Nineteenth Century Medical Guide

Chapter 276 272. "Expert" Consultation (1)

Austria can also be regarded as a veteran power in surgery. Although it is not as good as England, France and Germany as a whole, its upper limit is not worse than these countries.

The Academy of Surgery in Vienna represents the highest level of surgery in the empire. Dean Watman is recognized as one of the strongest maxillofacial surgeons in Europe. His son Ignaz is also a famous sharp knife player. Bill Roth The understanding of abdominal surgery is also at the forefront.

As another important branch of surgery at that time - urology, the Imperial College of Surgeons also had representatives who could lead the times.

"Mr. Jacob."

As soon as Kawei brought a group of people to the entrance of the surgery theater, he met the president of the Urology Association who came to the consultation today and is also one of the vice presidents of the School of Surgery: "Today is really special, I have to let people It was hard work to find you."

In terms of seniority, Carvey is enough to respect the teacher Jacob, who graduated from the Vienna Medical School in 1846.

However, the tone of respect also appeared in the mouths of Edward, Justina, and Edm at the same time. Even Mosier, who has never had a good impression of Kawi, is still respectful to him even though he is a few years older than Jacob. .

This relies on Jacob's excellent surgical skills, as well as his influence.

"You are too polite." Jacob took off his top hat, led the crowd in, and said as he walked, "I am half out of clinical practice now, and the School of Surgery is just a name. I still study Persia more. Language and modern medical education reform.”【1】

"Okay, you are young and promising." Jacob patted him on the shoulder with a smile, and said, "I have seen a few articles of yours in the "Vienna Royal Medical Journal", which are very good, give me a lot of room Less surgical thinking. If hematuria can be diagnosed and cured in this way, I might”

After all, he took out a few drawings from the box that were left after the inspection, and sent them to the doctors in the first row: "Here is the cell map that my laboratory researchers saw from the microscope, everyone We can pass it on to each other."

Therefore, most of them will first observe the development of the situation, and then choose whether to speak.

However, the microscopic examination just now is only qualitative, and the next step is more important positioning.On the court, only Mosier, Jacob, Massimov and Dean Waterman can connect the microscope examination and cystoscopy examination into a line.

Urine microscopy is a rather unfamiliar term, and so many doctors present have only heard of it, and no one has done it.

"Yes, I have improved the previous cystoscope, and I should be able to see the internal structure clearly." Carvey lifted the wooden box in his hand, "But the mirror is metal, and the mouth of the mirror cannot be turned, so the scope of viewing is still limited."

"Huh? What does that mean?"

Since the quarrel with Edinson, Carvey has received the support of Emperor Franz and Grand Duke Brecht, and he has never thought of saving face for anyone: "This is indeed a matter of concern, but it should not be placed in the Academy of Surgery It was discussed in the consultation site."

So after getting the manuscript, the somewhat cold atmosphere finally became lively: "Urine sediment is the substance after urine precipitation?"

"Qualify first and then locate, the thinking is really clear enough." Jacob murmured in a low voice, and suddenly asked, "Dr. Carvey, you just said that the current cystoscopy technology can only see a limited angle."

Jacob walked into the venue, and while waving to the surrounding colleagues who were already seated, he said to Carvey: "If the cystoscopy can be successful, do we need surgery next?"

However, out of safety considerations, as well as Carvey's caution and the limitation of endoscopic production time, he chose to start with the corpse first.

Maruna thought that making a head start would at least increase his exposure, but who knew that the other party didn't take him seriously at all.

In summer, corpses are perishable and difficult to preserve, so the price rise is also understandable.But now it was almost winter, and the corpse was still hard to find.

"Yes, it is indeed a bit strange. The outline is much rougher than the epithelial cells, and the volume is also much larger."

Mosier thought for a while, and said slowly: "I'm not very good at making evaluations, but at least I won't allow my students to ask such questions."

Sometimes the hospitals are so tight that a soaked corpse isn't even much cheaper than a French meal.Even so, there are still many hospitals bidding. It seems that the surgery, which was criticized by internal medicine as dirty and unprofessional, suddenly became popular.

