Tuesday, November 8, 2022

Game 474: Bugs and Drugs (1978)

Bugs and Drugs
United States
Independently developed in 1978 on PLATO educational system at the University of Illinois
Date Started: 4 November 2022
One of the things I've never made explicit is how my views of this hobby have evolved over the near-13 years I've been writing about it. I started this blog--or, rather, the project that became this blog--in a fit of self-hatred. It was the equivalent of resolving, having decided that I had a drinking problem, to drink myself to death. I meant "addict" quite literally, and darkly, and I obsessed frequently about how the hours I spent on my hobby were detracting from every other aspect of my life. 
How my view changed is an interesting story, perhaps one I'll analyze later, but not the purpose of this anecdote. Suffice to say, I wasn't in much of a mental space to fully evaluate the claim that Matt Barton made in Dungeons & Desktops that CRPGs are "possibly the best learning tool ever designed." I made fun of him for the quote in an early entry, although in a slightly later one, I did allow that I had learned a few things from RPGs. Still, it was a long distance from Pirates! having taught me the meaning of "broad reach" to Barton's hyperbole. I couldn't readily accept CRPGs as anything more than a waste of time.
Diseases that you can encounter on the first level of BND . . .
Someone should have told me about Bugs and Drugs. Here, in 1978, we have a game that provides such a good learning experience that I'm not sure it's even playable without a couple of semesters of medical school. I've barely gotten anywhere in the game, and already I've learned enough to be dangerous. For instance, high-dose penicillin may not always be the best choice, but it's rarely the wrong choice.
A year ago, it seemed likely that we would never see Bugs and Drugs. I included it among a list of games for which I compiled all existing information and thought that was it. But last month, Camelot author Josh Tabin alerted me that I could find the game on a reconstruction of PLATO maintained by Dale Sinder at the University of Illinois. He has some lessons not found on Cyber1, including this one. It just goes to show that you should never lose hope. Alas, I tried typing m199h into Sinder's system and still got nothing.
. . . and the medicines that you use to treat them.
Bugs and Drugs is a clever game. When I heard about its existence, I assumed it would be a simple reskin of The Game of Dungeons (dnd) with medical terminology--simplistic, obvious, and shallow (cf. GayBlade from 1992). Instead, it's a clever, difficult, and educational game that goes beyond Dungeons in many of its mechanics.
The things I've learned in my few hours with Bugs start with the first menu option: the Hippocratic Oath. I now know that this credo a) does not contain the phrase "first, do no harm," although it does have a similar sentiment; b) requires med students to give their teachers money if they need it; c) prohibits the oath-taker from aiding abortion or suicide; and d) is not really used anymore, having been replaced by other codes of ethics and oaths particular to certain regions and schools.
Gameplay superficially begins like Dungeons. The character starts as a pre-med student with rolled values for strength, IQ, constitution, and dexterity. While strength, constitution, and dexterity exist in the typical D&D range of around 3-18, IQ goes up to 250. In place of mage and cleric spells, each character also starts with a certain number of Type I and Type II meds. Gold pieces are replaced with "pearls of wisdom." You choose a name for your character and then a "group" from names like "Bedpan Commandos" and "Osler Marines" (after William Osler, 1849-1919, creator of the first residency program). I don't think the group has any impact on gameplay.
I hope most doctors have a higher IQ than this.
The game begins in the corridors of a 12-level hospital, each level 16 x 16. Your goal is to use your knowledge to fight infectious diseases, gain experience, and ultimately retire at a high enough level to knock someone else off the Hall of Fame roster. A winning game also requires you to find Leuwwek's microscope and pass Koch's Postulates. Antoine van Leeuwenhoek (1632-1723) was the "father of microbiology" and Koch's Postulates are a set of four criteria that Robert Koch (1843-1910) believed were necessary to link a microbe and a disease.
Level 1 of the hospital.
Where Dungeons had monsters roaming the hallways, Bugs has viral and bacterial infections, including chlamydia, leprosy, histoplasma, and influenza. You can try to generically (f)ight these enemies (interpreted in-universe as your body fighting off diseases on its own), but as in Dungeon, physical combat is a recipe for rapid death. For sustained success, you have to apply the right treatment to the right disease. Here, the complexities of the game reach heights we haven't seen in other PLATO titles. When I first heard about the game's premise, I thought the pairs would be relatively easy for anyone with rudimentary medical knowledge--penicillin with bacterial infections, Dramamine for nausea, and so forth. But it turns out that almost everything you encounter in this game is a bacterial infection (excepting some viral ones) and almost every drug in your bag is an antibiotic. Thus, success means having much more specific medical knowledge, like gentamicin works best against endocarditis but doesn't work at all against chlamydia. The response of an "enemy" infection to a drug is probabilistic rather than binary, so even if you relied on trial and error, it would take you a number of tries against the same infection to establish a success rate.
Meeting h. influenzae in the hallway. I now know this stands for "haemophilus" influenzae, which is a bacteria. It has nothing to do with influenza, a virus; it got its name because it was incorrectly associated with influenza by a German physician in 1892.
