Surgery is the practice of direct manual manipulation of an injury usually involving cutting open the body or entering an already open wound. This is differentiated from other practices such as medicine, herbalism, spiritualism or even magical healing. However these various healing disciplines may play a role in the surgical process.

Standard Procedures. Surgery has historically been the domain of the human and elven races in Santharia. The primary need arose on the battlefield as injuries occurred. There was a time when even the most minor injury resulted in a permanent disability or death. Over time the humans and elves learned that by intervening the injury could be managed or even fully corrected. The other main races of Sarvonia have not advanced as far as humans and elves in the practice of surgery for various reasons. Dwarves have advanced in some of the more barbaric surgical procedures described here; however the delicate surgeries requiring finesse and patience seem to go unpracticed by most dwarven tribes. Orcs have not advanced far in surgery for an entirely different reason. Surgery requires that one person helps another person to be healed. In general when an orc becomes injured the other tribe members view this as a weakness and will let the orc die. In some rare cases a particularly brave orc will attempt a makeshift surgery on his own body, however the effects of pain, blood loss and infection usually take over.

In the author's travelers throughout Sarvonia he has seen many varying surgical procedures. Kelancey the Green has this to say:

The following are the various surgical procedures witnessed in the travels of Kelancey the Green:

• Brain Exposure ("Trepanning", "Skull Drilling")
  Trepanning is a barbaric surgical procedure performed by some human tribes in Northern Sarvonia. This procedure is usually performed when a patient complains of chronic or migraine brain pain. Usually before the brain exposure procedure is performed the patient has already tried a number of other less intrusive measures, with no result, leaving them desperate and sometimes crazed. The procedure is performed using a tool called a treppan. The treppan is a two-handed twist screw. One model is shaped like a straight rod with two handles. A second fashion is a rod, about a fore in length, bent at right angles in four places, shaped like a straight-brimmed hat: One "brim" is the handle which remains steady, and the instrument rotates inside this handle. The "dome" of the hat is a second handle, which is spun around in a circle, and it is this handle which turns the screw. The other "brim" of the hat ends in a drill or countersink screw. With one handle being used to steady the instrument, the treppan bores a hole and removes a circular disc from the skull. For some patients this procedure relieves the pain. The ice tribes claim the procedure releases the inner demons while others believe the brain’s exposure to air heals the pain. However, in most cases the patient suffers infection and dies. In fact, the rates of survival are so low that the more advance tribes in the north and those in southern Sarvonia have outlawed the practice. At this time we are only aware of humans in the north performing this procedure.

• Blood Cleansing
  Blood cleansing is the withdrawal of blood from a patient’s body in an effort to remove the so-called “dirty” blood. Blood can become dirty in a number of ways such as disease, infection, curses and demonic possession. In fact some of the more barbaric tribes prescribe blood cleansing for the vast majority of diseases and illnesses. The idea behind the practice originates from the common understanding that blood contains the person’s life force. When the blood becomes contaminated it is necessary to remove that contamination or else the patient will die. Unlike contaminated water which is removed through the urine or contaminated air which is ejected by exhaling, contaminated blood must be removed by a healer.
  
  A number of different methods are employed to remove blood from the body. The most common and crude method is to simply puncture the patient in a high blood-flow area such as the neck, wrist or groin. If done correctly the dirty blood will escape the body in a rapid fashion. Another method used is the hot cup method. A cup containing hot air is pressed against a wound. The heat draws the dirty blood from the wound and is conveniently caught by the cup. Leeches are also used by some healers.
  
  In all these cases the typical practice is to continue drawing blood until the patient faints. This is the general indication that the contamination has left the body.
  
  While the practice of blood cleansing is generally used to heal patients of illness and disease, there have been reports of the practice being used to cure curses and demonic possession. Furthermore Kelancey the Green obtained this report from a local healer in one of the remote Ice Tribes in Northern Sarvonia.
  
  “Ahh yes. Just last year I attempted to clean the blood of a young man visiting us from the south. He wore a strange robe with runes and markings and carried a skinny staff. He was ill suited to survive in our lands as his robe was not thick enough to keep out the cold and his staff was not strong enough to kill even a small rodent for food. However when it came time to sleep our men noticed he was able to start his cooking fire with nothing but his fingers. the young man was quickly seized and brought to me for surely he was contaminated with magic. We attempted to rid his body of the magic, but it had taken a strong hold on him. His screams and protestations attested to the extent of the infection. Unfortunately the magic was too strong and he died before he had the chance to faint.”

