The spittle of feral beasts a welcome harbour for Pasteurella multocida. Blue-green slime-filled stagnant pools teeming with Pseudomonas aeruginosa. Your own filthy sweat and sebum laden with Staphylococcus aureus. All eager to slither into your open flesh to poison your blood and kill you.
Surviving the wound is one thing. What comes after is often much, much worse.
Exposure
You are exposed to Infection each time you suffer a significant open wound or particularly filthy attack. Examples of these include rolling on Death and Dismemberment tables, a bleed status effect, animal or human bites, and impromptu surgery. Any open, uncovered wound which is exposed to unsanitary conditions (e.g., contamination with stagnant water, a beast's insides, or foul vapours) is also exposed to Infection.
When exposed to Infection, you roll a number of d6's. If you are exposed during combat, you roll these at the end of combat. If you roll a 1 or 2 on any die, your wound has become Infected. Take a note of how many 1s and 2s you have rolled. This number represents the Virulence of your wound infection.
The base number of d6's is one. A non-exhaustive list of modifiers follows:
- +1d6 if the wound is not quickly washed and dressed.
- +1d6 if already suffering from systemic disease.
- +1d6 in an unsanitary environment (most dungeons, city streets).
- +2d6 in a filthy environment (a sewer, a beast's lair).
- -1d6 if in a particularly clean environment (a dedicated operating room).
- -1d6 if topical antiseptic is applied early (fortified wine, fine honey, povidine-iodine).
Progression
As time goes on, infected wounds rarely improve without dedicated treatment. Wound infections have four stages, all starting at stage 1:
- Localised Infection.
- Purulent Infection.
- Wet Gangrene.
- Sepsis, shock, and death.
The rate of progression of your Infection is proportional to its Virulence. Every 5-(Virulence) days, roll a number of dice equal to the Infection's Virulence. For each 1 or 2, increase the stage of the Infection by one. For each 6, decrease the stage of the Infection by one. For each 1, increase the Virulence of the Infection by one. An infection with a Virulence of five or greater represents a rapidly necrotising infection; roll every 1d6 hours.
Localised Infection
The first heralds of infection - rubor, calor, dolor et tumor - have appeared. Your wound is extremely tender and weeps the first bits of thin pus, although there is no immediate penalty.
Purulent Infection
The infection has become well-established, with a collection of organising pus tunneling under the skin and weeping through bandages. Leg: your speed is halved. Arm: any activities with the affected limb have a 3-in-6 chance of failing due to pain and swelling. Torso: temporarily lose one hit die. Head: automatically go last in initiative order, cannot cast spells.
Wet Gangrene
The wound blackens and fouls. Any limb affected by gangrene becomes permanently useless and must be amputated to resolve the Infection. Gangrenous Infection affecting the torso or head represents deep-seated visceral involvement requiring surgical intervention; you permanently lose one level even if this is resolved.
Sepsis, Shock, and Death
In the absence of systemic antibiotics or miracles, disseminated Infection is lethal. You have one day until you die from multi-organ failure (or 1d6 hours if rapidly necrotising).
Treatments
In the absence of modern medicine, advanced wound infection is typically fatal. Often, control of infection can only be achieved by cutting away infected tissue. However, if addressed early, infection can sometimes be managed conservatively with proper wound care in a clean environment.
Items
- Clean cotton bandages.
The foundation of any good field surgery kit. Thick cotton can either gently cover or tightly wrap. While this does not provide any benefit to an established infection, good cotton bandages that are changed when dirtied prevent the entry of infection into large wounds and can act as secondary dressings to poultices and other topicals.
10 feet of 4-inch wide clean bandage (1 slot) costs about the same as a decent steel dagger or a worker's day's wages. - Cotton bandages, honey and wine-soaked.
Effective antiseptic, fine honey and fortified wine further augment healing of infected wounds. For any wound affected by Localised Infection, the application of antiseptic-soaked bandages allows you to ignore any die with a face value of 2 when rolling against infection.
10 feet of 4-inch wide antiseptic bandage (1 slot) costs about the same as a decent backpack. Most likely, more than half of all "antiseptic" bandages sold have ineffective ingredients (such as treacle or other purported panaceae) and thus no effect. - Set of steel scalpels and scissors.
Clean sharp steel is the basis of effective debridement. While a dagger and torn cloth will work just fine in a pinch, safe margins and prevention of haemorrhage require finer tools.
A single set of simple surgical tools costs roughly the same as a well-made spear or good lantern. - Bonesaw.
The last reserve against infection. Use of a bonesaw instead of a wood-splitting axe or similar subtracts one die for saving against infection following amputation.
A decent bonesaw can go for surprisingly cheap from a butcher or barber-surgeon, about the same as a crowbar.
Procedures
- Debridement.
Any wound affected by Localised Infection or Purulent Infection may undergo debridement. Typically, this is with sharp scalpels. Each debridement decreases the stage of infection by one. Debridement decreases your Constitution by 1 (Virulence)-in-six times; this chance is doubled if using impromptu tools and doubled again if not performed by a trained surgeon. Debridement of the head resulting in loss of Constitution further results in either (on a further d6) damage to a mental score (1-3), loss of an eye (5-6), or coma (6). Following debridement, you must again save versus infection. - Amputation.
So long as a wound infection has not resulted in sepsis, an affected limb may be amputated. This cures the infection. Amputation may also resolve intractable haemorrhage of an affected limb. Any amputated limb is (obviously) rendered useless. If not performed by a trained surgeon, flip a coin to determine if the amputation is lethal. If performed by a trained surgeon, amputation is lethal 1-in-6 times. Following amputation, you must again save versus infection, with an additional d6 if wet gangrene was present in the limb.
