Obstetrics (Part 2)
I had to head down to the lab. Specifically, to the London Hospital Anatomy Dissection Hall.
“Fresh bodies, coming through!”
When I arrived, someone was rattling up with a handcart, announcing his delivery in a remarkably cheery voice. Judging by his relatively clean clothes, he wasn't a resurrectionist or an orderly from the workhouse, but rather someone sent from the police station. Come to think of it, the faces piled onto the cart were familiar. In other words, they were convicts freshly executed via arsenic.
“They're all men.”
Their condition was pristine enough for surgical drills. Granted, since they had succumbed to acute arsenic poisoning, a careless nick of the scalpel could spell disaster, but we would be operating with gloves, so shouldn't it be fine? It wasn't as if these corpses were going to sit up and exhale toxic vapors either, meaning noxious fumes weren't much of a concern. The only genuine disappointment was their sex.
“Er... is something amiss, sir?”
The junior constable looked thoroughly crestfallen at my lukewarm reaction. And why wouldn't he? Normally, we welcomed him like a savior. Whether it was me, Liston, or anyone else in the hall, we always greeted his arrival with open arms.
“Ah, it's just that I need female cadavers to practice certain operations.”
In plain terms, I needed women's bodies.
“Hmm. We rarely get female convicts condemned to the gallows...”
Catching on immediately, the constable scratched beneath his chin. Then, snapping his fingers, he clapped his hands together.
“I'll take a sweep through the slums. Their condition won't be pretty, but we're bound to turn up a few.”
To think an officer of the law could speak so brightly about finding dead human beings. The real tragedy, however, was that this was the unvarnished reality of the city. London's slumification had long metastasized into a chronic disease. Housing, water mains... hell, absolutely nothing had expanded to match the exploding population. The wealthy didn't care; if you had coin, you simply bought comfort in the West End. But what about the poor? The vast majority were driven onto the streets, where even the meager possessions on their backs were laid bare to the desperate, inviting violent muggings at every turn. Getting robbed was a stroke of fortune; the world here was rarely so gentle.
“I... suppose you're right.”
“Then I'll do the rounds with the senior officers later and haul whatever we turn up straight back here.”
“Right. Just... try not to bring anything too decomposed.”
“Haha! Sir, I've been running bodies in and out of here for months now. Don't you worry. We've got plenty of room left in the pit anyway, and... well, I don't have all that much on my plate today.”
In a Victorian London teeming with unsolved murders, having a constable casually proclaim he had little to do felt utterly absurd, yet such was the prevailing atmosphere. Besides, how could they catch anyone anyway? There weren't any security cameras to track down cutpurses and murderers. Still, what bothered me far more was his casual mention of 'the pit.'
Ugh, just the thought of it makes my stomach turn.
I've always had an iron stomach. How else could I have become a surgeon and survived the brutal grind of a modern trauma center? In fact, calling it a strong stomach felt like an understatement; working trauma tempered a man's gut into cold-rolled steel. On top of that, I had undergone the visceral butchery of nineteenth-century surgical training. Yet that pit... that pit was so vile I wondered if Blizzard had modeled the 'Pit' dungeon in Diablo straight after it.
Dumping unclaimed corpses gathered from every corner of London into a single mass grave, burying them in a festering heap... Even a colossal ditch filled up in the blink of an eye when bodies were hurled in weekly by the dozen. Consequently, the plague-pit grounds expanded by the day.
“Funny thing, though. The digging's been a whole lot easier lately.”
When that very constable had beamed while saying that, I wondered what on earth he meant—only to realize the earth was loose because it was thoroughly soaked in liquefied human rot. Fuck me... And where did all that putrid runoff end up? It poisoned the groundwater, and that contaminated groundwater drained straight into the River Thames.
We desperately needed modern sewage and waterworks. I had whined relentlessly to Sir Damien about it, but it had accomplished nothing. The sheer cost was astronomical. When I had asked, “How can the great British Empire be short on coin?”, he had merely sighed, blaming trade deficits from their insatiable tea imports...
“Is opium truly our only recourse after all?” he had murmured.
Terrifying bastard. I had no desire to know more. It only reaffirmed my conviction that getting entangled in imperial geopolitics was a terrible idea.
At any rate, the young constable departed with that promise, only to return scant hours later. The reason he exerted himself so eagerly on our behalf was that Liston had amputated his mother's leg. No, not out of sheer intimidation, but out of profound gratitude. It had been a diabetic foot ulcer, and she had been standing on death's door.
The catch was that without blood sugar management, the odds were depressingly high that her remaining leg would eventually have to come off as well.
Until insulin is discovered, there's nothing we can do, is there?
How does one even produce it? Hell if I knew. The vague memory I had was that the breakthrough originated with dogs...
Would injecting an extract harvested from a canine pancreas work?
Ultimately, that boiled down to human experimentation. In the twenty-first century, pulling a stunt like that bought you a one-way ticket to prison. And yet... did we have any alternative?
No, stop. Not now.
I decided to shelve the thought for later. If I scattered my focus on every medical milestone at once, I'd end up botching everything.
“How do these look, sir?”
“Splendid.”
“Seeing you smile like that warms my heart, Doctor.”
“Did I smile?”
“Aye. You always grin from ear to ear whenever a batch of bodies arrives. I was genuinely taken aback earlier when you didn't look pleased.”
“Did I now...”
Once the mental clutter cleared, the cart heaped with cadavers properly registered in my vision. Since these hadn't come from the pristine gallows, fatal wounds were everywhere, and the stages of decomposition varied wildly. It was an undeniably gruesome sight. If a smile had crept onto my face regardless, it was surely because I was picturing the living souls these corpses would help me save in the future. Certainly not... because I was some depraved maniac.