You may be thinking that if you played this game, you'd just have the game window open on one monitor and WebMD on the other, but it's almost like the game anticipates this. You only have a short time to choose an action before the infection gets to, well, infect you, with consequent losses of hit points and attributes. And while Googling may correctly match a few of the infections and their best treatments, I found most of the time, what the Internet told me was the best treatment wasn't one of the options in the list, or it just said "antibiotics" in general. Another issue is that this game was written 44 years ago, and some of the most effective drugs didn't exist yet or weren't yet understood to be effective. For instance, the Internet gives doxycycline as the most effective treatment for about half the diseases you encounter, but it's not one of the medicines in your bag. I believe this is because the antibiotic was embroiled in a patent dispute not resolved until 1983.
If all of this weren't enough, you also sometimes get quizzed about your medical knowledge in other ways. For instance, a "mugger" occasionally stops you in the corridors and demands the answers to questions not easily Googled. If you get his questions wrong, he steals your pearls, medicines, experience, or attributes; get them right, and you get rewards in the same categories. You also need to answer a question every time you use "viral therapy" as a medical option. The authors created a clever way of crowdsourcing these questions. If you find the "journal club" on the eleventh floor, you can write your own question. But if the creators deem that your question is "bad," they threaten to automatically destroy your character.
A question from the Google-fu black belt exam.
Still, part of me wonders if the questions are really that difficult, or if they would be something that almost every first-year medical student would know immediately. I would ask any of my readers with medical training: if you had the list of diseases and treatments shown here, would you be able to pair them in your sleep, or would they require some thumbing through a desk reference?
Beyond the difficulty imposed by the theme, Bugs offers a typical CRPG sense of risk and reward. As in Dungeons, exiting the hospital heals and restocks you, so things are safest near the entrance. Mortars and supply cabinets take the place of treasure chests, and masks, gloves, and gowns take the place of armor. Where Bugs goes beyond Dungeon is in its inclusion of a number of special rooms on each level of the hospital, each providing some benefit to the player. You can rest and restore your hit points in call rooms. Lounges let you spend your pearls on coffee, food, study, and sleep, all of which increase your attributes. Labs let you browse the diseases seen on the floor so you can prepare your responses. A cashier will give you your pay in pearls one time per hospital entry. There are both elevators and stairs for moving up and down through the floors.
The game enjoys its med student in-jokes.
Some other notes:
  • Intelligence is a key statistic for correctly applying medications even if you choose the right one, but it also comes into play in other situations. You can be so dumb you can't even operate the elevator, for instance.
  • Some of the objects you can find are creative. A beeper allows you to automatically page yourself to different floors, but with the downside that you can be randomly paged from floor to floor. You can find "Brilliance" (an inventory item), which lets you automatically assess the resistances of various infections.
  • In addition to the diseases that you fight like monsters in the corridors, you can become suddenly seized with a particular condition, with various consequences such as confusion, panic, slowness, and blindness. Sometimes, you can treat these diseases with the right medicine; other times, you have to answer a quiz question to get rid of them. Still others, you have to wait out.
I feel like I should just go home.
  • To balance the random diseases, there are what the manual calls "good surprises," including relic rooms with high-powered items and the aforementioned formularies, library keys, and hormones. Hormones will automatically resuscitate you if you die.
Finding a "relic room."
  • Death is accompanied by an amusing screen in which you're buried in the hospital churchyard. Markers indicate the last few hundred characters slain. 
In some ways, this is the most morbid death screen I've ever seen.
As with Dungeons, you get far more experience through treasure than through actually defeating the diseases, so finding pearls is key to leveling up. It takes 4,000 experience points to go from Level 1 ("pre-med") to Level 2 ("medical student"). From there, the experience requirements double for each level. You hit "senior resident" at Level 4 with 32,000, "attending" at Level 8 with 512,000, and "Nobel laureate" at Level 11 with over 4 million. The minimum number required to knock someone off the "Hall of Fame" as of right now is over 1.6 million.
The Hall of Fame. It indicates that 83 people have won this game in 42 years.
In about four hours with the game, I couldn't even get a character to Level 2. But I can see a way forward, if a long one. You occasionally find "formularies" as you explore, and each of these can be used one time to look up the optimal medication for each disease. Similarly, you can find library keys that let you look up answers to the miscellaneous questions you might be asked at various points in the game. With these resources (which are rare) you could very slowly build up a knowledge base that would allow at least some level of success.
Learning the answer to 1 of 147 mugger questions.
Even with this, it would probably take dozens of hours to win. I don't know if it's worth doing, but I am interested in how the meta-strategy changes at higher levels. It clearly isn't the same as The Game of Dungeons, where wealth attracts higher-level monsters. There also seems to be more fluid movement between the levels. I wonder if Nathan Mahney of "CRPG Adventures" and Ahab of "Data Driven Gamer" wouldn't want to partner with me on this one. We could share a login and jointly build the knowledge base. Alternatively, someone with an M.D. could come along and save us all. I'll leave it "open" for now, as much as it pains me given the number of other games currently "in progress."
An article about the game in Southern Illinois University's Daily Egyptian, 22 October 1982.

