A PLAGUE DOCTOR Class for Old School Fantasy & Horror.

The modern archetype - Plague Doctor from Darkest Dungeon (II) - a self-medicating, grenade-tossing, trailblazing young woman and general badass.

Approximately early edition D&D-ish system agnostic; * means optional. 

Description: A sub-class of the Assassin and the Cleric, the Plague Doctor is a pioneer and practitioner of scientific medicine in a world with magical healing, the harbinger of a scientific and technological revolution that will never come.

They seek to oppose and dismantle the exclusionary racket of magical healing (see 1e DMG pp. 103-104) - to replace it with their own rational and enlightened exclusionary racket based on cutting edge science (leeches, miasmas, humoral theory, astrology, phrenology, haruspicy etc).

Despite their alien appearance and grisly reputation (the traditional regalia is believed to date back to the first Plague Doctors who tended to the dying and tallied the dead when epidemic outpaced cure disease), Plague Doctors are serious professionals attempting to fill a gap in the landscape of healing.

Sometimes known as Leeches, Tallymen, or whatever their mask most resembles. They prefer you address them as Doctor or Master.

XP, attack matrix, saving throws:  As Cleric.

Hit Dice: d6 (*or 2d4 at 1st level, d4 each level thereafter for monastic Plague Doctors).

Prime Requisites: Dexterity and Intelligence.

Armour: Anything they like but it will hamper them as it would a Thief.

Plague Doctors prefer the distinctive and traditional uniform of their profession (equal to Leather plus closed helm, gauntlets and protective boots). Here's some unflavoured mechanics:

• Mask: Advantage/bonus to save vs. airborne disease, stench, smoke, poison gas, foul air etc. and/or doubles minimum safe time in those conditions. Also protects the eyes as (game) logic dictates.
• Surprise, listening and perception-type checks penalised by c. 20% due to restriction of hearing and peripheral vision. Can't detect anything by scent.
• You need to replenish the supply of medicinal herbs/neutralising substances in the mask daily and/or after exposure (1 unit of common currency every time) or the mask loses its protective properties.
• Depending on the tech level of the setting, the mask can be connected to an air pump or tank.
• Robes: Pre-modern hazmat suit. Advantage/bonus to save vs. splash, touch and other contact effects and/or doubles minimum safe time in applicable conditions.
• Protective, not indestructible.

Weapons: Knife and grenade-like missiles.

*Syringes, clysters and reinforced bellows for administering gaseous and liquid cures; surgical instruments (such as the cleaver, dagger, hand axe, and notched heavy cutting blade); firearms (for dispersing miasmas and frightening disease spirits); mancatcher, staff, club, spear, blackjack, net, whip, blowgun (for subdual and crowd-control); close range bolt guns (air, string, spring or powder) for administering end of life care. Flame-throwers. Burning oil and flaming torches. Poison and venom. Chloroform-soaked rag.

*Magic: Plague Doctors affect a pose of 1e Unearthed Arcana Barbarian detestation of magic (though they hold Clerics in lower regard than Magic Users).

But in reality they're not averse if it gives them an advantage, as long as they can plausibly ad/or stealthily deploy it while maintaining their public professional stance.

*XP awards for destroying magic items as part of their mission; incorporation of Barbarian First Aid to the Plague Doctor special ability.

Alignment: Any Evil - sub-class of the Assassin; in opposition to the healing gods.

The older, satirical archetype - Dr. Beaky.

Special Abilities.

Autopsy: Spend 2-4 hours (-1 turn for each level over 3rd; minimum 2 hours) dissecting and otherwise examining a corpse, and you have a 60% + 2% per level of accurately determining time and cause of death.

Sometimes cause of death is obvious/commonplace and will not need a roll/take the usual time. The older the corpse, the less accurate the results.

*% penalties if the corpse is non-human, non-humanoid and/or magical. Though you might learn something anyway.

Diagnosis: INT check to determine the medical problem (and the methods of treatment): mundane wounds, disease, poison, diet, age, madness etc. Cumulative +1 at 3rd, 6th and 9th level. Situational bonus or auto-success for having appropriate medical treatise/specialist diagnostic tools at hand. 

Sometimes the problem is obvious/commonplace and will not need a roll. Sometimes the doctor will make something up.

Sometimes the diagnosis cannot be made without communication and cooperation from the patient.

*In a magical world, a medical doctor may also be able to diagnose whether the problem is magical in nature, if not the specifics.

*Disadvantage/penalty if the patient is non-human, non-humanoid and/or magical.

First Aid: Term of convenience - tweak to suit your setting if it breaks immersion. This is bandaging or sewing wounds, applying ointment, irrigating, applying tourniquets, cauterising etc.

