Chapter 335: Medical Ethics in the th Century
Chapter 332 – Medical Ethical Issues in the 19th Century
“Let’s have a little watered down gin, the cold winds of winter nights are still quite chilly, and I can see that your faces are freezing red.”
In the private parlor on the second floor, Arthur pushed two glasses of amber-colored gin in front of the two uninvited strangers, and promptly lit his pipe and leaned back into the sofa.
“Thanks.”
The guest thanked him before lifting the glass with trembling frozen fingers, and gestured for the youth who had followed him to follow suit.
“John, you have some too.”
After receiving his master’s approval, the youth then picked up the wine and drank it in small sips.
Seeing this, Arthur just smiled and asked, “Your name is John?”
“Uh-huh.” The youth nodded, “John Snow, that’s my name.”
“Snow, Snow?” smiled Arthur and spoke, “Your last name and winter kinda go together. Let me guess, you’re not Scottish by any chance, are you? That’s where most of the snowflakes in all of Britain can be concentrated.”
The young man saw that this big shot was so easygoing, and for a moment, he also got bold, and he returned, “Sir, I am a Yorker. Do you know York? We get snow in the winter there, too.”
“Wow, another Yorker.”
Arthur laughed, “There are quite a few Yorkers in Liverpool, perhaps because it’s so close. To tell you the truth, you’re the second fellow Yorker I’ve met here.”
Snow was also a bit surprised when he heard this, and he spoke, “Were you originally a Yorker as well?”
“That’s right.” Arthur smiled and nodded, “More than that, I used to be a good Yorkshire pig breeder. If I hadn’t gone to school in London later in life, I would have been the best pig breeder in the area by now, although I’m not too bad at it now is all. By the way, have you ever raised Yorkshire pigs?”
Snow shook his head, “Never had one, but I’ve seen quite a few. I wanted to be a pig farmer once upon a time, but my father thought it was just as bad as being a miner. So he put in my uncle’s connections and introduced me to Mr. Hardcastle as an apothecary’s apprentice.”
“Apothecary apprentice?” Hearing this, Arthur turned his gaze to the middle-aged gentleman on the side, “So you are Mr. Hardcastle?”
The middle-aged man extended his hand, “Nice to meet you, Mr. Hastings. William Hardcastle, surgeon and apothecary who passed the Royal College of Surgeons.”
Although Arthur knew that apprenticeship was still the mainstay in many professions in Britannia at the moment, it still surprised him quite a bit that the doctor’s profession was doing the same.
He didn’t know many doctors, but they basically all had a proper university education.
These doctors, if not graduated from prestigious schools like the University of Edinburgh or the University of Glasgow, at the very least received two to three years of training at a specialized medical school.
However this doctor came out with a seventeen or eighteen year old apprentice right from the start, which inevitably made Arthur begin to doubt his professionalism.
Arthur spilled out the doubts in his heart, and Hardcastle didn’t hide his words.
He opened his mouth and said, ”Mr. Hastings, it seems that you don’t know much about the profession of doctors. In fact, for most doctors, they have to go through an 8-year apprenticeship during their teenage years. During these 8 years, they will learn various pharmacy knowledge under an older doctor and acquire basic pharmacology knowledge while assisting the doctor.
At the end of the eight-year apprenticeship, they enter a medical college for higher training, and then choose one of the Royal College of Physicians or the Royal College of Surgeons, depending on the direction of their studies, to undergo an examination. Only after passing this test, they are truly qualified to practice medicine on their own.
The kind of doctors you have encountered before who started out in university are basically rich young men from wealthy families, and their development paths are completely different from those of us who are really fighting on the front line. They control the academic circles, we are at the forefront of the clinics and hospitals.
Of course, I’m not saying this to accuse them of anything wrong. But just in terms of the experience of treating patients and saving lives, the two are not on the same level at all.”
Though Hardcastle balked at the idea of unintentional accusations, even a deaf person could tell by his indignant expression just how much the gentleman resented some of his peers.
It wasn’t as if Arthur couldn’t understand his feelings, though.
