I think it would be really cool if communicable diseases other than the infections and miasma we currently have were implemented into Dwarf Fortress. The symptoms of these diseases could be randomly generated. These diseases could range from minor colds that would incapacitate a dwarf for a few days to plagues that could wipe out entire settlements. Each disease could spread a different way. For instance, you could have some diseases spread through the venom of cave spiders or bees. Diseases could affect different species with some affecting all sentient races, and others only affecting specific animals. These diseases could have procedurally generated names like "Orange Pox" or "Sheep's Scourge". Diseases could also affect crops, like the potato blight but for plump helmets. There is so much room for creativity here. Some diseases could have more exotic, or magical effects on their victims, like turning them into a different animal or making them grow extra limbs. Historically plagues and diseases have played an enormously important role in the growth and decline of civilizations. There is no reason to think that this wouldn't also occur in a medieval fantasy world. There are just so many interesting possibilities. It would add a whole new layer to the game!