Chapter 106
***
Erpen Adamberta.
He had been a representative figure of the humoral theory, yet after the germ theory was announced, he became more fervent about it than anyone else—a healing elf.
He and I had been in regular contact ever since the presentation.
He said that since germs might flow in the blood, he wanted me to help prove it.
I gladly agreed the moment I got his message.
It didn’t take long at all for us to become close.
— “I’m sorry about the presentation. We healers can’t help but thoroughly verify any new theory that comes along, you see. I was a little too aggressive with my questions, and it’s bothered me.”
— “It’s fine. In fact, medicine advances because there are people like you, Erpen-nim.”
— “Thank you, Saint. Then, before we begin our joint research, may I ask you a few questions about infusions and bloodletting?”
— “Of course.”
Erpen was an ardent believer in the infusion and transfusion techniques I had created.
Originally, the most common side effect of his bloodletting treatment was hypovolemic shock.
But after I introduced infusion and transfusion techniques to the healing world, his bloodletting survival rate rose dramatically.
So much so that the survival rate jumped from 30 percent to 50 percent.
Was that why?
Even while our joint research was underway, Erpen never once tried to assert his authority over me; he was always friendly.
And as that connection continued, we grew close enough that he contacted me first the moment I discovered antibiotics.
“The last time, using the method you taught me, I succeeded in isolating bacteria from blood.”
“Congratulations, Erpen-nim.”
Office of Erpen Adamberta, director of the Adamberta infirmary.
Still unaware that I had come to tell him I had discovered antibiotics,
the elf healer greeted me as always and said,
“It was no easy task. There were so few bacteria in the blood that finding them wasn’t easy.”
Blood culture was originally a highly difficult task.
Drawing blood under sterile conditions was hard enough, and even after you finally managed it, the bacteria often just died outright.
But Erpen had done it in the end.
He had discovered that there were germs flowing in the blood and causing fevers.
“What will you name this disease?”
“I haven’t decided yet. Does the Saint have a name in mind?”
“What about sepsis?”
“Sepsis... a very intuitive name. Let’s go with that.”
Unfortunately, the title of discoverer of sepsis went to Erpen.
If it were up to me, I would have wanted to prove it first.
But my priority was discovering antibiotics, so I had no choice but to let this achievement go to that elf healer.
‘Well, it’s not like I can hog all the credit.’
Maybe because he thought he’d made a discovery that would go down in medical history in his old age, despite still having more than a century left.
Erpen seemed to be in a particularly good mood today.
“Then we’ll need to figure out how to extract these germs separately through bloodletting.”
Or maybe he was just excited at the thought of inventing a new bloodletting method.
He sounded like a lunatic obsessed with bloodletting, but in fact his bloodletting was carried out within a fairly scientific framework.
Since poison flowed in the blood, he would first cut a safe vessel to draw blood, then use healing magic to regenerate fresh blood and lower the concentration of the toxin.
He repeated that over and over until the toxin concentration was nearly zero.
Doesn’t that sound familiar?
That’s right.
The method was different, but the principle was exactly the same as emergency dialysis and fluid therapy.
‘It might actually be more effective than emergency dialysis.’
Dialysis in the 21st century is not a perfect technology.
It doesn’t filter out 100 percent of the waste products, it strips away a lot of nutrients, and it can break down blood cells or nutrients.
By contrast, bloodletting adapted with divine magic didn’t have those side effects to worry about.
Aside from the trivial drawback that the patient could die from hypovolemic shock or dehydration, Erpen’s bloodletting was top-of-the-line treatment technology by this era’s standards.
The reason he was so fixated on bloodletting was simply because it really worked.
But his bloodletting could never work against sepsis.
“As I explained, germs are organisms that keep multiplying. Even if you draw blood, if the germs left inside the body keep multiplying, you’re back where you started.”
“Now that you put it that way, I see. Unlike poison, germs reproduce, don’t they? Bloodletting may not be effective after all.”
Erpen immediately accepted that.
Then, all of a sudden, his expression darkened.
“...Actually, I know you’ve been deliberately holding something back.”
“What do you mean?”
“Among all the people who died because of my bloodletting, there must have been many whose germs were transferred through transfusions and killed them, yes?”
“....”
It was a pretty logical inference.
His transfusions were far from sterile procedures.
Perhaps, as he said, there may have been patients who died because of his faulty blood transfusions.
But I judged that possibility to be low.
