Secrets of the Plague Doctors - The Armoury.

https://www.keiththompsonart.com/pages/viraemia.html

Plague Doctors! As dangerous as Skaven and Tinker Gnomes combined!

*Everything here is optional, dependent on the tech-level of the setting and on how established the Plague Doctors have become. 

D&D-adjacent/barely system agnostic.

Armoured Suit.

Equal to BECMI Scale armour (the bridge between Leather and Chain), and has the same special properties as the traditional mask-and-robe already covered in the main entry for the Plague Doctor class.

Provides a +1 to saves and -1 to damage per die to AoE attacks (as for BECMI suit armour).

A full plate version can exist (BECMI suit armour RAW - the ahistorical version).

*Can form the basis for fantasy diving- and vac-suits.

Compounds - Miasma.

Associated with the classic elements of Air and Earth, miasma is the foundation of chemical/gas as well as germ warfare in the fantasy setting.

Unprocessed miasma has all the general properties of a stinking cloud cast at lowest level,  plus exposes those in the AoE to the associated disease. 

It is most readily harvested from purulent corpses and plague pits, and most people are happy to let the Plague Doctors get on with it, rather than dig into their secrets.

Addition of phlogiston can make a miasma mixture that it lighter than air. 

*It's up to you whether this mixture is dangerously flammable or perfectly safe.

All types of miasma can be neutralised by contact with universal solvent in sufficient quantity/proportion. Also, cure disease (Plague Doctors hate this one weird trick).

Can be delivered as grenade-like missiles or by Hygienic Patented Pneumatic Applicator. You need to rinse out the Pneumatic Applicator with universal solvent between miasma loads (this does not affect reload time).

Anti-Phlogiston: Fire extinguisher (Earth smothers Fire).

Instant on normal fire; normal probability per round for phlogiston; allows a new save at advantage/bonus and -1 damage per die for dragon/magical fire - though you decide if it's actually enough to put it out.

Fire monsters suffer (radiant/cold) damage equal to being hit by Dragon's Fire (see below).

Cannot be made lighter than air, as this would require the addition of phlogiston.

"Cloak of Fear": Brand name for fear gas.

Effect last while in the AoE and for d3 rounds afterwards; all saves vs. fear, horror etc and Morale Checks are at disadvantage/penalty.

*A scarecrow-themed Plague Doctor seems a good candidate for developing a more effective fear gas.

Concentrate: Ancestor of riot foam.

Equivalent effect to the spit of the Cave Locust, Giant. 

Cannot be made lighter than air, as its effectiveness comes from its concentrated substance - treat as (AD&D) Green Slime, rather than stinking cloud.

"Fog of War": Brand name for blinding gas.

A clinging gas that cause temporary blindness to those unprotected in the AoE and for d4+1 rounds after they leave/it dissipates.

The Plague Doctors also produce eye-drops (dilute universal solution) that will clear the eyes on the round following application. 

Frenzon: Failed experimental prototype intended to remedy broken morale on the field.

Anyone unprotected in the AoE and for d3 rounds afterwards is subject to uncontrollable hideous laughter. 

A failed Morale Check during this time triggers berserker frenzy, rather than retreat.

Subjects report vivid nightmares over the following d6+1 nights.

"Plague Wind": Brand name for disease gas.

Anyone in the AoE or targeted/splashed is exposed to a disease at double normal chances of infection, with an incubation period of 1-6 turns. Check each round of unprotected exposure.

Anyone infected is a carrier, but further instances of the disease are at normal rates of infection and incubation.

Compounds - Phlogiston.

The elemental form spontaneously and instantly combusts in contact with air. It is counterintuitively unreactive to flame/heat and has a very low flash/burn temperature.

Mix it with other ingredients, however, and it can quickly get out of control.

In terms of magical/scientific understanding, phlogiston is associated with the classic elements of Air and Fire.

The Plague Doctors ruthlessly maintain their monopoly on the practical secrets of phlogiston. Their covert/plausibly deniable operations to maintain this are not so covert and deniable as to encourage persistent outside research.

The three substances below are the most common applications of this discovery. They can be delivered as grenade-like missiles or by Hygienic Patented Pneumatic Applicator.

Alchemist's Fire: Dungeoneer's Molotov; this is your basic burning oil as featured in most pseudo-medieval fantasy settings. 

Its main advantage over standard burning oil is that it is half the encumbrance.

