Diabetes, Part 4
“Now, as you can see, the dogs have contracted diabetes.”
“Indeed.”
“Truly remarkable, isn't it?”
“As expected of Joseon...”
“How do you even know that? Shouldn't you take a sip yourself, Professor? How on earth can you tell whether the urine is sweet just by looking at it—mmph!”
Everyone was nodding in agreement with my pronouncement. Colin, who had been compelled to taste Lord Jamie's turbid urine earlier, made a brief, rebellious protest, but... well, what could one do? Liston swiftly clamped a massive hand over the apprentice's mouth. How dare he kick up a fuss over swallowing a mere mouthful of urine in the grand face of medical progress?
Wait... weren't you ready to drink literal sewage water before?
Pick a lane, kid. Either commit or don't. Stop trying to make an innocent man feel guilty.
In any case, I turned my attention away from Colin and addressed those who were actually prepared for a productive conversation.
“Which means there is undeniably something inside this pancreas. So then, how should we go about treating it?”
“How about grafting a pancreas back in?”
Ah, I knew someone would suggest that. The dream of organ transplantation... It was about time someone dreamt it, certainly. But it would hardly be an exaggeration to say it was utterly impossible until mankind conquered the towering mountain called the immune response.
While I wasn't an immunologist, at this point in history, there wasn't a single surgical procedure that successfully implanted foreign tissue into the human body. Why? Because no one knew how to suppress the body's reaction to foreign matter. In fact, it was worse than that: they didn't even understand why such a reaction occurred in the first place.
“That is certainly one approach,” I replied smoothly. “Let us give it a try. Conveniently, we have two more dogs right here.”
I knew the truth, of course. Carving the pancreases out of these two poor hounds and grafting them into the ones we had already mutilated was... well, nothing more than an unnecessarily complicated way to commit murder—or rather, canicide. But what choice did I have? The men of science in this era possessed bravery bordering on madness; the moment an idea popped into their heads, they immediately put it to the test. They wouldn't even hesitate if the experiment was performed on living human beings. Hadn't arsenic been used in exactly that reckless manner?
And despite everything, they say people are still quietly using arsenic all over the place...
Not yesterday, but just today on my way here, I had spotted an advertisement plastered on a street wall:
“Cover your walls in our arsenic wallpaper, and watch rats and vermin vanish!”
Madmen... Absolute lunatics. Rats! Creatures that thrived perfectly well in filthy, disease-ridden sewers! Why did people think those indestructible beasts were dropping dead or fleeing their parlors? If they had rubbed together even two functioning brain cells, the answer would have hit them like a brick, yet here they were, celebrating it.
“Splendid. As expected, you are exceptionally prudent.”
“Would he have become a professor at such a tender age otherwise? Haha!”
Consequently, no one raised any objections to my suggestion to test the transplant. In an age where basic human rights barely existed, who on earth cared about animal welfare? Sir Damien and Liston merely chuckled heartily, gazing down at the wretched hounds. Whether those two dogs sensed their looming fate or not, they let out nothing but pathetic, mournful whimpers.
Well... at least it wouldn't be an entirely meaningless resection. Honestly speaking, removing a pancreas was no trivial matter in the first place. To put it bluntly, did we have antibiotics here? Anti-inflammatory drugs? Not a single one. Having undergone major abdominal surgery under such primitive conditions, the poor beasts' blood sugar levels were currently skyrocketing off the charts. On top of that, whatever they ate passed straight through without being properly digested; their digestive enzymes had been stripped away right along with their insulin. They were only surviving this long because they were sturdy nineteenth-century street dogs; had they been pampered twenty-first-century pets, they would have dropped dead on the operating table.
“However, gentlemen, the truth is that we have no way of knowing whether such a pancreatic transplant will succeed or fail. Should it fail, the patient will surely perish. And so, an idea occurred to me...”
“What manner of idea?”
“If it came from your head, it may be devilish, but it will undoubtedly prove useful.”
“Indeed, let us hear it.”
Sir Damien, Liston, and the Hospital Director chimed in one after another. Ah, why was the Hospital Director here? Because in this era, diabetes was a rather pressing concern among high society. During the few spare days I had, I looked into the matter, and... well, "rather pressing" didn't begin to cover it.
