Chapter 124: Officially a Doctor [3]
“Oh my God. Just because the road is blocked, you break right through it?”
This… wasn’t this basically torture? When you thought about it, a lot of torture methods involved this area, the urethra, so it was not an unreasonable comparison. I mean… sure, piercing it might let the urine out for a while.
“But does this actually work?”
Since I had already finished digging up all the materials earlier, and because one nice thing about the nineteenth century was how much physical space you had to spread things out, I was huddled together with Joseph, Alfred, and Colin as we went over the documents. Coincidentally, I was holding what looked like something our late professor had written, along with a stick-like tool that had a needle on the end.
But it was not just a plain needle. It was separated into an inner needle and an outer cylinder, so the needle could slide back and forth while the cylinder stayed in place. Otherwise, I might have thought it was just a basic drill. Still, this was a very primitive kind of surgical tool.
“Wouldn’t this work…?” Joseph asked first.
Then Alfred joined in.
Honestly, we had all been reviewing the data for a while now, but it was the shock of what we found that made them speak up. It was not because we were squeamish. It was just… anyone with a prostate would naturally feel a bit solemn in this situation. Right?
“I guess they kept doing it because… it worked some of the time.”
Among the four of us, Colin, who had the most refined background and was in charge of “proper manners,” even stuck out his tongue in disbelief.
Then the three of them looked at me at the same time, as if they had agreed in advance. Well, that had always been the pattern. They looked to me whenever things got confusing. But now that I was technically a professor, I could feel their expectations growing heavier. They were hoping I would give them a reassuring “yes.”
Unfortunately, I had to disappoint them.
The prostate… it keeps growing with age… and this instrument is way too thick. There’s no way this will work.
Instead of answering, I just looked down at the instrument in my hand. For nineteenth-century medical technology, it was surprisingly advanced. Still, it looked scary.
If inserted correctly, sure, urination might be possible for a while. But in the process, you would be destroying the entire urethra. Once it became blocked again, which would happen quickly, there would be no saving it. And if a urethral stricture formed? That would be the end. Honestly, I had a feeling that happened a lot.
“No. It probably just opened temporarily.”
“Huh…”
“Wait… How did they even…?”
“They put this in there?”
Naturally, everyone looked horrified. As they should. Anyone would react the same. I had to react too. Empathy was one of a doctor’s most basic virtues, right?
I could tell their reactions came from deep, instinctive pain in the lower abdomen. But still.
“Look at the data,” I said. “The professor even pointed out the limitations. Once you insert a rigid rod like this…”
Due to anatomy, the risk of puncturing something else was incredibly high. Why? Because the urethra bent after entering the body. That was especially true for older men, who typically suffered from prostate issues.
In the twenty-first century, where I came from, accidents like this were rare because we used cystoscopes to safely guide instruments into the bladder. Even when inserting a Foley catheter, we used rubber tubing, so even if something went wrong, it would not pierce anything.
But here… there’s no such thing.
So you had to consider the anatomy when designing the tool. If the end were just a bit curved and blunt, it would slip in better. Lubricant was the other problem… but all you really needed was something soft and non-toxic.
While running through solutions in my head, I pointed out the issues aloud too. I thought to myself that if I had met this professor before he died, maybe I would have really liked him. Or maybe we would have fought, depending on how stubborn he was. Anyway…
“There’s always going to be a cavity here. Watch how it behaves. Is there a case where only blood came out, and no urine? That’s what this says. When you insert it and feel resistance, you’re supposed to lower the tip. Still… ah. It says there was a case where urine came out, but they had pierced the wrong spot. So…”
The professor’s records were extremely detailed. Some of his observations were impressively accurate.
It was common at the time to dissect patients who died during surgery, once the family had settled payment, of course. He was no exception. His notes described how, by piercing somewhere other than the urethra, a patient could urinate for a while… but the urine then accumulated in the abdominal cavity and caused death. Which, of course, was worse.
