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Vicissitude: A Treatise On The Role Of The Great Art Of Physick And Combat Surgery

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by: Christian Hendry for Sanguinus Curae

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It is with the greatest sense of grim urgency that I have researched and written this work, for it concerns the minimization of casualties among our Blessed Sect's ranks, the mitigation of potentially crippling injuries to our Sect brothers and sisters, and indeed the preservation of the (un)lives of those brave Sabbat soldiers prosecuting the war that will liberate all those of Caine's Blood from the machinations of those who would drag all of us into the pit of slavery and degradation.

From time immemorial, the Tzimisce Clan has practiced the Great Art of Physick; rendering the earthly and mundane forms of flesh and bone into whatever whims suited the fancy of the various practitioners. Some of the Clan, who espouse to follow the Path of Metamorphosis, seek to transcend even the form of Vampire, through the refinement of the body by means of Vicissitude. Many among the ranks of this most austere and noble Clan, a great pillar of the Sabbat, were chosen for the Embrace due to their mortal proficiency in the medical arts. Others, regardless of their former backgrounds, have through research and experimentation, accumulated a tremendous amount of skill in the manipulation of flesh and bone. It is to these most learned and skilled practitioners that this treatise is penned.

The Jyhad is, by its very nature, a violent struggle of extermination. It is also relentless. The sieges and crusades that the Sect prosecutes against enemy territory, by their very scope and nature, result in tremendous casualties among the Sect members taking part in the action. The learned reader must understand that this author is no stranger to the battlefield, and that this treatise is not a criticism of Sect strategy and battle practice. However, the losses among our forces participating in such actions can be minimized if there is a concerted effort of triage and evacuation of wounded Sect members to established field hospitals staffed by surgeons well versed in the application of Vicissitude in the treatment of traumatic injury.

The objectives of such practitioners should be:

1.) Rapid treatment of traumatic injuries to facilitate a quick return of the wounded to combat.

2.) Treatment of traumatic injury that could otherwise result in permanent disability in the patient.

3.) Treatment of trauma in order to prevent torpor/Final Death.

It is recommended that the current system of battlefield triage and wound assessment be converted to fit with Cainite physiology and to comply with these three established criteria.


Experienced and skilled practitioners of the Great Art of Physick are critical. Such Cainites should be well versed in Cainite Physiology, reconstructive uses of Vicissitude, cool in disposition, and able to maintain a high level of skill under the stress inducing conditions of battle. Such practitioners should also refrain from "improving" by means of Vicissitude, their patients' physical forms. Such indulgence can only lead to counter-productivity. Additional support personnel to assist the practitioners are also recommended. These should be equally well-versed in Cainite physiology, as well as the various forms of combat medicine and surgery applicable to the Vampiric form. As the front within a contested city is often static, there should be a number of Sect members present to serve in a defensive capability should the field hospital be threatened.


The site for the field hospital should be behind the lines of Sabbat held territory during a siege, and mobile if possible. However, it should also be within a short travelling distance from the front, to facilitate rapid delivery of wounded to treatment. On site should be, but not limited to, all the surgical equipment foreseen to treat all the various forms of battlefield trauma to be expected during a Sabbat crusade, copious amounts of stored vitae, a repository containing ghouled human tissue for transplant and grafting, mobile x-ray equipment, recovery beds, IV vitae delivery systems, and whatever additional equipment the practitioners anticipate. Also present should be an effective communications system linking the hospital to the command and control of the military operation, and by which the hospital can be contacted regarding the condition of patients en route for treatment.

Common Varieties of Battlefield Trauma

Trauma, Blunt Force

This form of injury can usually be managed by the individual Cainite, but can become overwhelming during combat situations. Blows suffered from enemies with the Potence discipline, vehicular attacks, demolitions, and repeated strikes with non-penetrating weapons, can all take their toll on a Cainite's body. Disrupted, pressure lacerated tissue are the most common soft tissue injuries to be encountered. The management of this type of injury as well as the rapid facilitation of its healing is best accomplished by a rapid IV introduction of vitae. This will also relieve the instinct for frenzy in most patients. Crushed, splintered, or otherwise fractured bones often accompany these forms of injury. The proper setting of bones by means of Bonecraft will greatly reduce the chances that the bones will heal improperly aligned. The learned reader must understand that ill-set bones, even in a Cainite body, can result in physical disability even after they have healed.

Trauma, Penetrating

This form of trauma includes those attacks such as knife wounds to Gangrel claws to wooden stakes. Such injuries are usually injuries to soft tissue, though damage to blood vessels and the heart of a Cainite can often result. Again, most Cainites can mitigate such injuries on their own, however, during the wild melees that often result in siege combat, Sect members can often become overwhelmed by such attacks. Practitioners should approach the patient's injuries from the inside out; fleshcrafting back together the damaged blood vessels within, before moving to the surface injuries. This will often involve the grafting of connective tissue back to muscle and bone, which are often lacerated during this form of injury. During this process a constant IV transfusion of vitae should be maintained. Additionally, as this treatment is often quite painful, opiate-laced vitae can be used to manage the patient's level of discomfort.

