Wind Rises in North America 1625

Chapter 428 Xinzhou Medical Affairs
A four-wheeled carriage bearing the insignia of the Ministry of the Army slowly drove out of the Xinhua Military Industry Ammunition Testing Ground, the horseshoes making a crisp sound on the cement road.

The car curtains were drawn low, and the shadows of people moving inside the car could be vaguely seen.

When the carriage reached the crossroads, it slowed down noticeably. Two young officers in crisp military uniforms jumped off the carriage, saluted it, and then hurried away.

The carriage soon merged into the central avenue and headed straight for the Dongping Second Hospital in the west of the city.

Zhu Tianrui stood under a pine tree at the street corner, raised his hand to straighten his general's cap, and the late spring sunlight cast dappled shadows on his epaulets through the leaves.

“Strange,” he squinted, “why did Minister Zheng’s carriage head west of the city?... He seemed a little nervous.”

Gui Yongliang leaned in half a step and lowered his voice, saying, "I heard that Madam Zheng has been having prenatal checkups at the Second Hospital of Dongping these past few days, and the doctor said..."

He looked around, then lowered his voice, "The baby is breech, it looks like it's transverse."

"Horizontal position?" Zhu Tianrui was taken aback upon hearing this, and his right hand unconsciously clenched into a fist.

Eight years ago, his mother suffered a difficult childbirth due to breech presentation, and ultimately...

"How is the situation now?" Zhu Tianrui's voice was a little tight, and his Adam's apple bobbed involuntarily.

Gui Yongliang shook his head: "I don't know the specifics. But I heard the hospital has organized a consultation with many senior doctors, so they should be able to come up with a feasible treatment plan."

The two of them looked in the direction where the carriage had disappeared.

During this period, if the mother discovers that the baby is in an abnormal position, such as breech (foot first), transverse (shoulder first), or occiput posterior, the baby may not be able to be delivered smoothly. In dangerous situations, it may even lead to the death of both mother and child.

Even if forced delivery is attempted and the fetus is forcibly removed, the baby's head may be the last to be delivered, potentially causing brain injury (intracranial hemorrhage) or spinal cord injury due to compression, resulting in a disabled child.

Within the Ming Dynasty, in cases of difficult labor, midwives would typically attempt to manually correct the fetal position, but the success rate was very low and the risks were extremely high, with a high probability of causing placental abruption.

Some people take traditional Chinese medicine such as "labor-inducing soup" in an attempt to correct the fetal position by strengthening uterine contractions, but this method is not very effective and may even increase the risk to the mother.

In many situations, the classic dilemma of "saving the elder or the younger" arises.

Although Xinhua's medical development was far ahead of that of the Ming Dynasty and Europe, and it had many ways to deal with "difficult and complicated diseases" such as difficult childbirth, there were still great risks in the rescue process.

“Minister Zheng is not only the head of our Army Equipment Department, but also one of the Central Executive Committee members. The doctors at the Second Hospital will do everything they can to ensure the safety of Madam Zheng and her child…” Gui Yongliang said softly.

Zhu Tianrui suddenly interrupted him: "I remember a few years ago, Dongping First Hospital seemed to offer some kind of 'external cephalic version' procedure to correct fetal position?"

“There is such a method,” Gui Yongliang said with a wry smile, “but it’s very risky in practice. What if it causes placental abruption or umbilical cord entanglement…”

He didn't say anything more.

Zhu Tianrui sighed softly, looking at the bustling pedestrians on the street, and suddenly remembered a statistical report he had seen last year at the Medical Department of the Army: before the large-scale promotion of new obstetric techniques, the maternal and infant mortality rate caused by malposition of the fetus was as high as 50%.

"Let's go." Zhu Tianrui straightened his uniform. "We're going back to headquarters. Minister Zheng doesn't want his subordinates gossiping about his family behind his back."

Gui Yongliang nodded, and the two turned and walked towards the Army Headquarters.

