Nineteenth Century Medical Guide

Chapter 244 240. Internal Medicine
Typhus and typhus have always been the big killers of population control. It was not until the emergence of antibiotics sufficient to fight them that the development of infection in patients was controlled.But there were no antibiotics in the 19th century. Even if there were antibiotics, they were still in charge of treatment. To really effectively prevent the spread of infection, you have to pinch its source fundamentally.

The source of typhus is Rickettsia lice [1], which is transmitted to humans through body lice and rat fleas.

Carvey's military doctor's manual spends a lot of space on regulating the army's water use and personal hygiene, and it also clearly explains rodent and insect control.But apparently, the Sixth Army doctor didn't take his manual seriously.

The military doctors of the Western Front Army also received the training of Carvey, but they were not bound by Carvey, and there was no point promotion system.

Besides, it was the physician here who dealt with Adams.

Carvey bid farewell to Adams, and instead of going directly to the doctor in charge, he went around the ward first, wanting to see with his own eyes how the situation had progressed.

He tightened his collar and cuffs, wrapped a black cloak, and followed by the guards, he opened the curtain and walked into one of the tents.

Suddenly a strange smell in the air pounced on the tip of his nose.

Without alcohol, without carbolic acid, Carvey hasn't smelled this smell in a long time.If I had to describe it, the air here was like that of an uncovered gutter oozing with filth.

At this time, two soldiers in military uniforms were carrying a corpse wrapped in fragments of a tattered cloak and walking towards the door.

"Come on, give way!"

Kawei glanced at the corpse, there was no blood on it, so he asked a lot: "Excuse me, how did he die?"

One of the most basic questions in modern medicine has become a difficult problem for everyone in this tent: "You have to ask the doctor, we don't know."

Carvey did not embarrass them, but continued to ask: "Oh, where is the doctor?"

The soldier suddenly saw the half-covered collar patch under Kavey's cloak, and trembled in his heart: "The patient is being treated inside."

"Thank you."

Kavey nodded and let the two of them go in.

[The best place to measure the disaster of a war is not the battlefield, but the hospital], this is a passage written by Ignatz in "Memoirs of a Surgeon".Carvey hadn't been able to fully understand the meaning of this sentence before, but now he fully understands it.

The Sixth Army's temporary rescue station, which was the barracks hospital that Etler mentioned earlier, had already fallen into a dilemma of shortage of medical resources.

Three of the four large tents accompanying the army are used to house the traumatized and wounded, and the other is a temporary medical ward, which deals with mild patients, and those with serious illnesses will be transferred to the surrounding farmhouses for care.

However, apart from slightly different treatment methods, the accommodation conditions of soldiers are not much different regardless of internal medicine and surgery.

There are hundreds of patients living here, and the shortage of beds is such that two people sleep in one bed, and many soldiers can only lie on the ground wrapped in blankets.There were several corpses among them, and the one that was removed just now was just one of them.

The head of internal medicine, Dr. O'Rourke, is standing at the back of the tent aisle, treating a patient: "Your forehead is a little hot, it should be just a cold, I will let the kitchen prepare leeks and rose petals for you , mash it thoroughly and then add some milk, stir evenly, and then."

"Will drinking that stuff help?" The patient's nasal voice was indeed very heavy.

"Drink?" O'Rourke shook his head and pointed to his temple, "No, that's for wiping his head."

"Wipe my temples?"

"Yes, rub it for 10 minutes, only in this way can it cool the blood and relieve the headache." O'Rourke simply wrote two strokes, "By the way, remember not to drink strong drinks when you have a cold, especially the bottle of wine on your body."

"Ok."

O'Rourke stuffed the medical records in his hand to the nurse behind him, and then took another one: "Next is."

"Is this Dr. O'Rourke?"

"Huh?" O'Rourke looked back at Kawi who was walking in the distance, "I am, who are you?"

"Deputy Inspector of the Military Medical Department, Carvey Hines." Carvey smiled and reported his home.

O'Rourke was taken aback, glanced at the collar badge, then looked at his face, but remembered the name: "Dr. Carvey, shouldn't you be operating on the wounded and sick on the northern line? Why did you come here?"

