TEXT: 1
  DISEASES OF THE SEA
  The Malady Codex III
  Diseases of the Sea
  
  2
  THE MALADY CODEX III
  The Malady Codex III
  Diseases of the Sea
  Written by: Jason Bakos, Themis Paraskevas
  Edited by: Tal Aviezer
  Layout by: Travis Legge
  Artwork by: Daemon Arts, Pixabay, Vecteezy, DM’s Guild Stock Art
  Special thanks to: Chad M. Lench, Blaise Wigglesworth
  DUNGEONS & DRAGONS, D&D, Wizards of the Coast, Forgotten Realms, the dragon ampersand, Player’s Handbook, Monster Manual, Dungeon Master’s Guide, D&D Adventurers League, all 
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  property of Wizards of the Coast. This material is protected under the copyright laws of the United States of America. Any reproduction or unauthorized use of the material or artwork contained 
  herein is prohibited without the express written permission of Wizards of the Coast.
  ©2016 Wizards of the Coast LLC, PO Box 707, Renton, WA 98057-0707, USA. Manufactured by Hasbro SA, Rue Emile-Boéchat 31, 2800 Delémont, CH. Represented by Hasbro Europe,  
  4 The Square, Stockley Park, Uxbridge, Middlesex, UB11 1ET, UK.
  
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  DISEASES OF THE SEA
  This supplement is written by medical students with 
  a love for tabletop roleplaying games. Inspired by a 
  wide array of ailments, and the medieval myths that 
  once surrounded them, we embarked on a mission: to 
  enrich other worlds with fantastic diseases. 
  Herein are presented a plethora of diseases, varying 
  from magical to microbiological in origin. This time, 
  they all feature themes related to the sea and are 
  inspired by the diseases that troubled those who 
  sailed the seas in the Middle Ages.
  We feel that every disease is something to be feared. 
  Deep in each civilization’s roots, there are myths, 
  remedies, and folklore, all revolving around the 
  ailments that affect its people. This supplement 
  will hopefully become a vital weapon in the arsenal 
  of dungeon masters inspired by the grim, epic, or 
  mundane conditions of the human body and mind.
  Do not underestimate diseases. Part of the dungeon 
  master’s art is to be able to stir feelings up in their 
  players, and there are few human conditions that 
  could accomplish that better than illness. Used as a 
  way to advance a storyline, to expand a character arc, 
  or to incite conflict, the following stories can serve 
  you well, but be warned! Use them too much, and they 
  might lose their value. 
  Also bear in mind that these diseases are not simply 
  a way to add mechanical complexity to your game. 
  A paladin, a monk, and a cleric will have powers to 
  overcome these maladies, but can one cleric heal a 
  whole country plagued by a dragon’s toxic fumes? 
  Try to focus on the worldbuilding and roleplaying 
  elements that a disease can bring to the table. 
  Imagine describing a town plagued by a wave of 
  sickness; bring to life a dragonborn whose scales 
  are falling out one by one. Those evocative scenes 
  are what we hope this book can provide.As for the 
  locations described in this supplement, bear in mind 
  that they are intentionally generic and intended to be 
  placed as your needs require. 
  This second installment of the Malady Codex treads 
  where the first Codex didn’t dare to: the realm of the 
  humanoid psyche. Mental illness remains a mystery 
  wrapped inside a puzzle. Although much research 
  has been done, mental disorders remain elusive, and 
  their treatment is still disputed. No single paradigm 
  for explaining mental illness exists. This is exciting 
  and terrifying for scientists and roleplayers alike. 
  The types of stories that can be told with the tools 
  presented here are testament to this.
  Even though the diseases of the mind in this book are 
  only imaginary, we are painfully aware of the gravity 
  of mental illness in the real world and the impact 
  they have on everyday life. In no way do we wish to 
  trivialize or stigmatize those suffering from such 
  ailments, nor do we . Having said that, the diseases 
  of the mind included within these pages should be 
  used to add depth, gravity, and an increased sense of 
  authentic humanity to any fantasy game.
  This is a toolset for the dungeon master. There is no 
  need to limit the utility of the tools we provide, so 
  we kept them open ended and without boundaries. 
  Explore the ideas presented here; include them 
  in your own words, alter existing locations of 
  known settings, or just use them for one-shots! The 
  possibilities are endless, and that is part of why we 
  play this game. We hope you enjoy.
  
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  THE MALADY CODEX III
  THE MALADY CODEX III
  “To all scholars and medical scientists;
  This manual is a catalog of the most fantastical 
  diseases I have encountered over the years in my 
  travels. I have met tyrants, conversed with madmen, 
  and barely escaped with my life from rather 
  precarious situations, all for the sake of knowledge. 
  The experiences I have gained cannot be simply 
  captured by my humble writing skills, so in hopes 
  of leaving behind something truly worth reading, I’ll 
  just do what I can best: describe the maladies I’ve 
  encountered.
  I am Acesius, a man who has spent his life studying 
  the humanoid body. I am a cleric of Apollo, one 
  who has met gods and, in my prime, helped bring 
  one down. As I settle down, too tired from old age 
  to continue with my adventuring habits, I write 
  this to present a portfolio of the most common 
  magical diseases that sailors might encounter in 
  their travels. It is my belief that every reader who is 
  interested in the more… fantastical of the ailments 
  that trouble us all should be aware of them. This 
  is the reason I continue to write this Codex of 
  Maladies.”
  This guide is a collection of diseases that are a mix 
  of magical and realistic. Most are based on real 
  world diseases; these should serve as an example 
  of the power maladies hold as storytelling tools. 
  First, some basic concepts are introduced. We then 
  provide a basic template you can use to create your 
  own maladies. Finally, the diseases themselves are 
  described. 
  How to Handle diseases 
  Contrary to the heading, this is not a guide for medical 
  professionals. Here, we offer a few insights on how 
  to handle the maladies presented in this codex. They 
  were designed to be storytelling tools. Feel free to 
  modify them as you wish, adapting them to fit your 
  style and your worlds. To fulfil their duty as story tools, 
  however, they have to have a mechanical aspect to 
  them, as this is a game after all. This element is also 
  highly adaptable. While we offer recommendations on 
  how to infect creatures, on the symptoms they present 
  with, and on how to cure diseases, we insist that you 
  take these with a grain of salt. The biggest change you 
  should think about making depends on your players. 
  If you have paladins, clerics, or monks in your party, 
  don’t forget that their classes have been designed to 
  give them an edge against all kinds of ailments. Don’t 
  take this away from them; encourage them. There 
  are few things more satisfactory to a player than to 
  suddenly realize that their high-level monk is immune 
  to a disease, saving them and proving how the long 
  hours the character has spent perfecting their art was 
  worth it. Apply a similar line of thought to healing. In 
  this edition of the game, we feel that the rules have 
  been intentionally left vague regarding the relationship 
  between healing magic and lasting diseases. Below, 
  we present a short list of tools that can be used to cure 
  a disease, and, when describing each one, we suggest 
  a way to get rid of it. Ultimately, it is up to you as the 
  DM to decide whether or not a paladin’s Lay on Hands 
  works, or if the disease is so powerful that it can only 
  be dealt with using a special remedy. 
  How to Handle infection
  We must now discuss an unfortunate truth: players 
  metagame. When one of the player characters is 
  injured or comes in contact with an infectious source, 
  the DM must ask for a corresponding saving throw. 
  Once they fail it, it’s no tall task for the player to 
  put two and two together and figure out that their 
  character may have been infected with a disease. 
  At that point, the players will do everything in their 
  power to cure the disease, casting spells and calling 
  in favors from paladins who can lay their hands on 
  them and rid them of their ailment. This presents 
  a problem both for the DM, who wants to use the 
  disease, but also for the narrative, as it gets disrupted 
  by this instance of metagaming. We have gathered a 
  few ideas that we believe can help you deal with this 
  phenomenon. It’s also noteworthy that these could 
  help you in other aspects of the game where the 
  players could be prone to act on meta knowledge. 
  Ask the players to make a Perception check. If they 
  fail, roll a Constitution saving throw for them, as they 
  didn’t notice the source of infection. This usually 
  works for smaller things, such as the bite of an insect. 
  (We advise that you write the incident down and keep 
  the folded note somewhere visible, so as to avoid any 
  confusion that might arise 5 sessions later.) Similarly, 
  have them roll a Medicine check to see if they know of 
  the disease.
  • Do not inform them about the outcome of the said sav-
  ing throw. 
  • Do not let them heal a disease their character would 
  not be suspicious of.
  • Use different spells to cure different diseases. Lesser 
  Restoration just might not be enough.
  