But after walking a dozen steps, Zhu Tianrui couldn't help but look back at the direction of the west of the city.
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"Cesarean section?" Zheng Lihui stared wide-eyed at the obstetrician in front of him, unable to believe his eyes.

“Uh, Minister Zheng…” Liu Azhu looked slightly flustered under the other party’s piercing gaze. “The day before yesterday, we used an external cephalic version to try to restore the baby’s position, but the effect was not obvious and we were unable to completely adjust the baby’s transverse position. Therefore, in order to ensure the safety of both mother and baby, we recommend that a cesarean section be performed immediately.”

"Minister Zheng, you can rest assured about this. We have performed this type of surgery more than thirty times and have considerable experience. This... cesarean section is not simply cutting open the mother's abdomen, but rather..."

"Alright, alright, you don't need to explain too much, I understand." Zheng Lihui rubbed his face vigorously with both hands and asked softly, "What is your current success rate for this kind of surgery?"

"..." Liu Azhu paused for a moment, then said in a low voice, "The success rate is... 50% to 60%."

"What are the risks involved in a cesarean section?"

“During the surgery, there is a risk of severe postpartum hemorrhage… The rate of thrombosis after surgery, as well as the chances of placenta previa and uterine rupture in subsequent pregnancies, are much higher than with normal delivery,” Liu Azhu said in a low voice. “In addition, babies born via cesarean section may have a risk of respiratory dysfunction.”

"Are there any countermeasures?"

"In the event of severe bleeding during surgery, we will use advanced suturing techniques to stop the bleeding, ensuring that the mother does not experience significant blood loss. After the baby is delivered, we will set up an incubator similar to the womb as a transitional space to minimize the baby's exposure to strong external stimuli."

“However…” Liu Azhu said, a hint of unease appearing on his face, “However, various unpredictable problems may occur during the surgery, and we… we cannot guarantee the complete success of the surgery. Please inform Minister Zheng of this, and be prepared…”

"..." Zheng Lihui was speechless upon hearing this.

So, even after more than a decade of development in obstetrics and gynecology, and dozens or even hundreds of clandestine human experiments, you still can't completely guarantee the success of a simple cesarean section?
In fact, while the Ming Dynasty was still relying on traditional empirical medicine to deal with diseases, and Europe was still in the dark period of bloodletting therapy, Xinhua had already pioneered a unique path in the medical field that integrates the wisdom of traditional Chinese medicine with the framework of modern medicine.

On the world medical landscape of the 17th century, the achievements "created" by Xinhua Medical Institute shone like a bright star, breaking the ignorance of that era.

This leapfrog development in medicine stems not only from the Xinhua government's strategic positioning of medicine as the "foundation of strength," but also from its practical needs for population growth and the development of the new continent.

After all, transporting tens of thousands of immigrants to New Zealand across the ocean every year would be impossible without a solid medical support and a sound epidemic prevention system; otherwise, all such grand plans would be nothing but empty talk.

At the beginning of the establishment of the new regime, a "Ministry of Culture, Education and Health" was set up in the central government, and medical development was incorporated into the national strategic plan.

Unlike the Imperial Medical Bureau of the Ming Dynasty, which primarily served the royal family, Xinhua Medicine has shouldered the dual mission of "universal benefit and service expansion" since its inception.

The first step was to break the closed model of traditional medicine's "master-apprentice" transmission and establish a medical school in Shixing City to systematically build a modern medical education system.

The medical school integrates the traditional Chinese medicine principles of "four diagnostic methods and eight principles" with later anatomy, physiology, and pathology. Xinzhou Medical College adopts a five-year training system, in which students study basic disciplines such as anatomy and physiology for the first two years, and then specialize in a particular field for the next three years.

Its anatomy classroom is equipped with 100 embalmed cadavers year-round, far exceeding the reserves of European medical schools at the same time.

It is this kind of education system that has cultivated a new generation of doctors such as Liu Azhu, who are not only proficient in the dialectical theory of the Yellow Emperor's Inner Classic, but also master modern techniques such as vascular ligation.

