Disease has always been underrepresented in role-playing games. There are a lot of reasons why that’s so, from the challenge of trying to mechanically represent the rather imprecise effects of sickness (to say nothing of different sicknesses), to the prevalence of magic, but the effect is the same: diseases aren’t really a concern. That’s something of a shame, because if your world is at all medieval-European in flavor, then illnesses should be a major source of concern and fear to the populace, including your player characters.

Making diseases in your game be a threat in proportion to their historical significance is a daunting task, and to be fair, The Roleplayer’s Leechbook doesn’t get bogged down in trying to do that. Rather, this book is a flavorful description of how illnesses were thought of and treated centuries ago, giving you the tools so that you can better dress up diseases to appear to be a fearsome thing. It won’t actually solve the mechanics of how to make a horrid plague in a world where remove disease is common, but to be fair, that’s not the book’s aim. What’s given here is a historical look at sickness and medicine, so as to make it better window-dressing for your game.

Chapter one is the introduction, which seems rather odd to me, since usually the introduction comes before the chapters start. In it, the author lays out the aim of the book, noting that the issue of magic in the world is touched upon, but only deftly, since this supplement is meant to be universal. The author also lists several other works that can be easily consulted for more on historical medical practices.

Chapter two covers several broad areas, each getting their own subsection. It opens with the major theory regarding bodily health of the time, the four humours – something I found exceptionally interesting. It goes on to cover a variety of topics, including what sort of training health care “professionals” had back then, what diseases were active, superstitions people had in regards to health, and more. Setting the tone for the entire book, each subsection has a paragraph at the end that gives an adventure plothook, which is a nice way to help tie specific topics into your game.

Chapter three covers the more specific aspects of medieval medicine, going over disagnosis and treatment for illnesses. This chapter does a good job in outlining the gruesome nature of medical practices back then, as there were few aspects of disease management that were clean or painless. Using leeches to let blood from a person (this is why medical texts were often called “leechbooks”) is just one of the mildest forms of treatment. Medicines were as likely to work as not, particularly if you bought them from scam artists who didn’t even try to create a real remedy. And the last resort, surgery, was a truly ghastly procedure.

Chapter four tries to introduce more practical ways of integrating the material in the book into your campaign. This largely takes the form of descriptions for new NPCs and locations. Of course, there are no stats, but the rich flavor text helps to make up for that somewhat. There are also a few new magic items described; however, not using stats largely reduces them to storytelling devices that will likely not translate easily, depending on which RPG you play.

Overall, I had a mixed but generally positive reaction to The Roleplayer’s Leechbook. As a source of flavor and inspiration, the book does a great job of making disease in the Dark Ages be very scary. However, the book has a touch-and-go treatment in regards to magic in the game. It gives the topic sporadic coverage, generically deciding to do so in regards to a low-magic world but occasionally drifting into high-magic topics such as resurrection. While I can applaud the attempt to try and cover magical medicine, the book’s focus is too broad to really do that subject justice, and it feels tacked-on in comparison to everything else. That’s a shame, because everything else about the book is quite well done and inspirational for the tone it presents.

Ultimately, the book works best if you throw out the sections on magic and focus on trying to make the flavor fit within the context of your game. Diseases and their treatment are a major factor in medieval fantasy worlds, and this book certainly helps put the “ick” back in “sickness.”