In combat, heal d3 with a DEX check; after combat, heal d4 without a check; within an hour, heal d2 (no check). 

It's a round action in combat, up to an exploration turn afterwards. You might need to make a check out of combat if you are under some other kind of pressure (e.g. field hospital under fire; ongoing natural disaster; demonic incursion; exam conditions; your patient is the king).

Max. once per per person per day at 1st level; twice at 4th level; thrice at 8th level. Only new wounds from combat or accident, not hp farming during downtime. Not cumulative with giving aid to 0 hp/Casualty state characters, or special assistance laid out in (e.g.) individual monster rules.

You can treat poison/venom up to the end of the round after it was administered (or within half the onset time, if using those rules), and you and the victim must sit out the next d4 rounds (d3 @ 4th level, d2 @ 8th). At the end, roll a new save. Success is equivalent to slow poison (1 hour/level). Max. per person per day as for First Aid.

*Nausea, sickness, stun, bleeding, choking, disease, parasitic infestation etc. could be treatable by a Plague Doctor in combat.

*Depending on the background logic of the setting, things such as Ghoul paralysis and lycanthropic transmission might also be dealt with this way. 

Kate Sherron. If you're in an Altered State, they look like moths/mothmen.

Knife Specialist: Automatically proficient at 1st level; automatically specialised at 4th level.

From 3rd level, you cause a bleeding wound on a crit or scoring 4 over the target number. 

A pint is lost every d3 rounds unless the wound is treated. Every pint past the 1st, lose one-third hp and 2 CON.

Only vs. approx. humanoid/human-sized targets with circulating blood.

You Backstab as a Thief of the same level.

*It might be cool to be able to use this on Vampires.

Languages: You are able to learn ancient/dead languages from 1st level.

If your INT is 15+, from 4th level you can learn the special languages of other alignments, druids, and thieves. 

In addition, if they exist in the setting, you can also learn the tongue of ghouls, the cant of grave robbers, the priestly languages of the cults of the dead and the undead.

This is to access obscure medical treatises and privately discuss treatment with reticent patients, so we are told.

Leechcraft (Bleeding): Remedial bloodletting, including application of leeches. It is recommended for a broad spectrum of disorders of the body, mind and soul.

Bleeding is rarely more than a few ounces at a time (max. damage = d3 non-lethal, d6 if you're prone to fainting). Otherwise, use rules for bleeding wounds.

It doesn't work.

Placebo Effect: Base 1% per level, plus your CHA modifier.

This is the chance an ineffective medicine or procedure has a beneficial material effect on the patient's condition.

*Further adjustments for renown of the remedy or the professional, expensive treatments, rare ingredients, how it's administered (e.g. placebo pills of different colour, placebo injections/enemas > pills, cutting you open, rummaging around and sewing you back up > injections), time spent, cultural factors, hypnotic suggestion etc.

Surgery: INT check, and the number rolled is the number of rounds/turns/hours of surgery, and the number of DEX checks you'll need to make. +1 bonus at 4th level; +2 at 8th.

If you roll a critical fail, you cause a bleeding wound and d6 appropriate Ability Score damage.

Every normal fail causes d3 lethal damage. Any surgery always cause min. d3 lethal damage.

If you succeed in all (or most, or enough) of your DEX checks, then the procedure was a success - but what does success look like in the pseudo-historical milieu of your choice?

As a starting point, think about what surgical procedures were carried out in the ancient to pre-modern period: trepanning (actually prehistoric), bone-setting, amputation (judicial and medical), circumcision, various degrees of castration, cataract removal, lancing and draining, abortion, cutting for the stone, a surprising amount of what we would now call reconstruction, aesthetic and remedial body-modification, prolonged torture.

Simple and commonplace procedures don't need multiple DEX checks, except if you want to roll for critical fails.

*Assistants, whether just an extra pair of hands or another trained professional, can improve chances of success and/or reduce the negative consequences.

*Transplants and grafts may be possible, if that works for the game/setting.

*This is also a Torture special ability - successful checks indicate the victim survives, not that they tell the truth.

The Vivisect - surgical possibility in a magical world. From The Talisman of Death. Art by Bob Harvey.

Thief Skills: You Pick Pockets, Move Silently, Hide in Shadows, Read Languages and Hear Noise as Thief of 2 levels lower (min. 1). You need to take your mask off to Hear Noise, unless using a stethoscope.

*You can never get one over on a Thief of the same (full/Plague Doctor) level as you, but you can an Assassin.

