Diseases in D&D have never worked great. It’s difficult to balance them, and then there’s the fact that most competent priests can cure them without much effort. As a result, I can probably count on one hand how many times I’ve seen them crop up in a campaign. Fact is, they’re just not a very fun thing for people to deal with. In 1998’s annual issue of Dragon, Kevin Melka tries to solve at least some of these problems, and though the result is only passably useful, it’s not a bad article nonetheless.
The first thing Melka did was decide that planar diseases are simply too deadly to deal with for a simple cure disease spell. Which kind of feels silly (let’s be honest here, it’s cheating), but oh well, it at least means that these diseases will offer a real challenge. However, in order to do this, he invents a spell called “cure greater diseases,” which is the same thing as cure disease, but now as a sixth-level spell that can deal with his new diseases. This is some real clunkiness, with the creation of a solution tailor made for a problem, and as a result the way of dealing with each disease he adds to the planes is essentially identical. It’s not really his fault, that’s just how magic and everything works, but again, diseases in D&D are just not a well-done mechanic.
The rest of “Planar Pestilence” is devoted to describing 11 of these diseases, and while they have a lot of mechanical similarities between them (cure it or eventually die, and the only way of curing it is through that new spell), at least their flavor varies quite a bit. That being said, the creativity of these diseases is pretty variable. Most of them are in fact just a planar version of normal diseases. Abyssal Rot is rot that, umm, comes from the Abyss (but it comes in two varieties—yay!). Beastland Fever is, as Melka notes, the plane’s “version of malaria.” Hive Plague is just the plague, only spread in the Hive by cranium rats, and Planar Rabies is… planar rabies. Yup, it’s just the normal disease with the word planar in front of it, and is harder to cure than typical rabies because the planes are a dick like that.
Which isn’t to say that there aren’t some legitimately interesting diseases here. The best of these is Fading Breath. “It’s said that when an evil Power dies, its last exhaled breath lives on forever to plague the plane it once called home.” If someone inadvertently wanders into this breath, even someone “immortal,” they become infected with a respiratory disease that kills in just 1d4+1 hours. The concept here is a unique bit of planar lore, even if the disease itself is still pretty uninteresting—cure it with cure greater diseases or die, nothing else to it.
I also quite like Prime Pyrexia, which is basically a system shock characters from the Prime Material Plane go into due to their difficulty adjusting to the planes. Unlike most of these diseases, it’s not 100% fatal if untreated, which makes it far more usable. And best of all, while “prime pyrexia is not contagious at any stage, [it] does tend to mark a newcomer’s arrival on the planes. Shifty bloods often use the diseases as an opportunity to take advantage of the clueless, peeling them out of their jink by selling them ineffective remedies.” I appreciate that in most cases, this disease is just a planar “kick me” sign taped to newcomers’ backs.
Melka also does an excellent job of imbuing the whole article with Planescape lore. Zombie Leprosy comes from Naratyr and was created by a proxy of Kiaransalee of Dead Gods fame, while The Pox comes from Anthraxus, who was fittingly introduced to us in “Pox of the Planes.” There’s even a note about Babble Fever from Faction War. As a result, the article feels part and parcel with the usual Planescape universe, and if you did for some reason want to use diseases, well, these would be the ones to try.
Ultimately, Melka can’t force diseases to become terribly interesting or usable in the game, but his effort is solid, and the writing and ideas are certainly good enough to use if for some reason that interested a DM. As it stands, I’d still give them a pass, but Melka even seeds in adventure hooks, such as curing Zombic Plague by dealing with Rotting Jack or a swarm of Beastland Fever-spreading mosquitos escaping from a portal. For most people this is a totally skippable Planescape article, but that’s not in any way to say that it’s a bad one. It’s just one of those parts of reality that’s never really worked well with the game.
