Nineteenth Century Medical Guide

Chapter 115 112. White Death
Tuberculosis can be drilled anywhere, so before the 19th century, doctors couldn't figure out what kind of disease it was, and it was easy to confuse it with other diseases, let alone the word "tuberculosis".For example, skin tuberculosis is called lupus vulgaris, pulmonary tuberculosis is called tuberculosis, and spinal tuberculosis is called Pott's disease. 【1】

It wasn't until scientists found in the anatomy that there were solid masses in the lungs of such patients, which felt like tubers on plant roots, that this disease was called Tuberculous (tuber is a tuber, and culous is an adjective suffix) . 【2】

Compared with the extremely straightforward naming method in English, domestic translation requires a lot of literature and art. It is "tuberculosis", just like the "hard knot" and "small nucleus" in the human body, and it can also be understood as "hard core". .

The patient's abdominal cavity is full of small white nuclei, which can be seen at a glance.Carvey saw many such typical cases of tuberculous peritonitis when he was young, but with the improvement of anti-tuberculosis treatment in China, such patients became less and less common, and he did not even have the opportunity to make teaching materials for students.

Now there are very, very few people who really understand and be familiar with tuberculosis, and some people have never even heard of the word tuberculosis.But if tuberculosis is given another title, they must have heard it before, and it is "white death".

"Dr. Carvey, what did you just say? What peritonitis?"

The assistant next to him explained: "I sound like 'peritonitis like a potato tuber'."

"It's tuberculosis, which is the white plague that we usually see, also known as the white death." Carvey explained a little, and then changed the subject, "There are many doctors and medical students present, I think it is more appropriate to use tuberculosis peritonitis .”

Because of the sudden rush of ascites and the pronoun of tuberculosis shouted by Carvey, the auditorium is now in chaos.

Hills in the audience understood what "tuberculosis" meant. It was taught in medical school, but he just mentioned it casually and didn't elaborate, because no one understood it, so it was impossible to talk about it.

Research papers on tuberculosis in cutting-edge medicine did not start to blow out until after 1875, and they only appeared sporadically before [3].Fortunately, Hills is a surgeon and has been dissecting corpses by Ignatz's side. He often encounters tuberculosis patients, and he knows very well that the growth of white balls in internal tissues is a typical pathological change of tuberculosis.

but.
"Can tuberculosis still grow in the abdominal cavity?" Hills drained the ascites, and then took out the mesentery and omentum that had thickened due to inflammation【4】.Looking at the dense tuberculosis lesions, he couldn't help saying to himself: "It's really terrible."

"It's a guess on my part."

After hearing about Semmelweis' handwashing and going through the regular meeting of the Academy of Surgery, Carvey has now become very cautious and is not in a hurry to throw away the definition: "But I did have the honor to see a similar case with the same abdominal pain and the same pain. He had a cough, was also thin and had ascites, and what he saw after being cut open was also such a horrible scene."

"Have you seen it? You are only 17 years old!" Someone in the audience "disapproved".

"It was when I was young." Carvey still put all the reasons on the head of a non-existent surgical barber in the Lombardy countryside, "My adoptive father died early, otherwise a series of surgical diseases would be published in his later years. Open your eyes, everyone, I learned part of my painting skills from him, which is very good.”【5】

There was a lot of discussion on the stage, and Hills in the audience stood alone by the operating table, not knowing what to say: "Do you have any evidence?"

"These small nodules in Mr. Edward's abdominal cavity are very similar to tuberculosis nodules, and any surgeon who has participated in the autopsy of tuberculosis patients can remember the characteristics of this lesion." Carvey explained, "In addition, tuberculosis Pleural effusion occurs, ascites occurs in abdominal tuberculosis, which is exactly the same."

In the absence of a series of perfect theoretical and test foundations such as bacteriology, microscopic examination, and tuberculin test, symptoms and lesion forms have become the absolute criteria for diagnosis.

However, these remarks by Carvey are more like speculations and cannot convince everyone, Hills is one of them.

This is the first operation after leaving the Municipal General Hospital. He originally wanted to declare his "independence" with an absolute victory, so he declined Carvey's request before the opening, and now he also declined Carvey's suggestion: " Dr. Carvey, the reasons you said still don't prove your point."

