The College of Chirurgeons is a civic Order on Immortal Realm built around a single design instinct: healing should be a public-facing profession, not a stat on a paper doll. Where stock UO has Magery + Healing as personal skills you train, the College adds an institution on top — ranks, examinations, public records, civic duties, reputation — and a maladies system that creates real reasons for other players to need a Chirurgeon's care.
This guide covers what the College is, how to join, how progression works, and how non-Chirurgeons interact with it.
What the College Is
The College is one of the shard's institutional Orders. It has:
- A Hall in Britain where Chirurgeons gather, attendants train, and examinations happen.
- A Provost — Master Aldric Vermeer — who serves as the public face of the Order. Joining flows through him.
- Ranks that progress through service rather than skill grinding alone.
- Public examinations that mark promotions as visible events rather than private skill-ups.
- A maladies system that gives the Order something concrete to do for the wider population.
The point isn't "we have a healer guild." The point is that healing on Immortal Realm becomes a publicly legible profession: you can recognize Chirurgeons by their robes, look up their rank on a public roster, see their service history, and know who's worth approaching when you need treatment.
How to Join
Find Master Aldric Vermeer at the Hall in Britain. Speak to him; the joining gump opens, walks you through the College's expectations, and on accept registers you as an Orderly — the entry rank — via OrderRegistry.JoinPlayer. The only joining gate is whether you're already in another Order; OrderRegistry enforces single-Order membership. There's no civic-record screening or skill prerequisite.
From there, progression is through service, not gold or grind. Members can open the Order's interface any time with [chirurgeons (or [order for the generic civic-Order gump) — both registered as AccessLevel.Player.
Ranks and Progression
The College runs a seven-rank enum but only the first three promotion gates are wired — Orderly→Attendant, Attendant→Practitioner, and Practitioner→Chirurgeon. Ranks above Chirurgeon (Physician, Surgeon, Master Chirurgeon) are present in the system so the framework can store them, but their promotion logic and exam content arrive in later phases.
| # | Rank | Gates |
|---|---|---|
| 1 | Orderly | Entry rank on joining. |
| 2 | Attendant | 30 service points + Orderly exam pass (24h retake cooldown on fail, scoped per-rank). |
| 3 | Practitioner | 100 service points + 10 lifetime Calmleaf Draught donations + Lung & Limb exam (24h cooldown). |
| 4 | Chirurgeon | 250 service points + 5 Mire Lung cures + Chirurgeon exam (24h cooldown). |
| 5 | Physician | Promotion gate not yet wired. |
| 6 | Surgeon | Promotion gate not yet wired. |
| 7 | Master Chirurgeon | Promotion gate not yet wired. |
The Hall's institutional figurehead — Master Aldric Vermeer — is described as the Provost but isn't a rank players can be promoted into. He's the joining NPC, not a position on the ladder.
Service points come from medical treatments and civic powers, with daily cap 200 SP/day:
| Source | Points |
|---|---|
| Cure The Shakes | 4 |
| Stabilize The Shakes | 2 |
| Cure Mire Lung | 8 |
| Stabilize Mire Lung | 4 |
| Cure Call Stones | 12 |
| Failed Call Stones extraction | 1 |
| Last Rites at a gravestone | 6 |
| Civic Absolve / Bless Writ / Prestige Hunt / Relic Aura (each) | 4 |
Promotion at every wired tier requires both service (point threshold + per-rank prerequisites) and a rank examination at the Hall.
Examinations
The promotion exam is a multiple-choice question/score gump the candidate works through alone at the Hall. Questions test understanding of malady identification, treatment procedure, civic-service expectations, and Order code. Score below the passing threshold and the exam fails with a 24-hour retake cooldown scoped to that specific exam (failing the Practitioner exam doesn't block the Attendant retake or vice-versa); pass and the rank promotes.
Failed exam attempts and pass dates are stored against the player's account so the cooldown survives re-logs.
