Nineteenth Century Medical Guide

Chapter 245 241. Application of Hen in Internal Medicine

If you want to understand high fever, you need to understand the standard body temperature. The time to determine the standard human body temperature is not far away, just 15 years ago [1].Therefore, Carvey's "Thermometer" article can be regarded as catching up with the trend, but there is still a long way to go before the official promotion.

Because as O'Rourke said, a high fever is not like a low fever, which can be judged entirely by the feel of your hands.

In the face of high fever, there was not much that doctors could do in the past, it was nothing more than symptomatic cooling.Because finding the cause needs to be based on basic medical theory, without theory, there will be no etiological diagnosis, and it will be impossible to treat the cause.

On the road of cooling, doctors at each stage have different understandings. The 19th century was regarded as a watershed for drastic changes in cooling methods, because the cooling effect of salicylic acid was discovered and clarified.

O'Rourke is not stupid, nor is he ignorant of the effect of salicylic acid on reducing fever, but at this time salicylic acid still has fatal flaws.Many patients may have several holes in the stomach and intestines burned by this drug before the fever subsides.

Stomach bleeding and perforation are definitely more difficult to deal with than high fever, and they are basically a death sentence when they appear, so the best thing to do is to question them loudly and choose not to.

O'Rourke, as a dedicated physician to his patients, has always been on the skeptical side and is extremely cautious about the use of salicylic acid.Of course, using it cautiously does not mean not using it. When a patient encounters a high fever that is difficult to subside, he will still choose salicylic acid with a high probability.

However, the situation of this patient is somewhat special.

High fever for the fourth day in a row, the use of carminatives is ineffective, and the burden of salicylic acid is difficult to use due to a bad stomach. These are the indications for using the "hen" trick.

Carvey was curious and couldn't figure out what O'Rourke would do with the hen, yet it turned out to be pretty straightforward.
"This is the last resort. If it can't be cured." O'Rourke took over the tied hen and a scalpel from the nurse. "Please hold his head."

The nurse pushed the patient's dry hair up to expose his forehead, and then held his cheeks with both hands.I saw O'Rourke lifted the hen into the air, turned his back to his forehead, then raised the knife with his hand and dropped it, piercing the muscle of the hen's back with one blow.

Carvey is not familiar with the dissection of chickens, but a single cut to the heart can easily damage the large blood vessels.

I saw the hen screaming a few times, the body kept struggling, and the warm blood began to flow out of the wound, slowly flowed out from the sharp blade, and slid on the patient's face drop by drop: "The blood of the hen can be used to remove the wound. The effect of high heat, and then wash it with cold water. I hope it will help."

Physical cooling?

Chickens have a higher body temperature than humans.
Perhaps the cooling itself depends on the cold water that washes off the blood at the end.

Carvey stared blankly at this scene, and he couldn't help but sigh in his heart while complaining: This is probably a biological product from the 19th century.

Such therapy obviously has no scientific basis, and it is a bit too much for internal medicine that is still in chaos.But Carvey still can't say that O'Rourke is a quack doctor. The limitations of the times make it difficult for him to deal with many diseases, and it also allows him to handle better than Carvey in some fields.

After all, modern surgery is also a hoop stuck on the head restraining Kavi.

"The next one is the guard who was bitten by a snake yesterday." The nurse and O'Rourke exchanged medical records and said, "I was going to be transferred to surgery, but the other side's bed is tight, so I can only stay here."

"Oh, how is the wound now?" O'Rourke asked.

"A little red and swollen, but it's not serious." The nurse lifted a corner of the bandage, looked at it twice and said, "The snake venom has not occurred, and he has not developed a high fever. Everything is going well."

"OK, all right."

O'Rourke casually wrote two strokes in the medical record, and glanced at Carvey: "Dr. Carvey, you are a surgeon. He has three wounds on his ankle. Can you give me some advice?"

The guard's ankle was wrapped with a thick bandage, and the dark dry blood oozing out could be clearly seen.Unlike the two doctors and nurses who disliked the wound, he bent down and completely untied the bandage.In front of his eyes were three serious sharps injuries, not snake bites.

Carvey immediately realized the reason why O'Rourke did this: "Dr.

