Yellow Fog

From Alori's Book of Ailments

This article contains the description of an epidemic which has similarities to real world events and stigma. Reader discretion is advised.

In the past two centuries, there are few tragedies that have stuck with me as much as the Yellow Fog. It swept through villages killing slowly over many major cycles. I sat besides too many patients as they faded away in pain unable to offer relief. But in that time, I also saw the strength of people able to rally together and find healing in a common tragedy.

Symptoms

• Headache
• Fever
• Nausea
• Dizziness
• Fatigue, malaise
• Shortness of breath
• Dark or bloody stool
• Delirium
• Jaundice

Disease Progression

Early Stage

Early symptoms of Yellow Fog tend to be mild and generic. This can make diagnosing the condition extremely difficult. Patients typically present with a headache, nausea, and low fever. For young and healthy adults, the disease may never progress past this stage. Treat the symptoms and suggest plenty of rest. If symptoms don't clear within two minor cycles, Yellow Fog should be considered as a possible cause of illness. Due to its natural origin, magical remedies are ineffective.

Infectious Stage

This is the most recognizable stage of the disease. The patient's fever wanes for several days and then increases sharply. It's also common for the patient's eyes and skin to be yellow and to experience fatigue, dizziness, and shortness of breath. The yellow skin may be difficult to detect except in very pale individuals, so yellow eyes are a better place to check. It's very common for people to start to improve in health for a few days only to worsen suddenly and for this cycle to repeat several times. The patient is visibly ill and needs treatment. Wilten root is best for treating Yellow Fog in this stage.

Late Stage

After about a major cycle of being visibly infectious, the patient's condition worsens significantly in the final stage of the disease. Here, the skin is much yellower, and the eyes appear to be urine yellow. The patient also presents with dark or bloody stool. The fever is very high at this stage, and the patient is delirious without relief. Intense treatment must begin as soon as possible. Silver pine bark extract is the only known treatment at this late state, and even Wilten root tea will do little more than delay the patient's death.

Treatment

If the patient hasn't started to experience liver failure, treat with hot Wilten Root Tea three times daily for four minor cycles. See page 377 for instructions.
If the patient is jaundiced, treat with Silver Pine Bark Extract, four drops daily above the tongue until jaundice clears. Then continue to treat with Wilten root, three times daily for eight minor cycles. See page 377 for instructions.

Wilten Root Tea

Wilten Root can be collected from the Tsargis Mountains. It must be sun dried for medicinal use. Wash the root to remove any dirt and debris. Lay the fresh root on woven mats and let sit in full sunlight for one minor cycle in summer or until the root appears shriveled and brittle. Store the root in a cool and dry area until needed. Finely chop to one marc per four stone patient weight, rounded up. Steep in six parts boiling water to one part chopped root. This produces one dose. Do not combine doses for multiple patients.

Silver Pine Bark Extract

Silver Pine only grows in the Windsong Mountains in Akea. Northern Silver Pine is a different, though related species, and cannot be used as a substitute. Roughly chop the bark sheets into chips and feed into a screw press. Press the bark and collect any liquid. Bark paste may be pressed a second time for maximum extraction.

History

Epidemic of 398 IA

The summer of 398 was famous for its drought and scorching heat which was uncharacteristic east of the Tsargis mountains. Trade with the dwarves brought in much needed food from the south, but with it came a deadly plague. The merchants were unaware of their unwanted and invisible cargo--a haze that came to rest over the villages throughout Dutan and Kealriv. The epidemic spread slowly at first, but by the middle of autumn, people all around Dutan and southern Kealriv began falling ill with an unknown malady. At first, people passed it off as some general illness due to the mild symptoms, however, the patients never truly improved. The winter of 398 was the deadliest on record with 11,000 deaths in Amel's Month alone. That number more than doubled the next major cycle.
As was tradition, members of the infected person's family would sit by their loved one to tend to their needs. However, this only spread the disease further. Bleeding was a common practice as a way to appear paler and also in some therapeutic cases. This exposed more people to infected blood, and it in many villages, everyone ate the same contaminated meat.
No one had a cure or effective treatment for the new disease. Many people blamed it on the dwarves, and amidst the general atmosphere of fear and despair, violence towards dwarves rose sharply. In Praetan, there were riots calling for the expulsion of the dwarves in the city, but city officials refused to give in to the demands. Elsewhere, villages were abandoned with the dead and dying left in the streets. Survivors took to the roads in search of new land when their homes were deemed unclean and unfit for living.
The Death Monks who typically performed burials rites kept their distance, and many families were forced to bury their dead without the proper rituals to ensure the soul would return to the gods. Trade and travel for leisure were heavily restricted, and the majority of people on the roads were those displaced by the plague.

