Nineteenth Century Medical Guide

Chapter 337 333. Tuberculosis and Hemoptysis
Tuberculosis has a long history and has been scattered with humans for thousands of years.It was also vaguely described in medical books, making it seem more like a physical trouble than a fatal disease.

Until the Industrial Revolution in the 19th century, the urbanization movement accelerated, and the urban population increased dramatically on an unprecedented scale.A large number of laborers who poured into the city competed with each other for the remaining living space of the upper class. The harsh environment and poor medical level made this period of time an excellent opportunity for the spread of tuberculosis.

They can spread to all levels of society, and poor people become the main targets of invasion because of their low resistance.From the Battle of Waterloo to the outbreak of World War I, tuberculosis killed 20% of adults aged 60-97.

The complexion of tuberculosis patients is mostly pale, and only in the afternoon does the characteristic flush appear, so people call tuberculosis the "white plague".

Everyone knows the "White Plague", everyone wants to cure the "White Plague", and everyone has nothing to do about the "White Plague", including the top doctors in the world.They didn't even know the reason for the treatment, and the battle against the plague was overwhelmed by the wave of failure before it even started.

After another 20 years, when Koch proposed the concept of Mycobacterium tuberculosis, they realized that the efforts of doctors in the past century had all been focused on cotton.

In fact, even Kavey had to be among them.

In the 19th century, there was no isoniazid, rifampicin, ethambutol, nor sodium p-aminosalicylate and streptomycin, so tuberculosis was difficult to contain.Even his good diagnosis will be limited by the lack of imaging, making it difficult to make a clear judgment.

It's just that Kawei is stubborn by nature, or it can be said that most top doctors have this problem.And he has more experience and means to fight against the white plague, allowing him to struggle to take a leg out of the tide of failure, barely take a difficult step, and step on the dry shore that only the winner deserves.

"Is it tuberculosis and hemoptysis?"

"Yes, yes!" The nurse's clothes were splattered with blood, and she looked very nervous, "There is too much bleeding."

"Karen!"

Just as Kawei was about to make people realize that his team was in the surgical theater, the pituitary extract that could immediately stop the bleeding was also left there together with other equipment and medicines.The nurse in front of him was too unfamiliar, and he couldn't trust him, so he had to do some basic first aid knowledge by himself.

He tore a tablecloth casually, took a pillow, some gauze and a stethoscope, and ran out with the nurse.

The patient was in his forties, with a pale face, kneeling on the ground with his hands propped up.There was a small puddle of blood in front of him, which didn't look like much, but it was different with the ones in front of the nurse.

Kavi stepped forward quickly, covered the blood on the ground with gauze, and felt his pulse with one hand and put on a stethoscope for auscultation.

The pulse of the radial artery was brisk, and the breath sound of the right lung was low, and there was a place where the breath sound disappeared.Fortunately for the patient, at least there is still treatment.

"Lay him down and get the stretcher."

"Let it down? He couldn't sleep on his back, he felt chest tightness and shortness of breath when he lay down, and the hemoptysis might get worse."

Just as he was about to finish speaking, the patient lay down easily with the help of Carvey.It's just that instead of lying on your back, you lie on your side, or according to Carvey, it's called the affected side position.This sleeping position + the compression of the upper cushion at the bottom can play a certain role in compression and hemostasis, which can be regarded as a first-aid measure. 【1】

"The amount of bleeding is not small, it is estimated to be 200ml, and a few more people will come!"

The patient's settlement comes second. As long as the patient can choose the lying position on the affected side according to Carvey's method, subsequent bleeding can be effectively reduced.

But this can only be relieved temporarily, and it is impossible to require the patient to choose this sleeping position all the time.What's more, the course of pulmonary tuberculosis is extremely long, and it is very unrealistic to rely on lateral compression alone.

Hemoptysis has reached such a level that there is no chance at all with the medical level of the 19th century. Carvey hopes to rely on surgery to give it a try, at least prolonging his life and buying time for lung resection in the future.But in front of him is not only the weak body of the patient with hemoptysis, but also the difference between the internal and external departments.

"Dr. Carvey, thank you for your help, and leave it to me."

Apparently, the nurse not only found the surgical ward closest to the corridor, but also ran to find the internist: "My name is Ned, and I'm his attending doctor."

"He needs surgery." Carvey didn't explain much to him.