Whatever Bugs and Drugs' virtues as an RPG, I like to think it was a solid learning tool for medical students. It seemed to work for the creators. Mike Gorback became a pain management specialist in Texas; David Tanaka practices internal medicine at the University of Colorado [Ed. I might have the wrong person on this one]; and Paul Alfille is an executive at Massachusetts General Hospital. If someone would write an RPG that would help with my terminal degree, I'd be a happy man.
Time so far: 4 hours


  1. I was always curious what this game was about. There were stories from what people remembered, but I wasn't expecting something this in depth. It is pretty neat.

  2. As Mr Spock would say: "Fascinating." Both the fact this game turned up after all as well as its content which is so different (at least in subject if maybe not as much in mechanics) not only from most other PLATO games of its time, but even from most CRPGs since then.

  3. Cool find! I'm not an MD, but having studied neuropsychology which required me to do some courses at the medical faculty, I developed an admiration for the sheer level of knowledge a doctor has to absorb in 6 years. And the exams were brutal: if you answered correctly, 1 point, if you left the answer open: 0 points, but answer wrong, -1 point. That deduction being a means of punishing guessing strategies which you also don't want in your practicing doctor.... I get it, but boy, psychology students were in for a hard time......From your description I really like the cleverness with how they substituted DnD elements with medical stuff. Serious gaming is on the rise as valid ways of training, rehabbing, treating psychiatric disease etc. This is more of a learning tool for students, but I like the premise. Would be nice to know what the higher levels bring with them in terms of complexity!

