SGB Chapter 332

## Chapter 332: Ethical Dilemmas in 19th Century Medicine

“A little diluted gin, please. It’s a cold night, and I see your faces are flushed from the wind.”

Arthur pushed two amber-colored glasses of gin towards the two uninvited guests, then lit his pipe and leaned back on the sofa.

“Thank you.”

The older man, his fingers stiff with cold, accepted the glass with a shiver. He then gestured for the young man accompanying him to take a drink as well.

“John, have some.”

With his mentor’s permission, the young man picked up the glass and sipped cautiously.

Arthur, observing them, smiled and asked, “You’re John, right?”

“Yes,” the youth nodded. “John Snow, that’s my name.”

“Snow?” Arthur chuckled. “Your last name suits the winter well. Let me guess, you’re Scottish? Most of Britain’s snow falls there, you know.”

The young man, emboldened by the friendly demeanor of this influential figure, replied, “Sir, I’m from York. You know York? We get snow there too in winter.”

“Oh, another Yorkian.” Arthur laughed. “There are quite a few Yorkians in Liverpool. Perhaps it’s because it’s so close. To be honest, you’re the second one I’ve met here.”

Snow, surprised, replied, “You’re from York too, sir?”

“Indeed,” Arthur nodded with a smile. “Not only that, I used to be a skilled Yorkshire pig breeder. If I hadn’t gone to London to study, I’d probably be the best pig farmer in the area now. Though I wouldn’t say my current skills are bad. Speaking of which, have you ever raised Yorkshire pigs?”

Snow shook his head, “Never, but I’ve seen many. I wanted to be a swineherd, but my father thought it was as pointless as being a miner. So, he got me an apprenticeship with Mr. Hadcastle, a pharmacist, through my uncle.”

“Pharmacist’s apprentice?” Arthur turned to the middle-aged man, “So, you’re Mr. Hadcastle?”

The man extended his hand, “Delighted to meet you, Mr. Hastings. William Hadcastle, surgeon and pharmacist, qualified by the Royal College of Surgeons.”

While Arthur knew that many trades in Britain still relied on apprenticeships, he was surprised to find that the medical profession was no different.

He didn’t know many doctors, but most of them had received proper university education.

Even if they weren’t graduates of prestigious institutions like Edinburgh or Glasgow University, they would have received at least two to three years of training at a medical specialist school.

However, this doctor appeared with a seventeen or eighteen-year-old apprentice, which made Arthur question his professionalism.

Arthur voiced his doubts, and Hadcastle didn’t hesitate to explain.

“Mr. Hastings, it seems you don’t have a deep understanding of the medical profession. For most doctors, they go through an eight-year apprenticeship in their youth. During these eight years, they learn various pharmaceutical knowledge from senior doctors and acquire basic pharmacological knowledge while assisting them.

After the eight-year apprenticeship, they then enter a medical specialist school for higher-level studies and choose to be examined by either the Royal College of Physicians or the Royal College of Surgeons based on their learning direction. Only after passing this examination do they truly possess the qualifications to practice medicine independently.

The type of doctors you’ve met before who went straight to university are mostly wealthy young men, their career paths are completely different from ours, those of us who truly fight on the frontlines. They control the academic circles, while we are in the clinics and hospitals at the forefront.

Of course, I’m not saying there’s anything wrong with them. But in terms of experience in treating diseases and saving lives, they’re not on the same level.”

Although Hadcastle claimed he wasn’t criticizing them, even a deaf person could tell from his indignant expression how much he resented some of his colleagues.

But Arthur could understand his feelings.

According to Hadcastle, a lower-class doctor had to go through an eight-year apprenticeship plus two to three years of specialist school training before they could practice independently, while those from wealthy families only needed three to four years of university study.

However, despite the longer training period for lower-class doctors, they were discriminated against because of their specialist school background. Medical students graduating from prestigious universities like Edinburgh and Glasgow were considered more valuable.

Whether it was publishing papers in medical journals or applying for positions in famous hospitals, they always came behind others.

Anyone would be angry in their position.

As one of the victims of academic discrimination, Arthur Hastings, a brilliant graduate of London University, had been intermittently slacking off on the frontlines of Scotland Yard for the same reason.

Why could Cambridge and Oxford second-class graduates get jobs at major companies like the East India Company and the West India Company, enter high-end departments like the Customs and Excise and the Post Office to serve their country, while London University academic scholarship winners could only hang out with Irish thugs on the streets of the East End?

Similarly, the reason why Eldred Carter, a gem in the Department of Classical Literature at London University, constantly ‘praised’ Cambridge and Oxford was self-evident.

