Chapter 337 - The Pharmaceutical Factory's Dilemma

Dwelling on Lingao's subtropical climate—its oppressive jungles and labyrinthine river networks—Shi Niaoren was convinced this godforsaken corner of the world harbored at least half the pathogens known to humanity. His old mentor back in the States would have loved it here. A pity he hadn't managed to lure the man along. That American was built like an ox and would have made an excellent laborer for the Ministry of Health. At the very least, he could have been put to work examining stool samples.

Speaking of which, Shi Niaoren regarded the pile of specimen jars before him with barely suppressed despair. A distinguished university professor, reduced to analyzing excrement. The indignity was beyond measure.

What gnawed at him even more was the rising infection rate. His examinations of asymptomatic individuals had revealed eggs from over a dozen parasites—liver flukes, tapeworms, and their ilk. Bacterial carriers were likely far more numerous, but the complexity of those tests exceeded their current capabilities. The broader transmigrator community simply failed to grasp how sophisticated modern medical diagnostics truly were.

Worse still was the willful ignorance his fellow transmigrators displayed toward parasites and infectious disease. Eating wild fruit without care. Hunting game in secret. Consorting with local women...

Every report he filed with the Executive Committee met the same fate: polite murmurs of acknowledgment followed by absolute inaction. They weren't taking it seriously—not one bit.

Perhaps a proper epidemic would finally clear the fog from Chairman Wen's and Superintendent Ma's minds? Shi Niaoren positioned another petri dish beneath his microscope.

Fortunately, this latest sample showed no sign of cholera vibrio or other highly virulent pathogens. Salmonella was present in abundance, however, which explained the unfortunate man's demise. Acute enteritis—treatable, under normal circumstances. Simple antidiarrheal medication and proper hydration would have sufficed.

"Basic antidiarrheal drugs and a few bottles of saline solution in the quarantine camp," Shi Niaoren muttered, "and this man would still be alive."

With summer approaching and gastrointestinal ailments certain to spike, they needed cheap, readily available treatments—immediately. His thoughts turned to the opium sitting in the Ministry warehouse, purchased in Macau and gathering dust ever since. As much as opium was a drug, it remained an exceptionally effective treatment for pain, coughs, and diarrhea. In their current circumstances, it bordered on a panacea.

He disposed of the specimen, scrubbed his hands thoroughly, and lit a cigarette. His first call went to Wu De, informing him the yellow health alert on the quarantine camp could be lifted. His second went to Wu Nanhai, urging him to address hygiene conditions in the cafeteria and food processing plant.

"...Tomorrow," Shi Niaoren checked his schedule, "I'll come personally to inspect. We should draft a summer hygiene notice while I'm there."

"Excellent—welcome, welcome." Wu Nanhai's voice carried a nervous edge.

"Relax. I'm not some Health Bureau official coming to levy fines," Shi Niaoren said. "And don't bother with any last-minute cleaning. I need to see the actual conditions so I can prescribe appropriate measures. If you cover everything in whitewash like powder on a donkey dung ball, I won't catch the real problems—and then we'll have serious trouble later."

After finalizing the inspection arrangements, Shi Niaoren considered calling the Pharmaceutical Factory but decided a personal visit would serve better. He'd been breathing in the stench of feces since five in the morning, and it was nearly noon. A trip to the factory would at least clear his head, and he could scrounge a meal at the farm while he was at it.

The Pharmaceutical and Medical Equipment Factory sat within the farm's perimeter—a composite reinforced concrete structure with a single chimney breathing smoke into the sky. It boasted its own boiler room, geothermal climate control, purified water supply, and a dedicated waste incinerator. First-rate facilities by any measure. Yet this was Shi Niaoren's first visit since the factory had gone operational. It wasn't his specialty, after all.

As a Level 1 facility, the factory maintained strict access protocols. The iron-clad gate was shut tight, and he had to ring the bell repeatedly before a face appeared in the door's small window—a face covered in burn scars. Shi Niaoren started.

Then he remembered: this was one of the disabled soldiers. These men had been assigned to guard posts at vital installations across the settlement.

"Dean!" The guard recognized Shi Niaoren immediately and hurried to open the gate.

Though Shi Niaoren vaguely recalled treating this man, the name escaped him. He offered a polite nod. "Is Zhao Yanmei in?"

"Yes, yes," the guard replied eagerly. "Please wait in the office; I'll fetch her—"

"No need. Just tell me where to find her."

