Chapter 295: The Beginning of Great Ming's Medical Reform (5.5k, seeking monthly tickets~)

In a large-scale briefing, the order of appearance itself signals importance.

Agriculture came first, dealing with grain, to resolve the dynasty's fundamental crisis.

Finance came second, dealing with armaments and transport, to address the phased crisis in Liaodong and to explore the possibility of upgrading the efficiency of materiel dispatch. So what is the third most important item, coming next?

Staying alive, of course!

The safety of Great Ming now rests entirely on the single person of Zhu Youjian.

If he were to die right now, the line of Prince Fu would most likely take the throne, and when that happened, how much of the New Policies would survive is truly not optimistic. Even worse, it might not even be Prince Fu — it's entirely possible that the civil officials of Great Ming would, with famine bearing down, first have a fine old debate over the imperial succession.

So, ever since he transmigrated here,

Zhu Youjian has never once left the palace, and is exceedingly cautious in everything he eats and where he resides.

As for things like going down to Jiangnan, he dares not even think about them for the time being.

He simply cannot set his mind at ease, not in the slightest, about the medical conditions of this era.

Xiong Mingyu stepped forward:

"The next report is on medicine, to be delivered by Fu Maoguang, Director of the Imperial Academy of Medicine."

As his words fell, an old man in a deep-red official robe walked steadily out from the crowd.

Although the colors of official robes in Great Ming are fixed by regulation, in practice this has long fallen into disuse.

Day to day, so long as it is not a grand court assembly, officials simply wear whatever color they please.

During meetings, the riot of colors, the profusion of hues, is actually quite pleasing to the eye.

Zhu Youjian, as a modern man, is naturally happy to see it and simply cannot be bothered to change it.

(Image attached: a Wanli-era Daily Lecture, with blue, yellow, brown, dark green, and light green all present. This is everyday dress; the color does not matter. For solemn sacrifices, they would all wear plain robes of blue-black.)

Though this man's beard and hair are already all white, his complexion is ruddy, his spirit hale and hearty, and his stride as he walks is steady and firm, without any sign of age.

He came before the ranks, adjusted his robes, and made a solemn bow:

"Your subject Fu Maoguang, who directs the Imperial Academy of Medicine and concurrently oversees the medical division of the Academy of Sciences."

"In these two roles, theory and practice must neither be neglected; therefore your subject presumes to combine them and report to Your Majesty together."

Zhu Youjian looked at this Director of the Imperial Academy of Medicine, the man who, theoretically, had bungled the treatment of the Tianqi Emperor to death, yet felt no particular resentment in his heart.

What conspiracy theorists love to do most is directly link two events together, then select only the favorable evidence and ignore the unfavorable. So it was with the death of the Taichang Emperor, and so it is with the death of the Tianqi Emperor.

If your stomach hurts, then it must be the fault of that restaurant you ate at yesterday.

Completely ignoring the fact that he also drank iced beverages that day, ate takeout, had been staying up late recently, caught a chill, had a weak stomach to begin with, and that everyone else who ate the same food was fine — and all such possibilities.

But they all overlook one problem.

Under a regulatory system like the Ming dynasty's, if the Emperor could not crush the so-called civil-official bloc, could he really not crush a single imperial physician?

No, of course they haven't overlooked it.

So in this conspiratorial narrative, the historical Chongzhen Emperor naturally becomes the beneficiary of the Tianqi Emperor's death — the evil emperor who, together with the Donglin faction, protected this Physician Fu.

Hah — if he were truly the mastermind of a conspiracy, he would have had to eliminate this man immediately once the deed was done; how could he have tolerated him hopping about until now?

In this world, only a dead man can best keep a secret.

Therefore, rather than believing there is a conspiracy here, Zhu Youjian is far more inclined to believe it is a matter of inadequate technical competence caused by the current medical-official system — just like the 44-hour standardized residency training, in two words: pure incompetence!

Fu Maoguang declared in a ringing voice:

"As discussed at the previous imperial council, in the first year of Yongchang, the medical division and the Imperial Academy of Medicine have seven items under their charge."

"The first is called: re-examination of medical officials."

At these four words, Fu Maoguang's originally calm voice suddenly sharpened considerably.