These words seem to have been processed. At first glance, they are a bit exaggerated, and even have a hint of magic.But most of the doctors sitting on the stage have seen Carvey's surgical techniques on the spot. Compared with each other, it is reasonable for an 8-year-old to know this.

The price of normal channels has been rising steadily since the middle of the year, and has been monopolized by several institutions.Seventy percent belonged to the Faculty of Surgery, and twenty percent belonged to the Faculty of Medicine of the University of Vienna.And 90% of the remaining [-]% was bought by the Municipal General Hospital, and the rest of the hospitals couldn't even get the soup scum.

"Maruna, the surgeon at Graze Hospital."

Before doing cystoscopy, Carvey still wanted to go through the most basic method in the diagnosis of hematuria: "Facing a tube of light red urine, our naked eyes have limited ability to observe, so we need to use a microscope at this time."

"Hey, Watman and I are both old, and we still have to look at the young people of your generation."

Therefore, many people did not come to the conference with the mentality of watching a performance, but to try to find the loopholes in Carvey's diagnosis.To put it bluntly, it is to find faults under the derivation of reasonable logical thinking.

This is a substitute recruited to fill the vacancy. There is no way to draw conclusions about his strength, but it is not difficult to see from the content of the question just now that his differential diagnosis ability is still a bit weak.

Carvey has long been tired of hearing those compliments. Among the words just now, the only thing that can arouse his interest is the last sentence: "What did the vice president just say?"

After all, for them, once they suffer from urinary tract tumors, it means that they have to undertake high-mortality surgery and postoperative painful daily life.

Carvey nodded: "You are?"

"really."

"It should be fine."

"Oh, it's nothing, it's nothing." Jacob walked quickly to the banquet and found his seat, "Go get ready."

"Thank you for your gentlemanly speech." Carvey bowed slightly to express his gratitude, "Unfortunately, I am not so gentlemanly."

"Where are you talking?" The one who spoke first was Edm, who had never spoken much, "When I performed lithotomy in Paris, Dr. Angwar, the chief surgeon, improved after several letters exchanges with you. Surgical methods have allowed me to survive to this day."

"I'm a bit skeptical of the personnel selection system at Graze Hospital. I have to have a good chat with Dr. Hills after he comes back." Carvey went to the preparation area and took out a new cystoscope, and said, "Dr. Maruna, here is You I don’t mind if you stay here, but please don’t make any more noise in the future.”

It seems easy, but in fact, when they questioned Kavey, they also entered the scope of Kavey's "attack".

Edm was very surprised that he might become the first tester of cystoscopy, so surprised that he wanted to try it at the embassy yesterday afternoon.

Now that the face is gone, maybe even the inner face can't be protected.

Jacob has been hearing Carvey's name a lot lately, and has met him a few times at the School of Surgery, but he has never had a good chat. Today is a good opportunity.

At this time, there were [-] to [-] doctors sitting in the operating theater, most of them were surgeons who performed lithotripsy, and the rest were physicians with experience in kidney diseases.The purpose of their coming here is to give a reasonable diagnosis and restore Edem to health as soon as possible.

It's a pity that there are always some restless people who don't play cards according to common sense. Before the experiment even started, and even before the simple patient introduction, some people couldn't hold back their excitement and took the lead in attacking: "Dr. Carvey, Hematuria is the rupture and bleeding of the urethra, wouldn’t it be inappropriate for you to stuff such a long strip of metal into it at this time?”

For today's experiment, the School of Surgery has also put in a lot of effort.

"It's not even acquaintance. I was hired by the hospital a few days before he went to the front line."

"Grates Hospital, you should know Dr. Hills, right?"

"Can this kind of microscopy make a diagnosis?"

"Excellent, my little achievement is no surprise."

Fortunately, these doctors still have the knowledge of physiology and pathology, at least they can recognize the cells inside. "This should be red blood cells and some epithelial cells, and that one is white blood cells."

Carvey watched the drawing spread far away, and then said: "Everyone is not very proficient in urine sediment inspection, and it's normal if you can't recognize them. Those few 'giant' cells stained blue are tumor cells. I I can tell you very clearly that what Mr. Erdem has is a tumor."

