The Engosem Plague
Transmission & Vectors
Engosem can be spread in a number of ways: through direct contact to Engap; any exchange of fluids with the infected, including the Water of Life's Breath; the inhalation of vapors and ash from the cleansing of things in contact with Engap, the infected, and the deceased; and in some cases, through direct skin contact. The most concerning of these is without doubt through the sharing of Life's Breath, as preventing this contact is virtually impossible.
Symptoms
Physical Symptoms:
- Fever
- Muscle fatigue and weakness
- Rashes and itchy skin
- Shakes and tremors
- Nausea and vomiting
- Convulsions.
Mental Symptoms:
- Drowsiness
- Disorientation
- General fatigue
Spiritual Symptoms:
- A sensation of crawling beneath the skin
- Glassy eyes
- Twisted visions and delusions
Treatment
Stage One
If Engosem is suspected, the person should be quarantined to limit the spread of the disease. At least six days is recommended, 12 for those more conservative. Uskhin should not be started without a definitive diagnoses, as exposure to S'ightor should be limited if at all possible. General treatment to reduce the fever (Chedary), ease the muscle strain (Lykut oil), and promote health and wellness should be undertaken instead.
Stage Two
Once Engosem has been identified, Uskhin should begin (a table follows with specific dosing instructions). Pustules should be drained at least once every-other-day. Removing the pustules does not speed up, much less guarantee recovery, so should not be attempted to prevent the spreading of Engap. Treating symptoms as they arise is also recommended, although the use of Lykut oil should stop as soon as rashes begin to appear. Bloodletting should not be performed except as a last resort. Those infected should attempt to get as much rest and perform as much prayer as possible to encourage recovery.
Stage Three
Stage three is the most critical for recovery. Doses of Uskhin should be doubled in size and every effort made to lower the fever and prevent dehydration. No person recorded has ever survived after progressing to the point of convulsions, so death preparations should begin at that point if not sooner.
Dosage Chart for Uskhin
Great care should be taken when administering Uskhin, as it contains S'ightor, and therefore should be used sparingly. Uskhin should NOT be taken as a preventative measure, as it does not prevent contracting Engosem. Do not exceed maximum dosages! Excess amounts of S'ightor can be deadly, especially for the very young!| Age & Condition: | Dosage: | Frequency: | Maximum: |
|---|---|---|---|
| Infants | 7 drops of Uskhin diluted with 1 soup spoon of rosewater | 1 hour | 11/4 vial per moonrise |
| Young Children | 1 soup spoon of Uskhin diluted with 1 & 11/2 spoon of rosewater | 3 hours | 2 vials per moonrise |
| Older Children & Young Adults | 3 soup spoons of Uskhin; optionally diluted with 11/2 spoon of rosewater | 2 hours | 7 vials per moonrise |
| Middle-aged Adults | 3 soup spoons of Uskhin; optionally diluted with 1 spoon of rosewater | 2 & 11/2 hours | 6 vials per moonrise |
| Elderly Adults | 1 soup spoon of Uskhin, diluted with 2 spoons of rosewater; 2 dried, powdered Mordels | 3 hours | 4 vials per moonrise |
| When dehydrated | Add 1 soup spoon of rosewater and 11/2 spoon of Tasisörm to every dose | As prescribed; halve time during stage three (2 becomes 1) | As prescribed; does not apply during stage 3 |
| During stage 1 | Halve standard dose of Uskhin | No more frequent than double the standard frequency (2 becomes 4) | No more than 1 vial per moonrise prior to fever; no more than 4 vials per moonrise after. |
Prognosis
Stage One
The first stage is a long incubation period which is nearly symptom-less. Infected may run a very low fever or experience muscle fatigue. Some patients described a sensation of something crawling beneath the surface of their skin. The exact time of this stage is still unknown, due to the lack of measurable symptoms, 12 days is the accepted standard.
Stage Two
Over the course of the second stage the oozing pustules so iconic of Engosem begin to develop on the arms, torso, and face. In addition to abscesses leaking Engap (a green and slightly sticky fluid, murky in complexion), fever, rashes, muscle fatigue, drowsiness, disorientation, and glassy eyes are all common symptoms. Once the pustules are actively leaking, nausea and vomiting become more likely. This stage may last only days or drag through weeks depending on the prior health of the infected and the strength of treatment.
