drawn out through a vein in the forehead. The correct time of the day and phase of the moon must be observed, and these vary according to the complexion of the patient.

The knowledge of when and where to remove blood, and the therapeutic purpose served by the procedure, is covered by the Ability of Medicine, but the actual removal of blood is a chirurgical procedure. Many physicians are forbidden by canon law from cutting, and are thus forced to procure the services of a chirurgeon to perform the actual act. The Chirurgy Ability grants the knowledge of how to ligate the arm, make the incision, recognize and avoid nearby nerves and arteries, and stem bleeding. The most common technique for the actual drawing of blood is venesection, that is, opening the vein with a sharp knife called a lancet; although some practitioners who have studied at Salerno are starting to use the Arabic technique of using blood-sucking leeches instead. The advantage of venesection is that the removed blood can be inspected as part of the diagnosis of disease (see Medicine).

Cautery involves the application of strong heat to the skin. It can be used to prevent the spread of a destructive lesion, invigorate cold tissues, break up putrefying humors imprisoned in a tissue, and stop the flow of blood. Cautery irons are instruments of metal, preferably gold but silver will suffice, which are heated in a fire before being applied to the patient in places and patterns prescribed by medical texts. There are a number of shapes of iron — hooks, leaf-shaped, needles, or spade-shaped, each suited to a particular purpose. This form of cautery is distinct from the surgical application of cautery used to treat wounds. For treatment of hot diseases, where the application of more heat might be detrimental, caustic substances such as lye are used instead of heated metal. Likewise, for dry diseases the chirurgeon may use cupping, which involves the application of metal cups heated in boiling water.

Surgery

Along with phlebotomy and cautery, minor surgery — incision, excision, cautery, and medication of swellings and blemishes on the skin — form part of the routine practice of a chirurgeon. Major internal surgery is only attempted in a handful of immediately lifethreatening or acutely painful conditions, such as urinary obstruction, gallstones, carious teeth, and the surgical treatment of cataracts. Only on a few rare occasions will a chirurgeon be called upon to perform major surgery (such as repairing physical damage to a major organ) and the chances of success are very slender. Trepanning is rarely used as a surgical procedure because of the risks involved, but for complaints that involve a surfeit of the sensitive faculty — characterized by hallucinations, delirium, and other mental problems — a hole in the head can serve as a temporary measure to allow the excess sensitive faculty to drain away. Amputation is rarely performed to cure disease, but instead is an emergency measure to stop wounds worsening (and thus comes under Surgical Intervention, below).

Not all diseases are amenable to surgical intervention; the descriptions of diseases above indicate whether surgery can assist. Assuming that a surgical intervention is possible, the chirurgeon must plan the operation, employing pharmaceuticals, alcohol, or strong men to render the patient immobile for the procedure. All surgery of this type inflicts a wound upon the patient to allow the chirurgeon access to the afflicted body part, but with luck the wound will be less serious than the consequences of not having the surgery. The Ease Factor is determined by the seriousness of the complaint being cured. On a success, the disease returns to its starting Severity (if it had worsened). Additionally, the patient receives a +3 to his next Disease Recovery roll, although this bonus may be partially or wholly nullified by the Wound Penalty of the surgical wound. On a failed Surgery roll, the patient receives no benefit from the surgery but still receives a wound. On a botch, the patient receives a wound that is one step more serious than indicated on the chart below, and the disease is unaffected by the surgery. Phlebotomy, cautery, and cupping can only affect the most trivial diseases (Severity 5 or less) on their own.

Surgery Roll

Dexterity + Chirurgy + Recovery Modifiers + Stress Die

Surgical Procedure	Ease Factor	Wound Inflicted
Phlebotomy	3	1 FL
Cautery and cupping	4	1 FL
Removing a rotten tooth	6	1 LW
Opening tonsils to cure quinsy	9	1 LW
Couching a cataract	9	1 LW
Trepanation	12	1 LW
Caesarian delivery (see Midwifery, below)	9	1 MW
Removing a gall stone or fistula	9	1 MW
Removing a cold or hot tumor	12	1 MW
Removing a consumptive tumor	15	1 MW

