Surgical Practices:

Surgery in Everwealth is a last resort, an act of brutal necessity performed by desperate hands in blood-slick rooms or battlefield trenches. True surgeons are rare, found mostly in the retinues of nobles, the employ of guilds, or buried behind clinic doors in fortified cities like Opulence or Catcher's Rest. In most of the kingdom, a “surgeon” might be the town tanner with a steady grip, or the blacksmith’s widow with enough guts to cut where others hesitate. Tools range from repurposed bone saws to iron-forged knives and fire-blackened tongs. Anesthesia, when available, comes in the form of gutwine, boiled poppy extract, or a sharp knock to the head. Magick is rarely used, either forbidden by The Arcane Coalition, feared by the poor, or too unstable for internal work. And when it is used, it’s usually to close, not cut. Amputations are the most practiced and reluctantly accepted form of surgery. Infected limbs are hacked off above the rot, cauterized with hot iron, then packed with salted moss or powdered limestone. Tumors are cut only if they bulge outward, and internal bleeding is more often prayed over than treated. Trepanning, drilling into the skull to “release spirits or bad blood”, is still performed in some lowland and border regions, especially on the mentally ill or those who survived magickal possession. Stitching is crude but effective when done by experienced hands, often using horsehair, fishing wire, or the sinew of small game. Few procedures are named formally outside the cities, with operations typically known by grim titles like “gut-stitching,” “bone scrape,” or “the quieting.” Despite its horrors, surgery remains an essential craft, more feared than revered. Those who practice it walk a razor’s edge between savior and butcher. Their knowledge is fragmented, often built from old battlefield notes, drunken recollection of pre-Schism texts, or experimentation on the dying. The Scholar's Guild hoards most true medical literature behind warded doors, and when such knowledge leaks, it is rarely in the hands of saints. Still, to the poor and the wounded, a shaky hand with a sharp blade is sometimes the only hope they’ll ever have. And in Everwealth, even that is worth its weight in silver.