Diabetes [1]
“What did you… say just now?”
“I suspect it is diabetes, Your Grace. I asked you to collect your urine in this.”
Duke Jamie stared down at the cup I had thrust into his hands, his expression curdled with absolute disgust.
It was an iron cup.
Truth be told, back in my laboratory I had some fine Chinese porcelain that Alfred’s father had given me as a gift. But wasn't the connotation of ‘Made in China’ completely different in this era compared to the twenty-first century?
Even after all this time, I still had trouble wrapping my head around it, but in the nineteenth century, Chinese goods were the very epitome of luxury.
Well… to be fair, the porcelain was exquisitely crafted.
‘Back in my day, Chinese manufacturing was straight out of a nightmare, though…’
Tainted infant formula that sent babies straight to the grave, kimchi stomped into existence by bare feet, dumplings stuffed with shredded newspaper… I didn't even need a search engine to remember them. More than a decade after reincarnating into this era, rattling off a few horrors from the top of my head was effortless. But in this day and age, goods from the Middle Kingdom were strictly high society.
“I… very well. But what on earth do you intend to do with it?”
“To determine whether you have diabetes or not.”
“Ha. Such a method exists? You Chosun fellows truly are something else.”
“Ah… yes, well. We have our ways.”
At any rate, Duke Jamie soon stepped outside. He had been complaining of frequent urination for a while now, so it seemed he wasn't bluffing; he offered no excuses about being unable to go on command.
You might wonder how on earth nineteenth-century doctors even knew the word ‘diabetes.’ It was a barbaric, primitive era, after all, wasn't it?
Yet surprisingly, mankind had recognized diabetes since antiquity. Even back in Joseon, it was known as the 'wasting-thirst ailment,' and tracing historical texts back to ancient times revealed that civilizations had long known of its existence. More importantly, people back then regarded it as far more terrifying than modern folks did.
“Is it truly diabetes? Good heavens, this is a catastrophe.”
Evidently not intimate enough with Jamie to accompany him to the chamber pot, Sir Damien remained in the room, his face darkened with dread. And with good reason.
In this era, a diabetic diagnosis came dreadfully late.
It wasn't as though blood glucose meters existed. By the time a patient was finally diagnosed, severe complications had almost invariably taken root. Though I hadn't compiled exact statistics, Liston had seen the lion's share of diabetic patients in our hospital, and from what I gathered, most were dead within ten years. Long before that, their legs were hacked off—or they perished on the table during the amputation itself.
“A catastrophe… indeed.”
At times like this, I desperately wanted to puff out my chest and say, Don't worry, I have just the cure!
Except I couldn't.
Why? Because insulin hadn't been discovered yet.
The only treatment at my disposal right now amounted to strict diet and exercise. Mind you, given the typical lifestyle of folks in this century, those two measures alone would work wonders. It wouldn't apply to the working class, who suffered from severe malnutrition, but the aristocracy was a different story—a staggering number of them were downright obese.
Overeating was bad enough, but their utter lack of caution regarding sweets was catastrophic. Sugar was an exorbitantly expensive commodity. True to this capitalist—no, mammonist—society, people believed that if something cost a fortune, it had to be splendid for your health, and they devoured it by the shovelful. Then again, considering plenty of these fools gluttonously scarfed down pastries laced with arsenic to make the icing whiter, sugar was hardly their only problem.
“Do you have no solution, Dr. Kim?”
“It isn't that I have nothing at all, Sir Damien, but it is not an ailment that can be remedied with a scalpel.”
“I suppose that makes sense. But what a disaster. Jamie may look like a fop, but he is of immense service to the British Empire. There is still so much for him to do… and my nephew is still so young.”
“As for your nephew, we cannot yet be certain whether it is diabetes or a prostate issue. I would have to examine him in person before rendering a judgment.”
“Come now, can a physician of your renown not diagnose him simply by hearing the symptoms?”
If I could diagnose a man through mere hearsay, I’d be a charlatan shaman, not a doctor. I sorely wished I could give him a good smack upside the head, but he was a nobleman, so smiling politely was my only viable option. Liston would have done the exact same thing; despite his fiery temper, Liston was remarkably adept at controlling his fury when standing before men of immense power.
