Nineteenth Century Medical Guide

Chapter 184 181. The medical theoretical basis of "flexibility" can be jumped repeatedly
Such a patient who is highly suspected of breast cancer has persistent severe headaches. During the hospitalization, he also experienced upper limb fractures on the same side as the tumor and multiple epilepsy. Most doctors' diagnosis will be biased towards breast cancer brain metastasis + bone metastasis. It is also sure to do a head ct + fracture site examination at the first time.

The function of examination is nothing more than to confirm the diagnosis and provide indication basis for the next treatment.

Once the diagnosis is confirmed, the next step is to establish a more tortured treatment plan.Local surgery, systemic chemotherapy, localized radiotherapy, palliative care only considering the quality of life, giving up completely after considering money, or deciding to take a gamble and find another way.

Although modern medicine is far from being able to achieve a perfect cure in the face of cancer, fortunately, every patient and family member can have their own choices, and the risks to be faced, the money spent and the possible outcomes are all acceptable. foreseen in advance.

But in the 19th century, patients had to deal with the unknown.

First of all, the condition is unknown.

Diagnosis in the 19th century did not have an objective criterion, or even a theoretical basis, and relied entirely on the experience of doctors.For the king of diseases—tumor, medicine in the early days only knew its harm, and lacked the vigilance of tumor metastasis.

Therefore, based on Massimov's decades of medical experience, Mrs. Santini's upper limb fracture was caused by a simple fall.And based on Ed Nelson's decades of medical experience, such a persistent severe headache should be caused by evil spirits.

Second, the treatment they need to face is unknown.

Patients can almost only passively accept the doctor's advice, and they and their families can only do right and wrong questions, rather than multiple-choice questions after weighing the pros and cons like modern medicine.True or false questions determine not only the execution of treatment, but also the fate and prognosis of patients.

The pain in the early stage of breast cancer can be tolerated, so the patient chooses to ignore the choice, and the result is spread + metastasis.

Because the headache cannot be tolerated, the patient can only accept treatment unconditionally in order to relieve the pain, and the result is that the more the treatment is, the more outrageous it is.

The final outcome of all treatments is also unknown.

The treatment selected by the doctor is the treatment that is most suitable for the patient's current condition in their mouth, and there are no adverse reactions and no complications.This is not against their will, because this is what they have been taught in class, and the vast majority of doctors believe in it.

Of course, the above three points all need a foundation, which is the foundation of the extreme lack of medical theoretical knowledge.If the ability is not enough, it will be futile to talk about more systems.

But when it comes to the height of Massimov and Ed Nelson, years of experience will bring them some doubts after colliding with reality.

For example, Massimov questioned whether his surgical ability could really solve Mrs. Santini's swollen breast cancer.Another example is that now Ed Nelson has also begun to question whether Mariana's seance and exorcism meeting has really reached the level of being able to get rid of evil spirits.

However, due to Marianne's identity and self-cultivation, his words were extremely restrained: "It's really rare to have severe epilepsy during spell treatment."

"There must be no problem with the enchantment, and there is no problem with the altar. I have arranged them according to the standard "Bible Magic"."

Mariana was sitting in the physician's office, holding Buster in her arms: "It's even more impossible for Buster to have a problem. Its psychic ability is impeccable, and it has even been recognized by the Pope. Although the Pope himself Don't like cats, but Buster is special."

Speaking of this, Ed Nelson raised his eyebrows: "From the symptoms, her epilepsy seems to be more like a backlash. Maybe our exorcism is too strong and stimulated it."

"Maybe."

Mariana was also taken aback by Mrs. Santini's strange reaction just now, and subconsciously stroked Buster's hair to relieve the pressure: "How is Mrs. Santini now? The reaction just now was really terrible."

"The convulsions are over, but the headache is still there."

"Well, if possible, I really hope to continue the remaining exorcism."

This kind of thing happened halfway through the exorcism, even if the patient had faith, he would doubt the feasibility of the exorcism, at least like Ed Nelson, he would doubt Mariana's level.Mariana also knew that she had no chance, and these could only be self-consolation afterwards: "She will be fine, right?"