  4. Been a big fan of your blog for years. I'm a huge RPG fan, and I've been a practicing MD (internal medicine) for nearly a decade. Knowing the best antibiotics for all of these bugs would be quite a feat even in a medical graduate, unless they specialized in infectious disease. Not a lot of yaws in America. If you want a doctor's perspective or help, I'd be happy to help out.

    1. But yeah, these questions are tough even for a doctor. I'm not sure if it's because they're 40 year old and so much has changed including disease names, or if they're just plain tough.

    2. I started medical school 26 years ago... almost went into ID... I'd never heard of the rhinoscleroma in the screenshot above. Of course, we have much better antibiotics for Klebsiella these days... many are the antibiotic advances after 1980.

    3. @arthurdawg This made me realize that the game is even more interesting, since it is also a preservation of the "medical-science" of those days (at least on an academic level?)

  5. So you get your infections _at_ the hospital? Sounds like it's set in Germany.

    I love the death screen. Buzz Aldrins Race into Space had a graveyard where you could see your dead astronauts, but this looks way more morbid.

    Great that this game turned up, it always sounded very interesting and your coverage of it is excellent.

    1. Nosocomial infections are a major issue in hospitals!

  6. A real surprise to see this one. Suddenly, other "lost gems" now have a chance to appear. Really awesome the depth of they managed to put into a videogame at the time, PLATO is really something so, so special.

    As always, thanks for you hard work Chet. Documenting such a niche part of human history is no small task.

    1. Yeah... really too bad that the m199h still remains so much of a mystery! Some unexplained mysteries are good for the soul, but I'd love to know the answer on this one!

  7. I am happy that with a name like this it didn´t end up a hippie tweeker joke, this is quite wholesome.

    1. Agreed 100%. With a name like that, I was prepared for the worst.

  8. Had literal jaw-dropping when I saw this one come up, I had mentally shelved it on my "oh well, I guess we'll never see it" games.

    Nathan + Ahab doing a combination with you on PLATO would be a dream team!

    Are there any 80s combo rpg/wargames on your list, maybe we can also get a Wargaming Scribe crossover?

    1. It's an intriguing prospect, but I am on a bit of an enforced hiatus right now; not a lot of mental energy to spend on blogging, and it's a toss-up whether I come back to the blog or not.

    2. Or maybe another text adventure/RPG and a crossover with Renga in Blue?
      (also, I would think the earliest possible RPG/wargame would be one of The Lords of Midnight sequels? Not sure if it counts as a wargame though)

    3. Oh boy. I am having flashbacks of exhaustively casting every spell on every enemy in dnd multiple times until determining that Eye of Newt works best on spectres and so forth. I don't want to say no to this, but with my current work/life demands, I'm going to have to say probably not.

      This game is weirdly reminiscent of my wife's previous job, who helpfully tells me that penicillin is definitely the wrong choice for treating hepatitis B, and that if your hospital's code silver policy is to answer medical school questions, you should change careers.

    4. Yeah, Hepatitis B is caused by a virus. Antibiotics won't help directly (they might still be prescribed if there's concerns about secondary infections)

  9. Does anyone know what "Bd. Elg." stands for in the list of medical titles in the graveyard screenshot? I get the rest, but that one has me stumped.

    1. Could it be "Board Eligible"? It's a title that says that you are one exam away of being Board Certified. Would not be a great fit in this particular list, but can't think of anything else. And it's not the best acronym letter either...

  10. I wonder, given the development pattern of these sorts of games, how close this version is to the one available in 1978, or whether it’s had several iterations since.

  11. “ One of the things I've never made explicit is how my views of this hobby have evolved over the near-13 years I've been writing about it.”

    Certainly noticeable, nonetheless!

  12. I would really like to see you do an interview with Matt Barton. I am sure they could hide your face and mask your voice to keep you anonymous.