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  DISEASES OF THE SEA
  • Have every player with the potential to be exposed to 
  the disease in this session roll a saving throw at a differ-
  ent time, such as the beginning. Write down the results 
  and explain that this is to not give away the precise mo-
  ment of “an event”.
  A disclaimer is, of course, mandatory here. We do 
  not assume that every party will metagame. We do 
  not also condemn it, as it is a valuable part of the 
  game in some ways. We are just trying to help DMs 
  who may find themselves in a situation where, for any 
  reason, meta-gaming could hinder the experience they 
  are trying to provide through the use of a disease. It 
  is also worth noting that sometimes it ist within the 
  bounds of reason and gaming etiquette for the player 
  to assume they have been infected. Just imagine 
  the typical scene of a nurse or a doctor in real life, 
  accidentally getting themselves pierced by a needle 
  that was used to draw blood from a patient. At that 
  point, it’s not metagaming. It’s common sense to 
  assume you have been infected.
  How to live witH infection
  A sailor’s life is tough. Each and every day, mariners 
  might find themselves in life-or-death situations, and 
  they have to prove themselves worthy of being on 
  board. This makes disease a minor but cumulative 
  aspect of a sailor’s life. They have accept the danger 
  and learned to live with it. This should not mean that 
  chronic diseases such as those we are describing 
  do not impact the whole ship. Ships make perfect 
  environments for epidemics due to the close contact 
  of people, and poor hygiene. An outbreak could kill 
  half of the crew and leave the other half unable to 
  command the vessel, leading them to certain death. 
  Thus, each ship has at least one qualified medic. One 
  would argue that a ship without a captain could end 
  its journey, but the lack of a physician would surely 
  doom the voyage.
  Realism is an important part of the Malady series. 
  Keep in mind that even if diseases have never 
  before been implemented at your table, they have 
  existed in your fantasy world since the beginning of 
  time. Both PCs and NPCs have seen their relatives 
  die from maladies  A character might begin their 
  journey already infected with a disease that is 
  slowly killing them, and they’re trying to hide it from 
  their companions until they finish their quest. Your 
  medieval society might be cruel and define a person 
  by a disease they are carrying. A character might be 
  deemed useless if they break their leg, and be left to 
  die on a mountain. But, as always, we have added a 
  more light-hearted malady that would be suitable for 
  any table. 
  example 
  The following should serve as a template for the 
  disease you are about to read.
  Acesius’ note
  Introduction to the disease
  Real life reference
  Origins 
  How it came to be. What caused this specific disease 
  to become a threat?
  Causes 
  How does it spread from a creature to another? How 
  can does one get infected?
  Symptoms 
  How does it look like? What does a patient 
  experience?
  Diagnosis
  How do you make sure that someone is infected with 
  this?
  Cure 
  How does a patient get cured of this disease? What 
  can others do to help?
  Plot Hooks
  How is this disease best used by the DM?
  saltmarsH’s fire
  They say every sailor contracts this disease sooner 
  or later. People doubt that you have spent time at 
  sea if you haven’t lost at least one friend to it. It’s 
  really not worth contracting it for a few moments 
  of fun, but what can a healer do except treat the 
  unlucky?
  Saltmarsh’s Fire is a sexually transmitted disease 
  with an origin story straight out of a fairy tale. Its 
  symptoms range from comedic to severe, and it is, 
  without a doubt, the sailor’s disease.
  
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  THE MALADY CODEX III
  Based on the real-life disease known as syphilis, 
  this malady is a spin on the most common sexually 
  transmitted disease that sailors and pirates alike 
  contracted. Syphilis was a huge problem in medieval 
  Europe. Those who spent their entire lives on ships 
  were prone to coming in contact with it, since they 
  usually sought to satisfy their primal needs in every 
  port town.
  Origins 
  Eons ago, a powerful dragon became disgusted 
  with the vile and unholy behaviors of humanoids. 
  After one catalytic event involving pirates who did 
  unspeakable things, she finally had enough. She 
  dove from the sky above the pirates’ ship and burnt 
  them all to death, sparing only one swab. She then 
  cursed the survivor, and he became the first to suffer 
  from Saltmarsh’s Fire. He was later cured, or so he 
  thought, so he continued on the same path of pleasure 
  without inhibitions. When he realized that the dragon 
  intentionally cursed him with a disease that would 
  become dormant, it was too late. The fire had begun 
  to spread.
  Causes 
  This disease is sexually transmitted. Those who work 
  in brothels have a higher chance of contracting the 
  disease, but it can affect anyone. There is no other 
  known means of transmission. It is hard to know 
  when you’re in danger of spreading or contracting 
  the disease as it comes and goes in waves, seemingly 
  disappearing for large periods of time. Any creature 
  that has sexual intercourse with a creature suffering 
  from Saltmarsh’s Fire, at any stage, must make 
  a successful DC 14 Constitution saving throw or 
  become infected.
  Symptoms 
  The disease presents itself in four distinct stages, each 
  lasting from a few days to whole years. A simple table 
  with a rough estimate of how long each stage lasts is 
  provided below: 
  Stage
  Duration
  1
  3 days.
  2
  1d4+1 days.
  3
  2d100 weeks.
  4
  Permanent.
  Stage 1: A few days after the incident of infection, 
  a rash appears on the infected area of the genitalia. 
  It is usually small, but the itch it creates reduces the 
  quality of everyday life for the infected. This mild 
  discomfort is usually ignored unless someone points 
  out that it is only the precursor to much more serious 
  symptoms. In three days the rash goes away on its 
  own.
  Stage 2:  A few weeks after Stage 1’s symptoms 
  subside, the more characteristic signs of the disease 
  develop. First and foremost, whenever another 
  creature touches the infected creature’s genitalia, the 
  rash reappears and bursts into flames. This is what 
  the name refers to, of course, and it is the result of the 
  dragon’s curse. When the rash ignites, the infected 
  creature takes 1d6 fire damage, and the instigator of 
  the symptom must make a DC 12 Dexterity saving 
  throw or take 1d6 fire damage. Other than that, the 
  infected are overtaken by fatigue; they feel sore and 
  they generally look sick. For the next 3-5 days, they 
  have one level of exhaustion that can only be removed 
  through magical means. 
  Stage 3: At this stage, the disease becomes 
  dormant. This means that all symptoms disappear, 
  and the infected creature feels as if it has been cured. 
  This, of course, is a dangerous folly, as they are still 
  very capable of spreading the disease.  
  Stage 4: Months, maybe years after the second 
  stage’s symptoms end, the final manifestation of 
  the disease takes root. The brain is mainly affected, 
  resulting in all sorts of symptoms like headaches, 
  deafness, blindness, faulty perception of space, a 
  