Trauma, Gunshot

The use of firearms, both among our own ranks, and among those of the Sabbat's infidel adversaries, has become widespread. As technology has increased, so has the lethality of these weapons. New developments in ammunition, when used in conjunction with rapid-fire weapons, can pose a formidable threat to even the stoutest Cainite. Gone are the nights of old, when Kine peasants were armed with sword and fire alone. Gunshot trauma worthy of Vicissitude repair must be considered overwhelming, and practitioners should expect patients to be suffering from multiple wounds. Mobile x-ray machines should be employed to determine the extent of projectile and projectile fragments still remaining in the patient's body. Immediate IV infusion of vitae should begin to ward off torpor. Hydrostatic trauma which results from the shock of a gunshot wound, has a tendency to explode blood vessels and internal organs, as well as causing bones to splinter when struck.

The higher the velocity of the calibers employed, the greater the likelihood of shattered bones. Long bones struck in such a fashion may be difficult to impossible to craft fully back to functionality, especially if the bones damaged are in a joint such as the hip. Therefore the transplantation of bones taken from ghouls, then crafted to fit properly in the patient body, can serve as a highly effective treatment for such injury. Great success has been achieved with such procedures, and as the bones are already accustomed to Cainite vitae, there is no rejection of such by the patient's own physiology.

Additionally, due to the devastating tissue damage engendered by new designs in hollow-point bullet design, grafting of ghouled tissue to the patient's body may be needed in some cases, especially wherein blood vessels and solid organs have been compromised. Grafted arterial tissue should be employed to restore vitae perfusion in the patient, and organ tissue to be restored to a non-lacerated state. Practitioners should strive to remove all projectile and projectile fragments lodged in a patient. As these are often jagged, they can continue to cause internal injury to the patient if left inside the body.

Trauma, Burns

Fire has always been the bane of the Cainite body. Due to the physiology of Vampires, the flesh of the Cainite is subject to combustion by flame, and is slow to heal such damage afterward. Such injuries are very painful to the afflicted, and can easily result in torpor or final death. Unlike Kine, Cainite flesh, once burned, has a tendency to turn to ash, and slough off the body. As such, grafting of tissue is the most rapid and effective form of treatment for traumatic burns.

Assessment of the severity of the burn is key. As always, IV infusion of vitae should be undertaken immediately, though this vitae should be laced with some variety of painkiller. Burns to muscle and skin should be assessed for depth of damage, loss of vitae perfusion, damage to motor muscle and connective tissue, damage to bone, neurological deficit, and percentage of body burned.

If connective tissue and nerve fiber has been damaged to the point of permanent disability, grafting of ghouled tissue should be undertaken at once. Using established surgical procedure, the wound should be excised of damaged tissues previous to the grafting. Nerve fiber should be grafted first, followed by damaged connective tissue and blood vessels. It is important to note that while the patient should be drugged, they should not be unconscious, as they shall need to guide the practitioner during the grafting to make certain the grafts function properly.

The reestablishment of vitae perfusion to the wound area is critical to make certain the new tissue rapidly becomes part of the patient's own physiology. Once these criteria have been met, grafting of striated skeletal muscle should commence, followed by subcutaneous, dermal, and epidermal graftings. For speed of procedure, which is often required by the pressures of a battlefield hospital, surgical staples can be employed in place of fleshcrafting during the last stages of the described operation.

Surgeons should be advised that while it is often more expedient to simply remove a burned muscle or other body part and graft another in its place, doing so violates the ethical trust the patient, a Sabbat brother or sister, has placed in the practitioner's skill. Every reasonable effort should be made, during the initial patient assessment, to save the maximum amount of the patient's original tissue.

The learned reader must understand that the organizational skills necessary to accomplish the crux of this treatise are, as yet, almost unknown within the Sect. However, as the Final Nights are without doubt upon us, the losses of Sect personnel which have been deemed acceptable during the military campaigns within the past, cannot be tolerated in present or future operations. The most basic of military tacticians understands clearly the need to facilitate the treatment of wounded troops in order to create a veteran pool of experienced soldiers, improve morale among the ranks, increase efficiency in battle, and hereby defeat the enemy. Clearly stated it is this author's opinion that by not instituting such medical protocols in future Sabbat sieges and crusades, we as a Sect are committing de facto treason by needlessly weakening our ranks in the face of an ever intensifying Jyhad.

May the many and manifest blessings of Caine be upon us all, and preserve our Blessed Sect through until our Final Victory.

- Professor Wolfgang von Ingolstadt
Koldun of Clan Tzimisce


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