"In the past, the Imperial Academy of Medicine's examinations were lax. Countless incompetents filled the ranks, and some even obtained the post of medical clerk through monetary contribution, yet dared to call themselves masters of the craft and had the audacity to prescribe for the noble personages of the palace!"

"After the first month, everyone in the Imperial Academy of Medicine, regardless of rank, must be re-examined in medical skill and their positions reassigned accordingly."

"The incompetent among them shall be purged! Those who bought their offices with silver, if found incompetent in the examination, shall be placed on a separate register, receive their salary only, and be forbidden from holding office! If they fail again after one year, they shall be immediately dismissed!"

Hearing these words, so full of killing intent, Zhu Youjian nodded with satisfaction.

Great Ming's system of selling offices through contributions, after years of implementation, had slowly become a routine fiscal operation.

By now, even purely technical agencies like the Imperial Academy of Medicine and the Directorate of Astronomy could open their doors to contributions.

This is as absurd as someone in later ages buying the title of chief physician with money, then actually daring to pick up a scalpel and cut someone open on the operating table. A few days ago, when the Ministry of Revenue was discussing how to deal with next year's financial shortfall of over five million taels, one of the proposals put forward was precisely to "expand the sale of offices" — which Zhu Youjian partially vetoed on the spot.

He is not opposed in principle to selling offices, or selling titles of nobility.

But he prefers large sums and small volume — doing big-ticket transactions in one go.

In this way, on the one hand you get the money, and on the other, you are in effect pulling the local strongmen and great merchants who can produce large sums onto the imperial war chariot, forming a community of shared interests.

Rather than the current situation, with large volume and small sums, turning official caps into rotten cabbages at a wet market. And as if large volume and small sums weren't bad enough, it has even generated "internal competition"!

The main destinations for contribution silver are the Ministry of Works and the Ministry of Revenue, the two biggest spenders.

When the Ministry of Revenue opened its contributions, it started with high prices and low volume: a single Imperial Academy student place cost four hundred taels, bringing in three to four hundred thousand taels a year.

Then the Ministry of Works took on the three great construction projects, ran short of funds, and followed suit by opening contributions!

And the Ministry of Works was even more ruthless: not only was the range of purchasable posts broader, the required silver purity was lower, and they even launched "price-cut promotions." This caused local rich men everywhere who wanted to buy offices to abandon the Ministry of Revenue en masse and turn to the Ministry of Works.

The Ministry of Revenue's income instantly plummeted to just over a hundred thousand taels.

The Ministry of Revenue saw this wouldn't do — they were cutting off my financial lifeline! So they followed suit and cut prices...

The price of an Imperial Academy student place is now not four hundred taels, but only three hundred ninety!

Going, going — don't miss out!

This world truly is one enormous makeshift troupe.

Zhu Youjian had originally intended to slowly abolish the Hanlin Academy, but the more he uses it, the more he finds this department increasingly handy.

All kinds of tracing of the origins of dynastic institutions, all kinds of collated reports on specialized affairs — it has greatly accelerated his learning.

By now, the original Daily Lecture and Classics Colloquium have been uniformly transformed into this kind of "specialized professional study session," held once every ten days.

At first the ministers still remonstrated, urging that more Daily Lectures be held, but after attending a few of these high-intensity study sessions, they stopped bringing it up.

It was precisely during last month's "Study Session on Sorting Out the Contribution System" that Zhu Youjian learned of the aforementioned state of contributions. In the end, the matter of contributions was set so that, within a single year, the Ministry of Revenue would open them for seven months, and the Ministry of Works for three.

And this ratio would be adjusted at any time according to actual need, to five-five, four-six, and so on.

After studying the entire chain of causes and effects, Zhu Youjian was left with no choice but to sigh.

He could only toss the matter to the Administrative Reform Group for now, telling them to carefully draw up new contribution regulations based on the principle of "large quotas, small sums." If all else failed, auctioning off the chance to "Dine with the Yongchang Emperor" was not out of the question either.

In any case, so long as you pay up, what harm is there in me keeping you company for a meal?

If you donate a million taels, I'll even serve you dishes myself!

Of course, it would be best not to put it so crudely — it could be packaged under terms like "Receiving Righteous Commoners" or "Bestowing a Banquet upon Righteous Commoners."

His thoughts pulled back, Fu Maoguang's voice continued to echo across the square:

"The second item is to summon physicians from all under Heaven."