“No, sepsis doesn’t develop that easily.”
Unless it’s a virus like hepatitis C.
Sepsis from a transfusion is rare.
Unless the blood bag itself was a clump of germs, or the needle had feces smeared on it.
Otherwise, it’s rare for sepsis to occur from the transfusion act itself.
White blood cells and immune cells aren’t that weak.
So I denied Erpen’s guess.
“The blood products are packaged cleanly and sent by our merchant guild, aren’t they? So there should be almost no one who developed sepsis from your transfusions, Erpen-nim.”
But Erpen didn’t seem to believe me easily.
“There’s no need to comfort me that much.”
No, really, I mean it.
Maybe because he’d been researching germs lately,
Erpen was overestimating how frightening germs were.
Naturally, that wasn’t a desirable situation either, so I corrected his misconception.
“If sepsis could arise from nothing more than a needle wound, then wouldn’t you get sepsis just from cutting your finger while turning a page?”
“Ah, now that you mention it.”
“Germs are scary, yes, but humans aren’t that fragile.”
We’ve only just learned about bacteria, not about white blood cells or the immune system yet.
So I could understand why he reacted almost like a hypochondriac.
Erpen cleared his throat awkwardly.
“Ahem... Sorry. Learning new knowledge at my age makes me feel as though I’ve gone back to my school days.”
“I understand. I went through that once too.”
Looks like even this world has med student syndrome too.
(*Med student syndrome : a kind of exaggerated hypochondria—worrying that a stomachache is stomach cancer, or that a fever while sleeping is lymphoma)
“Come to think of it, I came today because I had something to tell you, Erpen-nim.”
“What is it?”
“I’ve made a medicine that can treat most diseases caused by germs, including sepsis.”
Halt.
The hand of Erpen, who had been lifting a cup across from me, froze.
“...If I remember correctly, it’s only been about two months since you discovered germs?”
“I was lucky. Before discovering germs, our guild had been conducting a large-scale project on whether dyes could be used as medicine, and by chance I managed to find a drug effective against germs.”
It wasn’t a lie.
I’d already been running an antibiotic discovery project even before I started researching the germ theory.
There was one reason I could discover it this quickly compared to history as it happened originally.
I already knew part of the answer, and the scale of the research was on a completely different level.
‘Those people were individual researchers, while I’m a guild executive. Naturally, that’s to be expected.’
One person doing research and progress is slow?
Then hire a hundred people, lock them in a lab, and make them stare at microscopes for sixteen hours a day.
It turned out time and effort can be replaced with enough capital.
“I infected mice with germs and administered these drugs to the mice that developed fevers, and nine out of ten survived.”
Maybe because they were germs that had never tasted antibiotics yet.
It worked like a charm.
The germs in 21st-century Korea were hard to kill because of resistance, after all.
“We’ve also run a few clinical trials in Limbus Pit, and if we’re fast, we should be able to start selling it within two months.”
“....”
I shook a test tube containing red medicine in front of him.
Erpen quietly watched the medicine inside the test tube, then finally spoke.
“You didn’t make it in advance and then just pretend to discover it, did you?”
“....”
How did he know.
Seeing my silence, Erpen let out a snort of laughter.
“I’m joking. Is this the first time I’ve seen you do something like this? You clarified the mechanism of diabetes and made insulin within half a year, didn’t you? This wouldn’t have been difficult for you either.”
“I was lucky.”
“The gods only grant luck to those who work for it.”
*
I decided to name the antibiotic ‘Prontosil.’
“Then this medicine can conquer all germs, yes?”
“Unfortunately, there are germs it works on and germs it doesn’t.”
Prontosil is only effective against streptococci and pneumococci.
Its effect on other bacteria is almost negligible.
‘We need to make penicillin as soon as possible.’
Blue mold.
That damn thing still hadn’t shown up.
I was pretty sure I had made the healers scour almost every blue mold there was.
And yet I couldn’t find even one that looked remotely like penicillin, let alone the real thing.
‘What if it isn’t blue mold?’
Come to think of it, in this world quinine was also extracted from bark, not from an infusion.
Maybe not blue mold, but some green moss or another?
‘I guess I’ll have to check other molds too.’
In any case,
until penicillin appeared, Prontosil was set to remain the undisputed king of antibiotics.
“Have you decided the price of the medicine?”
“I’ll sell it cheaply. Far cheaper than quinine.”
