Diseases are an often underutilized tool in the DM’s box of fun tricks.  Typically they come about as a side effect of throwing in a monster that hasn’t been used in a while – such as a lycanthrope.  Only after the rules complications enter play does the DM remember why they don’t use them.

Then one of two things typically happens – either the party (or at least the afflicted member) dies because the party is completely unprepared, or the disease has almost no effect at all and presents no real challenge or change of pace.

In order to make diseases interesting they need to be introduced at a point in the campaign when they will be challenging and fun.  Putting in a disease that will cripple or kill a party member in the middle of an already challenging dungeon is a recipe for party wipe.  Put that same disease around the corner from a temple with all the cures at a reasonable price and nobody even notices.

In 4th edition there are levels associated with the various diseases.  This makes figuring out their difficulty fairly easy.  Once again, however, the options for curing a disease need to be considered carefully as well as their potential effects.

First, consider how likely a party member is to become afflicted with the disease.  What is the actual likelihood that the afflicting monster will hit with the given attack.  If the character is afflicted, what is the likelihood that a party member will recognize the disease?  Unless the party started somewhere around level 5 you probably have a pretty good idea of their play style and the disease question hasn’t come up yet.  In other words these shouldn’t be difficult questions to answer.

Consider the consequences of the disease on the party.  Who is most likely to be afflicted and how will they deal with it.  If it all seems too easy, then consider making the challenge a bit more difficult.  In general it is easier to make an encounter or dungeon easier on the fly than it is to make it more difficult, so plan for the party to handle your situation better than anticipated.

I recommend against introducing a disease if there is only one option for curing it – unless you can carefully control who gets the disease.  One typically very challenging situation is when the party healer gets diseased and nobody can help him out.  If there is only one person who can tend diseases with any reasonable hope of success, then as a DM you should have a backup plan for the party.  An NPC that can cure them, a magic item or something.  They may not need the help, but spending an entire session watching the party healer slowly degrade may not be the most fun.

There are situations where it is a good idea to afflict the party this way.  There are times when it can be a learning experience for the players and the characters.  It can open up new adventure hooks, but in general it is a better idea to treat diseases like all the other challenges – they are something the party is supposed to beat and be rewarded.

Like everything else, have fun with diseases!

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