In the hard scrabble lands of the mountain provinces, where peasants struggle to eek a living from the thin soil, the Rite of Bile Blood is offered to a man at the point in their lives when they are too old and infirm to work the fields, or should they become too injured to provide for their families. In some ways, it is considered both a great honor and a terrible shame.

Should the man accept the rite, a great funeral is held for him while he still lives. Stories are shared of his self-sacrifice and an empty coffin is buried. From that moment, the man is treated as though dead to the community, his soul considered to have departed his mortal remains, even if those remains remain talking and ambulatory.

The man is sequestered away from public view by the town shaman or holy man. The man is fed on a diet of fresh, female orc blood until his stomach swells. Orc raids are so commonplace in such areas that it is one of the few resources they have in abundance. No other food or water is offered; the potency of the orc blood alone sustains them.

The human form holds out as long as it can but, though it may take a week or a month, in time it succumbs to the rapacious orc taint, which spreads through his veins, reforming his flesh. He emerges transformed, the mind of a man in the body of an orc. Whatever his condition before, he is made hale and strong, though forever lowered to the status of a beast. The man is returned to his family as their property to serve them as a workhorse, tirelessly tilling the stony fields, enduring physical deprivations that would kill most humans.

While they may be a cherished beast-of-burden for their former family, they are distrusted by the rest of their community, even as the memory of the man they once were is enshrined and elevated to sit alongside the vaunted ancestors.

In the more remote, inhospitable reaches, few families do not own one of these pitiable creatures, for without their labor, survival would be almost impossible.