“As cheap as bleach?”
“I think so.”
Bacterial infections are more common than malaria.
The more common something is, the more accessible it should be.
‘Hygiene and prevention are basically a group project, after all.’
Hygiene and prevention don’t do much if only one person pays attention to them.
Not only me, but my neighbors and even the neighborhood beyond them all have to pay attention together for it to matter.
The reason I’m selling them cheaply is the same.
After all, if only a few people can enjoy it because it’s expensive, it won’t be effective.
“I’ve already spoken with the board. Many citizens won’t need to feel burdened by using this medicine.”
Some of the board members didn’t even know any better and kept wanting to sell antibiotics as pricey as Viagra.
Once I pushed it through, they backed down and agreed to sell it cheaply.
But unaware of my intentions, Erpen looked at me with moved eyes.
“Just like with the vaccine... you truly have no greed. No matter how I think about it, they canonized you as a saint far too late.”
“I feel the same way every time.”
Gregor, who had quietly been following behind us, also twitched his beard and nodded vigorously.
The uncomfortable gazes of the two of them turned at once toward my crow mask.
I clapped to brighten the mood.
“However, it’s still too early to use it right away. We’re planning to hide the fact that it’s a bacterial treatment and present it as a catalyst for healers.”
“Indeed, that would be best. We don’t know how dark mages might abuse these germs, so blindly spreading it around wouldn’t be good.”
Of course, keeping it completely secret would be impossible.
Still, that would be far better than not trying at all.
“Then may we try that medicine right away? Right now, we have patients admitted here who are strongly suspected of having sepsis.”
“I’ll explain the dosage and how to use it while I’m there.”
Erpen’s decision was swift and decisive.
Maybe because clinical trials weren’t yet a common concept in this world.
He had no qualms at all about using a new drug directly on patients.
“This is oral Prontosil. It’s used for mild infections and taken three times a day.”
“Then is this injection more effective and faster?”
“Yes. This is a water-soluble Prontosil injection. However, it must not be injected directly; it has to be administered indirectly through an infusion.”
“What’s the dosage?”
“Inject 20 mL of a 2.5 percent solution.”
Scribble, scribble.
Erpen jotted notes in his notepad.
In front of us was a patient panting as if about to be sent straight to the gods.
Erpen skillfully found the patient’s vein, inserted the IV, and then administered the antibiotic as I instructed.
“Then may I cast Heal now?”
“Yes. This is a healing spell that uses the Prontosil in the patient’s blood as a catalyst.”
After all, divine magic is just magic with divine power as its resource; the structure is the same.
I handed him a slightly modified spell formula.
“This is a spell formula I refined myself.”
“The basic framework is a low-tier Heal spell. Ah, since it’s a humoral-theory-based spell, there are still unnecessary pieces left in it. This part could probably be removed.”
He was the man who’d made divine magic that regenerates blood based on Heal, after all.
The moment he saw the new spell, he immediately started modifying it on the spot.
‘As expected, healers know divine magic better than I do.’
He scribbled on the formula a few times, then nodded and reached out toward the patient.
[Heal]
A pure white light seeped into the patient’s body.
As expected of the miracle of divine magic.
The patient’s condition improved in no time.
Prontosil seemed to have successfully worked as a catalyst.
I immediately asked Erpen.
“What do you think? You’re the first, Erpen-nim, to use Prontosil as a catalyst for divine magic.”
“....”
“Erpen-nim?”
Without answering my question, Erpen stared blankly down at his own hand.
Then he called over another healer passing by.
“You there, didn’t you have a sepsis patient? Try treating your patient with this spell and this medicine.”
“Understood, Director.”
That healer immediately cast Heal on his own patient as well.
And he showed exactly the same reaction as the director.
He froze there, blankly staring down at his own hand.
That process repeated itself several more times.
Prontosil was administered, Heal was cast, administered, cast.
Only after about ten healers had been left speechless did Erpen finally speak to me.
“Saint?”
“What is it?”
“What on earth did you make?”
“?”
“The divine power consumed by a low-tier Heal... has dropped to the same level as Refresh. If that’s the case... we could easily use it thirty times a day.”
And Erpen, looking stunned, stared up at the sky and muttered,
“…I never thought I’d feel so keenly that the humoral theory was nonsense.”
*
After that, the Adamberta infirmary saw an unexpected antibiotic boom.
— “On an infected wound, just one application of Prontosil... oh my god...! The divine power...!”
