Nineteenth Century Medical Guide

Chapter 426. Cancer

"Since my youth, the dirty tenements and barns on the Place Carrousel have been a disgrace to France. They are more like the garbage piled there that constantly hums about the incompetence of the government, which makes me feel like a thorn in my throat. Now that I have returned to Paris at the request of His Majesty the Emperor, the first job I have received is to clean it all up." - Georges-Eugène Haussmann, "Memoirs"

At the beginning, the overall transformation plan of Paris came from the hands of Emperor Napoleon III, and some of them can be traced back to the Napoleonic period. Many plans had been approved before Haussmann took office. He was actually just a project manager.

Na San saw that he managed the place properly and the transformation was in an orderly manner, which led to the subsequent drastic large-scale reconstruction.

From the Boulevard de Strasbourg and the Boulevard de Sevastopol to the Boulevard Saint-Michel, from the central city to the Île de la Cité, to the banks of the Seine and inside and outside the city walls, Haussmann turned a deaf ear to any opinions, ignored any opposition and compromise, and vigorously promoted the transformation plan.

Before its reconstruction, the almshouse was located in the slums surrounding Notre Dame de Paris.

It was a chaotic neighborhood filled with low-grade theaters and various shady places, interweaving wet and twisted paths. The densely packed shabby shacks were crowded with a large group of humble residents who were unable to resist the demolition team. They had to work more than ten hours a day or choose to steal to make a living.

At the end of last year, the residents and the poorhouse were sent to a village outside the city walls.

It may seem like a decent place, but after living there for a while, you will find that it is more troublesome than the original slum. The villages and towns are surrounded by various heavily polluted industrial areas. Next to the gate of the new orphanage is a sewage canal and a large wilderness. Workers have to travel several kilometers every day to and from their workplaces and residences to earn a few pitiful francs, and they have to be careful not to become the target of thieves.

This orphanage, which barely maintains its operations with the help of the village church, is their last refuge.

Unfortunately, not everyone can enter the shelter's door.

Sitting in the bumpy carriage, Kawi looked at the shabby sheds in the desolate and dilapidated villages and towns outside the city. They were separated by scrap wood boards from the garbage dump, and one or two rusty iron sheets were placed on the roof to at least ensure that there was a dry place in the shed when it rained.

"Mr. Haussmann, I think you have chosen the wrong career." Kavi said with a smile, "If you had entered the Medical School of the University of Paris, you would have been a surgeon with a promising future."

Osman was sitting next to Kavi and didn't understand what he meant for a moment. He looked up at the secretary and guard in front of him, and seeing that they didn't respond, he could only ask, "Why did Dr. Kavi say that?"

“There is a disease called cancer.”

Kavi turned around, stretched out ten fingers, and made a crab-like gesture: "They come from our healthy body tissues and will continue to absorb nutrients and grow, but they can't bring anything useful to the body."

"So surgeons will choose to remove them surgically." Haussmann is not stupid. He realized that Kavi was making fun of him. "We don't regard them as so-called 'cancer'. After the reconstruction of the urban area of ​​Paris, there are many new apartments and residential buildings. They can move in if they make money."

The secretary and the guard looked at each other in surprise. They never expected that Osman, who was never willing to compromise, would talk about people's livelihood issues with Kavi today.

Kavi shook his head, pulled the curtains shut, and stopped looking out the window. "You mean those apartments on the new boulevard?"

"Yes, many real estate developers have built countless apartment buildings on both sides of those clean roads, much more than the old city that has been demolished." Osman is still trying to explain, but even he knows how weak this explanation is. "We have also opened a 'charity studio' and have been raising funds to help them."

“It looks like this money, which has been raised over the years, is still on the way to help.”

"."

Kavi is just a doctor, and he knows that his ability is limited. Saying more will not change anything, and will only cause more trouble for himself. But for this senior official who has a similar personality to himself, he still hopes to give some advice based on the wisdom of future generations:
"Mr. Haussmann, I don't know how the government works internally, but I know the rental prices of those new apartments. The lowest is 30 francs per month, and there is only one single room with a shared bathroom in the building." Kavi said, "Do you think these poor people have the money to rent it?"

