Diabetes [3]
Dissuading Sir Damien had been no easy task.
He had kept prattling on about how a dog couldn't possibly be compared to a human being, and on and on he went. To be fair, he wasn't entirely wrong.
Animal testing wasn't universally applicable, after all. There were plenty of pharmaceuticals that appeared perfectly safe during animal trials only to prove disastrous in humans, just as there were countless compounds that showed miraculous efficacy in animals but did next to nothing in a person. That was the whole reason clinical trials existed in the first place—some things could only be confirmed by administering them directly to human beings.
Still, this is crossing the line.
Carving out a living person's pancreas just to see what happens? That was murder, pure and simple. What else could anyone call it?
By twenty-first-century standards, doing it to an animal was already ethically uncomfortable. But the problem was that this wasn't the twenty-first century; it was the nineteenth. A time when you actually had to argue yourself hoarse just to stop people from jumping straight to human experimentation.
"What about using black people, then?"
"Er, Your Grace... the slave trade has already been..."
"There are still those willing to sell their own bodies of their own accord. It's not entirely impossible to procure someone if one is determined."
"Ah, voluntarily? Well, in that case..."
Look at them. Just look at these lunatics.
Sir Damien might seem relatively sane at a glance—well, standing next to a man who had voluntarily castrated himself would make almost anyone look sane—but even so, here he was. And Liston was supposed to be the better one? The man genuinely believed it was fine so long as the subject volunteered!
Should I bother explaining that undergoing this meant certain death? No, that wouldn't help. They would just say, "They might die, but we'll pay them handsomely." And the horrific reality was that... people would actually step forward. Even now, there were countless desperate souls eager to sell their own blood for a few coins.
"No, absolutely not. We start with dogs. I am strictly opposed to experimenting on humans."
"Hmph... It is only a negro, after all."
"Well..."
If I were to shout, 'They're human beings just like us!', how would Sir Damien react? I didn't know. I had no idea! The one thing I knew for certain was that his response wouldn't be friendly. This was Europe, where human zoos would still be drawing crowds well into the late nineteenth century. Imperialist bastards...
How on earth was I supposed to persuade them? Just as I was racking my brain, Liston—our dear tea-swilling Scotsman—piped up.
"Might using a negro yield inaccurate results? The physiological differences between a white man and a negro, after all..."
"Ah, quite so! Yes! I hadn't considered that. We shall use a dog."
"Right, quite."
Well... It didn't leave a great taste in my mouth. Not at all. But at the very least, things were moving in the direction I wanted.
"Brought 'em in, sir!"
Where did we get the dogs? In this city, dogs were everywhere you looked. Considering the endless nuisance and danger posed by stray dogs, London really needed to do something about them anyway. Rabies aside, countless people died simply from the complications of infected dog bites.
In a world without antibiotics, I was realizing more and more every day just how terrifying a 'dirty wound' truly was.
"Well done. Now then... how shall we proceed?"
"We must anesthetize them first."
"Anesthesia?"
"We can't have them dying on us right away. We need to cleanly excise the pancreas and observe what happens afterward."
"Ah, quite right. Alfred?"
Alfred, our resident anesthesiology specialist, stepped forward at Liston's call, accompanied by Colin. Being respectable medical students forced to hold down stray dogs couldn't have been thrilling for either of them. But then again, just a short while ago, they had been used as human urine-testing machines. Compared to that, an animal dissection experiment was practically noble work.
"Yes, sir!"
Besides, the task wasn't particularly difficult. Alfred gave the valve a twist, and with a soft hiss, sprayed gas toward the trembling stray held fast in the coachman's burly grip. The coachman inhaled some of the vapor himself, his eyes rolling back slightly as his grip loosened, but if a fully grown man was affected like that, what chance did a dog have? It was already out cold.
"Hey, is it going to die from that?"
It was enough to make me genuinely worried about an anesthetic overdose.
"It should be fine, right?"
"Well..."
Perhaps it would be fine—it was a nineteenth-century dog, after all. In this era, neither beast nor man survived unless they were tough as nails.
At any rate, since the animal was under, Liston and I made a clean incision down the dog's abdomen and removed the pancreas, which sat in a slightly different position than in a human. It was my first time seeing a canine pancreas in person, but the procedure wasn't particularly complicated. It was just a matter of locating the organ that looked like one and excising it.
"Good."
"Let's do the other one as well."
"Right."
Just in case, we removed the pancreas from both dogs the coachman had brought. With that, today's experiment was concluded. It seemed unlikely they would produce urine immediately anyway, and subjecting them to further procedures on the very day their bellies had been sliced open and their organs harvested felt like pushing things too far.
The onset of diabetes is a foregone conclusion. What matters far more is the treatment.
Diabetes treatment. In the twenty-first century, there were countless medications available. A dizzying array of them... Yet among all of those, the only one remotely accessible right now was insulin. And even then, the refined insulin we knew in modern times was completely out of the question. I would have to settle for the crudest, earliest iteration of it.
What did that early form look like? Simple: administering what living organisms produced in its rawest state.
That doesn't mean I can just squeeze the juice out of this pancreas and feed it to a patient.
I gazed down at the two lumps of canine pancreas I had brought back to the laboratory like macabre souvenirs. They were considerably smaller than a human pancreas, but their contents wouldn't be fundamentally different. Which meant that while insulin was present in that tissue... digestive enzymes were present as well.
Crucially, those digestive enzymes broke down proteins, and insulin happened to be a protein. The moment you mashed the pancreas and extracted its juice, that precious insulin would be degraded into amino acids that used to be insulin. Pouring that crude extract into a patient, no matter how much, would accomplish absolutely nothing. Indeed, medical history was littered with precisely that failed attempt.