FL = Fatique Level LW = Light Wound MW = Medium Wound

Treatment of Wounds

Most requirements for a chirurgeon’s abilities are for “touching and cutting,” routine treatment of simple injuries such as broken limbs, sprains, dislocations, burns, scalds, cuts, bites, bruises, injuries to nerves, or skull fractures, as well as the treatment of all kinds of swellings or eruptions. A competent chirurgeon will clean and dress the wound, stitch it together with sutures made from hair or gut, and apply a plaster before bandaging the wound to keep it from putrid air. The plaster is a medicinal compress containing substances such as ash, mustard, linseed, and so forth, which will keep the wound clean, rebuild flesh, and reduce scarring. If the wound has ulcerated, perhaps as a result of disease or a wound that has worsened with infection, the plaster will contain caustic substances to cleanse the flesh. While medication is usually a function of medicine, the preparation and application of plasters also comes under the purview of chirurgy. Puncture wounds, particularly ones believed to be poisoned, are often treated by pouring boiling oil into the wound; this seals the flesh and destroys putrid humors, but is painful to the patient to say the least. Broken bones are splinted, and if they have broken the flesh the wound is treated like a puncture. Dislocations and sprains often need physical manipulation to re-articulate the joint.

In addition to the environment demanded for healing, there is also the issue of chirurgical care. The treatment that a wound receives immediately after it is inflicted can be as important as the weeks or months of care that follow. Thus, the bonus to the Wound Recovery roll from the Chirurgy Ability can be divided between first aid and palliative care. The rules presented here are an expansion of those found on pages 179-180 of Ars Magica Fifth Edition. Under these extended rules, the Wound Recovery roll becomes:

Wound Recovery Total

Stamina + First Aid Bonus + Palliative Care Bonus + Recovery Modifiers + Magical Aid + Stress Die

Chirurgical Magic Hermetic magic is very effective in speeding the healing of wounds. Even low-level Creo Corpus spells can give the same bonus to Recovery rolls as a skilled physician or chirurgeon, and can duplicate the effects of other applications of the healing Abilities. The Bind Wound spell is better than a successful First Aid roll, since any activity can be attempted without risking the worsening of a wound. A new guideline presented below allows the mimicking of a First Aid roll for those who are less proficient with Creo Corpus. Creo Corpus can also assist childbirth rolls (see new guidelines below), but if labor is still ongoing when the spell lapses, the mother must make an immediate childbirth roll, and this extra roll cannot result in improvement. Rego Corpus can be used to mimic any surgical procedure, similar to Rego Craft Magic (Covenants, page 49). The spell must be designed with Target Part if the object of the surgery cannot be seen from outside (such as a tumor). The magus requires precise control over his magic to have a successful result, and must make an Intelligence + Finesse roll against an Ease Factor equal to (Ease Factor for the mundane surgeon + 3). So to remove a rotten tooth, the roll has an Ease Factor of 9. Magical surgery involves no cutting, and does not result in any wound or bleeding, but the consequences of surgery remain. Thus, surgical intervention replicated with magic results in the acquisition of aging points or a Flaw, but the wound does not worsen. New Creo Corpus Guidelines Level 1 The target’s wounds are treated as one category less serious for the purposes of activities while injured Level 3 Give a character a +1 to childbirth rolls Level 4 Give a character a +3 to childbirth rolls Level 5 Give a character a +6 to childbirth rolls New Rego Corpus Guidelines Wounds inflicted with surgical magic mimic Surgery, and wounds prevented from worsening mimic surgical intervention. Level 5 Perform a trivial surgical procedure (inflicting a fatigue level) Level 10 Perform a minor surgical procedure, inflicting a Light Wound or preventing a Light Wound from worsening Level 15 Perform a major surgical procedure, inflicting a Medium Wound or preventing a Medium Wound from worsening Level 20 Perform a critical surgical procedure, preventing a Heavy Wound from worsening Level 25 Perform a life-saving surgical procedure, preventing an Incapacitating or Fatal Wound from worsening Blessed Relief of the Benighted Reins Rego Corpus 25 R: Touch, D: Mom, T: Part Cast on a patient suffering from a kidney stone, the stone is removed from the patient’s body and appears in the hand of the caster. The “surgery” requires an Intelligence + Finesse roll against an Ease Factor of 12; failure indicates that the stone remains within the target’s body. (Base 15, +1 Touch, +1 Part) Sever the Unwanted Limb Rego Corpus 25 R: Touch, D: Mom, T: Ind One of the target’s limbs is amputated cleanly and painlessly, without bleeding. The amputation requires an Intelligence + Finesse roll against an Ease Factor of 12; failure indicates that the target is left intact. If this roll succeeds, the target acquires the Lame or Missing Hand Flaw. If used instead of surgical intervention, the patient’s failed Recovery roll is treated as a stable result instead. (Base 20, +1 Touch)

