A COMPREHENSIVE MEDICAL ANALYSIS of the WITHERING: the PHYSICIAN'S GUIDE to the CURSE of H'BALA

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A COMPREHENSIVE MEDICAL ANALYSIS of the WITHERING: the PHYSICIAN'S GUIDE to the PSEUDO-MIASMATIC CURSE of H'BALA



A Treatise on the Symptomatic  Effects of the Withering, the Defining of the Stages of the Curse's  Progression; and the Various Means by which the Curse may be Tended  through the Arts of Medicine; First Edition

 

Father Mororn Glaemril; of Ilmater, the Disciples of St. Sollars the Twice-Martyred, and the Brotherhood of Mercy

First Edition published in MISTLOCKE, Ches 29, 1381 DR, by the Brotherhood of Mercy with the aid of the Society of the Shining Hammer.
 

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 As is the case in all of the  sciences practiced across this world of Toril; the Art of Medicine is  prone to a degree of insularity amongst its practitioners with regard to  research and discovery of procedures which, made widespread, would  stand to benefit the world at large. This is a result of the inherent  flaws of men, for many for wont of avarice deny and eschew the greater  good centered in the unified purpose that must be at the center of any  healer's being; to eradicate suffering and the fell influences of Talona  wherever she may be battled. It is in this interest that Ilmater's  Faith makes available now this treatise to the general public and all  those practitioners who here on Ymph battle the ravages of the  Withering.
 

 It is difficult at times to  conceive of the sum and total of sentient knowledge on any subject, much  less so when the topic is so thoroughly shrouded in deceit as is the  Withering. Yet the eternal foe of H'bala's deceit is Reason, which can  be defined as nothing less than our conception of the whole based on our  understanding of individual facts; in the manner of the arithmetician  who forms a sum from component figures. It is in this manner of noble  ratiocination that we must approach any proper and righteous study of  the Withering; an examination of the sum total of our knowledge borne of  the practicing of the medicinal art. Herein shall be discussed three  aspects of the Withering as it relates to the afflicted and the  physician alike.

First shall come a discussion on the nature of Her Curse and the means  by which it spreads throughout the corporeal form. Second shall be an  analysis of the progression of the Curse and a discussion on a common  set of 'stages' to be associated with various symptoms. Third shall  finally be addressed the various means, actual and theoretical, by which  the Withering may be treated through the Physician's Art. Through  education and training in the manners of diagnosis, the development of  procedures which shall relieve souls presently afflicted, and by  familiarizing ourselves with an essential set of terminology regarding  the Withering we can dispel ignorance and increase collaboration amongst  the public and professionals as we together go forth in search of a  cure and the abolition of this form of suffering.

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I.


 

Before  an in-depth discussion of treatment methods is possible, we must first  must examine and clarify what exactly the Withering is. Yet this is no  easy task, for the Withering, otherwise known as the Curse, or Her  Curse, is an affliction which seems to defy conventional understandings  of diseases and curses alike. It bears some of the hallmarks of both,  and yet still possesses aspects like unto neither. Thus as we go forward  in our discussion we must clear our heads of all existing notions of  disease and the norms associated with divine curse, for we are dealing  with what is more than likely something entirely unique to the world at  large.
 

 Disease as we define it is  borne either of an imbalance in the temporal, elemental, or natural  humors; all these borne directly Talona's miasmatic influence upon the  world. Her touch causes within an individual a malign festering which  can have a multitude of effects based on the strain of disease she has  put forth into an individual; almost universally negative excepting  those she may apply to the highest amongst her faith. They may however  be treated through divine means, purging the miasmatic element from the  body through the application of positive energy, or by harnessing  specific herbal, synthetic, or surgical  remedies which have an impact on the progression of one or several  diseases. The former is a gift from the gods, bestowed unto loyal  priests of varying faiths; the latter is the science and Art we call  Medicine. Coupled with this knowledge and key to our definition and  understanding of diseases is the ability possessed by certain miasmatic  infections to spread rapidly from a single infected individual unto his  neighbors and community. While not a hallmark of every individual  affliction bestowed by Talona, this aspect nonetheless empowers and  facilitates the destructive and devastating plagues which have swept  Faerun countless times in the past.
 