Treating Maladies
The work, day to day, is treatment.
Players on Immortal Realm acquire maladies through environmental exposure, combat fatigue, dungeon time, swamp travel, and prison stays. Some are mild and self-resolving; others worsen without treatment. Untreated maladies chain into worse stages — a player who ignores their Combat Aches may eventually find themselves with significantly degraded recovery rates.
Chirurgeons treat these. The basic flow:
- Examine. A short interaction that identifies the malady and its current stage.
- Choose treatment. Different maladies want different responses — bandaging, Numbing Draughts, Surgeon's Kits, Steaming Brazier rites for some chronic conditions.
- Apply. Some treatments are immediate; others have a recovery window the patient must observe before resuming dangerous activity.
- Record. Successful treatments are logged on the Chirurgeon's service record — both as proof of competence and as a contribution toward promotion.
A complete walkthrough of the malady system itself — what maladies exist, how exposure works, what triggers them — is in Immortal Realm Maladies.
Beyond maladies, Chirurgeons also perform Last Rites at a player's DeathGravestone — a ritual that clears all stacks of Mortal Shock from a player who's been dying repeatedly. Verified mechanics: the rite requires College membership (any rank), the gravestone owner must be online, the Chirurgeon must be within 2 tiles of the grave, and Chirurgeons cannot self-rite. The grave is consumed on completion and the Chirurgeon earns 6 service points toward promotion. Last Rites is one of the College's most-asked-for verbs from outside the Order — a player at high stack count looking for fast relief will go find an active Chirurgeon. It's the closest the system gets to a "summon a healer" ritual scene, and it's frequent enough to matter.
Public Service and Reputation
A Chirurgeon's reputation isn't a hidden stat. It's visible:
- On the Hall's roster (rank, service count, recent treatments).
- In the in-game public records the Order maintains.
- Through the social channel of word-of-mouth — the shard is small enough that named Chirurgeons get known.
A Chirurgeon who shows up consistently, treats fairly, and handles difficult cases well becomes someone players seek out by name. A Chirurgeon who's lazy, mercenary, or unreliable doesn't.
This is the design payoff. The maladies system isn't just a debuff loop; it's the mechanical scaffolding for civic recognition. The College isn't just a guild; it's an institution whose members have reasons to do public work and reasons to do it well.
How Non-Chirurgeons Interact
You don't have to be a member to engage with the College.
As a patient: contract a malady, find a Chirurgeon (Hall, public spaces, Discord), ask for treatment. Non-members are not turned away. The Chirurgeon may charge for tool costs (a Numbing Draught isn't free) but the service itself is public.
As an observer: visit the Hall to read the public roster, see who holds each rank, and watch the day-to-day treatment work that happens there. The exam itself is a private gump for the candidate, but the Hall's life — promotions announced, treatments running, service points filed — is public.
As a supplier: many Chirurgeon treatments use crafted reagents (alchemy, tailoring for bandages). Crafters supply the supply chain.
As a self-treater: some maladies can be self-treated without a Chirurgeon, just less effectively and without the social recognition that comes from being treated by an Order member. If you want pure independence, the option exists.
Why the College Exists
The shard's design intent: institutions should have public verbs, not just lore.
Most MMOs have healers. Some have healer guilds. Few have healer institutions where the act of healing is publicly visible, ranked, recognized, and tied to a maintained roster. The College is the shard's argument that healing-as-civic-profession produces more interesting play than healing-as-personal-stat.
Whether that resonates depends on what you want from UO. If you want a class to optimize, the College isn't the draw. If you want a profession to inhabit — with a Hall, peers, ranks, and a public record — the College is one of the strongest reasons to play Immortal Realm specifically.
Read Immortal Realm Maladies for the patient-side mechanics. Read Immortal Realm Custom Systems for the broader institutional layer the College sits inside. The download page is the on-ramp when you're ready to play.
