Healing Through the Ages

Today we look at the legacy of natural healing rules, without the benefit of magical aid. This is an issue that has a clear and dramatic trend over different editions of D&D. Was it the right one?

Medical Research

Obviously, different bodies, and different types of injuries, heal at different rates. But consider the following as a sample of non-lethal, mid-level injuries:

• Minor wounds can take around 3 weeks to heal. (AdvancedTissue.com)
• Second-degree burns take around 3 weeks to heal. (HealthLine.com)
• Broken bones can take 6 to 12 weeks to heal. (FootHealthFacts.org)

So the pattern is clear: For these mid-level injuries (not even talking about third-degree burns or major head wounds, etc.), the time for healing is on the order of some weeks. If you dig into the details, this can be aggravated or lengthened if the injured member is used or stressed too early in the process.

Original D&D

HEALING WOUNDS: As noted previously, energy levels can only be regained by fresh experience, but common wounds can be healed with the passage of time (or the use of magics already explained). On the first day of complete rest no hit points will be regained, but every other day thereafter one hit point will be regained until the character is completely healed. This can take a long time. (Vol-3, p. 35)

I think previously I read this as 1 hp/day (after the first), but now that I look at it more closely, it seems that I missed the key phrase "every other day", which seems to indicate an effective ½ hp/day of complete rest? (Note that Chainmail had no rules for recovery; and in fact no campaign rules or context outside the combat encounter itself.)

Basic D&D

Each day of rest and recuperation back "home" will regenerate 1 to 3 of his hit points for the next adventure. (Holmes Basic D&D, p. 7)

We can see this same rule in the Moldvay (p. B25). However, I'm unable to find any rule for natural healing in the later Mentzer (1983) or Allston (1991) rules. Was this an editorial oversight? (The piecemeal choose-your-own-adventure organization of Mentzer's Basic Players Manual makes this seem likely.) Regarding Allston, while I can't find a rule for natural healing, other passages seem to imply that it should exist (e.g., constructs "do not heal normally; magic must be used", p. 155; and regarding nonlethal combat, "he heals them through the usual means, such as a cure light wounds spell or rest", p. 267). Can anyone find a rule for natural healing over time in these books?

Another interesting place to look in this line would be Mentzer's "War Machine" rules in the Companion set. Clashes between armies in these rules result in casualty percentages, half of which are deaths, and half of which are wounded. Regarding the wounded, Mentzer writes:

If a force retreats from the field, treat all wounded killed. If a force holds the field after the battle, those wounded troops can return to action in 1d4 months. (DM's Companion, p. 15)

Now, that 1d4 month (4-16 weeks) recovery is actually a pretty good model of our real-world medical data above (where we saw 3, 6, or 12 weeks for moderate injuries). However, it's totally out-of-sync with the current or any other edition of D&D; there is no mechanic in any published D&D which would produce recoveries for normal troops at the (realistically slow) rate shown here. So while noble in intent, this highlights just one of the many ways in which Mentzer's War Machine is essentially blind and/or in contradiction with results from the normal D&D system itself.

1st Edition AD&D

For game purposes it is absolutely necessary that the character rest in order to recuperate, i.e. any combat, spell using, or similar activity does not constitute rest, so no hit points can be regained. For each day of rest a character will regain 1 hit point, up to and including 7 days. However a character with a penalty for poor constitution must deduct weekly the penalty score from his or her days of healing, i.e., a -2 for a person means that 5 hit points healing per week is maximum, and the first two days of rest will restore no hit points. After the first week of continuous rest, characters with a bonus for high constitution add the bonus score to the number of hit points they recover due to resting, i.e., the second week of rest will restore 11 (7 + 4) hit points to a fighter character with an 18 constitution. Regardless of the number of hit points a character has, 4 weeks of continuous rest will restore any character to full strength. (DMG, p. 82)

This is something like a doubling from OD&D's "every other day... one hit point" rule. (Note that the basic D&D rule from Holmes is on the order of quadrupling.) One problem that may be obvious with these starting rules is that characters with more hit points, presumably the heartier and healthier types, take longer to heal from injuries -- for very high level characters, maybe ten times as long as a normal man. Hence, I think, the addition of the last line: no matter what one's level or hit points, healing is always complete within one month. (We may or may not consider that a fully successful adjustment.)

2nd Edition AD&D

Characters heal naturally at a rate of 1 hit point per day of rest. Rest is defined as low activity--nothing more strenuous than riding a horse or traveling from one place to another. Fighting, running in fear, lifting a heavy boulder, or any other physical activity, prevents resting, since it strains old wounds and may even reopen them.

If a character has complete bed-rest (doing nothing for an entire day), he can regain 3 hit points for the day. For each complete week of bed rest, the character can add any Constitution hit point bonus he might have to the base of 21 points (3 points per day) he regained during that week.

In both cases above, the character is assumed to be getting adequate food, water, and sleep. If these are lacking, the character does not regain any hit points that day.

