A Shift in Standing [4]
Petty criminals.
When hearing that phrase, one must take care not to envision the minor infractions of twenty-first-century Seoul. This was not a matter of relieving oneself against an alley wall or drunkenly belting tunes in the dead of night. In Victorian London, an act was rarely deemed a crime unless blood was drawn or bones were broken—or unless someone had orchestrated a truly grand swindle. Yet with Mr. Ponzi still decades away from being born, elaborate financial fraud was hardly common. Least of all in the slums, where the notion of embezzlement was absurd on its face. To be swindled, after all, one had to possess something worth stealing in the first place.
"My word, what magnificent ruffians we have here."
Before administering any injections to the diabetic convicts, we first had to harvest their urine. A few of the wretches suffered not only from diabetes but also from advanced venereal afflictions, rendering their output... well, one glance was enough to curdle the stomach. Debating whether a jar of urine looked appetizing was an absurdity in itself, of course. Be that as it may, Liston and I stood before our gathered petty criminals, holding vessels from which the thickest clumps of pus and sediment had been carefully strained.
They might have been classified as petty offenders on paper, but in truth, they were seasoned street thugs. As Liston remarked, they bore thoroughly splendid scoundrel faces.
"Ugh..."
Yet if it came to intimidating visages, our side yielded nothing. Robert Liston... the Sword Master, the Virtuoso of the Blade, the Connoisseur of Amputation. How many men in the British Empire possessed the sheer nerve to glare into that man's eyes? A hardened underworld assassin with several murders to his name might have managed it, but petty brawlers whose greatest achievement was flattening a shopkeeper's nose had no chance at all.
"Come now, gentlemen. Smooth those scowls. You haven't been brought here for anything untoward."
"Here, take one each."
Reflecting on it, their crimes truly were minor by contemporary standards. In this era, a fellow had to leave a corpse or two in the Thames before anyone took him seriously as a man who spat upon the law. For the lot standing before us, landing in custody for a common brawl was simply a stroke of wretched luck.
"What... what is this stuff?"
"Do you need to know?" Liston replied, his brow twitching.
"N-No, sir! Not at all!"
"Ha-ha! Just a jest, my good man. I am a surgeon, and you are our patients."
"Eek!"
Liston slammed a heavy palm down upon the nearest ruffian's shoulder with thunderous force. Perhaps that was why the word 'patient' sounded less like medical care and more like a solemn vow that any disobedience would immediately qualify them for a stretcher. The poor wretch who took the blow turned deathly white from the sheer impact, and the color drained swiftly from his companions' faces as well.
"This is a special tonic... a fruit cordial of sorts, brewed personally by Doctor Pyeong."
"P-Please, have mercy!"
"Spare our lives, guv'nor! We beg of you!"
To obtain an accurate sensory assessment, some form of explanation was necessary, even if it took the shape of an unblushing lie. Yet dubbing it 'juice' only made their complexions paler.
"What is the matter with you all? I told you, I brewed it myself."
"W-Well, that's just it, sir..."
"Aren't we going to catch the cholera...?"
"Won't our throats close up until we suffocate?"
These insolent bastards...
What irritated me most was that I understood precisely which rumors had reached their ears. Struggling to suppress an involuntary scowl, I pressed on.
"Nonsense. Nothing of the sort. This is a panacea—a sovereign remedy."
"How are we supposed to believe—"
Empty assurances were doing nothing to soothe their dread. Seeing their hesitation, Liston stepped forward once more, towering over them like an executioner.
"And what will you do if you don't believe him? Did you not agree to wipe the slate clean with this arrangement?"
"W-We never knew our lives were on the line! Throw us back in the cells! We'd rather take the gaol!"
"It seems you fail to grasp your situation. You will not be walking out of this yard unless you drink."
"Ah..."
Only then did the full weight of their predicament crash down upon them. Their frantic eyes widened, finally taking in their immediate surroundings. They were in the rear courtyard behind the anatomical dissecting theatre. Through the grime-streaked windowpanes, the faint, pallid silhouettes of corpses stretched across tables were unmistakable. It took very little imagination to deduce that should they refuse, they might well find themselves laid out alongside the dead.
To an outside observer, such terror might have seemed theatrical.
Though in truth, it isn't entirely unfounded.
A stroke of exceptionally rotten luck in this age could very well land a living soul upon an anatomist's slab. I had no intention of doing so today, of course, but Victorian London was a place where one could easily end up on an autopsy table against one's will before the sun went down.
"W-We'll drink! We'll drink it down!"
"Capital. Swell it down, and describe the taste."
"Y-Yes, sir! Gulp... ugh... wait, what?"
"Ghk... eh?"
Consumed by primal panic, the ruffians began chugging the vessels in competitive haste. They had tilted the cups back with grimacing, tearful faces, but moments later, their brows furrowed in bewildered disbelief. Naturally so. It was sweet.
