Obstetrics and Gynecology [1]
I had to put the arsenic wallpaper out of my mind for now. What else could I do? I had done everything within my power; there was nothing more to be done.
Until just a moment ago, my brain had slipped entirely into nineteenth-century mode, so I hadn’t given it a second thought. But coming back to my senses, I realized I’d just conducted human experimentation. Well... the bastard had it coming, but still.
"Wait a moment."
"Ah, yes."
I barely swallowed the sigh climbing up my throat. The blood Blundell had poured into the iron vessel... It was a collective Spirit Bomb of blood, imbued with the fervent wishes of everyone in the room. And precisely because of that, it had already begun to clot.
If there was any slight improvement over how things used to be, it was my certainty that the iron vessel wasn't filthy. How did I know? Because Joseph, the Specter of Hand Disinfection himself, was standing right behind us. If you crossed paths with that maniac, you got forcibly scrubbed down whether you liked it or not. I often wondered if he’d always harbored an obsessive-compulsive streak, but his zeal for sanitation was bordering on terrifying.
"How is the patient?"
"What? We've no time for chatter! She's already dying!"
"I understand, but... please set that down for a second."
"Why on earth should I?!"
"The blood has already clotted. Do you really think that's going to circulate once it enters her veins?"
"Ha! My dear lad, you see only the step before you and miss the grand staircase."
In the past, whenever someone told me I didn't know what I was talking about, my heart would pound with preemptive dread. What fresh drivel are they about to spout now? How furious is this going to make me? But by now, I barely reacted. One grows accustomed to madness.
"Once it enters the veins, it dissolves right back into liquid!"
"Oh."
...All right, I take it back. That was startlingly novel nonsense. What in the blazes was he talking about?
"Do you take me for a fool who leaps blindly into the dark? I tested it extensively on dogs! Ha-ha!"
"Mm."
"And I tell you, they came back to life!"
"All of them?"
"Certainly not. Well over half died."
"..."
"Regardless, when I cut open the vessels of the hounds that survived, the blood was circulating swimmingly!"
Well, of course it was, you brilliant lunatic. If they survived, it meant blood was circulating. And conversely, every dog that couldn't manage that feat simply died. Still, that nearly half of them survived at all left me marveling at the nineteenth century—not only were the humans tough as leather, but the dogs were built like iron. Then again, he wouldn't have experimented on pampered pets; they were undoubtedly London strays. Any mutt that managed to survive to adulthood on the disease-ridden, smoke-choked streets of this city was hardly an ordinary beast.
"And in the dogs that died, wasn't the blood clotted solid?"
"Ha-ha! Why, blood naturally congeals upon death, does it not? A truly fascinating phenomenon in its own right. I wonder why it thickens so?"
If you don’t even know that, stop trying to pump a Spirit Bomb of coagulated sludge into a dying woman...! Blood was an excruciatingly complex tissue. Why else would the twenty-first century still be struggling to develop artificial blood? To think that a fluid packed with vital nutrients that flows without clotting inside living vessels was something you could just whip up and toss around was a fatal delusion.
Regardless, I turned my attention to the patient.
She's already...
Unconscious. Cyanotic, blue-tinged lips. She was completely past saving. Maybe in a twenty-first-century ICU... No, even in a modern tertiary hospital, a patient in this state would have no better than a fifty-fifty chance. So what were her odds here? A hundred percent fatal.
"Go ahead and use this. Here."
"Splendid, thank you! Out of the way! I have a life to save!"
Faced with such unyielding conviction, I simply handed over the instruments. Well, he had to try something. Who knew? Perhaps a miracle would occur, and she might somehow pull through.
"Ah."
At the very least, Blundell was not only a member of our fluid therapy team but its undisputed ace. He scrubbed the patient's skin vigorously with carbolic acid, made a precise nick with his scalpel, and drove the cannula deep into the vessel. He had performed a central venous catheterization entirely on his own initiative.
Thank you, Lord.
If that wasn't a miracle in this barbaric era, what was?
"Pour it in!"
"Right away, Doctor!"