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  DISEASES OF THE SEA
  sluggishness in movement, and even personality 
  changes.  You can assign these at will, or determine 
  which ones the infected creature suffers from with 
  the following table. Roll 2d6 and apply the results. If 
  you roll the same number twice, roll two additional 
  2d6, which means that the creature suffers from 3 
  manifestations of this stage. If you have a duplicate, 
  roll until you receive a different symptom.
  Roll
  Symptom
  1
  Headaches
  2
  Deafness
  3
  Blindness
  4
  Spatial Disorientation
  5
  Sluggish Movements
  6
  Personality Changes
  Diagnosis
  It is very easy to diagnose this disease as it is 
  common knowledge, especially amongst those who 
  live close to the ocean. A creature can recall the 
  causes, symptoms, and cure with a successful DC 
  12 Wisdom (Medicine) check. Creatures with the 
  Sailor background have advantage on this check. 
  One problem that arises in diagnosing and generally 
  discussing this malady is its cultural roots and the 
  way they reflect on its name. While many know it 
  as Saltmarsh’s Fire, enemy nations have come to 
  call it by their hated neighbor’s name. For example, 
  citizens of Waterdeep and Neverwinter might call it 
  “the Luskan Lashes” and elven kingdoms refer to it as 
  “Dwarven Itch”. Not only does this cause confusion as 
  people don’t realize they are talking about the same 
  disease, but it can also lead to dispute and arguments.
  Cure 
  To cure Saltmarsh’s Fire, at any stage, a creature must 
  consume a vial of dragon blood. This is commonly 
  referred to as Sanguis Draconis and is an expensive 
  material. If a dragon is slain, its blood cannot be 
  consumed immediately. Instead, it must be distilled 
  by a creature proficient in the use of a herbalism 
  kit, following a successful DC 14 check with the 
  herbalism kit. Sanguis Draconis is commonly sold in 
  port towns and other metropolises where the disease 
  is rampant, but is usually priced high. A wealthy 
  individual or an adventurer might be able to afford 
  it, but it’s commonplace for sailors to have to call 
  in favors or take up jobs just for one vial of Sanguis 
  Draconis. Note that in some places, the good-natured 
  metallic dragons donate blood in order to help the 
  poor and helpless. In other cases, Sanguis Draconis 
  can be distilled from the blood of a sorcerer with the 
  draconic bloodline archetype. It cannot be distilled 
  from the blood of a dragonborn.
  In the real world seas, Dragon’s Blood or Sanguis 
  Draconis (a gum resin taken from the berries of 
  palm trees) was commonly used to treat a variety of 
  diseases. This resin was used both as a medicine as 
  well as a varnish, and owes its name to its deep red 
  color.
  Plot Hooks
  This malady can mainly be used to enrich the 
  experience of a grim or realistic nautical game. It 
  adds depth to the world in a way that targets the 
  player characters and could end up creating the 
  circumstances for a fun roleplaying experience. 
  This disease gives the DM the opportunity to create 
  a quest with just one mission: slay a dragon and get 
  its blood. This could result in epic stories being told 
  on the table, and that, in its essence, is the goal of this 
  book. On the other hand, it could also entail a search 
  for a sorcerer with draconic blood, who might need a 
  favour in exchange for the donation.
  vutrim’s treacHery
  Deep sea creatures are truly a wonder to behold. 
  They all find peculiar ways to hunt for food. The 
  Vutrim is no exception, though I’m not certain if 
  it’s just a powerful sea creature or something else 
  entirely.  
   
  Vutrim’s Treachery is a malady that affects entire 
  crews. It has a dietary cause and can infect shipboard 
  voyagers at any time. The mental fog it creates makes 
  it easy for the ship to crash and sink, leaving the crew 
  powerless. That is when the Vutrim consumes them.
  Vutrim’s Treachery is, of course, based on the real 
  life disease scurvy. Scurvy was a major problem 
  in the pre-refrigeration era of sailing, as provisions 
  didn’t last as long and didn’t usually provide the crew 
  with all the necessary micronutrients. The lack of 
  Vitamin D in the body resulted in a disruption of 
  homeostasis, and, ultimately, disease.
  Origins
  The Vutrim, an ancient creature born in an era long 
  past, dwells the deep seas. It created a disease with 
  the intent to wreck ships and drown them beneath 
  
