Diabetes (Part 5)
Synthesizing insulin was, in truth, the ideal solution.
It went without saying. No matter how freely we could haul natural insulin from the slaughterhouse for next to nothing, the cost, purity, and sheer scalability could never compare to chemical synthesis. Still, it was best not to entertain impossible dreams.
'In original history, chemical synthesis wasn't achieved until the 1970s, and commercial production didn't hit the market until the eighties...'
That was well over a century away. If I happened to know insulin's precise structural formula by heart, we might have shaved decades off that timeline, but unfortunately, I was a clinician—and a surgeon at that. How on earth was I supposed to have a complex fifty-one-amino-acid polypeptide chain memorized?
"Ugh, the stench of blood."
In any case, I arrived at the slaughterhouse in the company of Dr. Liston.
It was, predictably, an utter shambles. In an era where hospitals treating actual human beings were filthy pigsties, what could one realistically expect from a place dedicated to butchering beasts? If you conjured the foulest, most horrific nightmare your imagination could muster, you might just barely stomach the sight before us. There was truly no reason for anyone to ever set foot in such a place. None whatsoever. Take my word for it.
"Good God..."
"Bloody hell."
Curses slipped from our lips unbidden. Well, to be precise, I only groaned; the foul oath came straight from Liston.
"What... brings you gents here?"
The laborer puffing on a ragged pipe outside the abattoir seemed just as nonplussed. Clad not in protective rubber but in coarse linen thoroughly steeped in crimson gore, he still held a butcher's knife firmly in hand. Under normal circumstances, the sight of a blood-drenched brute gripping a cleaver would have been downright terrifying, yet strangely, I felt no fear. When walking beside Robert Liston, there was nothing left on God's green earth to be frightened of.
"We came by carriage," Liston replied flatly.
"Pardon?"
"A jest. I am Liston. A physician... surely you've heard of me?"
Look at this towering ego. He practically radiated the unspoken conviction that any breathing soul in London ought to know his name.
"Ah... Liston, the one who rolls with the Oriental... Forgive my insolence, Boss. Didn't recognize you right away."
Yet the butcher actually knew him.
"Good day to you as well, Boss Pyeong."
He even recognized me.
Still, something felt terribly off.
'Boss...? What on earth is he on about?'
While I tilted my head in bewilderment, Liston nodded as if this were the most natural reception in the world.
"Since you know who I am, this will save us some breath."
"Aye, aye. What brings you gents all the way out here? We get corpses dumped on our doorstep from time to time, but they're mostly battered floaters and broken wretches—hardly fit for your trade, I reckon."
"Ah, no, nothing of the sort."
"Then... are you looking to send some fresh ones our way to dispose of?"
"Ah... no. I do not kill people."
"Hahaha."
The conversation flowed with appalling ease. Liston stared down at the butcher—if you could even call this blood-soaked fellow a mere butcher—who merely chuckled with a sly, knowing grin. Surprisingly, the man showed not the slightest hint of intimidation, simply taking Liston's words in stride.
'Well... I suppose that shouldn't come as a surprise.'
Come to think of it, anyone running an establishment like this amidst London's lawless underbelly had to be a hardened rogue. He was almost certainly entangled with half the criminal syndicates in the city, which explained why he discussed disposing of murdered bodies without batting an eye. The fact that he firmly believed we were fellow cutthroats of the same feather was rather unsettling, but that was a misunderstanding I could clear up later.
"We came to procure some bovine pancreases. Can you spare any?"
"Pancreas, you say? That's hardly fit for eating, Boss."
"We don't intend to eat it. We have a rather urgent use for it."
"Don't tell me... can that stuff be brewed into poison?"
"Medicine, man. Medicine."
"Aha. Well, whatever it is... give me a moment. I'll have to ask the chief."
"Do so."
"Right away, sir."
The mood was remarkably cordial. It felt as though we might walk away with a mountain of organs without paying a single copper.
"Eh? Dr. Liston and... Mr. Pyeong have arrived?"
