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Socially Unacceptable, or, The Case for Leprosy

This article originally appeared in Cepheus Journal #012 and is reprinted with permission in the March/April 2024 issue of Freelance Traveller.

In many settings and campaigns, disease plays no role. Either magic can cure it, technology has solved it, or the players have the knowledge to avoid it. Yet there has been much human drama historically over the contagion, suffering, and fear of disease. There are many rich plot lines and inspiration that can be used if disease exists as a factor in your game.

It is all very well for there to be magical or technological disease cures. There are a lot of less-interesting aspects of having disease around that don’t add much to a game. So, in order to strategically use disease as an element, it needs to be a special disease. One that, very specifically, is not curable by elements within the game.
The actual disease can be a hyper-active form of cancer, replicating rogue nanobots, a self-replicating curse, or something more imaginative. For the purpose of this article, we will call it “leprosy”.

In the modern world, leprosy carries a lot of cultural baggage which very succinctly communicates exactly the sort of fear and dread you wish to inspire in your characters. We are not simply creating game mechanics for the various diseases that have been called leprosy in the real world. We are just borrowing that name and applying it to a concept.

So, let’s look at some aspects that such a disease needs to have, and ways it can be used in a game.

Aspects of the Disease


Classical leprosy is a progressive skin disease, with lighter patches spreading over time. The exact manifestation you choose isn’t important. What is important is that the symptoms are clear and obvious to anyone observing the person. It should be hard to hide, and hard to deny once examined or revealed.


This is not a fast or immediately debilitating disease. It can take years, or even a lifetime to progress to the point of actually killing someone. It should have some sort of progressive effect, such as tiredness, weakness, an impact on the ability to use magic, or extreme sensitivity to exposure to radiation (such as sunlight or in space). Extremities may wither, lose function, or be prone to infection. It does not, however, affect the mental faculties. A person’s body may be decaying around them, but they are perfectly cognizant.


Leprosy is transmittable by close association or contact. But it is not easily transmittable. Since the effects are so calamitous, many people behave as if it is. After an adventure where someone has been around a person with leprosy in anything less than a hazmat suit, they should roll 2D. If they roll “snake-eyes” (2), then they have contracted leprosy. (Note: a referee may wish to have the player roll one die, and they will roll the other die secretly. It may take months or years for the disease to manifest. So having the player suspect, but not be sure, may provide an interesting campaign element.)

The Leper

Anyone with leprosy automatically has a Social Standing of 0; it doesn’t matter what it was before. Lepers occupy the lowest possible social rung in any society. In many places anyone who contracts leprosy is considered legally dead. All goods, property, and relations are forfeit.

Most societies require those with leprosy to wear obvious tokens, dress in expected clothes, or otherwise broadcast to those around them that they are lepers. Failure to do so is considered a severe public health crime and is draconically punished.

Most people shun lepers. Even those who know, intellectually, the low transmission rate, are highly likely to avoid any contact or interaction. More superstitious cultures consider those with leprosy to be damned by the gods and will have rituals and fetishes to protect against even the sight of lepers.

As such, there are very few jobs that a leper can perform. Nobody wants to be near them. Nobody wants anything they’ve touched. Most lepers have to subsist on charity. This is rarely regular, and more lepers die of malnutrition, neglect or depression than from their disease.

Leper Colonies

Because of the universal ostracization of lepers, their only real sense of community is to gather together in their own groups. Wherever they came from before, they are all lepers now. Those who have suffered for a long time can help those who have just contracted it, adjust, mitigate symptoms, and provide some solace to the social distancing they’ve had to suffer.

It also makes it easier for the societies that lepers exist in if they can shuffle anyone with leprosy into one place. In many places there is a balance between charity towards lepers as an act of generosity, and charity towards them as an act of containment. If just enough food and goods are provided to a group of lepers to discourage them from roaming and seeking their own fortune, then there is less for everyone else to worry about.

Some leper colonies have their own token coinage, as anyone outside will refuse to handle money touched by a leper. This allows for basic commerce to take place. Often a religious order will handle the interface layer between the colony and the outside world. These may be holy people doing it for charity, or they may be less scrupulous, doing it for attention.

Adventure Hooks

The existence of an incurable disease can be an interesting background element of a game. It can add depth and color to the society you are creating, without ever actually being plot relevant. However, it is an interesting tool to be used when crafting adventures in your world. We outline a couple of ways here to consider.

