shadow of britain

Chapter 825 Pregnant? Are you sure it's not a misdiagnosis?

On the outer harbor breakwater of Ramsgate, fishermen poured baskets full of herring onto planks, their cries mingling with the strong smell of the sea, while dockworkers used ropes and pulleys to hoist crates of cargo off the deck.

Arthur stood at the end of the dock, watching the mail ship that had just docked.

It was a white-hulled cruise ship with a black-painted bow and a sign that read "London" hanging on the side.

As soon as the ship came to a stop, the sailors pushed the gangway to the edge of the deck.

First to disembark were a group of merchants wearing top hats and ladies in light-colored dresses. Before they could speak, their luggage was pushed away by port workers in wheelbarrows.

Immediately afterwards, Arthur found the person he was waiting for.

He was a slender young man, dressed in a dark long dress coat, the buttons on his chest neatly arranged as if measured. He wore a slightly worn top hat, carried a black leather suitcase in his left hand, and occasionally raised his right hand to shield his forehead, as if adjusting to the glare of sunlight as he stepped from the ship's cabin into the sun.

John Snow was the first student in the history of the University of London to pursue a medical doctorate and was a licensed physician of the Royal College of Surgeons.

Arthur narrowed his eyes slightly, mentally comparing the person in front of him with his memories of five years ago.

When he first met Snow in Liverpool, Snow was just an eighteen-year-old greenhorn, an unremarkable apothecary apprentice. He wore a hand-me-down coat discarded by his master, the cuffs stained with indelible medicine marks, and a small leather bag slung across his shoulder. When speaking with him, Snow always seemed uncomfortable and reserved. At that time, all Snow knew was to run errands, grind medicine powder, and busy himself with attending to patients as Huddlescar instructed.

Now, his shoulders fully support the well-tailored tuxedo, and his gaze beneath the brim of his hat no longer flinches, but is steady and direct, as if assessing everything before him. His suitcase has been replaced with a doctor's medical kit, and his movements exude a composed and proud demeanor.

Five years can indeed bring about tremendous changes in a person, and this was true for him as well as for Snow.

Snow descended the gangway, paused for a moment on the stone path, took out the pocket watch he had bought with his academic gold medal prize money, and glanced at the time, as if to make sure he wasn't late. The sea breeze gently lifted the hem of his coat, revealing a light gray vest underneath and a left hand calloused from years of holding a pen and a scalpel.

Arthur stepped forward, extending his right hand to Snow as he walked: "Dr. Snow, it's been a long time."

Upon hearing Arthur's voice, Snow quickly put away his pocket watch and grasped Arthur's hand: "Sir Arthur."

Finally, he hesitated for a moment, but couldn't help but remind him, "Sir, it would be best if you didn't address me as 'Dr.' After all, I haven't passed the Royal College of Physicians' exam yet, and I'm just a surgeon right now. If those internists hear me using 'Dr.', it could cause trouble."

Arthur clearly didn't take that to heart: "What does it matter? Even if you're not an internist yet, aren't you pursuing your medical doctorate?"

Snow insisted, “Sir, as you know, the medical field is different from other places. People in the profession value lineage and qualifications the most. No matter how skilled a surgeon is, in the eyes of internists, he is nothing more than a high-level craftsman. They have always regarded ‘Dr.’ as their exclusive title. Before passing the examination of the Royal College of Physicians, even if you have obtained a doctorate, using this title will inevitably be regarded as an overstepping of authority.”

Arthur chuckled softly and patted his hand: "You still remember these old medical conventions. But in my opinion, a true doctor is one who can save lives, whether you write Latin prescriptions or sew. Besides, I call you 'Doctor' not to help you win any titles, but to acknowledge your current abilities."

Snow shook his head, but a faint smile crept onto his lips: "You've put me in the eye of the storm."

"The eye of the storm?" Arthur pointed to the street behind him. "You haven't seen what the real eye of the storm is like yet. Come on, let me buy you a Ramsgate ginger beer. It must have been more than half a year since we last saw each other, since Professor Marsden recommended you for your internship at Westminster Hospital, right?"

Snow nodded slightly, switched the medicine box to his other hand, and walked down the dock with Arthur.

The cobblestone street gleamed with a damp light under the sea breeze and tides. Various hand-painted signs hung in front of the shops on both sides of the street, including fishing tackle shops, bakeries, and small shops selling Dutch cheese and French wine.

Behind the iron-framed windows along the street, you can see tea girls boiling water in copper kettles, and several sailors chatting idly with their elbows propped on the counter.

Turn a corner and you'll find a small tavern with a sign that reads "Admiral".

Arthur pushed open the heavy oak door, the wood creaking against the frame with a low groan.

The bald bartender behind the counter, who was yawning, immediately turned around and took two glasses from the cabinet behind him as soon as he saw Arthur, and greeted him warmly: "The usual, Jazz?"

