Skill Scale Down 2021

This skill has been impacted by the Skill Scale Down. The impact of this for this skill is as follows:

• This skill remains. It will be gaining knowledge from Surgery and Poisons.
• All knowledge for Surgery and Poisons now counts as Medicine Knowledge.
• For how to deal with XP, please see the page Skill Scale Down 2021 for links, information, and a player guide.
• The scope of this skill now includes what was previously covered by Surgery and Poisons. Please ensure that you take this into account going forward.

Overview

Development Credit: Alistair/Incubus

The Basics of Medicine
Medicine is a science as old as civilization, though with many different variations across time, technological development and cultures. This skill - as known by doctors across Idalos - is one that encompasses the fundamentals of contemporary medicine, weaving examination, diagnosis, treatment, recognition and prevention of disease and knowledge of medicinal reagents into a complex weave of practices. It is impossible to call yourself a true master of medicine without gaining knowledge on the variable types of illnesses and afflictions and how to properly deal with them. However, all doctors of great skill know the fundamentals of medicine - as written here - and it is upon these fundamentals that they build and expand into other variations and less staple forms of the art of health.

Doctors and surgeons often work in tandem, and medicines can often benefit the surgical process. Thus, often medics and surgeons both learn some or all of the skillsets of one another to ensure they are at the peak of their professional practice.

Types of Practice

Diagnosis
This is the first and most essential goal of an aspiring doctor. In order to properly treat any condition, it must be diagnosed. Doctors learn how to properly diagnose illnesses and diseases early on, though the most complex of afflictions remain obscured from them until the later stages of their development. Diagnosis is, essentially, detecting and categorizing both common and uncommon symptoms, examining the current condition and medical history of the patient, and cross-referencing the information in order to properly determine the illness or affliction from which the patient suffers. It is through accurate diagnosis, and some would say only accurate diagnosis, that the more grievous of health issues may be properly solved.

Treatment
Treatment is of course the most varied, wide and fundamental aspect of medicine. Once you have discovered what is wrong with the patient, treatment can begin. This can take many forms, and treatment itself has thousands of different practices within this large category. Treatment can be anything from applying medicinal compounds, both preventative and recuperative, to prescribing a certain diet, to massaging a patient with physical ailments, cooling a fevered body with ice or exotic reagents, to sending the patient to professional surgeons for amputation.

There are many different types of doctors that specialize in many different forms of treatment. The most common are pediatric physicians (those who care for children), general physicians, physical therapists and assistant surgeons. All doctors can learn all forms of treatment, but such a task is colossal and has almost never been done. Thus, most specialize in one, two or rarely three forms of treatment and they often refer their patients who require a different form of assistance to someone else.

Prevention
Prevention is different than treatment and diagnosis in that it aims to treat - or prevent - something that has not yet occurred. Disease prevention is the most common form of prevention, and those concerned about a history of disease in their family, for example, may often seek assistance from a doctor. Prevention can be done in the form of prescribing herbs, teas, medical liquids, powders, and other such things in order to give oneself an inner fortitude to fight oncoming disease. During plagues and other incidents, prevention is often on the forefront of medical sciences.

The Usage of Tools
Tools are often used by doctors to examine individuals and treat them. Most doctors have basic tools such as leather bands to coagulate blood or test blood pressure. Specialized tools for seeing into areas of the body not otherwise accessible to the eye are another common item. There are some tools said to be able to properly measure heart rate, though heart sciences themselves are highly undeveloped at this point and so the average doctor generally only carries with them leather bands, some medicinal drugs and a first aid kit (see the Price List).

A current breakthrough is the experimental new use of sterilized and purified stingers from certain creatures. These stingers are sharp hollow tubes, and they allow the internal "injection" of compounds that would have previously had to be applied by opening the tissue with a knife and smearing it into the wound. Infection has become far less common as a result. Other experimental theories are being put forward every trial, but require long-term professional testing before being put into wide-spread practice.

