Shadow of great britain

Chapter 332 Medical Ethical Issues in the 19th Century

"Here's some watered down gin. The cold wind at night in winter is quite cold. I see your faces are all red from the cold."

In the private parlor on the second floor, Arthur pushed two glasses of amber gin in front of the two uninvited strangers, then lit his pipe and leaned on the sofa.

"Thanks."

After the guest thanked him, he picked up the wine glass with trembling fingers that were frozen, and motioned to the young man who came with him to have a drink too.

"John, please do some too."

After getting the master's approval, the young man picked up the wine and drank it in small sips.

When Arthur saw this, he just smiled and asked: "Your name is John?"

"Yes." The young man nodded and said, "John Snow, this is my name."

"Snow, Snow?" Arthur said with a smile: "Your last name goes well with winter. Let me guess, you are not from Scotland, are you? Most of the snowflakes in Britain are concentrated there. Woolen cloth."

Seeing how easy-going the big man was, the young man became bold. He replied: "Sir, I am from York. Do you know York? It also snows in the winter where we live."

"Oh, another Yorkie."

Arthur smiled and said: "There are quite a lot of Yorkists in Liverpool, maybe because it is so close to Liverpool. To be honest, you are already the second fellow countryman I have met here."

Snow was a little surprised when he heard this. He said, "Are you from York too?"

"That's right." Arthur smiled and nodded: "Not only that, I used to be a good expert at raising Yorkshire pigs. If I hadn't gone to London to go to school, I would have become the best pig raiser in the area by now. , although the ones I raise are not bad now. Speaking of which, have you ever raised Yorkshire pigs?"

Snow shook his head and said: "I have never raised one, but I have seen a lot. I used to want to be a pigherder, but my father felt that being a pigherder was as hopeless as being a miner. So I asked my uncle to help me. Introduced me to Mr. Hardcastle as an apprentice apothecary."

"Apprentice apothecary?" Arthur heard this and turned to the middle-aged gentleman aside: "So you are Mr. Hardcastle?"

The middle-aged man stretched out his hand and said: "Nice to meet you, Mr. Hastings. William Hardcastle, a surgeon and pharmacist certified by the Royal College of Surgeons."

Although Arthur knew that apprenticeships were still the mainstay of many professions in Britain, he was still surprised that doctors also did this.

Although he doesn't know many doctors, most of them have received serious university education.

Even if these doctors do not graduate from prestigious schools such as the University of Edinburgh or the University of Glasgow, they must at least receive two to three years of training at a medical college.

However, the doctor first appeared with an apprentice who was seventeen or eighteen years old, which inevitably made Arthur begin to doubt his professionalism.

Arthur openly confided his doubts, but Hardcastle didn't hide them.

He said: "Mr. Hastings, it seems that you don't know much about the doctor's profession. In fact, most doctors have to go through an eight-year apprenticeship in their teenage years. During these eight years, They will learn various pharmaceutical knowledge from veteran doctors and master basic pharmacological knowledge in the process of assisting doctors.

After the eight-year apprenticeship period is over, they will enter a medical college for higher-level training, and then choose one of the Royal College of Physicians or the Royal College of Surgeons to receive assessment according to their study direction. Only if they pass this assessment can they truly be qualified to practice medicine alone.

The kind of doctors you have met before who entered university for further studies at the beginning are basically from wealthy families. Their development paths are completely different from those of us doctors at the bottom who are really fighting on the front line. They control the academic circle, and we are at the forefront of clinics and hospitals.

Of course, I don't mean to accuse them of doing anything wrong. But as far as the experience of treating diseases and saving lives is concerned, the two are not on the same level at all. "

Although Hardcastle spoke unintentionally, even a deaf person could tell from his angry expression how disgusted this gentleman was with some of his colleagues.

But it wasn't that Arthur couldn't understand his mood.

According to Hardcastle, a low-level doctor needs at least 8 years of apprenticeship plus 2 to 3 years of junior college training from entering the profession to being able to practice medicine on his own, while those doctors from well-off families only need to go through 3 to 3 years of junior college training. 4 years of university study.

However, although the training period for lower-level doctors is longer, they will suffer discrimination because of their educational background in junior colleges. Medical students who graduated from prestigious universities such as Edinburgh and Glasgow are valued more than these low-level doctors.

Whether they publish papers in medical journals or work in various well-known hospitals, they always have to be ranked behind others.

Whoever it is, everyone will be angry.

As one of the victims of academic discrimination, the reason why Mr. Hastings, an outstanding graduate of the University of London, was intermittently working on the front lines of Scotland Yard was usually caused by this reason.

Why can anyone with a second-class degree from Cambridge and Oxford work for large companies such as the East India Company and the West India Company, and devote themselves to high-end departments such as the Customs Service and the General Post Office, while academic gold medals from the University of London can only be obtained on the streets of the East End? How about playing stick with an Irish gangster?

Similarly, it is self-evident why Mr. Elder Carter, the treasure of the Department of Classical Literature at the University of London, 'sings' the praises of Cambridge and Oxford every day.

