Nineteenth Century Medical Guide

Chapter 272 268. Microscopic examination (1)

Whether it is Chinese medicine or Western medicine that has not evolved into modern medicine, they all believe that the properties of urine are closely related to human diseases, and thus have developed their own urine testing methods.But before the maturity of modern medicine, Western medicine's urine test was more like a carnival of various chemical reagents, and the microscopic world under the microscope was rarely covered. 【1】

Of course, rare does not mean none.

Carvey is not the first doctor to put urine under a microscope. After all, microscopes have existed as early as the 17th century, and there has never been a shortage of "boring" scholars in the Enlightenment Age.However, in history, there are countless funs found out of boredom, but the people who can really demonstrate them scientifically are one in a million.

It was not until the 19th century that this kind of playful observation took advantage of the great development of medicine that it gradually entered the clinical track. 【2】

Like other medical developments, the so-called "on the right track" of microscopic examination did not happen overnight, and it took a long time, which seems to be quite a long time now, and it had to wait until the end of the 19th century for it to be fully accepted by clinicians.

Considering that the quality of microscopes in the hospital could not be compared with modern ones, and the precipitation of urine was not as fast as that of centrifuges, Carvey asked Edm to drink more water and prepare more materials.It was already 7 o'clock in the evening when he returned to the hospital, and Koch had been preparing for a long time with Savarin, Mattick and Auerbach.

"What do we need to check?" Savarin asked.

"This." Carvey put a few test tubes filled with light red urine on the tube rack, "You should have heard that a patient came to the French embassy with hematuria, and the color is what it is now. We It needs to be diagnosed and then cured."

"The color is so obvious."

"But that's not what you said about Koch's anthrax." Savarin was clearly unbalanced.

"French?"

The equipment factory is more like Kawei's private equipment manufacturing factory. If it weren't for the Prussian-Austrian War to take over the big order, it must be Kawei's unilateral profit-making business.

"The first point is a small hole in the experiment."

Koch has made sufficient preparations for this series of experiments on anthrax. In his opinion, the experimental process is very rigorous.There is infection, cultivation, and controlled experiments, so there should be no loopholes.

After hearing that there was a problem with his experiment, he couldn't help but feel a little disappointed, but he was more curious about it.He has already put all his energy into anthrax, and as long as there is still room for improvement, he has to make up for it in time: "Which two points?"

"I'm afraid this is a bit difficult." Koch said, "It is still in the war stage to transport periodicals from Paris to Vienna, and it will take at least one or two months in between. In case of accidents, the railway transportation is likely to be affected. bombing."

Koch's speed was the fastest, and he took his eyes off the microscope in a short while: "I see, it is very different from epithelial cells, and the shape is weird. But after the combination of high-power lens and staining, it can be seen clearly."

Seeing that he could think of a solution so quickly, Carvey couldn't help but lament the other party's scientific research ability, which can be achieved with just a little on-demand.

Savarin knew that he did not have the research mind of Koch, but he also graduated from a medical major, and he was a little older. He really didn't want to be left behind: "I just want to know what you think about typhoid fever?"

"It's also a liquid, and it's also not harmful to humans, and it can also provide the nutrients they need for growth."

Carvey talked about many knowledge points in a row, and at the same time drew a sketch on paper: "Come to me when you see tumor cells, it is the key to diagnosis."

"Okay, I'll try."

Uncovering the role of microorganisms in various plagues was an important discovery of medicine in the late 19th and early 20th centuries.Although modern medicine has been able to handle most bacteria, it was a major project that could save tens of millions of lives.

Carvey finished his experiment and looked at Savarin who was sitting aside.

Carvey turned to a sentence in the third experimental report: "It is very problematic for you to say that you are the first person in the world to discover spores. As far as I know, the French microbiologist and chemist Pasteur The spores were discovered last year."

"Are you going to have an operation?" Savarin asked.

Carvey stopped him from opening his mouth and said, "Don't worry, listen to me first. What I did before puerperal fever was just a preliminary experiment, just like what Koch did before. You only have a simple experiment report, There was no bacterial culture, and there was no paper on it."

