Penicillin
After my conversation with Rudiger ended, the feeling that settled over me was simple.
These people are finally starting to accept me as a doctor.
The head butler was ill, no one knew why, so they wanted me to come take a look?
That was pretty much a dead giveaway.
They can't ignore the fact that I fixed the knight commander, huh.
Anyone who had watched a man get a sword driven into his heart and still walk away alive would have a hard time dismissing me after that.
If someone saw that and still refused to acknowledge my skill, they were just blind.
Anyway…
What exactly was wrong with this man?
"Let me take a look at you, Head Butler."
At my call, Gilbert, who had already lain down on the bed, lifted his eyelids.
His face was so hollow and drawn that I almost wondered if this was truly the same strict man I knew.
"What are your symptoms? You must tell me everything without holding anything back."
The foundation of medicine was the interview.
Half of any diagnosis came from the information that left a patient's mouth.
In a place where precise tests were impossible, that interview mattered even more.
Gilbert let out a thin sigh and slowly opened his mouth.
"The headaches are severe. From time to time my head feels as though it is about to split open."
"Headaches. Anything else?"
"Lately walking has stopped obeying me. It is as if strength will not properly enter my legs… keeping my balance and walking has become difficult."
"Trouble with gait as well. Is there anything more?"
"…And."
Gilbert hesitated for a moment.
He clearly hated admitting any crack in his own perfection.
But when a man was in enough pain to die, there was no room left for pride. He continued soon enough.
"There are times when my memory cuts out in fragments. I forget what I was about to do a moment ago, or my mind simply will not stay clear. Fortunately it has returned for now, which is why I can speak like this, but…"
Severe headaches.
Gait disturbance.
And cognitive impairment accompanied by memory loss.
Even that much was enough for me to realize quickly that Gilbert's problem lay in the brain.
But it was still not enough.
The symptoms he listed were the basic signals that appeared whenever something went wrong inside the skull.
The possible diagnoses that came to mind alone already included encephalitis, chronic meningitis, brain abscess, chronic subdural hematoma, brain tumor…
If I said there were even more than that, would it make sense?
Gilbert's symptoms were that common.
I kept my gaze fixed on his eyes and asked,
"Is that everything?"
"…It is."
"Truly?"
When I pressed him, Gilbert's brow tightened.
I added firmly,
"If you hide symptoms from a doctor, the illness cannot be cured. Even if it is something embarrassing, you must tell me everything so I can lock onto the cause for certain. Even if it means saying you can no longer control your bowels. Is there anything you are concealing?"
Gilbert fell silent for a moment after hearing me. Then he lowered his eyes and spoke in a voice so small it almost crawled away.
"…Urinary incontinence."
"Pardon?"
"…I have difficulty controlling my urine of my own will."
Gait disturbance, cognitive impairment, severe headaches, and urinary incontinence.
As the symptoms gathered one by one, the outline began to take shape.
Now I had to determine clearly whether this was an infectious disease or not.
I opened my mouth again and asked the critical question.
"Have you recently had a fever, chills, or vomiting?"
At my words Gilbert frowned and shook his head firmly.
"None. I swear I have never had a fever. The same for chills or vomiting."
Then infectious disease is out for now.
If it had been encephalitis, meningitis, or a brain abscess—any infectious disease—high fever or vomiting would inevitably have accompanied it.
"……."
With the additional clue that it was not infectious, only three diagnoses remained in my mind.
First: chronic subdural hematoma—blood slowly pooling beneath the thin membrane covering the brain and compressing it.
Second: a brain tumor—some vile growth inside the skull crushing the nerves.
And third:
normal pressure hydrocephalus—cerebrospinal fluid that was produced but not properly absorbed, abnormally accumulating in the ventricles and pressing on the brain.
Those three…
What they all shared was that treating them required opening the skull.
One small mercy was that the trepanation tools themselves would not be hard to obtain.
Even in the Middle Ages of my previous life, people had drilled holes in skulls under the excuse of releasing evil spirits to cure epilepsy or madness.