"We will do our best." Ed Nelson nodded, and at the same time leaned forward and said, "Countess, I need to see my patient now."

Mariana got it right: "Go, I won't bother you."

"Let me get you a carriage."

"Don't bother, Nora is here." Mariana walked to the door with Buster in her arms. "If possible, please tell me the follow-up after the treatment is over."

"must."

At this time, Carvey and Massimov were standing in the internal medicine ward, in front of the busy physicians and nurses.

Regarding Mrs. Santini's illness, the internal medicine department was still at a loss. From top to bottom, it was believed that the soul of an octopus in the dark deep sea was causing trouble.But as surgeons who trust the reality in front of them more, the opinions of the old and the young next to the door have basically reached a consensus.

It's just that there are too many traces of Kavey's guidance in this "consistency".

"The tumor metastasis you mentioned means metastasis along the lymphatic channels?"

"In addition to lymphatic channels, there are blood vessels in the body." Carvey said.

Massimov gasped, lowered his head and pondered for a moment: "Tumors need blood supply, so it's not impossible, but can such a huge tumor really spread so far?"

"Breast cancer on the left side, fracture of the left upper limb, and the location of the headache is also close to the left side, which can't be considered far away."

"What? The fracture site is also a tumor?" This made Massimov somewhat unexpected, "I checked, and the symptoms seem to be just ordinary fractures."

"The patient is only in his 30s, and he just fell on flat ground, so the chance of fracture is not high." Carvey explained, "Even if there is a fracture, it should be in the thinner forearm, not the thicker back arm. Unless normal The bone has been damaged to a certain extent, and this damage increases the fragility of the bone, which eventually leads to fractures."

Overall, Massimov still trusts Carvey.

But trust is more based on surgery. For example, in abdominal surgery and breast surgery, Kavey has made a name for himself in the Austrian surgical field. Massimov almost treats the young man in front of him as an equal. people.

But in terms of medical theory, the old man was very cautious.

If he really wants to believe in Carvey, his attitude towards intracranial and bone tumors should be the same as that of breast cancer, and he should actively treat them with surgery.But now Massimov just stood by the door, looking at Mrs. Santini lying on the bed in the distance, without saying anything.

"The teacher thinks there are loopholes in my opinion?"

Massimov shook his head: "On the contrary, the theory you mentioned is logically consistent."

"The tumor has developed to the point where it is now, and we can't delay it any longer." Carvey suggested, "The patient should be sent to the surgical ward immediately, and the surgeon will take over with full authority, and then formulate a surgical plan suitable for the patient. Even if there is no way to completely remove it The tumor should make Madame Santini's life easier."

"I only say that the logic is self-consistent, but there is still no theoretical proof."

"Is it necessary to wait for Mrs. Santini to do an autopsy after her death, and then compare the cell structure under the microscope to prove the theory?" Carville shook his head repeatedly, "How can surgical treatment be bound by such things."

"But the patient is not mine." Massimov said the key point, "You can't even convince me, how can you convince Ed Nelson?"

Carvey realized that the root of the problem still lies in the insufficient foundation of medical theory.Nowadays, the knowledge of cell biology, physiology, and pathology is still too shallow and has not formed a system. Even if you learn it all, it will give people a vague feeling.

In order to get the old man in front of him to agree to have an operation with Ed Nelson, he had to explain his "theory" more thoroughly.

"Actually, this is the same as the colonization of some bandit countries, such as France, which claims to be romantic, and Britain, where the streets are full of gentlemen." Carvey said, "They send colonial troops around the world, and only a few people can A large colony developed after a few years."

The explanation was so straightforward that it was impossible for Massimov to understand: "You mean that after a small part of the tumor tissue fell off, it went along the pipeline to re-grow a new tumor elsewhere."

After the theory is updated, clinical thinking always needs to do some adaptation work.

