Nineteenth Century Medical Guide

The Internal Medicine Department of the Main Palace Hospital is the same as the Municipal General Hospital, regardless of system or severity, it brings together all kinds of patients.

If the internal medicine department of the Municipal General Hospital is a well-behaved baby who has never left home and only knows how to obey his parents.The Internal Medicine Department of the Main Palace Hospital is a young man who has experienced some world experience. He seems to understand many diseases but doesn't really understand them. In addition, he has just entered the rebellious period and his personality is very immature.

Insufficient research in basic disciplines has greatly restricted the development of internal medicine, and physicians always have an indescribable sense of powerlessness in the face of diseases.

And when you know the types and causes of diseases, but you can't cure them, repeated frustration will gradually wear down a person's will.

"If you want to become a qualified physician, you need not only have skills and a unique diagnostic vision, but also have a tenacious spirit!" Const Jean Bull, director of internal medicine at the Main Palace Hospital, is imparting experience to the doctors in his hands , "Although Mrs. Water's tapeworm treatment is a bit troublesome, as long as you persist, you will have a chance."

"Yesterday we increased the castor oil content to 20g, and the fern resin viscose to 50g, and the catharsis effect has improved a lot."

"But still only partial tapeworm proglottids can be seen in the feces."

Const dug out a magazine from the cabinet, and then took a bottle of ointment from his pocket: "This is the recently emerging medical cotton horse oil, which seems to have a good effect on the treatment of tapeworms. According to the introduction in the book, daily Take 3g, mix it with milk and swallow it, and it only takes 3-5 days to force out the tapeworm.”

The magazine comes from Lancet, England. The author is a doctor who specializes in treating tapeworms in Fife. He is best at catharsis. The article was published in 1865

"Okay, we will arrange for her to take it tomorrow morning."

Const sighed: "If even the horse oil doesn't work, you can only be sent to the electric shock room to try your luck like a tuberculosis patient. Eh? By the way, has the tuberculosis patient who was sent there an hour ago come back? "

"not yet."

"Why so slow?"

"Maybe there are too many patients who need electrotherapy. Dr. Sneijder personally accompanied them, so there shouldn't be any problems."

Their judgment on Sneijder himself was not wrong. He was an attending doctor with rich clinical experience, and he had solved many patients' troubles by practicing medicine for many years.But the result that appeared in front of everyone 10 minutes later greatly exceeded their expectations. The patient was carried in and his body was very weak.

The good news is that the hemoptysis that had been bothering the patient and the doctor for a long time disappeared, and the coughing was much less, but at the same time, a 10cm incision was made on the back.

"What's going on here? The electric shock room has also started bloodletting therapy now?"

"No, it looks like someone was stabbed with a knife."

"Don't be kidding, a knife down the back, not to mention the bones, can even shred the lungs inside, how can it be possible to suture the wound properly?"

Several possibilities appeared in their minds, and they even thought of the hospital being broken into, hijacked, and burned. But they just didn't expect that this tuberculosis patient had just undergone an operation, and the position of his right lung apex Several golf balls were stuffed.

"He fell down on the way to the electric shock room, hemoptysis was severe." Ned explained to Const and other colleagues, "Because there are clear regulations in the electric stimulation room, vomiting, severe sweating and drooling, and people who have just experienced Patients who have not completely stopped the bleeding after bloodletting therapy are afraid that there may be problems with the circuit. So "

"So what's the matter?"

"So I followed the advice of a surgeon and operated on the patient."

"Surgery? How long has it been?"

Const looked at the wall clock that had been running for an hour and a half, feeling very surprised, and couldn't figure out the logical relationship between tuberculosis and surgery for a while.Then he let go of this "ignorance" and began to pursue his subordinates who changed the treatment plan at will, and even gave up power to the surgery.

"Professor Const, I am his attending doctor." Sneijder thought about the explanation when he was held accountable, "I am only responsible for his health, so after the surgeon convinced me, I agreed this surgery."

The modern domestic medical system is similar to the political system, and the director can intervene on the patients under the care of other doctors.