— “Even on pneumonia patients, just once... huh?”
Because the fuel efficiency of divine magic when using antibiotics as a catalyst improved by nearly tenfold.
That level of fuel efficiency was the sort you only found in symbols like sunlight, crosses, and holy water.
Some healers, high on that rush, said they had to burn through every last drop of divine power they had today, so they bought Prontosil and headed down to Limbus Pit to volunteer.
— “More...! I need more experience!”
At that crazed spectacle, neither Erpen nor I could bring ourselves to stop them.
Well, if it’s good, it’s good, I suppose.
From time to time, there were even talks of declaring antibiotics a holy relic.
“Can that be declared a holy relic?”
“Why not? Quinine, insulin, and vaccines all received consecration, didn’t they? Antibiotics should too.”
Erpen already looked utterly convinced that antibiotics would become a holy relic.
“The Mensia sect is in for a rough time.”
At the same time, it was the moment their fate was sealed.
The Mensia sect was one that made its living from plagues—infectious diseases, to be exact.
But the antibiotic treatment method had been taken by the Adamberta sect.
There was no need to wonder what the Mensia sect’s future would be.
“Tsk... That guy Dormun did end up taking advice in the end, didn’t he.”
Erpen clicked his tongue sympathetically.
But he didn’t seem particularly sympathetic toward Dormun.
“He’s the elder representing a sect too. He should naturally take responsibility for his own choice. So Saint, please don’t take it too hard.”
I had been wondering if I should give them one more chance,
but Erpen even defended me, saying that was their responsibility too.
Thanks to his firm stance, I felt much lighter as well.
That was one day while I was conducting joint research with Erpen, testing Prontosil in various places.
“Director!”
A junior healer came looking for us in a hurry.
“A woman who had just given birth has been sent from the Rafabri sect! It’s a puerperal fever patient!”
“Those guys are fast on the uptake.”
Apparently, the news that we had antibiotics here had reached them.
I don’t know how they found out, but they must have decided the mother needed antibiotics right away.
“Come to think of it, Saint. Those Rafabri fellows are rather pitiful. I doubt they simply don’t believe germs exist.”
“I know.”
I already have a way to help them in mind.
But that can wait.
We immediately checked the mother sent by the Rafabri sect.
A somewhat stout woman was lying on a stretcher, panting heavily.
Erpen, after confirming the woman’s face, let out a sigh.
“Hah... I see why those fellows swallowed their pride and sent her straight here.”
“Do you know her?”
“She’s the Marchioness of Kernen. This is her fifth delivery. I know her because I once treated her white lead poisoning (*lead poisoning) with bloodletting.”
Saying that, the elderly elf healer skillfully took the patient’s pulse.
“The veins are...”
He felt along her arm.
“The veins are...”
He felt along the top of her foot.
“...?”
A look of confusion crossed Erpen’s face.
“I can’t... find the veins...?”
Just as he said.
I was looking too, and there was simply no way to find a vein.
‘The edema is too severe.’
The postpartum edema was far too severe.
Not a single vein was visible.
“An intramuscular injection...”
“It won’t work.”
Intramuscular injections are absorbed slowly.
If you inject it into the buttock, the medicine won’t spread until after the patient has already died.
“Then what do we do, Saint? Do you have any clever trick?”
“I do. Gregor will bring it soon.”
As soon as he saw the patient, Erpen had already figured it would be difficult to find a vein, so I had Gregor bring a certain object.
By now, he should be rummaging through the infirmary to bring back the item I asked for.
Just as I expected, he returned with it in under a minute.
“Saint! I’ve brought it!”
“You didn’t break any doors or walls, did you?”
“...I did break the doorknob a little, in my haste.”
“No, that was fine.”
A doorknob is nothing.
When lives are on the line, a little damage is fine if you’re in a hurry.
“I’ll compensate for that later, Director.”
Saying that, I took the object Gregor had brought.
In my hand was a huge needle, roughly the thickness of a pinky, if I exaggerated a little.
I instructed Gregor to press firmly on the mother’s shin.
Then I set the needle perpendicular to the shin.
“S-Saint... what are you going to do?”
“You do know blood is made in the bone marrow, right?”
“S... surely not...”
“I’m going to use that.”
“W-wait a second...!”
Before Erpen could say anything else,
I put my upper body weight into the needle.
Thunk!
And the needle pierced straight through the shinbone.