• Amputation
  During wartime the wounds received, however minor, usually result in infection. Some of the less advanced tribes attribute this infection to the supposed evil present in their enemy’s blades. More advance healers simply recognize that a warblade and the conditions on a battlefield lead to dirty and infected wounds. Amputation is the removal of a limb in order to stave off the spread of infection or poison, thus protecting the core body. Amputation is a rather common procedure performed during wartime and to a lesser extent during peacetime. Common procedures include the removal of a finger, forearm, or entire arm, likewise toes, lower leg or full leg. For certain the larger the body part amputated the more risky the procedure. The amputation procedure includes the careful cutting of the skin and muscle with a clean sword, knife or dagger followed by using a sawlike blade to cut through the bone. Success with this procedure largely depends on how effectively blood-loss and infection are managed. For certain the patient’s pain is also managed and during wartime this is usually accomplished through the consumption of alcoholic drink. Finally the remaining stump is bandaged and the patient is monitored.
  
  While speaking to an Erpheronian general about war wounds, an interesting observation was recorded regarding dwarven amputation. “We were in the heat of battle and I was beside a company of dwarves. One of the dwarven warriors was cruelly hit by a war mace crushing the bones in his left forearm. Without hesitation the dwarf laid his arm across a nearby boulder and his companion used his axe to hack off the limb near the elbow. The resulting wound was quickly bandaged and the dwarf returned to the battle immediately. I am not aware if he survived the battle.” This story corresponds to other rumors concerning the dwarven miraculous resistance to the pain of an amputation and their persistence on the battlefield.

• Santhalian Section ("Infant Extraction")
  New-Santhala has boomed in population over the past 100 years. While there are many causes, one is for certain, the increasing use of the Santhalian Section procedure, a groundbreaking procedure that has saved the lives of countless mothers and babies during childbirth. The procedure is quite simple. In the event that complications during pregnancy make natural childbirth impossible the surgeon will simply cut into the mother’s abdomen using a small sharp blade, sometimes referred to as a scalper or scalpel, and extract the baby manually. Regardless of the simplicity of the procedure, highly advanced knowledge of the female anatomy is necessary to avoid killing the unborn baby and the mother. To date only the healers in and around New-Santhala have been able to perfect the procedure giving birth to the name Santhalian Section.

• Extraction of Teeth
  Rotten teeth often wait for the most inopportune time to fester and incapacitate the bearer of bad teeth. Of course, the instrument of choice would be the barber's pincers, aided by a course of miyu beans to dull the pain. In less optimal circumstances, bowstrings and garotte cords have seen use in yanking teeth. A different approach would be to use a tanner's awl or a quarryman's chisel, along with a cook's wooden mallet, to "gently persuade" the tooth to come out.

• Eye Surgery
  While a very dangerous and rather unknown procedure, eye surgery has been attempted and succeeded, leading to at least moderate vision improvement on the subjects. The surgeon will push a long and very thin needle through the outer part of the eye to break up any 'blockages' and the remaining pieces are gently sucked up using an equally long and thin tube. Since this practice is rather dangerous and requires an expert’s skill, it is difficult to find surgeons willing to perform this outside of New-Santhala. Tere have been rumours of attempts by Northern healers, but whether the surgery was a success, or more importantly, if the patient lived, have remained so far, unconfirmed.

Experimental Procedures. The following procedures can be categorized as "experimental":

• Blood Insertion
  This procedure is the converse of the blood cleansing procedure. The idea is to somehow insert the healthy blood from an external host into the body of the patient thus revitalizing the patient with clean blood and health. The problem arises with finding a successful way to get the blood into the body. Quickly it was discovered that drinking the clean blood was not effectual. Early experiments attempted to pour the clean blood into the patients body through a small incision in the patients abdomen. Other experiments attempted to push the blood into the arm or neck by squeezing a leather bag full of clean blood through a glass tube and into the body. To date no blood insertion surgery has been a success, however gnomes are working on designing new glass tools that may enable a more precise insertion of blood. Healers we have spoken to are certain once the correct tool is designed the surgery will be a huge success with one healer quoted as saying "Imagine the possibilities. We have an abundance of clean blood all around us in our cattle, swine and sheep which goes to waste each time we slaughter our animals for food. Once we can figure out how to insert this clean blood into our patients we can cure all kinds of diseases and illnesses and save lives. The results will be revolutionary!"