As soon as Arthur saw Hardcastle, he seemed to see himself two years ago. He nodded with deep sympathy and said: "Sir, you don't have to be angry. Good times will come, good times will come, and people can't always be unlucky. Although the British tradition This country always likes to be old-fashioned and stubborn, but not everyone standing at the bottom of the river will be drowned in this cesspool. As long as you can make sense, show your value and correctness, and find another Investors who are willing to take a gamble, things will get better.”

Hardcastle's eyes brightened a little when he heard this.

He had been waiting for so many years for a chance to make a comeback. However, when he presented his proud discovery to everyone, what he received was not flowers and applause, but cold looks and a closed door.

Just like Arthur said, he is in urgent need of a courageous investor.

Mr. Hastings, the special anti-smuggling commissioner of Liverpool appointed by the four departments, is a very suitable candidate.

As if grasping at a life-saving straw, he confided everything that had happened to him.

"Mr. Hastings, I know what your mission is in coming to Liverpool, and you also know what your own mission is? We are all trying to quell the cholera epidemic in Liverpool. I don't know whether your work is in line with public perception. What is more important is achieving results, but I think in the field of doctors, as long as the patient can recover, that is better than anything else.”

When Arthur heard this, the red light of his pipe flashed and stopped: "Sir, if I understand correctly, you are saying that you have a cure for cholera?"

Hardcastle waved his hands hurriedly after hearing this: "No, no, no, Mr. Hastings, although I would like to tell you that I can cure cholera, my professional ethics do not allow me to do so. But... although I cannot guarantee it. All patients have recovered, but as long as you follow my method, I guarantee that the mortality rate from cholera will be significantly reduced."

When Arthur heard this, he couldn't help but straightened up a little: "What's the method you mentioned?"

Hardcastle saw Arthur's interest and hurriedly waved to the students beside him: "Snow, take out the report."

Snow took out a document from the small cloth bag he carried with him and put it on the table.

Hardcastle opened the document and introduced: "Actually, I have been investigating this disease since before the cholera outbreak. My teacher is Mr. Corbin, who served as a military doctor for the Indian Army in Bombay in his early years. , participated in many treatment of cholera patients.

He had long warned British doctors: 'Never give in to a patient's persistent and tragic request for water, for I have seen many patients die from drinking water. ’ This is basically the consensus of doctors who have medical experience in India.

I have always followed his teachings during the treatment of patients. But on this basis, I also discovered a lot of noteworthy things, which also made me start to have some doubts about the teacher's theory. "

Arthur asked, "What did you find?"

Hardcastle said: "I had a cholera patient. Before he was sent to the hospital, he fainted because he was too weak, and his arm was cut open by a stone on the roadside. However, when he was sent to me While here, I discovered that the blood flowing out of his wound was different from that of ordinary people. His blood was black and thick, which was caused by the body's extreme lack of water.

Due to his critical condition, it was no longer possible for me to continue to follow the teacher's drinking water regimen, because an article published by Professor Herman last year speculated that the direct cause of the patient's death was the thickening of the blood and the inability to circulate.

But feeding him pure water will definitely aggravate his diarrhea. In order to solve this problem, I re-read the recent research articles on cholera treatment. Among them, Mr. O'Shaughnessy's research on Newcastle patients caught my attention.

Through laboratory analysis, he found that the patient's blood had lost a large amount of water and neutral salts, but the missing elements in the blood were found to be excessive in the feces. Obviously, this result also verified Professor Herman's point of view: the crux of the patient's collapse and death lies in the obstruction of blood circulation caused by the loss of body fluids.

I wondered at that time if we could bring a certain high-oxygen salt into complete contact with the black blood of cholera patients, whether we could restore the patient's arterial properties and ultimately end the patient's severe symptoms. In order to complete this idea, the first thing I thought of was enema and intravenous injection. "

"A genius idea!"

When Arthur heard this, his eyes lit up. Hearing Hardcastle's detailed and professional explanation, he seemed to have slowly figured out the diagnosis and treatment methods of cholera with his modern thinking.

He grabbed Hardcastle's hand and asked, "Go on."

Seeing that Arthur's reaction was so strong, Hardcastle was a little excited for a moment.

He said: "I first prepared a solution containing potassium chloride, carbonate and soda to give the patient an enema treatment. However, because the patient's intestinal absorption function was already disordered, he could not absorb the salt solution normally, which aggravated his condition. Diarrhea symptoms. So, I started trying intravenous salt supplementation again.”

Arthur asked: "What's the result?"

Hardcastle laughed: "The patient was extremely ill, physically exhausted, with a weak pulse and extreme thirst, but when I gave him four consecutive infusions and injected 200 ounces of saline solution, he gradually came out of his coma. I woke up, my symptoms improved significantly, and I was finally on the road to recovery!”

Arthur couldn't help but stood up happily after hearing this, and put his hands on each other's shoulders: "Mr. Hardcastle, you really did not disappoint me! I assure you that your therapy will soon..."

Before Arthur could finish speaking, he only heard a snap, and the door of the reception room was suddenly pushed open.