"According to the military order of Grand Duke Brecht, come here to support."

"Oh." O'Rourke nodded and pointed outside the tent. "The surgical tent is not far away. Go out and turn right and walk no more than [-] meters to see the entrance. I won't send any patients here."

The diseases covered inside and outside are different, and the identities are even more different, and usually cannot be overridden.

The other party said it very directly and the meaning was very clear, but he didn't want Kawei to intervene.Carvey also knew that he lacked the "qualification" to intervene in the internal medicine issue, and all he could say was some methods to resist infectious diseases: "I heard that Dr. O'Rourke is in charge of the construction of the military hospital?"

"Yes, what's wrong?"

"I have some issues about hospital construction that I want to discuss with you."

After all, Carvey bears the title of Deputy Inspector, so it is reasonable to say that he has the authority to inspect. Besides, his attitude is not high now, so he has no reason to refuse: "Dr. Carvey can come to my office if you have something to do. A few patients, come if you are optimistic."

"No rush, no hurry, I happen to be interested in internal medicine, and I will watch and study by the side."

O'Rourke felt a little uncomfortable, but he couldn't say anything to him, so he could only bite the bullet and continue the rounds: "Bed 112 is flatulence?"

"Doctor, my stomach is full of gas, I keep grunting, and it causes unbearable pain." The patient can't bear the pain now, "It's like the thunder before the storm, I get nervous when it sounds .”

"I gave an enema last night, how did it go?"

"Okay, excreted something, but today it started again."

O'Rourke quickly wrote a paragraph in the medical record, and then explained: "Bloating is usually caused by indigestion, a lot of gas mixed with the fluid in the intestines to make a commotion noise, I guess it may be bread these days Too hard."

"Indeed, that loaf of black bread was too hard to swallow."

"It's a bit warm, but not too serious." O'Rourke put his forehead on his hand and said, "I'll give you a little carminative, and you'll be fine after two days."

"Wind repellant? What's in it?"

O'Rourke smiled and said: "Don't worry, it's similar to the mint water you usually drink【2】. If you don't like it, you can come to me, and I will give you another sweet ginger tea, but the effect will be less Worse."

"I've drank sweet ginger tea before, but it didn't help."

"Oh?" O'Rourke became vigilant, "It seems that the effect of simply using the carminative is very limited."

"What should I do?"

"It's okay, this is not a troublesome disease for me." O'Rourke was confident in his ability to diagnose and treat, crossed out the treatment method he had written down, and changed two strokes, "On the basis of the carminative, I added a teaspoon of turpentine, a small amount of ether, avega gum, and an analgesic, and it was sure to work within two hours of taking it." [3]

"Thank you doctor."

"You're welcome."

From the patient's point of view, O'Rourke is indeed a serious and responsible physician.Because his treatment is not limited to medicine, he also cares about the patient's diet: "Notify the kitchen to soak his bread in broth to help him digest."

"Yes."

"By the way, the cabbage and cucumber in the vegetables can't be served on his table. All the vegetable salads are cancelled, and the meat is halved. When seasoning, only salt is used. The after-dinner wine is replaced with diluted light brandy."

"Ok."

"I can't get enough of these things." The patient suddenly heard something wrong.

"What do you eat when you're flatulent, let your stomach rest well." O'Rourke sighed, and walked to the next patient, "This one still has a fever?"

"Yes, I have had a high fever for three consecutive days."

"Oh, the terrible weather in Gablenz has caused the whole ward to catch a severe cold." Seeing the patient's pain, O'Rourke couldn't bear it, "Where is the hen I asked you to find?"

"It's in the kitchen."

"killed?"

"No, don't you want to live?"

"It's fine if you don't kill it." O'Rourke asked the nurse to fetch the hen, and walked to the patient's side and touched his forehead and armpit repeatedly. "The body temperature is too high."

Carvey just stood there watching him.

Although the treatment methods for treating flatulence patients just now are fancy, they remain the same. They cannot escape the three major approaches of internal medicine: symptom + cause + stimulant.