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  THE MALADY CODEX III
  the waves. As they sink, both ship and crew become 
  easy prey for the Vutrim’s long tentacles. The creature 
  hunts all sorts of other sea creatures, but with its 
  disease, ships are the easiest target.
  Causes
  Spending prolonged periods of time at sea leads to 
  a lack of quality food. Preserving nutritious rations 
  is difficult during long voyages. If a creature goes 
  a number of days equal to 10 plus its Constitution 
  modifier without eating, or with a diet limited to low-
  quality food such as bread, beans, and salt pork, then 
  it becomes susceptible to Vutrim’s Treachery. The next 
  time it comes into physical contact with sea water, 
  the creature must make a  DC 15 Constitution saving 
  throw, or become infected.
  Symptoms
  The symptoms of this disease appear in succession, 
  presenting themselves in stages of some sort. 
  Stage 1: Blue and green skin spots appear on the 
  victim’s skin; these can appear anywhere on the body, 
  but are very bright and noticeable on the torso and 
  inside the mouth. 
  Stage 2: The victim’s thought process is disturbed, 
  as Vutrim projects images into its mind to lead to 
  confusion. This confusion leads to mistakes, which 
  can be fatal for the life of the ship, and can complicate 
  treatment. The creature has disadvantage on all 
  wisdom and intelligence checks. For some example 
  projections into the mind, see below.
  Stage 3: Extremely painful stomach cramps cripple 
  the creature, as its organs slowly die on the inside, 
  and its eyes cry tears of blood. The creature suffers 3 
  points of exhaustion and cannot take both an action 
  and a bonus action on the same turn. It must also 
  make a DC 15 Constitution saving throw, or also take 
  1d4 acid damage every turn. This is was kills the 
  infected.
  Stage 4: When the creature finally succumbs to the 
  disease, the internal organs quickly dissolve, leaving 
  behind a dangerous acid that slowly eats through the 
  body killing the creature.. The acid then proceeds to 
  melt the wooden floors, and eats away at the ship, 
  with the intent of opening a hole in it and sinking the 
  vessel. The acid melts wood and other soft materials, 
  like cloth, paper, and leather, but cannot melt any 
  metal or stone. It corrodes 5 ft of any material every 6 
  seconds.  
  The symptoms do not have a specific trigger after 
  which they appear, nor can anyone be certain of when 
  the next stage symptoms will manifest. However, as a 
  rule of thumb, the stages last approximately this long:
  Stage
  Hours
  1
  24
  2
  12
  3
  6
  4
  2-4
  Diagnosis
  Vutrim is a merciful elder evil. It gives the sailors 
  visions that reveal its identity, but it mixes 
  them with other visions of random scenery and 
  incomprehensible events. Thus, it gives a clever 
  diagnostician a chance to understand its masterplan 
  and put an end to it, perhaps even taking pleasure in 
  the occasional defeat at the hands of a smart mortal. 
  However, given that most infected creatures’ thoughts 
  are hazy and they cannot think straight, it becomes 
  very difficult to discern the important visions from the 
  random ones. Some ideas for what the infected could  
  see include:
  • Pirates raiding the ship.
  • Rats in the cargo infecting foodstuff.
  • A giant squid-like creature that has possessed someone 
  from the crew and is responsible for the disease.
  • A malicious wizard that is watching the ship through 
  his magic crystal ball.
  • A monk pouring lemon on a platter of food.
  • Someone spilling their blood over the corpses that the 
  disease claimed.
  • The captain of the ship opening a hole in the ship, let-
  ting the waves swallow it.
  • The ship crashing on a large sailing object and two 
  people trying to catch hold of  a piece of floating timber.
  • A humongous eye that opens in the deep sea, and the 
  ship with its passengers reflected in its iris.
  A DC 18 Wisdom (Medicine) check is required to 
  diagnose Vutrim’s Treachery, as very few ships actually 
  survive to tell healers about it. Knowledge of the 
  ancient monster’s existence brings the DC down to 15. 
  A detect poison and disease spell can also locate the 
  source of the problem, pointing to every infected sailor 
  and identifying the water as the catalyzing agent. 
  The Medicine check is still required to complete the 
  diagnosis and identify the cure.
  
  9
  DISEASES OF THE SEA
  Cure
  The infected creatures must be fed with good food, 
  though the effects will be greater if the recipe contains 
  lemons and oranges. Just one meal of nutritious food 
  will set the disease back to Stage 1, and a whole 
  day of eating healthy foods that contain lemons and/
  or oranges cures the disease. The fluids that the 
  deceased victims excrete can also be neutralized 
  with lemon juice. The disease can also be cured with 
  healing spells such as lesser restoration, or heal, 
  though these have no effect on the fluids that could 
  sink the ship. 
  Plot Hooks
  This disease is perfect for used in a mystery/
  investigation type of scenario. The adventurers 
  encounter a ship that has been infected with Vutrim’s 
  Treachery and must help the crew by correctly 
  diagnosing the condition and providing food and 
  lemons to protect the crew and the ship. 
  It also serves as an introduction to Vutrim, who 
  could be used as a major villain in future adventures, 
  or perhaps a patron for warlocks.
  Note that the characters can’t be infected unless 
  they, too, have been having problems with their diet. 
  Having said that, they likely have no idea that this 
  is the case. It will be interesting to see what they 
  come up with in order to protect themselves from the 
  disease. Let them roleplay whatever ideas they have, 
  but be ready to advance the story if the heroes become 
  bogged down. 
  squiditis
  “After studying Illithid creations, I have come to 
  the conclusion that they all carry the same psionic 
  essence in different quantities. Their invasion of 
  our realm could not leave our waters unsullied by 
  this madness.”
  Squiditis is an acute infection related to consuming a 
  specific type of sea creature, the vampire squid. It can 
  also spread as a result of combat with said creature. It 
  is a potentially deadly disease for any crew sailing the 
  seas, as it presents with very non-specific symptoms 
  at first, but can quickly climax and create all sorts of 
  problems.
  As with all the other diseases in this supplement, 
  this malady is based on something from the real 
  world related to the seas. This time, however, we 
  cannot give away our source. Let’s just say that 
  whoever contracts this squid’s disease will be very 
  cranky. 
  
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  THE MALADY CODEX III
  Origins
  When mindflayers first invaded the world, their very 
  nature was so alien that whole ecosystems underwent 
  substantial changes. As they usually do, the Illithids 
  conducted experiments on organisms, constantly 
  trying to create new species that would serve their 
  purpose. It is through these experiments that the 
  vampire squids came to be. They were designed to be 
  efficient hunters, capable of procuring large quantities 
  of seafood for their masters.
  Cause
  “I’ve seen a ship crash into a reef when the captain 
  and his navigator both contracted this disease.”
  Squiditis is a disease that can only be contracted by 
  coming in direct contact with a vampire squid, be it 
  dead or alive. Vampire squid live in deep sea waters 
  but might come close to the surface when darkness 
  prevails. They usually prey on smaller fish, but are 
  able to easily wrap their tentacles around larger 
  victims, such as humanoids. At the same time, many 
  creatures roam the seas that can best the vampire 
  squid, which means that the squid itself might get 
  eaten and spread the disease. Whenever a creature 
  comes in direct physical contact with the vampire 
  squid or a sea creature infected by it, it must make 
  a DC 15 Con Saving throw or be infected with the 
  disease.
  Symptoms
  This disease starts with non-specific symptoms such 
  as fever, a sore throat, dizziness, and itching in the 
  outer ear. The creature gains 1 point of exhaustion 
  that can only be removed by magical means such as 
  a lesser restoration spell. If, for any reason unrelated 
  to the disease itself (such as physical exhaustion), 
  the creature gains a second point of exhaustion, the 
  disease progresses from the physical first state to the 
  second state: that of the mind. The creature becomes 
  moody, indifferent, and does not want to cooperate 
  with others. It tries to avoid combat by any means, 
  and will only enter combat in a life or death situation. 
  At the start of every round, it must make a DC 15 
  Intelligence saving throw. On a failed save, it must 
  take the Dash action and run away from the encounter. 
  Any creature can make a Charisma (Persuasion) 
  check with a DC of 10 + (infected creature’s Charisma 
  modifier), in order to convince them to participate in 
  combat. If the check succeeds, the infected creature 
  can participate in combat normally until the end of the 
  combat encounter. 
  Diagnosis
  The disease cannot be discerned from other flu-like 
  diseases at its early stage. If a creature is proficient in 
  Medicine and is aware of a recent encounter between 
  the victim and the squid creature, it may diagnose it 
  with a successful DC 10 Wisdom (Medicine) check 
  or a DC 15 Wisdom (Investigation) check. During the 
  second stage, each DC is decreased by 5.
  Cure
  The disease may be cured by removing all points of 
  exhaustion from the infected creature, but this will 
  require magical means. At the dawn of every 10th 
  day that the creature is infected, it may try to remove 
  one point of exhaustion with a successful DC 15 
  Constitution save. This can also remove the first point 
  of exhaustion.
  The disease can be kept in check with the help 
  of music. Any kind of music will do the job. It halts 
  the progression of the symptoms, and improves 
  the general health of the infected creature. With a 
  successful DC 10 Charisma (Performance) check 
  using  any musical instrument, a creature can 
  remove the symptoms of the disease from all infected 
  creatures who can hear the music. Symptoms will 
  remain in remission until the infected creature 
  completes a long rest; an additional successful 
  performance will then be needed to alleviate the 
  symptoms again. 
  Plot Hooks
  This is a simple disease that can be used to enforce 
  the feeling of dread for the creatures of the deep. Not 
  only do they wreck ships and eat people, they carry 
  deadly diseases that can spell doom for crews. Due 
  to its illithid origins, it also ties in perfectly with any 
  other mind flayer presence in the area, and adds 
  depth to the influence these creatures have on their 
  environment. If you introduce this disease through an 
  NPC, we advise you use the musical element of the 
  disease to stimulate more senses for your players. 
  The scene of a grand approaching ship with lavish 
  decorations and three gigantic sails is awe-inspiring, 
  but the scene can be enriched by adding this note; the 
  grand playing of an orchestra, or the pirate songs that 
  taunt innocent ships.
  
