Chapter 143

This was not a symptom he had anticipated before coming.

Tuberculosis patients typically present with low-grade fever, and some show no fever at all or only negligible symptoms. But this fever—the one that left Professor Bramer struggling to speak during the discussion—arose spontaneously within the body, unnoticed until Krafft was focused on the physical exam.

"Your Grace, can you hear me?" Krafft moved two fingers left and right before the duke's eyes, noticing his gaze tracked them with a narrow range, accompanied by uncontrolled tremors and drifting—as if variable sensory stimuli were acting on the vestibular receptors, flooding the brain with information that rendered eye alignment impossible.

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

Without a thermometer, Krafft pressed his hand to the patient's forehead to estimate temperature. Though the fever came fiercely, the sensation remained within the moderate range—not high enough to cause such acute impairment of consciousness and function, nor should such synchronicity occur.

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

Wilbert and Feinann showed no sign of panic or surprise at the change—clearly, this episode was not the first, and it was self-limiting. Krafft 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, compensation would collapse into decompensation, and organs would self-destruct without intervention.

The fever was worsening. Twitches in the trunk and limbs had acquired independent wills, performing high-frequency contractions that produced no effective movement—similar to shivering violently in a frozen winter landscape. Indeed, that was precisely what it was: the body's temperature set point had risen, treating current body temperature as too low, triggering skeletal muscle shivering to generate heat. The manifestations were identical.

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

Krafft agreed with this view, though it felt strained, lacking rigorous evidence and the laboratory tests he relied on, yet oddly aligned with the lesion theory he had just dismissed in Professor Lindeng.

But it gave him a sense of déjà vu: one or more infectious foci were repeatedly releasing endotoxins or pathogens themselves—exogenous pyrogens—that triggered fever through a convoluted mechanism: "boring to explain, but basically white cells release endogenous pyrogens, cross the blood-brain barrier, and act on some region of the hypothalamus."

It made sense. Not just tuberculosis—prolonged consumption had lowered immunity, and a secondary infection had taken hold within this body.

What was it?

Without microbiological evidence, no one could answer him. And immediately followed another question: what caused the consciousness disorder? It didn't seem to result from fever, but rather another manifestation of the underlying pathology.

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

A response came: the Duke of Westmin's eyelids lifted slightly, signaling he still responded to external stimuli, not fully lost consciousness. He even struggled to control his disordered body, attempting speech to prove his sanity—but what emerged remained incomprehensible, disjointed nonsense.

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," Feinann couldn't help reminding. Seeing the chamberlain's displeasure, he halted further prompting of the duke: "But Professor Bramer's research made no progress. It's likely just the disease clouding the mind—meaningless."

"No," Krafft said, ending his examination, rebuttoning the patient's shirt and repositioning him, then casually completing the servant's task of approaching.

"What matters isn't the content of the words, but that the patient can still speak—only fails 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. In language alone, he retained partial function: he could hear, but not understand, and his expression was chaotic.

"We've seen this before," Krafft explained, pointing to the posterior superior margin of the temporal bone. "Patients with damage to this area don't lose speech ability like others with head trauma. They can still produce sounds—but never utter a correct sentence."

Wilbert's face had shifted from restrained displeasure to something worse. As castle chamberlain, he wasn't lacking in intellect—he immediately connected the knowledge. Now his mind found staying near Krafft uncomfortable, and his expression betrayed faint revulsion and alarm.

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

"This indicates temporary, reversible damage to this region of the skull during episodes." But this left him stuck: how could a periodic, localized functional impairment coexist with fever? And it appeared limb motor areas were affected too.

"What should we do?" Chamberlain Wilbert hadn't understood much, but he watched his master anxiously. The duke's symptoms had surged violently, yet the neurological deficits 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.

"It's complicated. This isn't merely a consumptive disease." Krafft's words froze the room. But he didn't want them to think he had a solution: "I believe, on top of the existing pulmonary consumption, a secondary infection has developed, with multiple intracranial foci."

"I need to know how often these episodes occur and how long they last."

"Hmm, roughly once a week. Duration and intensity are similar to this one." Feinann answered without hesitation—his observational discipline surpassed his peers: "I anticipated this episode, which is why I brought you here just in time."

"How about severity? Has it changed?" Krafft 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 consumption's inherent heat. Lasts at least half a day, onset and end unclear."

True. Pyrogens released into the bloodstream wouldn't vanish quickly. Krafft fell into thought—he had ideas, 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, the patient struggled awake, gulping honeyed chamomile-licorice tea to soothe his dry throat.

"Sir Krafft, 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 absorbed professors immediately apologized.

"I understood. You say I have two illnesses: one is the pulmonary consumption that will kill me, and the other—so far—won't."

"Yes. But the other may be more lethal. I'm unsure if it's related to the consumption or an independent disease. It may have formed foci in your body that periodically release toxins..." Though he didn't fully grasp the duke's intent, Krafft repeated his findings politely.

But the patient cut him off dismissively: "I'll treat the consumption first."

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

"Treat the consumption first."

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

"I decide for my own body."

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

"Young knight, I thought you were older than Feinann." The duke rose, gripping the chamberlain's shoulder. Krafft now noticed he was far taller than expected: "Keep it simple. I need one treatment. One chance to bet on living until next winter."

"Your Grace, I must point out: under these complications, your odds are slim." Krafft now understood the logic—he'd seen it before in Old Wood: viewing bodily impairment as a duel, victory defined by overcoming obstacles, whether limping to hunt bears or otherwise.

No matter the risk-to-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 bet 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 recommend them, Sir Krafft. I will bear the consequences of my own decisions."

A statement harder than armor. He knew now: no escape without delivering a treatment plan.

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

【Artificial pneumothorax】

This was an antique even among antiques.

"This treatment 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, Krafft's hands moved inward from both sides: "Until the lung collapses, its movement is restricted, allowing rest. Fluid circulation slows, limiting disease spread. 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.

Under the duke's insistence, the examination continued.

With the mindset of "it's already this bad" and "I can't change it," Krafft began the remaining physical exam. He needed to thoroughly assess the duke's ravaged lungs and indirectly evaluate cardiopulmonary function. If results were poor, he'd inevitably have to activate his spiritual senses.

Due to lack of tools, he had to press his ear against the patient's chest to listen. This inconvenience, within three intercostal spaces, ignited his desire to build a primitive stethoscope on the spot.

【Later, charge this to their tuberculosis project budget】

To avoid using spiritual senses, Krafft meticulously compared auscultation and percussion findings, striving for maximum accuracy. But objectively, the results confirmed what radiology pioneers had long known: machines and humans were separated by an unbridgeable gap.

Krafft still wanted to persist. He recorded another auscultation finding, moved to the other side, pressed against the lower right scapula, around the seventh or eighth intercostal space. Percussion here had produced a sound between tympanic and hollow—suggesting a possible cavity near the chest wall, its size alarming.

Pressing his ear close, a musical rattle entered his ear. He didn't recognize this sound.

Honestly, for someone rarely encountering such advanced tuberculosis, accurate diagnosis was too difficult. Krafft hesitated through two breath cycles—and still couldn't identify it.

For safety, he decided to percuss again. As usual, he placed the second phalanx of his left middle finger on the chest, struck with his right middle finger, waiting for the resonant echo.

A low, dull thud—dense, heavy—but unmistakably not the hollow, drum-like resonance he remembered.

"What's this?" Krafft struck again, still a solid sound. "How could it be solid?"