Chapter 110: Let's See Who Wins [1] —Pujijik.
Within Bojewon's inner courtyard, crude, unmistakable sounds rang out without pause.
Clearly, they were following Dongpa's orders and eating nothing.
Yet for some reason, the pace at which the watery diarrhea poured out had not lessened in the slightest.
It was enough to make one feel as though the body was determined to wring out even its very last drop.
"It's utter chaos."
Heo Jun muttered while covering his nose with his sleeve.
Heo Im had gone so far as to get a large amount of gauze from Dolseok and stuff up his nose with it.
"Urgh."
Yeoju, whose stomach was weaker, had turned her head far away.
This time, it seemed impossible to leave a visual record through drawings.
No, wasn't Lord Ryu Seong-ryong's anus harder to look at than this? Or not? Is this a different category altogether?
Kanghyeok tilted his head for quite a while, then nodded.
Because the scene surrounding them really did resemble a battlefield.
"Uaaaah."
"Ughhh."
"Ugh..."
First of all, there were groans and screams of every kind.
The people who could still make sound like this were actually among the better-off ones.
The ones in truly grave condition could not even open their mouths.
They were simply passing watery stool as it came.
The dehydration had progressed so far that it was causing fever.
First, I have to sort them quickly.
With a bitter expression, Kanghyeok looked back and forth between the house-call bag and Heo Jun.
The metalworkers Heo Jun had introduced to him were quite skilled.
The army retractor, scalpel, and other tools they had made were genuinely usable.
No, more than usable—they did not fall especially short even when compared to the original tools Kanghyeok already had.
The other instruments were slightly weaker in strength or lacking in fine detail, but not enough to interfere with surgery.
However, there were a few things even they considered entirely impossible.
One of them was the needle for injections.
Come to think of it, the needle really is...
They had made something roughly similar, but if he stuck that into anyone, it felt like they would die no matter who it was.
He had even packed a few away to be used during the Imjin War later.
They were basically weapons.
He could not use something like that on patients.
It would rupture all their veins.
In any case, because of that, there was still only a single usable IV set.
Which meant that among all these dehydrated patients, only one person could receive a large volume of fluid by intravenous injection.
He had to choose carefully.
"Mm."
When Kanghyeok stopped with a low sound, Heo Jun and Heo Im stopped directly behind him as well.
Yeoju stood far away and looked as though she had no intention whatsoever of coming closer.
"You may have gone through this once during the smallpox outbreak, but when there are this many patients, it's best to start by sorting them."
"Yes."
Since Heo Jun had at least experienced it once before, there was composure in both his tone and expression.
Heo Im, on the other hand, could not hide his tension.
Though he had worked for quite a long time as an acupuncturist at the Royal Medical Bureau, this was the first time he had faced so many patients at once.
—Gulp.
It was enough to make him swallow dryly without realizing it.
Kanghyeok looked at the two of them in turn and continued.
"First... watch what I do and learn from it. There's just one thing you absolutely must keep in mind. After touching a patient, never touch your own body with that same hand. Wash it immediately."
"Yes, yes, Scholar."
"Then... let's start with this man."
Kanghyeok stepped toward the patient sprawled before him.
He was the one who had not managed even a proper groan for some time and had only been relentlessly passing watery stool.
He had looked bad from the start, and even now it was hard to look away from him.
"Now then... what's your name?"
"Mm... just call me Dolsoe."
"Dolsoe, is it? Do you know where you are right now?"
"What? Bojewon, sir."
After that, Kanghyeok asked several more simple questions.
It was a test to see whether there had been any change in consciousness due to dehydration.
"First of all, this man Dolsoe has clear consciousness."
"Ah, so that's what you were checking."
Only now understanding why Kanghyeok had asked what seemed like useless questions, Heo Im nodded.
Seeing how quickly the two of them were catching on, Kanghyeok smiled in satisfaction.
"That's right. When our body lacks water, blood pressure falls. Then the amount of blood going to the head decreases... and consciousness can become clouded."
"When I listen to you, Scholar, it always makes me think how intricately connected the human body is."
This time, it was Heo Jun who offered praise.
Despite his extraordinary shamelessness, Kanghyeok felt a trace of embarrassment.
Because it was Heo Jun, of all people, praising him.
Quite some time had passed since he came to Joseon, but praise from great historical figures was still not easy to get used to.
"Ahem."
After clearing his throat several times, Kanghyeok turned back to the patient.
"You said Dolsoe, right? Stick out your tongue."
"What?"
"Your tongue."
"Yes, yes."
From earlier, Kanghyeok had already suspected that Dolsoe's tongue would be dry as a board.
Because part of his pronunciation had been slurred.
When the mucous membranes inside the mouth dry out, speech naturally becomes harder...
The patient wet his mouth briefly, then stuck out his tongue.
The tongue immediately called to mind a rice paddy cracked by drought.
This is the sort of thing it'd be nice to have drawn.
With some regret, Kanghyeok looked back.
Yeoju still could not bring herself to approach.
In that state, even if she did come closer, it was obvious it would be useless.
It would be a relief if she managed not to vomit, much less draw.
"Mm. If you look here, his tongue seems a bit odd, doesn't it?"
"Yes. It's cracked."
"And his lips are dry. If you look closely, his eyes are somewhat sunken too. And if you feel the pulse..."
Letting his words trail off, Kanghyeok took the patient's wrist.
More precisely, he was feeling the radial artery that ran along the thumb side.
It was one of the best arteries for indirectly checking the heartbeat.
"It's beating at more than a hundred times per minute. Since the blood pressure has fallen, the heart is beating faster to compensate."
Kanghyeok's explanation was the kind that gave absolutely no consideration to whether the patient understood it.
