Nineteenth Century Medical Guide

Chapter 135 132. A pair of good guys
When Kavi saw the pair of slightly swollen little things on Fernan's chest, he had a strong sense of sight.

But you can't see the problem just by looking at it, and the posture of Fernan sitting on the bed with his chest crossed is not conducive to judgment.If you want to be clear, you have to straighten your body, it is more intuitive to look at, and you can further rely on palpation for differential diagnosis.

Of course, this is a very personal matter.

The two plains suddenly protrude into small hills, which will definitely attract many curious eyes.Fernan seemed very open-minded, even willing to enter the theater for lithotripsy for bladder stones, but he still hesitated when facing them.

He looked at the patients around him who had lived together for so long, and was really embarrassed: "Dr. Carvey, what's going on?"

Carvey knew he was embarrassed: "Let's fasten the buttons first."

"It wasn't obvious after the operation. I thought it was just a side effect after the operation, so I didn't take it to heart. I thought it would be fine in a few days. But after so many days, they became bigger and bigger." Fernan suddenly Lowering the volume, he whispered, "It feels the same as a woman's when pinched."

The interns on both sides were just surprised when they watched it at first, but after he mentioned it, they couldn't help laughing.

"Is this funny?" Carvey turned back and said to them, "You can make him shrink back with two laughs? Don't even think about who you are!"

Both of them are rich young masters in formal attire, and they look a year or two older than Carvey, but there is no room for refutation in front of each other.Before passing the medical school graduation assessment, the hospital practice is obedience: "Teacher, what should I do next?"

Different from other hospitals, because there are many patients and poor people in the Municipal General Hospital, there is no curtain between the beds, so there is really no privacy at all for direct examinations.Fernan was in a special situation, he could walk and run, so Kavey simply took him to the examination room.

Judging from the shape, his chest has obvious hyperplasia.But he himself is not fat, this should not be as simple as being fat.

Because the suspensory ligaments of men are not well developed, the breasts that grow suddenly in a short period of time will pull the skin down and fall off【1】.

Just now Fernan had his chest in his mouth, and his field of vision was narrow, so he couldn't see clearly. Now when he stood up straight and unbuttoned his shirt again, everyone except Karvey couldn't help exclaiming: "Good guy! "

Not only are they swollen and protruding, but they even sag a little. Kawei is basically sure that it is male breast hyperplasia.

"Mr. Fernand is 26 years old this year?"

"Well, 26."

Kavey nodded, basically ruled out physiological hyperplasia [2], and the rest are pathological hyperplasia.The root cause is the disorder of sex hormones in the body, and the ratio of androgen: estrogen decreases.It may be due to less androgen secretion (gao pills), or more estrogen (adrenal gland), or less estrogen inactivation (liver).

If you want to dig deeper into the root of the disease, those are the ones that fit Fernand's situation, and the most likely one is the liver problem after drinking a lot of alcohol.

It's just that there are no blood and imaging tests, so there is no way to make a judgment, so we can only do a physical examination first.

"It's very soft, without nodules, it should all be mammary glands." Carvey said to the two interns behind him while doing palpation, "Do you know all the breasts?"

"Well, yes, I taught it in anatomy class."

"This is the abnormal hyperplasia of the mammary gland in men. It is rare, so you should try it."

Carvey gave way to the inspection position, and the two hands on Fernan's chest became four hands: "Use the pads of your fingers to feel, and slowly follow the order I said, to find out if there are any knots. Nodules or other tumors. If a female patient seeks a doctor, this method must also be used to judge whether it is a nodule or a tumor.”【3】

Fernan was very uncomfortable: "Doctor, what are you doing?"

"Teaching hospital, be patient, it will be fine soon." Carvey continued to explain the main points of palpation, "After touching a hard object, check its size, texture, whether it can move, whether the edge is smooth, and ask Is there any tenderness? Oh, by the way, please be sure to bring a nurse with you during the examination."

The two interns were very studious, and the whole inspection lasted 3 minutes.

