Nineteenth Century Medical Guide

Chapter 427 423. Another Obstruction

No matter what era, it would be difficult for an ordinary general hospital to treat such a special patient.

There is no way to properly solve this problem in the 21st century, as there are too many and too diverse departments involved, including respiratory, digestive, general surgery, infectious diseases, obstetrics and gynecology, mental health, and perhaps even ENT and cardiology. We may have to form a whole team of experts.

The treatment is also very troublesome. It takes a lot of energy just to deal with malnutrition and pneumonia. No one can say for sure whether her and her child's bodies can withstand the various treatment plans.

In the 19th century, most people did not want to solve the problem. They thought less trouble was better than more. They could not even handle the ordinary patients. Even if the mentally ill were saved and the children were born, they would eventually be sent to a detention center or an orphanage. How long they could live was completely dependent on luck.

If the child survives, the boy will be fine, at least he can survive by working 15 hours a day. The girl may have to follow Shilina's old path, or find a more reliable man to live with.
In fact, what Landreth said makes sense. It is indeed inappropriate to put a patient with severe mental disorder in a multi-person ward.

Kavi also knew that he was just trying to drive the mental patient away by using other patients' attitudes towards him, and he didn't want to get involved in this mess. With this guy's temper, it was useless to insist, so Kavi didn't force it.

If the Main Palace Hospital didn't work, the results were similar at other hospitals. Some hospitals directly refused, while others made unrealistic demands that made Kavi give up.

The reason was simple. During the World Expo, foreign royal families and other wealthy tourists flocked to Paris. It was normal for them to have headaches or fevers. If a madman was left in the hospital, it might be reported in the newspapers the next day, and it might even be labeled a "mental hospital" in the future.

In the end, Kavi secretly sent the person to the Medical School of the University of Paris through the back door.

Anyway, the whole floor is managed by Kavi, so as long as he doesn't do anything too extreme, no one will know. Moreover, Kavi helped the University of Paris to obtain clean tap water, and the water diversion channel that was originally connected at the end of the second phase of the water diversion project was advanced by several years, so it is normal for them to contribute a little.

Kavi watched as several young interns sent by Hott settled Shilina down, sighed softly, and said to the man next to him: "Dr. Landreth, I don't think I invited you here."

"Hmm? Didn't you promise me to come to the lab to help?" Landreth had already taken off his hat, changed into lab clothes, and put on a mask and gloves. "You said I was a big help and shared a lot of your workload. Why? You regretted it after the experiment failed?"

Kawi looked at the full set of medical equipment and medicines he brought, and couldn't say much: "If you put the person in the ward, it wouldn't be so troublesome now."

"That won't work. The system is the system. Although the Hospital Main is a public hospital, it has a clear rule that it does not admit mental patients, so I won't put a lunatic in my ward." Landreth was so thick-skinned that he didn't look like a gentleman at all. "But not admitting patients doesn't mean I won't participate in the treatment. You should have no objection to this, right?"

"I have a chief surgeon working for free to help me, so of course I won't refuse."

Kavi's teasing had no effect on Landreth. What he wanted to do most now was to greedily learn Kavi's medical skills. Everything else could be put aside: "How should this woman be treated? Should she take a bath to clean the wound and the parasites in the ear canal? Or should she give her an enema to solve the problem of intestinal obstruction?"

"What's your temperature now?"

Several young interns were not familiar with the new blood pressure monitor and thermometer, and it took them a while to give the result: "38.3℃."

"My blood pressure is a little low, 78/44."

According to the general rule, Kawi would like to solve the lung infection and malnutrition problems, because these are the most fatal. But the problem is that these two are the most difficult to solve.

Methylene blue can only fight infection, not pneumonia. He didn't have a suction device, and the herbal medicines used by the internal medicine department were even more useless. There were no intravenous infusions of vitamins and proteins, no nasogastric tubes to directly inject nutrient solution, and no water and electrolyte tests to balance it, so there was no way to correct malnutrition.

"Let's clean it first, take care of the wound on the sole of the foot, and then clean the ears."

"Row."