— The Yellow-Belly Plague by Hanaka Eriseinen and Lora Trebit

Search for a Cure

By the autumn of 399 IA, the plague had decimated Dutan and Kealriv with no clear end in sight. Seeking a cure became a top priority around the region with the best research teams in Kealriv working alongside local herbalists and physicians. In Ivran, Kemet Horn and Leik Unstaldr were experimenting with local remedies and conducting autopsies on the deceased. They discovered that many of the patients suffered from cirrhosis which presented as white patches on the liver along with a lumpy texture. Patients were anemic which was consistent with the symptoms of the plague.
Wilten root was the first effective treatment discovered. Nouvelt was one of the only villages less affected by the disease. Wilten root tea was a common remedy for headaches, though the raw root induced nausea. The local drink's concentration was well below the therapeutic dosage, but over time, it was enough to protect healthy individuals from becoming seriously ill. Horn and Unstaldr took a large sample back to Ivran where they tested out various treatment methods. However, they quickly found out that it was only effective in milder cases. For severely ill patients, another treatment was needed.
Meanwhile, in Ekkino, Kealriv, Ori Eriseinen was researching diseases with similar symptoms. In the winter of 399 IA, he came across the diary of Lifa Arkoni which described experiments with tree bark extracts for medicinal purposes. Arkoni is commonly regarded as the Father of Herbalism due to his contributions towards medicine. Of particular note, he developed a method of extracting liquid out of bark in addition to powder.
Eriseinen began his own experiments and worked with a local sawmill to obtain a range of samples. Fate smiled upon him when the sawmill received a shipment of Silver Pine. Even at low doses, the bark extract proved useful in relieving the symptoms of the plague. Further experiments demonstrated effectiveness in all but the most severe cases. However, there was one major concern. Silver Pine only grows in Akea, and importing it was costly.
Despite pressure from other members of the research team to abandon the project, Eriseinen published his findings about bark extract as a cure to Yellow Fog. He also sent letters to the Kealriv Parliament and King Regent of Dutan for aid in purchasing Silver Pine bark. The king regent agreed to fund a single shipment, unfortunately, he died of the plague before it arrived. In spring 401 IA, the silver pine bark finally arrived in Kealriv, and Eriseinen began producing as much of the extract as possible. It was first shipped to Praetan and distributed in Ekkino where the cure was nothing short of a miracle. Spurred on by this success, Eriseinen was able to obtain funding for additional shipments of bark.
The cost and extended time to produce silver pine bark extract left rural villages scrambling for a cure of their own. Many attempted to use Northern Silver Pine bark. Despite being a related species, it was completely ineffective. They had no choice but to treat patients with Wilten root tea when they could obtain it and wait.
By the end of 403IA, there was a more robust trade network between Ekkino and Akea for silver pine bark. Production of the extract was possible in a wider range of cities, and the disease had run its course naturally. Fewer people were dying of the plague, and those who became ill could be treated with wilten root. It's still unclear just how much silver pine bark extract impacted ending the epidemic.

— The Yellow-Belly Plague by Hanaka Eriseinen and Lora Trebit

Yellow Fog Today

Contrary to popular belief, the Yellow Fog continues to afflict people each year. Most people are able to recover on their own with minimal medicinal intervention. Dried wilten root is readily available in most settlements. Safe handling practices also greatly reduced the spread of the disease. However, there are a few recorded fatalities in rural and isolated areas where access to medicine is difficult.

— The Yellow-Belly Plague by Hanaka Eriseinen and Lora Trebit

Societal Impact

In the aftermath of the plague, there were drastic changes to how people saw public health. Prior to the plague, only one in every five villages had a physician or herbalist within walking distance. Following the plague, four out of five villages had a doctor or herbalist, often times located in the village center. Many cities in Kealriv created physician colleges and funded research efforts for other incurable diseases. These colleges also promoted sanitary measures of cleaning blood off all surfaces and wearing gloves when interacting with ill patients.
In Dutan, herbalists began sharing information more freely. The practice of aesthetic bleeding was outlawed, and mortuary shrines adopted a new practice of isolating bodies prior to washing. Additionally, the consumption of raw meat which was extremely common in western Dutan saw a sharp fall as people learned about the dangers of contaminated blood.
The plague devastated many communities. Based on surviving census records, nearly a million people either died or were forced to move due to the epidemic. In the ten years after the plague, there were five thousand new settlements registered in Kealriv. Estimates in Dutan are even higher. It's worth noting that this includes everything from single farmhouses being built through towns and cities. There are also instances of duplicate registrations where one family moves multiple times throughout the ten year period. Most of these new settlements were single residences and hamlets.

— The Yellow-Belly Plague by Hanaka Eriseinen and Lora Trebit

Alternative Name

Liver Rot, Dwarven Fever

Type

Viral

Origin

Natural

Cycle

Short-term

Rarity

Uncommon

Affected Species

• Elf
• Dwarf
• Goblin
• Human

Prevention

DO NOT

• Touch contaminated blood
• Kiss sick individuals
• Sleep in the same room as sick individuals
• Consume raw meat or organs

Occurrence in the Uk Qezin Desert

Historian epidemiologists have found records of a disease with a similar presentation to Yellow Fog in human and elf populations in the Uk Qezin Desert. Surprisingly, these incidences are isolated and don't cause epidemics, though there may be a year when cases are more common. Cultural practices and isolation seem to play a role. Culturally, blood was seen as an unclean substance, so there were fewer opportunities for contamination. Additionally, they have an embalming practice of drying the body in salt prior to burial which also has a purifying effect.

Chronic Yellow Fog

A milder form of Yellow Fog is more common, and following the initial infection, patients are able to make a full recovery. Death is rare, and jaundice is only a late symptom which may appear up to a year after infection if left untreated. However, the patient remains contagious and can pass on the infection to others years and decades later. Even though the disease can only be transmitted through contact with contaminated blood, many people remain wary of anyone who had Yellow Fog or is commonly in close proximity to those afflicted with Yellow Fog. In Rekkert, it's illegal to marry without disclosing if one has been infected previously with Yellow Fog.