  11
  DISEASES OF THE SEA
  tHe rainbow mist
  I once travelled to the Sea of Fluros in order to help 
  a fellow adventurer heal their wounds. These Mists 
  are very tricky, always elusive, moving with the 
  wind from one place to another.
  The Rainbow Mist is a supernatural phenomenon 
  that, without any explanation, closes wounds and 
  regrows limbs, but sometimes at a great cost. The 
  Mist is a large body of magical mist that travels the 
  seas, affecting all those who are engulfed by it. Those 
  who are healed by the Mist slowly transform into 
  different creatures, bound by the sea. 
  This malady was inspired from many things, both 
  from the stories we hear about the sea and from 
  the reality of medicine as a science. On one hand, 
  it combines mists, which have been used as a 
  storytelling tool since ancient times, and a real-
  life fantastical phenomenon, fluorescent marine 
  animals and plants. On the other hand, it serves 
  as a parallel to the countless microbiological 
  applications we have found in medicine, wherein we 
  derive beneficial material from potentially deadly 
  organisms, sometimes at great risk. 
  Origins
  Ever since the first civilizations formed and bards 
  began to sing about the wonders of the world, the 
  Rainbow Mist was present in stories. All who were 
  raised in a society with nautical traditions and folklore 
  know about it and its healing properties, but they also 
  understand how big of a wager it is to venture into the 
  sea, looking for a cure that comes with a heavy price. 
  As to how or when these Mists were formed, no one 
  knows. Some scholars believe that they originate from 
  the Astral Sea, while some clerics insist that it was 
  one of the old gods that gifted the Material Plane with 
  the elusive Mists.
  Causes
  The Mists are sometimes visible to the naked eye, 
  glowing brightly in all the colors that the eye can 
  perceive. Sometimes they only take one color, usually 
  blue or green, and blend in with the rest of the 
  environment. Depending on the shade and texture, the 
  creatures that are sailing in it might not even realize 
  it is there. In any case, the Mists have a very strong 
  effect on healing, and to anyone who casts detect 
  magic while in the Mist, a faint aura of evocation 
  seems to suffuse it. Whenever a creature suffers a 
  wound while inside the Mist, or comes into the Mist 
  with a wound, it is placed under the Mist’s influence. 
  If a creature with an amputated limb enters the 
  Mists, the influence also applies, even if the wound is 
  not fresh. If a creature drowns in the sea under the 
  Rainbow Mists, it is also affected. If a creature wants 
  to resist the effects of the Mist, it must make a DC 16 
  Charisma saving throw, or become “infected”.
  Symptoms
  The Rainbow Mist is a healing force that, when 
  applied excessively, can corrode and slowly change the 
  very essence of the creature it heals. There are three 
  distinct stages to the process. First, any wounds heal, 
  any limbs slowly regrow, and damaged organs regain 
  function. In every case, the tissue that was affected 
  gives off a light blue glow and remains transparent. 
  Second, the fluorescent tissue begins to spread, 
  replacing healthy tissue  surrounding the wound. 
  Gradually, it replaces as much of the creature’s healthy 
  tissue as it can. Finally, the creature mutates into a 
  marine creature. The following are the three stages, in 
  depth.
  
  12
  THE MALADY CODEX III
  1st Stage: While affected by the Mist, a creature’s 
  lost limbs may regrow. Limbs will fully regrow in 1 
  minute. The character also gains 5 extra HP when 
  they expend a hit die, for every die rolled. This gain 
  is permanent. When the wound is fully healed, the 
  disease progresses to the next stage. In this stage, 
  even magical wounds that cannot heal are replaced 
  with fluorescent tissue.
  2nd Stage: In this stage, the fluorescent growth 
  expands to healthy tissues. This leads to a plethora 
  of changes in the body. Fingers become webbed like 
  a frog’s, fins appear on the creature’s back, and its 
  skin is replaced by fluorescent fish-like scales. No 
  mental changes occur, but the creature will become 
  amphibious, meaning that it gains a swimming speed 
  equal to its normal speed and that it can breathe 
  underwater. When this transformation is complete, 
  the disease progresses to the next stage.
  3rd Stage: The affected creature is transformed 
  to a marine creature. Its brain is now affected and 
  its behaviour changes. It loses part of its sentient 
  personality, and animalistic instincts prevail. Everyday 
  it begins a journey to reach the depths of the sea and, 
  every night it tries to dive even deeper.
  The disease progresses at a constant rate which 
  slightly differs according to the race of the creature 
  (the bigger the creature, the longer it takes), but it 
  would take 10 minutes for an affected creature’s 
  wound to heal, 1 day for a limb to regrow, and 1 week 
  to finish the transformation). If the creature is inside 
  the Mist, the process accelerates by 10 times.
  Diagnosis
  This disease is easy to diagnose as a medical 
  condition, as long as you have heard stories regarding 
  the Rainbow Mist. To diagnose it, a creature must 
  succeed on a DC 10 Intelligence (History, Arcana, 
  or Nature) check or a DC 10 Wisdom (Medicine) 
  check. To know about its exact symptomatology and 
  cure, a creature must succeed on a DC 18 Wisdom 
  (Medicine) check.
  Cure
  There are two facets to handling this disease: curing 
  it and halting its spread. To halt its spread, a creature 
  must succeed on a DC 16 Charisma saving throw. 
  The growth can also be halted by applying mud to the 
  tissue, but if the creature comes into contact with sea 
  water for more than one minute, it automatically fails 
  the next day’s saving throw. The saving throw happens 
  daily.
   To cure the disease completely would mean 
  reversing its effects and turning the fluorescent tissue 
  back to normal. To accomplish this, a special ritual 
  must be performed with the help of a druid who is 
  part of the Circle of the Land. The infected creature 
  must come in contact with the mystical forces of the 
  earth, in order to balance the effect the sea had to it. 
  This ritual requires a handful of mud from a place 
  unsullied by civilization, the branch of a treant, and  
  a magic weapon. This ritual will strip the weapon of 
  its magical powers. The ritual must be performed at 
  dawn.
  Plot Hooks
  The Rainbow Mist is a very powerful tool for 
  worldbuilding, as it can be used by PCs and NPCs 
  alike. It can be part of the lore of your world, 
  depending on how folklore depicts those who find 
  themselves lost in the Mists. It also represents the 
  very real dangers of the sea and all the elements that 
  surround it. The Rainbow Mist becomes especially 
  deadly if combat breaks out while creatures are 
  surrounded by it, because they all become infected 
  and begin their transformation. 
  Another way to use the Mist to introduce it when 
  your players attempt planar travel, especially to 
  magical places like the Astral Sea. It can serve for a 
  reminder that they are entering uncharted waters, 
  both figuratively and literally, and that reality may not 
  obey its customary laws.
  Finally, there are many stories to be told of people 
  who wish to regrow limbs or cure incurable diseases, 
  and are willing to take a risk. Likewise, stories 
  regarding those who lost the bet and became cursed 
  by the sea, forever sailing it and without the ability to 
  leave, have great potential.
  rat’s curse
  I watched a city burn down, just to contain the 
  Druid’s Curse. When I realized that the malady 
  had mutated and spread to the sea, the only thing I 
  could do was pray to Apollo for salvation.
  The Rat’s Curse is an aquatic variant of the Druid’s 
  Curse, a disease created by the Fabled Druid as part 
  of his plot of vengeance against living creatures who 
  have defiled the environment for far too long.
  This disease is inspired by the Bubonic Plague, 
  commonly referred to as the Black Death. It was a 
  disease that claimed almost one third of Europe as 
  victims in the Middle Ages, and it all started with 
  