It must be lit on fire.

Dragon's Fire: Dungeoneer's Greek Fire.

Twice as hard to extinguish (by whatever methods) and twice as fast/likely to spread as normal fire/burning oil; +1 to damage per damage die.

It must be lit on fire, but can be done so even if wet, as long as it is not completely submerged.

Hell's Fire: Dungeoneer's napalm. 

Contains components of miasma, so can be spoiled by universal solvent.

It ignites on contact with the air and will burn underwater (so ingenuity makes an aquatic flamethrower possible).

Twice as fast/likely to spread as normal fire/burning oil, and can only be extinguished with anti-phlogiston, magic or letting it burn out naturally; +1 damage per damage die.

If you are the target of or are splashed with Hell's Fire, you also suffer d3 acid damage per round until the fire is extinguished.

Devices.

Flit Gun: Weaponised clyster/ an old-fashioned bug spray from the old-fashioned cartoons.

Max. 1 charge - which comes in a handy screw on/off cannister.

Two-handed; fouls/misfires like a firearm, but you can just replace the cannister as a normal reload to correct this.

Spray or cloud, but it's only 5' range/AoE - you will be caught in the splash, so wear your beaky mask and hazmat suit.

Hygienic Patented Pneumatic Applicator: Medical grade flamethrower.

Max. 6 charges, but randomise in secret as the mixture and the process are inconsistent: d6 for a single or untrained operator; d3+3 for a team of 2 Plague Doctors.

It is bulky, heavy, two-handed and misfires/fouls like a firearm. Potential to explode (AoE and damage depends on how many charges left).

It is slow to reload, even with a crew of 2; otherwise, it takes twice as long.

One charge can produce a 20' line/cloud (depends on substance), but d3 charges must be expended to produce a 20' cone.

A line target is the centre of a splash effect; everyone in a cone is a target, no splash.

Basic damage for the flamethrower is 2-12 (or as appropriate for burning oil in the setting/system), adjusted for whether it's Alchemist, Dragon or Hell's Fire. 

Dragon's Fire needs to be rinsed out with universal solvent for each reload, or the chances of misfire/fouling are doubled (this does not affect the reload time).

Because of its pre-burn consistency, Hell's Fire doubles the chance of misfire/fouling, but does not need to be rinsed out between uses.

Plague Censer: Pole-and-chain-mounted thurible used to burn and distribute miasma-based compounds.

Once lit, compounds burn for d6 exploration turns unless extinguished and produce a 20' cloud in one round. 

Effects are as for exposure to the relevant miasma. If you make your first save, you make others thereafter at advantage/bonus; three successes in a row, and you don't have to make any more vs. this batch.

As well as being less effective than other methods, Plague Censers are considered old-fashioned and/or unscientific, having their origin in the bale- and need-fire traditions of the past. 

Reinforced Bellows: Weaponised clyster.

Max. 2 charges.

Two-handed; fouls/misfires like a firearm; slow to reload. Line or cloud, depends on substance used.

If using Alchemist's or Dragon's Fire, you lose Initiative if you do not have an assistant to apply a lit match as you squeeze the bellows.

Half the range/AoE of the Hygienic Patented Pneumatic Applicator. You are at risk of being caught in the splash/cloud zone.

Does not need to be rinsed with universal solvent after using Dragon's Fire, as long as you're just reloading it with more Dragon's Fire.

Being a much simpler device than the flamethrower, the risk of fouling/misfire with Hell's Fire is not doubled.

Goggles/Lenses.

*Enlarging and focusing lenses are no better than 50% the strength of eyes of minute seeing or eyes of the eagle, but I've not done research on ancient to early modern period lens quality.

Blackened: You cannot see through them except when they give you auto-save vs. light-based and gaze attacks.

Stage -6 Nocturnal/Heliophobic Plague Doctors can see through these lenses as well as being protected from the light.

Frosted: Reduces everything to shapes of light and dark.

Protection vs. gaze attacks; hindered 50% as much as if you were averting your gaze.

Mirrored: As Frosted, but with a 10% chance of reflecting gaze attacks.

Must save vs. fire each time they are exposed or lose their mirrored property.

Smoked: Sunglasses; advantage/bonus vs. dazzle and snow-blindness.

Stage -1 Nocturnal/Heliophobic Plague Doctors can offset their penalty while wearing smoked lenses.