This world looked every bit as medieval to me, so the tools for boring holes certainly existed.
But having the tools did not mean everything was fine.
The real problem was where and how to perform such a perilous operation.
In surgery—especially brain surgery—the most critical factor was rigorous infection control.
No matter that this was a grand duchy, hoping for a perfectly sterile environment at modern medical standards in this place was essentially praying for a miracle.
No—I was not even asking for a sterile operating theater.
If only I had penicillin…
Antibiotics. Nothing was more necessary during surgery.
And simply making antibiotics would not be the end.
What about the anesthetic?
This was a procedure that required boring through the skull and touching the brain. I could not exactly tell him to bite down and endure it.
…In the end, everything comes down to opening the head to find out.
In a world without advanced imaging equipment like CT or MRI, there was no way to see from the outside whether blood had pooled, something malignant had grown, or it was simply water that had filled up.
In other words, every treatment began with drilling into the skull.
I hesitated briefly, then spoke to Gilbert.
"Would you like to hear the good news or the bad news first?"
"The bad news first."
Quite direct of him.
"Without treatment, you will die without exception, Head Butler. At the same time, treating you will require a great many things."
"…And the good news?"
"That I know the method of treatment, and I know everything that will be needed."
"……."
Gilbert created a stretch of silence.
I could see the depth of his anguish through his eyes.
Even so, I cut through his hesitation and continued.
"…There is something I left out of the bad news. To treat your illness, Head Butler, I will have to drill a hole in your head. Of course I will restore it afterward."
…I almost forgot to say that.
Failing to inform a patient of the surgical details in advance is a crime. A crime.
Gilbert's heavy voice left his mouth.
"You said that without treatment I will die."
"Yes."
"Without exception."
"That's right."
"And you said you can treat me."
"That's also correct."
"Then I have two choices. One: risk death from having my head opened, accept your treatment, and live a long life."
"……."
"Two: refuse your treatment and enjoy what remains of my life in a short span."
Having said that, Gilbert let out a short, dry laugh and continued.
"One: the second option has a flaw. In this condition of my body, can I even enjoy the remainder of my life?"
"……."
"Therefore I choose the former. I entrust my treatment to you."
Gilbert's tone remained as authoritative as ever.
But the tremor in his voice, and the way he looked at me, proved that he was afraid.
Who could laugh when they had just been told they were about to die?
I had already spent nearly six years in this place.
In that time I had developed every kind of affection and irritation toward the head butler, so this time at least—
…This will be my first surgery.
I had to give it everything I had.
When you leave your parents who used to scold you and start living on your own, the house feels empty, doesn't it?
I… felt something like that.
I truly hated the sensation of a person vanishing.
I kept turning over in my mind everything I would need.
Even so, the most important things remained antibiotics and anesthetics.
And I already knew the answers to both.
The antibiotic was penicillin.
The anesthetic was opium and mandrake.
…Yes, that mandrake. It is a real plant, after all.
Of course it does not have a face growing on it.
It simply shares the same name.
It must exist here as well.
Even if the name differed, a plant identical to mandrake would be present.
So I could ask Rudiger to obtain opium and mandrake for me…
The real issue is the penicillin.
Brain surgery without antibiotics was not surgery—it was practically murder.
I would have to smash open the skull and touch the brain.
Without any means of preventing infection, the patient would cross the River Styx before the operation even finished.
No matter what it took, I had to cultivate blue mold and produce penicillin.
And right now the greatest obstacle was the environment.
This is the North, after all.
A region that stayed cold and dry all year round.
Hoping for blue mold to bloom naturally and beautifully here was absurd.
For mold to proliferate explosively, a warm, damp environment around twenty-five degrees Celsius was essential.
I'll have to turn an entire room into a steam bath.
To do that I needed Rudiger's permission, an empty room sealed off completely, and the humidity inside raised until the air felt thick enough to choke on.
After that I would place several loaves of bread inside and wait until the blue mold bloomed.