“I won't forget this favor.”
“Think nothing of it, sir! I'll take my leave, then.”
With that, I ordered the waiting students to haul the corpses onto the dissection tables one by one. I summoned Blundell as well. As an obstetrician, he had the most pressing stake in this drill.
“You came too, brother?”
“There's surgery to be done; of course I'm here.”
“Right... fair enough.”
I hadn't called Liston, but he showed up anyway. It hardly mattered. In this era, individual surgical prowess far outweighed departmental boundaries. Strictly speaking, internal medicine textbooks went from a single slim volume in the 1980s to two massive doorstoppers by the 2000s, didn't they? And the 1980s were already an era of staggering medical advancement compared to this barbaric century, so what could one expect of the 1840s? In truth, dividing medicine into rigid specialties in this day and age was practically meaningless. Claiming, “I'm an obstetrician,” or “I'm a urologist”—it was all pure vanity.
“Obstetrics...”
Having assembled my crew around the tables, I cleared my throat to begin in earnest.
“Since we initiated the handwashing campaign, obstetrics has shown the most remarkable improvement of any field, hasn't it?”
“The greatest improvement by far,” Blundell agreed.
“We're doing even better these days,” Joseph piped up.
Both Blundell and Joseph—the fanatical specter of disinfection—nodded in vehement agreement. It was only natural. When doctors had been conducting internal pelvic examinations with hands filthy from the morgue, how could parturients not die in droves from puerperal fever? It was an arena where the before-and-after contrast was bound to be staggering. This miraculous turnaround was also the very reason Blundell hung on my every word.
“Yet even now, far too many mothers die. Especially in cases of obstructed labor... scarcely one in ten survives, does she?”
“Indeed,” Blundell sighed. “If the fetus fails to turn, we are virtually helpless...”
Even with monumental strides made, obstetrics remained the deadliest ward in the hospital. In truth, that wasn't Blundell's fault. Homo sapiens was simply an animal fundamentally ill-suited for childbirth. Owing to our disproportionate intelligence compared to the rest of the animal kingdom, our cranial volume was massive. The tragedy was that our bipedal pelvises remained narrow.
“And that is hardly the end of it. Have you ever delivered twins? Good heavens...”
Our ancestors hadn't waited months before naming their newborns without good reason. Ah, here I was rambling as if reminiscing about ancient folklore. For this world, it was the harsh present.
“Which is precisely why we must master the Cesarean section.”
“A Cesarean section? But... isn't that merely a salvage procedure to rescue the child? And even then, sparing the babe is considered nothing short of a miracle.”
Aye, historically it was. Unless luck smiled down with blinding favor, the infant perished right alongside the mother. The peritoneal cavity had never been a taboo realm solely for general surgery; obstetrics treated the abdomen with equal dread, making laparotomy the absolute last resort. Consequently, most incisions were carved into a woman only after she had already drawn her final breath—or seconds before it. How could a child starved of oxygen through a dead umbilical cord survive, especially when their clumsy cutting dragged on at an agonizing crawl compared to modern operations?
“And why did that convention take root in the first place?”
“Because touching the abdomen is taboo... wait. We already open the abdomen, don't we?”
Was Blundell an idiot for failing to connect the dots? No, he was simply shackled by the common sense of the nineteenth century. One might wonder why nobody thought of it when anesthesia and antisepsis were already established, but the truth was simple: progress was moving too fast. An anomaly named Kim Taepyeong had forcibly dragged these paradigms into the light before the medical world had even begun to digest them.
Heh. I suppose this is all my doing.
A smirk escaped my lips before I caught myself. Noticing Liston watching me with a knowing grin, I quickly tacked on a dollop of flattery to my prepared speech.
“It's all thanks to you, brother. You had the courage to cut into the abdomen first.”
“Haha, nonsense! You were the one who conceived antisepsis, my boy.”
“Haha...”
In truth, I had engineered every last bit of it, but sharing the glory cost me nothing. Only when Liston stood firmly behind me as my champion did the rest of the medical establishment fall into line.
“Regardless, we possess anesthesia, and we practice antisepsis. That means even if we open the abdomen, the odds of a patient expiring from surgical shock or falling victim to miasma are drastically diminished.”
“Capital! Then instead of bothering with natural labor, we ought to open up every single one of them!”
“No, no, absolutely not!”
The madman was talking complete suicide. Even in twenty-first-century obstetrics, natural vaginal delivery was overwhelmingly preferred whenever feasible. It wasn't just because vaginal birth was supposedly better for the newborn's microbiome or respiratory clearance; the maternal mortality rate of a Cesarean was roughly seven times higher. Granted, a Cesarean was typically invoked under perilous circumstances in the first place, but butchering every belly on principle was utter madness.
“Even under strict antiseptic protocols, the mere act of opening and closing the peritoneum carries a mortality rate of two to three percent.”
“A mere two or three percent!” Blundell blurted out. “Do you have any idea how many of my patients die on the birthing bed as things stand?”
“I... have a rough idea, Professor. But why add unnecessary risk on top of it? The purpose of mastering this surgery is to equip you with an ultimate weapon—a life-saving tool you draw only when your clinical eye tells you, 'She will not survive a natural birth,' or 'This delivery is turning fatal.'”
“Is that so...? But two or three percent... that feels practically negligible to me.”
This son of a bitch. Two or three women out of a hundred dying when they didn't have to was 'negligible'?
...Though to be fair, in this barbaric era where puerperal fever slaughtered twenty to thirty percent on a good day, two percent really was practically nothing.
“We can debate the ethics later; let's begin the drill. The cadavers are decomposing as we speak. Gather round, everyone. I've designed a procedure.”
“Oho!”
“Splendid. Let us see what you have conjured.”