Keeping Records
A newly recognized practice is to learn, in advance, if potential patients all react the same way, and to the same degree, to the medicines that are used in accepted treatments. This is to avoid complications in using a standard treatment on a patient that has shown to have a reaction to it. This can be done with the applications of small amounts to a healthy patient and see if there is a negative reaction. Any anomalies are recorded for future precautionary purposes.

This approach can also be applied to the taking of fluid samples from healthy patients. The look, color, consistency, viscosity and even odor of such fluids will often be recorded for cross-referencing with samples taken later, when the patient is actually stricken by disease or toxin. The aforementioned heart rates are another indicator that is often recorded when healthy. Differences in these aspects have begun to fill a significant portion of the information currently being used to make diagnoses.

Surgery

Development Credit: Rose Greenwood

Surgery is the skill associated with treating illnesses, deformities, or wounds by utilizing different surgical methods. These methods can range from carefully administered stitches to the amputation of a major limb. Often these methods involve the use of tools and specialized instruments such as scalpels, forceps, or saws. Skilled surgeons are a rarity within Idalos as it requires access to resources and knowledge in order to be successful in this field. A clean workplace and sterilized tools are a must if the surgeon is to avoid killing the majority of their patients. Although the source of infection is not well understood in Idalos, it is known that patients can become incredibly ill after surgery if the incisions or the surrounding environment are not kept hygienic.

Technique, knowledge and cleanliness are the three pillars of an effective surgeon.

Types of Surgery

Minimally Invasive Surgery

Available at Novice

This type of surgery rarely involves endangering the patient as there is less pain and a lower risk of infection associated with it. Administering stitches or making small incisions to treat illness or wounds is covered under this type of surgery. Examples of Minimally Invasive Surgery would include removal of potentially hazardous growths from the skin, lancing boils, or stitching a laceration.

Amputation

Avaliable at Competent

Amputation consists of the surgical removal of digits or limbs from the body of a patient. Amputation is sometimes the only way to save the life of a patient; either due to gangrene or extreme damage to the limb. With amputation the surgeon should always anticipate the possibility of the patient dying from blood loss during the procedure. Preparations must be made in order to prevent loss of blood.

Invasive Surgery

Avaliable at Expert

Invasive surgery involves any type of surgery that requires highly invasive means in order to treat the patient or diagnose a condition. The chance of infection is very high with this type of surgery so the surgeon must be meticulous in sanitizing the surgical space along with the incision site. Blood loss is also common with invasive procedures. A more common example of Invasive Surgery might include the removal of a tumor or locating sites of internal bleeding that require cauterization or suturing.

Experimental Surgery

Available at Master

As surgical techniques improve over time the master surgeon can begin experimenting with new methods of surgery that have never been attempted before. As the surgeon is breaking new ground they will be faced with a mixture of failures and successes. However, successfully created surgical techniques will enhance the field in far reaching ways. As surgical technology is still in it's infancy in Idalos, new methods and development to existing methods are being discovered every trial. Innovative masters in the medical field along with those blessed with divine inspiration are working tirelessly to solve health issues that have baffled healers for arcs.

Surgical Skills

Note: The development of new surgical skills is always ongoing. New skills can be added as the field advances.

Suturing

Avaliable at Novice

Sometimes known as stitching, suturing is the simple act of sewing wounds and incisions closed once they have been disinfected and treated. Suturing greatly minimizes the chance of a wound becoming infected and helps accelerate healing. A well administered set of stitches will also help prevent potential scaring.

*Note on Suturing - The Raft (Credit to Faith & Padraig): The Raft is a type of waterproof bandage that was recently developed in Rharne during Zi'da 716. It is made of a gel-like substance that promotes healing and staves off infection when applied. It can be used as a superior replacement for stitches where it is available. Availability for this item will be increasing over time as the formula becomes more well known.

