Pypyrus

Mad scratch fever

King Garde is a charming fellow. More humble than most rulers. More knowledgeable than most lords. And more handsome than most men who have weathered his storms. But I must say, he's an itchy fellow. Spent the whole evening scratching like a pomeranth while we enjoyed our vintage.
Benyamihn Bargor, Charian diplomat, 1200 AoE

P

ypyrus is a chronic, fatal disease. Although it is a rare condition, only affecting a tiny proportion of the population at any given point in time, it has been the basis for several major outbreaks throughout casterway history that have changed the fate of nations.

Transmission & Vectors

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t has been known for millennia that the disease can be transmitted via touch. Contact with infected skin carries an extreme risk of transmission. For this reason, all contact with the infected is typically avoided at all costs. However, cognoscenti have not been able to determine the true risk - if any - of contacting the unblemished skin of an infected person.

Poorly Understood

The extreme panic instilled by merely mentioning pypyrus makes it difficult to study and identify its transmission vectors. Although it's well-documented that contact leads to transmission, there are many unconfirmed theories about the extent to which infected skin can, in turn, leave contagious elements in its wake. When someone dies of pypyrus, nearly all of their personal items are burned, buried, or otherwise destroyed. Although it has not been scientifically confirmed, there is great fear that one could contract the disease by merely touching anything that had previously been in contact with the deceased.

Causes

A

lthough the exact cause of pypyrus is unknown, when new outbreaks occur, they always seem to originate from muddwood regions, or from those who have recently been in-or-around muddwoods. Of course, there are millions of people throughout the world who actually inhabit muddwoods and never come in contact with the disease. So it should not be taken that "living in muddwoods" = "contracting pypyrus". Nevertheless, muddwood regions are considered to be prime breeding grounds for whatever-it-is that ultimately causes the pypyrus infection.

Symptoms

S

cratching is the primary symptom of pypyrus. Before a victim even realizes they're infected, they will typically spend weeks scratching all around the infected area(s). In its earliest stages, the skin shows no signs of infection - other than the reddened irritation ultimately caused by overzealous scratching. This leads many early-stage victims to conclude that they merely have a rash.

Manic Energy

This early period, lasting 4-6 weeks, is also characterized by increased energy. The undiagnosed victim often enjoys a phase of hectic, nearly-manic adrenaline. They are easily excitable and will cut back their sleep to mere hours per night. During this period, the scope of the itching may spread to other areas of the body. But the intensity does not increase. They just feel exceptionally "itchy" and will therefore spend a greater time scratching than any "normal" person would. During this initial period, victims are not contagious.

It pains me to report that I know why we haven't heard from Sister Pauchner in some time. I made the trek to her muddwood cottage today. And when I entered the abode there was naught left of her but a pile of shredded skin and muscle, all ripped apart by her own fingers.
Baiya Viraga, Golian priestess, 2333 AoR

Thin Skin

The first tangible signs occur when the skin of the affected area takes on a grey-ish tone. The skin is still alive, but it is growing thinner, losing nearly all of its subcutaneous fat layer and becoming discolored due to a lack of proper blood flow. The physical manifestation coincides with a radically-increased desire to scratch the infected area. At this point, even if the sufferer can manage to stop themselves from scratching, the skin is susceptible to tearing under even the slightest stress.
This leads to a vicious downward spiral. As the skin grows thinner, the victim's itching sensation increases. As they scratch more intensively, this ultimately shaves more layers off the waning skin. The patch of skin, in turn, becomes even itchier. Left unchecked, this eventually leads to the victim tearing off their own skin which, by this point, has become paper thin.

Torn Apart

A pypyrus victim, left to their own devices, eventually suffers a gory fate. They will tear away massive swaths of their own flesh. They will dig into their own muscles - because the maddening, itching sensation does not always leave the area once the paper-thin skin is ripped from the surface. Some have been known to gouge out their own eyeballs. The ultimate cause of death for most pypyrus sufferers is massive blood loss. Deceased have been found that can barely be identified because they spent their last excruciating hours quite literally tearing themselves to shreds.