“Ah… So this just causes pain…”
“But if you pierced the right spot?”
“Yeah… if you really got it in right…”
Honestly, though, that was not easy. First of all, the ends were jagged. Plus, the tool was too straight. But even if, somehow, you did succeed… it still was not a great outcome.
Fine. I drew a diagram. I was not sure if it was anatomically perfect.
This really was not my area of expertise. If it were the anus, I could draw it with my eyes closed. But just because both were “down there” did not mean they were related. They were not. Not anatomically, and definitely not physiologically.
This was the urinary system. The anus was part of the digestive system.
“Oh…”
“And…”
“Wow…”
It was just a rough drawing, but it looked that realistic. The three of them could not stop staring.
Well, I was two hundred years in the future. It would be stranger if I could not draw like this.
After sketching the diagram, I pointed to the round structure pressing against the urethra.
“This is the prostate. I’ll show you in person during dissection later, if we get the chance.”
“Ooooooh.”
It was probably their first time seeing it visualized like this. Dissecting this area was actually very difficult. The bladder deteriorated quickly after death, and the prostate changed significantly with age.
So in the nineteenth century, where people barely accumulated enough knowledge before turning into critics, it was incredibly hard to build an accurate understanding of the prostate.
Plus, people had all sorts of wild ideas about that area of the body.
“Anyway, this is too large. Let’s say you make a hole. Sure, urine might start coming out right away. But do you think that actually relieves much pressure?”
“Oh… pressing like that…?”
“Yeah…”
“Then… all these patients…?”
Colin happened to find a list of patients. The professor must have worked tirelessly, seeing case after case. Some names were crossed out, others circled. I felt like I knew exactly what those marks meant.
So many had died… It was hard to put into words.
If what I was saying was true, it meant those patients died while undergoing a treatment that barely even worked.
Everyone fell silent again.
But then we noticed that the professor was aware of the problem. There was more. He had written a letter about it.
“Dear Dr. Harry.”
It looked like he intended to send it to someone named Dr. Harry. There were typos and crossed-out lines… Maybe he sent it, maybe he did not. But the content was striking.
“As you know, I have treated thousands of patients with benign prostatic hyperplasia. Yet fewer than ten actually improved.”
There were marks on the page. Was that… a tear stain?
It looked like it.
What was not clear was the emotion behind those tears.
Was it despair? Guilt?
He should have felt guilty. Even if he gave it his all, that did not justify the suffering.
“While walking one day… I heard rumors about retired sailors who had no difficulty urinating, despite their age.”
Huh? That caught my attention.
Surgery should be a last resort. Even as a cancer surgeon, I did not go around cutting patients who did not need it.
If the sailors were symptom-free, maybe they had picked up something new abroad. Maybe something that affected male hormones. Some kind of natural suppressant? It could be a medicine… or something close.
“Over the past ten years, I have met more than twenty retired sailors and soldiers. None of them reported urinary symptoms.”
Hmm. That was a bit ambiguous.
Did he just talk to random retired soldiers? Or did he actively search for ones with no symptoms?
That would be classic selection bias.
“They all had one thing in common.”
Oh? Now this might be something.
If there was another commonality besides “not peeing poorly,” this could be valuable.
The professor probably did not have the methodological background for proper clinical studies, but… sometimes luck played a role. There was a saying in my country: even a cow backing up might catch a mouse.
From the look of this data, maybe our professor had stumbled onto something useful.
“Hmm.”
I turned to the next line with a strange feeling in my chest.
“They had all suffered testicular injuries. Shot, stabbed, crushed… the methods varied, but the damage was the same.”
I did not know why, but I really did not want to read the next line.
But my eyes devoured it anyway, driven by curiosity.
“Could there be a link between testicular injury and urinary symptoms? I researched castrati, those castrated singers, and found they never experienced urinary problems, no matter how old they got. I was even able to dissect one of their bodies. The prostate was small. And from there, I got an idea.”
No… No… Don’t.
Please don’t get an idea from that.
Please.