  13. "Hey, Chet, why do you have so many searches for gonorrhea on your laptop?"
    "Its for a blog entry I swear!"
    Joking aside, I can't imagine searching for all those things in the heat of battle is very fun...or in general. I hope you didn't catch an eyeful of something very unpleasant.

  14. Fascinating game, thank you for covering it. I'm an M.D. from Germany, spezialised in Pneumology (Internal Medicine). I would love to have a try at the game. I suppose it's not possible over the internet?

    Let me try to give an answer on your question "if you had the list of diseases and treatments shown here, would you be able to pair them in your sleep, or would they require some thumbing through a desk reference". I haven't played the game, so i'm only hypothesizing, but i'm certain i could easily anwer most of the questions, although it would have taken some time of looking up answers in my textbooks. I'm pretty sure this game would actually help med students as a learning experience.

    1. For some reason, a few sentences of my comment were eaten up. I meant to write:

      I haven't played the game, so i'm only hypothesizing, but i'm certain i could easily anwer most of the questions nowadays. As a med student, the pairings of germs and antibiotics took up a whole semester, so as a med student, i would have been able to answer the questions aswell, although it would have taken some time of looking up answers in my textbooks. I'm pretty sure this game would actually help med students as a learning experience.

  15. A fascinating game, Chet! How cool it is that you experienced it! As for games being fit to be learning tools - I personally DO believe that games can teach some concepts very well, at least for people who easily and readily learn by gaming (not everyone is like that) - games can kinda teach by the way of "learn by doing", imitating real situations and rewarding correct choices/punishing wrong ones. (Of course, it only works for stable situations that stay equlivalent to themselves the next time you meet them, so that experience, while fallacious to a degree, still can teach for the next situation of the same kind in the future; while not every area of knowledge if like that, not every kind of situations permit expertise to exist, because of potentially great uniqueness (and, since, uselessness of past experience) - still, there are a lot of situations that are stable, repeating, solid and thus can be taught how to deal with them). I personally remember a couple of medicine games for Dos - "Life or Death" was their name, it was not an CRPG though, rather a surgeon simulator - or,to be honest, a Freddy Krueger simulator, because, honestly, at first your surgeries will be, alas, very Freddy-like.

    Still, CRPGs have an important aspect of simulation that is absent from other games - the gaining of experience and, thus, dynamical change of character's ability/task's subjective difficulty. Such games can teach not only skills, but also meta-skills - how to deal with "you're not yet strong enough to do that", or, for example, "you're strong enough in principle, but right now you're diseased/cursed/poisoned..." - meta-skills of assessing your own condition and abilities and making a decision of "whether to risk it". "Do you feel lucky, do you?" the game genre.

    In that sense a visual novel by the name of "Depression Quest", while not CRPG per se, kinda does teach a bit about life skills, where you have some kind of parameters (level of being depressed, or physical well-being for example), which puts some constraints on what you can or what you cannot do; it's quite an experience to find your character in a position where he has some choices and all the "good choices" (as in:"what people usually ADVISE to do in such a situation") are unavailable because of your condition (in the worst case, even "neutral choices" are unavailable, either).

    Still, a CRPG rather than an adventure game of such a kind would allow to experience, instead of linear (or poly-linear) combination of unique, but pre-determined situations - some kind of generative system that generates a lot of different situations of this kind by the way of combining elementary elements; something that The Sims tried to do, but kinda failed IMHO.

    I would LOVE to see you do a series of posts on this particular game, but, yeah, doing this alone is a monstrous task that we readers have no right to force on you.

    Still, a great game and a great story. Just.. fascinating.

  16. "if you had the list of diseases and treatments shown here, would you be able to pair them in your sleep, or would they require some thumbing through a desk reference?"

    I am in the field of infectious diseases, I think i would be in trouble pairing those organisms with what was considered appropiate treatment in 1978. While we still use penicillin for Syphilis things are very different for several of the other organisms listed.

    This game sounds really fun, at least to me.


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