Part of the transition we see here is that while OD&D demanded "complete rest" for any healing, 1st Ed. left out the word "complete", and here in 2nd Ed. the editor has taken advantage of that gap to distinguish between normal healing (1 hp/day, even on the march), and "complete bed-rest" (3 hp/day). This is now something like six times the initial healing rate we began with in OD&D. It still suffers from the healthier/longer-to-heal phenomenon (lacking the last line from 1st Ed.).

3rd Edition D&D

Natural Healing: You recover 1 hit point per character level per day of rest. For example, a 5th-level fighter recovers 5 hit points per day of rest. You may engage in light, nonstrenuous travel or activity, but any combat or spellcasting prevents you from healing that day.

If you undergo complete bed rest (doing nothing for an entire day), you recover one and one half times your character level in hit points. A 5th-level fighter recovers 7 hit points per day of bed rest.

Higher-level characters recover lost hit points faster than lower-level characters because they're tougher, and also because a given number of hit points represents a lighter wound for a higher-level character. A 5th-level fighter who has lost 10 hit points isn't seriously wounded, but a 1st-level fighter who has taken 10 points of damage is. (PHB, p. 129)

So this rule finally addresses the healthier/longer-to-heal problem, by scaling natural healing to character level. In so doing, it leaves healing at lower levels about the same (actually reduced in the case of "complete bed rest", the category being maintained from 2nd Ed), but radically increases healing at higher levels. For example, for a 6th-level character, healing is now 12 times over the OD&D baseline, or 18 times in the "complete bed rest" case.

The 3.5 rules accelerate this further:

Natural Healing: With a full night’s rest (8 hours of sleep or more), you recover 1 hit point per character level. Any significant interruption during your rest prevents you from healing that night.

If you undergo complete bed rest for an entire day and night, you recover twice your character level in hit points. (3.5 SRD)

In this revision, you don't even need a day of light work to regain hit points; it can happen in just 8 hours of time. And the "complete bed rest" is upped from ×1.5 to ×2 instead. So in this latter case it's about 24 times the healing rate seen in OD&D, for a 6th-level character.

4th Edition D&D

I don't normally go past the 3rd Edition of the game (and I've never played any such edition), but in this case the information is easily available online, and I think instructive -- it's actually a fundamental part of the 4th edition system design. Looking at a helpful blog post by MerricB on the subject:

Characters in 4E could heal themselves from a pool of healing surges – each equal to a quarter of their hit points. A typical character might have 8 of them available each day, and they were also expended by healing magic (which would provide a bonus to the healing). Whenever a character took a rest between combats, they could use healing surges to regain hit points. (Merric's Musings)

So -- in case you're not already aware of this -- in 4th Edition, characters could heal themselves effectively instantaneously, as soon as they had a minute or so breather outside of combat, for fully a quarter of their total hit points. At about 8 times a day, that's actually double their full hit points within one day, with no outside aid required; i.e., come back from a mortal injury twice every day. By my calculation for a sample 6th-level character, this represents approximately 100 times the healing rate from the OD&D basis.

5th Edition D&D

Again quoting MerricB regarding 5th edition:

Part of this idea [4th Ed. healing surges] remains in 5E, but with a couple of changes. First of all, they’re called Hit Dice, and they’re equal to the number of dice you roll to determine your hit points. Whenever you rest for an hour or more, you may expend as many Hit Dice as you like, rolling them and adding the total to your current hit points. Your constitution modifier applies to each hit die rolled.

A Short Rest is defined as being a period of 1 hour or more when you get a chance to bind wounds and generally recover. There are several abilities possessed by characters that also recharge when you take a short rest. It’s a lot longer than the time in 4E, so won’t be as frequently employed...

Long Rests and Full Healing: If you rest for eight or more hours, you get the benefit of a long rest: all your hit points are healed, and you regain half (rounded down) of your hit dice. For those who are used to AD&D, this is a major change in how the rules work. Without magic, it’d take weeks for a badly wounded fighter to get back on his feet! For those in 3E, it’s a change but they had wands of cure light wounds so it didn’t matter. For 4E players, this is less than they had, as they got all of their healing surges back! (Merric's Musings)

Note that none of this information seems to be in the free 5E basic rules release, or the SRD, so I'm taking for granted that Merric has it correct here. So, it seems like in 5th Edition, you can effectively get on the order of all your hit points back with a 1-hour rest, and then another all-your-hit-points unit back with the next 8 hours rest. That is: Similar to 4th Ed., two units of full hit points back in less than a day (although not all at once, instantly, as in 4th). So again that sounds like about 100 times the healing rate we started with in Original D&D (for a sample 6th-level character).

Conclusions

A summary of our findings are shown below (for the later editions, a 6th-level character is taken as the basis):

Note that the y-axis in the chart is on a logarithmic scale (the first time I've ever had to resort to that on this blog). This clearly highlights that the overall trend shows a surprisingly regular exponential acceleration in healing with each new edition of the game, approximately following a rule of f(x) = e^(0.72x), where f(x) is the multiplier on the OD&D baseline, and x is the sequential edition ID of the game as given above. Since e^0.72 = 2.05, this shows that, roughly speaking, the natural healing rate has regularly doubled with the release of each new edition of D&D (over the half-dozen or so editions to date).

