Shifting Ground [2]
Human experimentation was not my exclusive domain.
Calling it obvious felt somewhat unseemly. After all, wasn't there supposed to be such a thing as research ethics? Though, coming from a man currently engaged in clandestine clinical trials on living patients, preaching morality carried a rather rich stench of hypocrisy.
Regardless, a cure for diabetes was far too succulent a piece of bait. The moment rumors began leaking into the medical undercurrents, practitioners across London threw themselves headlong into the fray.
Our hospital was in a comparatively fortunate position.
Why?
"Because anyone caught poaching will die. Haha."
Did they take this for an open-source project? Did they imagine my patents were suggestions?
For all my complaints about how backward Victorian Britain was, this realm had maintained a formal concept of patents since before the fourteenth century. In this nineteenth century of ours, intellectual property was defended with genuine legal teeth. Granted, enforcement lacked the airtight rigor of the twenty-first century, but anyone could see that bringing this medicine to market meant reaping obscene fortunes.
Liston and I held the primary stake, with fractional shares parcelled out to the Hospital Director and our underlings. Blundell was hardly an underling, but he had received his share of the rights as well.
A lone foreigner would find such intellectual gold impossible to defend. But when the most violent surgical titan in Britain, an avaricious hospital administrator, and a rising medical cabal banded together, protecting our turf became child's play.
"A-Aargh! S-Spare me, please!"
Yet greed possessed a terrifying gravity of its own.
To think so many fools dared scheme to dip their spoons into the bowl shared by Robert Liston and Kim Taepyeong—former Qing dynasty underworld overlord turned practicing Joseon sorcerer.
Fortunately, our true secret had not leaked: the magical solution, that precise extraction mixture of alcohol and acidified water, remained strictly guarded. Nor had word gotten out that we were administering canine urine to captive convicts to track sugar depletion. Still, murmurs had spread that human trials were already underway, though I never imagined a competitor would be reckless enough to plunge straight into human flesh without the faintest clue what they were doing.
"How did this happen?"
At my question, the patient glanced sideways toward the man who had brought him in. The companion immediately averted his eyes.
What is this?
"I asked how he came to be in this state."
He clearly knew something, yet his jaw stayed clamped shut. When I pressed him with a sharper edge to my voice, he suddenly dropped straight to his knees.
"What on earth are you doing?"
"S-Spare me, sir! Greed got the better of me, I confess it!"
"What greed?"
"The... the treatment for the sugar disease..."
"A diabetes treatment?"
"Yes, sir."
"Hmm."
What kind of treatment had been inflicted to leave a man's belly in such an appalling state? Judging by the patient's gaunt frame and hollow cheeks, he probably had never suffered from diabetes in the first place. Type 1 was a theoretical possibility, but this was the nineteenth century. In this era, juvenile onset was a death sentence. Virtually no one survived past their teenage years. They simply perished.
"What did you do to him?"
"Well... you see..."
"Are you going to open your mouth or not?"
Having watched our prolonged exchange with mounting curiosity, Liston strode over, his face darkening into the terrifying mask of a vengeful war god as he cut in. The man—presumably a licensed practitioner—clamped his lips shut even tighter. Not out of defiance, surely. The poor wretch was simply paralyzed with pure, unadulterated terror.
"Guh... Aaagh!"
"How peculiar," Liston murmured, crushing the man's throat in an iron grip and pressing him down toward the floorboards. "My instincts tell me you are quite eager to tell us everything."
"I-I'll speak! I'll tell you! Please, unhand me! Aaargh!"
Ordinary fear freezes a man's tongue. But when terror transcends a certain threshold, the tongue loosens with miraculous velocity. The gentleman before us was no exception. The instant Liston pinned his windpipe against the floor, words poured forth in a frantic torrent.
"Speak like that," Liston growled. "Or I will ensure you never speak again."
"A-Aieee!"
"I told you to speak, not to screech. Have you no use for that tongue? Shall I excise it?"
"N-No, sir! It is just... across London, throughout the entire medical trade, the renown of you two gentlemen is immense!"
Oh. A physician after all. His wits worked quickly enough to reach for flattery first. Liston, being a creature susceptible to praise, loosened his fingers a fraction. Yet what Liston considered mild restraint still left the physician gasping in agony. Relieved of imminent strangulation, the man babbled desperately.
"Continue."