"The usual," Arthur said, placing his hat on the bar. "Another grilled cod, please, not too much pepper."

Snow stood in front of the menu hanging on the wall for a long time, not knowing what to eat, so he simply said, "Give me one of the same thing too."

The bartender smiled and agreed, then turned to give instructions to the kitchen.

Arthur, familiar with the place, chose a round table by the window facing the sea and gestured for Snow to sit down.

The bartender quickly brought over two glasses of ginger beer. Arthur raised his glass and gently clinked it against Snow's: "So, tell me, how has your year at Westminster Hospital been? I heard from Professor Marsden that Westminster Hospital speaks very highly of you."

Snow skimmed the foam off the rim of his glass with his fingertip, then took a small sip. The slightly spicy ginger-flavored liquor made him exhale with a sense of satisfaction: "I mainly studied under Mr. Anthony White at Westminster Hospital. You may have heard of him. Mr. White was a student of Sir Anthony Carlyle, the physician to King George IV, and also the president of the Royal College of Surgeons. Although he was somewhat lacking in a sense of time, I must say that Mr. White was the most skilled surgeon I have ever seen in my life."

As a veteran policeman, Arthur was naturally familiar with these well-known doctors in London.

Both Anthony White and his teacher Anthony Carlyle were prominent figures in the British medical community.

However, what they are most known for is not their medical skills, but a few interesting anecdotes.

Sir Anthony Carlyle, the Royal Physician, was a leading medical authority in Britain, having served as president of the Royal College of Surgeons, just like his disciple.

At the same time, he was also an absolute eccentric. He was most criticized for publishing two papers on "oysters" at the Royal College of Surgeons, which led to him being nicknamed "Sir Anthony the Oyster".

Of course, this doesn't mean Carlyle was truly an incompetent person. Even setting aside his medical achievements, his discovery of electrolysis with William Nicholson, and the electrolysis of water into hydrogen and oxygen, is enough to secure his place in history. As for Mr. White, he not only inherited his teacher's eccentric traits but also surpassed him.

As Snow said, White had a terrible sense of time and often forgot his patients' appointments.

But at the same time, he was also the inventor of a surgical procedure to remove necrotic femoral heads in cases of hip joint disease.

Such a risky surgical procedure naturally drew widespread opposition from the medical community. Even his teacher, Sir Anthony Carlisle, publicly denounced his student, calling him a "quack doctor" who disregarded the safety of patients, and threatened to report White, this traitor, to the Royal College of Surgeons.

However, despite widespread opposition from the medical community, White went ahead with the surgery and ultimately succeeded.

Even more embarrassingly, he waived the surgery fees for patients, in exchange for requiring recovered patients to visit their opponents door-to-door, including his teacher, Sir Anthony Carlyle.

“My time with Mr. White wasn’t exactly easy, but it was certainly very rewarding.” Snow put down his glass and placed his hands on the table. “He rarely explained the steps beforehand during surgery. When I first started working with him, I was always sweating profusely, afraid of being a step behind. But over time, I gradually learned to anticipate his intentions. I could tell from a glance or a flick of his wrist whether he was going to dissect, cut, or prepare to suture.”

Arthur nodded slightly and said, "Even if Mr. White isn't the best surgeon in England, he's certainly not far off. It's truly fortunate that you can learn from him. But didn't they arrange for you to do your clerkship in internal medicine?"

“It’s arranged,” Snow said with a smile. “Thanks to Professor Marsden’s recommendation, Westminster Hospital didn’t simply train me as a surgeon. In internal medicine, I report to Dr. John Bright, but Dr. Bright is not only a councilor and qualifier of the Royal College of Physicians, but he was also appointed this year as an advisor on psychiatry to the Lord Chancellor’s Court, so he rarely appears at the hospital. Most of the time, I mainly learn from Dr. George Roy, who is our medical lecturer and holds dual licenses from both the Surgical Society and the College of Physicians. He is an authority, especially in the treatment of respiratory diseases such as pertussis.”

Arthur was not surprised by Snow's answer. He knew that Snow's main interest was in infectious diseases, so it was reasonable for him to choose to follow Dr. George Roy, a leading expert in respiratory diseases.

However, the problem is that he is not interested in respiratory diseases right now; he would rather ask about gynecological issues.

Arthur took a sip of ginger beer and asked casually, "So... what about women's health issues at Westminster Hospital? Of course, I'm not talking about childbirth, I know that's under the obstetrics department."

Snow looked up and pondered for a moment: "Strictly speaking, there isn't a department in the hospital specifically for treating women's diseases. As you mentioned, childbirth and difficult labor are handled by the maternity ward, by obstetricians and midwives. Other women-related illnesses are mostly handled by internists, and occasionally referred to surgery. However, I guess the women's diseases you're referring to are probably those linked to emotional and neurological symptoms? If it's a mental health issue, most of them are recorded as 'hysteria' and managed by internists. If the situation is too severe, the hospital will directly recommend that the family send the patient to a place like Betlem Psychiatric Hospital."

