Diabetes, Part Two
“Even so, absolutely not.”
“Good heavens.”
A refusal was a refusal. Truly, sentencing an Englishman to a lifetime of nothing but English cuisine was a fate so cruel that even Hitler might have balked at it. Yet desserts in this era were an entirely different beast; setting aside the heavy metals stirred in purely for vibrant artificial coloring, they consisted almost entirely of flour and refined sugar.
It was cloying. Pure, concentrated sugar—and bundled as a lovely package deal with toxic pigments.
Well… there is a reason they call it sugar addiction.
While perhaps not on par with hard narcotics, sugar still induced a ferocious and lethal chemical dependency. In a world brimming with alternative pleasures, moderation might have been feasible, but in Victorian Britain, such comforts were scarce indeed.
“You must endure it regardless.”
“Ooooh…”
“You will die otherwise. You understand what happens when diabetes takes hold, do you not?”
“I know, of course, but…”
Had I not just explained, tailored strictly to a nineteenth-century grasp of anatomy, why contracting diabetes was practically a death sentence? Certain details might have strayed from modern scholarly accuracy, but necessity dictated the compromise. Frankly, by that standard, very little of what I had spouted since landing in this century was strictly orthodox anyway.
Regardless, Duke Jamie was thoroughly terrified by the mere mention of diabetes, and not entirely because of my lecture alone.
Why?
“Once struck, most perish within a year or two,” Liston cut in bluntly. “And your legs… are almost invariably severed.”
Such was the grim reality of this age.
It could hardly be helped; nineteenth-century medicine differed vastly from the twenty-first. To begin with, an accurate diagnosis was nearly impossible until the patient’s urine turned noticeably sweet, meaning the condition was caught disastrously late. To hand down a terminal diagnosis without a drop of insulin and prescribe nothing more than vague dietary moderation—could anyone reasonably expect to survive that? Not a chance.
“Which is precisely why you must refrain from sugar. Furthermore, you must exercise.”
“I exercise plenty as it is.”
“You mean… pastimes like hunting?”
“Naturally. As a proud peer of the British Empire, I engage in the hunt without pause.”
The very concept of exercise was virtually nonexistent in this era. Society still actively bickered over whether physical exertion was genuinely beneficial to health or inherently damaging. Even in the twenty-first century, while everyone agreed exercise was beneficial, fierce debate raged over precisely how much and what sort was ideal. In this primitive dawn of genuine science, people could scarcely distinguish what qualified as exercise in the first place.
Since no one had formally established a definition, I could hardly criticize him, but the prevailing sentiment seemed to equate any sufficiently masculine pastime with physical fitness.
“You scarcely move your body, do you?”
“What nonsense! I ride upon horseback and fire my rifle.”
“You hardly ride at a gallop, though.”
“Why on earth should a nobleman gallop recklessly when not engaged in battle? Such unseemly thrashing is fit only for the lower orders.”
Indeed. That was the noble definition of athletic pursuit. The beaters and servants herded the wild beasts into range, whereupon the esteemed gentry merely twitched a finger against the trigger. And should the quarry be only winged and attempt to flee? The hired hands calculated the angles, loosed the hounds, or fired a finishing volley, while the aristocrats simply chuckled in satisfaction over the tally.
Duke Jamie’s testosterone levels were already plummeting due to his self-inflicted castration, with his muscle mass actively melting away. If he continued relying on that brand of ‘exercise,’ he would not last six months, let alone a year. His metabolic capacity to burn glucose was dwindling by the day, and if he refused to physically exert himself on top of that…
My expression must have darkened visibly while following that train of thought.
“Ah, I meant no offense to you, of course. You are Noble Pyeong, are you not? A yangban, I am told.”
He was barking up entirely the wrong tree.
“Well… that is not entirely inaccurate, but regardless. You must physically move your own limbs.”
I pushed myself up and demonstrated a clean bodyweight squat. My form, if I said so myself, was rather immaculate. Besides, so long as the knees and lower back did not ache, a beginner’s squat did not need to be technically flawless. Whether the load engaged the quads or the glutes was utterly beside the point; what mattered was getting a sedentary man to move. Legs or buttocks, it was all part of the same frame. Wherever the bulk accumulated, muscle was muscle.