The vascular access was nothing short of magnificent. The slight problem, of course, was that what they were pouring in wasn't saline solution, but blood. And pooled blood from multiple bystanders at that... To make matters worse, it hadn't even been drawn with a clean syringe. Judging by the cloths wrapped around the wrists of the donors standing about, they had simply sliced open whatever veins were handy and let the blood bleed out into the bucket.
In other words, it had been subjected to merciless exposure to open air. Even without the mismatched antigens clumping together, blood exposed to air like that was guaranteed to clot on its own. And they had mixed multiple people's blood together on top of it...
I can't watch this...
Good grief.
A heavy sigh escaped my lips unbidden. If I kept staring, that sigh would swiftly graduate into a torrent of profanities, so I averted my gaze to survey the ward instead.
"Phew..."
Looking around actually brought a wave of relief over me. Why? Because it was no exaggeration to say the Obstetrics & Gynecology Annex had undergone a complete transformation.
For starters, every single bedsheet had been freshly swapped. The surgical ward and this annex were the two places where Joseph unleashed his fanatical devotion to sanitation. To be more precise, he had been kicked out of the wards managed by Gemmel and the other senior professors, chased away by colorful curses telling him to take his lunatic nonsense elsewhere.
The floor is practically gleaming.
Even the patients had been scrubbed clean like laundry. I use that phrase deliberately, because fewer than ten percent of them had ever washed voluntarily. Prejudices against bathing ran so deep in this era that no one would wash even if ordered to do so. That was until Joseph wheedled funds out of Uncle Liston and forcibly washed every patient from head to toe using chlorinated lime and soap.
Well... not that all of them went through that ordeal.
Since the patients here were predominantly women, Liston couldn't exactly march in bellowing threats. The atmosphere was inevitably quite different from the men's surgical ward. Though, whether Liston's method was right or not was another question entirely.
Thump, thump!
Whenever Liston pounded on the ward wall, every patient capable of dragging their body upright scrambled out of bed to wash. It looked less like a hospital and more like a penal labor camp, for God's sake.
"Ah... good heavens, no."
Lost in my musings, I heard the bitter lament spill from Blundell’s lips. The outcome I had anticipated long ago had finally unfolded at his fingertips. The patient had died.
It was unavoidable. It was an everyday tragedy in this hospital.
And yet...
"No! God, please, no!"
Look at the husband, screaming in raw agony. Could anyone truly brush this aside as merely 'inevitable'?
"The child... what about my child?!"
"The babe as well... I am terribly sorry, but..."
"Agh! No, no! Please, no!"
The maternal mortality rate of this era... In the absence of proper statistical records, one couldn't say with absolute precision, but it easily surpassed several thousand per hundred thousand births. Over one percent of mothers perished in childbirth. Although women were biologically predisposed to live longer than men, the overall life expectancy for females in this period was lower, precisely because of this butcher's bill in the delivery room. Well... even in twenty-first-century Afghanistan, things weren't much different.
"Damn it all to hell."
My own stomach churned, so God only knew what Blundell was feeling. To live as an obstetrician in this era meant harboring a despair equal in measure to the wonder of new life. And among his peers, Blundell was exceptionally devoted.
"Damn it, damn it all!"
Leaving behind the cooling corpse and the grief-stricken husband weeping over it, Blundell marched straight toward his laboratory. Listening from outside his door, I heard his muttered curses escalate.
"Fuck..."
Why on earth an internal Korean curse slipped through my teeth, I didn't know, but regardless, I found myself wanting to help. Not specifically because it was Blundell. It was simply that the situation desperately demanded it. Though, God knew the list of things needing reform was endless...
A Cesarean Section... With anesthesia, it's possible. Of course... doing it won't save everyone.
The husband's devastated face flashed through my mind. No matter how desensitized people were to death in this brutal century... the loss of a mother and her newborn always struck a different, sharper chord.
'It wasn't enough that my wife died, but you had to butcher her belly open too?! Did you... did you butchers murder her?!'
Could an obstetrician ever truly escape that accusation? Even in twenty-first-century South Korea, where the maternal mortality rate had plummeted below ten per hundred thousand—one of the lowest figures on earth—obstetricians were still routinely demonized and sued. What would it be like here? Would the excuse that death was inevitable carry any weight before a grieving husband staring at the horribly mangled corpse of his beloved?
No, indulging in such worries is a luxury.