Stage Three
Stage three may be averted entirely if proper treatment is administered throughout stage two and as such does not appear in all cases.Entrance to the third stage is very distinct: the fever spikes sharply, rising to such a height the infected are plagued with twisted visions hourly, shakes and tremors associated with such fevers also appear; the fatigue and disorientation become such they are incapable of rising from bed, had they been able previously; and stomach upset increases until dehydration frequently occurs. Stage three rarely lasts more than three days. Either the fever breaks and the infected begins to recover, or they succumb to convulsions. Fatalities before stage three occur rarely outside of the incredibly weak, but are guaranteed at stage three without treatment.
Sequela
Recovery from Engosem is a prolonged process. Once the fever has broken and all pustules have scabbed over and no longer produce Engap the infected is no longer believed to be contagious and need not be quarantined. Muscle fatigue and rashes will remain common for up to 6 weeks after the end of Engosem, during which one is compromised and especially susceptible to other illnesses, particularly disruptions of the spirit and afflictions of the skin and throat.
Some formerly infected reported a sense of lethargy and periods of disorientation throughout their lives, up to 46 years post infection in the longest recorded case. The scabbing of pustules is resistant to healing treatments and frequently scars.
Affected Groups
Engosem is an indiscriminate infector of Humans and there is little variance in the demographics of those infected. The only notable factor is the relative location to the sea and to commodities shipped by sea. Most Engosem outbreaks occur along the coast (particularly in port towns) or in cities which receive large influxes of sailors and traders recently come from Tako.
As with most illnesses of the skin and throat, the young, elderly, and infirm have an increased risk of contracting the illness.
One unexpected blessing of Engosem is that it can only infect Humans. While the [Dragonkin] of Tako are capable of carrying the contagion of the disease, they do not appear to be negatively affected by the disease. At this point it is still unknown if trueborn [Dragons] are such unaffected. Of the other Peoples of Envordel, there is no evidence [Elves] either serve as carriers or are capable of contracting the disease.
In birds, exposure to Engosem presents as an entirely different disease known as [Enyss] which has its own symptoms and treatment regimen.
Prevention
Due to the highly contagious nature of Engosem, everyone infected should be kept under careful quarantine. No one should remain in the same room with the infected without the burning of asherwood and protective equipment (a cloth mask over the nose and mouth). Nor should they remain at all for longer than three hours at a time, during the sun's apex, or beneath the harsh light of [Adyni].
No one should come into direct contact with the Engap! This fluid is one of the agents spreading the disease and cases contracted through the passage of green fluid seem more severe, although this has not been definitively proven.
Precautions to take when coming in contact with Engap: two layers of gloves (a set of cloth beneath a set of leather), a cloth mask covering both nose and mouth, incineration of all organics involved in the process (besides the person, of course), and ritual cleansing of all non-organic materials and people involved. Please note: this includes any clothing or bedding worn or used by people infected!
What to do when infection is suspected
Upon coming into contact with Engap:The person should be quarantined immediately and given three doses of Uskhin. No further doses should be given unless a fever develops, upon which they should be given doses normally throughout the course of the disease. If no fever develops, the person should still be kept under quarantine for 16 days after contact to ensure they are not contagious.
Upon coming into contact with a person known to have Engosem without proper preventative methods:
The person should be quarantined immediately, but no Uskhin should be given until a fever presents. If no fever occurs, the person may be released after 12 days of quarantine.
Epidemiology
Engosem was first brought the mainland of Envordel from the island of Tako via seafaring traders and sailors. The first outbreak of Engosem occurred in the port city of Kunal after a ship from Tako docked there. While the sailors were the first to take ill, the entire population of Kunal was decimated in a matter of weeks, quickly and unknowingly spread to the rest of Lleeld by merchants, messengers, and other traders. Only the most isolated communities within Lleeld remained untouched by the Engosem Plague.
As far as modern scholars are aware, Engosem never travelled beyond the boundaries of Lleeld as the disease only affects Humans. If the occasional Human traders into other areas carried and spread it, no one lived to speak of it.
