Greetings!

Yes, I believe that having professional medicine, healthcare, and sanitariums are an important element in the campaign. In my World of Thandor, I do not embrace the assumption that every temple and church in a community has a battalion of spell-casting Clerics that can simply heal everyone from any kind of injury, disease, or mental ailment. Having established that such spell-casting Clerics, Shamans, Druids and so on are something in the minority, a broader-based approach to healthcare and medicine becomes necessary, realistic, and prudent.

Historically, in highly sophisticated civilizations, such as Greece, Rome, Babylon, Persia, Egypt, China and India, they too, embraced different levels and styles of healthcare and professional medicine.

From this foundation, then, it seems that having professional Physicians, Nurses, Herbalists, Midwives, Barber-Surgeons, Apothecaries, and to some extent, Alchemists have a distinctive role to play in the local community, as well as the larger society.

Have you developed detailed healthcare systems within your campaigns? In my World of Thandor, in highly civilized cultures, I have professional Hospitals, local community clinics, Herbal shops, Apothecaries and Pharmacies, Barber-Surgeons, as well as Sanitariums. I have Sanitariums for the hordes of insane people, mobs of drooling, violent sociopaths, and psychotics. This kind of system of growing professionalization also sets up social and political conflicts--between Physicians and Midwives, for example, or risk-taking, driven Necromancers and insane Grave Robbers seeking to traffic in grave robbing and crazy, evil experiments on masses of poor people, carried off into the night by sophisticated gangs bringing living victims to such evil Necromancers and other crack-pot "doctors" and wizards working on all manner of debauched and vile experiments and research.

Then, of course, having a good idea of the medical knowledge and sophistication of an existing community's healthcare system and professional medical services, opens the door to all kinds of challenges posed by horrendous diseases and swift-moving plagues. That's always an entertaining aspect.

In addition, ditching or otherwise restricting such spells as *Regeneration* provides opportunities for loss of limbs, various kinds of diseased cripples, and the potential industry and scope of prosthetic limbs, hook-hands, peg-legs and so on.

What kind of dynamics and ideas have you chewed on for your campaigns when considering such issues and dynamics?

Semper Fidelis,

SHARK

I've played WFRP (2e) and they had houses of healing and sanitariums. These were often run by the church of Shallya, but that doesn't mean that magical healing was available (but sometimes it was). OTOH, I've also played in an Eberron D&D game where most church leaders of the various faiths are not spellcasters and healing is a secularized activity dominated by a magically gifted group of halflings. For those that went to the halflings with deep pockets, magical cures were possible. For those of humble means, a clean bed with access to fresh food & water along with the applications of bandages, splints, and mundane poultices was more the order of the day. Communicable diseases were often cured on the cheap as these services were often paid for by taxes.

D&D, and fantasy RPGs in general, tend to create a sharp divide between spellcasters, who have the power to perform ostentatious and often combat-related miracles, and everyone else. That's not very historical, because science and magic have the same roots. They're an attempt to describe and explain nature, and mixed truisms with nonsense, mundane practicality with fantastic confabulations. There were folk traditions as well as more formal bodies of learning, like the natural philosophy of druids like Taliesin, or eventually alchemy.

It probably makes sense to treat it as profession-based, and to create a body of beliefs and practices that blur the line between the mundane and magic for each one. Decide on the institutions; do you have formal universities or schools for physicians and alchemists, or is it passed down by rote memory? What special role do midwives have, and are men barred from witnessing childbirth? What kind of lucky or superstitious precautions are taken, like putting something over a door, or performing certain acts in a ritual manner, a prescribed number of times? What are the differences between more formal knowledge, like say an apothecary vs. an herbalist?

Have fun with it. Maybe midwifery is the highest magic, touching on life, and includes the most powerful archmages in history. Maybe alchemists use craft to transform materials, which in turn shapes the spirits, and the consequences of their elixirs and salves include twisted brownies of sylphs; they are as hated among the fey as necromancers are among the living. Maybe physicians are sponsored by the wealthy and serve the poor for free, but test all their remedies on the indigent before trying it on their patrons. Maybe plague doctors are a specific specialty, and are sent in to manage not just traditional diseases, but also lycanthropy and the undead plagues; and many host dozens of diseases, poorly arrested by chants and flagellation, within their own bodies.

In my own campaigns major healing tends to be found only in the larger cities and capitols. Minot healing might be had in smaller towns. But do not count on it. And depending on the situation, they may be spent allready from healing others. Comeback tomorrow.

Medicine is a tricky one as it depends on how readily availible potions are in the campaign. I tend to handle them much like healer NPCs in that they are rarer in the smaller towns and more common in the larger. There might be someone local who makes bare basic healing potions or other curatives. But it takes time and materials.

As for sanitariums. Also depends on the setting and how severe the mental illness is. From experience, Id guess its mostly going to be kept "in the family" and or under lock and key if its a real problem. Lesser eccentricities would probably be put up with if they didnt interfere with day-to-day work. But f its a violent sort then odds are sooner or later they will be put down like any other monster that cant be reasoned with.

Speaking of. In Neverwinter one of the campaigns is about demons infiltrating a sanitarium in Helms Hold and turning the patients into cultists, and then using that as a foothold to infiltrate and turn citizens into more cultists. Eventually they overwhelm the city when the cultists revealed themselves.

My campaign world is made up of small villages and towns ... not much in the way of any large institution. For "medicine" I use an NPC "Healer" class, comprising those with natural talent but who never trained to be a full fledged Shaman (the primary "clerical" class in my game). I like the mechanical simplicity of just giving Healers a tiny subset of those already well-defined shamanic abilities.