While the blood-drenched worker darted off, Liston and I passed the time surveying the surroundings. Several cattle stood penned nearby, lowing plaintively, their dark eyes brimming with tears as if fully aware of their impending fate. Small wonder. Their brethren were hanging by iron hooks right in front of them, while offal and gore lay strewn across every inch of the cobblestones.
"Shall we cut back on meat for a while?" I murmured.
"Aye, that sounds wise. This place is..."
Could meat harvested from a pit like this truly be fresh? Not a chance in hell. Even if it had been fresh when the beast drew breath, it certainly ceased to be the instant the blade fell. The old Liston would have scoffed and devoured a bloody roast without a second thought, but not anymore. The man had become utterly obsessed with antisepsis. Both of us stood there, shaking our heads in mutual disgust.
"What an unpardonable slight! Keeping the finest syndicate in all of London waiting outside..."
"Precisely, Boss. Had they sent word in advance, we would have received them with proper honors!"
The faint commotion I had overheard earlier turned out to be dead serious. A man clad in a black suit—though hardly the sort worn by polite gentlemen—came sprinting toward us, hot on the heels of the bloodstained laborer. Dark stains speckled his lapels, unmistakably crimson. Was it cow's blood? I dearly hoped so.
"Well, well! To think the legendary Boss Liston himself would grace our humble yard! Did my lads commit some discourtesy?"
The newcomer possessed the face of a hardened felon, yet the moment he reached us, he bowed at a crisp ninety-degree angle. Well, anyone would show such deference before Liston. The Scottish titan didn't merely look terrifying; he was an inherently dangerous man.
"Ah, yes. And your name?"
"Josh, Boss."
"A fine name."
"If it pleases you, may I pay my respects to Boss Pyeong as well?"
"Oh, by all means. He's my cherished little brother."
"As expected of him! Greetings, Boss Pyeong!"
Wait... why was he bowing to me?
While I stood frozen in confusion, the blood-soaked butcher let out a booming laugh.
"When word spread that you dressed those two notorious bastards in frilly frocks, paraded them for public mockery, and ended up snuffing out their very lives... we were thoroughly humbled, Boss. I wager there isn't a bruiser left in London who swings fists and doesn't tremble at your name."
"Ah... that. Haha."
This was utterly absurd. Hadn't that entire spectacle been staged solely to save a dying patient? Left uncorrected, this misunderstanding would paint me as a ruthless mob boss. I cut my awkward laughter short and offered a hasty clarification.
"That was merely an experiment."
"Hoh... Conducting experiments on such notorious scamps... Truly remarkable."
I gave up. These lunatics had already constructed an unshakeable myth in their heads.
"In any case, we have a request," Liston interjected.
"Anything, Boss! We would consider it an honor."
"Can we take all the pancreases left over from the cattle you butcher?"
"Pardon?"
"Is that a problem?"
"A problem? Perish the thought! If you fancy, we can even carve out human pancreases for you!"
"No... let us hold off on that for later. Perhaps when dealing with condemned criminals on the scaffold."
"Aha! Yes, of course. So this is merely the beginning!"
Josh rubbed his palms together eagerly, his eyes gleaming with savage anticipation. Madman... What on earth did he take us for? We were physicians, damn it! Men who poured blood and sweat into preserving human life! Granted, our methods might occasionally appear somewhat unhinged from an outside perspective, but every single thing I did was genuinely, truly aimed at keeping people breathing.
"Since our honored guests are here... Oi, you lot!"
At Josh's bellow, the roughnecks scattered across the yard—the very ones actively hacking cattle to pieces—dropped their tools and came rushing over.
"Boss Liston here wants all the pancreases! No, no, you bloody fools, not yours! You lot are loyal to a fault, eh?"
After a brief, chaotic flurry, what was the result? Exactly as expected: we walked away with a monstrous haul of bovine organs.
"That is an extraordinary amount," Liston murmured.
"Indeed, sir. It certainly is..."
