Episode 54: Sinusitis Surgery… How Did They Do It? [1]
Episode 54: Sinusitis Surgery… How Did They Do It? [1]
Sinusitis.
Sinusitis was the medical term. They said your sinuses were inflamed, but really, just think of it as inflammation in the spaces beside your nose. If it was causing headaches like it did for this patient, it probably meant the inflammation was in some of the deeper sinuses.
Ah… I really don’t want to do this…
Did I even have antibiotics? Antibiotics… blue mold…
I started wondering where I could leave a piece of bread to grow mold. But all I really knew about Penicillin was that it came from blue mold. Was there only one type of blue mold that produced Penicillin? Probably not. There must be plenty of bad molds out there too. What, was I supposed to feed it to the patient?
That’s murder. It’s murder.
So what could I do?
“Ah.”
A brilliant idea came to me. There was no law that said you had to do surgery. When treating sinusitis, the first thing you did was rinse the nose.
“Patient.”
“Yes?”
“You have inflammation in your sinuses. That’s probably why you’re getting headaches.”
Then again, maybe it wasn’t the cause.
I looked out the window. The sky was gloomy. Was it going to rain? No, this was just London.
The air was horrible. The fine dust in twenty-first-century Korea had nothing on this. This place was pure hell.
Isn’t sinusitis practically a given in a place like this?
Of course your head would hurt more when you bent forward. It seemed very likely that inflammation in the sinuses was the cause.
Still… what if I was wrong? What if I woke him up just to tell him to blow his nose, and it turned out not to be sinusitis? How would I live with that guilt?
“Do you want to remove your nose?”
“No, no.”
Wait, what was I thinking? If something was causing the problem, remove it, sure. But this was an age where even the patients reacted with, No, no.
I shook the absurd thought from my head and refocused.
“Let me clean your nose.”
“Huh? Wash my face?”
“No, your nose.”
“The inside of my nose?”
“Pyeong, are you insane?”
“What are you suddenly talking about?”
I was giving perfectly sound medical advice, yet everyone around me looked horrified. I guess “cleaning the inside of your nose” sounded weird to them. These people didn’t even wash the outside of their noses. Hygiene in this era was questionable at best. Just look at the Thames.
“No, listen. Just bring a kettle. Oh, and make sure the water has been boiled.”
“Boiled water? You’re going to pour it into his nose as treatment?”
“No! You’ll kill him that way!”
Joseph, clearly misunderstanding, clapped like he had come up with a great idea and ran off to the kitchen, looking strangely forlorn. Who knew why? I wasn’t the one who came up with that idea. In a normal hospital, supplies would be readily available in the ward or at least nearby. But here at the “prestigious” London medical school, no one had even washed their hands before I arrived. Everything was far away.
So we waited. In the meantime, Alfred asked a question.
“But… can your nose actually give you a headache?”
“Ah…”
A good question, even without knowing anatomy. Most diseases could only be fully understood when you understood both the physiology and the anatomy. And even in the twenty-first century, anatomy wasn’t fully settled. There was still debate about what counted as variation versus deformity.
So in this time? Everything was a mess.
“Just wait. I’ll dissect it later and take a closer look.”
“Ah, right. You’re a genius at dissection.”
“I am, but…”
I hesitated. Dissecting the face always felt unsettling. Formalin preserved corpses into stiff, doll-like things. During anatomy class, the face was usually kept covered for that reason. Humans had an instinctive aversion to seeing faces damaged. It was how we recognized each other.
Still, if I wanted to understand nasal anatomy, I would have to go there eventually. Though, honestly, I had forgotten a lot of it.
If I ever need to do surgery in this area, I’ll definitely need to practice…
Thankfully, for the same reason, most cadaver faces were intact. This was a time when the face wasn’t typically touched unless there were boils or injuries. Even the most curious minds couldn’t overcome the primal reluctance to tamper with it.
“Ugh, it’s hot!”
Joseph returned, carrying a steaming kettle.
“Patient, come here. Closer to the spout.”
“Oh, it’s hot!”
“No, not that close! The steam rises quickly. Just angle your nose toward it.”
“Uh… okay.”
I helped reposition him. His nose had turned slightly red from the heat, but now the steam was entering it properly.
“This feels like some kind of magic treatment…”
“It’s not.”
“No? I feel like I’m inhaling something mystical…”
“It’s not magic.”
To be fair, it did look a little mystical, with white steam entering the nostrils. Maybe that was why I found it familiar. I was Asian, after all. Didn’t Native Americans also have steam-based rituals? Even if I didn’t look like them, the image fit. That kind of prejudice lingered everywhere.