When Fernan buttoned his shirt again, he asked, "What should I do now?"

"Take off your pants first."

"???"

"hurry up."

Fernand really didn't understand why the top became bigger and he had to check the bottom, but since they were all men and it was the doctor's request, there was no time to worry.The result of the examination was as expected by Kawei, the size and shape of the bilateral gao pills were all right: "It seems that the problem is in the liver."【4】

Fernand pointed to his upper right abdomen: "Mr. Alphonse often talks to us about his liver, which is said to be comparable to the fattest foie gras."

"This is not a good thing." Carvey picked up the medical record and made some records.

"It's true, it's disgusting to think that my internal organs are almost the same as the food on the table." Fernan said so, but he was still curious, "Is my liver the same as his?"

Carvey stopped writing and explained: "If his is foie gras, then yours should be similar to black bread."

"???"

"You have drunk too much."

"It's okay." Fernand didn't think there was any problem with drinking. "Satimo and Lagurete next door drink much more than me, and I haven't seen them like this."

"Come on, touch my stomach."

Carvey motioned him to lie on the examination bed, with his legs bent, put his four fingers together on his right hand, and palpate with the end of the middle two fingers: "Inhale, inhale, continue to inhale. Okay, now exhale, exhale, exhale slowly and then come back again." , inhale.”【5】

Decades of clinical experience have allowed him to feel the texture of the liver with a simple sense of touch, which is not what a normal liver should feel [6]. Fortunately, there is no shifting dullness or drum sound, and there is no fluid accumulation in the abdominal cavity.

"Doctor, how are you?"

"The liver is a little bigger and the texture is a little hard," Carvey said, "but it's softer than the black bread I just said."

"That's okay?"

Carvey sighed, considering the current level of medical treatment [7], it is really impossible to tell the truth about early liver cirrhosis: "It can also be said that it is not easy to cure. If you want to live longer, you should Hope you quit drinking."

"How about that!"

"If it doesn't work, then I won't treat you little things, you'd better ask someone else." Carvey pointed to his chest and said, "But I don't think there are many doctors in Vienna who can completely cure it. .”

"Can't it be cut off?"

"Yes, just cut off the penis together." Carvey flicked the quill in his hand, "If it's not cut well, it might dent a large piece, if it gets infected and festers again."

Fernan is very concerned about his appearance. Speaking of this, he has completely cut off other thoughts: "If Dr. Carvey can really remove them without affecting their original appearance, I can try to quit drinking."

"It's not about trying, it's about quitting now!" Carvey was very firm. "There's no rush for the operation. You just finished the lithotripsy and you need to rest for a while. Wait another half a month until your physical strength recovers."

"Ah? Still waiting?" Fernan was in a dilemma. "If it grows any longer, the clothes will almost be unstoppable."

Carvey really admired his courage: "Don't want to wait? Then don't blame me for dying on the operating table."

"Okay then, just wait."

"I'll write you a date. You usually pay more attention to their size. If there are any further changes, come to me." Carvey wrote a few notes into notes and handed them to him, "Remember, don't drink anymore gone."

Fernand should have suffered liver damage caused by alcohol. The liver was hard but did not become smaller but rather enlarged. It was the early stage of liver cirrhosis.

Of course, these are all information brought by palpation, not a real diagnosis. All Kawei can do is to urge him to drink less alcohol.In fact, even if it is really clear that it is a liver problem, he has no medicine in hand, and treatment is almost impossible.

All Carvey can do is minimize his pain.

Delaying liver damage by abstaining from alcohol, and getting rid of those two annoying little things was the way to improve his quality of life.It's just that it's not easy to really quit drinking, and it requires the efforts of family members. Unfortunately, he has never met Fernan's family members.

After the ward round, Carvey went to see several women who needed cesarean section. One of them was approaching her due date, and the operation was scheduled for the day after tomorrow.

It was still early when he left the hospital, so he didn't rush home, but went to see Laszlo first.