Preventing/Stopping Blood Loss

Avaliable at Novice

There are many methods for preventing blood loss but the most common way is to simply apply pressure to the wound or incision site. This can be achieved with hands or a tourniquet of some kind. Additionally substances with styptic (anti-hemorrhagic) properties can be used to slow or stop bleeding. An example of a simple styptic agent would be cornstarch. In rare cases where hemorrhaging must be stopped quickly and there is no time to use gentler methods, cauterizing can be used to stop excessive bleeding. This method is not always advised since it is often very painful for the patient.

Sanitizing a Wound/Incision Site

Avaliable at Novice

Methods for sanitizing a wound can be incredibly varied depending on the skills of the surgeon. The simplest way to sanitize a wound or incision site is to thoroughly wash the area with clean warm water and a freshly laundered cloth. This method does not guarantee protection from infection but it does remove some of the risk. Other methods can involve the use of herbs with sanitizing properties or other chemical compounds.

Treating Broken Bones

Available at Competent

The setting of bones typically involves the surgeon manually manipulating the fractured bone in order to align the pieces that have been damaged and dislodged. This skill can take both a fair amount of strength and a delicate touch to accomplish successfully. Once the bone has been set it can then be set into place for healing by either a brace or a cast. Immobilizing the bone after being set is of utmost importance if the limb is to heal correctly. If treated by an unskilled surgeon, sometimes the bone can grow back incorrectly and become malformed. In this case another more capable surgeon should be tasked with re-breaking the bone in order to set it correctly.

Sedation

Avaliable at Expert

Sedation involves the use of chemicals to induce unconsciousness in patients. Sedation is typically used to render the patient unconscious so surgery can be performed painlessly. Use of sedative chemicals or compounds must be done with extreme care since these substances can very easily kill a patient if given in excess. Additionally the surgeon must take into account that their patient may wake up during surgery if they do not give them enough of the sedative to begin with.

Blood Transfusion

Available at Master

This skill is a rarity among surgeons in Idalos as it has only recently been discovered and successfully tested. The master surgeon is only able to successfully utilize this skill due to their ability to ensure completely sanitary conditions during surgery. Additionally the surgeon must have the skills to ensure that the blood type of the patient matches the blood type of the donor. It is now understood that not all blood is the same; if incompatible blood is used then the patient can become extremely ill or potentially die. Typically tools such as needles and tubes are required to accomplish a successful blood transfusion.

Complementary Skills

Alchemy: Much like chemistry, alchemy can be used to create a great variety of substances that can be used as sedatives or painkillers. Beyond that the alchemist can create equipment that may better serve the surgeon that normal surgical tools.

Science: Useful in creating chemical agents for use in sterilizing tools and the surgical work space. Additionally, chemistry is key in creating sedatives and painkillers that can be used to reduce the physical stress of surgery.

Detection: The surgeon is better able to notice changes in vital signs and locate problems during surgery

Discipline: Allows the surgeon to stay focused; in the heat of a battlefield or during a delicate procedure.

Endurance: Endurance will aid in keeping a tired surgeon on their feet.

Gardening: May provide the surgeon with knowledge associated with plants and their uses as sedatives or antibacterial cleaning agents.

Needlecraft: Suturing is made cleaner and more uniform; enables the surgeon to leave fewer scars.

Poisons

Overview

The study of poisons and drugs extends far beyond the simple crafting of deadly chemicals. It takes no study to enter a general store, buy some rat poison, and jam it down an enemy's throat. The skill comes in getting away with it. This is not referring to some daring escape from angry guards. Nor some guarantee that the victim does not gag it back up. The skill is in the engineering of the compound so that no one even knows the toxin has been administered until the perpetrator is long gone and never even suspected. As well as so embedded in the victim's biological systems that he cannot be saved.