"Director Zhao instructed..." The guard hesitated. "No one is to enter while she's working. I'd better notify her first."

Room numbers beginning with zero indicated the basement—likely the strain laboratory. Though biochemistry wasn't Shi Niaoren's field, he understood the principle well enough. Zhao Yanmei was probably cultivating strains and didn't want foot traffic introducing contaminants.

"How do you notify her?" Shi Niaoren asked, curious. The factory had telephone service, but no internal extensions.

"This way." The guard led him into the guardhouse, limping on an injured leg. Shelves lined the walls, divided into rows bearing small nameplates. Above each nameplate hung a bell connected to a pull cord.

In careful, unsteady characters, the guard recorded the date and visitor's name in the register, then tugged the rope beneath a particular nameplate. A moment later, the corresponding bell chimed in response.

"Director Zhao has been alerted. She'll come up right away."

"Clever system." Shi Niaoren recognized the similarity to hospital call bells. Simple but effective for conveying basic information. The hospital could use something like this. He made a mental note to ask Zhao Yanmei about it later.

Zhao Yanmei's office was separate from the main building. Shi Niaoren waited quite some time before she appeared.

As it turned out, she'd been inoculating Kasugamycin cultures in the strain laboratory. This particular antibiotic served primarily agricultural purposes—preventing crop diseases—with minimal medical applications. It saw occasional use for minor infections, nothing more. Shi Niaoren couldn't help feeling a prick of dissatisfaction. Their joint venture with the Agricultural Committee seemed to be prioritizing farming needs over medical ones.

Noting the displeasure on his face, Zhao Yanmei anticipated his thoughts.

"This is practice work," she explained. "Kasugamycin cultivation is relatively straightforward and doesn't require exacting environmental conditions. If we can master this process, cultivating other strains will be much easier."

"What strains are next on the agenda?" Shi Niaoren pressed. "What about Penicillin?"

"Cultivating Penicillin isn't the difficulty—purification is." She frowned. "That will have to wait until our facilities improve. For medical applications, we can tackle Oxytetracycline first. It's a simpler process."

Oxytetracycline would still be valuable—its efficacy matched Tetracycline, making it a reasonably broad-spectrum antibiotic.

"Oxytetracycline would be good," Shi Niaoren agreed, his expression softening.

Zhao Yanmei's next words soured his mood again: "It's also excellent for fattening pigs."

"Fattening pigs?"

"Mm. Old Yang mentioned it." Old Yang, of course, was Yang Baogui.

"I'm afraid we won't have enough for human use at this rate. We're desperately short of antibiotics!" Shi Niaoren clutched his chest in exaggerated anguish.

"Impatience won't help," Zhao Yanmei said evenly. "None of our antibiotics have undergone animal testing. Given our production conditions, impurity levels will be high. Using them on humans too soon could cause serious complications..."

"We can't afford to worry about that now," Shi Niaoren countered. "First we establish that something exists. Then we worry about perfecting it."

Zhao Yanmei, who had come up through a proper pharmaceutical factory, remained uncomfortable with such rough-and-ready approaches. She fell silent.

"It's not quite so urgent, is it?" she finally ventured. "The Acid and Alkali Plant is about to begin production. The Coal Chemical Combined Plant will follow soon after. Once those are running, we'll be in much better shape."

"I saw the announcements in the newspaper." Shi Niaoren remained skeptical. "But coal chemical products are mainly industrial—synthetic ammonia and the like. How does that help us produce antibiotics?"

"Sulfonamide." Zhao Yanmei's eyes lit up. "Ji Situi told me: once the Combined Plant is operational, one of the byproducts will be raw material for sulfonamides."

Shi Niaoren knew precisely what that meant. Sulfonamide—first discovered in dyes—had been the most effective anti-infective agent before the advent of penicillin-class antibiotics. In this timeline, where bacteria had yet to develop resistance, sulfonamide alone could save countless lives.

"You're certain?" He nearly leapt from his chair. This was extraordinary news.

"Ji Situi himself said so. He's an expert—he wouldn't speak carelessly."

"Yes, yes—we must follow up on this! Absolutely must!"

"No need to rush. The Acid and Alkali Plant fires up the day after tomorrow. The Coal Chemical Plant will take longer; according to Ji Situi, they haven't even stockpiled enough coal."