Stage -3 reduce their penalty to -1 and make saves vs. light-based attacks normally.

Grenade-like missiles (Vial Bombs). 

Basic rules as for the setting/system. Splash/cloud radius is normally/nominally 5'.

Delivers a dose of phlogiston or miasma with the relevant effects, though grenade-delivered miasmas will dissipate in normal conditions within 3 rounds (2 if it's raining, 1 if it's windy). This is a function of volume, so dumping a load of grenades at once or in quick succession could get a proper stinking cloud going.

You can also fill them with acid, holy/unholy water, and universal solvent.

Not forgetting the example of Darkest Dungeon:

Disorienting blast causes 2d6 non-lethal damage and save vs. temp. deafness in splash radius. All in 10' (30' in darkness) must save or be dazzled d3 rounds (no save if surprised; low intelligence light-hating monsters will probably retreat).

Noxious blast causes d8 non-lethal damage to the target and d4 splash; save or nauseated as for a lowest-level stinking cloud (advantage/bonus if only splashed).

Plague grenade is the same as the noxious blast, but everyone hit is exposed to a disease at disadvantage/penalty. They are a somewhat old-fashioned weapon, dating back to before miasma could be refined and the disease component separated off.

Substance - Universal Solvent.

Carbolic steam spray - antiseptic and caustic.

Universal solvent can be put through the Hygienic Patented Pneumatic Applicator, and can be used as a line or a cone. Addition of phlogiston allows deployment as a cloud.

As well as neutralising miasma (target, splash and AoE), it will kill all small animals of 2 hp or less (save allowed if appropriate). 

Larger animals (including humanoids) are affected as the rash component of an irritation spell and must save vs. temp. blindness (advantage/bonus if only splashed). If it's a line or a cone, they suffer d3 damage on the first round, 1 hp on the second (unless immediately doused in water); if it's a cloud, they suffer 2 hp on the first round, 1 on the second, and make their save vs. blindness at disadvantage/penalty.

As well as a pesticide, it is also an effective weedkiller - plant monsters suffer (necrotic/acid) damage acid equal to being hit by Dragon's Fire, and this can only be healed with Druidic magic.

Disease/parasite monsters suffer similarly, but can heal from this damage at half-rate.

Syringes.

The main effect will be from whatever you've loaded them with. 

If you're using onset times, then a syringe is at least 50% to 100% faster than ingestion.

Fine (Glass) Syringe: Recognisable as vintage drug paraphernalia. Needs a padded case, but barely encumbering.

0 damage  + special vs. S and M targets; no effect vs. L. 

Breaks on a successful hit, or an odd-numbered miss.

Crude (Metal) Syringe: The old-fashioned type; crude in comparison. Needs a cork on the end to carry safely; about as encumbering as a dagger/iron spike.

1 lethal damage + special vs. S and M targets; crit only vs. L.

Breaks on an odd-numbered miss.

Two-handed Syringe: Modified clyster. Reservoir for max. 3 doses. Too awkward to conceal; about as encumbering as a hand axe/mace.

As dagger + special vs. S, M and L targets.

Fouls on an odd-numbered miss; d3 rounds to resolve.

Syringe Thrower (Tranquiliser Gun): Two-handed projectile device; short range only; ammunition cannot be reused, hit or miss.

As Light Crossbow for Fine (Glass) Syringes: 1 hp + special.

As Heavy Crossbow for Crude (Metal) Syringes: d3 hp + special.

Commentary.

Are there any medical dictatorship settings?

How about an alternative Krynn, with the Plague Doctors emerging post-Cataclysm? 

You bet the Plague Doctors would be up to their neck's in it in undead-apocalypse settings, for better or worse.

Bearing in mind the necromantic inclinations of the Plague Doctors and the different relative standards of magical integration across settings, they could also add necro-tech to their arsenal.

Secrets of the Plague Doctors - The Pharmacopeia.

A medicinal miscellany suggested by the Plague Doctor class, or that turned up in the research.

Gary Chalk/ Flight from the Dark/ 1984

No price tags attached, because the Plague Doctors will charge as much as they think you can afford - though not as much as for clerical healing (until they've safely toppled the temples).

Usual * for extra-optional.

Anaesthesia and Pain Relief.

These certainly put you in an Altered State.

Ether/Chloroform: roll 3d6 each round to beat unwilling patient's Constitution (or save vs. poison) to KO them for 1 hour; grapple/Strength to administer via rag or mask.