If we go back to OD&D and look at our 6th-level fighter example, say hit points of 6 × 4.5 = 27, and a healing rate of ½ hp/day, we see that this character can regain all of their hit points in 27 × 2 = 54 days ≈ 8 weeks. That's actually a fair simulation of how long it realistically takes to heal one or two deep cuts, a halfway bad burn, or a broken bone (see the top section above). The most recent editions (4th/5th), granting something like 100 times the healing rate, or recovery from 2 mortal wounds every day, can only be considered as wildly cartoonish. (Note that the entire analysis above pretends that we keep character hit points constant over the years; if we also take into account that PC hit points were themselves getting inflated, then the multipliers would look even more ridiculous.)

Now, someone might argue that hit points don't represent real injuries, but this is a debauched interpretation seen in 4th+ edition, and doesn't square with earlier editions of the game. Yes, 4th/5th edition makes the assertion that lost hit points may not be any real injuries at all; possibly just temporary fatigue or windedness instead. But even if we look at the 3rd Edition text above, there is no such indication; lost hit points are always some kind of injury, even for high-level characters (possibly just a minor cut or bruise). Moreover, the fact that side-effects of attacks trigger on any successful hit -- e.g., poison triggers for saves, energy-draining attacks, etc. -- contradicts the idea that a hit or lost hit point may not be any injury.

So: What to do in our house rules for an OD&D game? We are sensitive to the problem that healthier (higher-level) characters take geometrically longer to heal with a fixed ½ hp/day rule (or any other fixed number of hit points per day). We could also say this: Another problem with this rule is that it's still unrealistically too fast for low-level creatures. For example: take a normal man of around 3 hit points; even the worst wound which takes him to near zero hit points will be healed fully in less than a week, only 6 days. If we want something resembling the 3-12 weeks healing time from our initial medical examples, then we would argue for slowing it down in these cases even more. (See also the Mentzer War Machine rules above for a similar intent.)

Let's say we want any character to recover from zero to full hit points in some number of weeks like this. There is little to do but subjectively pick the number of weeks that makes us happy: this number could be 3, or 6, or 12, or something like that. I'll suggest picking 4 weeks to be a bit generous, and also to sync up with the 1E AD&D rule for capping the healing time. Hence:

Characters heal one-quarter of their full hit points for each week of complete rest.

Let's say we round this up to the next whole number to be charitable in cases where a creature has less than 4 hit points (like half of normal men). It occurs to me that (Crom help me) this slightly echoes the increment regained from 4th Edition's "healing surges" -- although on a time increment of weeks instead of seconds. Also assume that this requires comfortable rest in bed with amenities -- as in, a hostel or inn at town.

If we compare to the OD&D rule, the major change is of course scaling our healing rate to the overall hit points of the character in question. For 1st-level characters, the healing rate has decreased (to about a quarter of the book rate). For a 3rd-level character with around 15 hit points, healing rate is about the same as the OD&D book rule (hey, 3rd-level again: links one, two). For a 6th-level character, the rate has approximately doubled (and so in line with the 1E text). You can extrapolate the rest, I'm sure. 

I think I can imagine someone complaining "that's too slow for our adventures!" but I actually don't think there's any legitimate justification for such a position. For example, MerricB writes above: "Without magic, it’d take weeks for a badly wounded fighter to get back on his feet!", but I don't see any fundamental reason why that's a bad thing -- merely non-cartoonish. We can, of course, simply hand-wave the weeks of recovery time in-game, just like we do for days or nights or whatever the camping pace is.

Moreover, this rate of time actually helps to solve a bunch of other problems we commonly encounter in the D&D game. Some examples: (1) The party retreats to rest overnight, and the DM is confronted with coming up with some reason why the depleted monsters don't immediately get overrun the next morning. (2) The party wants to camp in a room of the dungeon, as they can get most of their needed recovery back in just 8 hours if they can only hold the door shut. (3) Our campaigns and timelines routinely run on an overly-accelerated basis: whole adventure paths take only days in-game, and PCs advance from 1st to 20th level within the course of a single game year. Slowing down the recovery time (to a realistic basis) could serve to put the brakes on all of that, and generate campaign stories that better resemble what we read in fantasy literature. (Especially in conjunction with reduced clerical healing magic, and possibly seasonal effects like no-travel-in-winter, etc.)

Comments or modifications?

Edit: Pretty soon after I wrote the preceding, I then slightly adjusted the rule in my OED campaign to the following:

Characters heal their level + Constitution bonus in hit points for each week of complete rest.

The primary reason for this is to just avoid the fractional math of computing 25% of a character's hit points every week that they rest (instead, a simpler to express & compute addition of integers). Assuming a basic hit die of 1d6, so average 3.5 hit points per level, this works out to roughly the same 4 weeks time to fully heal. And the modifier for Constitution adds some extra flavor/awareness to that ability score, echoing the use of the Constitution modifier in the 1E rules. This has been found to be satisfying and stable in our games since that time.