Landreth didn't have the airs of a chief doctor at this time. He put on gloves and went forward with the interns to deal with it: "What about the enema? When is the enema? I heard that she hasn't had a bowel movement in four days."

"Forget about your enema for now. Enema is not suitable for pregnant women. It can easily stimulate the uterus and cause premature birth. Her intestinal obstruction is actually..."

Enemas also have contraindications. Enemas cannot be used in all situations. In many cases, enema fluids can over-stimulate the intestines and cause adverse effects. Kawi is also having a headache now. Without imaging examinations, the diagnostic ability of the surgical department has dropped by more than half.

"what happened?"

The only thing you can trust at this time is sight, touch, percussion and auscultation: "You guys take care of it first, I'll feel your belly and see how many months the baby is."

Landreth immediately became interested and handed the saline solution and tweezers to the intern beside him: "You can also do palpation?"

"That's not that difficult." Kavi comforted Shilina and gently placed his hand on her belly, "You can perform a cesarean section, but you can't do a palpation?"

"I haven't learned it. Who will teach me?" Landreth stared at Kavi's hand, looking at it very carefully. "Hujier and I don't have a very good relationship. I'm too lazy to ask him. Anyway, if a cesarean section is needed, I will do it. If it's not necessary, he will handle it himself."

While doing the palpation, Kavey explained the four-step palpation method. Just as he was about to let Landreth do it, his hand suddenly stopped in a strange place, and the pads of several fingers slowly moved to the left as he felt.

"what happened?"

"has a problem."

"What's the problem?" Landreth said, looking at the numbers he had just recorded. "Although the baby's biparietal diameter and head circumference appear to be a little small, considering the mother's malnutrition, she should be almost full-term."

"No, it's not the baby that has a problem, it's her stomach that has a problem." Kavi looked at Shilina, who looked quite confused, and asked, "Do you have a stomachache now?"

"."

Shilina's cracked lips moved slightly, looking like she was smiling, but soon returned to their original state and became unresponsive. She just turned her head and stared blankly at the wall, holding the mattress with both hands, trying to restrain her body from shaking, as if she had already gotten used to being surrounded by men.

Kavi also considered that her mental disorder would have a certain impact on the consultation, and had asked the nuns some questions before. However, the nuns also had to work to earn money and were not very concerned about the daily lives of those in the shelter.

"You vomited in the shelter, and you felt sick several times in the car." Kavi was not discouraged and asked again, "Did you vomit anything strange?"

Shilina still didn't reply, but her reaction became more intense. She clutched the bed sheet tightly with both hands, shaking uncontrollably. The muscles on her face were twitching constantly, and she looked like she was about to explode. "Vomiting something strange? What is that?"

Landreth didn't understand what Kawi meant by asking this question, and couldn't help but walk forward to see if there was any residue at the corner of her mouth. Kawi wanted to stop her, but he was still a step too late. Shilina had been holding it in for a long time, and finally couldn't help but spray it all out in one breath.

Suddenly, a mass of stomach contents that was difficult to describe in words covered Landreth's hair, face, and clothes. It was sticky, warm, and smelled terrible. It was a sour smell that could only be encountered when dissecting a corpse. It had already entered his nose following the rhythm of his breathing.

He took several steps back, bent down, and kept wiping his face with his hands, trying to get rid of the dirt. Due to the professional ethics of a doctor and a bit of gentlemanly manners, Landreth couldn't curse. Of course, it could also be a more direct reason, because the stuff between excrement and digestive residues was already smeared everywhere like pancake batter on a baking pan early in the morning.

"Don't be nervous, Dr. Landreth. It's just some food residue. You must have seen it during your internship in internal medicine." Kavi comforted him.

"what"

Landreth opened his eyes with difficulty and took the clean cloth that Kavey handed him. After wiping it twice, he realized that it was useless. The stomach contents that seemed to be wiped away would leave a heavy mark on his face, and under the influence of the air, it would stick to his face more and more closely, just like he had just been fished out of a mud pit.

He threw the dirty cloth to the ground in annoyance, muttering to vent his dissatisfaction: "My face stinks! Ah. What is this?!"