“Hmph… This is rather difficult.”
“It will be. Nevertheless, you must perform it daily.”
“Is there no medicinal remedy instead? Something like Fowler’s Solution?”
“Pardon…?”
Downing a tincture of arsenic would certainly settle matters once and for all. If one was terribly anxious about managing a diabetic body, destroying the body entirely was indeed an effective permanent solution. But that was homicide, not medical treatment. Of all people, I could hardly sanction such madness.
“Absolutely not. You must control your diet and exercise.”
“Sigh… Very well. In any case, so long as I forgo dessert and practice these contortions, I shall not die, correct? My thanks.”
Perhaps weary of hearing my unrelenting badgering, Duke Jamie hurried out of the parlor. Curiously, he headed not toward the exit to his carriage, but deeper into another wing of the estate. It reeked suspiciously of a man running straight into the arms of some quack doctor who promised sweet, effortless lies.
He has a year at best.
I was not wishing ill upon him out of spite for his obstinacy; it was a cold, objective medical prognosis. Had he retained his male hormones, matters might have unfolded differently, but his diabetic deterioration had likely accelerated precisely because of the castration. The disease’s progression and virulence would inevitably prove far more aggressive than usual.
“Look here.”
As I brooded over the grim outlook, Sir Damien, who had lingered behind, called out to me.
“Yes, Your Grace?”
“You are harboring rather grim thoughts, are you not?”
“Pardon me?”
“Liston remarked upon it earlier. Whenever your face twists into that peculiar grimace, you are invariably contemplating something dreadful. Watching you stare after Jamie’s departing figure with that very countenance makes me exceedingly uneasy.”
“A misunderstanding… Surely a misunderstanding, my lord.”
“Then what were you pondering?”
I had been contemplating that Jamie had roughly twelve months left to live, during which he would suffer gangrenous amputations, slip into total blindness, endure renal failure, and perish in agony.
Well… grim is an entirely fair assessment.
I could hardly feel wronged by the accusation. Even so, confessing such unvarnished thoughts aloud was out of the question. They would look at me like an unhinged demon—not that they did not already accuse me of being sinister on a regular basis.
“I was merely wondering if some alternative measure might be found.”
“Were you? Why?”
“Because… should Duke Jamie proceed as he is, I fear the outcome will not be favorable.”
“T-That will never do. Jamie currently bears an immense responsibility on behalf of the realm.”
“A grave responsibility?”
“I cannot delve into particulars, but it concerns an enterprise that may well determine the next century of the British Empire. You may judge him lightly having seen only his eccentricities, but the man is far more capable than you realize.”
Indeed. I had always assumed that being a duke implied some modicum of stature, but watching him voluntarily castrate himself and run about wearing a glued-on false beard tended to vaporize any lingering respect.
“He is a far more remarkable fellow than he appears. But tell me—do you believe a remedy exists?”
Sir Damien, by all accounts, was an exceptionally formidable peer. His sheer authority aside, every enterprise he touched was impeccably managed. Of course, this being imperial Britain, God only knew what sordid machinations he orchestrated behind closed doors, but if a man of his standing vouched for Jamie, there had to be truth to it.
“I know you are not a man moved by mere coin, but I shall reward you handsomely.”
Better still, there was money on the table. Judging by how casually he had gifted me an expensive microscope before, Sir Damien’s idea of a ‘handsome reward’ existed on an entirely different plane from ordinary men’s purses. Naturally, if no medical inspiration struck, all the gold in London would accomplish nothing. Fortunately, an obscure piece of medical trivia flared urgently to the surface of my mind. Of my three closest friends back in my past life, one had been an endocrinologist.
“It is not entirely devoid of hope… though even in Joseon, the method has yet to be fully established.”
“Oh? Pray, speak on.”
“Aye, diabetes has long captured my curiosity as well. Speak, lad,” Liston chimed in, leaning forward.
As the man who had lopped off more diabetic feet than anyone else on the planet, his interest was piqued. Blundell and the other apprentices leaned in with equal fervor.
Meanwhile, Alfred—who had narrowly escaped tasting urine—and Colin—who had actually been forced to swallow it—were glaring at me with an entirely different brand of intense interest. Alfred throwing fits was nothing new, but seeing Colin radiate murder was a first.