"Hehe, Dr. Carvey is really a typical surgical thinking. Anyone who sees him wants to be solved by surgery."

Snyder smiled and asked the nurse to start cleaning the hallway, and with the help of other assistants around him, he squeezed out of Carvey's position: "This is very serious tuberculosis, and ordinary medical treatment is difficult to work, let alone surgery."

Carvey can't help it. Surgeons are naturally inferior to internal medicine. This is not the Municipal General Hospital where he dominates. As long as the other party asks, he has no room to refuse.

Of course, with his current status, it is still possible to make some necessary suggestions under the premise that he cannot refuse.

"I was wondering why the internal medicine patients came to the surgical ward. Where are you going?"

"Go to the electrical stimulation room." Ned pointed to the front door. "You can see it when you walk out of the door. The reason for passing here is because this road is the shortest."

It was the familiar electrotherapy again, and Carvey was already numb: "Is the electric shock effective?"

"The effect is still there. The key is whether you can persist." Sneijder glanced at Carvey and thanked him again, "Thank you, Dr. Carvey, for your help. Next time, if you need help from the internal medicine department, please feel free to ask."

Carvey smiled, "There's no need to do it next time, I need your help now."

Ned:? ? ?

"I advise you that it's better not to help the patient up."

"You mean using a stretcher?" Sneijder looked at him suspiciously. "Although hemoptysis is a troublesome symptom, electric shock combined with bloodletting should be able to achieve certain results."

Carvey:? ? ?
After being reminded by the other party, he saw that there were bandages and gauze used to stop bleeding after being bitten by leeches on the patient's calf.

"The amount of hemoptysis is so huge, why use bloodletting therapy? Is it different from bleeding on the limbs and spontaneous bleeding from the lungs?"

"Of course it's different. Hemoptysis occurs only when the lungs are too sticky and wet, which means that there is too much fluid in the body." Sneijder should be regarded as a conservative in traditional medicine, and he can already compare with some physicians in the Municipal General Hospital. Comparable, "I heard that Dr. Carvey has not experienced systematic medical teaching, I think."

"I have graduated from the University of Vienna." Carvey interrupted his guess.

"Oh?"

Sneijder was a little surprised, but after a quick adjustment, he was ready to use his degree to continue to suppress.However, the patient didn't give him this chance, and just after being helped up by the nurse, he coughed again after walking two steps.

"Dr. Snyder, he's coughing up blood again!"

"Hurry up and take him to the electrical stimulation room."

Sneijder firmly believed that moderate electric shocks could alleviate the symptoms of tuberculosis, and he firmly believed that hemoptysis would not cause too much harm. The real trouble was the impact of tuberculosis itself.But it was easier said than done. The patient couldn't support his body at all, and fell to the ground again.

"Where's the stretcher?" Sneijder finally gave in, "Get a stretcher!"

"I'm coming."

"Come on, let's lift him up together."

Seeing him ignoring his posture, Kawei sighed and said, "I have to immediately press him to stop the bleeding according to the posture I just placed, or he will die soon!"

"Don't worry, it's not the first time he has coughed up blood."

Still refusing to listen, Sneijder stood by the patient's side to help, preparing to put the patient on a stretcher.However, the repeated drastic changes in body position further aggravated the bleeding in the patient's lungs, and he coughed again.

The blood was like bursting shotgun, spraying blood spots of different sizes on his face and clothes, and at the same time dissuaded the nurses and assistants on both sides.

The approach of the two brought two completely different results. In the eyes of others, the better and the worse don't need to be measured by academic qualifications.

Nurses and assistants have no right to treatment, but those who want to keep their jobs will not question Sneijder's treatment plan at this time.

But seeing that the patient was about to be tossed to death, the nurse who called for help just now thought of an unavoidable solution: "Dr. Sneijder, the electric stimulation room will not allow him to have hemoptysis while undergoing electric shock therapy. The patient who did this last time has already .”

"I know!" Ned took out a handkerchief and wiped the blood on his face, "Forget it, send him back to the ward and observe for a while."

The nurse agreed quickly, but her hands and feet slowed down significantly. She looked at Carvey with an expression of "I've tried my best, help him quickly".

Carvey didn't have time to look at her expression. In his heart, the hemoptysis patient was already his patient: "Dr. Sneijder, surgery is not what you imagined. He can completely relieve the hemoptysis symptoms through surgical treatment."