"I know the evidence in my hand is still weak, it's more just speculation, and it's debatable to call it 'tuberculosis' directly." Carvey suggested, "But since the patient I saw when I was a child was so similar to Edward, I feel that I I have an obligation to remind you."

"Remind me?" Hills began to prepare for cleaning: "Remind me what?"

"My father's patient not only had tuberculosis in the abdominal cavity, but also had tuberculosis in the intestinal tract. And those tuberculosis happened to block the intestinal tract, so it caused severe pain and constipation."

Carvey looked at the operating table and sighed, and said: "Tuberculosis is really troublesome, with a wide range and many lesions, as long as it can cure constipation."

According to the treatment method of modern medicine, the treatment of Edward's situation is also based on internal medicine.Because the best way to fight tuberculosis is always those anti-tuberculosis drugs, surgery can only deal with some organic lesions that cannot be changed by drugs, and it cannot play a decisive role.

Abdominal pain and intestinal obstruction caused by tuberculous peritonitis have different causes. Some can be relieved by surgery, and some can only be closed for conservative purposes. 【6】

According to Carvey, Hills only needs to take a needle to let go of the ascites, and there is no need to open the abdomen.But now that his stomach has opened, it's like opening a watermelon and can't close it. He has to do something, otherwise it will be too embarrassing in public.

Surgery can continue to focus on "exploration", closely related to today's theme.

There are no more than three things to look for, one is whether there is concomitant intestinal tuberculosis, the other is whether there is adhesion between the mesenteric omentum and the intestinal tube, and the other is whether there is ulceration of intestinal tuberculosis.Edward has abdominal pain and intestinal obstruction, so there must be one out of three, and that is the target of this operation.

Regardless of whether it is the real mastermind of tuberculous peritonitis, in short, let the audience watch it first.

Intestinal adhesions cannot be managed [7], so the goal is to find intestinal tuberculosis.Hills only needs to avoid those miliary intra-abdominal disseminated lesions, find the tumor in the intestine, no matter what it is, cut it off and perform intestinal anastomosis to end this tricky operation.

The difficulty of the operation was a bit higher, but Hills had worked as an assistant in Moraso's operation and had seen Ignatz's intestinal suturing.

If it is done well, Edward's tuberculosis will definitely not be cured, but his constipation can be relieved a lot.If you can't do it well, then Kavey has nothing to do, so you can only ask for luck.

But Hills is a strong person after all, and he has already shown his determination by letting go of his position in the Municipal General Hospital.He felt in his heart that Carvey might be right, but he couldn't agree with his mouth: "Dr. Carvey, you mean to let me ignore these crazy spreading lesions?"

"You can't control it, you don't necessarily have to cut off all the tissues with lesions."

Hills looked at the thick omentum in his hand, and said firmly, "Forget about the intestinal wall, but the affected omentum and mesentery must be removed."

Carvey: "."

"Thanks to Dr. Carvey for his reminders and suggestions. Although I don't think it's helpful to me, I still thank him from the bottom of my heart."

Hills snapped his fingers to the assistant, and then made a skin incision: "Because there are too many lesions in the patient's abdominal cavity, I decided to enlarge the incision and remove these lesions by the root. I can't judge the extent of the lesions yet. Therefore, the exact surgical method cannot be given.”

Although Hills is stubborn, he has also learned a lot from Carvey, at least the hands of the operation are honest.

Soon, Edward's body was covered with a layer of gauze, and the soft tissues in his body were taken out of the abdominal cavity, and he lay quietly on the gauze.

The workload of removing these mesenteric omentum is huge, and it takes a lot of time to free them one by one, and it is not something a doctor of Hills' level can do.Even if Ignatz takes over, he will still feel a headache when he sees a large piece of soft tissue in front of him that can't tell the difference between southeast and north.

But in terms of difficulty, this operation is enough to be called a success.

"This is the first attempt in history." Varela, who was sitting behind Carvey, was very excited, "Omentum and mesentery total resection, tsk tsk, full of momentum."

Carvey shook his head and muttered softly, "It's meaningless if the patient dies."

"You can't say that." Varela seemed to have heard his words, and leaned forward and said, "Cesarean section is difficult enough, and the mortality rate is high enough, but since it was invented, surgeons have chosen to try it one after another. .”

"That's impossible."

"The patient's abdominal pain is unbearable, there is no way."

Carvey looked back at the reporter who was arguing with him, and chose to keep quiet, but before he kept silent, he still replied: "According to what you said, surgery is actually simple, and you can cut wherever it hurts."