First Aid

First aid is immediate treatment of the wounds: cleansing the site of damage, adding cleansing compresses to draw out the bad humors, and suturing (stitching) the wounds. If first aid is received within one day of being wounded, then the patient receives half of his chirurgeon’s Chirurgy Ability (rounded up) to his subsequent Wound Recovery roll. First aid applied after more than a day has elapsed gives no bonus to the Wound Recovery roll. As well as starting the healing process, first aid can also prevent a wound from worsening for a short period of time, allowing the patient to get to a place of safety for the proper healing of his wounds. When tending a patient’s wounds, a chirurgeon can make a First Aid roll against the Improvement Ease Factor of his patient’s most serious wound on the Wound Recovery Table (ArM5, page 179). If this is successful, the patient is treated as one category higher with respect to Activity While Injured (ArM5, page 178). The effects of a successful First Aid roll last just one day, and cannot be repeated. A botched First Aid roll provokes an immediate Wound Recovery roll, and the patient receives no First Aid bonus.

Example: Halfgrim suffers a Light and a Medium wound in combat. He is treated with a First Aid roll against an Ease Factor of 12, which is successful. For the next day he can perform activities as if his Wound Penalty was between –1 and –2 without risking his wounds worsening, rather than his actual Wound Penalty of –4. He still suffers his actual Wound Penalty to any rolls or totals.

First Aid Bonus To Wound Recovery

(chirurgy / 2)

First Aid Roll

Dexterity + Chirurgy + Recovery Modifiers + Magical Aid + Stress Die Vs Improvement Ease Factor

Palliative Care

Palliative care is the ongoing treatment of a patient’s wounds: changing bandages, cleansing wounds, and attending to diet and environment. A chirurgeon can provide palliative care to a number of patients at a time equal to his Chirurgy Ability without affecting his usual seasonal activities, and can care for a maximum of five times this number of patients by pushing himself to his limit (see Seasonal Activities, above). Chirurgeons who work in hospitals can also coordinate a number of other chirurgeons or nurses of lesser skill equal to his Leadership Ability in addition to those patients under his direct supervision. These subordinates apply the Palliative Care Bonus of their supervisor to a number of patients equal to their own Chirurgy Ability.

Palliative care adds half of the chirurgeon’s Chirurgy Ability (rounded up) to the Wound Recovery roll. The total bonus to the Wound Recovery roll from Chirurgy (First Aid and Palliative Care combined) cannot exceed the Chirurgy Ability of the character supplying the palliative care.

Example: Halfgrim received his First Aid after the last battle from another grog, but was then brought back to the covenant for recovery under the covenant’s skilled medicus. The grog’s Chirurgy is 2 and that of the medicus is 5; so Halfgrim’s Wound Recovery roll has a +1 First Aid bonus and a +3 Palliative Care bonus. Had the medicus been available for First Aid, the total bonus for both First Aid and Palliative Care would have been +5 (his Chirurgy Ability), not +6.

Palliative Care Bonus To Wound Recovery

(chirurgy / 2)

Nurses In Mythic Europe women typically take on the role of palliative caregivers for patients, and assist physicians in maintaining a healthy environment for recovery from diseases. Even in poor households it is usual for the housewife to have some Chirurgy Ability, which she uses for the benefit of domestic servants (if any) as well as family members. Hospitals are occasionally attached to monasteries, convents, and medical schools, and the staff perform their Christian duty to provide for the sick. Some hospitals were instituted specifically for those injured on Crusade (the most famous of which is the Jerusalem Hospital built by the Order of St. John), whereas others specialize in the treatment of leprosy or other chronic ailments. In game terms, a nurse can act as the lead chirurgeon in both first aid and palliative care, or (more often) take the role of a subordinate, passing the benefit of the lead chirurgeon down to those under her direct care. In addition, nurses attached to hospitals or medical schools often pick up some Medicine, and can act as subordinates during therapy (see Practice of Medicine).

