episode_0047

Episode 47. An Unknown Plague (3)

****

The mayor of Imentia sighed.

The situation in the city was not good, and the gloomy atmosphere in the conference room now reflected that fact.

“Let’s summarize today’s situation.”

“There is strong opposition to the curfew.”

“What… … Is there a way? The stench coming up from the sewer at night could spread the disease.”

“People are said to be unable to sleep because madmen scream and pray in tongues every night.”

There’s no way to stop someone from yelling at home, especially if there are multiple people…

“Oh my.”

“The temple said that about ten more people with a similar illness were found yesterday.”

“Is it too much or too little? At least it didn’t skyrocket, so that’s fortunate. What did the professor say?”

“I don’t know, so I said I’d go see the patient.”

“Doesn’t that professor know what kind of illness it is? He hasn’t come back yet?”

“Yes.”

The situation was desperate. Nothing was known about what the disease was, how to respond, and how far it would spread.

In the end, we have no choice but to hope that the professor will figure out what the illness is and come up with a solution. There is no other way.

****

Medicine is not a cold science that requires putting a dying son second. But the science of monarchy may be.

We arrived at Imentia and received a situation briefing. Now we plan to go and see the mayor’s son, who is the first patient.

Manta, the second son of the mayor.

It is said that he contracted an unknown disease while on an overseas expedition and is currently quarantined in one of the towers of Imentia Castle.

Hemoptysis, skin rash, cough, phlegm. It’s not impossible that it was pneumonic plague, but there were a few things that made me a little suspicious.

It’s hard to believe Hedwig’s question at face value. Even though she’s a skilled person, it’s by this world’s standards.

As rational as it may seem, who would call prescribing heroin to a kindergartener or cutting off limbs with a dirty saw treatment?

That might be a bit of an exaggeration. Anyway, I have to see it for myself. It’s better to see patient-related information once than to read it a hundred times in writing.

But why is the hospital room so far away?

“No, why is it so high?”

“It’s a top.”

Istina muttered quietly.

“Why are you putting the patient on top? It hurts his legs.”

“I would have kept it far away. To isolate it.”

My legs hurt. It must be at least 6 stories high. Even if it’s supposed to be isolated, I think this is a bit too much.

How do you eat? Do you really think they bring food up to the 6th floor every day?

I will work hard.

We arrived in front of my son’s room a few minutes later. Istina and I stopped walking. We checked the plague doctor’s mask and knocked on the door.

“This is a doctor. May I come in?”

There was no specific answer.

“Hey, I’m a doctor. May I come in?”

“Ugh. Gulp.”

I guess that means I can go in. I opened the door to the room with Istina and went in. It was a nice, sunny room.

In the center of the room was a bed, and on the bed lay a man with a haggard appearance.

Let’s infer from what we see.

Judging from the items in the room and the position of the slippers, it seemed like he had been walking around until recently. That means he was able to walk around.

Well, since it’s not a situation that requires active care, I guess you could put it on top.

A wooden tray sat on the floor next to the door. The menu probably contained steak and porridge.

I don’t know why they gave it to me like that, but I think it tasted good.

The conclusion is that he can still walk and eat. It doesn’t seem like he cleaned it himself, but the room was generally clean.

Now let’s look at the patient.

The patient looked tired, but he was sitting up in his bed and looking at us. His expression was dull, and there were some red spots on his skin.

Her eyes were sunken. Her hair wasn’t visible on her head, but there was a lot of brown hair hanging from the head of the bed.

If it’s a week’s worth of hair, it seems like a lot of hair has fallen out. I was a bit worried.

I guess I need to get treatment quickly.

The mayor didn’t have that much hair, but it’s not good for a young friend to be like this already.

More than that.

Hemoptysis, red spots on the skin, hair loss, these are all typical symptoms of radiation poisoning. Is it really radiation poisoning? Surely not.

There’s no way it’s radiation exposure.

It’s a fantasy world, so there’s no way there’s a uranium mine or a decommissioned nuclear power plant nearby.

Let’s stop playing detective.

“Hello, patient,”

“Call, call. What is it?”

“We are doctors from the Imperial City. We heard that a plague is spreading in Imentia, so we were dispatched in a hurry to see a patient.”

The patient frowned.

