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Seven Deadly Plagues

A Malady Codex Special

by Jason Bakos and Themis Paraskevas

First Thoughts​

You ever just pick up something not knowing you needed it until you read it and then you realize fuck this has been missing from my life? This is one of those things for me. I own the six other products in this line and I have created a dozen or so diseases based off of previous projects but haven't used them - there was something missing on my end. With the introduction of creatures you can kill to end the diseases being spread I have a list of monsters I'm going to create to introduce diseases to my world and players.

Design and Layout


The design and art of this book is amazing. Perfectly conveyed the feel of a medieval times medicinal book. Each plague has unique artwork, the Plague of Blood is my favorite. 

Really great layout choices were made here. First we get a little blurb from Acesius, a "sidebar" about the potential real world equivalences, a bit of lore, a deep dive into the plague and its followers capped off with treasure and potential plot hooks. 

Handling Disease and Infection

We get a few pages talking about how to use the diseases.  It's a good start and can help DMs work through how they'll use them. There is something I want to highlight because  I liked it being explicitly called out since I know I'm guilty of having done this before: 

"If you have paladins, clerics, or monks in your party, don’t forget that their classes have been designed to give them an edge against all kinds of ailments. Don’t take
this away from them; encourage them. There are few things more satisfactory to a player than to suddenly realize that their high-level monk is immune to a disease, saving them and proving how the long hours the character has spent perfecting their art was worth it

Plague of Blood

It is rare to meet a survivor of the touch of an Old One, but if there's one place they would end up it's the Acesion. We take special care of those befell with this misfortune, always trying to connect the dots and predict where the avatar will appear next.

The lore behind this plague made me think of like the scary urban legends we might have heard when we were younger. The first time the plague appeared it was a dark night, dogs were howling more than they usually did, and there was the stench of fiend in the air. It's winter time so everyone is locked up in their homes trying to stay warm. Then a figure appears riding a three-legged horse accompanied by dozens of soldiers. Anyone that doesn't die from the figure's touch is cut down by the accompanying soldiers. 

The figure gets its power from a "cursed" amulet (like is it really cursed? depends on who you're asking tbh cause my lawful evil paladin would take this thing in a hot second) which turns it into the avatar for an unnamed Old One. The current avatar need not be the original since any soldier of the Red Army can challenge the avatar in deadly combat to claim the mantle. The Avatar can be killed but the amulet can only be destroyed through divine intervention. 

The symptoms are appropriately bloody/blood related. One causes blood to pour from your ears and eyes, one reduces your max hp and potentially turns you into a pool of blood, another does a massive amount of damage and paralyzes you as your blood freezes over, finally (and my favorite) a year after someone has been infected their blood boils and if anyone comes in contact with the blood they suffer the same effect.  I really like this last one because the first three are immediate, in the presence of the Avatar affects and the idea of something like this laying dormant and then happening again has such good story telling potential. 

The cure is equal parts magic and old real world practices. A calm emotion spell is used to deal with the post-traumatic stress of the situation and leeches are used for the tainted blood in someone's system. I really love that the mental aspect of contracting a disease like this was addressed. 

Plague of Dementia

No book that studies diseases can ever be complete without a reference to an Illithid. This one is unlike any other, a looming threat over our heads that could strike without any notice. I need you to pay heed to the subtle signs. 

So dungeons and dragons doesn't have a good track record with mental health issues, it's apparent in the Madness tables. What I've seen from these authors now and previously leads me to believe that they have respect for the people living with mental health issues and approach the topic with the respect it deserves. That being said I don't have dementia, neither does anyone in my family or friend group that I have contact with.

I love Illithds aka Mindflayers. I love playing them and making weird squelching noises to represent their tentacled mouth. I knew one day I would run a campaign with Illithid as the BBEG, but I wasn't sure how I would do that. Well this plague has given me  some ideas.

So the lore behind this plague uses a bit of the standard mindflayer lore. They are slavers, the gith rose up and destroyed their empire and they are trying to reclaim it  - the twist is how they are going about it. After the fall of their empire one particular elder brain started brainstorming the best way to conquer the world. Through trial and error "a special kind of psionic beacon" was created and placed in an important location of the society they wanted to infect. Due to these experiments the skin of the Illithids turned red and they became known as the Crimson Empire. 

This particular disease affects the mind and turns those infected into different types of slaves: caretaker, worker, soldier.  Symptoms vary between the different types of slaves, but they all have stages that affect their memories and abilities. 

The cure requires the elder brain that created the plague to be destroyed, there is no other cure it. I really like this because even after the player's have rid a town of any lingering Illithids there's an entire fortress of Illithids to get through before getting to destroy the Elder Brain. 

Plague of Statues

Many consider this to be a pseudo-plague, but after careful examination and deep thought, I’ve come to the conclusion that the effect that befell these people qualifies as one. Watch out for wax kobolds.

Compared to the others this plague is very chill and fucking goofy and I love it. It could just be because kobolds are involved that I find it goofy but either way I love it.

So you got your tribe of kobolds led by Gud the Leader, a powerful kobold wizard, who wanted to be the most powerful kobold that ever existed. He found a map to Old Elven Ruins that held a wax artifact but there was a catch - the artifact could only be touched on the longest day of the summer. So years and years went by before the Gud and the Yellow Kobold Tribe found the artifact - a "marvelous Elven statue made from wax." But it was a trap! As soon as he touched the it, the wax embraced him turning him and the whole tribe into wax statues. Now that is an actual cursed object. 

Of course that isn't the end of the story, if it was how would it be a plague? Every year on the summer solstice the Yellow Kobolds become flesh again and kidnap villages to give them to Gud. If a kobold is killed "they are reborn from wax inside the great hall."

Gud has been made one with the statue and shares the power of banished elven wizard who wants to wreak havoc on the world once a year. 

This disease is spread in two ways:  a kobold knocks a villager over the head and brings them to Gud or a someone is stabbed with a wax knife which turns them into a statue after a few hours. 

After the initial stab victims are paralyzed. Next their body starts to waxify, becoming stiffer, finally the creature is permanently transformed into a wax statue. But silver lining "the creature doesn't age or suffer from environmental conditions" and for a tenday retains consciousness and can answer telepathic communications.  I think it's a small mercy the consciousness fades after a tenday - although if I use this ability I am gonna have them remain conscious.  There is also an alternative stage 3 for creatures with a high constitution, immunity to the poisoned condition, or has black dragon heritage. "They suffer local waxification, which may cause them to lose a limb or some organ function."

A healing spell can fix the waxification if a creature is in stage 1, 2, or alternative 3. Otherwise the body needs to be regenerated to bring them back to normal. 

Final Thoughts​

I loved every part of this supplement. This is the seventh product in this line and they are still going strong!​ I think this might be better than the first six. Get your copy and check out the other four plagues and unleash them on unsuspecting players!



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