Treatment

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he history of pypyrus "treatment" is almost as gruesome as the disease itself. Since infection is viewed as a localized phenomenon on the skin, original thinking was that a victim could be cured by cutting out the infected area. Of course, during the period when this treatment was most popular, anesthetics were nearly unknown. And so-called surgical techniques were nothing more than glorified butchery. Nevertheless, during some of the more egregious outbreaks of the Age of Expansion, many thousands of infected were subjected to this barbaric treatment.

I leave you what little I can. And I regret having to end things this way. For it is in me to face the horror of this dread disease, but I cannot bear the thought of being butchered alive by the flayers.
Leilanie Champasak, Collian fish herder, 1840 AoE

Flayers

Teams of flayers were dispatched to affected regions. They typically consisted of several large men whose sole "talent" was the ability to pin down the infected and bind them to a makeshift operating table. They were accompanied by the head flayer who carried a horrific assortment of knives designed to separate all manner of flesh, sinew, and muscle from the screaming patient. The flayers always dressed, from head-to-toe, in full-body leather, including gloves, boots, masks, and imposing hoods. The practical use of this garb was ostensibly to protect them from the infectious detritus of their patients. But it also served to give them a nightmarish appearance. They stank of their own sweat, mixed with the decay of congealed blood, and the stench of rotting body tissue. Their knives - often crafted from razor-sharp ebny - were caked in the detritus of those they'd previously tried to save.

Sadism

As horrific as these flayers seemed, they were an accepted strategy whenever a particular arbyr, city, country, or region experienced a new outbreak of pypyrus. The flayers were finally banned, with their last deployment occuring in the Quillian outbreak of 2052 AoE. The cognoscenti lobbied stridently, for hundreds of years, for an end to the flayers. After extensive research, they documented that the survival rate for flayer "treatment" was actually worse than those who were simply left alone. Even in the rare cases when the flayers' methods successfully eradicated the disease, the victims would usually die from blood loss, infection, or flat-out shock. Many elderly were known to suffer massive heart attacks on the flayers' operating tables. And the cognoscenti came to believe that the flayers' ranks were populated mostly by sadists who cared little about curing anyone and plied their trade merely as a form of brutal, state-sanctioned torture.

Amputation

But the abandonment of flaying did not make pypyrus treatment much more humane. If the victim's infection is confined to a limb, that limb can be amputated. Since the infection is almost always on the victim's hands and fingers (because they are constantly using them to scratch the affected area), this usually means that the hands are removed, in addition to whatever portion of the arms and legs show signs of the infection. Of course, if the infection is on someone's face/scalp or on their torso, amputation cannot be used as a potential cure. Yet even in these cases, the hands are still frequently amputated as a means of ceasing the scratching, and thus, halting the spread to other areas of the body.

Restraint

Simply restraining victims is a viable approach to protect them from themselves and others. But unless the caretaker has significant skill in this area, they are quite likely to bring further harm upon the infected. Pypyrus victims are infamous for their tenacious ability to free themselves of any bindings, all for the purpose of resuming their scratching. Any rope or twine of poor quality will be destroyed - usually within hours. Any shackles that focus solely on the extremities (e.g., irons on the wrists) will inspire the infected to strain so hard against them that they will shred several layers of skin - and even muscle - purely for the purpose of wriggling free so they can continue scratching. The most "responsible" way to bind the infected is to use a full-body restraint - something that allows almost no movement of the arms, legs, or even the head. However, cognoscenti medical logs indicate that if this approach is used, and the victim is actually lucky enough to survive the infection, they will also have a nearly-100% likelihood of emerging in a permanent state of fevered insanity. The urge to scratch is so intense, that being denied of it seems to "break" the brain and shatter one's sanity.

Prognosis

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oughly 20% of those who contract the disease will manage to survive, even without treatment - assuming that they haven't scratched out their own internal organs before their bodies' immune systems can eradicate the contagion. For those lucky enough to survive the infection, the affected skin grows thick and rough over the region that was previously stricken. If the infection was on a visible area, this can leave them looking disfigured and completely unattractive. Victims who are "only" affected on their limbs, and have those limbs amputated in a timely manner, have an 80% recovery rate - with the other 20% finding that, even after amputation, the disease reappears on some remaining part of their body.
Other than the drastic approach of amputation, there has been no other medical cure discovered. All manner of medicines and poultices have been attempted - to no avail. If a victim cannot be treated by amputation, they must hope that they are in that fortunate 20% of the population who can manage to weather the infection on their own.