In the anatomy course, students not only study the descriptions of internal organs in "Collected Cases of Injustice Rectified," but also develop a three-dimensional physiological understanding through animal dissection (later developing into human dissection).

In the field of diagnosis, the study of pulse diagnosis in traditional Chinese medicine is combined with simple instruments such as stethoscopes and blood pressure monitors (using animal bladders or leather as air bags) to form a dual diagnostic system of "traditional Chinese medicine syndrome differentiation + new medical indicators".

This integration is by no means a simple addition, but is based on the "Qi and Blood Theory" of Traditional Chinese Medicine.

Xinhua Medical also took the lead in proposing the concept of "microcirculation" and attempted to use silver catheters for vascular exploration four years ago, nearly a century earlier than similar research in Europe.

In 1638, the first edition of the "New China Medical Encyclopedia" was published. This book, which can be called the "Hippocratic Oath" of the New World, standardized industry practices such as surgical disinfection, drug formulation, traditional Chinese medicine prescriptions, and medical record writing.

In the operating rooms of two hospitals in Dongping, doctors in white coats had to sterilize instruments by boiling and wipe the operating table with diluted carbolic acid solution—procedures that are commonplace in later generations are considered medical revolutions in today's world.

According to statistics from the Ministry of Health in 1639, after adopting standardized disinfection procedures, the postoperative infection rate in surgery plummeted from 65% ten years earlier to 9%, a figure that European surgeons could only dream of.

For immigrant fleets and settlements crossing the Pacific Ocean, disease prevention was a matter of life and death.

Xinhua Medical has demonstrated advanced prevention and control thinking in this field, and has built a three-in-one epidemic prevention system of "quarantine-immunization-public health".

In 1626, when Xinhua forcibly relocated dozens of Spanish immigrants from the Banderas Valley (now Puerto Vallarta) in Mexico to Shixing Port, it established the first maritime quarantine station, thereby setting up a "three-check" system for all foreign ships and personnel: checking the health records of crew members and immigrants, inquiring about the sanitary conditions of cargo holds, and verifying the animals and plants carried.

In response to highly contagious diseases such as smallpox and plague, which are common in the Ming Dynasty, the quarantine station is equipped with isolation areas and fumigation and disinfection rooms.

In 1630, a smallpox epidemic broke out among the indigenous tribes near Guangfeng (now Sanich City). In addition to immediately activating the blockade mechanism and isolating the epidemic area, the Xinhua government also urgently vaccinated residents within its jurisdiction with cowpox, effectively preventing the epidemic from spreading to the Xinhua-controlled area.

Inspired by the traditional Chinese medicine concept of "fighting poison with poison," Xinhua Medical, combining later vaccine cultivation methods, improved the variolation technique in 1635.

Unlike Daming's high-risk approach of directly using smallpox scabs, Xinhua doctors used the "multiple passage attenuation" technique to culture the smallpox virus in animals such as cattle and sheep for more than 20 generations to produce a vaccine with low toxicity.

In 1636, the smallpox vaccination program for immigrants entering Xinhua began to be implemented, switching from cowpox to human smallpox. As of last year, the smallpox mortality rate had dropped from 30% during the same period in the Ming Dynasty to 0.5% (excluding residents of non-native tribes).

Even more forward-thinking was the fact that Xinhua's medical department established a "Pathogenic Microorganism Laboratory" in 1638, where they observed pathogens such as plague bacilli, tuberculosis bacilli, and anthrax bacilli using microscopes with magnification that increased year by year. This was two hundred years earlier than Pasteur's microbiological research.

In the clinical field, Xinhua's medical advancements are even more impressive.

While European novice surgeons were still using red-hot irons to stop bleeding, Xinhua Surgery had already entered the era of "precision operation".

While the pregnant women in Daming were still struggling in the sweat of the midwives, Xinhua Gynecology had already established a systematic plan to reduce the mortality rate of dystocia.

