How Can I Use Realistic Disease in My Story?

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Disease and infection were deadly, particularly before modern medicine, germ theory, vaccinations, etc.

However, having the main character get a coughing fit, diarrhea, and pustules does not usually make for a great adventure story. You can’t outwit or outfight cholera.

You mention “A Basic Understanding of Medicine” as an anachronism fantasy needs, but is there any way to include more realism while still having a fun adventure?

– Dave L

Hey Dave, great to hear from you again!

This is a tricky question that I think about a lot. On the one hand, the history of disease and humanity’s struggle with it is fascinating. On the other hand, often that history is nothing but painful death in the face of something no one understands, which doesn’t generally make for a great story.

One option, of course, is to build a story around fighting a disease even though it’s misunderstood. Your story could focus on one of those rare breakthroughs where people actually figured out a way to fight the disease, like John Snow and the Broad Street Pump. Or, you could also have a story where your heroes have to deal with people who are treating the disease incorrectly: “No, don’t bleed the patient, they’ve already lost too much fluid.” There would need to be a reason why your heroes know more about disease than everyone else, but that shouldn’t be too hard. Maybe they come from a country with more advanced medicine, or they’ve uncovered ancient writings from a more scientifically advanced period.

Alternatively, you could have a story where characters have to keep going despite not understanding the illness that’s devastating their community. This could be a personal drama of villagers trying to provide comfort for each other, like you’ll find in the novel Eifelheim, or it could be the story of an empress trying to keep her state running even as the plague wipes out entire communities. These are both pretty grim, but so is disease.

If you want your protagonist to avoid the disease even though they don’t understand it, the best option I’ve found is for them to have caught the illness in the past and survived it. That often makes a person immune to catching the illness a second time, allowing them to provide aid without getting infected. It would probably seem contrived if the hero got sick in the story and then just recovered thanks to their immune system, but if it happened in backstory, audiences are more likely to accept it.

And, of course, there’s always magic. In a fantasy setting, you can make the disease as realistic as you like and still have a fighting chance against it, so long as the heroes can find the ancient Staff of Healing before it’s too late.

Hope that gives you some ideas!

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  1. LeeEsq

    The only fantasy series that attempted to deal with disease in the Medieval Ages in a realistic manner is David Edding’s Belgariad. In the extended series, a plague outbreak provides a useful background element because it gives the heroes on opportunity to escape from captivity and continue the fetch quest. Other fantasy series tend to ignore disease or do the entire magical healing route rather than deal with the messiness of medicine in the Middle Ages.

    • Rose Embolism

      There’s also a story to be made about people fleeing or avoiding a disease. The Decameron for example has the framing device of ten young people sheltering in a villa outside of Florence, in order to escape the Black Death.

      • LeeEsq

        Or the Masque of the Red Death for a darker take on the fleeing from disease genre.. The realities of medieval medicine is something that nearly every fantasy author seeks to avoid though. It doesn’t matter whether they are writing a politically tinged YA novel or a sword-sorcery-sex romp a la Conan the Barbarian or a comedy or satire of the genre. It’s one of the near constant rules, medieval medicine will be ignored in favor of magic because bleeding, maggots, and barber-surgeons are all rather gross in a not fun way.

  2. Eric Jackson

    The Gentleman Bastard Series by Scott Lynch does an excellent job of using a humours based medical theory that pervades the story.

  3. Richard

    Instead of having a plague outbreak as a plot point / motivator, I’m wondering if Dave L. is simply thinking about what to do if/when one of his characters gets sick, or is already ill.

    The illness could confine the character to home, minimizing their contacts with the world. Like Nero Wolfe, they’d need to rely on others to be their eyes, ears, and legs. Or explain why a character must go to them, and not the other way around.

    A temporary ailment like a cold or migraine could result in the character missing the significance of something, or being unable to respond quickly in a crisis.

    One can also do a bit of research into illnesses like malaria, typhus, syphilis, and smallpox and see what mild cases are like. These diseases aren’t necessarily an immediate death sentence. Nor do they spread as quickly as one might fear.

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