Once I confirmed the blue mold had appeared, the next step was preparing a culture medium for it to feed on and grow.
That part was simpler than expected.
Boil potatoes thoroughly, mix plenty of sugar into the water to make a meal for the mold, then scrape a little of the blue mold and float it on the surface of that liquid.
If the temperature and humidity were maintained properly after that, the mold would spread across the surface of the broth like cotton fluff and exude a yellow liquid.
That was primitive penicillin.
Of course a process of filtering and refining it to raise the purity still remained, but…
Depending on the time available, I might not even manage that.
In the end the greatest challenge was constructing a perfect high-temperature, high-humidity greenhouse in the North where the mold could grow vigorously.
I quickly organized the list of necessary preparations in my head and leaned back against the chair.
"This needs to happen quickly."
The surgery had to take place as soon as possible.
If it were truly possible, within two days.
But considering the cultivation process for penicillin, that was physically impossible.
Realistically I estimated it would take at least four days before we could operate.
And four days…
"Is too long."
It was far too long for Gilbert to hold out.
"Haa…"
I was still clutching my complicated head when—
Creeeak—.
The door of the Infirmary opened carefully.
The culprit who opened it was…
"My Lady?"
It was Selene.
Her face looked somehow downcast.
Had her aura manifestation been going poorly since yesterday?
I did not have the leisure to check on her every day right now…
"What brings you here…"
"…Father said you would be helping Gilbert."
"……."
"He told me you would be busy, so if possible I should postpone giving you the dried persimmon for later…"
"……."
"B-but I still wanted to give it to you…"
Ah.
So our young lady was wearing that long face because she was sad she might not be able to give me the dried persimmon?
How can a person be this kind?
It was not that she looked upset about having the treat taken away from her.
She looked upset because she might not be allowed to give it away.
"I won't… be too much of a bother, will I…?"
"Of course not."
Selene being a bother? Nonsense.
She had arrived at exactly the right moment to refresh me when my head was spinning.
"If anything, I think My Lady will need to visit every day."
"…Huh?"
"I think I'll only be able to keep my strength up if I eat the dried persimmon you bring me every day."
As a butler here, the only way for me to take in sugar was by shoveling lump sugar into my mouth.
But if I could get that sugar from dried persimmons?
Then of course I should eat the delicious dried persimmons.
"Really…?"
"Of course. So you can come find me without worrying. Though sometimes I might not be in my seat…"
When that happened it would be better if she went back instead of waiting.
When I added that,
a soft smile spread across Selene's lips.
After the rest period with Selene ended,
I went straight to Rudiger, listed Gilbert's condition and everything required to save him, and requested a room for producing penicillin.
Rudiger said he understood at once and ordered the servants to convert a spare room in the Main Building for that purpose.
I expected him to tell me to use a room in the Annex. This is a little surprising.
Setting that aside,
I also brought up the matter of the anesthetic.
"Anesthesia… so you mean making a person unable to wake no matter what pain they feel?"
Rudiger asked me that, then said he would hire a high-ranking mage so that we could make use of the mage's sleep magic.
"I didn't know sleep magic existed."
In practice that was the best method of all.
Anesthesia using opium—poppies—meant employing narcotic analgesics, which carried the risk of addiction.
Mandrake could be used as an anesthetic, but it was a poisonous plant; if the dosage went wrong, it simply killed the patient.
In that situation, the sleep magic Rudiger proposed was a ray of light.
"For now…"
What I had to do immediately was create a high-temperature, high-humidity room and put bread inside it.
"I'll just make the room like a wet sauna."
We built a dedicated Penicillin Cultivation Room in the Main Building.
For the first two days I left the bread inside and did not open the door at all.
Blue mold blooming within twenty-four hours was physically impossible.
And so, with a touch of impatience, I greeted the morning of the third day of penicillin cultivation.
"…This is blue mold."
Blue mold had bloomed on the bread.
Blue powder visible above white cottony fluff.
When I brought my nose close, there was not even a smell.
No matter how I looked at it, this was the prototype of penicillin.