If diagnosed around the age of thirty, patients typically perished within four years. In cases of Type 1 diabetes—juvenile diabetes—it was even more catastrophic, with children rarely surviving even a single year. The elderly tended to last a bit longer, but that was under ordinary circumstances; for someone like Lord Jamie, who had been chemically castrated of his testosterone, surviving even a year would be a miracle.
At any rate, this was an era where catering to the aristocracy was the only way to rake in serious fortunes, and thanks to me, our hospital's roster of highborn clientele had expanded considerably. It was only natural that the Hospital Director possessed an immense, burning interest in diabetes.
Well, if the Director puts his weight behind this, there's virtually nothing we can't pull off.
After all, the old fox carried considerable clout.
I cleared my throat and resumed speaking.
“We extract the juice from the pancreas and administer it.”
“Juice...?”
“I recall reading somewhere that squeezing the juice from a rooster's testicles and consuming it significantly enhanced a man's virility.”
“Does that even make sense?”
“Hear me out first.”
“Very well.”
Liston tilted his head with a dubious frown, but I saw right through him. In truth, his interest had been thoroughly piqued. On their way home, every last one of these men would probably stop by a butcher to buy a pair of rooster testicles.
That's precisely why I said 'consuming it' instead of injecting it...
For testosterone or organ extracts to actually have any physiological effect, it had to be injected into the bloodstream. If you ingested it, whatever active components it contained would be completely broken down by stomach acid and digestive enzymes. But if I told them it had to be injected, these reckless fools would immediately start sticking needles into their veins! What would happen if they injected unsterilized rooster extract and contracted sepsis? I couldn't say whether the men gathered here would make great contributions to humanity, but they were certainly useful to me, which meant I had to keep them alive and in one piece.
“This disease arises because the pancreas fails to perform its function. In that case, wouldn't providing whatever comes out of the pancreas resolve the issue?”
“There is logic in that.”
“But aside from a transplant, what other method could there be?”
“Did he not just say we should squeeze its juice? You pretend to be a man of few words, Liston, yet you never listen when others speak.”
“I looked into it and discovered there is a slaughterhouse nearby,” I pressed on. “They butcher several head of cattle a day... What if we obtain pancreases from there, extract the liquid, and administer it? Naturally, we must first verify whether bovine extract is effective.”
“Oh... will they give them to us for free?”
“If they refuse, I shall procure them myself.”
“Reassuring, as always.”
If my memory served me right, this was roughly how it went down in original history as well. How did I know this obscure trivia? Because back in modern times, I had a colleague who was utterly obsessed with diabetes. When coordinating academic conferences, one inevitably had to collaborate with fellows from other departments... and every single time we met, he talked about diabetes and nothing else. After listening to him blabber for well over a year, I thought he'd finally run out of things to say. But the moment his clinical anecdotes dried up, the lunatic began recounting the entire history of diabetes research.
I'm sorry I lost my temper at you back then, my friend.
Thanks to his ceaseless babbling, I was putting it to splendid use in the nineteenth century.
“Once we acquire the bovine pancreases... we cannot simply squeeze them as they are, can we?”
“Why not?”
“They must be disinfected.”
“Ah.”
“Chloride of lime!”
Disinfection... Well, strictly speaking, it wasn't wrong. A cow's pancreas was reasonably clean on the inside, though of course it would get contaminated during extraction. But the reason I was chanting "disinfection, disinfection" right now was for an entirely different purpose.
“Wait, no... Joseph, you saw what happened back then. It destroys everything. You'd end up administering chloride of lime straight to the patient—do you think they'd survive that?”
“Ah... I suppose that's true.”
That sank Joseph for the moment. The lunatic brought up chloride of lime for every single problem under the sun. To be frank, carbolic acid alone was more than enough. The stench was foul, but it worked wonders when scrubbing down surfaces.
“I have given this deep thought: what about using alcohol?”
“Alcohol...?”
“Well... while it does possess some antiseptic properties, is it not difficult to produce and terribly cumbersome to use?”