In truth, even Heo Im, who had diligently attended Kanghyeok's lectures and reviewed them afterward, found much of it hard to follow.
The only one who fully understood him was Heo Jun.
"Then doesn't that mean the dehydration is extremely severe?"
"That's right. He's probably lost more than one-sixth of the water in his body."
"Heo."
"But since he's young, he's enduring it relatively well. His head probably hurts, he's dizzy, and he's weak all over."
"Oh."
At Kanghyeok's words, the patient's eyes widened.
Because he was suffering every single one of the symptoms just listed.
They said a true famed physician could tell everything just by looking at a face.
Kanghyeok at that moment was exactly that.
All at once, respect for Kanghyeok began to rise in the eyes of the patient and those around him.
"If you touch here, you'll probably find some fever too."
"Aha. He's quite warm."
"As for treatment..."
Kanghyeok sank briefly into thought.
If this had been a hospital, he would have hooked up an IV without a second thought.
No matter how good oral rehydration therapy was, it was still less effective than pouring fluid directly into the veins.
But there was only one usable IV set.
Even caution upon caution would not be enough.
The dehydration is severe, but his consciousness is clear...
First of all, he was young.
And perhaps because he normally did heavy labor, his build was quite sturdy as well.
In other words, it seemed unlikely that he would collapse immediately.
"Hey, Dolseok!"
Having made up his mind, Kanghyeok shouted for Dolseok.
Dolseok, who had been boiling water in the kitchen, rushed over in a hurry.
"Yes, Young Master."
"Have you boiled any water?"
"Yes. One cauldron's done now... and I've set another one on."
"That was fast. Here, fill this container with water. And bring some salt and honey too."
Kanghyeok handed him the measuring cup he had commissioned from the blacksmith.
Calling it a measuring cup was generous; it felt rather imprecise.
Still, it ought to hold about one liter.
When he poured a one-liter IV bag into it, it had roughly matched.
"Yes, yes. But this is iron, so it's hot..."
"It can't be helped. Wrap it with gauze or something and bring it."
"Ah... yes. Ouch, hot."
Dolseok came running back with his hands bright red from the heat.
In his other hand he carried the honey and the salt.
For all his faults, he was a loyal fellow.
Whatever he was told to do, he did it.
Though he always has to grumble about it.
If he was going to do it anyway, why not just do it?
Why grumble and invite a beating?
Kanghyeok truly could not understand the reason.
"Here it is."
"Right, good work. There are a lot of patients here, so keep boiling and cooling it diligently."
"Yes, yes."
With that brief praise, Kanghyeok began preparing the oral rehydration solution.
So what I've got is honey, water, and salt.
Compared to the university hospital, it was so meager it was not even enough to make him sigh.
Especially when he thought of the oral rehydration formulas that had advanced and advanced in recent times, it was ridiculous.
Honestly, it'd be better just to dilute some Pocari Sweat a little and give them that.
But what else could he do?
If there were no teeth, one had to chew with the gums.
He had to make something work somehow.
"First, we need to add a little salt."
One fortunate thing was that he could use the syringe as a measuring device.
Using the syringe, Kanghyeok measured out 4 grams of salt and poured it into the water.
That made it roughly a 0.4% saline solution.
Of course, there would be quite a lot of impurities in it.
But since it was not being injected directly into a vein, it probably would not matter much.
Need sugar too.
It was a blessing that there was at least honey.
Without it, he could not even begin to guess how he would produce a sugar solution.
If I put in too much, it could actually worsen the diarrhea.
If the goal had been simple nutritional supplementation, then the best thing would have been to feed the patient honey outright.
But if he did that, the honey's high osmotic pressure could pull even the small amount of water remaining in the body into the intestines.
It would be like throwing oil on a fire when the patient already had diarrhea.
Let's just use 50 grams.
Using the syringe, Kanghyeok mixed roughly 50 grams of honey into the water.
Since the water had not completely cooled yet, the honey melted in quickly.
That makes it about a 5% glucose solution.
If only he could add nutrients like amino acids to it, it would have been ideal.
Those were among the nutrients considered essential in modern oral rehydration solutions.
Give up what has to be given up.
Amino acids, of all things.
On Joseon soil, that was effectively impossible.
Even if he had the proper equipment, it still would not work.
He had long since forgotten the chemical structures.
"All right. Done."
After producing the crude oral rehydration solution, Kanghyeok held it out to the patient.
Fortunately, while he was making it, it had cooled enough to be drinkable.
The problem was the patient's anxiety.
Naturally so, since he had been hearing Dongpa shouting the whole time.
"Can I really drink this? If I drink it, I'll just shit again..."
"You'll shit even if you don't drink. Just drink it. You have to drink if you want to live."
"But..."
"Drink."
"Th—"
"Drink."
Watching the struggle between Kanghyeok and the patient from afar, Dongpa gave a sneer.
In his eyes, what Kanghyeok was doing now was no different from madness.
"Ah..."
"Drink it. Otherwise you'll die."
Kanghyeok thrust the water at him in a somewhat forceful manner.
The patient looked deeply flustered, then soon began gulping it down.
Because Kanghyeok in front of him was frightening enough, and because he remembered how accurately he had guessed the symptoms earlier.
—Gulp, gulp.
With a satisfied expression, Kanghyeok watched the patient drink the liquid with terror-filled eyes.
He did not forget to add one last line at the end.
"You saw that, right? This is how you make it."
"Oh... can someone with watery diarrhea really drink water?"
"Yes. You have to replace what they're losing. Otherwise they die."
"Heo..."
While Kanghyeok continued his brief lecture, a commotion suddenly broke out among the patients assigned to Kanghyeok's side.
"Hey, hey, this one's convulsing! He's foaming at the mouth all of a sudden...!"
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