"This matter must first use the 'microscope' as bait."

At the word "microscope," a flash of barely concealable fervor passed through Fu Maoguang's eyes.

"This subject has already rendered the microcosmic entities discovered in the earlier phase — the prick-shaped bacteria, the spherical bacteria, the fuzzy bacteria, and so on — into meticulous illustrated plates, delivered them to Editor-in-Chief Ruan of the Great Ming Times, and secured the page layout."

"The matter of bacteria will also be explained in a dedicated article — this is the true face of the microscopic world, the source of all diseases!"

"Once this matter has fermented for a while and begun to show some results, we will immediately follow up by issuing the summons to compile the Great Ming Medical Canon."

"It is precisely by means of what the microscope has yielded that we shall reorder the medical principles of the world! Revise the materia medica, and reformulate the prescriptions!"

At this point, Fu Maoguang could not help but grow fervent and eager, his graying beard quivering faintly.

Even though the capital teems with nobles and high officials, in terms of the quality of physicians, it is still far inferior to Yingtian Prefecture.

The Jiangnan region is, after all, the most prosperous place under Heaven, where literary culture flourishes and renowned physicians emerge generation after generation.

As for the quality of the physicians in the Imperial Academy of Medicine — to put it bluntly — at times they do not even measure up to the famous doctors among the common folk of the capital.

Yet, if one wishes to supplement the ranks with renowned physicians, simply throwing money at the problem is no good solution.

Many of the Great Ming's famous physicians come in part from hereditary medical families, and in another part from Confucian scholars who switched professions — as the saying goes, "Failing to be a good minister, then be a good physician." They possess tremendous local prestige and connections, deeply beloved by the gentry and common people alike, and the highest-earning among them can even reach the level of a hundred gold pieces per consultation. These people do not lack money; what they lack is "renown," and what they lack is the "Dao."

Therefore, they can only be lured with truth, lured with the chance to leave their names across a thousand ages.

When the microscopic world beneath the lens is unveiled before them, when the theory that "bacteria cause disease" crashes against the fortress of their established understanding, no true physician can resist the temptation to pursue such truth.

"The third item is that the single field of women's medicine shall be divided into two separate fields: gynecology and obstetrics."

Fu Maoguang paused briefly, his expression turning somewhat awkward.

"Of these, the field of obstetrics shall be personally headed and overseen by Empress Dowager Zhang and Empress Zhou."

At these words, the crowd on the square instantly erupted in an uproar, but then quickly fell silent again.

They were all hearing this for the first time, and for a moment did not know what stance to take.

Preach about how women must not show their faces in public? Preach about how the imperial clan and high nobility must not be defiled?

They did not even need to think to know what this Emperor was going to say.

He was certain to drag Empress Ma out to make his case…

Truly, saying anything would be saying it in vain.

Zhu Youjian, however, did not care about their attitudes.

The matter of obstetrics was something he was determined to push through with force, and to push through with great fanfare. On the one hand, it was naturally so that Zhu Youjian's rear palace could spread its branches and scatter its leaves, for the healthy birth of the Great Ming's crown prince.

On the other hand, this was also a major move in Zhu Youjian's grand strategy.

He intended to use this technology to gain enormous prestige among the common people, and to further unite hearts and minds.

In an age where difficult childbirth meant the "gate of hell," the moment the success rate of midwifery rose from fifty percent to ninety percent, no one left under Heaven would ever again question the allure of "science."

The advance of science would become utterly unstoppable.

This was a power that hot-air balloons, bicycles, cement, steam engines, and all such other things could not even begin to match.

There is no other technology that radiates across a broader population, is easier to implement, and holds greater value to the human heart than "midwifery."

Even if this one technology is certain to spur a population explosion, and would, in very real terms, push the Great Ming one more step toward the edge of the cliff.

Yet at this very moment, this is benevolent governance — benevolent governance so great it could not be greater.

Zhu Youjian would, against all pressure, force this matter through to fruition.

The louder the opposition, the greater the prestige he would ultimately reap.

Fu Maoguang, likewise paying no heed to the crowd's reaction, continued reading on:

"The fourth item: the field of smallpox medicine shall be dedicated solely to the improvement of smallpox control."