"Hardcastle! I knew it was you! Have you, the executioner who conducts medical experiments on patients, had enough trouble? I warn you, if you don't reflect on your behavior, when the cholera is over, I will definitely go The Royal College of Surgeons at Westminster is applying to disqualify you from practicing medicine!”

Arthur turned around and saw an angry old gentleman standing outside the door. He walked up to Hardcastle in a few steps, raised his cane and wanted to hit him.

Not to be outdone, Hardcastle grabbed the opponent's cane and glared at each other: "Mr. Rosenberg! It's you who should reflect! I have demonstrated the feasibility of intravenous injection to you before, but you Not only did you verbally abuse me, but you also kicked me out, and even withheld the paper I was about to submit to The Lancet. What are your intentions in doing this!"

Rosenberg?

As soon as Arthur heard this surname, he immediately understood the identity of the old man. This was the chairman of the Liverpool Health Committee and the most famous doctor in the local area.

Arthur said: "Mr. Rosenberg, are what Mr. Hardcastle said just now true?"

Rosenberg glared at Hardcastle and said, "Mr. Hastings, don't listen to this guy's nonsense. I withheld his paper and scolded him for being a quack who doesn't care about the life and death of his patients, but This is all for public safety. I guess he must have just shown you how advanced his treatment is, but I can prove to you that this is just a scam set up by a small doctor in a street clinic! "

After saying this, Rosenberg snorted suddenly, took out a document from his arms and threw it on the table.

"Take a good look at this document! This is the conclusion report of the Statistical Department of the Liverpool Health Board on cholera patients at Hardcastle Clinic. According to the investigation report, only 9 of the 56 patients who received saline injections recover completely.

In other words, the pathological conclusions Hardcastle claimed and the treatments derived from them did not actually succeed in curing many patients. His diagnosis and treatment survival rate is not even in the upper reaches among the doctors in Liverpool, and it can hardly even be said to be at the middle level. "

Arthur picked up the document and rolled his eyes twice, his brows frowning more and more: "This..."

The report shows that Rosenberg did not lie, and what he said was true.

But Arthur couldn't figure out why Hardcastle, who sounded the most like the correct answer, would deliver such ugly results.

Is it data falsification?

Doubting the statistics, Arthur decided to give Hardcastle another chance and asked, "Is this all true?"

Hardcastle's face turned red and his fists clenched. He held it in for a long time and finally chose the one he valued more between honor and conscience.

He nodded and said: "Yes, Mr. Hastings. The recovery rate of my patients is indeed not high, but are you willing to listen to my explanation?"

If Hardcastle told Arthur that the data was false, Arthur would definitely not give him a chance to defend himself after verifying it.

But Hardcastle directly admitted that his cure rate was not high, which made Arthur dispel his doubts about him.

Perhaps Hardcastle's method is not 100% correct, but this doctor should not harm people subjectively.

Arthur nodded: "Of course. And I believe Mr. Rosenberg will also be very willing to hear your reasons."

When Rosenberg heard Hardcastle admitting the problem, he was about to throw him out angrily, but when Arthur spoke, he could only hold back his nausea and speak.

"Okay! Then you can say it. But even if you say something fancy today, it won't change the fact that you are an empiricist quack who tests new methods on patients. I have to say, Hardcastle, I am very disappointed in you. ! If it weren’t for the sake of your teacher Mr. Corbin, after you came to me that day, I would have written to the Medical Association to request that your medical qualifications be revoked!”

When Hardcastle decided to force his way into the ball, he had already made plans to cut off his retreat. He knew that after today, he would either become famous or completely lose his qualifications to practice medicine. Before he and the authorities at Liverpool Health Board, a decision had to be made as to who was the quack.

Hardcastle took a deep breath and spoke.

"Mr. Hastings, as I said before. I am just an ordinary street doctor, and many of my patients come from working-class families. And workers, as you know, if they are not already terminally ill, they I don't want to see a doctor anyway.

Moreover, among the workers, many people have many basic diseases besides cholera, and their bodies are already very weak. I swear on my honor to Hippocrates, most, if not all, of my patients have gotten much better after receiving intravenous fluids. However, they died of other diseases during the recovery phase.

If complete recovery is used as a standard, then what I did was indeed not good enough. But if we are talking about curing cholera and getting them out of critical condition, then my success rate can reach 55%. "

When Rosenberg heard this, he angrily said: "Hardcastle, even if you don't take into account the sequelae, the figure of 55% is slightly higher than the average cure rate of 45% for cholera. Besides, how did you do it? I know that the deceased patient died of other diseases! Do you still want me to make it clearer about this matter? You, a guy who has lost honor and morality, how dare you do such a thing! Do you know that standing on the side of Who is the gentleman in front of you? I have been speaking for you, trying to save some dignity and honor for you, but I never expected that you would be so shameless!"

Arthur originally didn't know why Rosenberg was so angry, but now he seems to have figured out the reason.

As a police officer, he knew exactly how to figure out the cause of a patient's death.

Arthur stared at Hardcastle and asked, "You dissected the patient's body?"

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