Surgical Intervention

Sometimes, despite the care of a chirurgeon, a patient’s wounds worsen as a result of a failed Wound Recovery roll. In these cases, rather than allowing the wound to fester with infection, a chirurgeon can use emergency surgery to attempt to prevent the decline of his patient. Resorting to major surgery is a risky strategy, and there are often adverse consequences, and yet it can save lives. Typical surgical interventions involve deep tissue cautery with boiling oil or red-hot metal, amputation to remove a morbid limb, trepanation to reset a fractured skull, or suturing of damage to internal organs. Unlike other surgery (see above), these procedures do not cause a wound because they operate on a pre-existing wound. However, they all come with lasting consequences to the patient.

Any time a Wound Recovery roll fails, a chirurgeon can opt for a surgical intervention. He must make a Surgery roll (see Surgery, above) against an Ease Factor of 9. If successful, the surgical intervention works and the wound does not worsen; treat the failed Wound Recovery roll as if it was a Stable result instead, including the +3 benefit to subsequent Wound Recovery rolls. However, the surgery has a permanent consequence, as listed in the table below. If the Surgery roll fails, then the wound worsens and the patient suffers the permanent consequences. On a botch the patient’s wound worsens by two steps; that is, a Medium Wound becomes an Incapacitating Wound, and anything more serious results in death.

Wound Consequences of Surgical Intervention Light Make an immediate Aging roll Medium Acquire two aging points in a Characteristic appropriate to the type of wound Heavy Gain a Minor Flaw appropri ate to the type of wound Incapacitating Gain a Major Flaw appropri ate to the type of wound

Aging points and Flaws that can be gained from surgical intervention depend on the location of the original wound:

Head Major Flaw: Blind, Deaf, Mute Minor Flaws: Disfigured, Missing Eye, Missing Ear Characteristics: Int, Per, Com, Pre

Torso Major Flaw: Crippled, Enfeebled Minor Flaws: Disfigured, Fragile Constitution Characteristics: Sta, Str

Limbs Major Flaw: Crippled, No Hands Minor Flaws: Disfigured, Lame, Missing Hand, Palsied Hands Characteristics: Dex, Qik

Midwifery

Almost exclusively the province of female practitioners, the skills of a midwife are employed throughout pregnancy; however, it is the birth itself that requires the most intensive effort on behalf of both the mother and the midwife. Childbirth is perilous for both baby and mother — about two in every ten births result in the death of the mother; and if the mother dies, the baby almost always suffers the same fate. In another one to two births out of every ten, the baby perishes but the mother survives. The chance of survival of mother and child is greatly enhanced by the presence of a midwife, and the majority of births are attended by a midwife with a Chirurgy score of at least 1 or 2. A character with no practical experience of childbirth (such as most male chirurgeons) can assist, but suffers a –2 penalty to his Chirurgy Ability.

If it is desirable to play out childbirth as part of a saga, the Wound Recovery rules can be used to simulate the process. The onset of labor is treated as a Medium Wound to the mother, except that Wound Recovery rolls are made every 2 hours. This wound is not a real wound, but it is a useful gauge to determine the duration and severity of labor.

Once the mother reaches an “unwounded” status, the baby is born, However, every time the mother’s condition worsens, the baby loses a Fatigue level, and if it loses five Fatigue levels, it dies. If the mother dies before the baby is born, then the baby dies as well, unless a surgeon is available to perform a Caesarian delivery (see Surgery, above). If a surgical solution is used to deliver the baby prior to the mother’s death (which is highly unusual), then the (real) Medium Wound she suffers from the surgery penalizes the mother’s Recovery rolls by –3. Both mother and baby are left at the Dazed level of Fatigue following childbirth.

The Practice of the Apothecary

There are areas of crossover between the Abilities of Medicine and Profession: Apothecary (see Characters, Profession: Apothecary), although these are complementary rather than alternative Abilities. Knowledge of Medicine contains the basics of herb craft, but concentrates on how medicinals effect changes in the humors and restore eucrasia. The Profession: Apothecary Ability covers the encyclopedic knowledge of the qualities of individual herbs, animal parts, and minerals that have medical benefit. The apothecary knows where and when to obtain the raw ingredients of his trade, and how to assemble them into the most appropriate pharmaceutical to treat the complaint. Profession: Apothecary is an adjunct to Medicine; it has little practical use on its own. An apothecary who does not possess Medicine cannot prescribe a remedy with any therapeutic effect; nevertheless, this does not prevent the more unscrupulous members of the profession from pretending to.