"Correct."

"But don't worry, he just mentioned one sentence, and didn't explain the role of spores and the life history of the bacteria under study." Carvey reassured, "You can mention this scholar in your later papers, and then express your own found, but I personally hope that you can read his published articles."

"Don't worry, I have asked the French embassy to do it. Of course, the premise is that Mr. Edem's hematuria must be cured."

"Remember that one dilution is not enough, two more dilutions are needed."

Carvey put his gaze on the test tube rack just now, and soon everyone including Koch also looked at the test tube rack: "Yes, urine! There are protein, blood, and mess in the urine. Pile things up, it will definitely support the growth of anthrax bacteria!"【3】

Moreover, they were convinced that anthrax was caused by bacteria. The experiment was on the avenue of truth, and the result was in line with the conclusion, so there could be no mistake: "I have thought about it for a long time, and there is no problem with the experiment. In the end, as long as the relevant papers are written, we will It can be published in the Vienna Medical Journal."

"This urine sediment test mainly checks for tumor cells." Carvey told a teacher the precautions before the test, "You have to find them from a pile of red blood cells, white blood cells, and epithelial cells. Sediment That’s all for the amount, and I’ll have to get it from Edem tomorrow when I run out, so it’s best to end the battle at once.”

"This water may not work." Koch thought for a while and said, "Bacteria need nutrients to grow, but water may stop growing soon."

Before hearing this passage, I was still walking on the road I thought was correct, thinking that I was going very steadily, and firmly believed that the end was in sight.But after hearing this passage, a secret door suddenly appeared beside the original path: "It makes sense, it makes sense! Why did I forget that there is this variable!"

"Huh? Sophisticated? Look outside?" Koch was still young and didn't understand what he meant. "I'm a researcher, and of course I usually do research. As for the outside world, as long as it allows me to survive, the rest has nothing to do with me." How much does it matter."

Koch admired Carvey's ability very much. Just being able to propose that Bacillus anthracis causes anthrax infection is already very advanced.

"What about the rest?"

He knows Savarin's mentality, he helped you Kavi first, why should he favor Koch who came last?

Regardless of whether it is first come first, or his own clinical qualifications and Pu'ao nationality, he should be ranked first.Not only was he unconvinced, but even Mattick, who was beside him, found it strange to give up the most important results to Koch.

Carvey opened several experimental reports and found the column of the experimental process, saying: "The inoculum you choose is not pure bacteria, nor can it be pure bacteria, but tissue extracts mixed with bacteria, blood and exudate. This raises doubts about whether the anthrax is caused by these bacteria, or whether it is another substance that is carried by the fluid that acts as a carrier, a pathogenic substance that no one knows."

"I have it here too."

Among them, the pharmaceutical factory has the absolute upper hand. The previous several medicines have already made a lot of money through the acquisition of the empire itself.The equipment factory is not good enough. The spread of surgery is not that simple, and its difficulty is not comparable to that of using theory to determine the use of drugs.

"I have red blood cells here. There are too many. But I saw two in the corner." Savarin said, "The cell body is very large, the nucleus is also large, and the cytoplasm is very rich"【11】

"Do you know how to control it?"

Now that surgical technology is absolutely invincible, the laboratory is one of the main directions that Carvey is pushing, and the second is the medical device factory and pharmaceutical factory on Laszlo.

Koch is like a passerby who is in the game and doesn't know it.

Now with Erdem's hematuria, Carvey thinks it's a good opportunity to add bricks and tiles to the equipment factory.

"Of course I believe that the experimental results are correct, because the experimental results are my guesses." Carvey said, "I took a quick look at the carriage just now. The design and process of the experiment are good, but there are still some flaws in it. After thinking about it, I think there are two things that need to be corrected.”

Koch was a little surprised at the development of the world's technology: "Has someone discovered it?"

After filling this loophole, Koch couldn't think of any other deficiencies, and asked, "Then what's the second point?"