In the past, I might have buried myself in anxiety and brooded over it for days. But not anymore. Look at the Obstetrics & Gynecology Annex right now. Ever since the medical staff began scrubbing their hands under my unrelenting pressure, mortality had been plummeting. For mothers capable of normal vaginal delivery, the death rate had already fallen to a reasonable baseline. That meant the next frontiers demanding my intervention were the Cesarean Section and blood transfusions.
As for transfusion... I have no idea how to sort out blood typing and anticoagulants yet, so let's tackle the Cesarean Section first.
That didn't mean I barged through Blundell's door immediately. Every human being—especially one burdened with holding life and death in their hands—deserves the right to grieve in private. I had never fallen into despair quite that deep myself, but I had never forgotten the sight of my mentor in my past life, weeping silently against the wall of a darkened, empty operating theater.
There should be literature on this.
A Cesarean Section... Admittedly, obstetrics wasn't my specialty. But I possessed enough passing knowledge to get by. Wasn't Julius Caesar himself rumored to have been carved out of his mother's womb according to legend? Though considering his mother lived for many years after his birth, that story was almost certainly bogus. Caesar... they said he wore his laurel wreath just to hide his receding hairline. A whole life steeped in vanity and tall tales...
Screeech.
Pushing such idle trivialities aside, I headed straight for the medical library. This was one of the perks of being a professor. In this era, books were so outrageously expensive that commoners weren't permitted anywhere near them. But a professor had free rein to touch whatever he pleased. Heh.
"All right..."
Leafing through the grime-stained tomes, I indeed found accounts of Cesarean Sections. There was actually a recorded case from the 1500s—the sixteenth century—where the mother had miraculously survived. But reading how it had been performed, it was clear she had been saved by nothing short of sheer, dumb luck.
Good grief... they opened the abdomen vertically instead of horizontally.
The text even noted that the child had been pulled out with a scar across its scalp from the scalpel blade. They had simply hacked the poor woman open blindly.
But then, what else could one expect?
Slicing open an abdomen without anesthesia...
Imagine how frantically the surgeon must have sawed through the flesh. And at a time when anatomical understanding was far cruder than it was today. Because of that, the records revealed that a Cesarean Section was treated virtually as a taboo procedure. It was performed only as an absolute last resort, and saving the mother’s life was never the objective. It was done strictly as a salvage operation to rescue the infant. The grim reality, however, was that even the child rarely survived. The trauma of the procedure itself was perilous enough, but the aftermath was worse. In an era like this, how could a motherless infant hope to survive?
Hmm.
Glancing out the library window, I gazed down at the soot-blackened streets of London. Surviving without a mother in this industrial hellscape was infinitely harder than it had been in centuries past. But beyond that grim reality, shouldn't we be saving the mother as well?
Mom...
I miss my mom.
I really want to eat braised kimchi with pork and tofu.
The risks of anesthesia will have to be borne.
Cravings aside, I began outlining the blueprint for a viable Cesarean Section. I couldn't replicate the twenty-first-century method verbatim. For one thing, I didn't know the exact specialized obstetrical technique down to the millimeter. I only knew the broad surgical principles, and even if I knew every nuance, executing modern protocol here was out of the question. The anesthesia techniques were entirely different, the pharmacological arsenal was vastly limited, and above all, postoperative care in this era was abysmal beyond belief.
Among all these hurdles, the starkest discrepancy lay in anesthesia.
There’s no way we'll discover that chloroform or ether is perfectly harmless to a mother and her unborn fetus!
It had to be a race against the clock. We wouldn't have to butcher the patient at breakneck speed as surgeons did when patients had to endure the raw agony of unanesthetized surgery, but the exposure still needed to be as brief as possible. Inhaling that foul gas or ether for an extended period could never end well for either patient.
To achieve that, we needed a transverse incision.
Even for me, that concept felt slightly unfamiliar. From a general surgeon's perspective, a vertical midline incision seemed more intuitive, didn't it? But there was a reason modern obstetrics favored a transverse incision.
In my previous life, I wouldn't have given it a second thought. But living in this primitive era changed my perspective completely. Every single minor surgical technique, every standard line of incision, had been carved out across history at the cost of countless human sacrifices.