"Very well. Let's set that aside for now." Shi Niaoren remembered his actual purpose. He described the current sanitary conditions throughout the settlement and proposed that the Pharmaceutical Factory produce some essential medicines.

"...Antidiarrheals. Physiological saline. Glucose solution. And bleaching powder."

Zhao Yanmei sighed. "To be frank, what we can deliver immediately is limited: distilled water for injections, a dozen or so proprietary Chinese medicines, physiological saline, and alcohol. Even glucose presents difficulties..."

"There are complications with the physiological saline as well," she continued. "The salt from Yanchang Village isn't pure enough—too many impurities. And we're running short on sulfuric acid. We can't produce infusion-grade saline yet; oral solutions will have to do for now."

"What else do you need? I'll submit another request to the Planning Committee."

"We need far too many things. I'm afraid even Commissioner Ma can't conjure resources from thin air." Zhao Yanmei smiled ruefully. "Doctor Shi, you should understand—modern pharmacy is fundamentally chemistry."

"You mean—" Shi Niaoren grasped her meaning immediately. "Chemical supplies are insufficient?"

"Insufficient doesn't begin to describe it. They're virtually nonexistent. Take the glucose rehydration solution you mentioned. The process is simple—starch plus acidification. But I have no acid: neither hydrochloric nor sulfuric. I'm forced to use enzymatic methods, which are time-consuming and labor-intensive. Even then, I can't correct the pH of the glucose we produce—because we have no alkali."

Shi Niaoren nodded slowly.

"Gauze and absorbent cotton are the same story. Normally, they must be degreased first—which requires caustic soda. But caustic soda is in desperately short supply. Our available disinfectants are inadequate. The products we're able to produce are barely acceptable. It's fortunate we haven't faced many major trauma cases." She paused. "For now, beyond strain cultivation and proprietary Chinese medicines, the Pharmaceutical Factory can't produce anything truly effective."

"Take comfort—these problems will be solved soon. The chemical plants in Bopu will begin producing any day now. I'll speak with the Planning Committee to ensure the Pharmaceutical Factory receives priority allocation." Shi Niaoren did his best to raise her spirits.

"That would be a relief. With the Three Acids and Two Alkalis available, we'll be able to manufacture a great deal more." She rose and retrieved a sheet of paper from her desk drawer. "Here's a list of coordinated needs and urgent material requirements."

Shi Niaoren examined it. The inventory was extensive: specialized knitting machines for gauze production; complete tailoring equipment and skilled workers for making masks; various large vessels—clay pots, iron pots. The glass factory's order list was the longest by far, encompassing vessels, piping, and alcohol blast burners.

"Also, small injection vials," Zhao Yanmei added. "Those are difficult to produce. The glass factory may not consider them worthwhile; the Planning Committee will need to issue direct research and development orders."

"You're preparing to manufacture injections? Oxytetracycline injections?"

"Traditional Chinese medicine injections, for the time being. We're looking at honeysuckle, isatis root, and Shuanghuanglian preparations, along with cardiac stimulants. Atropine extraction should be feasible."

"That—" Shi Niaoren remembered all too well the fatalities caused by TCM injections in his own time. "Is it safe?"

"Not entirely. TCM extracts contain complex mixtures of components, and the underlying pharmacological mechanisms aren't fully understood. However, preparations like honeysuckle, isatis root, and Shuanghuanglian have decades of clinical use. The mortality rate remains acceptable—they're not considered particularly dangerous. As for Atropine, it's inherently hazardous, but it's also a critical emergency medication. The potential benefits justify the attempt."

"Understood." Shi Niaoren recognized this was simply the reality of their situation.

"I have one more request." Zhao Yanmei hesitated. "All glass containers used by the hospital—injection bottles, infusion bottles, medicine vials—please save them and transfer them here. We can recycle them."

These items were already being preserved. Regulations required that no modern materials be discarded; everything was stockpiled against future need.

"We've been saving them. Washed and sterilized, too. They're currently under the Planning Committee's inventory. I'll arrange for their allocation to you."

"One more request—" Zhao Yanmei seemed to feel she was pushing her luck. "Could you possibly spare us an X-ray machine?"

Shi Niaoren stared. An X-ray machine! Those were Special Controlled Equipment. Because they involved radioactive sources, the transmigrators had exhausted considerable effort to acquire just three units. They were expected to last decades. What on earth would the Pharmaceutical Factory want with one?