  13
  DISEASES OF THE SEA
  rats that travelled in the cargo holds of ships. While 
  the symptoms of the Black Death are more closely 
  mirrored in its reimagining in the Malady Codex I, 
  this variant focuses on the notion that a few rats can 
  bring civilizations to their knees.
  Origins
  The Druid’s Curse travelled through the swamp 
  waters, in animals and carcasses, and swiftly began 
  to evolve in order to survive in aquatic environments. 
  It evolved, and, almost like an intelligent organism, 
  learned to manipulate the elements and became an 
  entirely new strain that is easily distinguishable from 
  the original disease.
  Causes 
  Insects carrying the disease reside inside the flesh 
  or on the skin of small animals such as rodents and 
  sea rats. These animals enter ships when they come 
  close to coasts or when they’re brought aboard as 
  food by the sailors.  The pests bite any creature they 
  cross paths with, and the disease enters the blood, 
  spreading to every inch of the infected creature’s 
  body. The rodents also infect supplies, which upon 
  consumption bring the curse down on 
  unsuspecting creatures. No matter 
  the method of contact, if a creature 
  is exposed to the Rat’s Curse, 
  they must succeed on 
  a DC 20 Constitution 
  saving throw, or 
  become infected. his 
  disease is one of the 
  few rare examples 
  of a penetrative 
  malady, which 
  can affect even 
  creatures that 
  are normally 
  immune to 
  diseases (such as 
  paladins).
  Symptoms 
  When the disease enters the bloodstream, it travels 
  throughout the entirety of the body. For some reason, 
  it prefers to take shelter in specific parts, especially 
  the elbow and the chest. After it has settled in, it 
  starts to affect the creature in a very conceptually 
  simple way; it retains fluids. This sea disease’s main 
  manifestation is swelling of several body parts and 
  organs of the body, due to the accumulation of water 
  in them.  
  One of the easily recognizable manifestations of this 
  disease is the effect it has on the hands of the infected. 
  Characteristic nodes appear in the inside part of the 
  elbows, as well as on the wrists. These nodes gather 
  water from the rest of the body, and block the return of 
  fluids from the arms to the body, which results in the 
  extremities becoming severely enlarged. Due to the 
  location of the nodes, however, only the forearms and 
  the palms swell up. he lower torso also fills up with 
  water, resulting in the appearance of an enlarged belly.
  Infected creatures also suffer from dyspnea, which 
  means that they find it harder to breathe, and they are 
  known to enter a fit of what is known as violent water 
  
  14
  THE MALADY CODEX III
  coughing. Any time the creature overexerts itself 
  physically, it must make a DC 25 Constitution saving 
  throw, or enter a coughing fit. Water comes out of its 
  lungs, leaving behind a taste of seaweed and salt. The 
  cough is so violent that the creature drops whatever it 
  was doing, just to try and breathe again. The creature 
  becomes incapacitated. In the end of its turn, it must 
  make another saving throw, or continue coughing. If it 
  succeeds, the cough fit stops for good. If it fails three 
  consecutive times, it falls unconscious, as it has been 
  deprived of oxygen for too long. When unconscious, 
  it starts to make Death Saving throws. As for what 
  counts as physical overexertion, we leave this to the 
  DM’s judgement, but a few examples could include 
  using the Dash Action, remaining locked in combat for 
  more than 3 rounds, taking a critical hit or having to 
  make any difficult Strength or Dexterity check. 
  Another symptom that is caused by retention of 
  fluids is that the creature’s veins fill up and protrude 
  on their torso and neck. This is the chronic part of the 
  disease, and also the part that leads to certain demise 
  unless treated. Every day after the infection, there is 
  a chance that  a multitude of veins inside the body 
  spontaneously break and cause extreme hemorrhage, 
  which means that blood will fill the body on the 
  inside. This condition is unfortunately only treatable 
  with the highest levels of magic, such as the Wish 
  spell or Divine Intervention. The chance of this event 
  occurring is 0% on the first day, and it increases by 
  1% every day after that. A violent water cough crisis 
  increases the internal bleeding chance by 5%. The 
  d100 should be rolled at the end of the day. If the roll 
  is below the current internal bleeding percentage, 
  then sometime during the next day, perhaps tied in 
  with some strenuous activity or perhaps out of the 
  blue, the event occurs.
  Diagnosis
  This malady is man-made, and it hasn’t been around 
  for many years. Still, due to the exponential rate 
  of its spread, healers from all corners of the world 
  were forced to quickly learn about it and figure out 
  a way to heal it. Any creature proficient in Medicine 
  can diagnose this with a successful DC 12 Wisdom 
  (Medicine) check. 
  Cure 
  The Fabled Druid created his original Curse with the 
  intent of showing no mercy to any living organism. 
  As such, he went to great lengths to make sure that 
  his disease would be resistant to healing magic and 
  mundane curing methods. Only high levels spells 
  like Wish or Divine Intervention can relieve a patient 
  of the curse. The sad reality of this disease is that 
  it spreads fast in unsuspecting populations, and its 
  victims only live for a few months. 
  Perhaps out of pity, or maybe as a contingency 
  plan, the Druid allowed just one plant to completely 
  remove the disease from an organism. For the Druid’s 
  Curse, this was a flower that could be found on wild 
  shambling mounds. However, this affinity for the 
  Sparkleaf was lost when the malady mutated. A new 
  plant took its place as the panacea of the curse, one 
  that can be found in the depths of the sea. It is known 
  as Flower of the Far Realms, and it is a wonder of 
  marine biology, as it blooms on coral reefs. The 
  Flower of the Far Realms, or Realmreef for short, is 
  a flower that can be found only in treacherous reefs 
  and also in some Underdark locations known only 
  to the best and most courageous explorers. It also 
  sporadically sprouts on other planes of existence, and 
  it is to that fact that the flower owes its name. Some 
  experts believe that the reefs share a connection with 
  the mythical Aboleth, a creature that inhabits both 
  Underdark and undersea environments, and is said to 
  be have mythical roots. The theory seems to hold true, 
  as most places with large gatherings of the Flower of 
  the Far Realms are abandoned or occupied Aboleth 
  lairs.
  As for the coughing fits, any creature can attempt 
  to help the affected creature out. Generally, the 
  best way to relieve them of the stress created by 
  the water in their lungs is with a spell that controls 
  water. Other than that, any creature can attempt to 
  expedite the procedure by force. A creature can take 
  an action to perform a rough medical maneuver, 
  where the belly of the victim must be pressed with 
  heavy and spontaneous pressure, causing all of the 
  water to come out at once. Knowing how to perform 
  this maneuver requires a successful DC 14 Wisdom 
  (Medicine) check, or a background in medical training. 
  Even without formal training, however, it is possible 
  that some will try to perform the maneuver. Have 
  them roll a simple Dexterity check to assert how 
  skillfully or clumsily they hit the victim, and based on 
  the situation, assign a corresponding DC.
  Plot Hooks
  This is meant to be a deadly disease, one that can 
  spell doom for entire villages and that could throw off 
  the balance of the world in a few months. The Fabled 
  Druid set out to correct the balance of civilization 
  and nature, and if his curse spreads, then he may 
  just succeed. Should you introduce this disease in 
  