“My apologies. I shall strive to improve. However, if you bring him to me or grant me the opportunity to make a house call, I will do my utmost.”
“No need to apologize, haha! Liston, haven't you slandered the lad? You claimed he possesses the temperament of an evil fiend, yet he seems gentle as a lamb.”
“Hahaha! You say that only because you don't know him, Sir Damien. Spend a little more time around him and you'll see… Surely you heard about the arsenic execution?”
“Ah, that. I heard Jamie hasn't been sleeping well ever since. He served on the battlefield in his prime, but watching a man slowly waste away before his eyes must have unnerved him. In any case, I leave my nephew in your hands later. First, attend to Jamie.”
“Understood, Your Grace.”
A rather concerning remark had slipped into the conversation, but I decided to let it slide. Arsenic… Yes, even I had to admit that spectacle had been a bit grim. But it had been unavoidable. A necessary sacrifice to save countless more lives down the road.
“Here, I brought it.”
While we were busily fostering high-society camaraderie, Duke Jamie returned, gingerly carrying a cup brimming with viscous fluid. The moment my eyes landed on it, my heart sank.
‘Blast it, I forgot to tell him to catch a midstream sample…’
Splashes stained the outer rim of the cup. Judging by the sloppy droplets, he had started collecting from the very first drop, then awkwardly yanked the vessel away mid-flow. In modern terms, the specimen was likely contaminated with superficial bacteria. But in truth, it didn't matter. How on earth was I going to culture bacteria right now anyway?
“What do you intend to do with this? What method could you possibly use?”
Evidently mortified to leave a cup of his own urine perched brazenly atop the mahogany table, Duke Jamie seemed desperate to have it whisked away. He hovered over me, urging me forward. With no other choice, I summoned Alfred. I took no pleasure in what was about to happen, but the Duke’s impatience left me no room to maneuver.
“Why are you calling me…?”
“Allow me to explain first.”
“Er… very well. Proceed.”
Leaving a bewildered Alfred standing awkwardly at my elbow, I addressed the noblemen. Though I was an orthopedic surgeon by trade, diabetes was such a massive cornerstone of pathology that I knew it inside and out. Besides, there was no need to delve into esoteric biochemical pathways. I simply needed to scare the living daylights out of him so he’d understand that contracting this meant he was thoroughly screwed.
“Now then… diabetes. As the name implies in our tongue, it is an ailment defined by sugar spilling into the urine, is it not?”
“Indeed.”
“However, if one looks closely, this sweetness is not confined to the bladder alone. In the East, there is an ancient saying.”
“Ah, Chosun wisdom! If it comes from Chosun, it must be trustworthy.”
I genuinely wondered what bizarre, mythical utopia these Englishmen envisioned whenever they heard the word 'Chosun.' It defied comprehension. If my lies ever came to light… well, to hell with it. Let future-me deal with the fallout.
“Have you ever heard that mosquitoes flock to the blood of those who pass sweet urine?”
“I… no. I have never heard such a thing.”
“The people of Chosun possess remarkably keen powers of observation, and thus such adages were born.”
“Fascinating. But is it true? And if so, why?”
“Because their blood is sweet as well. The very sugar found in the urine saturates the bloodstream.”
“Good lord…”
“Consider what happens to sugar water or honey, Your Grace. It becomes thick, sticky, and sluggish, does it not?”
“It does. Wait… are you suggesting my blood has turned into syrup?”
Medically speaking, it never reached quite that extreme. If his blood had literally turned to honey, he’d already be six feet under. But what did that matter? Once a lie had left the station, the train couldn't stop until it reached the terminus.
“Precisely so. Now… what happens when our blood ceases to flow?”
“A man dies. Even I know that much.”
“Indeed. When the blood stops, life ceases. And even before complete death takes you…”
“The foot rots off.”
This time, the interruption came from Liston—the man who could rightfully be hailed as the preeminent authority on diabetic gangrene in all of Britain, if not the world.
“Quite right, Brother Robert,” I said. “You’ve noted before that limbs severed from trauma differ markedly from those amputated due to rotting feet, haven't you?”
“Aye, the difference is night and day! Before anesthesia, I was in such a mad rush to hack through flesh that I had no leisure to inspect the tissue, but nowadays I take my time. And when I look… the blood vessels are entirely different. They are utterly choked and clogged. And without fail, every last one of those poor devils passed sweet urine beforehand. Wait… could that be why they die so easily? Ah—not that I am saying Your Grace is about to drop dead, of course!”