Arthur saw Hadcastle as a reflection of himself two years ago. He nodded empathetically, “Sir, don’t be upset. Things turn around, and fortunes change. One can’t always be unlucky. Although Britain’s traditions dictate that this country always prefers old-fashioned stubbornness, not everyone at the bottom of the river will drown in this cesspool. As long as you can make sense, demonstrate your value and correctness, and find an investor willing to take a gamble, things will get better.”

Hadcastle’s eyes lit up at these words.

He had been waiting for a chance to turn things around for so many years. However, when he presented his proud discovery to everyone, he was met not with flowers and applause, but with cold stares and closed doors.

Just as Arthur had said, he desperately needed an ambitious investor.

And Arthur Hastings, the special investigator appointed by four departments to Liverpool, was a perfect candidate.

He grabbed onto this lifeline as if it were a drowning man grasping for a straw, revealing his ordeal.

“Mr. Hastings, I know your mission in Liverpool, and you know your own mission, right? We’re all here to quell the cholera epidemic in Liverpool. I don’t know whether conforming to public perception is more important in your work, or achieving results, but I believe that in the medical profession, as long as the patient recovers, that’s all that matters.”

Arthur’s pipe glowed red, flickering on and off, as he listened, “Sir, if I understand correctly, you’re saying you have a way to cure cholera?”

Hadcastle hastily waved his hand, “No, no, no, Mr. Hastings. While I’d love to tell you I can cure cholera, my professional ethics don’t allow me to do that. But… although I can’t guarantee a full recovery for every patient, I can guarantee that following my method will significantly reduce the death rate from cholera.”

Arthur straightened in his chair, “What method are you talking about?”

Hadcastle, seeing Arthur’s interest, hurriedly beckoned his student, “Snow, get the report.”

Snow pulled out a document from his small cloth bag and placed it on the table.

Hadcastle opened the document and introduced, “Actually, I started investigating this disease before the cholera outbreak. My teacher, Mr. Corbin, worked as a military doctor for the British forces in Bombay in his early years and participated in many treatments for cholera patients.

He warned British doctors long ago: ‘Never satisfy the patient’s persistent and miserable thirst for water, for I have witnessed many patients dying from drinking water.’ This is also a consensus among doctors who have worked in India.

I’ve always followed his teachings in treating patients. But based on that, I’ve also discovered many things worth noting, which made me start to question my teacher’s theory.”

“What did you discover?” Arthur asked.

Hadcastle replied, “I had a cholera patient who fainted from weakness before being admitted to the hospital, and his arm was cut by a stone on the roadside. However, when he was brought to me, I discovered that his blood was different from that of ordinary people. His blood was black and thick, which was a result of extreme dehydration.

Due to his critical condition, I could no longer follow my teacher’s method of controlling water intake because Professor Hermann’s article published last year speculated that the direct cause of patient death was thickened blood and impaired circulation.

But giving him pure water would also worsen his diarrhea. To address this, I re-examined recent research articles on cholera treatment. Among them, Mr. Osnossi’s research on Newcastle patients caught my attention.

Through laboratory analysis, he found that the patients’ blood lost a large amount of water and neutral salts, but the missing elements were found in excess in their feces. Obviously, this result also validated Professor Hermann’s view: the crux of the patient’s collapse and death was fluid loss leading to circulatory obstruction.

At that moment, I wondered if we could fully contact a high-oxygen salt solution with the black blood of cholera patients, would it be possible to restore the arterial properties of the patients and eventually terminate their severe symptoms. To achieve this idea, the first thing that came to mind was enema and intravenous injection.”

“A brilliant idea!”

Arthur’s eyes lit up, hearing Hadcastle’s detailed and professional explanation. With his modern thinking, he seemed to slowly understand the treatment of cholera.

He grabbed Hadcastle’s hand and asked, “Go on.”

Hadcastle, seeing Arthur’s strong reaction, was a little excited.

He said, “First, I prepared a solution containing potassium chloride, carbonates, and soda and gave it to the patient as an enema. But since the patient’s intestinal absorption function was already disordered and couldn’t absorb the salt solution normally, it actually aggravated his diarrhea. So, I started trying intravenous salt supplementation.”

“And the result?” Arthur asked.

Hadcastle smiled, “The patient was already at death’s door, weak, with a faint pulse, and extremely thirsty. But after four consecutive infusions, injecting 200 ounces of salt solution, he gradually woke up from his coma, his symptoms improved significantly, and he eventually recovered!”

Arthur, unable to contain his joy, stood up and placed both hands on the other man’s shoulders, “Mr. Hadcastle, you did not disappoint me! I assure you, your treatment will soon…”

Before Arthur could finish, there was a bang, and the door to the private room was suddenly pushed open.

“Hadcastle! I knew it was you! You, the executioner who conducts medical experiments on patients, have you had enough? I warn you, if you don’t reflect on your behavior, when the cholera is over, I will definitely apply to the Royal College of Surgeons in Westminster to revoke your medical license!”