"The snake venom is too ferocious, and ordinary antidote is difficult to work, so it can only be bled immediately." O'Rourke explained.

"This is no ordinary incision and bleeding."

"The success rate of ordinary bloodletting is very low. Only by completely removing the tissue around the wound and then using the cupping method can a large amount of blood be sucked out in a short period of time and relieve the attack of snake venom." O'Rourke sighed, "Although my knowledge of anatomy is not outstanding, But you can still make out skin, muscle, and blood vessels."

"Cupping?" Carvey heard a very familiar word in it, "Doctor O'Rourke also cupping?"

"This is a serious medical treatment method, of course you have to do it!" O'Rourke knew that Carvey was a half-way doctor, and said, "Just take a piece of paper dipped in spirits, light it in the wine glass, and turn the glass upside down On the wound, it can quickly bleed blood and suck out toxins."

This is probably the best way to deal with snake venom in the 19th century. It perfectly fits the bloodletting therapy, which is much cleaner and more thorough than drafting herbs and sucking it out by mouth.

If Kavey met such a patient himself, he might do the same in the end, but there must be some ideological struggle in the middle.In the face of snake venom, time is life, and a short pause may have missed the best time to deal with it.

"Dr. O'Rourke handled it very well." Carvey looked at the wound in front of him and asked, "By the way, have you been disinfected after the bloodletting?"

This is what he cares about the most, and it is the only thing that O'Rourke has learned during this training: "I did the disinfection exactly as required in the "Military Doctor's Manual", replacing the soldering iron with carbolic acid. Then I used half a glass of brandy, every Once every 15 minutes, pour it on the wound. Finally, choose mustard ointment or a piece of cotton soaked in ammonia water to put on the chest to resist the drowsiness caused by snake venom.”

"What are ammonia and mustard pastes for?"

"Protect his heart."

"...Okay." Carvey nodded slightly, "The surgical treatment is very good."

"That's good."

Although the treatment of ammonia and mustard paste in the end seems redundant, the previous steps are still correct.In the absence of alcohol, using brandy is also considered a low-efficiency substitute, and carbolic acid is quite good anyway.

It also made the soldier's wound appear less serious.

"However, the wound is so wide open that it will be difficult to heal without stitches."

"We don't have needles and threads for sutures in our internal medicine department."

"It doesn't matter, I usually use what I bring." Carvey looked back at the guard captain behind him, and took the surgical instrument box he handed over, "Just need to do a little suture, and then wrap it with a carbolic acid bandage. "

O'Rourke is a very pure physician, conservative, stubborn, full of disdain and hostility towards surgery.But at this time, Kavi was superior to him in terms of military rank and position in the military medical department, so the flattering words that should be said still had to be said: "I have troubled you."

"Just a simple stitch, no big deal."

Carvey’s suture needles were hung with silk threads from the very beginning, and they were used whenever they were taken out. With the help of tissue forceps, the three wounds were resolved within 2 minutes: “One of the wounds has a relatively high tension, and the suture will affect the blood supply instead. , to increase the difficulty of healing, cover it with oily gauze coated with turpentine and wait for it to recover slowly."

O'Rourke stood by the bed the whole time, and did not go to the next bed. Carvey's suturing skills were all in his eyes: "Dr. Carvey's skills are really superb."

Carvey simply rinsed the suture needle and tissue forceps, wrapped them in gauze and put them in the drawer at the bottom of the equipment box: "It's just the most basic suture, which doesn't explain any problems."

"I also have a surgeon by my side, so I can tell the good from the bad." O'Rourke said very reservedly, and quickly looked at the last hospital bed. "The last one should have severe high fever and abdominal pain. How do you feel today?"

"No, not much." The patient's voice was weak.

"Show me the results of the enema."

The nurse took the enema record sheet, which stated the enema time, enema liquid formula and excretion volume: "The excretion volume is not bad, but the body temperature and abdominal pain have not disappeared."

"Ginger liqueur and barley tea have no effect【2】?" O'Rourke was a little puzzled, "Warm wine and tea should relieve the abdominal pain."

"It's a little better after drinking it, but it will hurt again soon." The patient covered his stomach, his face was very bad, "It hurts too much, do you want to give me some calomel? Sweat a little, and vomit overnight It might be fine."