"I used to see anthrax from time to time in a small town in Lombardy. Some with skin ulcers had to be amputated, but in the end it didn't help." Carvey said, "Typhoid fever is different, and it has nothing to do with surgery. side."

"It's okay, I already have a solution." Koch said, "These extracts can be diluted to reduce their concentration. Although the content of bacteria will also be reduced, bacteria are living things and they will continue to multiply."

"When you and Mattick solve puerperal fever together, and you have the ability to design experiments and write papers by yourself, I think you can consider typhoid fever." Carvey said, "You just asked me what I think about typhoid fever, I think it’s better to look through medical journals from other countries.”

"If you really want to work on microbes, you can get rid of puerperal fever first."

"The next day is about the world." Carvey sighed, "Don't just think about studying the subject, sometimes you still have to look at the outside world."

"How to dilute it? With water?"

Carvey nodded: "I don't need to say more about the theory, you all know it well. The discovery of tumor cells in the urine indicates that there is a tumor in the urinary tract. And the tumor is easy to fall off and rupture, which basically confirms the hematuria source."

Competition is good, but too much competition can be a headache.

Of course, there are also bacteria in urine, and it is not difficult to see [10].However, I hope that what you are looking for is tumor cells, which are much larger than epithelial cells, with cell bodies of different sizes, forming suspicious cell clusters in piles or scattered.The volume is several times, ten times or even hundreds of times that of normal white blood cells. "

"Red blood cells are biconcave discs with a diameter of 8m, and the same shape indicates non-renal hemorrhage【5】;
White blood cells are spherical, with a diameter of 10-14m, slightly larger than red blood cells, and the cytoplasmic particles will be clear after staining【6】;
The rest of the irregular cells that are larger than white blood cells are epithelial cells, the individual is larger than white blood cells, irregular in shape, with angular edges, and the nucleus can be seen【7】;
In addition, you can also see the casts formed after protein aggregation, which are cylindrical protein aggregates formed by the coagulation of proteins, cells and their disintegration products in renal tubules and collecting ducts, and are the most valuable pathological components in urinary sediment .Sometimes red blood cells, white blood cells, epithelial cells, etc. will gather around【8】;
The last is crystallization, showing a shimmering octahedron or envelope shape, with two diagonal lines intersecting each other, sometimes in various shapes such as rhombus, and occasionally in the shape of dumbbell or cake【2】

Savarin sat next to Koch, in front of him was the medical records he had just collected.It seems that the teacher is mobilizing many people, but he himself does not have much confidence. The initial momentum has long been polished by the complicated collection process and uncertain results.

"There has been precipitation, and when the precipitation process is complete, we will take the sediment below for a microscope examination." Carvey asked them to sit down, while he still stood, "We still need to wait for a while, just to talk about this paragraph first Time Koch's experimental results."

"Well, it really needs to be diluted twice more, so that the original extract content can be completely removed, but the bacterial content can be retained to ensure the absolute objectivity of the experiment." Koch was a little excited, "If this experiment is also successful, then the Bacillus anthracis It is the only causative agent of anthrax."

"You must have misunderstood it, I didn't mean it that way."

Sedimented tissue was lightly spread on glass slides, stained with methylene blue, and placed under a microscope. 【4】

"England and Prussia, too."

Kawei hastily read the medical records written by the physician, put down the booklet and said: "I don't have any opinion. Typhoid fever is an internal disease, and I don't see it much."

When the topic enters a field that you are familiar with, especially if you have experienced it before, your confidence will naturally increase.

"I thought you would help Koch do those experiments." Carvey joked, and randomly took one of the medical records to read.

"You have to determine the location first." The report of the microscope inspection did not end, and Carvey's question continued, "How about the red blood cells? I mean, what is the shape of the red blood cells? Is there any irregular deformation or rupture?" 【12】

"Maybe not."

"I didn't see it here either."

"Let me take a look." Carvey leaned on Koch's microscope. Under the mirror were large red blood cells, which were regular in shape and did not appear deformed. "It seems that the location can be basically determined. It should be in the lower urinary tract. Wait until tomorrow." further inspection."

(End of this chapter)