"Rumors have been flying that following in your footsteps is bound to yield... yield extraordinary fortune."
"Oho... look at these audacious rats. And?"
"Someone saw you visiting the slaughterhouses! And returning with pig sweetbreads—pancreases! And your search for diabetic patients has hardly been kept a secret, has it?"
"So you deduced that the pancreas held the cure for the sugar disease."
"Yes, yes, precisely!"
"Who else knows of this besides you?"
"Pardon? There are... far too many..."
"Bring every last one of them here."
"I-I cannot possibly—Aaaaargh!"
"Do you suffer from an auditory defect? Do your ears displease you?"
"I will handle it! I will bring them all! Aaaagh!"
Only after the quack was reduced to a sniveling mess of snot and tears did Liston finally release his throat. In the meantime, the patient had shrunk back into the examination bench, shivering in utter petrifaction.
"Now then, my good man," I said gently.
"Eek!"
"Did you submit to this because he offered you money?"
"Y-Yes, sir. Please, just don't take the shillings!"
"I am not a highwayman."
"P-Please, spare my life!"
The wretched soul trembled uncontrollably. It was hard to blame him. The doctor who brought him was still groveling in agony on the floorboards, and the patient's own condition was dire. He looked half-dead already.
"I cannot make any guarantees on that front."
"Urrgh..."
"Look at that. He's fainted."
"Pyoung, does it not strike you that your timing was rather ill-considered?" Liston asked.
"Pardon?"
I blinked innocently. I had only stated the truth because the man looked ready for the morgue. Liston merely shrugged, offering no further explanation.
Regardless, the patient took precedence.
"What exactly did you inject into him?" I demanded of the quack.
"I... I crushed raw pig pancreas, strained the fluid, and stabbed it into his belly."
"With what?"
"With... this."
"Good God... you absolute bastard."
While I leaned over the patient, Liston inspected the instrument the physician produced—a crude cross between a trocar and a metal pump—and spat a virulent curse.
In truth, the horror was understandable. The hypodermic syringe as the modern world knew it would not take its refined form until the late nineteenth century. Before then, instruments were barbaric monstrosities.
"What in the name of Bedlam... Did you never play with reeds as a boy?"
The hollow needle itself was only invented around the middle of the nineteenth century. Its design likely evolved from children squirting water through hollow reeds—a pastime that had existed since ancient Egypt. It took thousands of years of human civilization just to evolve that plaything into an injection needle. What this back-alley quack held was barely more than a blunt metal tube.
"You..." Liston hissed. "You madman, you used this contraption as an injector?"
"Sir? An in-jec... what?"
"Never mind. You injected raw pancreatic juice directly into his abdomen. Pyoung, what will become of him?"
Knowing the correct answer—and not knowing the immense mountain of clinical failure that had historically paved the way to it—Liston was beside himself with fury. A civilized gentleman might swallow his temper, but Liston was under no such constraint. Physically, he was an absolute titan, and socially, our ever-deepening ties with Scotland Yard gave him near-total impunity.
Thwack!
Liston brought a meaty fist down on the back of the quack's neck, venting his irritation while knocking the man cold so he could eavesdrop no further.
"The digestive enzymes... they have eaten through into the peritoneum," I reported, inspecting the wound.
"Down to the peritoneum? Let me see."
"Look here."
"Bloody hell."
Colin, diligent as ever, leaned in close. If Joseph were here, he would feel deeply slighted by that praise; currently, Joseph was away on an evangelical hand-washing crusade alongside Dr. Blundell. Given its paramount importance in Cesarean sections, Joseph and Blundell had become practically inseparable of late. At this rate, I wondered if Joseph might abandon surgery altogether to become an obstetrician.
Regardless, Colin worked with the frantic devotion of a captive hostage. Even now, he gripped the brass gas lamp with white knuckles, illuminating the wound with desperate focus. Thanks to his efforts, we had a crystal-clear view of the lesion, though the sight offered zero comfort.
"What can be done for him?" Liston asked.
"I am not certain. Mmm..."
The patient groaned feebly in his stupor. Clinical thermometers existed in this era in the broadest sense of the word, but they were monstrous, foot-long contraptions completely unsuited for routine bedside practice. I laid the back of my hand against his forehead; scorching heat radiated from his skin.
"A-Am I... going to die?" the man wheezed, briefly fluttering his eyelids open.
"We will do our utmost."
"Ugh..."