  15
  DISEASES OF THE SEA
  your games, know that it should send out a powerful 
  message: civilization as we know it is in trouble.
  As for the everyday use of this disease, some port 
  towns might have already become used to seeing 
  people with enlarged forearms go on their lives and 
  there might even be a need for a special infirmary 
  or organization to be set up to treat those that suffer 
  from the water retention symptoms.
  An evocative concept would be that of a pirate 
  captain that has discovered a place where the Flower 
  of the Far Realms naturally grows in abundance, and 
  has made that his lair. Imagine a temple partially 
  submerged in water, with mold growing in the cave’s 
  walls, treasure chests filled with loot spread all 
  around, and an endless supply of Realmreef. This 
  pirate could act as a major villain in your stories, one 
  whose lair must be infiltrated in order to procure large 
  quantities of the healing plant. The captain is known 
  for being one of the first to contract the disease, but he 
  was fortunate enough to discover that the Realmreef 
  cured it. Nonetheless, just to be safe, he has made 
  it a habit to constantly snack on the plant, which 
  has become a sort of trademark for him. Needless 
  to say, Captain Marlon “Snack” Sidgaster also has 
  a role in spreading the disease, as he has a very 
  strong economic incentive for doing so. He is trying 
  to establish himself as a crime lord of the high seas, 
  based on this treasure of the Flower of the Far Realm. 
  falling disasters
  There is always going to be one clumsy rigger 
  that’s gonna fall off the mast while tying the sails. I 
  guarantee it. Always treat the ship’s surgeon with 
  at least some respect. You never know when you 
  might need him to set your bones back in place.
  Falling disasters are not a disease in the form that 
  one might expect, but rather a set of rules on how to 
  deal when a creature falls from significant height, or 
  suffers an violent injury. Please note that this disease 
  is intended to be rarely used, and only when the 
  situation calls for it. It is also advised not to use it on 
  the heroes, as it might be too punishing, even for a 
  gritty/realistic setting. Instead, consider this a set of 
  rules that help you track injuries, in the case that they 
  happen naturally in your game’s story.
  Though most do not associate bone fractures with 
  the term disease, the condition does in fact qualify 
  as one. As such, we thought that it would be fitting 
  to at least deal with such a wide-spread subject 
  somehow, even if it only entailed the presentation of 
  some simple rules, rather than a fantastical disease. 
  Note that the mechanical symptoms are not fully 
  representative of the real life counterpart fractures, 
  but rather a representation of the biggest hindrances 
  a fracture can pose to movement and functionality.
  Origins 
  This disease has existed for as long as organisms 
  have had bones to break. It is by design that the 
  organs that hold our bodies together crack, bend, 
  and break, only to be reformed. Most of the time, 
  when creatures partake in strenuous activity, bones 
  suffer microfractures that quickly heal.. Sometimes, 
  unfortunately, the break is too big, causing immense 
  pain and discomfort, while also limiting range of 
  motion. It is quite common to have a nautical accident 
  while sailing the rough seas, climbing tall masts, or 
  fighting off pirates. 
  Causes 
  When a creature falls from a high place, the body is 
  not designed to handle the impact well. As a result, 
  bones many fracture. After taking damage, the 
  creature must make a Constitution saving throw. The 
  DC equals the number of feet the creature has fallen 
  from. Failure results in a broken bone.. The number 
  and type of bones broken differ according to how 
  badly the saving throw was failed.
  In the following table, the choice is made by the DM if 
  there are two or more options.
  DC Fail
  Type of Fracture
  <5
  1 bone from Table A.
  6-10
  2 bones from table A, or 1 from table B
  11-15
  2 bones from table A and 1 from table B, 
  or 1 from table C.
  >16
  2 bones from table A, 1 from table B and 1 
  from table c.
  Natural 1
  Same as previous, but one more bone 
  from each category. (optional rule)
  Symptoms 
  The bones that are prone to breaking have been 
  categorised based on the severity of the disability that 
  ensues. Table A includes minor injuries, which would 
  only hinder everyday tasks mildly. Table B features 
  major injuries that cause important drawbacks during 
  the healing phase, including the ability to move. Table 
  C describes the fatal injuries a creature can suffer 
  when breaking a bone, which might either prove 
  deadly or cause a permanent disability.
  
