The RaW for infections are brutal!!!

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ChrisDDickey
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Joined: Sun Nov 27, 2016 10:02 pm

The RaW for infections are brutal!!!

Post by ChrisDDickey » Sat Oct 05, 2019 7:33 am

The RaW for infections are brutal!!!  If a physician and lots of medicine are not available, severely damaged characters with a wound or two will almost certainly die. 

This thread is basically just to get corrections, comments and opinions about what people think about the infection rules. There are also a few questions and rules interpretations along the way. 

I recently had occasion to read and really think about the infection rules, and boy are they brutal! If a character is wounded, and has lots of current damage, and there is a physician available, they are unlikely to suffer an infection. If there is medicine, but no physician, they stand a small chance of not dying from infection. If there is nether antibiotics nor a physician, they stand almost no chance of not dying by the RaW. What is more, the higher Current Damage you start out with, the more likely you are to die of Infection, thus characters with high Durability can avoid death by current damage for a while, but unless a physician and medicine is available, are almost certain to die of infection a few days later. 

Now I know that one of the goals of 1879 was to be more gritty, dangerous, and realistic, and I know that prior to WWI, more soldiers died from infections or disease than died actually on the field of battle, but the RaW have practically zero chance surviving a wound and high damage without a physicians assistance, which I think is a bit too gritty. There ought to be SOME realistic chance of surviving without a physician and modern medicine. 


Background: So we had a party provisioning for an extended jungle expedition. We had a large budget to stock up on what we needed, and we had a priest, who had physician skill, and he stocked up with physician kit refills and medicines, but nobody now knows how much of each. That player quit the campaign, and nobody really gave a thought to that character fading away with all the parties stock of medicines. In subsequent sessions we had a few players with single wounds, but the current damage was always low enough that the wound was cleared away before anybody bothered taking a closer look at the infection rules. Now we just finished a fight with one character having 40 points of current damage and two wounds. The character has durability, so is still conscious, but with no physician within a weeks travel, and no guarantee of that native village having anything like an antibiotic, he seems doomed according to RaW. We are not going to use the RaW in this situation, but still it seems like the lack of a physician should not be an automatic death sentence in the RaW.. 


Now if we played this out by RaW, the character, with TOU step 7, would make recovery tests, with a -2 to the result. This would result in an average result of 5 (sure, some rolls will probably be higher, but some will also probably be lower). Thus, on average, it will take 8 recovery tests to clear out the current damage. Thus 2 and 2/3 days of recovery tests. If I interpret the rules on page 240 correctly, The character takes his recovery tests for the day he was wounded, but does not risk becoming infected that day (Note that this is a generous interpretation of the rules, assuming that an infection test does not need to be made the day a wound is taken, and assuming that "+2 for each day after the first" is referring to days in which an infection test must be made, not referring to days in which you are wounded. Ether of those could be interpreted less generously, which makes the situation even worse). The next morning, he still has current damage so automatically takes a new recovery test, at that time (I assume it is at this time) he makes an infection test (TOU only since he does not have Stout Constitution), TN 7 (6 plus 1 for having a 2nd wound). Assuming the character has a step 7 TOU, he has about a 50% chance of making that. The character takes the remainder of that days recovery tests, which (assuming average results of 5 on each test), lowers current damage to 10. The next morning he makes another infection test, TN 9 (6, plus 1 for a 2nd wound, and plus 2 for it being the 2nd day he makes an infection test). He has about 1 in 3 chance of making this test. This 2nd mornings tests will on average clear all of his remaining damage. The third morning, he (finally) heals one of his wounds, but needs to make another infection test because he has a wound remaining, TN 10 (6 plus 4 for being the third day). At step 7 he has 1 in 4 chance of making that test. The 4th morning I presume he would heal his 2nd wound without needed to make another infection test.

If I did my math right, he has only about 1 in 24 chances of succeeding in all three infection tests. If he does get infected, then there is no way to clear up the infection without both antibiotics and a physician, and it is merely a matter of time (about 5 days assuming normal statistics - maybe a few days longer given some lucky rolls) before the infection inevitably kills him.So to sum up, if no physician and no medicine can be found, the character has 23 in 24 chances of dying within 6 to 10 days. 

Lets look at the situation if medicine is available, but a physician is not. If clean bandages and powdered penicillin are applied to each wound each day, then the TN for the infection test is 6. In the example above, this would require (depending upon how the rules are interpreted) somewhere between 5 and 7 doses of penicillin @ 1/2 each and physician kit applications at £1/5 for 3. That probably works out to about 3 pounds sterling, but well worth it. The problem is that even with all that medicine, the wounded character still needs to make three infection tests, TN 6. Assuming a TOU step of 7, Each one has a 7 in 12 chance of succeeding, so the chance of making all three is only 20%. If even one is failed, a wound becomes infected and there is no way to cure it without a physician, thus there is a 4 in 5 chance of dying within 6 to 10 days if there is medicine, but no physician. 