The other people in the lab were all new graduates who had never seen such a scene before. For a moment, they were shocked and didn't know how to react. In the whole lab, besides Landreth's voice, which was restrained to the limit, the only sound was Shilina's laughter that was like rags being torn repeatedly.

"Go get some water so Dr. Landreth can wash himself! Get some more people to clean the floor."

Kavi wanted to laugh, but he quickly held it back because the facts before him had verified his previous guess: "Wait, don't move!"

"what happened?"

"I told you not to move!!!"

Kavi took a pair of tweezers from the instrument tray nearby, covered his nose with a handkerchief, and approached Landreth, removing a thin white thing from his wet blond hair. It was covered with mucus and dirt, and it slowly twisted its body under the grip of the tweezers until it curled up on the tweezers.

Landreth calmed down after being called by Kavi, and his attention was focused on his hand: "Is this a bug?"

"roundworms."

Kavi's previous series of guesses came together, and everything made sense: "She eats little and is not very old, so the possibility of mechanical intestinal obstruction is very low. It turns out that the previous diagnosis was wrong. This thing is what actually caused the intestinal obstruction."

“It turned out to be roundworms”

Landreth also had an epiphany, but it was not about the worms and the corresponding treatment methods, but about an Italian helminthologist from 200 years ago: "It reminded me of Reddy's book Observations on Living Animals Found in Living Animals, which shocked me at the time."

Kavi didn't respond, but turned around, found a glass dish, and carefully placed the live worm in it.

"Why do you keep the worms? Do you want to do research on them?" Perhaps because of his dull sense of smell, Landreth seemed to have forgotten that he had something smelly on his face. "But it's hard to deal with this thing hidden in the body. It's hard to remove it surgically. She's pregnant, so I think she still needs an enema."

Kavi would never perform surgery on Shilina just because of an intestinal obstruction. After thinking about it, it seems that the only option is enema: "The baby is almost full-term, enema is not a bad idea, but..."

"what happened?"

"What are you going to use for the enema?"

Landreth finally waited for the intern to bring clean water, and then took a rag to wash his face clean: "Herbs, there are many kinds of herbs in internal medicine, just pick a few and pour them directly into your mouth."

This reckless approach is definitely not Kavi's first choice: "We don't know how the roundworms will react to the enema solution, and her body can't stand it. If the worms encounter stimulation and drill around, the consequences will be disastrous."

"That"

Landreth dried his face and hair and changed his clothes, but he still felt the stink, so he sprinkled some more alcohol on himself: "I do have a suggestion."

"What suggestions? Tell me now."

"The Chinese medicine books I collected earlier have descriptions of this kind of worm. They should also tell you how to get the body to expel the worms automatically." Landreth sniffed his body repeatedly and continued, "But Chinese characters are too difficult to understand. The same word has several meanings. I can only get a general idea, but I don't know what specific medicine to use."

"Where's the book?"

"At my house." Landreth suddenly remembered that Kavi was also a Sinology enthusiast. "Can you understand it? It's pure Chinese characters without any French annotations. Even the Marquis Elvi may not understand it!"

Kawi looked at the little bug in the glass dish and complained, "Didn't you say you were very capable? How come you can't even understand a Chinese medicine book?"

"Hey, you're going too far!"

Although he said so, Landreth's face was somewhat excited. He had been suppressed by Kavi's surgery these days, and this was his chance to make a comeback: "It just so happens that I have always wanted to have a good exchange with you. I will go home and get the books now, and have a good Sinology competition!"

"What's the point of comparing this?" Kavi didn't understand his train of thought. "The most important thing is to deal with the worms in her stomach."

Landreth dropped the rag and walked straight out the door. "Just as surgical skills can be divided into strong and weak, so can Chinese studies. If you can understand that book, I'll give you my position as professor of Chinese studies at the University of Paris!"

"No, no, no!" Kavi waved his hands quickly, "I'm not interested in that position, and I can't possibly teach students at the University of Paris. I think I'd better forget it."

Landreth became angrier as he listened. The man had already walked out the door, but he could still hear his voice, which lacked the bearing of a gentleman: "Just wait for me!!!"

(End of this chapter)