"Would it kill you to simply tell the poor devil he will live?" Liston chided under his breath.
"How can a physician make promises he cannot guarantee?"
"Why shouldn't you? Who is going to hold you to account?"
"Hmm."
Fair point. Who was going to sue us? Malpractice litigation did not exist, and even if someone attempted to lodge a formal complaint, the police would quash it before the ink dried.
"I will save you, sir. Without fail," I said, leaning down.
"Ugh..."
"You clicked your tongue over him like an undertaker for five straight minutes," Liston scoffed. "Do you truly expect him to believe that now?"
I glared at Liston. Damned if I did, damned if I didn't.
"So, how do we treat this?" Liston asked again.
"First... hmm."
Should I deploy the sacred technique of moldy bread? I studied the patient's sunken features. An impoverished laborer driven to desperation. He had never possessed high blood sugar to begin with. In a twisted sense, that was his sole stroke of luck. If a man with normal blood sugar had received an effective dose of pure insulin, hypoglycemia would have finished him on the spot. Insulin made a remarkably efficient poison, after all.
Instead, he had taken a dose of raw digestive enzymes straight into a belly almost devoid of subcutaneous fat.
"The liquefaction of the skin is extensive," I explained. "And severe infection has spread through the surrounding margins."
"Doubtless plunged that filthy spike in without a shred of cleansing," Liston noted.
"Undoubtedly. Look at the state of that so-called needle."
Just like Liston's surgical knives in the old days, the crude metal tube was crusted with dried blood and rancid fat from prior misadventures.
"Surely this poor wretch was not the only one he stabbed?" Liston muttered, his brow furrowing.
"Ah... there is never only a single victim."
"Hey! Wake up, you mongrel!"
While Liston shook the unconscious physician awake with a few robust slaps, I examined the margins of the necrotic tissue more closely. The pancreatic enzymes had dissolved the superficial flesh and eroded into the peritoneal layer. But the immediate lethal threat was no longer the enzymes—it was virulent bacterial infection.
Naturally. The fluid forced into him had been teeming with filth, the needle was a septic rod, and the skin had never been scrubbed.
Debridement is essential. The margins are turning black and purulent.
Closing such a gaping, festering wound immediately was out of the question. But how was I to convince these nineteenth-century gentlemen of the necessity of radical debridement?
Claiming that maggots had miraculously materialized from the aether would hardly fly right now. Joseph would throw an absolute fit the moment he returned, and introducing live maggots onto a perforated abdominal wall carried terrifying risks. If even one burrowed past the peritoneum into the abdominal cavity, it would trigger catastrophic peritonitis.
Ah, of course. The miasma doctrine. I simply need to prove that the corrupting miasma has colonized this flesh. We have already demonstrated its presence on unwashed skin... perfect.
Fortunately, the intellectual paradigm among my immediate circle had shifted dramatically. Excising a tiny sliver of the necrotic margin, I placed it beneath the brass microscope, demonstrating the swarming hordes of miasmatic animalcules to their horrified eyes. Armed with visual proof of demonic corruption, I secured immediate consent to carve away the putrid flesh.
Next came chemical disinfection.
"A-Aaaaargh! Kill me! Just kill me instead, please!"
"Should we administer anesthesia?" Liston asked, wincing at the shrieks.
"Yes, that would be merciful."
Our current antiseptic arsenal was limited to carbolic acid, chloride of lime, tincture of iodine, and high-proof alcohol. Every one of them caused stinging pain even on intact epidermis; splashing them directly onto exposed subcutaneous tissue and eroded muscle was agony incarnate.
As the patient shrieked, I caught sight of a pale-faced figure bolting out the door of the ward. Chasing him down was too much trouble, and with the Hospital Director himself standing in the corridor, I smoothly pivoted to the matter at hand.
"This is what happens when one injects foreign matter without rigorous disinfection," I said, projecting my voice clearly toward the Director. "No matter how troublesome it is to secure pure spirits of wine... it remains an absolute necessity. Do you understand?"
"I understand, I understand," the Director stammered, sweating slightly. "However..."
"However?"
"You didn't... engineer this horrific demonstration yourself, did you? Merely to convince me of your alcohol expenditures?"
"Of course not. What kind of demon do you take me for?"
"Right. Of course. I believe you."
The nerve of this greedy old bastard, I thought irritably, whining every time I requisition another barrel of grain alcohol.