"What do you want to do? Do you put cotton in his chest to stop the bleeding, or cut out his lungs?"

Carvey was a little surprised: "These two answers are a bit close."

"No kidding, the surgery will only cause more bleeding, and he won't even live until the ether effect ends."

Carvey simply judged the amount of hemoptysis in the next two times, checked his heart rate and current mental state, and said: "The situation is still passable now, and the operation is still effective. At least I can guarantee that the number of hemoptysis is not too much. But if it passes During this period, surgery will only become more difficult."

Snyder looked at the blood on the handkerchief, but didn't speak.

"Even if I don't need surgery, I still have drugs that can stop the bleeding." Seeing that he didn't continue to refute, Carvey knew that his words had already had an effect. "You should know better than me what the end result of hemoptysis caused by tuberculosis is."

The construction of new urban areas in Paris has attracted a large number of labor force, but also increased the infection rate of tuberculosis.

Although Sneijder has not yet reached the height of the director, he has also taken over a large number of tuberculosis patients, and he understands the helplessness of not getting good results despite his hard work.Looking at it from another perspective, his persistence is actually the same as that of Carvey, and it is essentially different from the old stubbornness who insists on opposing after seeing the effect.

"Surgery. Are you sure surgery can solve it?"

Kavi nodded.

While wiping the blood on his body, Snyder looked at the patient lying on his side. After struggling for a moment, he said, "What are you going to do? Can you give me a plan to persuade me to support you?"

"Specific plan." Carvey shook his head and simply explained: "Dr. Sneijder, surgery is not just about cutting out tissues and organs."

"???"

At this time, in the Second Surgery Theater, Cedieu's surgery attempt is still going on.

Sutures were threaded back and forth between the stomach wall and the intestinal mucosa, but the results were not good, and the possibilities Carvey said kept playing out in his hands.Fortunately, Sediyo's mind is stable enough to look at this matter with a normal mind, so the atmosphere of the practice was not bad at the beginning.

The only thing he can't bear is that he can always hear some descriptions of Kavey's previous intestinal anastomosis from these assistants from time to time.

Once there is a comparison, no matter how stable the mind is, some strange changes will occur uncontrollably.

And when a nurse from the internal medicine department rushed into the theater, this change of heart changed from a quantitative change to a qualitative change, like a ignited oil barrel, which suddenly burned up: "Who are you? What are you doing here? "

"Um, I'm a nurse."

"This is the place for surgery, get out!"

"Professor, I'm really sorry, that was Dr. Carvey who said he was going to send the patient here." The nurse resisted the pressure and forced the stretcher behind her into the door, explaining at the same time, "It's a patient with severe hemoptysis. , the bleeding was very profuse, I have already discussed with Dr. Sneijder."

It is a very common thing for practice to give way to surgery, and Sediyo will not fail to understand.

But when something was blocked in his heart, nothing was pleasing to the eye: "Kavi and Dr. Sneijder agreed? Did you agree with me? I'm still practicing and doing surgery here!!!"

"There is really no other way. The First Surgery Theater is still in use. We can only find a solution here."

"Am I not using it here?"

"But Dr. Carvey said"

"It's not normal for a hemoptysis patient to be sent to surgery. Isn't this an internal medicine patient? Can surgery be cured?" The irritability brought about by the practice completely hindered his judgment, "Are you an internal medicine nurse?"

"Yes."

"Tell you, Dr. Sneijder, that the surgery can't accept this kind of patients, at least I can't."

"This"

The scene was very embarrassing at one time, the patient was put at the door, it was wrong to come in and it was wrong to go out.In the end, Herman couldn't help but said, "Dr. Carvey said he was going to send the patient?"

"correct."

"So where is the other person?"

"Oh, I remembered, he went looking for something!" The nurse suddenly looked at Cedieu, and asked a question that had nothing to do with the operation, "Professor, do you usually play golf?"

"Huh?" Cedieu stopped and looked back at her. "Isn't it normal to play golf? What's wrong?"

"Dr. Carvey heard that there are often organizations in the hospital to play golf, so I want to ask if you have any balls." The nurse was afraid that she might not be able to express herself properly, so she made a gesture with her hand, "He wants to ask you for golf balls."

(End of this chapter)