Disease & Plague Guide
How to prevent infections, treat food poisoning, manage sanitation, and keep your colony healthy through winter and beyond. A single plague outbreak can wipe out half your settlers if you are unprepared.
Diseases in Going Medieval are not random bad luck. They are the direct result of poor colony management. Every disease has a cause, and every cause has a prevention. Understanding the disease types and their triggers is the first step toward a self-sustaining colony that never loses a settler to sickness. This guide covers every disease type in the game, sanitation best practices, a step-by-step plague response protocol, and a winter disease prevention checklist. For related topics, see our Herbal Medicine Guide and Wounded Settler Healing guide.
Common Diseases in Going Medieval
Going Medieval simulates several disease types, each tied to a specific cause. Wound infections arise when injuries are left untreated in dirty environments. Food poisoning strikes when settlers consume spoiled or raw meals. Hypothermia and heat exhaustion are temperature-related conditions that reflect poor clothing or ventilation planning. The plague is the most dangerous: it spreads between settlers and can decimate a colony within days if left unchecked. The table below summarizes every disease type, its cause, symptoms, severity, treatment, and prevention strategy.
| Disease | Cause | Symptoms | Severity | Treatment | Prevention |
|---|---|---|---|---|---|
| Wound Infection | Untreated wounds in dirty rooms | Wound turns yellow, settler develops fever | High | Herbal Poultice and clean bed rest | Treat wounds in Decent-or-higher quality rooms; keep floors clean |
| Food Poisoning | Eating spoiled or raw food | Vomiting, mood drop, reduced work speed | Medium | Rest, clean water, and Medicinal Tea | Always cook food before eating; discard spoiled meals |
| Cold / Hypothermia | Prolonged cold exposure without warm clothing | Reduced movement speed, shivering, potential death | High in winter | Move indoors near a heat source; equip warm clothing | Assign wool or leather clothing before winter; heat all living quarters |
| Heat Exhaustion | Working near furnaces in summer without breaks | Mood drop, occasional fainting, reduced work speed | Medium | Rest in a cool room; provide ale or tea | Rotate furnace workers; build ventilation in forge areas |
| Plague (Outbreak) | Rat infestation near food stockpiles | Spreads between settlers; rapid mood collapse | Critical | Isolate infected; apply Antidote; burn contaminated food | Keep food in raised storage; maintain distance between kitchen and refuse |
Sanitation Audit: Is Your Colony Safe?
Most disease outbreaks trace back to one of five sanitation failures. Run this checklist on your colony after the first winter to catch problems before they become deadly. The most common mistake is placing the refuse pile too close to the kitchen. Wind carries contamination particles, and settlers walking through refuse track germs into food preparation areas. The second most common failure is leaving blood and vomit on floors, which dramatically increases wound infection risk for any settler treated in that room.
| Area | Risk | Minimum Requirement | Pro Tip |
|---|---|---|---|
| Kitchen | Food contamination | Floor must be paved; no blood or vomit nearby | Build kitchen at least 5 tiles from refuse pile |
| Hospital / Recovery Room | Wound infection | Room quality Decent or higher | Add a window and rug for quality boost; keep separate from living quarters |
| Food Stockpile | Spoilage and rat infestation | Enclosed room with door; preferably underground | Build a root cellar for winter storage; spoilage is slower underground |
| Refuse / Corpse Pile | Plague, mood penalty | At least 15 tiles from any living space | Build a dedicated dump zone downwind; assign haulers to clean daily |
| Well / Water Source | Contamination from nearby waste | No refuse within 10 tiles | Build wells on natural terrain, not on paved floors, to maintain water flow |
The Plague Protocol: Step-by-Step Response
If a settler shows plague symptoms (fever, vomiting, rapid mood collapse, and a disease icon on their portrait), you have approximately two in-game days before it spreads. Follow this protocol immediately. Hesitation is the leading cause of plague deaths in Going Medieval colonies.
Step 1: Isolate Immediately
Draft the infected settler and move them to a room at least 10 tiles from any other living space. Assign a separate food stockpile with 10 or more cooked meals. Build a door and forbid other settlers from entering.
Step 2: Assign a Dedicated Caretaker
Select a settler with Medical skill 5 or higher. Set their work priority to only Medical and Hauling. This settler will bring food, apply poultices, and monitor the patient. Keep the caretaker away from the main food stockpile when possible.
Step 3: Treat with Antidote or Poultice
If you have an Antidote (requires Medical skill 10, Herbs x4, and Charcoal x1), apply it immediately. If not, apply a Herbal Poultice every 12 in-game hours. Keep the patient on bed rest until the disease icon disappears. This typically takes several days.
Step 4: Sterilize the Source
Find the contamination source, which is usually the food stockpile near the refuse pile. Burn all contaminated food by selecting it and choosing the Dump option, then assign a settler to haul it to the refuse zone. Clean blood and vomit from floors using the Clean area command.
Step 5: Prevent Recurrence
Move the refuse pile at least 15 tiles from any building. Build a dedicated food storage room with a door and walls. Assign a daily cleaning schedule: select the Kitchen and Hospital zones and use the Clean command every morning.
Winter Disease Prevention Checklist
Winter is the deadliest season for disease in Going Medieval. Settlers spend more time indoors, ventilation is poor, and food spoilage increases due to longer storage times. Use this checklist before the first snow falls to ensure your colony survives the cold months without a single disease outbreak.
- Stockpile 30 or more herbs: Winter diseases consume herbs faster than any other resource. A 5x5 herb plot harvested in autumn should cover your needs.
- Build a dedicated recovery room: A 3x3 room with a bed, table, and window. Room quality Decent or higher. This is your hospital.
- Heat all living quarters: Place a brazier or fireplace in every bedroom. Cold settlers get sick; warm settlers do not.
- Verify food freshness: Check every food item in your stockpile. Move anything with low freshness to a root cellar. Spoiled food causes food poisoning, which weakens the immune system and makes other diseases more likely.
- Assign cleaning duties: Set one settler with Hauling priority to clean blood and vomit daily. Filthy floors significantly increase infection risk.
- Keep 10 or more bandages ready: Winter raids still happen. Untreated wounds in cold, dirty rooms almost always lead to infections.
Frequently Asked Questions
Can diseases spread between settlers?
Yes. Plague outbreaks can spread from settler to settler if they share living spaces or food stockpiles. Isolate infected settlers immediately by drafting them and moving them to a separate room with their own food supply. Assign a dedicated caretaker with Medical skill 5 or higher to treat them.
How do I know if food is spoiled?
Hover over the food item in the stockpile. Spoiled food shows a red icon and a spoilage timer. Food stored in a root cellar or underground room spoils significantly slower than food in an above-ground stockpile. Cooked meals spoil faster than raw ingredients, so cook only what you need.
What is the best room quality for preventing infections?
Rooms rated Decent or higher significantly reduce infection risk. A Decent room requires a clean floor, at least one light source, a bed, and a door. Adding a window, rug, or paintings can push the quality to Good or Fine, further reducing infection chance to near zero.
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Last updated: July 12, 2026