Nineteenth Century Medical Guide

Chapter 271 267. Experiment Report and Inspection

Modern medical examinations can be roughly divided into two types.

One is laboratory examination. In the early years, it relied entirely on microscopes, but now it can also rely on various instruments to distinguish blood, urine, feces, and cells and other components in various sliced ​​​​tissues.

The other is imaging examination. The earliest ones were various speculums. After X-ray and B-ultrasound came out one after another, the choice of imaging examination became more and more abundant.

For the differential diagnosis of hematuria, the first and most important step is to do laboratory tests, which is why Carvey chose to go to his own laboratory.

Because there is no shooting device now, the cells in the urine under the microscope should be shown to those in the laboratory to improve their experience.At the same time he could take a good look at what Koch had discovered in the past month.

From the beginning of the preparation period for the Prussian-Austro-Prussian War, the future father of microbiology encountered some troubles.

In fact, his study tour time in Austria was very limited, and he had to go back in July as planned.But because of the relationship between the two countries, it is actually time to leave at the end of May.

After returning to China, Koch will be able to obtain a doctorate from the University of Göttingen School of Medicine. He is not too fond of clinics, so he should be able to work in the Institute of Chemistry in Berlin through his connections.

The Institute of Chemistry is just a compromise choice between clinical medicine and scientific research. His interest is not strong. Compared with him, staying with Carvey is more relaxed and comfortable, and he can see some things he has never seen before.

"Wait!" Justina suddenly said while sitting on the sidelines, "After you mentioned it just now, I can see it. Uncle, you have indeed lost weight, much thinner than when I just left Paris."

"He saw that I was studying anthrax before, and he could only do it by himself, and he always felt uncomfortable. Later, I suggested that he also start a research project, and after looking around, he was interested in typhoid and typhus. Recently, he has been collecting cases in the hospital .”

"No, no, Dr. Mercier, these are just things that were taken by the way." Carvey explained, "I went to medical school mainly to find my colleagues in the laboratory, and the next step is to do some research on Mr. Erdem's urine. Several tests, I need their help."

Carvey took over several experimental reports he brought, and didn't have time to read them for the time being: instead, he looked at the young man behind Koch and asked, "Who is he?"

"it is good."

And now, Koch has an extra Carvey in front of him.

Historically, he had no choice but to go to work at the Institute of Chemistry in Berlin for six months.Finally, he gave up under the advice of Welshaw, the father of cytopathology, and returned to the clinic again. Starting from the clinic, relying on the accumulation of work, he slowly found his own research direction.

"...You still remember this incident." Mosier complained, "You know that you deliberately bypassed the embassy and went back to the medical school to get the experiment report?"

Anyway, he was bored on the road, so Massimov asked aloud, "Can you let me have a look?"

"I have nothing to do with Pasteur, and in France, Pasteur is not that popular." Mosier snorted softly, "I believe in science, and I don't believe in it until there are no clear experimental results to support it." A small thing can have an effect on a human being."

"Forehead"

Mossier didn't know much German, but Massimov, who was sitting next to him, could still understand: "Anthrax?"

Carvey nodded: "What about the others?"

"The assistant I hired," Koch said, "has just graduated from the University of Vienna Medical School, and his name is Auerbach."

"Uncle, here I come."

Mosier looked at him, then looked at Carvey who was reading the experiment report on the opposite side, and took the handed over report.The content was indeed the same as what the other party said. The infectivity of anthrax was further confirmed, and the bacteria found in the microscope were also drawn by Koch with a pen, and then equated by a series of explanatory texts.

Edm didn't have the airs of the French Marshal's brother, even in the French embassy, ​​his every move was very decent.

Carvey, who had gotten used to this kind of talk back in the surgical academy, shrugged his shoulders and said nothing more.

"Doctor Carvey, why are you back?" Koch was wearing a mask, and there was no atmosphere of war between his brows, "I have already figured out the anthrax you gave me. Thank God, here is what I need most With a microscope and enough experimental materials, my results will definitely surprise the whole world!!!”

Carvey's words and the two papers he gave allowed Koch to skip the "torture period" of more than ten years in the middle, and set foot on his favorite path from the beginning.

Mosier in disbelief: "This"

"Well." Carvey quickly flipped through the first experiment report, closed it and handed it over, "From the results of the first experiment, anthrax is caused by bacteria."