"The technique of human variolation shall gather renowned physicians for deliberation, and research on the 'cowpox' matter mentioned by His Majesty shall also commence immediately."

This arrangement regarding smallpox and cowpox carried no strong political significance.

After all, smallpox is an "epidemic disease" with an outbreak cycle.

In most regions, even knowing that the human variolation technique exists, people still will not get inoculated.

Only when a smallpox outbreak erupts do the gentry and villagers everywhere scramble to seek out human variolation for inoculation.

There are even wicked and cunning sorts who pass off useless powder as a fine vaccine strain.

After the common people are inoculated, they believe themselves safe, yet cannot withstand the slaughter of true smallpox.

As for the human variolation technique itself, it is in fact a process of repeatedly detoxifying the scabs of those who have had the pox.

At present, it is actually already very highly developed.

Person A contracts the pox; take their scabs, mix with water, grind into powder, and administer to Person B.

The scabs from Person B's pox are then given to Person C. Person C's, in turn, to Person D.

And so on and so forth; under this repeated detoxification, the survival rate of variolation can already reach ninety-nine percent.

But — what if Zhu Youjian were that one percent?

What if the future crown prince turned out to be that one in a hundred?

He could not take that gamble, nor did he dare to.

For this reason, Zhu Youjian even broke precedent and directly deployed the "Grand Prophecy Art," explicitly pointing toward "cowpox" as the direction.

As for why cowpox and not horsepox, goatpox, or monkeypox — that he would not explain. Let the imperial physicians puzzle it out themselves.

And if the cows of the Great Ming proved unusable, then they would cross vast oceans, spend ten thousand in gold, and scour every breed of dairy cow from Europe to bring back and test one by one. When it came to preserving his life, no amount of money was too much.

Fu Maoguang continued:

"Fifth, the surgical branch shall specialize in dissection. Preliminary notice has been given to the Ministry of Justice to preserve the remains of heinous criminals for this purpose." At the word "dissection," quite a few officials' brows furrowed involuntarily.

The body, hair, and skin are received from one's parents; to injure or harm them is a grave unfilial act.

Dissecting the dead — the very sound of it was, after all, somewhat unsettling.

Zhu Youjian took in every reaction from the assembly.

On the matter of dissection, he had originally expected to encounter a great wave of opposition.

He had even wondered whether the matter should be deferred for a while, lest too long a stride tear something vital.

Yet when he summoned the physicians of the Imperial Academy of Medicine a few days ago to discuss it —

these old physicians, who ordinarily seemed so mild and unhurried, reacted in a way that caught him off guard.

Not only did they not object, but one after another, their eyes lit up.

Fu Maoguang went so far as to directly cite the classics of the Old Ancestor:

"Your Majesty, the Yellow Emperor's Inner Canon: The Spiritual Pivot states: 'As for a man of eight chi, with skin and flesh present, the exterior may be measured, palpated, and traced to gain understanding; once dead, he may be dissected and examined.'"

"The Old Ancestor long ago said that after death, one may dissect and look inside to see what it truly looks like!"

Truly, for every matter under heaven, there is an Old Ancestor!

And then, one physician, as though presenting a treasure, handed over a diagram.

Zhu Youjian looked at it — it was something the Old Ancestors of the Song dynasty had done: the Chart of Preserving Truth.

(Image attached: O my wondrous Old Ancestors... is there anything they did not know?) The five viscera and six bowels in the diagram, though not as precise as modern anatomy and with some oddities in placement and scale, had already taken rudimentary form. The markers, lines, and annotations on it were, moreover, the classic annotation methods of later cartography!

Since there was no professional resistance, what was there to wait for?

Begin the dissections! Begin the dissections!

Although Zhu Youjian himself did not fully understand the significance of dissection to medicine —

it was certainly significant! Otherwise, why would silent teachers be so precious in later ages?

If dissecting one yields no insight, then dissect a few more; there will surely be gains.

For now, they would practice on condemned felons.

Later, once his authority had grown enough to amend the law on "commuting punishment by payment of silver" —

(Note: It is precisely because of this statute that Zhu Youjian now basically does not execute corrupt officials, only confiscates their property and levies fines for embezzlement.)

— those corrupt officials and venal clerks who deserve their punishment would naturally become silent teachers for anatomical instruction, making the sole contribution of their lives to the medical enterprise of the Great Ming.