Intestinal flatulence is hyperactive bowel sounds, and there are many things that can be identified from the perspective of modern medicine.If you count abdominal pain, it can be roughly divided into three situations: inflammation, intestinal obstruction and intestinal bleeding.

The patient did not have diarrhea, and inflammation could basically be ruled out. There was no symptom of internal bleeding, and bleeding could be temporarily ruled out.The diagnosis that fits him best now is intestinal obstruction.From this point of view, the treatment given by O'Rourke is generally considered to be in line with the condition.

It's just that this patient had taken rhubarb-like laxatives before, and it seems that the obstruction is not optimistic. It's hard to say how effective the treatment plan will be.

"Doctor Carvey, what do you think of my diagnosis?" O'Rourke asked suddenly.

"I really can't comment on internal medicine diagnosis." Carvey smiled and said, "However, I have seen Dr. Fatolad's ward rounds, and I personally think that the way you handled it just now is very inspiring to me."

"Oh?"

Fattorad's position in the Austrian medical field is unquestionable, basically equivalent to Ignatz's position in surgery.O'Rourke was secretly pleasantly surprised by what Carvey said: "Dr. Fatolad's internal medicine knowledge is much deeper than mine, but the treatment of this simple disease is similar."

The flatulence happened to fall into the arms of the catharsis-based medical treatment, and it was the hen just mentioned that really made Kavey feel strange.

Regardless of whether the patient has a cold or other diseases, what role can a hen play under such a high body temperature?
The key is that it is still alive!

"What is the hen you mentioned just now used for?"

"A way to lower the temperature." O'Rourke couldn't hide the distress in his heart, and said with a sigh, "This is a relatively extreme method, and ordinary patients don't need to do it. But he has had a high fever for three days in a row. There is no other way."

Carvey really didn't understand what cooling had to do with hens, so he didn't bother to ask.

Now that he has gotten close to him, seeing that his guard has been dispelled, Kawei slowly walked towards the hospital bed and asked, "Do you mind if I take a look?"

"It's okay, let's see."

Judging from the temperature from the patient's forehead, the body temperature probably exceeded 39 degrees, and the continuous high fever basically has nothing to do with a cold: "Has Dr. O'Rourke used a thermometer, which is very helpful for disease diagnosis."

"Thermometer? That's too troublesome." O'Rourke shook his right hand, "The back of my hand is the best thermometer. Sometimes the machine makes mistakes, but it doesn't."

"Ok."

Carvey is most concerned about the typhus found in Adams. If there is such a patient in such a ward environment, there will inevitably be more patients of the same type.

So his first step was to lift the quilt to look at the patient's torso skin. The reason why typhus has the word "spotted rash" is because it produces a lot of rashes.

This bright red rash is the most prominent feature of typhus and occurs in more than 90% of patients.The earliest location is on the chest and back, and the limbs are affected differently, and some people do not spread to the surroundings and face.

Even if the rash subsides, there will be pigmentation in the end.

It doesn't matter if Kavey doesn't lift it, it's like opening the nest of bugs, and suddenly several black spots jump in front of Kavey: "A lot of fleas!"

"There must be a lot of fleas in the wards of the field hospital."

O'Rourke has long been familiar with this, but the red spots on the patient's chest made him a little surprised: "Huh? Why did he get a rash? I didn't find any rash when I checked before."

"Dr. O'Rourke only checked the first day?"

"Yes."

"The rash usually appears three or four days after the onset, and you need to take a look at it every day." Carvey leaned forward and said, "The rash is bright red, and it should have appeared not long ago. How long has he been sick?"

"It's been four or five days." O'Rourke had already vaguely had a bad feeling, "Could it be him"

"It's typhus."

"What a bad luck!!!"

"You guys need to get the fleas out of here."

"Fleas? What do fleas have to do with typhus?"

As soon as he said this, he realized that O'Rourke didn't know that typhus and fleas were related.But there is no need for him to deliberately explain, because the nurse's voice came from the door just now: "Doctor, doctor, the hen you want is here!"

(End of this chapter)