You Can Finally Live Your Medieval Plague Doctor Dreams in This Grim New Survival Sim

PST Games just announced Plague Doctor: Life in Pestilence, a medieval medical simulation that puts you in the iconic beaked mask during humanity’s darkest pandemic. Set during the Black Death, you’ll start as an unknown quack and evolve into a reputable physician as the plague spreads day by day. The game challenges you to establish a clinic, gather medicinal resources, perform period-accurate surgeries, and make impossible choices about who lives and dies when resources run thin. Coming soon to PC via Steam, this dark simulation promises to blend medical management with survival horror as you watch society crumble around your makeshift hospital.

What Is Plague Doctor: Life in Pestilence

Plague Doctor: Life in Pestilence is a medieval medical simulation developed and published by PST Games. The announcement trailer showcases a first-person perspective where you don the infamous plague doctor outfit complete with the leather beak mask filled with aromatic herbs meant to ward off disease. You’ll manage your own clinic during the height of the Black Death, treating desperate patients with the limited and often barbaric medical knowledge of the 14th century.

The game emphasizes the grim reality of medieval medicine. Forget modern surgical techniques or antibiotics. Your tools include leeches for bloodletting, saws for amputations, herbal remedies of questionable effectiveness, and prayers hoping divine intervention saves your patients. The trailer shows graphic surgery scenes, body piles in the streets, and the psychological toll of watching entire communities succumb to disease. This isn’t a sanitized medical simulator but an unflinching look at what treating plague victims actually entailed.

Core Gameplay Systems

The game revolves around several interconnected systems that create tension between medical ideals and harsh survival realities. You’ll need to gather resources including medicinal herbs, surgical tools, bandages, and food for yourself and any staff you employ. Resource scarcity forces difficult decisions about who receives treatment and who gets turned away to die in the streets. The trailer emphasizes that you can save those affected by the plague or watch it all crumble, suggesting a failure state where your clinic collapses under the weight of too many patients or insufficient supplies.

Surgery appears to play a major role, with the trailer showing close-up procedures performed on plague victims. Given the medieval setting, these surgeries will likely include amputating infected limbs, draining buboes, bloodletting, and other treatments that were standard practice despite often doing more harm than good. The game seems committed to period accuracy even when that accuracy is deeply uncomfortable, which should appeal to players wanting authentic historical simulation rather than romanticized versions of medieval medicine.

The Plague Doctor Aesthetic

The iconic plague doctor outfit serves as both historical accuracy and visual identity. The leather beak mask, wide-brimmed hat, and full-length waxed coat created an instantly recognizable and unsettling silhouette that has become synonymous with the Black Death. The game leans heavily into this imagery, with the trailer showing the player character in full regalia examining patients, performing procedures, and walking through plague-ravaged streets.

The aesthetic extends beyond just the costume. The trailer showcases medieval architecture with timber-framed buildings, narrow cobblestone streets, and the omnipresent smoke from burning bodies meant to purify the air. The color palette emphasizes browns, grays, and sickly yellows with occasional splashes of red from blood or the characteristic plague buboes. This grim visual style creates an oppressive atmosphere that reinforces the hopelessness of fighting an unstoppable pandemic with medieval technology.

Building Your Medical Reputation

The game promises progression from unknown quack to reputable plague doctor, suggesting a reputation system that tracks your success rate and community standing. Successful treatments likely increase your reputation, attracting more patients and potentially wealthier clients who can pay for premium care. Conversely, high death rates or botched surgeries could damage your standing, causing patients to seek treatment elsewhere or angry mobs to blame you for the plague’s spread.

This reputation mechanic adds strategic depth beyond just treating individual patients. Do you accept high-risk cases that could damage your reputation if they die, or do you turn away the sickest patients to maintain your success statistics? The ethical dilemmas inherent in medieval medicine become gameplay mechanics that force players to confront the same impossible choices real plague doctors faced when overwhelmed with more patients than they could possibly save.