"It's... sweet?"
"It ain't poison!"
"Whew... thank God. This is an infirmary, after all... Even the Mad Doctor Pyung wouldn't..."
I was fairly certain I caught a deeply offensive epithet muttered under someone's breath, but for the moment, I let it slide. Every man agreed that the concoction was sweet.
"It's sweet for all of you? Mine's got a foul, bitter aftertaste..."
Save for one fellow.
A quick glance confirmed he had drawn the sample taken from the convict with heavy suppurative discharge. I had strained out the thickest matter, but evidently, the essence had lingered. Well, science required sacrifices.
In any case, the tasting had only begun.
"Very good. Rate the sweetness of what you just drank on a scale from one to ten. Now, try this next cup."
"Uh... yes, sir. If you say so."
There was no reason to assume every diabetic convict possessed identical blood sugar levels. While crude, testing the variation in perceived sweetness promised valuable clinical correlation. I divided the samples systematically, ensuring each petty criminal sampled the output of every diabetic patient.
The moniker of 'Mad Doctor' was beginning to feel uncomfortably accurate. But what choice did I have? This was necessity, not sadistic curiosity. I was not doing this for amusement. Had quantitative biochemical assays for blood glucose or glycosuria been readily available, I would have used them without hesitation. While chemical precipitation methods existed in theory, the reagents were prohibitively expensive and the protocols hopelessly labyrinthine. One had to exhaust the simpler empirical methods first. Besides, swallowing a mouthful of urine had never killed anyone.
"Now, wait in here while I prepare the next batch of cordial."
"Right, sir."
"Is that one sweet too? I wouldn't mind another cup, to be honest."
We herded the petty criminals out of the yard and ushered them into an adjacent lecture hall. A few of them, parched from fear, were practically clamoring for more. The venerable monk Wonhyo's epiphany upon drinking rainwater from a skull in the dark truly was an eternal truth: sweetness is entirely a matter of perception. Here were London thugs begging for another draught of filtered urine.
"You lot, move over this way!"
"Yes, yes, right away, guv."
"Pardon me, doctor, but where you stuck me with that needle is itching something fierce."
"Let me see. It's fine. You won't drop dead."
The diabetic convicts were sequestered in a room as far from the lecture hall as possible. If they caught sight of their own fluids being measured into tasting cups, our grand scientific experiment would collapse in an instant. I was committing no crime, yet an odd prickle of guilt gnawed at my ribs. Once the separation was secure, I huddled with my pupils, Blundell, and Liston to review our findings.
"So your intention is to test varied concentrations across the different subjects?"
"Precisely," I replied. "Diabetes does not progress at a uniform rate in every constitution. Severity differs from man to man."
"True enough... Even the lad who sampled canine urine noted that each hound tasted slightly distinct. But tell me, Pyeong..."
"Yes?"
"You aren't merely doing this to watch wretched scoundrels lap up human piss for your own amusement... are you?"
"Certainly not! Every drop serves a rigorous purpose. Why on earth would you harbor such an atrocious suspicion?"
"Because you linger over it so," Blundell murmured, stroking his chin. "Duke Jamie is slipping closer to his grave with every hour that passes."
"As terrible an affliction as diabetes is, a patient can linger for a year or more. Conversely, administer pancreatic extract at an unchecked concentration, and death arrives before dusk. You saw what happened to the hound."
"Aye. Fair point."
That particular hound was currently resting in the rear courtyard. Six feet below the grass, that is.
"What if word of this gets out?"
Alfred inserted himself into the conversation, his brow furrowed with genuine distress.
"What of it?"
Even if the convicts talked, most of them would never see the outside of a cell again. Or rather, they might—stretched across our dissecting tables. A month in a London gaol was practically a death sentence; half the inmates perished before their trials, whether beaten to death by cellmates or snuffed out by typhus and rampant damp. When I offered this flat observation, Alfred winced, then leaned closer.
"It makes us sound like ruthless gangsters! You don't... you don't actually conduct pagan blood rituals in the dead of night, do you?"
"Don't be absurd!"
"Right, right, I'll take your word for it. But listen—many of those ruffians bear gang marks. I recognized ink my father warned me about. If their mates or gang captains discover what we made them drink..."
"Ah."
If the underworld caught wind that their men had been forced to imbibe human urine on our premises, retribution was not impossible.
"Fret not on that account, gentlemen. The peace of London rests securely in the hands of the Metropolitan Police."
The constable stationed by the door chuckled softly, a response that inspired zero confidence. These were the very men who frequented the same taverns, bathhouses, and backrooms as the syndicate bosses.
"The officers assigned here report directly to the Commissioner," Liston added with a hearty grin, reading my unease. "Furthermore, they are men beholden to Duke Jamie's patronage. Rest easy."
He folded massive arms across his chest and leaned down slightly.