Carried away by enthusiasm on a subject he knew intimately, Liston had committed a catastrophic slip of the tongue. But it hardly mattered. Duke Jamie had already turned pale as a sheet, his soul practically departing his body. What sane man wouldn't lose his wits upon being told his blood was congealing into honey?
In the past, he might have huffed and puffed, denounced us as vile quacks, and bolted to a real charlatan like Harry. But unfortunately for him, he had tasted the fruits of my medical prowess far too many times to doubt me now.
“What must I do?! Save me, I beg of you! I still have far too much left to accomplish!”
“I understand your plight, Your Grace. Your contributions to the Empire are irreplaceable. Furthermore, we have not yet confirmed the diagnosis. We must verify it first.”
“Ah, of course! Yes! It might not be diabetes after all! Quickly, test it at once!”
“Very well. Alfred?”
Did the boy possess some animal instinct for impending doom?
Instead of answering, Alfred took a hurried step backward, preparing to bolt. But Liston’s massive mitt shot out and clamped onto his shoulder like an iron shackle.
“Could you tell us whether the urine is sweet or not?”
“You… you bastards…”
“Wait, Liston! If I had known what he was going to ask, I would never have caught you!”
Liston hastily released his grip, but the truly desperate party in the room was Duke Jamie.
“I beg of you! Please! Just one sip! Drink it, I beseech you!”
Tyranny of the highest order. Ordering another man to swig your piss!
“You… you absolute piece of shit…”
Yet the authority of a duke was absolute. Alfred dared not curse the noble peer directly, so he aimed his murderous glare squarely at me. Rather than feeling threatened, I felt an overwhelming wave of guilt. Come to think of it, I really had used the poor lad as a pack mule far too often.
“Senior, this is of paramount medical importance. We need to establish a sensory baseline for sweetness… and we need someone with a refined… gifted palate.”
Just as I scrambled to devise a persuasive excuse, Colin stepped forward.
Without uttering a single syllable, the aristocratic lad seized the iron cup and gulped down the lukewarm fluid.
He swallowed, lowered the cup, and solemnly reported,
“It is sweet…”
“Right! It’s sweet! It was diabetes after all!”
“Master… this constitutes the progress of medical science, does it not?”
“Indeed it does, Colin. Magnificent work.”
Deeply moved by his fanatical devotion, I heaped praise upon him. But then Blundell, who had been observing the spectacle in stony silence, casually tossed out a remark.
“If all you wished to know was whether it contained sugar, couldn't you have simply poured a splash over an anthill? Ants would swarm it in an instant if it were sweet.”
“Oh.”
Well, look at that.
Such a method actually existed.
I hadn't known. It hadn't even crossed my mind.
“Oh?”
Colin and Alfred simultaneously locked eyes onto me, their stares burning with raw, unadulterated homicide. I resolutely averted my gaze. Knowing that playing dumb wouldn't save my skin for long, I frantically whipped my head back toward Duke Jamie.
“As you have witnessed, Your Grace, you have diabetes. If you refuse treatment… your legs will be severed, among other grim fates. You will adhere to the regimen I prescribe, will you not?”
Fortunately, Duke Jamie was so terrified out of his wits that even Colin, freshly reeking of urine, dared not interrupt the exchange.
“Yes! Yes, absolutely! I shall do whatever it takes! Even if you command me to wander a graveyard at the dead of night, I shall obey!”
That might have sounded like madness to modern ears, but such beliefs were shockingly commonplace in this era. People clung to the bizarre superstition that undergoing some grueling, agonizing penance would magically purge disease from the flesh. Naturally, it was utter nonsense.
“Compared to such horrors, my prescription is child's play.”
“Tell me! What is it?!”
“You must abstain from all desserts.”
“Ah… now, see here… that is a bit much.”
A sane man might have thought him entirely deranged. A gentleman who just pledged to stalk among tombstones in the freezing dark was now balking at the mere thought of skipping pudding? But keep one crucial detail in mind:
Our dear Duke Jamie was an Englishman.
He lived in a country where, practically speaking, desserts were the only edible food on the entire bloody island.