Upon hearing the result, the entire theater of surgery became restless.

"Tumor. There is a tumor! That cell map is a bit weird."

Speaking of dead bodies, a very strange phenomenon has recently emerged in the Viennese medical industry.The price of corpses, which has been maintained for many years, has suddenly increased a lot since May this year. The original price range of 30-80 has risen directly to 50-120 kroner, and there is no sign of a fall.

Carvey first described Edem's symptoms in detail, which is also his only symptom so far, long-term asymptomatic hematuria.

"Hematuria does mean that there is damage, otherwise blood would not flow from the blood vessels inside the body to the outside. But this kind of long-term damage must have its particularity. If we can't find its particularity, we can't make a diagnosis."

"Well, it should be a major operation."

"What do you mean by that?" Maruna was a little anxious, "I just wanted to discuss it with you, and I didn't expect to quarrel."

If you want a suitable corpse, you can either dig the grave secretly against your conscience, or go to a black market agent to negotiate a price against your conscience.

"Yes, everyone can take a closer look at the pictures on the drawing."

"Didn't understand?" Carvey looked at him and "translated" the words again, "I mean, I knew about this kind of pediatric problem when I was 8 years old, and there is no need to discuss it here. "

"This is the corpse of a 65-year-old male who died in an accident just three days ago." Carvey looked at the name tag on the toe of the corpse and said, "It has been preserved in carbolic acid for the past three days. The body suffered little damage, with all limbs and torso intact. The only trauma.
He lifted the white cloth, exposing his shoulders: "The only defect is his head. The head is gone, but fortunately, the cystoscopy test doesn't need it, so it can be regarded as 'perfect'."

"Correct."

After listening to Mosier's speech, coupled with the gradually gathering sight around him, Maruna realized the seriousness of the problem.

"Okay, if you have no other questions, this consultation will officially begin."

He really wanted to see what big moves this young man could make in the urological surgery: "I heard that you will have a cystoscopy later?"

Most of the accumulated corpses belonged to owners. In order to make the cystoscopy examination go smoothly, the college bought a "perfect" corpse from an unknown underground market at a high price of 170 crowns yesterday.

"I said that there is no need to discuss." Carvey glanced at Mosier who was not far away, "Dr. Mosier, you are a surgeon who specializes in prostate surgery, do you think what I said makes sense? "

"After many tumors are resected, it is necessary to use a microscope to check whether the cells inside have abnormal proliferation, and then the conclusion of the tumor can be drawn." Carvey retorted, "Similarly, if the epithelial cells in the urine have abnormal proliferation , I also have reason to suspect that there is a tumor in the urinary tract."

However, things have long been out of his control, and Carvey's counterattack will only become more violent: "If it is just an ordinary urethral injury, it is impossible to last for such a long time. I think that as a surgeon who often deals with urethral stones, I have definitely experienced it." The patient had postoperative hematuria. However, as long as the urinary tract is unobstructed, most surgical injuries can heal slowly within a few days."

"kindness?"

"What's the point of examining cells in urine?"

"That's good, that's a big improvement. I've been doing blind bladder stone resection all my life, and I've always used my hands to locate it. I didn't expect the times to develop so fast." Jacob stopped his voice suddenly, and asked Karvey in a low voice, "It's not the first time cystoscopy has appeared. Are you sure it will be successful?"

This is indeed the basis of surgery and does not require any theoretical knowledge, but anyone who has worked with surgeons for a period of time knows it.

Maruna's face became even more ugly, because he really didn't expect this.

"If no tumor is found, how do you know whether he has bladder cancer or kidney cancer?"

This is a good question. Carvey thought about meeting him during the inspection before explaining: "Actually, this is easy to explain, because this cystoscopy does not only see tumors."

"Not just a tumor?"

"After all, the scope of the mirror cannot be turned, and the mucosal tissue around the urethral opening cannot be observed." Carvey compared his hands to a cystoscope and a bladder, and explained, "But the source of hematuria can be seen. After all, the junction of the ureter is facing the urethral opening. It is the best position for cystoscopy observation."

(End of this chapter)