Patient cannot normally be woken by damage/pain while in effect.

Paralytic: equal to Ghoul's touch. Save vs. coma if two doses overlap.

It's optimistically described as an anaesthetic. At least the surgery can be performed undisturbed. 

*If actually derived from Ghouls, recipients risk exposure to the corpse-eating sickness and/or rising as Ghouls if they die while under the effect.

Sleeping Draught: patient sleeps for 2d4 hours in 3d4 rounds; they are allowed a save each turn if resisting the effect (*slowed and immune to fear during this time).

Double dosing puts the save at disadvantage/penalty and a crit fail leaves the patient in a coma. 

A triple dose is proof against nightmares, dream intrusion and spirit possession. While awake you are temporarily immune to non-lethal damage and are subject to post-hypnotic suggestion.

If you take 3 or more doses in a week, save vs. addiction. If you take 6 or more doses in a week, save vs. addiction at disadvantage/penalty.

If you take triple doses 3 or more times in a week, save vs. coma for each triple dose thereafter.

Double and triple doses are considered effective anaesthesia; a single dose is aftercare. 

Soma: Commandeered from the Druids in the name of science. Makes you feel immortal.

A full dose has the following effects: halves non-lethal/subdual damage taken; -1 hp lethal damage per damage die; +4 save vs. stun, and fight on at 0 hp (to whatever is the negative hp limit used at your table), but make all Dexterity-based rolls at -4.

They will attempt to strip off their armour/clothes and drop their carried equipment if not restrained. 

Lasts d3+1 hours.

If you take it 3 or more times in a week, save vs. each dose or lose 1 Constitution permanently. 

You can take it twice in a day, but must save vs. hallucinations (or second sight). If you take it thrice, save vs. overdose at disadvantage/penalty (effects as for cough medicine, immoderately used, or purgative, plus Constitution loss).

A normal dose (barely a pinprick in a sugar pill) is enough to ease general aches, pains and fevers for d3+1 hours with no other mechanical effect. You couldn't fit enough pills in you to get anything resembling a full dose.

*Possibly derived from a dangerous and/or intelligent mushroom monster (e.g. Violet Fungi, Myconids).

Healing Herbs.

Whatever occurs naturally, that would be processed and prescribed by your setting's herbalists, folk healers and apothecaries, is potentially available to the Plague Doctors.

Some iterations of the Plague Doctor organisation will condemn folk remedies etc. as being superstitious nonsense, and/or perceive them and the practitioners to be a threat.

Healing Salve.

I generally think of healing salve as giving +1 to natural healing, even when active/adventuring (or doubling the effect). Even in a high(er) magic setting, it's a non-magical medical treatment.

You decide whether this stacks with or is already abstracted into the Plague Doctor's Treatment ability.

Or, if you prefer, the more potent version from 2e Sages & Specialists: 1 hp per day active/adventuring, d4 hp per day resting, d4+2 hp per day complete bed rest (*or these could be increments of efficacy, black mummia to alicorn to golden mummia).

Alicorn (Unicorn Horn): whether this actually contains any Unicorn will depend on your setting, but that's what it's branded as.

One dose is equal to a half-strength purify water spell (a 6-inch cube) and, applied to an infected wound, gives a new save vs. infection.

It's also an active ingredient of healing salve (see black mummia), though not necessarily in purity/concentration enough to purify water and fight infection in addition.

Black Mummia: extract of mummy (post-mortem process).

Touted as a general cure-all, but principally an active ingredient in healing salve.

If it has been harvested from an undead Mummy, after 1 week of use you must save vs. addiction. 

Once addicted, you must save after each week of continued use or contract Mummy/Tomb Rot. 

Once this kills you, you rise as one of the undead (d8; 1-5 Zombie, 6-7 Ghoul, 8 Mummy).

Golden Mummia: extract of mellified mummy (pre-, para- and post-mortem process). 

Touted as a sovereign cure-all, but principally an active ingredient in healing salve.

It is no more effective than black mummia, but significantly more expensive and renowned.

If it has been harvested from an undead Mellified Mummy (approximately, Mummy + Adherer), after 3 consecutive uses you must save vs. addiction. 

Once addicted, you must save every 3 uses or contract Honey Rot (as Mummy Rot, but also produce 2 pints of Killer Bee honey per day - anyone consuming this must save vs. disease).