"Besides, should any street scum dare come calling, it would save us the trouble of hunting them down. We could simply crack their skulls and haul them inside for fresh clinical material."
Strangely, that was far more reassuring than the policeman's oath. Yes, indeed. A single Robert Liston was worth a whole division of the Metropolitan Police.
Heartened by his presence, I continued the titration. As I stepped up the insulin dosages administered to the diabetic patients, their urine gradually lost its cloying sweetness and turned sharp and bitter to the tasters' tongues. Through this methodical process, I established a rough threshold for therapeutic versus perilous dosages in human physiology. Humans, being substantially larger than canines, required a considerable volume of extract, which made high-gauge subcutaneous injections rather uncomfortable. It would have been far better to concentrate the liquid further by driving off excess water.
Boil it down? No, heat will denature the insulin protein entirely. Letting it evaporate at room temperature... who knows what bacterial swarms would bloom before it dries?
If only I possessed a proper chemical purification protocol to isolate the crystalline hormone. But how could I know such advanced methods? Had I possessed the expertise of a synthetic organic chemist, I would have pursued chemistry in my past life instead of medicine. And had I done so, I would likely have ended up in this era blowing myself up in an unventilated cellar with ether vapors, dying before I ever made a name for myself. Surviving as a surgeon had at least brought me wealth and prestige.
"The dosage appears stable enough to attempt on Duke Jamie," I announced.
"Excellent," Liston nodded. "In fact, Sir Damien sent word only an hour ago inquiring after our progress."
"Shall we summon His Grace, then?"
"Instead of attending him at his residence?"
"The extract is unstable; it must be prepared fresh and administered under direct observation," I insisted. "There is no helping it. Duke or monarch, the requirements of the medicine do not alter."
"Quite right. He will understand. If any peer of the realm possesses patience for our craft, it is Duke Jamie."
With that, the preliminary trial was formally concluded. The petty criminals departed with remarkable haste, utterly mystified as to why the doctor's marvelous cordial tasted more like foul water the more he 'refined' it, yet thoroughly convinced that lingering near the dissecting hall invited sudden death. The diabetic prisoners, on the other hand, displayed an unexpected fondness for the needle.
I had described the injections with clinical severity, but the patients experienced genuine physiological relief. When severe hyperglycemia is tempered even slightly, systemic exhaustion, raging thirst, and polyuria abate. The convicts felt the fog lifting from their bodies.
"Keep us here, doctor! We beg of you!"
"Please, sir! Another day!"
Or perhaps they simply dreaded returning to the damp squalor of their stone cells. Had this been a modern hospital in the twenty-first century, I would have maintained their maintenance therapy indefinitely. Here, it was impossible. The extraction process was vastly too labor-intensive and costly. Such precious medicine was scarce enough that it had to be reserved for those who kept society running, or at least those who could fund its advancement.
"Well, well. Is this... the sovereign remedy?"
"Yes, Your Grace. A therapeutic extract for the sweet-water disease."
"Remarkable."
"Is something amiss, Your Grace?"
Duke Jamie had arrived almost immediately upon receiving the summons. Given his recent withdrawal from high-society functions, his schedule was unusually clear. While he claimed to be occupied with matters of grave imperial consequence, a duke rarely attends to administrative drudgery in person anyway. At least, that was my presumption; I had never walked the gilded halls of high aristocracy myself.
"It feels like barely days since we confirmed the diagnosis, yet you have already produced a treatment... Every time I observe your work, Doctor Pyeong, my convictions waver."
"Which convictions might those be?"
"No matter. Merely an old man's wandering thoughts."
With a faint grimace of resignation, Duke Jamie pulled his fine linen shirt upward, exposing a substantial midriff that rippled with soft folds. Having spent the morning examining emaciated convicts whose ribs pressed against their skin, the contrast was staggering. Being a duke certainly had its dietary privileges.
I drew the cloudy pancreatic fluid into a large glass syringe. Beside me, Joseph fell upon the Duke's exposed abdomen like an avenging fury, scrubbing furiously with a cloth soaked in carbolic solution.
"Ouch! Confound it, man, that burns!"
"If it doesn't hurt, it isn't clean!" Joseph barked, rubbing until the flesh turned raw and red.
"What insolence is this?"
"Pray forgive my assistant, Your Grace," I intervened smoothly. "He is entirely possessed by the spirit of antisepsis. Though I must confess, his logic is sound."
Once the skin was thoroughly scrubbed, I positioned the needle against the subcutaneous tissue of the Duke's flank and advanced the plunger steadily. We were beginning at the conservative lower bound of our safety margin.
"This initial dose may not resolve your symptoms immediately, Your Grace. It will require several administrations to determine your exact physiological requirement."
"Understood. Am I required to remain here for observation?"
"Yes, for several hours."
"Very well. I shall simply summon my secretaries and conduct my council from this room."
And thus, in the shadow of the anatomical theatre, our historic treatment of diabetes commenced.