A master toxicologist can engineer an attack with such suddenness and mystery as to be on a par with magic. The very squeak of an overtone produced by a musical instrument may trigger a muscular cringe, causing a physiological spike of seemingly negligible effect. But there may already be several elements of the final compound in the victim's body; each one ineffectual until completed by the simple heating of the skin from a blush of embarrassment - the final element. The chain reaction begins; the victim withering and dying before the eyes of a horrified crowd; the musician dragged off for interrogation, pleading his innocence in vain.

Now of course, there is something to be said for the learning of different sources of the toxin itself. And they are found in every class of flora, fauna, mineral and gas; as are the reagents which allow the "fine tuning" of the toxin's effect envelope. Even the novice can create deadly compounds. But they are easily detected, not only by the look and smell before being planted in food or drink; but by the look and smell of the food and drink after being spiked.

Also, there is the potency concern. Generally, the more tailoring a compound undergoes, the less potent the final toxin will be. Increased skill will allow a greater degree of purity, which equates to both greater potency and shelf life, in addition to the added control over secondary effects, triggers, delay and disguised origin. These skills are what the toxicologist truly develops as he grows in skill.

This "tailoring" and "engineering" is accomplished through the use of reagents. These substances are not generally toxic in and of themselves, though they are rarely beneficial either, but they are the means to control the release and reaction of the toxin. An unskilled poisoner can smear a toxin on the blade of his dagger, and is every bit the threat to his target that a devious master is. But the toxin is plain to see. So an adversary may change his mind about staying to fight, or may adopt a different fighting style that makes the presence of the toxin less likely to be significant.

With a little more skill, the poisoner may include a masking agent, to hide the discoloration of the compound. As well, he may blend a thinning and binding agent to make the compound smear as easily as water, but still stick to the blade. Other masking agents will neutralize smell, or glare from the coating.

Legend speaks of a master that acquired a sample of a target's own mucus and reverse engineered a toxin so that, even after all the other elements were in place, the man still needed to sneeze to introduce the last element of the compound to trigger the poison. Obviously the target's own mucus was not toxic to him. But the master had found a capability, in its texture, to immediately seal away an inhibiting reagent. The target actually had the entire toxic compound in his body, but one element was blocked by the presence of this inhibitor. So when the man sneezed, the sealing capability of his own mucus blocked the inhibiting agent, allowing the full blending of the toxin.

The man had actually been poisoned halfway around the world. But had been in such good health that he had not sneezed until he reached a city where certain pollen triggered his allergies, causing him to sneeze. The Toxin Master had done his research on his target and learned of this allergy. Panic ensued, the population believing all kinds of exaggerated theories about what killed the man, never knowing it was an element in a drink in one tavern; the prick of a dart in another; a spice in a meal at an inn; an oil in a massage at a brothel; a sample of perfume in another; and a small stain on a chilled cloth he wiped his face with on a hot day.

Now of course, it is rare that such a degree of misdirection is required. Politics were the guiding purpose in that scenario. Most folks simply want an edge in a fight, or a quiet strangling death in an alley to someone who has bullied them all their life. But perhaps a powder to be blown in the face is a better method than a coated dagger. Or a mist from a plant sprayer instead of something hidden in the gravy on a man's potatoes.

Also, death may not be the intention. Perhaps an inn owner would like a new rival discredited. It would be very handy if it appeared that several customers got food poisoning from the man's stock, but no one needs to die of it. In these cases, reagents will be necessary to alter the form of the toxin to make it easier to administer by the chosen method. As well as to make the debilitating result more closely resemble the bacterial nature of food poisoning, rather than an outright toxic chemical.

Because the interactions between mortal cultures have been so strained, there is little sharing of information academically. As a result, there are virtually no assumptions made about what sources yield what toxins and/or reagents. New discoveries are being made every day in one corner of Idalos or another. The skilled toxicologist is the one that makes these discoveries. Learning, for example, that some mineral, believed to only be used to make dyes, can also be dissolved in water laced with the rinds of a local fruit, and that the resulting gas is a paralytic poison. But that this same rind, when NOT mixed with this mineral, is also an antitoxin to that very same poison.

