“In front of patients, I will always be a pupil.” Dr. Xiaoqian Zhang: the founder of the modern Chinese gastroenterology
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Dr. Xiaoqian Zhang (张孝骞, Hsiao-Chien Chang) was an outstanding clinician, therapist and medical educator, a member of the Academic Divisions of the Chinese Academy of Sciences, he is considered to be the founder of the modern Chinese gastroenterology (PUMCH, 1988). As a doctor, he made a systemic and deep research on human blood volume, gastric secretion function, peptic ulcer disease, gastric ulcer and gastric cancer, celiac tuberculosis, amoebic dysentery, ulcerative colitis and so on. He diagnosed and treated multiple intractable diseases. As an educator, he emphasized the training of clinical basic skills, urged students to grasp the utilization of science in study and work. He trained a large number of talents for Chinese medicine.
In 1923, he was offered a chance to further study at Peking Union Medical College Hospital (PUMCH). During the residency period in PUMCH, because of his excellent performance, he got an opportunity to study in the Johns Hopkins Hospital for one year in 1927. Under Prof. Harrop’s supervision, he immersed in the study of human blood volume. In 1928, he published two research articles in the Journal of Clinical Investigation on progress in blood volume, which was highly appraised by peer scientists and had been widely referenced in professional literature throughout the world (Chang and Harrop, 1928; Chang et al., 1928). Though being invited to stay in the United States, he was concerned more about his impoverished motherland. After returning to China, he hosted a series of research work. In 1931, he published another research article entitled the blood volume in hyperthyroidism on Journal of Clinical Investigation, which was also received extensive attention from peer scientists worldwide (Chang, 1931). In the 1930s, he created the first gastroenterology group in PUMCH and published several research articles on gastric secretion function (Chang, 1933). Since then, Dr. Zhang developed into a well-known clinician gradually.
After the “September 18th Incident”, the Japanese aggressors pressed in step by step. Dr. Zhang, who had been working in PUMCH for 13 years at that time, decided not to work under the control of the invaders. In 1937, he accepted the invitation from his alma mater and moved back to Hsiang-Ya Medical College to continue his study. Unfortunately, as the Japanese aggressors advanced southward, Hsiang-Ya could no longer survive in Changsha. Teachers and students left school one after another, and the college was deep in crisis. At the most dangerous moment, Dr. Zhang took over the role of dean and decided to move the whole college westward to Guiyang. They overcame various difficulties, taking 40 tons of teaching equipment and books with them. Students, faculty staff and their families, approximately 300 people, finally reached Guiyang in one week. In the winter of 1944, the Japanese invaded Guiyang and the college was in panic again. At that time, Dr. Zhang once again led the teachers and students to set foot on a long journey to Chongqing and continued their classes until the end of the War (Rong and Liu, 1987). With perseverance and courage, he avoided the Hsiang-Ya from being destroyed by war and reserved an important source for the Chinese medical science, which was a vivid interpretation of his patriotic feelings that “spring of life, even if mixed with blood and tears, should flow in one’s own country” (PUMCH and Xiangya Hospital of Central South University, 2008).
In the middle of 1960s, a female patient who would shock once catching a cold came to PUMCH. Dr. Zhang had a familiar feeling with the patient and asked about her medical history and found out that she had been hospitalized in PUMCH due to dystocia hemorrhage 30 years ago. However, the original medical records and data were completely gone because of war. After thoroughly digging into a pile of his old special “notes” and fragments of memories,he was suddenly enlightened. The original hemorrhage caused necrosis of the pituitary gland, leading to hypopituitarism, resulting in deficiencies of endocrine thyroid glands, adrenal glands and lacks in emergency response. When the patient was subjected to an emergency infection, the shock would occur. Based on this, she was diagnosed as Sheehan’s syndrome. She was given thyroid and adrenal cortex hormones as an alternative treatment, and then her condition improved quickly (PUMCH, 1988).
Many of his lifelong mottoes has been praised until now like “Tread, as if on the thin ice; Walk, as if on the brink of a deep gulf” (Ge, 2016). In the winter of 1981, he received a medical record requiring him to give a written consultation, and the patient was a farmer. After reading the medical records, he demanded the bone marrow aspiration and lymph node examination for the patient. Two days later, having not received the results of the tests, Dr. Zhang, though in his 80s, went to visit the patient in person regardless of the distance and severe coldness. He had a particular affection on the patients, even in his late years. One night in March 1987, Dr. Zhang who just weakly woke up in the ward, asked for the vice director of the internal medicine department to come to his bed. He cast his doubt directly once he saw the vice director: “The hospital is so large that there are so many patients. Can they find a doctor at night in an emergency?” After getting a satisfactory answer, he fell asleep without any burden. Stories like these are too numerous to enumerate. Medical ethics and medical skill were always completely unified for him. “I would die before I give up” was Dr. Zhang’s life philosophy all along (PUMCH and Xiangya Hospital of Central South University, 2008).
Dr. Zhang was erudite in medical knowledge and clinical experience and was well known for his profound theoretical foundation, but he never slacked in the pursuit of advanced knowledge and studied sedulously during his lifetime. He spent almost every Sunday morning in the library. After cataract surgery, he wanted to read once seeing things. In case other people might stop him, he ordered a car to the library by himself regardless of his ophthalmologist’s dissuade. When he was caught by others, he laughed and said humorously, “it seems that one cannot do anything wrong but you know I haven’t read books for such a long period”. On that day, he kept reading until the closed bell rang for several times. When Dr. Zhang was already an octogenarian, his students advised him not to go to the library on Sunday. He replied, “medical science nowadays is developing so fast and I could hardly catch up with it without continued learning” (PUMCH, 1988).
On August 8th, 1987, Dr. Zhang passed away in Beijing, at the age of 90. There were two regrettable things for him: one was “the Clinical Supplements” had just started; the other was his desire of continuing outpatient service until the age of 90 never came true. As what was written in “Hippocrates: The Oath of Medicine”: “In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves”. Dr. Zhang used “caution, prudence, dread and fear” as his life motto and carried out the oath all along (Zhang, 1982).
A hundred and twenty years later, Dr. Zhang’s edification, forthright admonition and his voice and expression still emerge in our mind. China has been undergoing a radical change after Dr. Zhang’s period, and PUMCH, the hospital he dedicated his whole life to, is now also heading into a new era. China has already grown up with a more advancing healthcare system and healthier people which were just the destination Dr. Zhang had been struggled for throughout his life (Zhang, 1983).
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