"With this much, wouldn't Sir Jamie have enough to last a lifetime?"
"Well..."
It was the first time in either of my lives seeing a cow's pancreas. As befitting such massive beasts, the organ was enormous. Considering a cow's stomach alone provided more tripe than a single man could ever finish, the yield was substantial. But my mind was already racing ahead.
"What are you pondering so deeply?"
"I was thinking that it won't be quite so simple."
"Why?"
"Because these will rot, sir."
"Will the extract spoil even if dissolved in water?"
"Most likely, yes."
To be perfectly honest, I didn't know the exact chemical preservation techniques for crude insulin extracts. But in an era without mechanical refrigeration, how long could organic extract possibly remain viable? It wouldn't even have a meaningful shelf life. In all likelihood, a batch would spoil the very day it was prepared, or the next day if we were exceptionally fortunate. We would have to conduct rigorous trials to determine its stability, but the road ahead certainly wouldn't be the rosy path Liston envisioned.
How did I know? Because while the discovery of insulin dramatically transformed the management of diabetes, it did not instantly grant salvation to every sufferer.
'Diagnostics are another massive hurdle.'
We couldn't rely on tasting urine or waiting for ants to swarm sweet piss forever. Ultimately, we needed a method to quantify blood glucose. And that would require establishing precise protocols: when to draw blood, what threshold constituted a definitive diagnosis, and how to track fluctuations. Diagnosing and treating a systemic metabolic disease was no small feat.
"At any rate, let us return to the laboratory posthaste," I said.
"Aye. By the way, your reputation has grown quite formidable. You ought to feel proud."
"Is... becoming famous among criminal syndicates truly something to be proud of, sir?"
"It is for me. Think about it. Life becomes remarkably convenient."
"Convenient... in what manner?"
"Have you ever had to wait in line when entering an establishment with me?"
Wait in line? At restaurants? Tailor shops?
"Now that you mention it... not once."
"All thanks to my reputation. Going forward, the same will apply even when you walk London alone."
"Oh... that does sound rather pleasant."
"Not only that, but you will find goods offered to you at permanent discounts."
"Hoh."
"On occasion, merchants will simply press their wares into your hands for free."
"That is crossing into extortion, sir."
Come to think of it, I had played a rather aggressive part during the arsenic wallpaper crisis... but that was done entirely to save lives, so surely it was justified. The shopkeepers were the ones peddling poison as household decor in the first place. None of that was my fault.
"Ah, but there is one drawback," Liston added casually.
"A drawback...? Do the police come after us?"
"Eh? The police are on our side. Half the lads back there are thick as thieves with the local constabulary. What rubbish are you spouting? In this town, the gangs and the police share the closest brotherhood of all."
"Then... what could the drawback possibly be?"
If the police turned a blind eye and the common folk trembled in fear, weren't we essentially untouchable lords of the street? Just as I was marveling at how lucrative this underworld status seemed, Liston rolled up his coat sleeve. Beneath the heavy fabric, a slab of terrifying muscle came into view, marked by a jagged, pale knife scar.
"Every now and then, some ambitious fool tries to make a name for himself by cutting me down. Such challenges have grown rare of late... but seeing as you are a rising star, a few reckless scoundrels might harbor foolish ambitions against your neck."
"Someone attacked you, Boss?"
"Aye."
"What happened to the man who did it?"
"Don't you recall? The fellow with the matching puncture wound right here."
"Ah... wait, what?"
"You dissected him."
"Ah."
Bloody hell...
"It was a fair duel," Liston said breezily. "Entirely legal under the circumstances."
"Right... of course."
"By the way, can you actually hold your own in a brawl? Judging by your temper, you seem the type who'd fight like a savage."
"No, sir. I cannot fight at all."
"So you possess a foul temper without the muscle to back it up?"
"My temper is remarkably mild to begin with, sir..."
"That sounds rather precarious. Procure yourself a pistol. And whenever possible, make sure you stick close to me."
"I... understood, sir."