Although Massimov felt that Carvey's theory was trustworthy, he was still struggling with the name and origin of the tumor, because the location and symptoms of the tumor were different.Intracranial tumors manifest as headaches and seizures, tumors on bones manifest as increased bone fragility, and breast cancer itself is just swelling and tingling.

Is it inappropriate to use the same name to represent three tumors?
"Teacher, you should look across the ocean. The Americas occupied by Britain and France have developed into the United States after driving out the aborigines who used to live there."

Massimov's thoughts suddenly became clear: "So that's how it is."

At this time, Ed Nelson's voice came from a distance. After seeing off Marianna, he went straight to the ward, hoping to see Mrs. Santini's situation: "The seance is over, why haven't you left yet?" ?”

"We're discussing the condition."

"Such a stubborn and severe headache is really troublesome." Ed Nelson said helplessly, "Combined with the failure of the exorcism just now, I am afraid it is impossible to completely cure it."

"Has the teacher considered changing the treatment method?"

"I've tried many kinds, but the effect is average." Ed Nelson didn't lose his confidence in treatment, and vaguely demonstrated his right to treat patients, "But don't worry, I already have a treatment strategy that matches the symptoms. "

"What treatment?"

“At first we applied to the hospital to buy an electric bath for the treatment of some intractable skin diseases, muscle pains and mental disorders,” Ed Nelson said, “but the application was put on hold because of funding.”

Massimov sneered at this: "Come on, do you think the life of a shoemaker's wife can make the dean spend a lot of money to buy this expensive machine?"

"Of course not."

Ed Nelson knew the dean very well: "But if the treatment is really effective, then Mrs. Santini can become strong evidence. Even if the dean continues to refuse, it is still a debt to me, and I will apply for other devices later. At that time, he might be in the way of sympathy, so he approved it."

"But the question is, how do you get her to take an electric bath?"

"There is a resort in the suburbs, and there are two sets there, and the business is pretty good." Ed Nelson said with a smile, "Tomorrow I will take the patient there for treatment. If there is no accident, Mrs. Santini will be able to recover that night. home."

Seeing that the patient was about to fall into his palm again, Carvey wanted to struggle again: "But the patient has already received electric shock therapy, and the effect is not good."

"It's just a partial electric shock, and it doesn't stimulate the whole body like an electric bath." Ed Nelson explained, "It's a weak electric current that can relax the whole body, compared to ordinary electric shocks."

Speaking of this step, it seems that there is no room for further suggestions.

But Carvey did not choose to give up like Massimov, but wanted to struggle again: "From the reaction just now, it seems that the evil spirit in the patient's skull was stimulated by the exorcism, which caused the overreaction. epilepsy."

Massimov: Why did the tumor become an evil spirit again? ? ?
Ed Nelson: Like me? ? ?
In the face of different people, in order to achieve the purpose of surgical treatment, Carvey chose a completely different interpretation route.Massimov can still take the orthodox medical route, but for Ed Nelson, he can only choose theology: "I think the evil spirit just wants to come out to breathe."

".Interesting, let's go on!"

"The skull is closed, filled with soft brain tissue, it has no room to live."

Carvey tried to confuse the already separated theology and medicine again: "It's like a small room without doors and windows. Not only is the space small, but there is no light. People will definitely go crazy if they stay in it for a long time. At this time, if you go inside Infuse some messy things, and people will resist. It is this repeated resistance that leads to headaches."

Massimov: What are you talking about? ? ?
Ed Nelson: Makes sense! ! !

"This is similar to the idea of ​​ancient Roman medicine." Ed Nelson pondered for a moment and asked, "Do you think the current bath will continue to stimulate it, but it will cause a more severe headache."

"It is true from the previous course of disease development."

"Then what do you think should be done?"

"As the teacher said just now, according to the ancient practice, Mrs. Santini's head should be drilled open to open a window that can ventilate the room that has been closed for a long time." Carvey said, "But the primitive drilling technique is too simple , my plan will go further than before.”

[Can anyone guess what surgery was chosen? 】

(End of this chapter)