Well, it was my blunder. But I had no choice. Ants… how on earth was I supposed to remember ants at that exact moment?
I would have to apologize later, or perhaps treat them to a round of strong ale. Pushing the guilt aside, I recalled the rambling lectures my endocrinologist buddy used to deliver over drinks and parted my lips.
“Back home, patients throw a fit whenever you mention daily insulin injections… but insulin is literally the crux of the whole disease. Do you even know how it was first discovered…?”
To be completely honest, I could not remember every clinical detail. I was neither an internist nor a diabetic patient myself. Had diabetes not been such a monumental pathology, the explanation would have flown in one ear and out the other over beers.
“Have I not mentioned before that my homeland, Joseon, possesses a fierce martial tradition? Despite being a modest kingdom bordered by vast empires, there is a reason we have preserved our sovereignty against both the Qing and the Wa without ever bending the knee.”
“Oho, is that so?”
“Then why on earth are you so scrawny?” Liston grunted.
I blithely ignored Liston’s jab and wove my fabrications with practiced grace. Calling myself a master of tall tales had once been self-deprecating humor, but through sheer repetition, the lies now flowed like poetry.
“At any rate, skirmishes remain frequent along our northern border.”
“Indeed…”
“I rather fancy visiting the place myself,” Liston mused.
If Robert Liston were loosed upon the Joseon frontier, it would be an absolute bloodbath. The man might very well reclaim the Manchurian plains single-handedly with a bone saw. Not that he would ever make the voyage, of course.
“Naturally, many soldiers suffer horrific injuries. Among them was a warrior who took a blade directly here.” I pointed a finger toward my upper abdomen.
“In the belly? Surely he perished.”
“Yet he survived. By miraculous chance, his life was spared.”
“Did he? And then?”
“He pulled through, but from that day onward, he began passing sweet urine.”
“How could anyone possibly have known that?”
To hell with it.
“Because ants swarmed it.”
Silence hung for a beat, before two voices cracked across the room.
“Then why in bloody hell did you make him drink it earlier?!”
“You bastard!” Alfred howled.
“Professor! We demand an explanation!” Colin shouted, his face turning crimson.
“I forgot.”
“Ah. Well, that happens,” Liston grunted reasonably.
“Y-You…!” Alfred sputtered, clutching his hair.
Whatever. I would apologize to them later. Right now, spinning the yarn to Sir Damien was far more pressing.
“At any rate.”
“‘At any rate’?” Colin hissed through clenched teeth.
Glare with your butcher’s eyes all you wanted; what could an apprentice do in front of Duke Damien and Robert Liston?
“Following his eventual passing, a post-mortem dissection was performed.”
“They conduct anatomical dissections in Joseon?”
“Occasionally, along the frontier.”
“Splendid! A truly enlightened nation of medicine!”
“Indeed, quite so.”
To harm the body given by one's parents is the height of unfilial impiety… Bah, who cared about Confucian doctrine right now?
“Upon inspection, an organ nestled behind the stomach was found to have suffered profound trauma.”
“Hm?”
“The pancreas?” Liston muttered, leaning in.
“Precisely. The pancreas. It leads me to suspect that the pancreas bears an intrinsic connection to the pathology of diabetes.”
“There exists an organ called the pancreas?” Damien asked, brow furrowing.
“Yes, Your Grace. Tucked right behind here.”
Around the room, heads nodded in solemn contemplation. It sounded remarkably plausible. In historical reality, that landmark discovery had been achieved through canine vivisection—researchers had excised a dog’s pancreas, watched it promptly develop severe diabetes, and witnessed it waste away and die. I had merely transplanted that experiment into the dramatic narrative of a wounded soldier to make it digestible to nineteenth-century gentlemen.
Of course, replicating the actual proof would require our own experimental trials.
“Shall we procure a few stray dogs, then? Or do you require human subjects?” Sir Damien asked calmly.
Human experimentation was a bridge too far, even in this lawless medical frontier.
I shook my head firmly at Sir Damien.
“D-Dogs. Let us begin with dogs.”
Animal testing was vastly preferable. Anything was better than butchering human beings in cold blood.