According to Hardcastle’s statement, from the time of entry into the profession to be able to practise medicine on their own, an underclass doctor would have to go through at least eight years of apprenticeship plus two to three years of training in a specialized school, whereas those from well-off families would only need to go through three to four years of university studies.
However, although the training cycle for doctors at the bottom of the ladder is longer, they are discriminated against because of their educational background in specialized schools. Medical students graduating from prestigious universities such as Edinburgh and Glasgow are just more highly regarded than these lower-class doctors.
Whether it is publishing papers in medical journals or joining various famous hospitals, their sequence is always going to be at the back of others.
Anyone else would have to be angry about this.
As one of the victims of academic discrimination, the reason why Mr. Hastings, a brilliant graduate of the University of London, was intermittently swinging for the fences in the first line at Scotland Yard back then was usually caused by this reason.
Why is it that even a second-class degree from Cambridge Oxford can take up a job in a big corporation like the East India Company or the West India Company, and dedicate himself to such high-end departments as the Customs and Excise Department and the Post Office, while an academic gold medal from the University of London can only accompany Irish hooligans to play with sticks on the streets of the East End?
By the same token, the reason why Mr. Elder Carter, the jewel of the Classics Department of the University of London, ‘sings the praises’ of Cambridge and Oxford every day is self-evident.
As soon as Arthur saw Hardcastle it was as if he saw himself two years ago, and he nodded his head with deep sympathy: “Sir, you need not be angry. If you don’t have the best of luck, the time will come and go, one can’t always have bad luck. Although the tradition of Britain dictates that this country always prefers the old-fashioned stubbornness, not all those who stand at the bottom of the river will be drowned in this cesspool. As long as you can reason, show your worth and rightness, and find an investor willing to take a gamble, things will turn out all right.”
Hardcastle’s eyes brightened a bit when he heard that.
He had waited so many years for a chance to turn his life around, yet when he took his proud discovery and presented it in front of a large group of people, instead of flowers and applause, he was greeted with cold stares and closed doors.
Like Arthur said, he is in desperate need of a bold investor.
Mr. Hastings, Liverpool’s special inspector of smuggling, appointed by the four departments, is a very suitable candidate.
It was as if he had grabbed a lifeline and spilled all about what had happened to him.
“Mr. Hastings, I know what your mission is in coming to Liverpool, and you know what your own mission is? We are both trying to quell the cholera epidemic in Liverpool. I don’t know whether it is more important in your work to conform to public perception or to achieve results, but I think in the doctor’s profession, as long as the patient recovers, that is better than anything else.”
The red light of Arthur’s pipe flickered and stopped when he heard this, “Sir, if I understand you correctly, you are saying that you have a cure for cholera?”
Hardcastle waved his hand hastily at his words, “No, no, no, Mr. Hastings, as much as I would like to tell you that I can cure cholera, my professional ethics will not allow me to do so. But …… although I can’t guarantee that all the patients will recover, as long as you follow my method, I guarantee that I will be able to drastically reduce the mortality rate of cholera.”
Arthur couldn’t help but straighten his body a bit when he heard this, “The method you mentioned is?”
Seeing Arthur’s interest, Hardcastle hurriedly waved at the student beside him, “Snow, bring out the report.”
Snow fished out a document from the small cloth bag he had with him and placed it on the table.
Hardcastle introduced the document as he flipped it open, “Actually, I’ve been conducting investigations into this disease since before the cholera outbreak. My teacher was Mr. Corbin who had served as a military doctor for the Indian forces in Bombay in his early years and had been involved in many cases of treating cholera patients.
He warned the doctors in Britain very early on: ‘Never meet the persistent and miserable pleas of the sick for water, for I have seen with my own eyes many of them die from it.’ And this is basically the consensus of doctors who have practiced medicine in India. I have always followed his teachings in my treatment of patients. But on top of that, I have discovered many other things of note, and that has started to make me question my teacher’s theories a little bit.”
Arthur asked, “What have you discovered?”