Once this kills you, you rise as one of the undead (d8; 1-5 Ghost, 6-7 Mellified Mummy, 8 Vampire with bee affinity/abilities).

Prophylactics.

An ounce of prevention and all that.

Graverobber's Balm: goes by a number of other names, such as Four Thieves Vinegar.

Gives advantage/bonus to saves vs. disease for d6+6 turns. Additional doses extend duration, but are not cumulative.

It gives an additional small bonus (c. 5% or +1 or equivalent) to saves vs. diseases and parasites carried/spread by the undead. 

*Depending on your setting assumptions, this could be applied to Ghoul paralysis, too.

Mithridate: advantage/bonus on saves vs. disease/poison for 3+d3 hours.

If doses are overlapped, you are nauseated for that time.

If you take theriac while taking mithridate, they neutralise each other.

Remedies.

Tried and tested. No snake oil here. Some of them might put you in an Altered State.

Cordial: new save vs. non-magical conditions (excluding disease and poison); +1 save vs. non-magical cold for d4+4 turns.

Once per night, a dose of cordial allows you to ignore the effects of fatigue for d4 turns. It will also delay the effect of sleeping draught for the same amount of time. Further doses feel restorative but have no mechanical effect. 

More than 3 consecutive doses in 1 hour is emetic. Pace yourself.

Cough Medicine: gratifyingly effective.

Used immoderately, for d8 hours the patient suffers weakness, has second sight and must roll for astral/ethereal/psionic random encounters. Save vs. poison or lose 1 Constitution permanently.

Probably an opiate of some kind.

Elixir: restores patient to 1 hit point if at 0 hp/Casualty State, and/or down to -10 hp if administered within 6 rounds (use your judgment).

Gives advantage/bonus vs. aging damage and on non-magical death saves for 6+d6 turns.

Emboldening Vapours (Smelling Salts): immediate recovery from unconsciousness (including sleep) and nausea, and you get a new save vs. non-magical shock, stun, fear (including any secondary effects such as paralysis or weakness), and confusion.

It will restore 1 hp to someone currently reduced to 0 hp by non-lethal and/or subdual damage.

Patient is staggered (later-edition condition if no rules) for the round in which vapours are administered. 

They may also ignore any effects of fatigue for the next d3 rounds, and each dose delays sleeping draught for 1 turn.

Emetic: if taken within half the onset time of ingested poison (or within 6 rounds if not using onset time), patient gets an extra/new save (or save at advantage/bonus).

You are nauseated for 2d6 rounds (as the later-edition Poisoned condition, if you don't have rules already).

Also works on some internal parasites, and could be ruled helpful vs. certain magical potions (and other consumables).

Nepenthe: medicine for sorrow and post-surgery trauma; patient must fail their save in order to forget (the last 24 hours, or 3d8 hours if you prefer dice rolling).

Combine with hypnotic suggestion to suppress specific memories

After the 3rd effective dose, patient must save vs. addiction (or use some rules for opiates).

Panacea: effective against any non-magical negative condition.

New save if administered while suffering (oral or injection). 

Save at advantage/bonus if administered in the same round as the condition is bestowed/takes effect (injection only - Plague Doctors can do this automatically as long as they are not incapacitated/restrained and are within range; other characters must roll Dexterity or Initiative to do so).

Purgative: save vs. poison; success=weakness d6 hours, failure=sickness (as Centipede, Giant).

Even if you make the save, you're narratively shitting and puking for the duration.

Works on some poisons (see emetic) and some internal parasites, but it's mainly used as part of a general treatment programme (regardless of whether it's useful).

Allows a new save vs. addiction when you first become addicted.

Theriac: gives a new poison /venom save if administered within one-third of onset time (or within 6 rounds if not using onset times).

Multiple consecutive doses can be administered.

Supplements.

Not every discovery has a clear medical use.

Ambrosia (Beauty Cream): the economic cornerstone of the pharmacopeia.

One dose gives +1 to Comeliness, and if you use it consistently for 10 days, then daily thereafter, the bonus is +2.

As nobody uses Comeliness, this is meaningless.

*Source is 2e Sages & Specialists and it's a Charisma bonus (cf. philtre).

Aphrodisiac: it contains enough emboldening vapours (stimulant), nepenthe, sleeping draught and soma to make you think that it's doing something - particularly when taken in the appropriate circumstances (at a party, in the boudoir). 