“All right, patient. How does your nose feel?”
“Huh? Oh… It’s easier to breathe now. Much easier.”
“It’s a miracle cure!”
Joseph and Alfred looked like they were about to faint from excitement. I sighed.
“No, it’s not.”
“Then what is it?”
Why breathe through your nose? The nasal cavity had three curved structures called turbinates, which increased the surface area. There were lots of blood vessels in the nose too. As air flowed through, it was warmed and humidified, making gas exchange in the lungs more efficient. Since the brain consumed the most oxygen, breathing through your mouth could cause problems. Mouth breathing was even linked to ADHD.
I can’t believe I’m explaining this here…
After a moment, I asked, “Have you ever blown your nose in the shower?”
“Huh?”
“Yeah?”
This era didn’t understand theory. I had to approach everything through lived experience.
“With warm water, I mean. You’re from a wealthy family. You bathe often, right?”
“Now that you mention it… yeah, I think that’s the only time I blow my nose.”
“Me too.”
“A lot comes out when you do, right?”
“Yeah… it’s gross.”
“But a lot comes out.”
The two blushed like schoolboys. They came from a merchant family so wealthy even London had to respect them, and a devout Quaker family at that.
There was no shame in this. The air in London was horrendous.
“That’s when I realized warm steam might help open up the nasal passages and release the buildup inside. That’s what I was thinking.”
“Oh…”
“Come to think of it… I did breathe easier back then.”
“It’s simple, but if no one points it out, you don’t notice.”
“And… you’re really a genius.”
“Seriously… a genius.”
And just like that, more rumors about my “genius” began to spread. Honestly, it wasn’t ideal. These exaggerated stories would only add to the misunderstandings. Still, these two would definitely be loyal to me now. And with Blundell and even Liston slowly changing their stance, my position was getting stronger.
“Anyway, now for the patient. Would you like to blow your nose?”
“Uh, sure.”
While I had been explaining, the patient sat silently, looking moved. Not surprising, considering I had saved him from death’s door. Plus, I had just demonstrated something that seemed miraculous.
Pop!
He blew his nose using his bare hands. Well, there was no toilet paper in this world. What could I do? Honestly, I wanted to see the results too.
“…And it’s yellow.”
“Is it always that yellow? Mine’s not that bad…”
That wasn’t just a runny nose. That was pus. Thick, sticky, yellow clumps.
“How’s your headache?”
“Oh… much better. It was pounding for twenty-four hours straight, especially worse when lying down. But now… wow. It’s really better.”
The symptoms were improving.
At this point, I felt confident enough to give a full diagnosis. No X-rays, of course, but for this era, it was the best possible.
“It’s definitely this buildup in your sinuses. It might just be temporary relief, though. Keep blowing your nose while the water is hot. Once it cools down, I’ll show you how to rinse properly.”
“Yes! Thank you so much! How can I ever repay you…?”
“Let’s just get you treated first.”
Repay me? How? He was clearly poor.
But if this treatment could be proven effective, that would be worth more than any money.
There are both nobles and commoners suffering from this…
No one was immune to headaches. Everyone breathed the same filthy air. If they realized that a simple steam treatment worked better than surgery…
I might get rich!
As I daydreamed, the water cooled. In the meantime, the amount of pus the patient expelled was astounding, enough to fill a small paper cup. It was probably a mix of steam and mucus, but still.
“All right. Now I’ll show you how to rinse the inside of your nose. This will be even more effective than what we’ve done so far.”
It might look a little ugly, but the results?
They would call it a miracle.
Translator’s Notes:
Sinusitis — Inflammation or infection of the sinuses, the air-filled spaces around the nose and forehead. It can cause headache, nasal discharge, facial pressure, and pain that worsens when bending forward.
Penicillin — An antibiotic originally derived from Penicillium mold. In this historical setting, Taepyeong knows the modern concept but cannot safely reproduce it.
Formalin — A chemical preservative used to keep cadavers from decomposing. It makes tissues stiff and artificial-looking.
Nasal Cavity — The hollow space inside the nose through which air passes before reaching the lungs.
Turbinates — Curved structures inside the nasal cavity that warm, humidify, and filter incoming air.
Gas Exchange — The process in the lungs where oxygen enters the blood and carbon dioxide leaves it.
ADHD — Attention-deficit/hyperactivity disorder. The narrator is referencing modern associations between chronic mouth breathing, sleep or breathing issues, and attention problems.
Quaker — A member of the Religious Society of Friends, a Christian group known historically for plain living, pacifism, and strong community values.
Thames — The major river running through London, associated in this period with severe pollution and foul smells.