Medication is the principal form of active intervention in any disease, and using the right herbal preparation is vital to the effective practice of medicine. Where the two professions are kept distinct, a physician describes the symptoms and complications to the apothecary, who then prepares a decoction designed to counteract the symptoms. The medicinal has to be selected according to its qualities, so that for a dry condition a moistening medicine is given, and so forth. Secondly, the nature of the part to be treated must be considered when deciding on the strength or dose of the medicinal; if a organ that is normally hot is made cold by a disease, the strength of the heating power of a medicine has to be greater than in the case of a cold organ made colder. Finally, medicinals are administered according to the stage of the disease, and adjustments should be continually made to the prescription to reflect the changing state of the patient. Gentle medicinals are used first and stronger ones later, unless the threat to life is great and a delay would be injurious. So long as a physician has the constant assistance of an apothecary during the treatment of a disease, the penalty to the Disease Recovery roll due to lack of medicinal preparations (see Recovery Modifiers, above) is reduced by the Profession: Apothecary Ability, although it cannot become a bonus.

The properties of each curative ingredient are well established, based on its physical appearance, its Sympathy, and its Hidden Virtues (for details of the latter two concepts, see Chapter Five: Experimental Philosophy). Each medicinal substance has a primary effect as a warming, cooling, drying, or moistening preparation, but also possess other functions: cleansing, strengthening, pain-relieving, stupefacient, and so forth. Most medicinals are primarily botanical in nature, although many have animal origins, and some are minerals.

Commonly Used Ingredients

These ingredients can provide Shape and Material Bonuses for magi and for philosophers (see Chapter Five: Experimental Philosophy). Use the largest degree of hot, cold, moist, or dry as the strength of the bonus. Example: Valerian (hot 1, dry 2) grants a +2 bonus to laboratory activities affecting the heart, bowels, or kidneys. Agrimony (hot 1, dry 1, Jupiter in Cancer), affects liver, spleen, kidneys, & joints, cleansing and binding Amber (hot 3, dry 3, Jupiter in Cancer), affects head & lungs, stops bleeding Angelica (hot 3, dry 3, Sun in Leo), affects heart, stomach & womb, resists poison Balm (hot 2, moist 2, Jupiter in Cancer), affects lungs, heart, & stomach, cheers heart & mind Betony (hot 2, dry 2, Jupiter in Aries), affects head, lungs, kidneys, & heart, diuretic Blessed Thistle (hot 2, dry 2, Mars in Aries), affects head & heart, opens channels & cleanses Coltsfoot (cold 1, dry 1, Venus in Cancer), affects lungs, treats inflammation Dandelion (cold 2, dry 2, Jupiter in Cancer), affects stomach & liver, opening & cleansing Eyebright (hot 1, dry 1, Sun in Leo), affects eyes & head, restores sight & strengthens brain Fox Lungs (cold 2, dry 3, Jupiter in Cancer) affects lungs, strengthens stamina Geodetes (cold 1, dry 3, Mars in Scorpio), affect the male sex organs Gold (hot 1, moist 1, Sun in Leo), affects the heart, strengthens vital faculty Henbane (cold 4, Saturn in Aquarius), affects joints & inflammations, narcotic Hops (hot 2, dry 2, Mars in Virgo), affects liver & spleen, purges phlegm Ivory (cold 2, dry 3, Venus in Leo), affects heart & stomach, promotes fertility Jasper (hot 2, moist 2, Venus in Sagittarius), affects womb & blood, aids childbirth & stops bleeding Lead (cold 3, dry 2, Saturn in Cancer), affects any inflammation, dries up humors Lettuce (cold 2, moist 2, Moon), affects most parts of body, calming Mallow (cold 1, moist 1, Venus in Virgo), affects bowel, purges choler Millipedes, boiled in oil (hot 3, moist 2, Jupiter in Libra), affect kidneys & liver, diuretic Pyrites (hot 3, dry 1, Sun in Aries), affect the sight, cleanses and disperses Sapphire (cold 1, dry 3, Mercury in Virgo) affects the bowels & senses, resists poison Senna (hot 2, moist 1, Mercury in Aries), affects head, heart, liver, spleen, purges melancholy Swallows (hot 1, moist 2, Sun in Taurus), affect head, eyes, & throat, prevent drunkenness Thyme (hot 3, dry 3, Venus in Cancer), affects head, lungs, stomach and womb, promotes menstruation Valerian (hot 1, dry 2, Mercury in Leo), affects heart, bowels, & kidneys, astringent Viper Flesh (hot 3, moist 3, Mercury in Pisces), affect nerves, resist poison Willow (cold 2, dry 2, Moon in Aries), affects head & joints, cleansing & pain relief Example Components of Poisons Hot: viper venom, aconite (also called monk’s hood, wolfbane, thung), mineral acids, lye, cantharides (extract from a beetle), poisonous mushrooms, sal ammoniac, sugar of lead Cold: scorpion venom, hyoscyamus (also called henbane), hellebore, opium, hemlock, bittersweet Dry: verdegris, cinnabar, saliva from a mad dog, belladona (also called dwale or deuil, meaning “grief”), bitter almonds, black crows drowned in brine, litharge (white lead), asafetida Moist: coal gas, strong purgatives (e.g. colocynth), realgar and orpiment (both of which contain arsenic), tares (seeds of a particular grass), brains of cats