In foreign countries, the attending doctor is the only person in charge of the patient. The so-called director is only responsible for managing the operation of the department and his own patients, and will not intervene in the treatment of other patients.Of course, there are far fewer surgical patients, and the director is often in full charge.

France in the 19th century had only just taken shape and was still very immature. Const sometimes intervened, but more often he offered his opinions.

"How your patient is finally treated is up to you, but this is ridiculous, surgery? Tuberculosis? Can these two things be linked?"

Sneijder had a delicate relationship with him, he was both a mentor and a subordinate, and he was also a candidate for director after Const retired.

He didn't want to make the relationship worse, and he knew that Conster had the right to intervene in these matters. As the attending doctor, he should give an explanation: "The patient had severe hemoptysis on the way, and the total amount exceeded 300ml. At this stage, it is difficult to survive a week. Not even electrical stimulation."

"Well, although electrotherapy is effective, it also has great limitations for refractory pulmonary tuberculosis." Const returned to the surgery issue, "Could surgery be able to handle it?"

"The patient's hemoptysis has indeed stopped."

"It's a coincidence."

"He is an old patient, and you know what's going on." Ned poured himself a glass of wine, then found a chair and sat down, and briefly explained the current situation, "The operation is not particularly difficult, and the speed is also very fast. After that, it was also very stable, but the breathing was faster."

"What about hemoptysis?"

"Not once."

"Hehe, that's impossible."

Const smiled and shook his head again and again. It wasn't that he didn't believe Sneijder's words, but that what he said was seriously inconsistent with the surgery he knew.

But the magic of surgery is that it can always use a series of dangerous invasive operations to achieve some effects that cannot be achieved by internal medicine in a way beyond ordinary people's understanding.The golf ball used by Carvey is completely beyond the scope of Const's understanding, but it only needs a little explanation from Sneijder to understand the principle.

After listening to the whole process of Carvey's operation, the chief of internal medicine, who has been in the main palace hospital for more than 20 years, finally believed in evil: "Closing the tuberculosis cavity and ruptured blood vessels by compressing the entire right lung? How can you still play like this, Sergeant Dio isn't stupid, old man."

"Well, actually." Sneijder took a sip of wine, "Actually, Professor Cedieu is the assistant, not the chief surgeon."

"Huh? It's not him? Who is that? Now the surgery department has lost its only commendable theater performance, and only Cedieu can do it."

"Who is the most discussed in the medical circle in Paris recently?"

"Yes." Const didn't care about surgery, so he didn't remember the name. He only knew that the other party was from Vienna. "Is that the Austrian who came to Paris for no reason?"

At this time, after a short rest in the lounge, Kavey once again called Cedieu, who had become a member of his assistant on the surface.

He needs to put several patients who have just been admitted to the hospital on the surgical schedule, especially the patient with abscess around the ganglion. The infection ranges from the periganglion to the popliteal fossa of the left lower extremity. The situation is not optimistic.

This extensive tissue abscess included the buttocks and lower extremities, the skin was inflamed, and severe cellulitis had developed.If it is not handled properly, it may eventually cause necrotizing fasciitis. If this is the case, there is nothing to do when Jesus comes.

But in fact, it is already quite dangerous now, at least Carvey can't find a way to solve such a large abscess smoothly.

But in the eyes of others, perianal abscess and anal fistula are very common operations. The lower part is cut directly, and the higher part is hung in the old way. It is far less exciting than stuffing golf balls into the chest cavity.

Moreover, in terms of the impact on today's medical treatment alone, pus drainage has no technical content, and the filling surgery that can curb tuberculosis and hemoptysis is definitely more valuable.

"Since it is confirmed that it is an abscess, it is not difficult as long as the pus is drained."

Cedieu is still more interested in the new role of golf: "Judging from the results of the operation, the hemoptysis has indeed improved a lot. But after all, the golf ball is a kind of foreign body, which is directly inserted into the important chest cavity. Will it happen after a long time? has a problem?"

"There are indeed some problems. Even if there is no problem, we have to take it out when the conditions are ripe." Carvey briefly introduced, "The perianal abscess of this patient is too large. If it is cut open, it will only cause more serious injuries." Fester. Even if the disinfection work is done, the incision may not heal in three months."