Lets look at the situation if a physician is available. The physician will make physician tests, one for each wound, TN 5. If he fails a test, he may attempt again (up to patents number of daily recovery tests per wound attempts per day). Once he eventually succeeds on both wounds, the patents recovery tests will no longer have the -2 due to the wounds. The physician can make additional physician tests to actively boost the recovery tests. This will probably knock at least one day off of the recovery time, healing the 2nd wound the 3rd day, rather than the 4th. It does not appear as if anything other than physician test refill usages need to be used up. Don't need additional antibiotics (maybe they were included in the physician kit refill). 

The physician skill description says "Treating Wounds also eliminates most risks of infection." but does not define the term "most". I have decided to interpret that as "most of the normal risks of infection", which is to say the normal risks of infection described on page 240. Which is to say if the patent keeps to calm, dry, bed-rest, there is no risk of infection, you only need to make infection checks if the wound gets dumped into a swamp or in some other way increases the risk of infection such as not keeping the wound as clean and dry. There could however be differing interpretations of that rule. 


Lets also look at getting an infected person to a physician. There is a great big logic bug in the rules for curing a person of infection. "In order to clear an infection, the character must be treated with antibacterial medication and receive medical care (a successful Physician Test by another character or a Gamemaster Character) for a number of days equal to the duration ofthe infection." Using this rule, it is clearly impossible to clear up an infection except upon the very first day. IE: you get an infection, and the doctor treats it the first day, and it is cured. If the doctor fails to treat it until day two, then the doctor can never catch up, the duration continues to grow until the infection is cleared up, but the infection is not cleared up until treated a number of days equal to the duration, which continues to grow during treatment. I think the obvious intent here is to replace the words "duration of the infection" with "number of days the infection was not successfully treated". 

Also note that for some reason the rule quoted above specifically does not allow a character to treat their own infections. I personally feel that this is both unnecessary, and unrealistic. Sure it is harder to treat your own infections, but only because the infection lowers your own PER which will lower your physician test. But if you are the only physician available, the rules adding a gratuitous limitation that only "another character" can treat your infection seems both unnecessary and wrong. 
Thus a better version of the rule would be wrote:In order to clear an infection, the character must be treated with antibacterial medication and receive medical care (a successful Physician Test per day) for a number of days equal to the number of days the infection was not successfully treated.

So to sum everything up, According to the Rules as Currently Written, having a physician available is not just handy or a luxury. Taking a wound and a lot of current damage absolutely requires access to a trained physician or wounds will almost certainly become infected, and because infections can only be cured with a trained physician test and antibiotics. Expeditions away from civilization ought to have two physicians along, since physicians can't cure their own infections.

I can't say that I disagree with the conclusion that expeditions away from civilization ought to have at least one person with some medical knowledge along, but the chances of infection and certainty of it killing seem unrealistically harsh. Not that millions of people have not died of infections, and that having a physician and antibiotics available are not greatly, greatly preferable. It is just that their lack should not be an automatic death.

Slimcreeper
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Re: The RaW for infections are brutal!!!

Post by Slimcreeper » Sat Oct 05, 2019 12:33 pm

I didn't work through all of these scenarios in the same way that you did, but I came to the conclusion that you can either have an adventure game or a dying of sepsis game. Same thing for the rules for taking Warping Damage.

(I don't know if you've looked through those rules, but Cusa should a have been making a Warping test with a base Step of 6 or 7 against his MD every time he cast a spell, and if it succeeded taken Step 9 or 10 damage on top of the strain. Assuming Open Astral Space. Also, in Open Space, every TN is supposed to be increased by 2. I have, ahem, not been playing with those rules. A reasonable option would be to have Warping Damage happen on a rule of 1 on a Spellcasting Test, and have it cause Stun, not Damage. But that is aside from the topic.)

I do think it would be good for the rules to reinforce the idea that penicillin was an absolute life-saving game-changer, but if the rules are so harsh you can't use them then you never use them and they fail to serve their purpose. So far I've just declared them optional and not used them.

As for house ruling, I have decided to experiment with allowing Wounds to let a Recovery Test cause negative healing, AKA damage, in my Earthdawn game (starting next week!). It kind of breaks my suspension of disbelief that you can just not get medical treatment if you have 8 wounds and you'll just get better. In 1879, that might be the test that determines infection. If a Recovery Test results in damage, the wounded character is Infected and takes an additional wound. Something like that. But I haven't really thought through that.

*Edit though maybe it would be better if Sepsis was written up like a disease, since it is one.

ChrisDDickey
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Re: The RaW for infections are brutal!!!

Post by ChrisDDickey » Sun Oct 06, 2019 7:12 am

I saw that @Andrew1879 posted in the Product Line Errata, but just wanted to note that it did not fix the big logic error in the rules that makes it impossible to clear up an infection except upon the very first day.
for a number of days equal to the duration of the infection
This is impossible to do except upon the first day! Example: no physician succeeds in treatment the first day. On day two the number of days treatment must be successful is 2. But it takes two days to achieve those successes, so by this time the duration of the infection is three days, so the number of days treatment must be successful has grown to three. By the time it is possible to achieve the third success, the number required has grown to four! There is no way to catch up! The wound simply remains infected until the character inevitably dies. Even with treatment. This is a logic bug that should be easy to fix.