• Organ Removal
  Normally when a patient complains of pains within the core of the body the healer will administer normal pain management procedures. If the pain persists the healer may conduct the blood cleansing procedure. However we have evidence that some more radical healers have been attempting to cut open the body and remove the organ causing the pain in hopes the problem would be cured. Miraculously some patients have survived the initial surgery however almost in all these cases the patient has died from the loss of the organ. There have been reports that certain organs have been removed without causing immediate death. One such organ is located in the lower abdomen subsequenlty named the "appending organ" or "useless organ". Another successful case was the result of removing one of two organs in the lower back. The assumption is the redundant organ was not needed. However this is only the case with the redundant organs of the lower back, the redundant breathing organs of the upper chest are apparantly both necessary to the survival of the patient.

• Reattachment Procedure
  The vast number of amputations that occur especially during war time has led to experiments of reattachment. In this procedure the patient's amputated limb or limb from another host is attached to the patient in hopes the limb will become alive and function. Reports of this new experimentation initially led to many hundreds of volunteers. To date only early experiments with this procedures have been conducted with no success. In every case the attached limb is immobile and unfeeling. Within hours the limb begins to putrify and stink. In days the limb becomes fully black and bloated. In some cases the limb becomes "sick" in which the sickness spreads to the patient causing death. The news of the horrors seen in these early experiments has spread and now almost all reattachment experiments are performed on war prisoners and criminals.
  
  Further report have been heard of the reattachment surgery being taken to further extremes. Rumours exist that experimentation with cross race attachments are being conducted with no success. One rumour even suggested that experiments on dead corpses were being conducted wherin the "best" parts of each race were attached to a dead human host in an effort to create the perfect race. Apparantly student mages were attempting to reanimate the corpse when officials from the Ximax academy stepped in and ended the affair.

Closing Wounds. Surgical wounds are closed in generally the same manner as the various types of cuts and wounds. Examples include the following:

• Blue Myrmex Stitches
  It is well-known that the wild tribes of Nybelmar and Aeruillin commonly use the stone myrmex to seal small cuts, drawing the edges of the wound together and then placing the insect’s head along the incision, whereupon the beast spits its defensive material, which hardens upon exposure to air. A single myrmex can seal about a thumbnail’s width of cut before its supply becomes exhausted (indicated by an unwillingness to bite and a lax, drooping abdomen), and another insect must be chosen. The sealed cut resists infection, and the ‘stitches’ will hold up well under perspiration and water. The stitches should be renewed each day, as this lessens the risk of the wound becoming infected as the heads decay. It is recommended that this method is only used in extreme emergencies, as the numbing effect of the myrmex venom could cause permanent disabling if used in excessive amounts.

• Silkel Tree Thread Stitches
  The silkel tree, also called the Ilárol’pherán ("Silver Tree") or Cáo fá Eú'reóll, ("Child of the Tree of Life"), in Styrásh, is regarded as one of the most beautiful trees in all of Caelereth, and many believe it to be touched by a kind of immortal magic. Either its enchanting appearance, or perhaps its amazing healing powers, or maybe its inclination to grow in places touched by myth and wonder, lead to the belief that it’s a tree closer to ethereality than to corporeality. This sheeny tree has a number of uses, many of them of medicinal purpose. The tree is mostly known for its thread-like bark that can be made into silk. The silk is used as stitching/suturing thread. Using a large strand of silk, the healer will double stitch the wound. This is done as a precaution, for the silkel thread might break. Then bandages are added and wrapped tightly. Silkel trees are rare, found in forests all throughout Caelereth, especially Thaelon, Bolder, Quallian, Zeiphyrian, Sharadon Forest, Auturian Woods, Shaded Forest, and others.

20th Molten Ice 1671 a.S. Information provided by Seeker and Kelancey the Green