So how was I to solve this?
"Mmm..."
I was alone in the laboratory. Alfred and Colin had tried to pick a fight with me over the urine incident, only for Liston to drag them off by the collars to the anatomy dissecting room.
And Joseph? Well...
"Did you wash your hands?"
"Hands!"
"Wash your hands!"
He was probably barging into some hospital ward right now, barking like a madman. Thanks to his zeal, the mortality rate was plummeting, but... he was making just as many enemies along the way. Since Joseph's enemies were effectively my enemies, I wondered if I should rein him in. Yet what could I do? He was doing the right thing. Still, I really needed to replace the harsh chlorinated lime wash with something less brutal on the skin...
Click, whirr.
Pondering these thoughts, I adjusted the microscope gifted to me by Sir Damien and peered at the canine pancreatic tissue. The histological structures I had memorized during pathology lectures came into focus. Dominating the field were the acinar cells. These were the cells responsible for secreting digestive enzymes—the functional backbone of the exocrine pancreas. In the original timeline, when researchers first performed pancreatectomies, they hadn't anticipated anything related to diabetes; they had merely expected severe impairment in the digestion of proteins and fats.
There we go. Found them.
Scattered among the acinar cells were clusters that resembled tiny islands: the famous Islets of Langerhans. You can guess what they do by now, right? They are the cells that produce insulin.
The problem is, if word gets out that I already know all of this right now, I'll be in serious trouble.
Even the simple claim that 'removing the pancreas causes diabetes' was suspicious enough on its own. It was fortunate that Liston had firmly decided to trust me; otherwise, I would have been in hot water long ago. Plus, the network of aristocratic connections formed through Liston served as a sturdy shield. But babbling about acinar cells and Islets of Langerhans was crossing an entirely different line... Discovering that such structures even existed—let alone discerning their physiological function—was something that wouldn't happen for another fifty years in regular history.
Someone might even propose a pancreatic transplant.
Ah, our nineteenth-century pioneers... Such 'enterprising' gentlemen... Anesthesia had barely been introduced, and already I heard rumors of surgeons attempting all manner of grotesque, bizarre operations. I had deliberately walked away to avoid vomiting from the gory details, but I caught wind that some were even dabbling in plastic surgery.
Bloody hell... What ungodly horrors were they performing? My hands had trembled so hard I had to leave the room. If I learned any more, I knew my surgical conscience would compel me to step in and fix it.
Well, if they suggest a transplant, I can just try it on a dog, watch it die, and say, 'Oops, looks like it doesn't work.'
There would inevitably be trial and error. While I would do everything in my power to keep human beings off the chopping block, many dogs were going to die in the process. It was regrettable, but unavoidable. Still, the most pressing matter right now was replicating historical progress: finding a way to extract usable pancreatic juice for a patient.
In theory, it's simple enough.
If you knew the underlying mechanism—the specific functions of the pancreas—it was remarkably straightforward. By ligating the pancreatic duct leading to the intestine, digestive enzymes would back up, causing the enzyme-producing acinar cells to atrophy and die off over time. Once those cells had withered away, you could harvest the remaining pancreatic tissue and crush it, yielding an extract rich in insulin without destructive digestive enzymes. Inject that, and you could save a life.
It was an exceedingly tedious and cumbersome process. But chemical synthesis of insulin wouldn't be achieved until the late twentieth century. How could I possibly pull that off now? It was completely unrealistic.
Wait, didn't they later use pancreases from slaughtered cattle?
Was I seriously supposed to ligate an animal's pancreatic duct, wait weeks, cut it open, harvest the tissue, and squeeze out the extract every single time a dose was needed? Good grief... Lord Jamie could afford that. The man was filthy rich. But what about everyone else? I needed a far simpler process.
Ah, that's right. Cattle. They used slaughtered bovine pancreases. And insulin... doesn't dissolve in alcohol. Hmm.
How could I employ that simplified process while, damn it all... avoiding suspicion? As I racked my brain for a convincing pretext, a sudden epiphany struck me!
I felt as though I finally understood why the heavens had plucked me up and tossed me into the past. This was something only I could pull off. The Master of Deception. Only Kim Taepyeong, sorcerer from Joseon, was capable of this.
Anyone else? An internal medicine specialist? They couldn't perform surgery to save their lives, so they'd be out immediately. Another surgeon? Surgeons were knife-wielders by nature—they generally lacked the silver tongue needed for delicate manipulation.
Me? I was in a league of my own.
"Oh... Ants truly are swarming around the urine!"
"Not only that, look at the beast! It is practically on death's door!"
At any rate, a few days passed while I let my freshly fabricated explanation mature in my mind. Today, we gathered once more to inspect the dogs. In truth, Liston and I had checked on them daily, but today's special guest was Sir Damien. The two of them were positively thrilled as they observed the two dogs, which were now reduced to utterly pitiable wretches.
I wondered if these men possessed a shred of human decency, but ghastly as it was to watch, seeing them revel over dogs was a hundred, a thousand times better than watching them do it over human beings, so I kept my mouth shut. More importantly, there was something else that needed to be addressed.
What good was extracting insulin if that was all we did? Without any means to calculate precise dosage, administering the correct amount would be impossible. Nor could the patient inject themselves multiple times a day like modern patients with commercial insulin pens. I would have to administer it myself. Which meant that on top of receiving insulin, the patient would have to put in serious effort of their own.
"Does Lord Jamie take any exercise?"
"Hm? Ah, no. He is far too busy."
See? It was always like this. He'd carry on like that until he went blind and had his legs amputated, only then crying about how he should have taken better care of himself.
In any case, insulin was the more urgent priority right now. I parted my lips to unleash the grand tale I had prepared. Ah—after a sip of water, of course.