Varela agreed with this sentence very much: "Yes, isn't this the meaning of the existence of surgery."

"Does that have a headache?"

"Head" Varela choked back just as he was about to answer, "Forget it, I'll continue watching the operation, this operation is more interesting than the half-hour amputation."

The operation time is longer than everyone imagined, even Hills is no exception, except for Kavey.The workload is so huge, the main surgeon is not very proficient, and the speed of the operation cannot be accelerated at all.

After all, it was his own boasting, and Sears had to finish the operation even if he had to bite the bullet.

The audience on the stage also bought tickets, and there was a technique they had never seen before. Although the process was very boring and the commentary was sparse, after all, they bought tickets to enter the arena, and they always felt at a disadvantage if they didn't finish watching.

Everyone in the theater didn't want to give up halfway, but the patient didn't think so much.

"Ms. Hills, the patient's hand is moving."

"Suppress him, and quickly suck him ether." Hills squeezed a mass of tissue, "The operation is almost over, don't let him wake up."

"it is good."

The assistant turned around in a hurry, went back and took out the ether anesthesia equipment he had just used.

Pour a certain amount of ether into the container, and then put the mask on Edward's mouth and nose. After the slowly volatilized ether gas enters the patient's airway and diffuses into the brain, the anesthesia will be successful.

"Cough cough cough~~~"

Edward had a severe cough, but fortunately there was a mask to cover it, so the scene wasn't too bad.

"What are you doing?" Because of the violent shaking of his body, Sears had to stop the knife in his hand, and turned to press Edward's body with his assistant, "Is the anesthesia finished?"

"I, I don't know either."

The assistant, who just graduated from medical school, seemed flustered. This was the third operation in his life, and the anesthesia was the first time in his life: "I did it according to the method you did before, teacher, Seeing him take five or six breaths, he should be under anesthesia. But."

There was another violent cough, and Edward, who was half asleep and half awake, bounced up slightly, and spewed out a big mouthful of blood again.

"Bring the gauze quickly!" Hills was very dissatisfied with the effect of the anesthesia, "And you, wipe off the mask and put it on him again!"

The assistant didn't dare to make a sound, and hurriedly followed suit.

After all, the effect of ether still suppressed the stimulation of coughing in the lungs, and Edward lay quietly under the scalpel of Sears again: "Today's operation was full of twists and turns, and there was a small accident just now. Now my assistant has done it again." The anesthesia is done, and the operation continues."

Hearing this sentence, many viewers breathed a sigh of relief, and for them, they had passed the hurdle with the chief surgeon.

The operation theater has returned to calm, but the tense and exciting atmosphere has not completely subsided. This operation has entered the final stage of closing.

"Teacher, you don't persuade him either."

Carvey couldn't bear to see it, and still hoped that Ignatz could help to say a few words: "The patient is so thin and hemoptysis just now, so lying down like this is not an option. And even if the operation is successful, the patient's body can't bear it, I'm afraid I won't live long."

"Do you think he can listen?" Ignatz shook his head, "It's almost over anyway, let him go."

The operation was still going on under the joint efforts of Hills and two assistants. Carvey sat in the second row and could barely see some suturing and knotting operations, and many fine anatomical details could not be seen clearly.Sometimes, due to the physical occlusion of the doctors on the stage, the temporary operation picture is missing.

At this time, Carvey can only guess the progress of the operation through their facial expressions and movements.

The expressions of the three people before were very natural. Although they were occasionally nervous and dignified, they remained on a relatively stable baseline as a whole.But when the operation was about to end, the assistant who had just given the patient anesthesia suddenly became flustered.

He was very nervous, so nervous that he couldn't know what to do, even more nervous than when he was under anesthesia just now.

Carvey was a little curious, and looked at his hands again. One hand was helping the hook to maintain the surgical field of vision, while the other hand was resting on Edward's arm, as if measuring his heart rate and pulse.At this time, when I saw the patient again, he was very quiet, except for the open stomach, only the blood stains from the previous hemoptysis and a pile of pink foam remained around the mouth.

"teacher."

Ignatz, like other spectators, stared at the central surgical area: "Huh? What's wrong with you?"

"Go and see the patient."

"Patient? Didn't the patient sleep well?"

"I feel like the patient is dying."

(End of this chapter)