NOVEL WEB Chapter 18
Episode 18. Dispatch of the Plague Doctor (1)
****
In 1831, a Paris travel guidebook recorded that “The water of the Seine is drinkable but acts as a mild laxative.” For reference, a mild laxative means diarrhea-inducing medicine.
This must be the ultimate in positive thinking: “I drank Seine water and got cholera with diarrhea? Perfect timing, I needed a laxative!”
Modern folks call it cholera. From this term alone, we can infer a few things:
First, cholera was rampant before the modern era. It had to be, since before Pasteur, they dumped sewage into rivers based on miasma theory.
The logic being, get the bad air away from people as fast as possible.
Crazy by our standards, sure.
Second, even cholera-water could pass for some as just causing “a bit of diarrhea” if you’re healthy.
Here’s my point:
In areas where many deaths occur due to bacterial dysentery, there’s likely severe malnutrition or other underlying issues at play.
We should consult Teacher Hedwig further and decide. No harm in hearing her out.
“How long can the knights wait?”
“About an hour.”
“Then let’s discuss for an hour before heading out.”
I grabbed a pile of papers and a pen.
“Let me give you the answer upfront. This disease is a type of bacterial dysentery, spread through fecally contaminated water. Treatment involves hydration and antibiotics, though mostly hydration suffices, as antibiotics aren’t very effective here.”
Hedwig looked bewildered.
“How do you know that?”
“It’s obvious. Though I’ll recheck once we arrive, my assessment is probably correct.”
Hedwig nodded.
“Please continue.”
“Cholera bacteria and its toxin can be neutralized by boiling water… .”
“Simple solution!”
“Not exactly. This isn’t treatment but prevention. Do everyone in that city have the money or time to boil water daily?”
No idea, but historically, they likely couldn’t afford it.
“Isn’t there also lack of evidence that it spreads through water? I respect your opinion, Professor.”
I nodded.
“Waterborne transmission is just my hypothesis. We should experimentally verify it once we reach the scene.”
Hedwig agreed.
We decided to save further discussion for when we arrived on-site anyway. After all, we’d need to explain everything again there.
Especially to local officials.
The wyverns were faster than expected, whipping our hair and robes dramatically in the wind.
“When will we arrive?”
“It’ll take quite a while!”
The wind drowned out most of the words.
“What’s our destination?”
“The Free City of Lapis!”
Let’s stop trying to talk. My vocal cords might collapse before getting any useful info.
In my past life, I’d flown on planes a few times. But seeing the world from above like this? First time in this world.
The wind slashed across my face like a blade.
Three wyverns were mobilized for this mission.
Each carried one of us—me, Hedwig, and Istina—with a wyvern knight up front.
The scenery was beautiful, but the well-kept city outside the castle walls looked surprisingly dirty and drab. The city we’re heading to will likely be similar.
After a long journey, we finally arrived.
The three wyverns landed in the castle courtyard. Istina clung to a garden statue, dry-heaving.
“I would’ve given you motion sickness medicine if you’d mentioned it earlier.”
“Ugh, I didn’t realize I’d get seasick…”
“You’re not gonna throw up, are you?”
“No…”
I took motion sickness meds beforehand myself. Should’ve prepared more. Knew better.
“A relief station has been set up in front of the castle gates. We’ll discuss response strategies there.”
“Do we have enough staff?”
“Well… There are some church personnel, local healers, and a few others quickly brought in by imperial government intervention.”
Hedwig scanned the area.
“Let’s unpack, inspect the site, and see patients. Let’s meet back in an hour at the relief station.”
I nodded. Istina was still dry-heaving beside me. Looks like she’s really struggling. How long till she feels better?
****
Treating cholera patients.
In most cases, bacterial dysentery patients don’t need antibiotics. Death primarily results from dehydration.
While antibiotics might save lives, they aren’t always necessary. They won’t treat symptoms like fever or cough, nor can they solve dehydration.
Dozens of patients were admitted to the relief station.
I was assigned five. Guess my one-day packing from the academy might not be enough. Could take longer than expected.
Let’s start with what we can do.
“Istina, healing magic.”
“Yes.”
Istina raised her staff and began praying while I examined the patients.
Patient One:
An ordinary middle-aged man, likely a peasant judging by his dirt-streaked clothes. Probably a farmer.
Still alive, though clearly unwell.
“Let me check your conjunctiva. Open your mouth slightly please. And let’s assess skin turgor.”
Since I already know the disease, I just need to gauge severity. Not as bad as expected.
Standard treatment for cholera is doxycycline. I placed a few pills by the patient’s bedside.
“Take one with each meal.”
Istina waited nearby.
“See? Key symptom of bacterial dysentery is dehydration. Your conjunctiva is dry, tongue cracked, and skin turgor poor.”
“Ah, that makes sense.”
Classic signs of dehydration.
If dehydration worsens, electrolyte imbalances cause nerve dysfunction, blood pressure drops due to low blood volume.
The best option is intravenous fluids, but that’s not the main focus. Most important is identifying and stopping the source of infection.
I retrieved a coat hanger.
“Why the hanger?”
“To hang the IV bag.”
I found the patient’s vein, inserted the needle, and connected the IV. The patient stared at me.
“What is this?”
“A form of magic.”
Life support line, basically. But since IVs can’t be applied universally here, we need to find the root cause.
****
I was summoned here to devise a solution. While treating patients is part of it, pinpointing and resolving the disease’s origin is key.
“Where are we going now?”
Are they quick or slow workers? They’re moving without explaining anything. Good momentum or poor communication?
They’re leading me somewhere again. Since we’re entering the castle, it’s probably a strategy meeting with Lord Lapis.
“This is the conference room inside the castle. You’ll likely discuss solutions to this crisis with Lord Lapis.”
“Understood.”
There must have been a tipping point. Cholera cases likely existed before, but something triggered explosive growth.
Like contamination of the main water supply.
“This is the conference room.”
We seem to be late. Quite a crowd had already gathered in the lord’s meeting hall.
A woman wearing a feathered hat sat at the head of the table, looking like she hadn’t slept for three days. Likely Lord Lapis or a direct family member.
Several doctors in black coats and masks were also present.
Now it clicks.
Hedwig represents the empire. She came to assist Lord Lapis regarding this crisis, bringing me along as part of the effort.
“We’ve brought Healer Istina from the Imperial Palace and Professor Asterix from the Academy.”
No applause followed. Lord Lapis merely sighed softly.
“Ah yes, Professor Asterix. I am Lady Laflenia of Lapis. Thank you for coming.”
“Thank you for having me.”
I bowed respectfully.
“Shall we continue the previous discussion? To prevent further spread, we need to eliminate the cause… “
These people don’t know the cause.
“The epidemic is spreading exponentially. Healing magic alone has limits. Even bringing more healers won’t suffice indefinitely.”
“Hmm. We’ve lit bonfires throughout the city to dispel miasma and discouraged large gatherings… “
Preventing gatherings is a surprisingly modern approach, but bacterial dysentery doesn’t spread through contact.
Lady Lapis looked at me.
“Professor, what are your thoughts?”