 A Curse, in contrast,  represents not a subtle miasmatic erosion of the body's functions but a  direct weakening of the body and soul through the influence of a fell  entity. The source can vary wildly, and there are certainly a plethora  of examples where curses were bestowed without the intervention of a  deity, yet the central aspects of any Curse remain constant. It weakens  the body and mind at a rate which is usually constant and borne of a  subtle infusion of negative energy into the mind and body of the victim.  This results in difficulty thinking and performing physical tasks, both  common means of diagnosing a curse. More telling, however, is the  unquantifiable yet powerful weighing of the soul which is present when  one toils under the effects of a curse. Such an affliction may be  removed through the use of a spell or blessing specially readied for  just that purpose, or through other powerful magics. The medicinal art,  unless through surgical means removing an offending implanted item, has  little bearing on the outcome or the removal of the curse and its  effects.
 

 Yet as we undertake an  examination of the Withering itself, we shall find that while it bears  some of the markings of each of these definitions, it suits not our  definitions of a disease or curse to a degree that it would be  reasonable to declare a direct association. In support of the former,  the Withering has the ability to spread itself through the means of  interpersonal contact; being associated often with travel within a  specific area and amongst tainted flora and fauna. Its progression  within the body through different stages of infection (as shall be  discussed in detail in the following section) marks it similarly in the  former category. Yet it has not proven the case that any medicinal  treatment attempted thusfar has been shown to have any effect at all on  the progression of the Withering. No synthetic or herbal remedies to the  Withering have been devised, nor do regular means of addressing  miasmatic afflictions through the aid of the Divine have any success  when applied to Her Curse. At the last, there is no disease that has not  been borne of the divine whose final stages lead inevitably unto a  lasting state of undeath.
 

 In support of the latter  possibility, we must acknowledge that the only available means of  treatment available widely are powders and charms, or the blessings of  priests, which are designed to remove curses. The casting of a remove  curse spell upon an infected individual will have the effect of seeing  some of the Withering's progression reversed, albeit at a significant  cost to the caster or the applicant as the case may be. Likewise, there  has never been an instance recorded of an individual recovering from the  Withering once it has begun its insidious trek through the body. Yet no  curse functions in the manner described above; taking the outward form  of a disease and spreading through contact with infected air, water, or  flesh. What then are physicians to call this affliction, which bears the  hallmarks of both yet cannot conclusively be established as one or the  other?
 

 The Withering is best defined  as a “Pseudo-Miasmatic Curse”, for in truth H'bala's fell craft has  produced an affliction which functions as a disease yet has all the  resilience and tenacity associated with the most damning of curses. Yet  even as we define it as such, our knowledge regarding the manner in  which a disease spreads lends hope for the development of treatments and  methods of forestalling the progression of the Withering. Yet to see  the suffering of this island lessened and to conduct research properly  toward this end, we must examine the Withering from the perspective of a  disease in detail that we might understand how its hold over the bodily  tissues is established and expanded.

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II.

 We then come to the dissection  of the Withering from the perspective of the physician; an examination  of its effects upon tissue and progression through a total of five  stages I herein seek to define clearly. The Withering at its core is a  progression from a state of health to undeath through a slow but steady  corrupting of the bodily tissues. A rough  description would be to  suggest that the infection begins in nonessential tissues, from there  spreads to the vital internal tissues and finally culminates in the  complete necrotization of the mind.
 

 This process preserves the  essential functions of the vital organs and the brain itself; the body,  mind, and soul are in many cases subject to the same weaknesses that the  living are possessed of. For example, strikes against a withered  opponent's vital organs shall have the same effect you would see upon a  normal individual in many cases. With regard to most of the vital  tissue, the process leading unto necrosis has changed their form,  appearance, and in some cases function, however it has not rendered them  nonessential to the survival of the Withered soul. The Withering can  thus be said to culminate in a corruption of living tissue into what can only be termed a fell mockery of the original.
 