Social overuse mechanics can be reskinned drunkenness rules.

*Aphrodisiac is also a commercial euphemism for abortifacients, contraceptives and bogus fertility treatments.

Emboldening Vapours (Stimulant): ignore levels of fatigue for d6 hours at a cost of temp. -1 to Wisdom, Dexterity, Charisma per dose.

You can hold off fatigue for max. 36 hours before needing to save vs. d6 temp. Strength and Constitution damage per dose.

After 3 consecutive doses, save vs. addiction per dose.

Once the effect has worn off, you immediately suffer all levels of fatigue at once and you need +50% recovery time from normal.

Cancels out sleeping draught.

Philtre: once taken, the next person to communicate with you has 2d4 temp. Charisma (to you only) for the next 4+d4 turns.

Once the effect wears off, you can roll Intelligence to realise you were influenced. Even if you don't, prior low-regard for the influencer might be intensified by the sudden contrasts in Charisma.

This is no more effective that the friends spell.

Availability and distribution is clandestine, on a par with poison (and at least twice the price).

Spagyric: one dose will increase the effectiveness of 1 attribute of another pharmaceutical by 50%.

By itself, purgative.

Weird Alchemy.

The processes of extraction and production are jealously guarded secrets. 

Luminiferous Ether: two substances in a vessel that, when mixed, produce a light source as good as a jar of glow worms that fades over d4 turns.

If you pay more, you can get one guaranteed to last 3 turns.

It is not extinguished by exposure to water, nor lack of air. It is not fire, so unaffected by magic etc. working on that element.

Counterintuitively for some, it does not contain/require phlogiston.

Manna ('Drow Lembas'): alchemical food that is instantly destroyed by exposure to sunlight.

Exposed to air, but kept in darkness, properly wrapped, it will last 60 days before disintegrating. Eat it darkness or low light conditions, quickly.

Lightweight and nutritionally dense (equal to one day's ration), it is not appetising. The same property that prevents it being poisoned, putrefied or diseased (including parasites) means it cannot be seasoned.

Kept in an unopened packet it is good for a year.

Manna is not a cost effective way to feed oneself, let alone end world hunger.

*It can be fed to constructs/undead to quell their appetite for human flesh/life energy, if it seems appropriate in context.

*The process of creation exposes the Plague Doctor to mild radiation poisoning.

Miasma: the quintessence of disease. 

It has the general properties of stinking cloud cast at minimum level (3rd), plus exposure to the disease it is derived from.

Neutralised by universal solvent. 

Phlogiston: the quintessence of flammability. 

Exposed to air, it instantly burns up as bright flame, so can be used to dazzle or ignite low flash-point material. 

It is unstable and cannot be stored for any length of time or in quantity in its elemental form. 

Stored in airtight darkness, it deteriorates in 30+d20 days; 2d6 days once exposed to air and light.

Universal Solvent: discovered while attempting to develop a cheap substitute for holy water, this is a broad spectrum disinfectant, cleaning solution and weedkiller. 

Applied directly to a wound, it causes 1 hp lethal damage but will neutralise any disease in there. It will also neutralise parasites and poison if administered in time (if no rules for this, then no later than the end of the next round).

It inflicts d8 lethal damage to plant, filth and disease monsters.

It is a poison if drunk (min. effect purgative) but there's no way you could disguise it in food or drink (effectively putrefying it).

It can be used to purify water, but makes it poisonous.

Commentary.

Nothing here is meant to be as good as or to directly compete with magical healing. That's the point.

None of them are magical of themselves (i.e. they do not detect as such), but they probably require a magical background environment to exist.

All can be administered as pills, potions, injections, and liquid, smoke or powder pumped into various bodily openings. Some can be smoked, whether or not mixed with newly-discovered, precious, life-sustaining tobacco.

For some more pseudo-historical/thematically appropriate general medicine, plus henbane, opium, and all the other good stuff in the doctor's bag, I direct you to the Ghastly Affair Presenter's Manual.

Same overall acknowledgements for source material as for the Plague Doctor.

I always liked that the Citadel/Warhammer Plague Elemental was a sub-type of Air Elemental (and the Life and Death Elementals as sub-types of Earth) - at least until they were re-branded as daemons.

Tony Ackland/ L - R: Life, Death and Plague Elementals, plus Balrog (Baalrukh?)

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.