Treatment: Being cared for/treated by a Plague Doctor with at least basic kit/resources improves natural healing:

• +1 hp per day of normal activity (adventuring)
• +2 hp per day of light activity (downtime between adventures)
• +3 hp per day of complete rest (deliberately recuperating)
• +4 hp per day in an actual hospital (or equivalent)

In lieu of promoting natural healing, if the Plague Doctor makes an INT check, care/treatment allows a +2 to a save vs. disease or poison/venom, if allowed. +3 with access to decent medical supplies and conditions, +4 in an actual hospital (or equivalent).

Soft cap max. 6 patients per day (-1 hp for everyone for each patient over 6; penalty also applies to relevant supplies and ability checks).

*With assistants, decent medical supplies and ideal conditions you can offset some of the penalties for more than 6 patients.

*Concentrating on one patient at the expense of the others gives advantage/bonus for them, disadvantage/penalty for everyone else. If you only have one patient, you can't concentrate on them any more than you already are.

Actually Slough Throt, a skinless sorcerer from 2000AD's Slaine, but I think the character design illustrates another visual possibility, or one for a pseudo-historical time period significantly earlier than quasi-medieval/early modern. Art by Mike McMahon.

In Practice.

Research/Training.

You must perform dissections equal to your current/old level in order to progress to the next level.

If not, then:

• you do not gain a level (you do not lose the XP)
• all your ability checks, saves etc. for medical practice are at disadvantage/penalty
• lose specialisation bonus with knife; cannot inflict bleeding wounds
• no level bonus for autopsy (and roll at disadvantage/penalty)
• all treatment inc. First Aid only 50% effective

To regain these abilities, you need to do twice as many dissections as you failed to do.

Dissections must be of a intelligent humanoid cadaver and take 2-4 hours each (not including prep time; autopsy time saving for level doesn't count).

Autopsies carried out do not add to this total.

The Price of Knowledge.

In a magical setting, your explorations converge with those of the Necromancer, and intimacy with death elides with undeath. Meaning that you are vulnerable to arcane corruption.

*Ravenloft Powers Checks could also apply, or be used as an alternative corruption system.

10% chance at 3rd level, 30% at 4th. Otherwise, you get your first at 5th level, then one every level thereafter: roll d10. 

Everything advances a Stage on rerolls. Living Death trumps Cadaverous Appearance. Allergies will be to things that are hard to avoid in your professional practice, your darker nature, the façade of a normal life, adventuring.

1. Allergy: Stage 1: save vs. contact/exposure or -1 to all rolls for d4 turns per contact/turn of exposure; nausea (-2 all rolls) 1 day if consumed; Stage 2: auto-fail save vs. contact/exposure for -1 to all rolls for d6 turns per contact/round of exposure; sick as per Cave Locust spit if consumed. Stage 3: any contact/exposure and -3 to all rolls for d3 days; save or die if consumed.
2. Animal Aversion: Stages: -1, -3 then -6 Reaction Roll for animals and children; at Stage 3 any roll of doubles means carnivores attack, herbivores stampede.
3. Cadaverous Appearance: Roll d8 and count up the scale from Skeleton: that's the type of Pseudo-undead you're going to start resembling (min. 3 Stages).
4. Exposed to a Disease: Stage 1 is just a normal exposure (though most likely to be Mummy/Tomb Rot); Stage 2 is especially virulent/the previous exposure compromised your immune response - saving/recovery rolls at disadvantage/penalty; Stage 3 you'll always be a carrier - treat regularly to halt/reverse symptoms and prevent spread (*these might be two separate problems).
5. Living Death: Roll d8 and count up the scale from Zombie: that's the type of Undead you're going to start resembling (min. 3 Stages). Weaknesses, compulsions/diet/habits first, then immunities/resistances, then special abilities. You are Turned as a Special, but you are not fully undead until you die.
6. Morbidity: Stages: -1, -3 then -6 to Charisma, and cumulative +1 save vs. horror per Stage - so obsessed with wounds, disease, death, dying, surgery, questionable medical paradigms, and ethically-challenging thought experiments that you're not pleasant to be around.
7. Nocturnal/ Heliophobic: Stages -1, -3 then -6 as a Goblin/Orc vs. sunlight. In addition, at -3 you are also at disadvantage/penalty vs. light-based attacks; at -6, you gain dark-/infra-/night-vision, you auto-fail saves vs. light-based attacks and will be blinded until you recover for d4 hours in total darkness.
8. *Unholy Compulsion: Look up the Sacrifice table from the Necromancer class by Lew Pulsipher in White Dwarf issue 35 - this is your new (additional) dissection schedule. Same penalties for not doing these as Research/Training dissections, and you need to do twice as many to make up. Compulsive dissections do not count towards Research/Training. These are neither medically necessary nor possible to pass off as such.
9. Weakness/ Fatigue: +1 level of permanent Fatigue unless you take progressively more addictive, expensive and hard to source drugs.
10. Weakness/ Stat Damage: -1, -3 then -6 (d3) CON, DEX or STR, unless you take progressively more addictive, expensive and hard to source drugs.