 Yet it is the process by which  this corruption takes place which we are most interested in, for it is  this avenue which holds the most promise for a potential medical means  of forestalling the progression. It is my belief that the Withering  progresses through the formation of nodes of undeath,  which are in essence small lumps of outward-expanding tissue that has  been necrotized. The initial nodes are located along the bloodstream,  and small components of undead tissue break off to generate a systemic  infection where it may have at once point been localized. This leads to a  progression from small nodes to ever larger nodes appearing in varying  places through the body as the mortal form attempts ineffectually to  beat back its progression.
 

 It is here where we shall  define five progressive stages of the Withering, which provide a useful  reference for diagnosis and research alike. All have distinctive  characteristics which allow for an individual trained in examinations to  separate the afflicted patient into these established categories.
 

 

 Stage I:  Initial infection is denoted often by the symptom of itching about the  arms and in rare cases the lower legs. Whether this is the Withering's  initial point of entry to the living system at large or merely the first  sign is at this point unknown. Examination of the lower arm and wrist  will in the vast majority of cases reveal small black or mottled-brown  marks under the skin along the ulnar veins and arteries in the wrist.  These can be observed in some cases along the median antebrachial and  radial veins in addition to the radial artery. What these represent are  the initial formation of small nodes of necrotized flesh, flakes or  of  which shall separate and travel through the bloodstream to propagate the  wider infection seen in later stages. Diagnosis at this stage involves  checking for the above signs of infection, and conducting an examination  to determine that there are no detectable nodules as discussed later.
 

 Stage II:  Represents an infection which has progressed beyond the initial stages  toward clear evidence of the presence of nodules in the core of the  body. This can take several forms; the presence of any one indicating  that the Withering has progressed to this stage. Nodules have a tendency  to form in specific areas, often appearing along the diaphragm; the  muscle which separates the thoracic cavity of the human body from the  abdominopelvic. Diagnosis involves attempting to locate these nodules  through touch as the patient breathes deeply. Unidentified lumps or  unusual movement of the diaphragm as the individual breathes are  markings of this stage in the Withering. Other indicators include a  blackening of the palatinate tonsils, which are located in the back of  the mouth near the esophagus, and the appearance of an unusual green  tint in the iris and cornea of the eyes. Presence of more than one of  these effects likely indicates a greater progression.
 

 Stage III: Represents  a shift from a localized set of infections to the corruption of the  vital organs and bones. Defined and diagnosed by the presence of two or  more of the indicators of a stage II infection, along with intermittent  bouts of extreme muscle, joint, bone, or gut pains along with difficulty  in breathing. These symptoms are very rarely life-threatening but  represent one of the prime reasons individuals seek out treatment.  Confirmation of the identity of the infection at this stage is  essential, as many individuals requesting treatment for pains which are  suggestive of the Withering may in fact be suffering from an unrelated  disease concurrently. None have established with certainty whether the  progression of the Withering increases or decreases an individual's  innate resistance toward more common miasmatic infections.  
 

 Stage IV: Chronic  skin decay, usually occurring in a sudden and abrupt 'overnight' shift.  The individual at this stage is suffers massive death of the skin  tissue, with healthy malleability and firmness giving way to a variety  of unnatural pallor and textures. Skin often becomes dry and brittle,  crusts over with what resembles eczema , or develops large sores of  necrotized skin as what remains of healthy, living skin is slowly  subsumed. In all cases, the decaying tissue seems to attract flies in  abundance, leading to further decay and corruption. This stage is  evident for all to see, and diagnosis is usually instant and proceeds  directly to treatment.
 