A patient like this is very dangerous even in modern times. It is very likely that the body temperature is hovering around 38 today, and the next day when you open your eyes, you will find that the abscess cavity has begun to die.

Then came septic shock, and then multiple organ failure that night, without waiting until the next day.

And surgery isn't much better, especially now that antibiotics and antiseptic capabilities are scarce.It is really not difficult to cut the abscess cavity, but the difficulty is how to achieve effective drainage after cutting, and how to make the new granulation grow into flesh.

Many large abscess cavities ooze continuously after incision, followed by new pus. It takes months to completely clean up the incisions that enter the muscle layer.

These are not the most critical. What is more troublesome is that most of the perianal abscesses that can be boiled into such a large abscess have some underlying diseases.The most common is the representative of endocrine diseases - the leader in diabetes and rheumatism - lupus erythematosus, which has a high affinity with infection.

Modern medicine will definitely try to use drugs to fight against these two chronic diseases, coupled with sufficient antibiotics and a series of fine surgical care.

But now there is no such condition, and Carvey is not even willing to delve into the patient's physical foundation, because it is a bottomless pit, and it is just a waste of time in the end.

"Everyone still cares more about the technology at the operating table, but in fact, it is more important to get off the operating table." Carvey looked at them as if he saw himself when he was young, "Surgery is not only about excision, but also the new type of surgery just now. treatment method."

His ideas are obviously several generations ahead of those present, and it took only three assistants with him for a while to understand the meaning of these words.

Especially for an elderly surgeon like Cedieu, it is difficult to understand the importance of postoperative incision management: "I admit that there are certain skills in drainage of pus, but whether the postoperative healing depends entirely on luck, if the patient's body is originally It’s not good, and there’s nothing we can do.”

This is the reason Carvey heard many times in Vienna: "Is there a big syringe here?"

"Big syringe? How big is it?"

"At least 20ml."

"No."

"Then use a wide-mouth bottle, just seal it well, and the effect will be similar." Carvey has already begun to think about the care plan after the operation. "Use a large bottle that is connected to a suction device during a cesarean section."

"That has."

"Choose five and use them after surgery."

"That much?"

"Not enough stock?"

"It's not enough, but I think it's too much. If you take them all away at once, the number of suction bottles that can be used in the theater will be reduced by more than half." Cedieu didn't quite understand the use of these bottles, "Actually, the bleeding is special. The ferocious cesarean section doesn't use so many bottles, why do we have to prepare so many?"

"Since it's not enough, make more preparations."

In terms of medical equipment, as long as conditions allow, Carvey has always advocated increasing revenue more than reducing expenditure, and things that are useful for surgery and postoperative recovery cannot be saved: "The huge main palace hospital should not be so petty."

Sediyo didn't know what the bottle was for, so he thought it was just a bottle, so why bother.

If it was someone else, he would have started complaining a long time ago, but now it is Kawei who is making the request, and he still needs to be "pious" enough to learn the technology.Especially the golf filling technique, the effect is immediate, and the process is not complicated, but watching it once is not enough for him to gain the confidence of being a surgeon, and he needs to watch it a few more times.

"I'll get someone to do it, and it will be ready tonight."

"The next thing is the rubber tube. It takes about 10." Carvey made a calculation, "First get [-] tubes."

"so many?"

"No?"

"Rubber is not glass, so it's not that easy to get. If you really want so much, you have to go to the rubber company to find a way."

"Then hurry up and use it tomorrow."

Sediyo responded to every request: "Okay, I'll send someone to go."

"The last thing is gauze and ointment, there must be these two, especially ointment is something that has been carried forward from France." Carvey suddenly thought of something, and asked again, "By the way, is there a sponge?"

"Sponge? Why do you want that thing?"

Carvey has seen nobles use high-grade natural sponges, which feel good and have good water absorption performance: "If you want that kind of high-grade sponge, it must be soft and have good water absorption performance."

The surgical instruments in Cedieu's mind are still limited to various metal utensils such as knives, saws, pliers, and tweezers: "This is not cheap, and what is the use for surgery?"

"It's not for surgery, it's for after surgery."

Live too much recently, headache