  16
  THE MALADY CODEX III
  Table A Bones
  Loss of function
  Clavicle
  You cannot draw a longbow or two-handed 
  weapons.
  Fingers  
  (Not Thumb)
  You have disadvantage on Dexterity 
  (Sleight of Hand) checks using that hand 
  and do not gain benefits on tools. Roll for 
  Amputation. 
  Jaw
  Eating takes twice as long. Injuring a jaw 
  during its healing phase leads to inability 
  to speak.
  Tail
  You have disadvantage on acrobatic 
  Checks. Roll for Amputation.
  Ribs
  You cannot take the Dash action.
  Radius - 
  Forearm
  You have Disadvantage on Weapon 
  Attacks made with that hand. You cannot 
  use that hand to defend with a shield. Roll 
  for Amputation.
  Table B Bones
  Loss of Function
  Wrist
  You may not wield weapons or shields 
  with that hand.
  Thumb
  You use any item with disadvantage 
  with this hand. Roll for Amputation.
  Talus - Ankle
  Your speed is halved.
  Shin
  You need some sort of walking stick 
  to walk at your normal speed, or 
  your speed becomes 10ft. Roll for 
  Amputation.
  Table C Bones
  Loss of Function
  Thigh
  Your speed is 0 . Unless a Successful DC 
  15 Medicine Check is performed within 
  the first 2 hours, the bone dies, leaving 
  you with a permanent limp. Also roll for 
  amputation.
  Arm
  You cannot use this limb to perform 
  any activity, including using somatic 
  components or wielding a weapon. Also 
  roll for Amputation.
  Pelvis
  Your speed is 5 ft. This area is full of 
  nerve fibers, and unless a successful DC 
  25 Medicine check is performed within 
  the first 6 hours, you roll for one of the 
  following effects, which are permanent: 
  1) loss of function in the urinary system 
  and genitalia. 2) You lose control over 
  one leg. 3) Hypersensitivity. If you are hit 
  on the leg, you feel immense pain. Your 
  speed is 0 for 1d4 rounds.
  Skull
  Hemorrhage appears .During the 
  following 12 hours your mental state 
  worsens, with the following symptoms 
  appearing one by one: Dizziness, 
  amnesia, nausea, headache, and 
  finally comma. If not treated within 
  12 hours, you die. Until it heals, any 
  blow to the head will cause you to lose 
  consciousness.
  Spine
  Extreme damage is caused to the neural 
  spine. If treated carefully during the 
  healing period, you heal completely. If 
  violent movement occurs during that 
  time, then it might become paralyzed or 
  bleed out, resulting in death.
  These symptoms remain until they are healed, 
  unless it is specified that they are permanent. Bone 
  fractures heal based on the table they are included in, 
  as analysed later in the Cure section below.
  amputation rules
   Some bones have a chance to become infected and 
  cause death of the surrounding tissues. If not treated 
  within one day, the infection will cause a systemic 
  reaction and death. Treatment for this is amputation- 
  in other words, removal of the bone. One day after 
  the incident, roll for bone infection. Category A has 
  a 10% to be infected, Category B has a 25% chance, 
  and Category C has 50%. If not treated within one 
  day with amputation, the creature dies. This rule only 
  applies to bones that have the “Roll for Amputation” 
  note.
  Diagnosis
  A broken bone is easy to diagnose, especially if it 
  presents with a specific symptom, or if it is so out of 
  place that it becomes visibly misplaced. Any creature 
  can diagnose a broken bone with a successful DC 12 
  Wisdom (Medicine) check.
  Cure 
  Table A injuries need a small time to heal. In order 
  to enter the healing phase, another creature must 
  perform a successful DC 10 Wisdom (Medicine) 
  Check to put the bone back in place. Every time a 
  check is performed the creature takes 1d4 damage 
  unless it has taken some kind of pain medicine. 
  Healing time is between 1 to 4 weeks. {roll a d4}
  Table B injuries need a moderate time to heal and 
  require minimal movement/usage of that bone. In 
  
  17
  DISEASES OF THE SEA
  order to enter the healing phase, another creature 
  must perform a successful DC 15 Wisdom (Medicine) 
  Check to put the bone back in place. Healing time is 
  between 4 and 8 weeks, but every time the injured 
  creature tries to use that bone takes 1d4 damage and 
  the healing time increases by 1 day.
  Table C injuries need moderate time to heal and 
  require zero movement/usage of that bone. A similar 
  check as before is needed but the DC is 20. Healing 
  time is between 4 and 8 weeks but every time the 
  injured tries to use that bone takes 1d12 damage and 
  the healing time increases by 1 week.
  Broken bones can be healed by healing magic 
  that would restore at least 10 hit points (even if the 
  creature being healed is already at full hit points).
  Plot Hooks
  This is more of a ruleset than a storytelling tool, 
  and as such, it pales in comparison to the rest of 
  the maladies of these codexes in regards to its plot 
  purposes. Still, we think that it’s useful to have a 
  few extra rules in your library, ready to be used at a 
  moments notice when your player decides to jump off 
  a cliff. Many of them think they are gods, after all. 
  
  18
  THE MALADY CODEX III
  appendix a: monsters
  Vampire Squid
  Large beast/Monstrosity?, unaligned
  Armor Class 12 (Natural Armor)
  Hit Points 60 (6d10+24)
  Speed Swim 30 ft.
  STR  15 (+2) 
  DEX 13 (+1) 
  CON 18 (+4)
  INT 12 (+1)
   WIS 10 (+0)
   CHA 4 (-3)
  Skills Perception +2
  Senses Darkvision 30 Ft., 
  passive Perception 12
  Challenge 3
  Water Breathing. The 
  vampire squid can breathe 
  only underwater.
  Actions
  Bite. Melee Weapon Attack: 
  +6 to hit, reach 5 ft., one 
  target. Hit: (2d8 + 4) 
  piercing damage.
  Tentacles. Melee Weapon 
  Attack: +6 to hit, reach 10 
  ft., one creature. Hit: 15 
  (2d10 + 4) psychic damage. 
  If the target is Medium 
  or smaller, it is grappled 
  (escape DC 15) and must 
  succeed on a DC 12 
  Intelligence saving throw or 
  be stunned until this grapple 
  ends. Any creature that 
  comes in contact with the 
  squid’s tentacles must also 
  make a DC 16 Intelligence 
  check or become infected 
  with Squiditis.
  
  19
  DISEASES OF THE SEA
  appendix b: magic items
  Flag of Disease
  Common, wondrous
  This green flag depicts a painted skull with closed 
  eyes, black on a white field. It is a known symbol 
  of disease, and signals that the ship is in need of 
  assistance from healers. Nautical laws and morality 
  oblige sailors to respect the Flag of Disease, and it is 
  common knowledge that a deadly disease will befall 
  anyone who harms a ship that flies it.
  Rainbow Jar
  Very rare, wondrous
  This jar contains a sample of the Rainbow Mists. 
  It has a magical lid that allows healers to open it 
  without the substance dispersing into the air. It 
  contains enough Mist for five uses. When a dose of 
  the substance is applied, treat it as if the creature 
  became submerged in the Mist, but it only affects 
  one injury at a time. 
  Truth Compass
  Very rare, wondrous 
  This compass is made out of a fine steel and is 
  adorned with features like shells, fish and the waves of 
  the sea. On the inside of the lid it has a clear mirror.
  The compass always points to the north, unless 
  someone looks at themselves in the mirror and wishes 
  to find a certain object or thing. Then, the compass 
  points to that. This feature lasts for 24 hours and can 
  be used once per day.
  
  20
  THE MALADY CODEX III
  appendix c: furtHer adventures
  If you want a taste of how our diseases can be used in a game setting, and specifically in a mystery type of 
  encounter, then check out Encounters on the Savage Seas by Jeff C. Stevens et al. Volume II features “A 
  Sailor Fears Disease”, written by Jason Bakos. The supplement is excellent, as it offers a satisfying variety of 
  encounters that can be used to add flavour to your nautical campaigns.
  If you want to explore other diseases, then consider checking out The Malady Codex and The Malady Codex 
  II: Diseases of the Mind. In the first installment of the series, we present 11 diseases that you will undoubtedly 
  recognise as magical variants of some of the most well-known diseases that ever plagued humanity, and in the 
  second, we describe 10 magical diseases of the mind that are bound to enrich your stories. 
  
SOURCE: textdata/thevault/Dungeons & Dragons [multi]/5th Edition (5e)/3rd Party/Jason Bakos/The Malady Codex III - Diseases of the Sea.pdf