This is just an example of how wide open the world of toxin and reagent discovery still is. Where one city may insist that only arboreal or fungal sources yield nerve toxins, another city may find such sources to yield primarily skeletal-eroding versions. One spider's venom causes nerve spasms that can be directed and perfected to stop a heart, where a spider on the other end of the continent causes brain damage and psychosis.

It's all in the creativity of the theory and the care taken to research and test it. Good luck.

Delivery Methods

Blood Toxins: The classic. This is smeared on a weapon, and gets in the blood stream from a cut. Or could be simply smeared by hand on an open sore. Responds to proteins in the blood. Be sure you do not have a cut on that hand. Here again, reagents can hold its effect until the blood carries the toxin to its desired organ.

Airborne: These are inhaled as gases or mists. Most often, these need to be tailored to dissipate quickly and only respond to wet internal tissue, like lungs or saliva. Otherwise, it can be very dangerous to assume that every wisp of an airborne toxin was actually inhaled by the target. Keep a cloth handy to cover your own mouth for a few minutes.

Ingestion: The other classic. Slipped into food or drink and most often tailored to be triggered by stomach acid. If it responds to saliva, a significant amount of the dose could be spit back out, resulting in failure. Pretending to swallow is a tactic many food testers employ when they are in on a plot.

Contact: Self-explanatory. This is frequently a liquid that soaks into skin. However, an airborne type may be blown onto a target. Most likely the eyes. Often hidden on towels or rags, possibly slipped into the inside of coat sleeves.

Examples of Reagents

Thinners and Thickeners: As it suggests, these are simply to adjust the texture of the toxin to make it more versatile in delivery. What is normally a blood toxin, could be thinned to be able to be sprayed as a mist. Or an airborne toxin could be thickened to apply to a blade.

Inhibitor: An element that prevents some stage of the toxin's completion or release. Commonly used to make it difficult to know when the target was poisoned. Also, to prevent the effect from manifesting before it reaches the target body part.

Trigger: The element which is going to react with the compound to unleash the toxin within the target. It is often not part of the compound itself. For example, in the Ingestion example, the "trigger" is the stomach acid.

Binder: An element that keeps the properties of two different reagents or toxins together, so the effects of both will be unleashed simultaneously. It usually has no direct impact of its own as far as the nature of the toxin's effects go.

Combinant: An element that actually blends the properties of two different reagent or toxins. This is used instead of a binder when it does not matter how soon the properties are blended.

Accelerant (or catalyst): Basically the opposite of an inhibitor. It speeds up the chemical reaction of two or more different combined elements.

Metabolizer: An element that encourages the generation of whole new elements within a target. For example, a fungus on the trunk of a tree secretes a metabolizer that causes the tree to synthesize an inhibitor, in an attempt to block the incursion of the fungal growth. An additional fungal enzyme transforms this inhibitor into a food source for insects, whose depravations soften the wood, allowing the fungus easier access. These also are the bases for secondary effects. The metabolizer generates some new element which then reacts to an additinal part of the compound included for that very purpose. This is how the initial episode of, say, paralysis, is followed by weeks of confusion.

These are, of course, just a few examples of the discoveries being made. New theories are being put forward all the time.

Skill Ranks

Novice (0-25)

A novice doctor has begun to learn the basics of diagnosis and treatment. They are usually able to perform nursing tasks and can assist patients with non-severe conditions. They often prescribe medicine or differing diets to their patients, and very often misjudge diagnoses for their patients. These individuals tend to be assistants rather than actual doctors and surgeons, and a patient left in their care may be better off than otherwise, but not by all that much.