When he returned to Göttingen and found that his future was bleak, the first thing that came to his mind was Karvey.

"Oh, it's the lab report these days." Carvey put down the equipment box after getting in the car, put the file on his lap, and opened a page, "After all, it's my own lab, I need to see what they're doing. something."

Unexpectedly, as soon as he returned to Göttingen in June, he received a reply letter from Chemical Research [1].The general content is that he did not graduate from a chemistry major, and he must start as a basic researcher in the institute.At the same time, the Institute also hopes that he can focus more on chemical research rather than medicine.

If they didn't have these experimental reports in hand, both of them would feel that this young man was talking nonsense.

There was no need to exchange letters, because the relationship between the two countries was already very tense at that time, and it might take several months for the reply to be placed on his desk.So after receiving his diploma, Koch picked up his bags and set off for Vienna again.

The three people in the carriage didn't know why Carvey came to the medical school. This man was always mysterious and his words were always vague.But both Mossier and Massimov were clinicians, indifferent to military politics, but sensitive to various documents in the academy.

"Okay, let's put the report aside for the time being." Carvey retracted the experiment report, and continued Edmu's topic just now, "Mr. Erdem's body is more important."

"Oh, anyway, time is not urgent, you guys will take him to the hospital when he comes back." Carvey said, "By the way, why did Savarin go to the hospital?"

Mosier felt strange, "How did you, a surgeon, start to study internal diseases?"

"Yeah, dirt," Carvey explained. "Some patients with anthrax have never had contact with sick animals, and some haven't even touched live animals. So it only proves that there is a relationship between animals and between animals and people." contagiousness, without really knowing it."

The other is in the United States on the other side of the ocean. A veterinarian named York also published in 1859 about the phenomenon of anthrax suspected to be contagious among cattle.

Then, through cystoscopy, take a closer look at the inside of the bladder to determine the location of the tumor.

The urine is first centrifuged and sedimented, and then the sediment is selected for smear microscopy. The targets are red blood cells, white blood cells, proteins, casts, epithelial cells and this time the target: tumor cells.

An elderly man with a history of smoking and bladder stones for many years, and a painter who has been in contact with paint for a long time, all high-risk factors are accounted for, and the early symptoms are also consistent.However, bladder cancer surgery is very complicated, and treatment is not easy. It is impossible to make a diagnosis based on these things, and then open Edem's stomach.

"It turns out that you should prepare the microscope and dye first, and you need to do a few experiments at night, and the hospital doesn't have enough microscopes." Carvey glanced at the report in his hand and said, "I'm going to the French embassy now. Saw it on the road."

"It should refer to the spores formed on the surface of bacteria." Kavi spread his hands and said, "Although this is not the first time it has been discovered, it is the first time that its function and the life history of anthrax bacteria have been mentioned. Thousands of types of bacteria Ten million, if you guess more boldly, maybe many of the diseases we have are related to these little guys."

Koch's next experimental report subverted their cognition.

Carvey looked him up and down: "The old man is in good health and very energetic."

Now three months have passed, and the seeds that Carvey planted in early summer have already taken root and germinated. When he returned to the laboratory again, the harvest was in front of his eyes.

"soil?"

But the war is imminent, and the country must be above science. Koch decided to return home, at least to get his diploma first.

"Oh, yes, anthrax," Carvey said. "There have been many reports recently that anthrax is contagious and can be transmitted from cow to cow. However, I personally suspect that human anthrax may also come from cows or even from cows." Infected from the soil, but there is no evidence"

Therefore, he hopes to find exfoliated tumor cells through urine sediment examination, so as to confirm the diagnosis of urinary tract tumors.

This made Koch a little hard to accept.

"No, Dr. Mosier!" Carvey didn't need to explain, Massimov himself would explain for him, "The process of this series of experiments is very rigorous, and I can't find any mistakes or omissions."

Ten minutes later, Carvey left the medical school and got back into the carriage.

"It's not bad, but the color of the urine is a bit scary." Edm didn't think of the bad, but just laughed at himself, "I always feel that there are several leeches living in my bladder, and they give me free bloodletting treatment every day .”