In modern times, pockets of Engosem still occur every half-dozen years or so. All these outbreaks can be traced to trade with Tako and once spotted are quickly quarantined and dealt with. Engosem presents very little threat to the modern human and fatalities only occur in the very young, very old, and those already ill.
History
The first recorded case of Engosem occurred in [Kunal] in {year}, observed by [Hatet of Kunal], a {priest} of Shyxir who served also as a healer of Sultasi (in the historical sense, Healers of the modern sense had not yet evolved). He wrote to one of his former mentors, {Priest} Segal of Sultasi's Order, of a sailor recently come from [Tako], with all the symptoms of Engosem. In the end, most of Kunal succumbed to Engosem, including the original sailor and {Priest} Hatet.
A sailor recently returned from a trading voyage to Tako is strewn about my sick bed and has been for five days now. I know not what to do for him, as I have never seen the likes of this illness before. He came to me with a low fever, complaining of weakness in his limbs. I prayed over him, rubbed him with Lykut oil, gave him two spoons of Chedary, and sent him back to the home of his parents where he was to stay while his ship lay in harbor. Fearing he had brought disease back with him from Tako, I burnt Asherwood throughout the temple, which is likely the only reason more have not fallen ill, for within a moonrise he returned.
There were patches of angry skin spread across his body, which grew in number and size until he was splotchy with discolored pustules. Lykut afforded nothing but pain, so I cleansed him and gave him more Chedary. After another moonrise the pustules began to burst, bleeding a sticky green fluid that reeks of sweet poison and leaving behind open wounds which still refuse to heal, though I have tried everything of which my master taught. His fever has risen and when awake he complains of dizzy spells and does not always know where or why he is here. Even mixed ground Mordels with the Chedary has done little. When I checked on him not an hour before sitting to write this letter to perform the fourth bleeding, his eyes had become dull, though he knew me and spoke to me.
The most alarming thing I fear I must report to you is that he is not the only one. Four other men from the same ship have called upon me since, although only two have progressed so far as pustules. I know not what this foul curse is, and I beg of you to lend me your wisdom in this matter as you do in so many others. Too, I beg of you to send a messenger before the port authority, and let them know disease may ravage us if we continue to accept ships coming back from Tako.
Within three weeks of the letter being dispatched, Engosem had grown to an outbreak of nearly 300 people over six settlements with 14 fatalities. Priest Segal is believed to be the one who first began calling the disease Engosem, as he did so in his report to the King's Councilors on {day of year}. It is also uncertain to what Engosem is supposed to reference.
The seventh to approach the council was Priest Segal of Sultasi's Order; he spoke at some length of a disease spreading along the northern coast from Tako, called Engosem, which has already claimed lives. Priest Segal recommended closing all ports and harbors to ships from Tako until a cure is found. A decision is to be made upon the next meeting of councilors.
A number of treatments were derived and tested over {year/years}, all with little success. While some had shown signs of slowing the progression of the disease and the severity of symptoms, no known person who had contracted Engosem had survived long enough to recover. In a single year, the death toll was {number}.
By the end of the year, Engosem was widely regarded as a curse upon all of Lleeld, rather than a traditional illness. A large movement emerged driven by the religious community to change the lifestyle of the people in an attempt to appease the angry deities who had cursed them. Unfortunately, all this lead to was infighting between the religious sects as they disagreed over who had cursed them, who would help them lift the curse, what behaviors were objectionable, and what kinds of changes would be required of them to be rid of the disease. Some of this discourse devolved into riots which spanned numerous towns.
The deities have turned their eyes from us and cast punishment out on all for sins I know not. Together, we as one people must turn our prayers and pleas unto the Merciful, for He is the only one who shall snatch us all from the path to Eternity's Gate.
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Author's Notes
Please forgive the formatting; the sidebar will be better balanced in future. An official timeline for Envordel has yet to be established, so ignore all the dates. Big picture: The Era of the Pyre happens after the Dividing Wars but before Haren's Revolt. History for this is VERY much a WIP. Currently it's more of an overview of the entire Era of the Pyre as a time period rather than the history of the disease itself, even though the two are intrinsically linked. Many spots in this article have yet to be fleshed out. Feel free to take a peek at the notes for a condensed overview of some of the missing information.