The Novice surgeon is capable of performing minimally invasive surgeries. Infections can be very common if the novice does not work ceaselessly to keep themselves and their tools clean. Due to inexperience, patients are more prone to bleeding excessively under the care of this surgeon. Some might consider it preferable to avoid treatment altogether rather than face the scalpel of the novice. Suturing is done with little concern for preventing scars, so stitches are often messy and lacking in uniformity. At this level the surgeon only understands the very basics of preventing blood loss. The use of tourniquets is sloppy and ends up failing half the time. The novice is only versed in sanitizing wounds and work areas with boiled water and freshly laundered cloth. The use of chemical agents for cleaning is typically beyond the knowledge of this surgeon.

The student has progressed to the manufacture of basic toxins. He has not yet had cause to learn a great deal about reagents, beyond triggers, thickeners and thinners. He is experienced with basic pieces of lab equipment, and may even have ideas of new tools and processes. For safety's sake, he is not trying to expand his grasp of different sources beyond the one or two that first got him interested. Once he gets those down pat, he will venture cautiously into new territory.

Competent (26-50)

A competent doctor has decent knowledge on general medicine, illnesses, toxins and diseases. It is uncommon for them to make an incorrect diagnosis, if given all of the necessary information, in the case of simple conditions. But their treatments are often imperfect, even with a correct diagnosis, in the case of complex medical issues. A competent medic can often be a successful assistant to a surgeon. They know the basics of cauterizing and disinfecting, but they might not detect the symptoms necessary to diagnose the correct form of treatment or surgery. Thus, complex illnesses such as necrosis (and by extension gangrene) may go unseen by them, or they may prescribe an entirely incorrect treatment. Many patients have died at the hands of a competent doctor who made an incorrect call in the proper treatments. Often, they see later that the records they kept are better off being discarded.

At Competent, the surgeon has become much better at keeping their workspace and tools sanitary. Now patients run a much lower risk of become ill from infection following their surgery. Now that the surgeon better understands the importance of a clean workplace they may now begin using antiseptic components and chemicals to further prevent the chance of infection. The risk of blood loss has lowered and the surgeon has become competent at stopping blood loss more easily should it occur. The competent surgeon can now successfully amputate fingers and toes to prevent conditions such as gangrene or frost bite from damaging the limbs. Keep in mind that amputations will be painful since the surgeon does not yet understand the delicate nature of using sedation on their patients. Attempts to amputate larger limbs will almost always result in death. Stitches will now be more uniform and straight, allowing wounds to heal cleanly and lessen the chance of scaring. Competent surgeons can now successfully set bones and prepare them for healing with the use of a cast or brace. Due to inexperience these surgeons may run the risk of incorrectly aligning bones from time to time.

A whole new world opens up to the toxicologist. He has learned enough to know that he hardly knows anything at all. The safety lessons he has ingrained into his procedures benefit him greatly as he starts to dabble with new things. But it will be a long hard road, with each new source and reagent application he discovers. Care and testing is paramount. Strangely though, he finds that after a recent lab mishap, he did not suffer quite such an effect as he'd feared. Could he be developing a resistance? It would only be a slight one, and only to the products he's been working with for a while. He also comes to realize that chemical impact does not always have to be debilitating or deadly. He begins to work on drugs and antidotes. He also finds the potential for secondary effects opening up.

Expert (51-75)

An expert doctor is one that nearly always makes the right call in diagnosis. Their knowledge of symptoms and medicines is extensive and they can spot the beginnings of nearly any disease, affliction or illness. They can properly put together correct treatments for their patients via medical history and even family history, thus they are reliable for the practice of prevention as well as treatment. They nearly always know which medicine to apply to an illness, wound or oncoming disease, and can determine the quantity and dosages necessary. Few patients who go to an expert doctor find themselves anything but better after being given their care. Records kept by these professionals can be trusted to be detailed, accurate and highly informative.