Fu Maoguang continued his report:

"Sixth, the Metal-Instrument Department, abolished in the Longqing era, shall be reestablished, and physicians shall be sent to Liaodong to be recruited."

This item held nothing particularly remarkable.

The frontier garrison towns were harsh places to endure, and physicians were therefore scarce.

As for military physicians specializing in treating wounds, their skill levels were even more uneven.

In times past, many Regional Commanders of the frontier garrisons had submitted memorials on this account, requesting the court to dispatch physicians.

And physicians of the Imperial Academy of Medicine being sent on external assignment to the borderlands to manage epidemics was itself one of their duties.

For example, this very Director of the Imperial Academy of Medicine, Fu Maoguang, had in his youth gone to Liaodong to manage a seasonal epidemic — he was a physician who had truly seen blood and witnessed life and death. Once the microscope was invented, the concepts of bacteria and microorganisms could be disseminated.

Then, with the spread of knowledge about disinfection and hygiene, the survival rate of wounded and disabled soldiers should rise dramatically.

As for whether the tools for sawing off thighs needed improvement, whether any anesthetic was available, whether trauma salves could be refined — those were not matters Zhu Youjian could guide.

After all... in his previous life, he had scored only 23 in biology.

Fu Maoguang closed the memorial and reported the final item — the one that seemed the most inconspicuous but would, in truth, have the most far-reaching impact:

"Seventh, the Barefoot Doctor's Handbook that Your Majesty spoke of is most sound in principle."

"The medical theory involved in this matter is quite simple, yet it requires ascertaining the common ailments of each locality and providing simple, inexpensive, and effective methods of treatment."

"In truth, it is a matter where 'practice' far outweighs 'principle.'"

"Your subjects shall first conduct investigations and surveys within the Northern Metropolitan Region. After compiling and clarifying the common ailments, we shall draft a proposal and send it down to the villages for trial implementation." Zhu Youjian nodded and spoke:

"In the way of medicine, We are also ignorant. There is no need to treat the directions We have given as golden rules."

"In all matters, let comparison and data be the standard."

"When a method is promoted, whether it is effective or not shall not be judged by the reasoning of sages, nor by the laws of the ancestors, but by data alone."

"Simply do a good job of collecting and tabulating the data."

Fu Maoguang drew a deep breath, nodded emphatically, and accepted the command.

"This subject obeys the decree!"

"The method of statistical data from the 'debate between human and geographical factors' has been illuminating to all the imperial physicians."

"The example Your Majesty previously raised, of deducing the source of a plague from data, has also been diligently studied by the entire Imperial Academy of Medicine."

"The protocols of the double-blind test, though cumbersome, will also be rigorously implemented by the Imperial Academy of Medicine."

"In this undertaking, we shall assuredly take reality as our basis and data as our basis."

Zhu Youjian watched Fu Maoguang withdraw, his gaze deep and distant.

Chinese medicine, passed down over thousands of years, was — at least in this era — a medical art far surpassing that of other civilizations.

Consider Charles II of England, born a dozen or so years later, that so-called "Merry Monarch."

By the Qing dynasty, when he fell ill he still enjoyed a series of hair-raising top-tier European medical services — bloodletting, induced vomiting, enemas, cauterization, and the like. Zhu Youjian was no partisan of the Chinese medicine school or the Western medicine school either.

In any case, they should be studied and improved using scientific methods.

If there is improvement, persist; if there is no improvement, refine.

In an age with no Western medicine to jolt it, Chinese medicine had no need to defend tradition against an adversary, nor did it harbor any sectarian biases — it would naturally find its own optimal path forward.

In fact, Chinese medicine itself was in a constant process of improvement.

The continuous refinement of specialty divisions is one example.

The abolition of the original incantation-healing and proscribed-texts specialties is another example.

Of course, such divisions of subjects were still insufficient, but Zhu Youjian believed it would develop well on its own.

From the Emperor above down to the common people below.

In the face of life's impermanence, every person is the most devout pragmatist.

(Attached illustration: the changes in official medical specialties from the Yuan dynasty to the fifth year of Longqing. These are the specialty divisions of the Imperial Academy of Medicine; folk practice was close but certainly not identical.) (Why did the massage specialty disappear — did the Great Ming emperors not enjoy massage?)