Medicinals

There are four degrees of medicinals, whether eaten, taken in the fluid state, or applied directly to the surface of the skin:

• A medicinal that is hot, cold, dry, or moist in the first degree has a mild action on the body that is imperceptible to the senses;
• The second degree possesses a greater degree of action, without perceptibly interfering with the natural function of the body;
• In the third degree there is evident interference with function, but not sufficient to be harmful;
• The fourth degree causes destruction or death of tissue.

Medicinals of the first degree are used to qualify the effects of food in the maintenance of eucrasia; so, for example, cooling salad herbs are used in summer to ease the heat in the bowels engendered by that season. Medicinals of the fourth degree are all poisonous, and are only used in the most extreme of cases (see Poisons, below).

Heating medicinals cause the removal of offending humors by thinning them and expelling them in the sweat. In stronger degrees, they are used to cut and scatter tough humors, to clear obstructions, and resist poisons. They promote proper concoction by cherishing the digestive force. Moistening medicinals soften the body and strengthen the expulsive force. They ease coughs and constipation, but can also thicken the blood and counteract acrid humors. Drying medicinals consume moisture, arrest discharges, diarrhea, and loss of blood, and firm up organs to restore proper function. Cooling medicinals are used to ease the heat of choler, to reduce fevers, and to treat insomnia. Every ingredient is ruled by a planet and a star sign, which indicates to the apothecary which qualities it has, and what body part it can best affect.

Pharmacy Medicinals are administered in a number of forms. Simples are made from a single ingredient, whereas compounds combine the effects of a number of ingredients in a single preparation. The easiest of all medicines consists of herbs infused in hot water to make a tisane or tea, or else boiled with the water and then strained to make a decoction. A handful of a herbs in a pint of water is sufficient for four or five doses. Simple waters are produced by steeping the herbs in wine. Syrups are made from the juice of herbs heated with sugar or honey to make a thick liquid. Conserves and preserves are made from whole flowers or fruit respectively, preserved in honey. Pills are prepared for the administering of bitter medicines; they are made from powdered ingredients added to a syrup and then rolled into balls. Simple oils are made by gently boiling ingredients in oil or adding herbs steeped in wine to oil, which is then heated to evaporate the wine. Ointments are made in a similar way but using pig grease rather than oil, and then mixing the product with turpentine and wax. The labor rules deal with the day-today preservation and preparation of ingredients, and a physician with access to an apothecary can reduce the Recovery Modifier for not having medicinal ingredients by the Profession: Apothecary Ability of his supplier (although the penalty cannot become a bonus). It is not normally necessary to detail the contents of an apothecary’s stores or to determine the longevity of each ingredient. However, in exceptional cases this may be useful. Make an Dexterity + Profession: Apothecary roll. The Ease Factor for this roll is determined by the length of time that the preparation lasts until its medicinal qualities fade. It typically takes a week or more to prepare an ingredient from the initial harvest to the stored product, although this is not usually continuous work. Mineral ingredients normally do not need this preservation. Duration Ease Factor Weeks 3 Months 6 Seasons 9 Years 12 Decades 15 Indefinitel 18 If the preserved item is also an Arcane Connection, and it is preserved for a duration longer than the duration of the Arcane Connection, then the Duration of the Arcane Connection is increased by one category. For example, an apothecary preserves the scale of a dragon, and achieves an Ease Factor of 15. Not only does the scale retain its medical benefits for decades, but its duration as an Arcane Connection is extended from Months to Years. Only Arcane Connections that are plants or animal body parts can be extended in this manner by an apothecary.