“During the World Expo, the rent did increase a bit.”

"That was the price last winter. Now the lowest is 70 francs."

Kavey didn't want to debate with him any more, he just wanted to express his own views: "I have no interest in economics or politics, but from my observation, I found that people are selfish. If even the country doesn't help the poor, do you expect the capitalists who love money to help them?"

Osman took a deep breath and shirked his responsibility like many of his peers: "This is not my concern."

"Indeed, this should be what His Majesty the Third Emperor is concerned about." Kavi spread out his hands and said with a smile, "Isn't he afraid that these working-class people who originally supported him will eventually become his enemies?"

Osman did not answer this question, nor did he know how to answer it. He never intervened in the sentiments of the people, and his contemptuous and arrogant attitude would not urge him to think carefully about this question. Osman was just the right-hand man who executed Nasan's orders and the scapegoat after the incident.

Seeing him like this, Kavi had no desire to continue expressing himself. In the final analysis, he was just venting.

But he still had to thank Osman.

In the past few days, Kavi has experienced Mathilde's invitation, the failure of the experiment, the discovery of "Bertie's" identity, the settlement of the medical school's water pipeline, and the planning of the party. He is really exhausted from dealing with these trivial matters frequently.

There was still more than a week of vacancies left, and Landreth didn't want to see him. Although he didn't object to him going to the Hospital Main Palace because of Bertha, Kavi didn't like to bite the bullet and take over the job. If he was left idle like this, he really didn't know how to stay in this city.

Fortunately, Osman gave him a chance to "catch his breath". Perhaps finding a patient in the orphanage to save him would be a good job.

It is lamentable that even when a mentally ill person chooses a place to live for the rest of his life, his or her fate may vary depending on the amount of property he or she has.

The wealthy can live in a sanatorium run by a psychiatrist in the suburbs, where there are mountains, water, fields and manors, allowing them to fully feel that they have lost only a little of their spirit.

Those with a lower status could stay in a sanatorium in the city for the same price. Although the hardware facilities were not as advanced and there were only manors, there were many artists among the patients. In the past, everyone was a frequent visitor to the salon and knew each other.

If you are poorer, and you are roughly at the level of the middle class, you will live in an ordinary mental hospital. There are no comfortable hot springs or other enjoyable things, but instead cold water hydrotherapy, hypnosis, anesthesia, enema, etc.

The lowest class are the working class, who often have neither the time nor the money to go to a mental hospital. They can only work until they can no longer do their job, and then be taken to the worst mental hospital and imprisoned for free.

Since many psychiatrists have advocated non-custodial treatment for mental patients, most mental hospitals have given up using mechanical restraints to treat their patients. Therefore, these mental hospitals that mainly use imprisonment are not called mental hospitals, but temporary detention centers, which can only guarantee daily physiological needs and do nothing else. For women like Shilina, relief homes and shelters are where she goes.

Today, the temporary shelter is located next to a dilapidated church. It may look decent on the outside, at least it has a complete roof, windows, earthen walls, and even an attic. But if you go inside, you will face the pungent stench and mosquito bites that make ordinary people doubt their lives.

There was no bed here, only a pile of rags, blankets and weeds, and Shilina curled up in the corner.

Thin, extremely thin.

It wasn't the kind of systemic exhaustion caused by cachexia, nor was it the edema and skin and bones caused by lack of vitamins and proteins. Shilina's thinness was caused by long-term hunger, the purest kind of thinness.

Anemia made Shilina's face pale, except for the occasional twitching of facial muscles, there was no difference between her and a dead body. Fortunately, there was a half piece of black bread that she had not swallowed, and her hands could still move. Even with a big belly, she could still lie on her side and sew buttons on a piece of clothing.

Her hair was cut into pieces for easy washing, and her clothes were tattered. She had no shoes on her feet, and there were many wounds on the soles of her feet, many of which had healed, but one was festering and oozing pus, and flies would stop there from time to time to take a bite.

