A land is reigned by a circle of powerful men who control every aspect of the citizen's life. This cabal changes members often. In reality, the spectres of a small necromantic covent possess and control the people in power. Since they simply possess the bodies, they can leave when old age overcomes their shells and possess a new up-and-coming noble.
Pick up a pathology/microbiology book, and add the diseases/syndroms to your game. Your players will freak out.
Coughed at? Diphteria. or tuberculosis?
Drunk from a muddy stream? Or just walked through? Well, let us introduce you to schistosomiasis...
Hit by a stream of energy? Too moch mana is ust like too much radioactivity - perhaps all mages could develop cancer early if too powerful...