The development of Xinhua Surgery focused on solving three major problems: "hemostasis, analgesia, and infection prevention." In 1632, based on the descriptions in many traditional Chinese medicine books and with the assistance of a large number of renowned physicians from the Ming Dynasty, Xinhua's medical department successfully developed a "Mafeisan Improved Agent" containing datura and aconitine, which could induce a state of light anesthesia in patients through oral administration.

In 1636, he "invented" the silver clip hemostasis method, using special silver clips to close blood vessels, replacing the traditional hot iron burning method.

In 1633, the Spanish colonial authorities of Mexico launched a major invasion, and the Chinese army and navy, after a fierce battle, defeated the Spanish expeditionary force.

In this battle, a total of 32 people underwent amputation surgery (including 17 Spanish soldiers). Dongping Hospital used silk thread to ligate blood vessels and applied plaster casts to fix the residual limbs after the operation, which resulted in a survival rate of up to 80% for these patients.

Even more groundbreaking was the successful execution of the first appendectomy at Dongping Hospital in 1635. The surgeon, Dong Xinping, performed the first appendectomy without the aid of blood transfusions, and the patient recovered and was discharged less than half a month after the surgery thanks to his precise vascular ligation technique. This achievement predates that of the British surgeon Claudius Emmanuel by a full century.

Faced with the difficult labor of Minister Zheng's wife, Xinhua's gynecological medicine also demonstrated its advanced technological reserves.

Despite the risks associated with external cephalic version, this technique has been standardized through over two hundred clinical cases. The procedure involves slowly rotating the fetus through the abdominal wall with both hands, achieving a success rate of 45%, far exceeding the less than 10% manual correction rate of Daming Midwife.

Although Zheng Lihui questioned the "60% success rate" of cesarean section, it was worlds apart from the desperate choice of "saving the mother or the baby" in the Ming Dynasty.

The "double-layer uterine suture technique" developed by Xinhua doctors uses catgut to continuously suture the myometrium and then uses silk suture to suture the serosa, reducing the risk of uterine rupture after surgery to 3%.

To address the breathing problems of newborns, they designed a "constant temperature incubator" that uses charcoal heating and humidity control to simulate the intrauterine environment, increasing the survival rate of cesarean section babies to 82%.

According to statistics from 1639, the maternal mortality rate in Xinhua had dropped from 15% at the beginning of the immigration period to 2.2%, a figure that European royal families at the time could not match.

The leapfrog development of Xinhua Medical is by no means accidental; behind it lies the Xinhua government's profound understanding that "population equals national strength."

In order to safely transport tens of thousands of immigrants to the New World, the fundamental issues of "being able to afford to move, be able to give birth, and be able to live well" must be addressed.

During the immigration process, each ship was equipped with a doctor, a number of medical tools, and a large quantity of commonly used medicines.

In newly established settlements, the construction of medical and health facilities took priority over administrative office buildings.

This "medical-first" and "comprehensive protection" immigration and settlement strategy kept the mortality rate of Xinhua immigrants at around 2%.

More importantly, Xinhua Medicine has achieved a paradigm shift in "knowledge transmission".

Unlike the secret, experiential transmission of traditional Chinese medicine, Xinhua has built an open knowledge-sharing system through various means such as medical schools, medical journals, academic training, and exchanges.

In 1635, the library of the New Zealand Medical College was completed, housing more than 2000 volumes of Chinese medical classics and monographs, more than 120 translated works of Western medicine (mainly obtained indirectly through Spanish American colonies), more than 40 theoretical and practical manuals on various departments such as surgery, internal medicine, gynecology, pediatrics, and ENT compiled under the auspices of the Ministry of Health, as well as more than 7000 clinical notes written by doctors from various parts of Xinhua.

This systematic accumulation and dissemination of knowledge has enabled the development and progress of Xinhua Medicine to no longer depend on the flashes of brilliance of individual renowned doctors, but to become a replicable and iterative scientific process.

As Zheng Lihui watched his wife being wheeled into the operating room, the afternoon sun shone brightly and dazzlingly, illuminating the entire corridor through the windows and seemingly dispelling some of the gloom in his heart.
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(End of this chapter)