Poisons

Using one mouse stung to death by scorpions, pulverized euphorbium, spurge and its leaf, hellebore, oppoponax, and mustard, combine all ingredients in a lead crucible, cover tightly and bury in a dungheap for two weeks. Then grind all the ingredients well, being certain to reduce the mouse bones to a fine powder. Add a little saffron. This is supposed to kill in one day, or two. — The Book of Poisons, Ibn Wahshiya

Any substance that is hot, cold, dry, or moist in the fourth degree causes harm to the body, and in sufficient quantities can cause direct wounds to the flesh. Excessively hot or cold substances are acute in nature and their effects are usually immediately evident. A substance that is hot in the fourth degree actually burns the flesh, and external application causes blistering and inflammation. Taken internally, these poisons disperse the vital faculty, causing acute pain, shortness of breath, and a fever. A substance that is cold to the fourth degree is a narcotic, congealing the vital faculty and stupefying the senses. Poisons that are dry or moist tend to be chronic poisons, rarely having an instantaneous effect. Extremely dry substances desiccate the body, causing under-nourishment and consumption, and those that are toxic in the quality of moisture dull the activity of the body and take away natural strength.

The knowledge of poisons is covered under Profession: Apothecary since they have therapeutic uses. Unless a character specifically collects poisonous ingredients (which could raise suspicions if such a thing was discovered), the manufacture of a poison usually requires the apothecary to specifically go searching for the requisite ingredients, as detailed above. Only simple poisons (those that inflict a Light Wound, and that have an Ease Factor of 6 or less to resist the damage; see ArM5, page 180 for more details) can be manufactured without knowledge of the correct formula (see Chapter Five: Experimental Philosophy for more details).

The Apothecary’s Store

A practicing apothecary has a store of medicinal herbs that is being constantly replenished by frequent forays into areas where his raw ingredients may be found in the proper season. He is also likely to maintain a garden for the cultivation of easilygrown plants, and will also buy more exotic ingredients from his trading contacts as they become available at a reasonable price. The Ability of Profession: Apothecary covers the knowledge of where and when to find herbs, and how best to preserve them so that their qualities are available all year round. In any season in which the character is practicing his trade — gathering, preparing, and preserving ingredients, and concocting medicinals — the character generates Labor Points. This mechanic was first introduced in City & Guild, Chapter Two: Labor, and is briefly reiterated here. Labor Points do not accumulate in the character’s “free seasons,” that is, those seasons in which they acquire experience from sources other than Exposure.

Labor Points Per Eligible Season

(intelligence + Profession: Apothecary) X Wealth Multiplier

The Wealth Multiplier is 2 for a character with the Poor Flaw, 6 for a character with the Wealthy Virtue, and 3 otherwise.

An apothecary’s business loses 36 labor points every year. These points represent the general stock and trade of an apothecary in terms of sales to physicians and spoilage. Rich apothecaries lose the same number of labor points each year as poor ones, since the former simply have a richer clientele who demand more expensive ingredients. A town apothecary has a smaller client base than one in a rural setting, but the demand for his wares is greater due to the less-healthy living conditions. Any labor points that remain each year can be accumulated to plow back into improving the business; full details of this mechanic can be found in City & Guild, pages 37–40.