The possibility of infection has reduced to the point that patients often survive surgery without any complications. The expert surgeon is absorbed with cleanliness. Blood loss and scarring from incisions or stitches are a rare occurrence. It is at this stage that the surgeon is capable of successfully amputating any limbs with little difficulty. Additionally the expert surgeon can begin experimenting with more invasive surgeries. Invasive procedures will be met with many difficulties as the surgeon learns techniques associated with such risky operations. At this level the surgeon can use sedation to make the surgery much less painful for their patients. From time to time the surgeon may administer the incorrect dose of sedative and run the risk of killing their patient or allowing them to wake mid-surgery. Setting bones has become commonplace for the expert surgeon. Only rarely does the surgeon mistakenly misaligned a fractured bone.

The poisoner is energized to find his resistance becoming more pronounced. This enthusiasm is diminished though, when he discovers the meaning of the word "withdrawal", as it pertains to his drugs. There is no longer any limit to what natural sources he can work with, but he is clearly better at the old ones than the new ones. But he is able to make use of sources from pretty much anywhere, with testing. His toxins have created a demand for his antidotes, and the grim realities of a world at war have also generated a demand for his feel-good, or performance enhancing, drugs. Depending on his morality, he may or may not wish to make his drugs less addictive.

Master (76-100)

A master doctor will know how to properly deal with nearly any situation. They have seen and studied the worst of toxins, diseases, and even debilitating forms of magic from all across Idalos, and will almost instantly be able to recognize an affliction and prescribe the proper treatment. They know of medicinal reagents and many of their sources, numerous variations of treatments for most every condition, all the signs of negative reactions to standard practices, and detailed knowledge of diseases from all across the world; and can usually perform all aspects of medicine quite well. As someone with complex knowledge on the versatility of practically all known medicines, they can usually help to fight even previously unknown illnesses, and guide a patient back to good health and rehabilitation; even in the case of permanently scarring afflictions. The records kept by these masters are highly sought after by medics around the world.

Through careful preparation the master surgeon is capable of maintaining a pristine clinical environment that guarantees the complete prevention of all infections. The chance of blood loss is almost completely mitigated due to the sheer skill of the surgeon. If blood loss occurs the master surgeon can easily stop the blood flow with very little effort. With the perfected use of sedatives they have rendered surgery nearly completely painless. Patients rarely if ever run the risk of dying from sedation or waking up during surgery. The master surgeon never scars or maims their patients as they have an incredibly delicate touch and impressively nimble hands. The technique used in setting bones has become perfected as the master surgeon is always successful in setting a fracture. Blood transfusion can be accomplished at this stage, although this procedure will always carry the risk of the patient dying or become very ill the surgeon does not take every precaution. All forms of surgery come easily to this surgeon. As such, the master can begin developing new surgical techniques via experimentation. Experimental surgery will be fraught with trial and error but through careful study and experience the master surgeon is capable of pushing the field ever forward.

Just when the poisoner thought he was at the top of his craft, a new element is introduced. Fractive elements. Where immortals have died, or from the bodies of those imbued with immortal powers comes a new reagent and goal to work towards... Mutagens! Found within the very soil and seed of fracture sites, he learns of supernatural potential. Creatures bent or resurrected by immortal will may hold secrets to compounds capable of unlocking spectacular abilities. Or they may hold cursed afflictions of horrific fates. Theories abound that some of the horrors walking Idalos today originated in the minds of mortals, and not immortals. And now, only such bizarre new toxins hold any real threat of accidental poisoning for the Toxin Master.

Progressing Medicine

• Capstones
• Grandmasters
• Tier 2 PCs

Medicine Knowledge

The collapsible below has examples of Skill Knowledge for this skill. If you are unsure of what Knowledge is, please check the Knowledge Primer for details. Please remember that our Peer Reviewers will be checking to make sure that your Knowledge claim is appropriate to what you have learned in the thread and ensuring that you are not duplicating knowledge.

A guide to knowledge can be found here (this link takes you to the site) and the person reviewing your thread will do so following the steps laid out in the Peer Reviewer Guide. If you wish to use one of these knowledge in your request, please ensure that it is appropriate to your thread.