Hosts & Carriers

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here are no verified carriers of the disease, but in recent centuries the bottonfly has become a central target of cognoscenti study. Fresh outbreaks are known to originate in muddwoods and bottonflies are common in those regions. Members of the Scarlet Bottonfly Company are believed to suffer a higher incidence of pypyrus, although this contention is difficult to substantiate due to the Company's secretive and quasi-criminal nature. It's entirely possible that there are many insects which carry seeds of the disease, but that the bottonfly is a more-likely infectant due to the pests' propensity to bite and the species' myriad uses, which have led casterways to aggressively harvest them.

Prevention

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ecause the most obvious transmission vector comes from touching the infected, prevention starts by avoiding all contact with others. During "normal" periods, when there are only a handful of infected on the fringes of society, this simply means that those who care for the diseased are copiously clothed. But during wider outbreaks, when panic spreads throughout a region, this has fostered longstanding practices where people - even, presumably-uninfected people - go to great lengths to avoid any-and-all contact with each other. This has spawned odd periods in history where certain societies have been known to dress in head-to-toe coverings - even when the weather is unbearably hot. These outfits take on their own bizarre, nearly-gothic styling, complete with grotesque masks, over-sized hoods, fanciful gloves and boots, and multiple layers of long flowing robes, tunics, or other expansive garments.

They tell me that I'll be quite comfortable in the colony. They assure me that I'll be provided the best medical care, and that all my needs will be attended to. I realize, of course, that these are all lies.
Alanna Champasack, Enoerian cobbler, 3232 AoG

Exiled

Given the severe risk to the broader society, and the dire prospects of those who are infected, some cultures have simply stopped trying to treat them at all. For those who cannot be saved via amputation, they are often shipped off to colonies. In these sad environments, they will live out their remaining months digging away at themselves until they collapse in a pool of their own fluids. These settlements can be established in any sufficiently-isolated area, but several islands across Excilior are infamous as past-or-current pypyrus colonies. The contagion is so feared that saltfoots will go to great lengths to give these isles a wide berth.

Epidemiology

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ince its discovery, there's never been a point when pypyrus infection has fully "gone away". There is always some tiny portion of the population stricken by the disease. However, societal constructs have gone a long way toward keeping the occasional instance from turning into a full-fledged outbreak. Specifically, the infected in most countries are quickly shuttled off to isolated colonies where they will either be cured (unlikely) or die in a setting that does not threaten the broader society. However, every so often - seemingly, in 300-400 year intervals - a major outbreak still manages to flare up, typically tied back to some origin point in a local muddwood. When this occurs, the speed with which it flies through the population can be frightening. And the subsequent death tolls can change the course of nations. After these outbreaks - which can take as long as 20 years to fully burn themselves out - the surviving population usually returns to some semblance of "normalcy", during which the rare occurrence of the disease can once again be contained by exiling the victim to the nearest pypyrus colony.

History

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he first recorded case of pypyrus occurred in Auld Cervia in 470 AoC. It came at, perhaps, the worst possible time, when the first nation was weathering the still-unexpected effects of the 2nd Trial of Syrus. Although there were many factors at play, the ensuing, full-blown pypyrus outbreak had a direct impact on the splintering of Auld Cervia and the end of the Age of Cervia.

Altered History

Pypyrus has been a primary or secondary contributor to many seminal events in casterway history. For example, the first king of Charia, Garde Montagu, died after an excruciating battle with the disease. His successor, King Helinand, went on to instigate the Nomadic Wars, which in turn fostered and cemented the longstanding xenophobia that has existed between Nocterns and oplanders for thousands of years. There are many other would-be leaders, conflicts, discoveries, and related historical events that never came to be, or were severely altered by, the destructive presence of pypyrus upon the primary players.

Pronunciation

pihh-PIE-russ

Type

Viral

Origin

Natural

Cycle

Chronic, Acquired

Rarity

Uncommon

Affected Species

• Human