The Throne of Suffering

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It stands way out in the middle of a vast desert in Acheron, the fourth circle of Hell, towering some twenty-odd metres above the flat sands – a throne carved of dark red stone, rough-hewn yet quite elaborate, a stark contrast against the brightness of the surrounding sands. The throne stands vacant, avoided even by the native asuras, to the extent that a party luckless enough to find their way to Hell could very well find the vicinity a relatively safe place to make camp.


Legends are divided on the origin of the Throne. Some say it was crafted by Urgathoa, Raiser of Strife, as her portfolio explicitly includes diseases and the skull-like designs are reminiscent of her holy symbol. Yet there are rumours that Urgathoa has personally denied creating it. Certain legends also seem to suggest that the Throne itself was integral to Urgathoa’s ascension. Some historians claim the Thronne was the work of Morgoth, the Searing Eye, before he was sealed, but his portfolio does not specifically include disease and his eye symbology seems at odds with the motifs of the Throne.


Whoever created the Throne, it is a major artifact1 with the ability to craft entirely new diseases. By sitting on the Throne and activating it with the correct spoken phrases, anyone can create a new disease and either bottle it or inflict it upon any one creature they know or can see.

If you choose the second option, there is no range limit, but unless you can see your target from the Throne, you need to have met them at least once and speak their full name. If your target is visible from the Throne, you can point to them instead of speaking their name. They must be directly visible – casting a scrying spell does not allow you to affect anyone you might see through it.

If you instead choose to bottle the disease, it becomes like a poison. A bottled disease can be applied to a weapon, drunk, poured over a person or object, or used as a spell focus for the Contagion spell. The most appropriate way to use it depends on the transmission vector. For example, pouring an injury-transmitted on someone won’t do much (unless you pour it on a wound); but if it’s transmitted by contact, it would definitely infect them.

However, creating a disease also takes a toll on your body. The moment the bottled disease is created or the chosen target is infected, the creator of the disease also becomes infected, not with the disease they created, but with a different rare disease which some call the wasting sickness2.

The Throne of Suffering weighs about 20,000 pounds, and extends several feet beneath the sands, with the outer edges of the pedestal entirely covered by sand. Given the strength and motive, it would be possible for someone to shift it from its place in Acheron.


These are ad-hoc, untested mechanics, so take them as guidelines rather than rules. Crafting a disease on the Throne of Suffering incurs an XP cost in addition to the wasting sickness. You can choose the name of the disease, the nature (extraordinary or supernatural), the transmission vector, the DC, the incubation period, the type and amount of ability damage it causes, the number of successive saving throws required to recover, and a number of other attributes or effects.

Apply the following modifiers to a base of 500XP:

Transmission vector +XP Notes
Ingested 500 Usually can be inhaled too with a +2 bonus to the save; subtract 50 XP if it can’t.
Inhaled 500 Usually can be ingested too with a +2 bonus to the save; subtract 50 XP if it can’t.
Injury 250
Contact 100
Magic 50 Never transmitted; only inflicted via the Contagion spell or similar magical means
Incubation period +XP Notes
None 1000 Disease takes effect immediately if you fail the initial save, with no incubation period
Hours 100 Use if the incubation period is less than 20 hours
Days 50 Use if the incubation period is less than 7 days
Weeks 5 Use if the incubation period is less than 6 months
Months 0 Use if the incubation period is less than 2 years
Years -25 Use if the incubation period is 2 years or more
Other Effects +XP Notes
DC +1 50 Assume a starting DC of 10. DC can also be reduced to reduce XP cost.
Extra saving throw 500 Can be applied more than once; makes it much harder to recover from the disease
Persistent 1500 Disease can only be cured by magic (such as remove disease); stacks with cursed
Cursed 1500 Disease can only be cured by magic after the curse is removed (mummy rot is an example)
Side-effect 500 × _rolls_3 Additional condition requiring second saving throw (as with blinding sickness)
Ability damage 50 × max damage Can be spread over multiple ability scores; power points count as an ability score for this
Permanent ability drain 1000 × damage amount Must succeed additional saving throw or some of the damage is permanent.
Supernatural in nature 500 Most diseases are extraordinary, not supernatural
Maximize damage 1000 × damage amount Always take the maximum ability damage from the disease.
Spell effect 1000 × spell level Disease imparts a spell effect on the creature, such as bane (saving throw as the spell)

  1. Overwhelming aura, class level 40 

  2. Wasting Sickness (Su); DC 30; no incubation period; no natural means of transmission; take 1d6 Cha damage on failed save; recover after succeeding at 5 successive saves 

  3. Multiply by the number of rolls that trigger the side-effect. 

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