"The person who was originally in charge of this place couldn't stand it after just a few days, and he took the government pension and disappeared somewhere."

A nun in charge held a large basin of dirty clothes in her hand and said to them, "As long as people here are conscious and able to move, they have to work, doing the simplest piecework, about 4-8 hours. They can't concentrate for a long time, 8 hours is the limit."

"What about you? You guys want to work too?"

"We are from the church next door. We don't have much money to begin with. If we want to maintain our daily needs here, we have to work."

“How much can you make in a day?”

The nun pointed to the nuns hanging their clothes outside the door and said: "Each of us can earn 2 francs a day, but when we average it out with them, it's only 30-50 centimes, which is only enough to buy bread for them."

"That's too little." Kavi continued, "Her belly?"

"abdomen?"

The nun put down her dirty clothes, wiped her hands on her old skirt, looked at the four well-dressed men in front of her, and said with a smile: "If you have not eaten for three or four days, you are starving and stumbling on the road. At this time, a man said that he has endless steak, bread and red wine, you will follow him without hesitation."

At this time, another older nun hung up the clothes outside the door and walked in with a bucket: "You are asking questions even though you already know the answer, right? Doing this is better than dying on the side of the road and becoming a corpse with no one to claim it!"

Kavi couldn't bear to listen any longer and helped Shilina to complete the procedures.

The so-called formalities were actually very simple, just signing their books and helping her pack up. Shilina was also different from the others, except for a small booklet beside her, she had nothing else.

Before leaving, Kavi left behind a 100-franc note, which can be considered a kind of fate.

Perhaps Osman really liked her writing, because he flipped through the booklet as soon as he got it. It was still in the same condition as the book, with a tattered cover and a blurry title.

Unlike the completed book, the booklet only contained a scribbled introduction, which took up about four or five pages.

"How strange! There is not a single trace of erasure in the entire article, not a single word has been changed!" Osman read it very carefully, "Her talent is really amazing, I have never seen any text written more brilliantly than this."

Kavi was not interested in that. All he could think about was how to keep the woman alive. "Mr. Osman, I have a bad news and a good news for you. The bad news is that, except for being alive, there is nothing good about her."

Osman closed the booklet: "What about the good news?"

"They're still alive."

Kavi gave Shilina a physical examination in the carriage. The more he examined her, the more his brows furrowed and the more headache he had.

What is visible to the naked eye are plantar infections, malnutrition, oral ulcers and anemia. In addition, she has rales and sputum sounds when breathing and her body temperature is also very high, which should be a serious lung infection.

A simple measurement of heart rate and respiratory rate showed that they were very fast, and the sound of auscultation was a little far away, which could not rule out pericardial effusion and pleural effusion. Her stomach was not flat, and the shifting dullness of the swollen pregnant belly was positive, which should indicate a lot of ascites. At the same time, her bowel sounds were also very hyperactive, which might be due to the monotonous diet structure and dry stool leading to intestinal obstruction.

Compared to these, lice on the body and hair, and maggots in the ear canal seem less life-threatening.

Such a complex situation would be extremely difficult to deal with even in modern times, and young doctors who have never dealt with external parasites and severe malnutrition may not know where to start.

And on top of that, she had a baby in her belly.

From a doctor's perspective, considering Shilina's current condition, it is not a child but a bomb, and childbirth is the fuse that detonates the bomb.

"You must be kidding me!" Landreth stood at the door of the ward and stopped Kavi. "You want to send a crazy woman who was fished out of the garbage dump into my ward??? Are you mentally ill because of too many failed experiments?"

"Hey, watch your words." Kavi coughed twice and explained, "She's pregnant and very sick."

"Paris is so big, there are so many sick and pregnant women!" Landreth raised his hand and pointed everywhere, "Do you think I will let them in if they want to be admitted just because they are pregnant? What's more, she is a lunatic. Have you ever considered the feelings of other patients?"

(End of this chapter)