The wealthy Hungarian businessman had been dealing with Franz since he learned of the news of the impending war between Prussia and Austria, hoping to use his own strength to quell the war.For a businessman like him, although war can also be profitable, it is far less comfortable than usual.

He was optimistic about Prussia before, but now that he understands Austria's combat readiness, he thinks that Austria's chances of winning should be greater.Once the Prussian-Austrian war breaks out and Austria wins, the Austro-Hungarian line that was previously used as a bridge will change from an equal negotiation between the two places to a reverse post by Hungary. The situation is very unfavorable for Hungary.

If Hungary does not agree to the terms, the merger talks will be put on hold indefinitely.

Because the Austrian emperor preferred to move westward to obtain substantive German unification, rather than playing a small game of eastward expansion with a group of foreigners, the merger of Austria-Hungary was a helpless move to maintain the image of a great country.

"War may be inevitable." Laszlo was sleeping on the couch, enjoying the sunshine in the spring evening. "You should have received the earl's order."

Kawei stood aside, drinking the milk tea just brought by the butler, and nodded: "I have to report in a few days, write a name, and then get familiar with some internal rules of the military doctor. I don't know when I have to go with him "

"I guess it will be July or August." Laszlo sat up, "If Chino can work harder, the time can be extended to September."

"I don't know how many more people will die. It will be fine if there is no war."

"It's difficult." Laszlo sighed, "It's not up to us to decide how things will develop. At this point, it depends on who will do it first. All I can do is hold down Franz's hand so that he won't be in a hurry. Go ahead."

"Let's not talk about this for now."

Kavi came here not to talk about the Prussian-Austrian War, but for his own surgery and scientific research: "Before you recommended my rubber factory, can it make gloves?"

"I asked, and it's not a big problem." Laszlo also took a sip of milk tea, stood up and stretched his shoulders, "It's just that rubber is very expensive, and the original cost is not low. modeling"

"Money is not a problem." Carvey used this sentence this time, "As long as the quality passes the standard."

Laszlo smiled: "I didn't expect people to use rubber to make gloves. What do you want?"

"Rubber gloves are convenient for disinfection and cleaning. With the same disinfection and cleaning process, rubber gloves are definitely cleaner than hands."【8】

"I don't understand medical care, anyway, I'm sure I can help you with the gloves you want." Laszlo began to get into his own topic, "The previous patent has been approved, and the pharmaceutical factory has also started work. It is expected to be produced in April." Plenty of oxytocin."

Kavi nodded, looking at Laszlo who was looking at him: "Well, what then?"

"Then? Of course it's your blood anticoagulant." Laszlo said, "You don't think our pharmaceutical factory only makes this kind of medicine, do you?"

"I told you about the anticoagulant after the operation, and it needs some technical support before it can be used."

Laszlo finally revealed the nature of a businessman: "What I want is to make money. Since you opened a pharmaceutical factory for you and met so many conditions for you, shouldn't you speed up the progress here? Time waits for no one, My Dr. Carvey."

Carvey understood what he meant: "The paper is already in a hurry, and I will translate it into several languages ​​and submit it to some medical journals."

"No, not enough!" Laszlo reminded, "How much time will it take to come and go, by the time the medical community spreads your method, the war will be over long ago."

"I know that there will be no news in a few months, and it depends on luck whether I can be picked up by those journal editors, so I thought of another good way." Carvey tapped two fingers lightly. The small wooden table next to the person, "Since the war is inevitable, since the war will cause heavy casualties, and I was conscripted to be a military doctor."

Laszlo frowned slightly, and immediately understood the meaning of Carvey's words: "You mean to use autologous blood transfusion by war, and then sell the anticoagulant to Franz?"

"When I go back, I will write a plan for autologous blood transfusion, and send it to the Military and Political Department when I report it." Carvey said with a smile, "This is a good thing that can save a large number of wounded in the empire, and it can also help our little ones. The pharmaceutical company injected a lot of money."

Laszlo raised the cup of milk tea, and a smile finally appeared on the corner of his mouth: "It is indeed a good thing, a great thing!"

(End of this chapter)