If Unholy Compulsion as written is too strong a flavour, how about you pique the interest of the Order of the Gash, or the Practice (Book of Unremitting Horror/ Invasive Procedures for Fear Itself rpg) instead?

Another visual possibility. Art by Alberto Ponticelli.

What Was Left Out.

Masks: Different types and philosophies based on their masks/regalia.

Granbretan Beast Orders; various Egyptian deities (and Stargate); the Order of the Fly; Dream's Helm (from Sandman); Venetian/masquerade masks; the early masks/helmets of fire-fighters and diving suits; things that resemble bad taxidermy elephants, rabbits (floppy eared), ducks, foxes and koala bears; single and multiple tentacle-trunk-faces; ballooning throat pouches.

Hazmat Robes: straw raincoat-style, feathers, hair, hides (like Slough Throt), waxed cloth, oiled silk, monster skins, rubber.

Special Materials for Surgical Instruments: silver (anti-bacterial properties), obsidian (still used today), jade.

Specialists: the alchemists, the apothecaries, the alienists, the anatomists; warrior-surgeons and war criminals; actual assassins; medical martial artists; perfumiers.

Organisation: Practices, Colleges, Orders, Guilds. The infirmary; the hospital; the asylum; the sanatorium.

More in common with 1e AD&D Assassins and Monks gaining followers than a sensible community health recruitment policy.

How prestigious (as compared to folk and clerical healers)? Ancient establishment or recent disruptors?

Medicine: remedial and recreational (see the Apothecary and both Chiurgeons, below).

Apothecarial Arsenal: poison gas, Greek fire, smoke bombs, flash pellets, zombie powder, extreme hygiene flame throwers, a cheap alternative to holy water.

Anonymity/Secret Identity: That Plague Doctors rarely to never allow themselves to be seen unmasked or unrobed; that the regalia can take on the attributes of the wearer, that these can persist and be transmitted.

Commentary.

Someone's done Darkest Dungeon heroes for LotFP. The Plague Doctor is a Cleric with vial bombs and remove fear memorised. I think that's pretty good.

The Treatment special ability is mostly the Medicine NWP from 2e Masque of the Red Death. Because Medicine is better than Healing? (The Plague Doctors certainly think so)

Some of the other Plague Doctor homebrew out there: for B/X; 5e Darkest Dungeon conversions; for Ye Olde School Games (and Black Hack) - this one both minimalist and flavoured. 

The Apothecary and the Healer NPC classes from 2e's Sages & Specialists. The Apothecary is a minor Magic User with a laboratory for identifying and brewing potions, also a number of other interesting things (including stimulants and painkillers, as well as an aphrodisiac that makes you think your Charisma's raised and beauty cream that apparently underwrites their whole business). The Healer has a herb garden and can heal more people better by filling NWP slots with duplicates of Healing and Herbalism.

Andrew Wyatt's Chiurgeon class from the 2e Ravenloft Book of Secrets was a really useful foundation - thank you.

There's also a 3.5e prestige class (con)version (which I only just found while looking for the link to Wyatt's).

Both are more effective at what they do than my Plague Doctor, as they're more in the Victor Frankenstein/Dr. Moreau/Herbert West direction, whereas I'm leaning into the pseudo-historical - "the procedure was a success, but the patient died" - and extrapolation in an implied setting.

A Ghastly Affair has questionable medicines (including mercury for your syphilis) that would fit right in here. And drugs on the edge of medicine/magic which might also. And a bit of the Mad Scientist class.

Sub-class of the Cleric, because so is the Pulsipher Necromancer - a thematic ancestor.

Also ancestors, (barely) the dead alchemist from The Philosopher's Stone 1e AD&D scenario (White Dwarf #66) and (in outlook) the 1e AD&D Artificer class from White Dwarf #68.

Sub-class of the Assassin. It just seems appropriate - I originally wondered if I could use the 1e Assassination table for a medical procedure or something. 

(Table for payment by level of 1e Assassin vs. level of victim could be used to determine how much a Plague Doctor charges for how grand a patient)

Obligatory #BOSR reminder that the implied setting of D&D is an American one, right down to your expensive life-saving medical care being denied by an unassailable power.