Chapter 143

This was not a symptom anticipated before arrival.

Tuberculosis patients' fever patterns typically manifest as low-grade fever, and some patients show no fever or only negligible symptoms. Yet this fever—the one that left Professor Bulimo speechless in discussion—arose spontaneously within the body, emerging unnoticed as Kraft focused on the physical exam.

"Your Grace, can you hear me?" Kraft extended two fingers before the duke's eyes, moving them left and right; he observed the eyes' narrow tracking range, accompanied by uncontrolled tremors and drifting, as if some variable sensory stimulus was acting upon the vestibular receptors, flooding the system with information that rendered eye alignment impossible.

"......" Unformed words behind the lips shattered into meaningless syllables before they could exit, forming an irrecoverable, chaotic jumble of sounds—like a cursed incantation.

Without a thermometer, Kraft pressed his hand against the patient's forehead to estimate temperature. Though the fever came fiercely, the tactile sensation remained within the moderate range, insufficient to cause such acute impairment of consciousness and function, nor should such synchronicity occur.

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This overturned the initial reaction: the consciousness disorder was not a result of fever, but a concurrent symptom.

Wilbert and Fernand showed no signs of panic or surprise at the change—clearly, this episode was not the first, and it was self-limiting. Kraft pressed the radial artery; the pulse was rapid but weak, like a failing respiratory system attempting compensation through increased contraction frequency.

It was a foolish strategy: once all reserves were exhausted, the body would swiftly enter decompensation, and organs would self-destruct without intervention.

The fever was intensifying; convulsions in the trunk and limbs resembled independent wills, performing high-frequency contractions that produced no effective motion—similar to shivering uncontrollably in a frozen winter landscape. Indeed, that was precisely what it was: the thermoregulatory set point had risen, and the body now perceived its current temperature as too low, triggering skeletal muscle shivering to generate heat. The manifestations were nearly identical.

If so, something must be affecting the thermoregulatory center. Many possibilities exist—infectious and non-infectious causes—but acute fever is usually infectious in origin.

Kraft agreed, though the reasoning felt strained, lacking rigorous evidence and the laboratory tests he relied upon, yet it oddly aligned with the lesion theory he had just dismissed in Professor Lin Deng.

But this triggered a sense of déjà vu: one or more infectious foci were repeatedly releasing endotoxins or pathogens themselves—exogenous pyrogens—which, through a convoluted mechanism ("too tedious to explain, but basically: white cells release endogenous pyrogens, cross the blood-brain barrier, trigger a cascade, and act on some region of the hypothalamus") induced fever.

It made sense: not only tuberculosis, but prolonged consumption had lowered immunity, allowing a concurrent infection to take hold within this body.

What was it?

Without microbiological evidence, no one could answer him. And immediately followed another question: what of the consciousness disorder? It did not appear caused by fever, but rather another manifestation of the underlying pathology.

Kraft tried a different address: "Your Grace, can you hear me?"

The call elicited a response: the Duke of Westminster's eyelids lifted slightly, signaling he still responded to external stimuli, not fully lost to consciousness. He even struggled to control his disordered body, attempting to speak and prove his sanity—but what emerged remained incomprehensible, disjointed gibberish.

This stirred the old duke's frustration. He raised his trembling hands, trying to write something, his movements misaligned as if battling an invisible enemy—but these efforts ultimately failed, as if the words had been cursed, erased before they could be conveyed.

"We've tried recording these utterances," Fernand interjected. "Professor Bulimo believed we might extract disease-related information." Seeing the chamberlain's displeasure, he halted further prompting: "But his research yielded no progress. Perhaps the disease merely clouded the mind—meaningless."

"No, I happen to disagree." Kraft ended the exam, rebuttoned the patient's shirt, repositioned him correctly, and casually completed the servant's task of adjusting the pillow.

"What matters is not the content of speech, but that the patient can still speak—merely unable to convey meaning."

【Wernicke's aphasia】

Again, the dreaded task: deducing damaged brain regions from functional deficits. Evidence showed the duke's cerebral dysfunction was not diffuse or indiscriminate. Rather, in the language area alone, partial function remained: he could hear, but not comprehend, and his expression was chaotic.

"We've encountered this before," Kraft explained, pointing to the posterior superior margin of the temporal bone. "Patients with damage to this region retain speech production ability, unlike others with head trauma who become mute—they can still articulate, but never utter a correct sentence."

Now Wilbert's face was no longer merely restrained displeasure. As castle chamberlain, he was no fool—he immediately connected this knowledge to its source. His mind now found lingering near Kraft uncomfortable, and his expression involuntarily betrayed faint revulsion and alarm.

Fernand merely nodded noncommittally. He was past the age of disciplinary dogmatism, understood anatomy, and accepted the notion that a lesion in one area could produce a specific symptom.

"This indicates temporary, reversible damage to this region during episodes." But this left him stuck: how could a transient, focal neurological deficit coexist with fever? And apparently, motor areas were affected too.

"What should we do?" Chamberlain Wilbert understood little, but watched his master anxiously. The duke's symptoms had struck violently, yet the neurological impairment lasted less than a simple febrile seizure—already, fine motor control was improving; he reached for the steaming chamomile-licorice tea. Wilbert hurried forward to steady the cup.

"The situation is complex. This is not merely a wasting disease." Kraft's words froze the room. Yet he did not wish them to believe he had a solution: "I believe, atop the existing pulmonary wasting disease, a secondary infection has merged, with multiple foci in the cranium."