Online Co-op Functionality

Surprisingly, Plague Doctor: Life in Pestilence includes online co-op according to its Steam page features. This suggests multiple players can run a clinic together, potentially dividing responsibilities between gathering resources, performing surgeries, and managing patient intake. Co-op could make the overwhelming nature of plague treatment more manageable by letting friends specialize in different aspects of medical care.

The co-op implementation raises interesting questions about how the game handles decision-making and resource allocation between players. Can both players perform surgery simultaneously on different patients? Do you share a resource pool requiring coordination, or does each player manage their own supplies? The announcement trailer doesn’t show multiplayer gameplay, leaving these details mysterious until closer to release or during potential beta testing phases.

Historical Accuracy vs Playability

Balancing historical accuracy with engaging gameplay represents a significant challenge for any medieval medicine simulator. The reality is that plague doctors had limited understanding of disease transmission and almost no effective treatments. Most patients died regardless of care received, which makes for depressing gameplay if simulated too accurately. PST Games must walk a line between honoring historical reality and creating mechanics that give players agency and the satisfaction of successfully treating patients.

The announcement trailer suggests the game leans toward accuracy even when uncomfortable. Graphic surgery scenes, body piles, and the overall tone indicate PST Games isn’t sanitizing medieval medicine for mass appeal. This approach should attract players specifically interested in historical simulation willing to accept that success means reducing death rates rather than eliminating mortality entirely. The inclusion of clearly doomed scenarios where you watch everything crumble suggests the game embraces the historical reality that many plague doctors failed despite their best efforts.

Similar Games in the Genre

Plague Doctor: Life in Pestilence joins a surprisingly robust sub-genre of dark medieval medical games. The Plague Doctor of Wippra released in 2022 as a point-and-click adventure focused on puzzle-solving and narrative rather than simulation. Surgeon Simulator’s goofy physics-based surgery contrasts sharply with the serious tone PST Games is presenting. Medieval Dynasty includes medical elements but focuses more on settlement building than healthcare specifically.

The closest comparison might be games like Project Hospital or Two Point Hospital stripped of their modern conveniences and optimistic tone, then transplanted to the Black Death. Players who enjoyed the management aspects of those titles but wanted darker subject matter and historical setting should find Plague Doctor: Life in Pestilence appealing. The game also draws comparisons to survival crafting games where resource scarcity creates tension, except instead of building shelters you’re building funeral pyres.

Steam Features and Accessibility

According to SteamDB information, Plague Doctor: Life in Pestilence will support Steam Achievements and Steam Cloud saves. The game requires a 64-bit operating system and is listed as Windows-only at launch, though many indie developers add Mac and Linux support post-release if demand justifies the porting effort. The game carries a General Mature Content descriptor, which is unsurprising given the subject matter involving disease, surgery, and death.

The Steam page is live for wishlisting despite no confirmed release date beyond “Coming Soon.” PST Games likely wants to gauge interest and build a community before committing to specific launch windows. Wishlisting helps developers understand potential market size and provides notification infrastructure for when release dates are announced. Given the announcement trailer just dropped in early December 2025, a release sometime in 2026 seems probable assuming typical indie development timelines.

What We Still Don’t Know

The announcement trailer raises more questions than it answers, which is typical for initial reveals meant to generate interest rather than explain every system. We don’t know how progression works beyond the general “quack to reputable doctor” arc. What specific upgrades or abilities do you unlock? Is there a skill tree for learning new surgical techniques or herbal remedies? Does the clinic physically expand as you succeed, or is progression purely mechanical?

The day-by-day progression mentioned in the trailer suggests either a time management system where you must accomplish certain goals before plague spread overwhelms your capabilities, or a narrative structure with specific story beats tied to days. How much agency do players have over the story versus following a predetermined path? Can you fundamentally change outcomes through skilled play, or does the narrative railroad you toward inevitable tragedy regardless of performance? These details will determine whether the game has replay value or functions as a single playthrough experience.