"Calomel is not used in this way." O'Rourke denied the patient's own judgment, and then said to the nurse, "Let the kitchen add some sweet angelica to his bread."【3】

"Okay, I took note."

"Then put a few more slices of sweet radish juice in his wine [4]." O'Rourke's treatment for abdominal pain is more dietary therapy, "Try it first, and I'll find a way for you when it doesn't work."

The patient broke down a little when he heard the radish: "I want to eat other things, I can't just eat a piece of bread and half a bottle of wine for three meals a day!"

"Your abdominal pain is severe, and you can't eat indiscriminately until it's relieved," O'Rourke said. "Please trust my judgment."

"I'm so miserable"

"I know, but bear with it for a few more days until the abdominal pain subsides."

O'Rourke didn't write too much in the medical record, but continued to tell the nurse, "He drank too much, and his bad breath is very bad. Chew some orris root for him later, and rinse his mouth with soda water after chewing. .”

"Ok."

After dealing with more than 100 soldiers in the tent, O'Rourke finally breathed a sigh of relief: "Dr. Carvey, I'm done here. If you have anything to talk about, go to my office."

Carvey was standing beside him, but he was looking at the patient just now.

Abdominal pain is more in favor of surgery in modern medicine. As long as gastroenteritis is ruled out, most abdominal pain is urgent and requires surgical treatment to relieve it.So when seeing this patient with abdominal pain, the first thing Carvey thought of was some common acute abdomen.

"Can I see it?"

The two had already found out about each other, and Kavey knew that although the other was a little stubborn, it was not as serious as Fatolad.O'Rourke also knew that although Carvey was young, at least he had a solid foundation in medicine.

The most critical point is that both of them know that the other is really thinking about the patient.

In front of patients, the dispute between internal medicine and surgery seems insignificant.

Carvey got the consent, and went forward to do the most basic abdominal examination - palpation. The initial pressing position was in the middle of the upper abdomen he was covering just now: "Does it hurt here?"

"It hurts!" The patient raised his body slightly, trying to prevent him from pressing down with both hands, "gentle."

Kavi didn't give him a chance, and immediately switched to the lower abdomen: "What about here?"

"It's okay here." The patient breathed a sigh of relief.

"Here?" This time it was changed to the lower right abdomen.

The patient shook his head: "It doesn't hurt."

Karvey nodded, and quickly switched the palpation point to the upper abdomen again. This time, he was obviously rushing to make a diagnosis, so the patient cried out when he touched it: "It hurts, it hurts too much!!!"

O'Rourke, who has always followed the principle of not touching the patient, looked at the patient and yelled, not understanding the reason for Carvey's doing so.But he didn't interrupt Carvey's diagnosis, he just stood by the hospital bed and watched.

The nurse didn't have his concentration, so she couldn't help but whispered, "Doctor, he did this."

O'Rourke put his finger in front of his mouth and shook his head: "He is a student of Chief Surgeon Ignatz, so there is always a reason for him to do so."

However, the patient's cries did not stop, and after the positive tenderness, his Murphy's sign was also positive.As Kavey quickly pulled away the right hand that was pressing on his stomach, the pain swept through his body again.This time it was so painful that I couldn't speak, and it took me a long time to get through this wave of pain.

"Right upper quadrant tenderness, rebound pain, shoulder pain before?"

The patient wanted to scold her, but Carvey said it all: "It hurts the shoulder too."

"It should be cholecystitis caused by gallstones." Carvey gave his diagnosis.

The diagnosis was so sudden that O'Rourke didn't even have time to respond: "How to treat this situation?"

"Surgery or conservative treatment is an option," Carvey said. "But in this case, even if you survive these days with conservative treatment, it will turn into chronic inflammation and recurring pain."

"What about surgery?"

Carvey immediately considered the transfer conditions and the rear hospital, but still felt that it was not appropriate: "The operation is also very troublesome. The conditions here are too bad, and accidents are likely to happen."

"I think it's better to treat conservatively."

Unexpectedly, at this moment, the patient, who was in so much pain, said, "Can the operation be cured?"

"Yes, but the probability is not high."

"I don't want to be in so much pain in the future, it's better to have surgery!"

(End of this chapter)