"I need to know how often these episodes occur, and how long each lasts."

"Ah, roughly once a week," Fernand replied without hesitation. His observational discipline far surpassed his contemporaries. "I suspected this episode was imminent—your arrival was timely."

"How about severity? Has it changed?" Kraft touched the duke's forehead again—the heat remained, asynchronous with neurological symptoms. "Also, have you monitored the duration of this fever?"

"Difficult. It often blends with the wasting disease's inherent heat. Lasts at least half a day, onset and end unclear."

Indeed, pyrogens released into the bloodstream wouldn't vanish quickly. Kraft fell into thought—he had theories, but all were guesses. And he knew, if he kept thinking, no answer would come.

The scene grew tense: consulting experts debated endlessly, family members wore worried faces, and the patient struggled to awaken from confusion, gulping down chamomile-licorice tea sweetened with honey.

"Sir Kraft, it seems you learned little from your ancestors." The dry voice belonged to the duke, having reclaimed control of his vocal cords and mouth. The two professors immersed in thought immediately apologized.

"I understand. You say I have two illnesses: one is the pulmonary wasting disease that will kill me, and the other, for now, will not."

"Yes. But the other may be even more lethal. I'm uncertain whether it's related to the pulmonary wasting disease or an independent condition. It may have formed foci in your body that periodically release toxins..." Though he didn't fully grasp the duke's intent, Kraft politely reiterated his findings.

But the patient interrupted dismissively: "I will treat the wasting disease first."

"But we don't yet know if the other affects treatment..." Kraft felt further deliberation was necessary—rushing into therapy carried too great a risk.

"Treat the wasting disease first."

"It could lead to even worse consequences..." This had to be stated.

"I decide for my own body."

Fine. The duke understood his meaning—and still insisted.

"Young knight, I thought you were older than Fernand." The duke rose, gripping the chamberlain's shoulder. Kraft now noticed he was far taller than imagined. "Simplify it: I need one treatment, one chance to bet on surviving until next winter."

"Your Grace, I must point out: under these complications, your odds are slim." Kraft now understood the logic—he'd seen this behavior in Old Wood: viewing his body's disability as a duel, measuring victory by overcoming obstacles, whether limping to hunt bears or otherwise.

No matter the risk-reward ratio, if even a sliver of possibility existed, they would act.

Call it courage, or recklessness—it was easy to understand why they chose this. Those who reached such positions were all veteran members of the Survivorship Bias Club: they'd gambled and won their entire lives; their bodies had never betrayed them.

"And you may lose your current palliative life expectancy."

"Your duty is to propose viable options—not to recommend them, Sir Kraft. I will bear the consequences of my own decisions."

A statement harder than armor. He knew now: he wouldn't leave without delivering a treatment plan.

"Very well." Kraft took a deep breath, like exhaling before opening a dusty attic chest to retrieve an ancient relic. "Allow me to introduce artificial pneumothorax."

【Artificial pneumothorax】

This was an antique even among antiques.

"This therapy is based on current surgical knowledge of the human body. Our lungs are encased in two membranes; normally, the space between them is sealed—like a tightly corked, deflated water bladder."

"The risk lies in injecting air into that space, causing it to expand and compress the lung." As he spoke, Kraft's hands moved from both sides toward the center, illustrating the process: "Until the lung collapses, its range of motion is restricted, granting it rest. Circulation slows, limiting disease spread, and the eroded pulmonary cavities are compressed, promoting healing."

"Undoubtedly, this is a risky, invasive, non-curative therapy. If you insist, I will complete the examination and plan your treatment." For the first time, he hoped the risk disclosure would deter the patient.

"Why not?"

It seemed the first step was always the hardest.

At the duke's insistence, the examination continued.

With the mindset of "it's already this way" and "I can't do anything about it," Kraft began the remaining physical exam, carefully assessing the extensively damaged condition of the lungs and indirectly evaluating cardiopulmonary function; if the results were poor, he would inevitably have to resort to using his spiritual senses once.

Due to the lack of tools, he had to press his ear against the patient's chest to listen, and this inconvenience during auscultation across three intercostal spaces fueled his desire to hastily fabricate a primitive stethoscope.

【Later, charge this to their tuberculosis project budget】

To avoid using his spiritual senses, Kraft carefully compared the findings from auscultation and percussion, striving for maximum accuracy and reliability. Yet the objective results still proved that the decades-long pursuit of new instruments by the radiology pioneers had indeed been justified—there was an insurmountable gap between machines and human perception.

Kraft still wanted to persist a little longer. He recorded another auscultation finding, moved to the other side, and pressed against the area just below the right scapula, roughly at the seventh or eighth intercostal space; this region had produced a sound during percussion intermediate between a drum and a hollow jar, indicating a possible cavity near the chest wall, its size requiring caution.

Pressing his ear close, a musical rattle entered his ear canal. He did not recognize this sound.

To be honest, for someone who rarely encountered tuberculosis at this severity, accurately diagnosing it all at once was too difficult. Kraft hesitated through two respiratory cycles and still could not decipher it.

For safety's sake, he decided to perform percussion again. As usual, he placed the second phalanx of his left middle finger against the chest and struck it with the middle finger of his right hand, waiting for the resonant feedback from the hollow area.

A low, muffled sound emerged—dull, thick—but unmistakably not the hollow, drum-like resonance he remembered.

"What's going on?" Kraft, refusing to believe it, struck again—still a dull sound. "How could it possibly be solid?"