Led by the servants of the embassy, ​​he entered the living room with others and sat down. The first sentence he spoke made people puzzled: "I don't know if the old man's weight has changed recently?"

The other party's question was a little bit angular, and Carvey just looked at the report, and said with a smile: "Bacteria are the enemy of surgery. As long as it is related to bacteria, I think it is worth researching. Even Mr. Pasteur should understand it." Agree with that statement."

When he heard gross hematuria, the first thing that popped up in Carvey's mind was bladder cancer.

When he returned to Vienna in mid-July, Carvey was overjoyed and left him two papers and a sentence.

After the mouse was dissected, the dissection was re-dissected, and the visceral tissue fluid of the mouse was extracted for microscopic examination again.Just like the bovine spleen extract before, a large number of bacteria were also found in the mouse viscera extract.

After seeing a few more documents that suddenly appeared in Carvey's hands, both of them became interested: "Dr. Carvey went to school to get the manuscript?"

Massimov took the report and began to read it.

How can a person be defeated by this invisible thing, it is simply denying the meaning of human existence!
But in front of the drawing manuscript of the mallet-like anthrax bacillus slowly turning into round spores, the two could not find any evidence to refute it.They would never have thought that they would see such an incredible discovery just by following Carvey to the University of Vienna.

However, when he saw Carvey, a trace of surprise still flashed unnaturally on his face: "It's a pleasure to meet you, Dr. Carvey."

"Weight?" Edm shook his head. "I don't think so. I have always had a good appetite. I just ate several plates of oysters at noon."

"It can 'clothe' itself? What the hell?"

One is an anthrax paper published in the French Journal of Medicine by French microbiologist Casimir Davina in 1863. He mentioned that anthrax can be transmitted directly between cattle and cattle, rather than individual individuals.

From the very beginning, Carvey was trying to keep him. Even though he knew the hostile relationship between the countries behind the two, Carvey was still willing to vouch for him, just like the Italian surgeon Bottini.

"Anthrax is contagious?"

"This is just the beginning, two doctors." Carvey smiled and took out the second and third experimental reports, "Koch's subsequent reports are all based on the first report, which continues to prove that anthrax is not the only one. Only cattle with anthrax can spread it, and these bacteria can even exist in the soil for a long time."

In fact, Koch's experiment seems very simple now, that is, the spleen of a cow that died of anthrax was crushed, and then the interstitial fluid was extracted.After spotting the bacteria under a microscope, the interstitial fluid was injected into healthy mice with a syringe.

The result was already expected by Carvey. The vaccinated mice were soon infected with anthrax just like the cow.

"It's just grandstanding." Mosier was a little dissatisfied.

After Justina walked into the embassy, ​​she first saw Edem observing the flowers and plants in the yard, and then happily introduced Karvey who was walking behind her: "This is what I mentioned to you before. Dr. Carvey Hynes, the surgical technique is very powerful. He heard that you were ill, so he rushed back from the front battlefield without stopping."

Carvey knew that this was a cognitive bias that occurred when matching his age and experience, and he had often seen it since he traveled here.It's just that Edm hid it better than the others, and the expression quickly dissipated into his smile.

Is disease related to microbes?

This series of experiments made Massimov unbelievable: "The results are shocking. To be honest, I still can't believe my eyes."

What Carvey needs to do is the most routine microscopic examination of urine sediment.

"I think anthrax is caused by bacteria, but I don't have time to research it, so I'll leave it to you."

Massimov, who was on the side, was also a surgeon. He had only seen anthrax patients, and he didn't know the connection between the disease and microorganisms.But he believed in Carvey, and was quickly attracted by Carvey's statement.

"Savarin is at the Municipal General Hospital. Mattik should be in class, after all, school has just started."

Carvey laughed a couple of times, but didn't refute.

"Really? Maybe the waistline is a little smaller, but I don't care about it." Edm rubbed his stomach and asked Karvey, "Does Dr. Karvey think this has something to do with my bloody urine?"

"It does have something to do with it." Carvey quickly changed the subject, "If the old man doesn't mind, you might as well drink more water."

"Oh, I've been drinking it all the time." Edham pointed to the freshly placed milk tea cup on the table, "This is already the third cup of today."

"Drink more." Carvey also gave him his own milk tea, "Drink more to urinate more, I need to take your urine for a test."

(End of this chapter)