“I thought it was a grim reaper or an undertaker. I thought it was time to die, just.”

“No.”

“Please take off your mask.”

“You can’t take it off, right… … ?”

Anyway, let’s start the treatment.

“When did the patient start feeling sick?”

“As soon as you get off the boat.”

“Didn’t you get sick during the adventure?”

“Oh, I’m on an adventure. Maybe it’s because I’m nervous, but I never got sick.”

I sighed. I couldn’t see any clues. What on earth could be causing this?

“I heard you had hemoptysis. Was there blood in your sputum? When did you start hemoptysis?”

“After coming.”

“Is there blood in your sputum?”

“Yes.”

“Try coughing again.”

“Call, call, call.”

The patient coughed several times.

It wasn’t a very deep or severe cough. When you have a serious respiratory illness like pneumonia, you can hear a deep cough with phlegm coming up.

It’s not like I coughed often either. Is it not a serious illness?

I checked the patient’s conjunctiva and skin tension. I’m not sure if the skin tension is normal, but there doesn’t seem to be any signs of dehydration.

“How much water do you drink?”

“Three cans.”

The patient scratched his head briefly.

“Did you figure out what the disease is?”

“No.”

“Old sailors call it sailor’s disease. They say it’s a disease that occurs when you stay at sea for too long or go too far.”

“Really?”

“They said it would get better after about two weeks on land. I thought it was like that.”

Sailor’s disease. What on earth is that? Should I consider it a peculiar infectious disease from overseas?

I stepped back from the patient and looked at Istina. Istina tilted her head.

“Istina. What kind of disease is this?”

“I don’t know. Isn’t it the Black Death?”

That’s what Hedwig and the city government came to, but it’s not impossible.

Black Death.

It is a disease that is called that because the patient dies after the skin turns black. This patient only had a rash, but the skin did not turn black, and he did not look like a patient who would die soon.

The treatment for the Black Death is doxycycline. It can be treated with antibiotics alone.

When I think about it, I can’t help but think that it wasn’t the Black Death.

If it had been insect-borne plague, there should have been scabs at the site of the bite, and gangrene of the skin and soft tissues should have occurred. If it had been pneumonic plague, the victim should have already been half dead.

No, human-to-human transmission is impossible except for pneumonic plague. Based on the information we have so far, the Black Death can be completely ruled out.

“I don’t think so. This patient is not black and doesn’t seem to be dying soon. It’s hard to see it as the Black Death.”

“Then what disease is it?”

“I need to think about it some more.”

I don’t know. Let me think about it a little more.

The patient coughed up blood… …?

Hemoptysis is a fairly rare symptom.

The most common cause of hemoptysis is lung cancer or bronchial cancer, although coughing too hard can cause bleeding there.

Let’s go back to the basic premise.

“Istina. What is hemoptysis?”

“This is a symptom of blood mixed in sputum.”

“What is the differential diagnosis?”

“I’m vomiting blood.”

“again.”

“I don’t know.”

Oral bleeding. Since sputum is spit out through the mouth, even if there is blood mixed in the sputum, it cannot be ruled out that it is blood coming from the mouth, not from the lungs or bronchial tubes.

So, these days, strange diagnoses like lung cancer, radiation poisoning, and the Black Death are being made because of hemoptysis.

Let’s start with the premise that hemoptysis is present. I turned my head back to the patient.

“Patient, please open your mouth.”

“Ugh… … .”

I put on my gloves and pulled back the patient’s lips to check his gums. As I suspected, the patient’s gums were bleeding a little.

“Are you a sharp type?”

No. At least it’s not as serious as the Black Death, radiation poisoning, or lung cancer. But is it possible to get a disease worse than those three?

“Istina! Look at this.”

“Yes. Oh, from the gums-”

“I can see blood coming out.”

“Yes.”

“It’s not hemoptysis. There was no hemoptysis from the beginning. It was just blood coming out of the mouth, and it came out when I sneezed or spit.”

“I see… … ?”

Istina didn’t seem to understand what I was saying. It’s a pity. If she were a modern doctor, she would have figured out what the disease was as soon as she heard that her gums were bleeding.

I opened my mouth. The patient and Istina looked at me with eyes full of anticipation.

“What kind of disease is this… … .”