 Stage V: Partial  corruption of the brain, outwardly evidenced by an unholy green glow to  the eyes stemming from the cornea. This stage of the Withering is  usually followed within hours or days, rarely more than a week, with  full and complete necrotization of the body and mind, with the new  being's existence devoted in service to H'Bala. This is the final shift  before complete undeath, and individuals at this stage must seek  immediate treatment or take other means to see their soul freed before  they are bound to service in undeath. Diagnosis is nigh irrelevant by  this stage, and treatment must begin at once.
 

 

  With this understanding and  this terminology, physicians and those who seek to treat or understand  the Withering can communicate in terms which are clear and concise with  regard to their own health or the health of their patients. Yet as with  all diseases, there will be cases which defy the norm or the established  literature associated with the Withering. Those who seek to treat and  diagnose the Withering must be vigilant for new or unusual cases which  defy the common logic set forth here. Nevertheless, by establishing and  understanding the nature of the Withering's progression, we are afforded  a new set of tools by which it can be fought.

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III.

 


  We come then to the final  goal and ends to which the medicinal art strives; the curing of disease  and forestalling of unnatural death, be it at the hands of Talona or  H'bala. While the present treatments for the Withering are borne either  of the Arts of divine magic or arcane forces, the potential for a  yet-untapped cure within herbalism or alchemy remains a powerful drive  for researchers in both of those fields. Medicine shall stand forth  alongside existing treatments as we learn more and come to understand  the Curse with which we now live.
 

 Most common and effective amongst the many treatments for the Withering is that of prevention.  Sorely-afflicted individuals or those who regard their own progression  with a close eye will note that the Mist upon Ymph has a powerful effect  in forestalling entirely the progression of Her Curse. Thus, though the  Mist itself is fraught with deceit and dangers, we may take solace that  the Withering does not make noticeable progress in those residing  within Mistlocke or the Forgotten Forest. Other treatments being  difficult or prohibitively expensive, a common suggestion given by any  physician familiar with the Withering is for the afflicted to seek out a  home within Mistlocke or its surrounding environs; just as one would  send the sufferer of consumption unto a dry climate.
 

  Secondary due to the damaging  effects of the treatment is the application, through spell or charm, of  positive energy oriented such as to remove a curse. The effect this has  is to restore necrotized tissues unto a state of life. This is possible  due to the nature of the Withering as being a corrupting element; not  one which would change entirely the form of the afflicted. As the  tissues retain their same form, removing the curse can reduce some of  the nodules of undeath and eliminate others. Yet this treatment comes  with a backlash, as the individual applying the spell or charm suffers a  backlash upon their own forms as the energy of the spell interacts with  the Withered tissue. This can result in a slight loss of memory, a  weakening of the muscles in the arms, legs, or core, and even a dulling  of the eyesight. It is a necessary Toil borne by Ilmater's Faith and  those who carry out these treatments, yet is invariably damaging.
 

  Little in the way of  stone-mortared remedies beyond this exist. However, there have been  reports of tonics produced by the Stewards of Ymph; the druids and  tenders of the land, which have an effect on the individual similar to  the removal of a curse without the backlash. As of yet, these reports  and a means of reproducing this tonic are unconfirmed and unknown, but  are the focus of many alchemists and herbalists researching this matter.  
 

  Ymph and its peoples suffer  daily under the strain of the Withering and H'bala's fell works, yet  hope is not lost for final salvation. Yet it shall require as we go  forth a careful and reasoned approach toward the development of a  lasting cure or treatment for the Withering. As we call upon Ilmater's  Aid in the works of medicine, we must never cease approaching this work  with the same ratiocination exemplified in this analysis. By defining in  simple terms the Withering, we see ignorance quashed and the fears of  the layman and citizen allayed. By analyzing the Withering's progression  and developing techniques and tools for its analysis, we enable  ourselves in future research. Finally, by understanding the existing  techniques for treating the Withering and approaching the matter from a  perspective of prevention, we undertake His Toil as we go forth in our  search for a cure. There will yet come a day that by His Mercy and the  tireless efforts of good men devoted to works rational and logical, we  shall see this Curse lifted and any of its remnants borne away.