Hardcastle spoke up, “I had a cholera patient who fainted before he was brought to the doctor because he was too weak and his arm was cut open by a rock on the side of the road. However, when he was brought to me, I noticed that the blood coming out of his wound was different from the average person in many ways. His blood was dark and thick, which was caused by an extreme lack of water in his body.
Due to his critical condition, it was no longer possible for me to continue to follow my teacher’s controlled water intake therapy, as an article published by Prof. Herman last year speculated that the direct cause of a patient’s death is the result of thickened blood that is unable to circulate.
But to feed him plain water would also certainly aggravate his diarrhea condition. In order to solve this problem, I went back over the recent research articles on cholera therapy. Among them Mr. O’Shaughnessy’s study of the Newcastle patient attracted my attention.
He found by laboratory laboratory analysis that the patient’s blood had lost a large amount of water and neutral salts, but that the elements missing from the blood were found to be in excess in the feces. Obviously, this result also confirmed Prof. Herman’s view that the cause of the patient’s collapse and death was the loss of body fluids which led to the blockage of blood circulation.
I wondered at the time whether, if we could bring some kind of highly oxygenated salt into complete contact with the black blood of a cholera patient, we might not be able to restore the arterial properties of the patient and ultimately put an end to the patient’s severe symptoms. And in order to accomplish this conception, the first two routes that came to my mind were enemas and intravenous injections.”
“A vision of genius!”
When Arthur heard this, he also could not help but light up, hearing Hardcastle’s such a detailed and professional explanation, he who possessed a modern mindset seemed to have slowly figured out the method of diagnosis and treatment of cholera.
He grabbed Hardcastle’s hand and asked, “Continue.”
Hardcastle saw that Arthur’s reaction was actually so strong, and for a moment he was also a bit excited.
He opened his mouth and said, “I first configured a solution containing potassium chloride, carbonate and soda to treat the patient with an enema, but because the patient’s intestinal absorption function had been disrupted, he was unable to absorb the salt solution properly, and instead aggravated his diarrhea symptoms. So, I started intravenous salt supplementation attempts again.”
Arthur asked, “What were the results?”
Hardcastle laughed, “The patient was already terminally ill, his body was weak, his pulse was weak, and he was extremely thirsty, but after I administered four consecutive infusions of 200 ounces of salt solution, he gradually awoke from his coma, and his symptoms improved significantly, and he eventually went on to recover!”
Arthur could not help but rise with joy at his words and press both hands on the other’s shoulders, “Mr. Hardcastle, you have indeed not disappointed me! I assure you that this therapy of yours will soon ……”
Before Arthur could finish his words, he only heard a snapping sound, and the door of the parlor was suddenly pushed open violently.
“Hardcastle! I knew it was you! Have you, the executioner of medical experiments on patients, made enough of a scene or what? I warn you, if you don’t reflect on your behavior, when the cholera is over, I will definitely go to the Royal Society of Surgeons in Westminster and apply to ban you from practicing medicine!”
Arthur twisted his head to see that standing outside the door was an angry old gentleman who took three or two steps to Hardcastle’s face and raised his cane to punch the other man.
Hardcastle defiantly clutched the other party’s cane and angrily glared at him, “Mr. Rosenberg! The one who should reflect should be you! I had already argued the feasibility of intravenous injection to you before, yet you not only badmouthed me, but also swept me off my feet, and even withheld the paper I was going to submit to The Lancet, so what exactly were your intentions in doing this!”
Rosenberg?
As soon as Arthur heard this surname, he immediately understood the old man’s identity, this was the chairman of the Liverpool Health Board and the most reputable doctor in the area.
Arthur spoke, “Mr. Rosenberg, is all that Mr. Hardcastle just said true?”
Rosenberg glared at Hardcastle and said, “Mr. Hastings, don’t listen to this guy’s nonsense. I did withhold his papers and called him out for being a quack who doesn’t care about his patients, but it’s all for the sake of the public’s lives. I bet he just showed you how advanced his therapy really is, but I can prove to you that it’s all just a scam set up by a small street clinic doctor!”