Upon hearing this, Arthur immediately pulled out the medication order from his pocket: "Could you help me take a look and tell me what these medications are for?"

Snow took the slightly wrinkled piece of paper and bent down to carefully scan the name of the medicine.

He first lightly touched the "Laudam" with his fingertip: "This is a general pain reliever and sedative. As you know, it is used by almost all chronic patients and neurasthenia sufferers."

His finger then slid down to "valerian root powder" and "lemon balm tea": "Both of these are mild herbal sedatives, mainly used to relieve anxiety and insomnia. If they are prescribed to female patients, it may also be to soothe her... well, her monthly mood swings."

Then, he gently tapped the line for "aromatic benzoin tincture": "This can be used for respiratory inflammation and olfactory sedation. It is often used on patients who are prone to fainting or shortness of breath."

Finally, his gaze fell on "ergonomics," and his brows furrowed even more deeply: "This is rather special. Ergonomics is mainly used to induce labor, stop postpartum hemorrhage, or control abnormal uterine contractions. It can strongly stimulate the smooth muscle of the uterus, so the dosage must be extremely careful, otherwise it may cause fatal spasms. By convention, this drug can only be prescribed by doctors who are extremely familiar with the patient's condition and are willing to take the risk."

Snow picked up the medication list and examined it again in the sunlight: "If these medications were purchased at the same time and prescribed by the same person, then it's almost certain that the patient's problem is more than just emotional stress. Either she's recovering from a childbirth event, or someone is interfering with her menstrual cycle."

"Childbirth?" Arthur nearly jumped out of his chair upon hearing the word. "John, are you sure?"

Snow examined the list more carefully: "Judging solely from this medication list, it could indeed be labor. But to determine the specifics, I need to see the patient. As I mentioned earlier, another possibility is that the doctor wants to intervene in the patient's menstrual cycle."

Snow paused slightly at this point, seemingly realizing that his earlier statement about "intervening in the menstrual cycle" could evoke too many associations in a non-medical context.

So he slowed down and switched to a more formal expression: "In our line of work, if it's written as 'catamenial regulation,' it generally refers to the use of medication to regulate a woman's monthly cycle. As for the reasons for medication, it could be that the cycle is too long or too short, or there is excessive bleeding, or it could be accompanied by severe menstrual neuralgia."

As he spoke, he folded up the prescription and gently placed it on the table.

“However…” Snow added, “In medical records of the court or high society, such cases are often not written outright. Usually, they are only summarized with a general phrase like ‘the lady’s discomfort,’ and only the person in question and the prescribing doctor know whether it is neuralgia, metrorrhagia or some other problem.”

Arthur tapped the table lightly with his knuckles, silently noting down the wording: "Let me rephrase the question. If the prescription is deliberately mixed with these sedatives and ergot to conceal the true cause of the illness, could it mask the patient's real symptoms?"

Snow paused for a moment: "In the short term, it may be difficult for outsiders to see any clues from the surface, but the risks are great. Laudame and valerian will make the patient calm and slow to react, and aromatic benzoin tincture can mask the odor in the breath, but the side effects of ergonomics cannot be completely hidden, especially when the dosage is too high, which may cause abnormal gait, numbness in the fingertips, or even a sallow complexion."

He looked up at Arthur, his eyes filled with doubt: "Sir, where did you get this prescription? The person who wrote it seems not only highly skilled, but also very familiar with how to use these medicines without attracting attention. In other words, this is not something an ordinary rural doctor could do."

Arthur paused for a moment, then picked up his glass and took a sip of ginger beer, the bubbles rising to the surface.

"John, you're not in a hurry to go back to London after coming to Ramsgate, are you?"

Snow smiled and nodded, saying, "Didn't you say you had a patient here? Even if I were to leave, I would have to wait until my rounds are over."

Arthur nodded slightly, put down his cup, and said firmly, “Alright, John. Get ready. You may have to make a house call in Ramsgate over the next few days, and it will be a… very discreet one. I expect you to adhere to your medical ethics regarding patient privacy.”

Snow raised an eyebrow, but didn't press for details. He simply reached out and put the prescription into his shirt pocket.

He had actually heard about these sordid things in high society before.

No matter how you look at it, it's nothing more than Sir Arthur Hastings or one of his friends getting some young lady pregnant. The senior doctors at Westminster Hospital have to do this kind of private work every now and then.

Snow smiled and agreed, "As you know, Sir, I'm a professional doctor. I never ask who pays my fees, only whether I can save lives. Please rest assured, I will never reveal anything that shouldn't be said."

(End of this chapter)