The Informant

A highly placed member of society from a number of years ago contracted leprosy. They were subsequently stripped of all titles, wealth, and property. There was even a funeral held for them, and they have hardly been mentioned since. (Social elites don’t like to be reminded that they are mortal!)

Present day, in whatever mystery the players have been investigating, there is a key and crucial piece of information they need to solve the puzzle. Unfortunately, it appears to be irrevocably lost, until one of their last leads mentions they know someone who would know that, but they are dead.

They then explain that they only mean “dead” in the legal sense, and they reveal the informant contracted leprosy. Last known they had been exiled to a nearby leper colony, and they may still be alive.

The players can seek out the leper colony, navigate their way to an audience, and make contact with their informant. Although physically deteriorated, they are all there mentally, and can remember the exact information the players need. They no longer care about the political repercussions, since no one else cares about them. Even money is mostly meaningless in their new life. All they ask for is some creature comforts that are hard to come by in the leper colony.

The Curse

To accomplish some great deed, a player must undergo a curse. Perhaps it comes with wielding a great artifact, or dispelling the magic guarding a fabulous horde, or the price from some villain in exchange for a valuable piece of information. Or whatever the campaign needs that requires a great sacrifice.

The curse is, of course, leprosy. The player can know in advance, so they have a difficult decision to wrestle with. (Or a difficult choice between the players as to who will be cursed.) Or you can just telegraph that it’s something horrific they can’t imagine. The important part is that an incurable disease that results in ostracism is a real penalty that afflicts characters in a much more visceral way than a simple game mechanic like “­1 on all stats”.

Because the disease only progresses slowly, it isn’t the sort of thing that will have an instant deleterious effect on them. And their compatriots probably won’t treat them any differently. But, over time, as the visible effects become more obvious, anyone they come into contact with will react accordingly. And, of course, compatriots will have to start rolling monthly to see if they contract it!

The Disguise

To enact some caper, the players have to infiltrate somewhere. They may come up with the idea, or someone might suggest to them that they might dress as a leper. They have a characteristic dress, and a characteristic complexion. It’s not a hard disguise.

Wherever they go, people take note, but not too closely. Certainly no one is going to ask for ID! Neither are they likely to be physically ejected from any location. Ranged weapons may be threatened, but they are unlikely to want to deal with the problem of having to dispose of a leprous body. Most likely the security guard who drew the short straw will be volunteered to yell at them from a distance or try to bribe them to leave with some form of charity.

Although their identity might be preserved, the attention might make it difficult to accomplish their goal. Unless, of course, their goal is to be a distraction! A particularly bold character might co­opt an actual group of lepers and take a chance of not contracting it.

For an interesting turn on things, the characters might find themselves infiltrated under the guise of a group of lepers.

The Cure

The whole role of leprosy in the campaign is that it is a disease that cannot be cured. But players are often tasked with achieving the impossible. Much like acquiring a rare artifact, or priceless cargo, such a cure should be the culmination of a long, arduous quest. And, like many such things, several side quests might be involved to get various ingredients, elixirs, please niche gods, or sequence rare plants with unique genomes. All required for the solution.

The cure itself should probably be such that it is only effective for the one individual concerned. Unless you’ve had your fun and are happy to banish leprosy from your campaign, then it can be a revolutionary new approach that can cure anyone. Or, as a variation of The Curse, the “cure” might be to transfer the leprosy from one person to another.

Convenient Disposal

Anyone contracting leprosy is damned to a life apart from society. Anything touched by a leper becomes something that no one ever wants to touch again…

Inventive players may find ways to use this to their advantage. If there is a difficult succession with war brewing over it, or a dangerous rebel stirring up the countryside, it would really, really, be just too bad if they contracted leprosy. Kind of a very macabre version of “get thee to a nunnery!”

Similarly, if there is a McGuffin that everyone is fighting over, a finely crafted sword, or stunning piece of artwork, and it is handed off to a leper, that may drastically reduce its potential. Of course, such could be sterilized, blessed, or otherwise rid of the disease. But given the stigma around lepers, all will look on it with much distrust.

And, as a turnabout, the referee might consider doing this to their players. Just as they are closing in on that long sought after quest item, it ends up in the hands of a leper. What risks are they really ready to take?