Note: I would love to see a rule where it was possible to clear up an infection though shear TOU, no physician or medicine required. Something like "Instead of a physician test, the infected character can make a TOU test (with the TOU penalty for having infection) TN 10 with each success counting as a successful physician test to fight infection".

I can think of several fairly easy fixes to the logic bug, with the 2nd fix easier to word than the others and gives a good chance of desirable results.
One fix is to allow for extra successes to count (IE: eliminate the phrase "number of days treatment" and substitute it with some text that means number of successes, but only one test can be done per day, such as
"In order to clear an infection, the character must be treated with antibacterial medication and receive medical care in the form of cumulative successes on Physician Tests equal to the duration of the infection, only one Physician Test may be done for this purpose per day."

This would at least make it possible to save somebody, but would require very excellent physicians tests. Example, somebody is brought to hospital on day 3 of an infection, they have -3 to most attributes. A physician test is made that gives two successes. The next day they are -4 to most attributes and unless the daily physicians test can achieve three successes the patient will die the next day when one of their attributes drops to zero. Like I said, this method would at least be logical, but is not my preferred method of solving the logic bug.


My suggested text for this paragraph, that eliminates the logic bug, and gives a good chance of saving the patient is...
Failure indicates that the Wound has gone septic. The character suffers a –1 penalty to their Strength, Toughness, Dexterity, and Perception Steps for each day the Wound [was not successfully treated] [remains infected]. If any of these Steps drop to zero, the character dies. In order to clear an infection, the character must be treated with antibacterial medication and receive medical care (a successful Physician Test [that may only be attempted for this purpose once per day] [by another character or a Gamemaster Character]) with a number of cumulative successes equal to [the number of days the infection was not successfully treated] [the duration of the infection].

I like this version of the rules, because it keeps access to a physician as the best option with an excellent chance of survival, but increases medicine only (with no physician) from a slight chance of survival to a fairly good (but not excellent) chance of survival, and increases nether physician nor medicine from no chance of survival, up to a slight chance of survival. These seem both better and more realistic to me.

To put it all together in one clean paragraph...
Failure indicates that the Wound has gone septic. The character suffers a –1 penalty to their Strength, Toughness, Dexterity, and Perception Steps for each day the Wound was not successfully treated. If any of these Steps drop to zero, the character dies. In order to clear an infection, the character should be treated with antibacterial medication and receive medical care in the form of cumulative successes on Physician Tests equal to the number of days the infection was not successfully treated, only one Physician Test may be done for this purpose per day. Instead of a physician test, the infected character may make a TOU test (with the TOU penalty for having infection) TN 10 with each success counting as a successful physician test to fight infection. Penicillin injections (see page 298) may be used to bolster this TOU test, but additional doses do not allow additional resistance tests when not administered by someone with the physician skill.
Also Note: Am I missing something? Does "a successful Physician Test by themselves, another character, or a GMC" convey some nuance different than "a successful Physician Test" or "a successful usage of the Physician Skill"? I am wondering if you are thinking that the first makes it more obvious that a Physicians Kit usage is expended? Or the extra verbiage is conveying something else?
Last edited by ChrisDDickey on Sun Oct 06, 2019 12:49 pm, edited 1 time in total.

ChrisDDickey
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Re: The RaW for infections are brutal!!!

Post by ChrisDDickey » Sun Oct 06, 2019 12:44 pm

page 240 (the rules on infections) wrote:If the character’s Wounds are treated with antibacterial medication, such as powdered penicillin, and clean bandages, no additional penalty is incurred for the day.
page 298 (the equipment entry for penicillin) wrote:Applying the powder grants a +6 Step bonus to Resistance Tests to avoid infection.
Do both of these effects apply? One dose of powdered penicillin per wound per day both keeps the target number from increasing and gives a plus 6 bonus to the resistance test? Because if so the RaW medicine only option suddenly becomes much more survivable, if the reader happens to notice both effects in the rules.

LexiLiegh
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Re: The RaW for infections are brutal!!!

Post by LexiLiegh » Sun Oct 06, 2019 5:51 pm

Chris, if I am understanding correctly the infection test only occurs if there is a wound. So once the wounds are cleared, there is no more infection test right? You're just dealing with the effects of an infection[reduced perception]. So at that point you treat the infection since the wounds are gone, correct?
Minion of GMAndi

ChrisDDickey
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Re: The RaW for infections are brutal!!!

Post by ChrisDDickey » Mon Oct 07, 2019 9:01 am

Kind of. There are two sets of rules, rules to avoid infection, and rules to heal infection, and wounds will not heal while they are infected.

The initial goal is to heal your wounds before they become infected, once the last wound is healed you don't have to worry about infection any more. Physicians tests, keeping wounds clean, and powdered penicillin help with the roll to keep your wounds from becoming infected.

However wounds that become infected will not heal until the infection is done away with (page 240, last bullet point), so if your wounds do become infected, you have to heal them. My understanding is that physician tests and (probably) injected penicillin can do that. If you can get rid of the infection, the wounds can heal.

And the effects of infection are not only reduced perception, but also toughness, strength, and dex, and if any of those drop to zero you die.

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