Alcohol had to be used. Why? Because that was what they used in original history. One might wonder why I didn't improve upon it if that was already known, but... it was simply the near-perfect method.
First of all... it obliterates all the digestive enzymes.
Alcohol... Had anyone ever poured it onto an open wound? It hurt like absolute hell because it indiscriminately ravaged living tissue. Could puny digestive enzymes possibly withstand that onslaught?
Yet insulin survives it.
That... was truly a biochemical miracle. I had no idea how insulin managed to endure such harsh treatment, but it did. Of course, alcohol alone wasn't enough. It evaporated rapidly, and insulin didn't dissolve particularly well in pure alcohol anyway.
“Alcohol evaporates rapidly, as you know. Furthermore, we cannot be certain whether alcohol alone provides adequate disinfection. And so, I considered another possibility... what if we prepare a very weak acidic solution?”
“Acidic...? Sulfuric acid?”
“That stuff stripped the very floorboards! You wish to pour that into a human body?”
Liston and the Director stared at me with wide, horrified eyes. Of course not. Were they insane? Why on earth would I inject sulfuric acid into a human body? That was capital punishment!
“A very weak acid.”
“Just how weak are we talking about?”
Unfortunately, I couldn't fire back an insult at the next question—because I didn't know the exact pH either. Still, that hardly mattered. We could obtain bovine pancreases for free, and in generous quantities. If the butchers were stingy... well, the moment they realized we desperately needed cow organs, they might demand money. But what would happen once Liston stepped forward? If anyone had the guts to demand coin while staring into Robert Liston's imposing, murderous visage, I'd have no choice but to respect them. Of course, I was certain no butcher would dare. I would bet my life on it.
“We shall have to experiment and find out.”
“Ah.”
An acidic solution could dissolve insulin. Not break it down, but extract and suspend the insulin molecules within the fluid. Thus, by treating minced pancreas with a mixture of alcohol and acidified water, the alcohol would destroy the harmful digestive enzymes while the acidic water extracted the insulin. Once left to sit, the volatile alcohol would evaporate away, leaving behind a solution ready to be injected into the patient. Naturally, determining the exact dosage to inject would remain another daunting homework assignment. Administering too little was manageable; it would merely be less effective. But if one injected too much...
Insulin can easily kill a person.
That wasn't an exaggeration; there were plenty of real-world cases where insulin had been wielded as a murder weapon. It even featured in films. In Memento, an anterograde amnesiac husband repeatedly injected his diabetic wife with insulin until she died, but that tragic misunderstanding was almost mild compared to cold-blooded reality. There were countless cases where people deliberately weaponized insulin for premeditated homicide.
We'll figure it out step by step, just like everything else.
We were going to need an awful lot of dogs. In original history, I heard dozens of dogs had been sacrificed during Banting and Best's trials. Back in my previous life, I had scoffed, thinking how primitive and barbaric early medical research was. But now that I was standing in their shoes, having to recreate it from scratch, I realized those researchers had been exceptionally fortunate to succeed with only dozens. People always cursed what they didn't understand. Once you truly grasped the desperate circumstances and grueling trial-and-error behind scientific breakthroughs, you couldn't bring yourself to criticize. If anything, all that remained was sheer awe...
“Shall we head to the slaughterhouse first, then?”
“Yes. Let us go procure some pancreases.”
“Excellent. Let us be off.”
“Right behind you, Brother.”
In any case, the group fell for my excuses hook, line, and sinker. Disinfection... It was truly a blessing that we had visited Paris. Had we not gone, they wouldn't have grasped the concept of antisepsis in the slightest... And under those circumstances, how could I have ever persuaded them to do this? It would have been impossible. Of course, even with the groundwork laid, this was hardly a walk in the park. Persuading Victorian doctors to treat animal innards simultaneously with alcohol and an acidic solution required sheer rhetorical wizardry.
Was this the very reason I was transmigrated to this era?
To spin silver-tongued lies and save that many more lives... Because in this entire backwards century, I was the only man capable of doing so.
Shaking my head at my own audacity, I climbed into the carriage alongside Liston. It was time to head to the slaughterhouse and extort—pardon, borrow—some cow pancreases.