An apothecary has a number of additional drains on his stocks beyond that of his normal trade, and so may lose additional labor points in a year:

• An apothecary’s store that is supporting one or more regimens (see Prevention of Disease) costs three Labor Points per year per physician.
• Each medicinal theriac or alchemical reagent (see Chapter Five: Experimental Philosophy, Formulae) made from the ingredients of an apothecary’s stores costs one Labor Point per five points (or fraction) of the Ease Factor.
• Each ligature (see Chapter Five: Experimental Philosophy, Ligatures) sourced from an apothecary’s stores costs one Labor Point.

An apothecary who wishes to avoid this drain on his resources can seek out the specific ingredients he needs for regimens, formulae, and ligatures. To find an ingredient, make a Perception + Profession: Apothecary stress roll against an Ease Factor of 9; each search takes a base time of one month. The Ease Factor may be varied according to terrain, time of year, and assistance; see below for typical modifiers. Success indicates a Labor Point-equivalent of ingredients is found. For every point in excess of the Ease Factor, either another point of ingredients is found, or the time taken is halved. These can be combined in the case of a good roll; for example, a character who makes the roll by four may take a month to find five points, or find three points in a week, or spend just under two days to locate a single Labor Point’s worth. The roll may be repeated as many times as necessary unless the character botches, in which case he is searching in the wrong environment or at the wrong time of year, and cannot identify a suitable replacement. Excess ingredients discovered in this manner do not add to the character’s Labor Point total, since this mechanic represents taking time out from one’s normal trade to find specific ingredients (or their substitutes) rather than gathering and preserving them in the correct season.

Search for Ingredients

Per + Profession: Apothecary, Against Ease Factor of 9

Modifiers to Ease Factor for searching

Situation: Apothecary Familiar with Area
Modifier: – Local Area Lore*

Situation: Assistants
Modifier: –1 per assistant**

Situation: Inhospitable Terrain (eg. heavy snow)
Modifier: +1

Situation: Barren Terrain (eg. desert, bare rock)
Modifier: +3

Situation: Winter
Modifier: +2 (in addition to terrain)

* No broader than a region of a country (Kent, Lower Lorraine), or a specific terrain feature (Black Forest, Pyrenees) ** An apothecary can have one assistant for each point of his Leadership Score. Each assistant must have at least either Profession: Apothecary 1 or Local Area Lore 2.

Pharmacy Magic Creo magic can be used to stock an apothecary’s store, but the spell must be Ritual or else the ingredients vanish at the expiry of the duration. Few magi have bothered to take the time to invent such a spell, whichwould require a minimum of 4 pawns of vis to cast (since Ritual spells have a minimum of 20th level). Medicinal ingredients are processed plant or animal products (in that they are created already dried and preserved), or raw mineral ingredients. Each casting of a spell of this type creates a single variety of ingredient, and each spell contributes one Labor Point, regardless of the quantity produced — it is variety, not quantity, adds value to an apothecary’s business. Enterprising magi might sell the excess, but must be careful about their tribunal’s restrictions regarding the magical creation of wealth (see Covenants, page 57 and City and Guild, page 130). Intellego magics such as Hunt for the Wild Herb can be used to find ingredients more efficiently. These spells cannot assist in the regular upkeep of the apothecary’s store, which is planted and harvested rather than found, but they can assist in the search for extra ingredients. If the character is under the effects of this spell for the whole duration of a search, then the Ease Factor of searching for ingredients is reduced by 3. Rego Craft magic (Covenants, page 49) can prepare ingredients for preservation; such spells require an Intelligence + Finesse roll equal to the Ease Factor + 6 to correctly duplicate the week’s work in an instant. Conjuration of Wild Thyme Creo Herbam 20 R: Touch, D: Mom, T: Group, Ritual Creates ten thousand doses of wild thyme, prepared and dried and ready to use. A different spell is required to create each type of herb. (Base 2, +1 Touch, +2 Group, +3 size)

Attribution

Attribution Based on the material for Ars Magica, ©1993-2024, licensed by Trident, Inc. d/b/a Atlas Games®, under Creative Commons Attribution-ShareAlike 4.0 International license 4.0 ("CC-BY-SA 4.0"). Ars Magica Open License Logo ©2024 Trident, Inc. The Ars Magica Open License Logo, Ars Magica, and Mythic Europe are trademarks of Trident, Inc., and are used with permission. Order of Hermes, Tremere, Doissetep, and Grimgroth are trademarks of Paradox Interactive AB and are used with permission.