At the end of his sentence, Rosenberg grunted violently and pulled a document out of his pocket and threw it onto the desktop.
“Take a good look at this document! This is the report of the statistical department under the Liverpool Board of Health on the conclusions of the cholera patients at the Hardcastle Clinic. According to the survey report, of the 56 patients who received saline injections, only 9 have fully recovered.
In other words, these pathological conclusions in Hardcastle’s mouth and the treatments deduced from them did not actually succeed in curing many patients. The survival rate of his treatment is not at all in the upper echelons of the various doctors in Liverpool, and can hardly be said to be even of middle rank.”
Arthur picked up the document and flipped through it twice, and his brows became more and more furrowed with it, “This ……”
The report showed that Rosenberg hadn’t been taking things at face value, and that what he had said was true.
But Arthur couldn’t figure out why Hardcastle, who sounded most like the right answer, would deliver such an ugly result.
Could it be falsified data?
Out of his skepticism of the statistics, Arthur decided that he should still give Hardcastle another chance, and he opened his mouth to ask, “Is this all true?”
Hardcastle’s face flushed red and his fists clenched, he held his tongue for half a day before finally choosing the one he valued more between honor and conscience.
He nodded, “That is correct, Mr. Hastings. It’s true that my patients’ healing rate is not that high, but are you willing to listen to my defense?”
If Hardcastle told Arthur that the data was false, then Arthur would definitely not give him a chance to defend himself after checking the facts.
But Hardcastle directly admitted that his healing rate was not high, but it made Arthur dispel his doubts about him.
Perhaps Hardcastle’s method wasn’t 100% correct, but this doctor shouldn’t be able to harm people from a subjective point of view.
Arthur nodded, “Of course. And I’m sure Mr. Rosenberg would love to hear your reasons as well.”
Rosenberg had originally heard Hardcastle admit to the problem and was about to storm out of the room and throw him out, but Arthur gave the word and he could only hold back his nausea and open his mouth.
“OK! Then you can say it. But even if you say flowers today, it won’t change the fact that you’re an empirical quack who tests new methods on patients. I have to say, Hardcastle, I’m very disappointed in you! If it wasn’t for the sake of your teacher, Mr. Corbin, after you came to me that day, I would have already written a letter to the Physicians’ Association asking for your license to practice medicine to be revoked!”
Hardcastle had already made plans to cut off his retreat when he decided to force his way into the ball. He knew that after today he would either make a name for himself or be disqualified from practicing medicine altogether. Before he and the authorities of the Liverpool Board of Health could decide who was really the quack.
Hardcastle took a deep breath and spoke.
“Mr. Hastings, it’s like I said before. I’m just an ordinary street doctor, and many of my patients come from working families. And workers, as you know, don’t want to see a doctor anyway if they aren’t already terminally ill.
And there are many in the working population who have many underlying diseases besides cholera, and are already very weak. I swear on my honor to Hippocrates that most of my patients, though not all, have been in much better physical condition after receiving intravenous injections. However, they have died of other diseases during the recovery phase of their bodies.
If complete recovery is the criterion, then I really did not do enough. But if it’s in terms of curing cholera and getting them out of their critical condition, then my success rate can reach fifty-five percent.”
Rosenberg sniffed angrily, “Hardcastle, even if you don’t consider the after-effects, the figure of fifty-five percent is just slightly higher than the average cure rate of forty-five percent for cholera. Besides, how do you know that the dead patients died of other diseases! What is going on here, do you want me to make it any clearer! How dare you do such a thing, you man who has lost his honor and morals! Do you know who this gentleman standing in front of you really is? I’ve been speaking for you, trying to salvage a little bit of dignity and honor for you in the end, but I never thought that you’ve actually become shameless to this extent!”
Arthur originally didn’t know why Rosenberg was so angry, but now he seemed to have figured out the reason for this.
As a police officer, he knew very well how to figure out the cause of a patient’s death.
Arthur stared at Hardcastle and asked, “You dissected the patient’s body?”
(End of chapter)