Arthur turned his head and saw an old gentleman with a furious expression standing outside the door. He strode towards Hadcastle and raised his cane as if to strike.

Hadcastle, not backing down, grabbed the cane with one hand and glared back, “Mr. Rosenborg! You should be the one reflecting! I already argued the feasibility of intravenous injection to you, but not only did you insult me, you threw me out, and even confiscated the paper I was preparing to submit to *The Lancet*. What was your intention in doing this?!”

Rosenborg?

Arthur recognized the name immediately, understanding the old man’s identity. This was the chairman of the Liverpool Health Committee, and the most famous doctor in the city.

Arthur said, “Mr. Rosenborg, are these words from Mr. Hadcastle true?”

Rosenborg glared at Hadcastle, “Mr. Hastings, don’t listen to this guy’s nonsense. I confiscated his paper, and I called him a quack who didn’t care about the lives of his patients, but it was all for the sake of public safety. I’m guessing he’s just shown you how advanced his treatment is, but I can prove to you that it’s all a hoax set up by a little doctor from a street clinic!”

With that, Rosenborg snorted and pulled out a document from his pocket, throwing it on the table.

“Take a good look at this document! This is a conclusion report from the statistics department under the Liverpool Health Committee on the cholera patients at Hadcastle’s clinic. According to the investigation report, out of the 56 patients who received saline injection, only 9 fully recovered.

In other words, the pathological conclusions and treatment measures deduced from them, which Hadcastle claims, haven’t actually successfully cured many patients. His treatment survival rate is completely not in the top tier among Liverpool doctors, and it’s hard to say it’s even in the middle tier.”

Arthur picked up the document and glanced at it, his brows furrowed deeper and deeper, “This…”

The report showed that Rosenborg wasn’t talking nonsense. What he said was true.

But Arthur couldn’t figure out why Hadcastle, whose method sounded like the most plausible answer, had such disappointing results.

Was the data fabricated?

Suspicious of the statistical data, Arthur decided to give Hadcastle another chance, asking, “Is all this true?”

Hadcastle’s face flushed red, his fists clenched. After a long pause, he finally chose the one he valued more between honor and conscience.

He nodded, “Yes, Mr. Hastings. My patient recovery rate is indeed not high, but would you be willing to hear my explanation?”

If Hadcastle had told Arthur that the data was false, Arthur wouldn’t have given him a chance to explain after verifying it.

But Hadcastle directly admitted his low recovery rate, which dispelled Arthur’s suspicion.

Perhaps Hadcastle’s method wasn’t perfect, but the doctor wouldn’t intentionally harm people.

Arthur nodded, “Of course. And I’m sure Mr. Rosenborg would be happy to hear your reasons too.”

Rosenborg was about to explode with anger after hearing Hadcastle’s admission, but Arthur had spoken, so he could only hold back his disgust and say.

“Alright! Then go ahead. But even if you talk yourself blue in the face today, it won’t change the fact that you’re an empirical quack who’s experimenting on patients. I have to say, Hadcastle, I’m very disappointed in you! If it weren’t for the sake of your teacher, Mr. Corbin, I would have written to the Medical Association to revoke your medical license after you came to see me that day!”

Hadcastle, when he decided to force his way into the party, had already prepared to cut off his retreat. He knew that after today, he would either be successful or lose his medical license completely. A decision had to be made between him and the authorities of the Liverpool Health Committee, who would be the real quack.

Hadcastle took a deep breath and began.

“Mr. Hastings, as I said before. I’m just an ordinary street doctor, and most of my patients come from working-class families. You know, workers, if they’re not already at death’s door, they won’t see a doctor under any circumstances.

And among the working class, many people have many underlying illnesses besides cholera, and their bodies are already very weak. I swear by Hippocrates, not all patients, but most of my patients have shown significant improvement in their health after receiving intravenous injections. But they died from other illnesses during the recovery phase.

If full recovery is the standard, then I haven’t done a good job. But if we’re talking about curing cholera and getting them out of critical condition, then my success rate can reach 55%.”

Rosenborg, furious, rebuked, “Hadcastle, even without considering the sequelae, a 55% figure is only slightly higher than the 45% average cure rate for cholera. Besides, how do you know the dead patients died from other illnesses! Are you trying to make me say it more clearly! You, a man who has lost his honor and morality, how dare you do this! Do you know who this gentleman standing before you is? I’ve been speaking for you, trying to salvage some dignity and honor for you, but I never imagined that you’d be so shameless!

Arthur originally didn’t know why Rosenborg was so angry, but now he seemed to understand the reason.

As a policeman, he knew how to figure out the cause of a patient’s death.

Arthur stared at Hadcastle and asked, “You dissected the patient’s body?”

(To be continued)