Community Initial Reactions

Early community response on Reddit and social media has been cautiously optimistic. Players appreciate the unique setting and subject matter rarely explored in gaming. The authentic historical approach appeals to simulation enthusiasts tired of fantasy settings or sanitized history. Some concern exists about whether the gameplay loop remains engaging once the initial novelty wears off, as treating endless plague patients with limited tools could become repetitive without strong progression systems or narrative hooks.

The mature content and grim tone will limit mainstream appeal, but that seems intentional. PST Games is targeting players specifically interested in dark historical simulation rather than chasing mass market accessibility. This focused approach increases the chance of satisfying the niche audience that actually wants to roleplay as a medieval plague doctor rather than disappointing everyone by compromising the concept for broader demographics.

FAQs

When is Plague Doctor: Life in Pestilence releasing?

PST Games hasn’t announced a specific release date beyond “Coming Soon” on Steam. The announcement trailer dropped in early December 2025, suggesting a 2026 release window is probable based on typical indie development timelines. Wishlist the game on Steam to receive notifications when the release date is confirmed.

What platforms will the game be available on?

Plague Doctor: Life in Pestilence is confirmed for PC via Steam with Windows support. The game requires a 64-bit operating system. No console ports or Mac/Linux versions have been announced, though indie developers sometimes add additional platform support after launch depending on demand.

Is Plague Doctor: Life in Pestilence historically accurate?

The game aims for historical accuracy in its depiction of medieval medicine during the Black Death, including barbaric treatments like bloodletting, leeches, and amputations. However, some gameplay concessions are necessary to make it engaging rather than purely depressing, as most plague patients died regardless of treatment in reality.

Does the game have multiplayer or co-op?

Yes, the Steam page lists Online Co-op as a feature. This suggests multiple players can run a clinic together, though specific implementation details haven’t been revealed. The announcement trailer doesn’t show co-op gameplay, so exact mechanics remain unknown until closer to release.

Who is developing Plague Doctor: Life in Pestilence?

PST Games is both developing and publishing Plague Doctor: Life in Pestilence. Little public information exists about PST Games as a studio, suggesting they may be a newer developer or small independent team. This is likely their first major release based on available information.

How graphic is the game’s content?

The announcement trailer shows graphic surgery scenes, disease symptoms including plague buboes, body piles in streets, and other mature content. The game carries a General Mature Content descriptor on Steam. Players uncomfortable with medical gore or disturbing historical content should approach cautiously.

Can you actually cure the plague in the game?

Given historical accuracy, completely curing the plague seems unlikely. The trailer emphasizes you can “save those affected, or watch it all crumble,” suggesting success means managing the crisis and reducing deaths rather than eliminating the plague entirely. Failure states apparently exist where your clinic collapses under overwhelming patient numbers.

Will there be a demo or early access?

PST Games hasn’t announced plans for a demo or early access period. Many indie simulation games do offer demos or early access to gather feedback and fund continued development, but nothing has been confirmed for Plague Doctor: Life in Pestilence yet.

Conclusion

Plague Doctor: Life in Pestilence occupies a fascinating niche that few games dare explore: the unglamorous reality of medieval medicine during humanity’s deadliest pandemic. By committing to historical accuracy even when that means depicting barbaric treatments and overwhelming mortality, PST Games is crafting a simulation for players who want authenticity over power fantasy. The progression from unknown quack to respected physician provides structure, while resource scarcity and impossible ethical choices create meaningful decision-making beyond just clicking through procedures. Online co-op adds a cooperative element uncommon in dark simulation games, potentially letting friends share the burden of treating endless plague victims with medieval tools that barely work. Whether the gameplay loop remains engaging across multiple hours remains to be seen, but the concept alone justifies attention from simulation enthusiasts and history buffs. If you’ve ever looked at a plague doctor’s beaked mask and wondered what practicing medicine during the Black Death actually entailed, Plague Doctor: Life in Pestilence promises to answer that question in graphic, uncomfortable, historically grounded detail. Head to Steam and wishlist it now if you’re ready to trade modern medical miracles for leeches, prayers, and the grim satisfaction of slightly reducing mortality rates during the apocalypse.