As long as pain has existed, there have been creatures who wondered how it could be negated. When knives were first crafted, one of the first things for which they were used was to try to cut pain out of the body.

Although early attempts at performing surgery were less than wholly effective and not particularly safe, in the millennia since many races have learned some of the secrets of cutting bodies open and, more importantly, sealing them up again. The healers who become expert in this field are known as chirurgeons, or surgeons. Where healing magic is scarce, the chirurgeon is sometimes the most effective life saver.

Many Chirurgeons are Experts or Aristocrats.

Rogues, with their reliance on both high Dexterity and high Intelligence, tend to make the best Chirurgeons.

Clerics sometimes take up the mantle, but the loss of spellcasting ability dissuades many from this path.

Other classes rarely become Chirurgeons, though it is not unheard of; some of the finest Chirurgeons ever to live have been Paladins who sought respite from combat and turned their skill with blades to another use.

Hit die: d6


To qualify to become a Chirurgeon, a character must fulfill all of the following criteria.

Skills: Heal 7 ranks.

Feats: Skill Focus (Heal), Weapon Focus (knife, dagger, or scalpel/surgical blade).

Class Skills

The Chirurgeon’s class skills (and the key ability for each skill) are Bluff (Cha), Diplomacy (Cha), Heal (Wis), Intimidate (Cha), Knowledge (any) (Int), Perception (Wis), Sense Motive (Wis), and Sleight of Hand (Dex).

Skill Ranks Per Level: 4 + Int modifier.

The Chirurgeon
Level BAB Fort Save Ref Save Will Save Special
1st +0 +1 +0 +1 Improved Take 20
2nd +1 +1 +1 +1 Second, Do No Harm
3rd +1 +2 +1 +2 Third, Do Further Harm
4th +2 +2 +1 +2 Dull the Senses
5th +2 +3 +2 +3 Chirurgeon’s Knot
6th +3 +3 +2 +3
7th +3 +4 +2 +4 Team Leader
8th +4 +4 +3 +4 Prevent Disease
9th +4 +5 +3 +5
10th +5 +5 +3 +5 A Poor Workman

Class Features

All of the following are features of the Chirurgeon prestige class.

Weapon and Armor Proficiencies

Chirurgeons gain proficiency with surgical blades if they are not already so.

Improved Take 20 (Ex)

A Chirurgeon learns the value of working slowly and methodically and one who takes 10 or 20 on a Heal skill check gains an additional +4 circumstance bonus.

Second, Do No Harm: A Chirurgeon’s mastery of anatomy and knowledge of the body’s pain centers allows him to cause harm as well as repair it. At 2nd level, a Chirurgeon’s critical threat range with all slashing and piercing weapons increases by 1.

Third, Do Further Harm: Few realize a healer can do great harm until it is too late. At 3rd level, the Chirurgeon gains the ability to sneak attack for 1d6 points of damage as a 1st-level Rogue. If a Chirurgeon already possess a sneak attack, his sneak attack damage increases by 1d6.

Dull the Senses (Ex)

After much practice and experience, the Chirurgeon has become adept at judging how to dull a patient’s pain during surgery.

Beginning at 4th level, a Chirurgeon who has alcohol, opium, or another pain-killing agent readily available may calculate an optimum dosage for a patient on a successful DC 15 Heal check, regardless of the usual DC to use the drug. The dosage calculated renders a creature unconscious and helpless and prevents it from suffering any pain until 2d6 hours after the surgery is completed.

Chirurgeon’s Knot

After extensive practice in tying knots, the Chirurgeon is a master at the task. At 5th level, a Chirurgeon receives a +4 bonus to all Heal skill checks when closing wounds or staunching the flow of blood.

Team Leader (Ex)

At 7th level, the Chirurgeon’s confidence, skill, and reputation command the obedience of anyone helping the surgery. Whenever a creature uses an aid another action to assist the Chirurgeon, it provides a +4 instead of a +2 bonus.

Prevent Disease (Ex)

Although the Chirurgeon may not understand the workings of bacteria and viruses, years of practice have given him an instinctive knowledge of what predisposes a patient to illness post-surgery. Any creature operated on by a Chirurgeon of at least 8th level gains a +4 bonus to Fortitude saving throws versus post-operative infection.

A Poor Workman (Ex)

At 10th level, the chirurgeon has become so adept at his craft that even working with sub-optimal tools is no significant impediment. Such a Chirurgeon who has even basic tools available is always considered to have the +2 circumstance bonus from working with masterwork artisan’s tools.

Section 15: Copyright Notice

Insults & Injuries copyright 2021 Skirmisher Publishing LLC.

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