Chapter 30: Acute Childhood Convulsions

A commotion arose inside. Two young maids, hair coiled into upright buns, came slowly out, their joined hands supporting a child.

He looked three or four, bundled up like a little panda. His whole body jerked rhythmically. His head was thrown back, eyes rolled upwards, and his small face was utterly pale. Harsh sounds came from his throat; his jaws worked incessantly, and bloody white foam clung to his mouth.

A short, stout man in a flat blue gauze futou, a knee-length silk-lined jacket and blue silk trousers bustled beside them. He looked every inch a country moneyed man. Sweat covered his round forehead as he shouted for speed and care.

A young woman with a hairpin in her cloudlike coiffure kept wiping her eyes. Behind them, a stout, richly dressed elder with a grizzled beard swayed over his walking stick.

“My darling! What’s happened to you?”

They laid the child on the couch. His back arched violently, his belly thrust upwards, his limbs rigid and bent back. He made painful, choking sounds.

Crying and calling his name, the maids seized his stiff arms and tried to force him flat. The tenants lifted the couch.

“Wait!”

Zuo Shaoyang rushed forward.

“Don’t do that! You could break his limbs. And he’s struggling to breathe. Carry him like this and he’ll die before you reach town!”

“What?”

The richly dressed man turned.

“Who are you?”

“A travelling doctor, here with my father. We heard your son was taken ill. You mustn’t force down his limbs. This is opisthotonus following convulsions; forcing them could cause fractures. The blood in the foam means he has bitten his tongue. He needs treatment immediately.”

He sounded knowledgeable enough to earn some trust.

“What should we do?”

Zuo Shaoyang set down the chest, took out a tongue depressor and opened the child’s mouth, placing it between his teeth.

“Otherwise he may bite his tongue badly, or even through it.”

“Thank you!”

“There’s phlegm in the saliva and rattling in his throat. It’s gathering thickly. Town is more than an hour away. Without immediate action it could block his windpipe and suffocate him.”

His mother began crying.

“What are we to do?”

The father bent to listen. There was indeed a phlegmy rattle. His face changed.

“We must first rouse his consciousness and open the orifices so he can cough it up himself. Then take him to a skilled physician in town. He won’t last the journey otherwise. Let me examine him.”

Desperate, the man waved the maids aside.

Zuo Shaoyang inspected the child carefully.

“How did it begin?”

“He caught cold some days ago. Fever, cough, sneezing, runny nose and chills. We took him into town and got medicine…”

“Where? What medicine?”

“Huimin Hall. It was called… what was it?”

He turned to his wife. She could not remember either and asked a maid. Fortunately, the girl who prepared the medicine recalled enough.

“Something with ephedra, gypsum and liquorice. A long name.”

“Ephedra, Apricot Kernel, Liquorice and Gypsum Decoction?”

“Yes! That’s it.”

Commonly shortened to Ma Xing Shi Gan Tang, the formula treated coughing due to lung heat and was suited to an external wind pathogen with heat congesting the lungs. It sounded appropriate.

“Did it help?”

“Somewhat. The fever eased, so we brought him home. But this morning it suddenly became much worse. We were about to take him back when he began convulsing.”

Zuo Shaoyang took the child’s wrist and used one finger to assess all three pulse positions. After a moment, he said gravely, “Wind with cold invaded his lungs. It hasn’t resolved, and phlegm-heat congestion has caused high fever and acute convulsions. We must rouse him so he can cough. If that fails, we’ll have to…”

He left the rest unsaid.

If the child showed life-threatening suffocation despite attempts to revive him, he would have to perform a tracheotomy. A minor operation in modern surgery, but unknown here. He dared not mention it lightly or frighten the family further.

What he had said was frightening enough. The father saw the child’s purple lips and laboured breathing and turned anxiously to the elder.

“Father, what shall we do?”

The old man looked at Zuo Shaoyang, then searched about.

“Young doctor, where is your father? Please ask him to help us decide!”

They did not trust his judgement. He could only sigh inwardly and point at Zuo Gui, still approaching slowly.

“There.”

The two men hurried to meet him and bowed.

“Doctor, our child’s ill. Your son says it’s acute convulsions. Please examine him.”

Zuo Gui stroked his beard, deeply uneasy.

Since opening the shop, he had chiefly treated headaches, fevers and diarrhoea. He had never managed a child’s convulsions and did not know how. Saying so would disgrace him; treating blindly and delaying proper care would be a far greater sin.

His son recognised the uncertainty but could not instruct him openly.

Zuo Gui remained composed. After examining the child, he nodded.

“Acute convulsions, yes. But… we only brought medicines for wind-cold on our rounds, nothing for this. Take him into town quickly.”

His father was afraid to treat him. Zuo Shaoyang grew desperate. The child needed a clear airway now or might suffocate on the road.

Before he could speak, the elder cupped his hands.

“Saving a life is better than building a seven-storey pagoda. Please help. Son, give the doctor his fee!”

He had already believed Zuo Shaoyang’s clear and accurate explanation. Cheats who merely boasted were a minority among travelling physicians; most possessed secret pills or remedies for unusual conditions. The son’s youth alone had made him seek the father.

The claim to have no suitable medicine sounded like an excuse. The old doctor must be bargaining, demanding payment first. He knew nothing of their promise to charge only after recovery.

The father patted his waist. He had no money on him. A village notable had little reason to lug heavy copper coins everywhere.

“Steward! Pay the doctor!”

The steward carried money and hastily opened his purse. Before he could count, the master snatched it and offered the bulging bag to Zuo Gui without looking inside.

“A small token. Save my son and there’ll be more.”

Zuo Gui reddened and waved it away.

“That isn’t what I meant. We treat first and charge only if it works.”

The more he said, the more certain they became that he wanted money. His words also suggested confidence in a cure. Their pleas grew more fervent.

Seeing him still hesitant, the father pressed the purse into Zuo Shaoyang’s hands.

“Please persuade your father to save him!”

“Father, his life comes first. Help him!”

“Yes! Thank you, Doctor!”

Father and grandfather bowed repeatedly.

The money had been forced on his son. Refusing again was awkward. But Zuo Gui had no idea what medicine to use.

He examined the child once more, took the pulse, inspected the tongue and stood stroking his white beard in silence.

Every eye was on him.

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