Nineteenth Century Medical Guide

Chapter 473 469. That "Woman"

7月19日清晨5点，离拉斯洛制冷机所在列车汇报即将进入巴黎的消息已经过去了1个多小时，距离卡维进入解剖室则还有不到4个小时的时间。

A four-wheeled carriage was speeding along the dirt toward the suburbs of Paris.

In the car sat Lex and Xiaona, who had fulfilled Kavey's promise to them since they had completed the 100 heads mission. Not only did they receive a substantial pay raise, they also became Kavey's official errand boys.

The destination of the carriage was a manor in the southeast corner of Paris. The two had been bumping around in the carriage for more than two hours.

However, this kind of bumpy ride was nothing in their eyes. This mission was much simpler than catching dogs and buying heads. It was nothing more than carrying the bodies of the dead all over Paris.

Before coming here, they had already visited three hospitals and successfully captured two bodies. The other one was not taken away because he suffered severe trauma in a duel and had a splenectomy on his abdomen. The cause of death was excessive blood loss caused by damage to large blood vessels.

It is not known whether it was caused by the surgery or the trauma itself.

The man was 38 years old, and the card was before 40. He also had a history of alcoholism. The location of the vascular injury was also very delicate. The two could not determine whether the rupture location would affect Kawi's transplant material. Considering various reasons, they had no choice but to give up.

Anyway, the newspapers on the 18th had already published the news that the surgical association where Hott worked had raised the price of corpses from the original 50 francs to 150 francs. If this method could not receive enough corpses, the price would be further increased.

After passing a dense forest and the family cemetery, the carriage arrived at the gate of the manor. Before the driver got off, the servant who had been waiting here for a long time opened the iron gate.

This is a French manor with a century-old history. The layout is stable and conservative. Compared with the manors in the urban area of ​​Paris, it is surrounded by trees and flowers and is more peaceful. The carriage passed through the wide and unique garden and stopped at the main entrance. Lex and Xiaona jumped out of the car and went up to the bedroom on the second floor under the guidance of the butler.

From the moment he entered the room, the sound of a melodious piano echoed in the room. It was not until he reached the second floor that he saw an old woman playing the piano. The timbre of the piano was ordinary, and even Xiao Na, who was a dabbler among dabblers, could hear the amateurishness of the other party's skills. However, the song itself was very special, and the person playing the piano was familiar enough to hear the sadness in it.

"People are here?"

A middle-aged man with a bald forehead and a goatee walked out of the bedroom and said, "You two should wait in the next room for a while. When the lady finishes playing this song, we can go see her together."

Lex and Xiaona were anxious because it took two or three hours to get to the main palace hospital. It was almost dawn, and they had to find a few more bodies so as not to affect Kavi's work.

However, they have been in contact with nobles more recently, and their dressing and interpersonal skills have gradually become more decent. They have also repeatedly heard Holt and Kawi emphasize that this kind of work requires being "obedient" and careful, and they also know that this kind of work cannot be rushed and must be carefully considered before taking action.

They didn't know what had happened to the family, but they knew clearly that the owner would never send this telegram to the Surgical Association for a mere 150 francs. The time of the telegram was earlier than the required time of death of the body, so the person should still be alive when the telegram was sent. As for whether he was dead or alive now, they didn't know, and they didn't dare to ask more. They just responded and stayed in the house obediently.

"I was a child when I heard Chopin's Nocturne Legato." Xiao Na put his hands in front of him and gently moved his fingers to the rhythm. "The technique is very crude, but the emotion is very full. There is loneliness in the sadness, or it can be said to be a resistance to this unfortunate world."

Lex put his finger in front of his mouth and touched his lips lightly: "How can you judge others when you play the piano yourself?"

However, Xiao Na had already been immersed in it, and slowly came to his senses: "Wait, where is this place?"

"Where?" Lex took the tea brought by the servant with a smile and answered softly, "Nohan Manor. Mr. Holt said before that we should come here to pick up a little girl and send her to the main palace hospital regardless of whether she is dead or alive."

Xiao Na looked bitter: "I stayed up late and my mind was not very clear. I didn't expect it to be Nohant Manor. This was where Chopin and his girlfriend lived before. After so many years, the hostess should still be the same person."

The servant did not respond, but simply nodded.

At this time, the music stopped, and the short and stout old woman came over with the help of the middle-aged man: "Thank you both for waiting for me."

"It doesn't matter." Xiao Na didn't know what to say, but at least he was sure that the person in front of him was Chopin's girlfriend who had lived with him for nine years. "You must be Ms. Orlo."

"Yes, I was the one who sent the telegram."

The old woman had short hair, wore a black dress, and held a man's cane. If you hadn't gotten close enough, you wouldn't have believed she was a woman over 60. She stood at the door and said, "Just call me by my pen name, George Sand. It sounds more comfortable to be a man."

Everyone came to the bedroom, where a little blonde girl about Bertha's age was lying on the bed.

"Her name is Fenlina. She is 7 years old this year and 122cm tall, much taller than when I was a child." George Sand stood at the end of the bed and looked at her, his hands tightly gripping the bed frame. He seemed to have aged several years. "She was almost dying when I sent the telegram. She finally died half an hour ago. I wanted to see you, but in the end I couldn't do it."

Lex checked the body and found nothing unusual. He was ready to hand over the receipt and money. "The body meets Dr. Kavi's requirements. We have accepted it. The receipt lists several ways to deal with the body after the autopsy. Just sign your choice."

However, George Sand seemed to dislike this hasty approach. He directly refused the francs and threw the receipt to the servant without even looking at it: "Where is Dr. Kavi? Didn't he come?"

The idea of ​​not charging money was already in mind. Those who can live here are wealthy families, and their daily expenses are more than this figure. As for the receipt, it really doesn't mean much to the family of the deceased who sold the body. It was only because Kavi insisted that he did so.

The only thing that is incomprehensible is that the other party is only interested in Kavi and ignores the money and the method of dealing with the body.

"He is really busy. He has to dissect several bodies these days, and then he will have to do surgery," Xiao Na explained. "After this is over, he will also have to do surgery on His Majesty the Third Emperor."

"I thought he would come." The old woman was not interested in Kavi's work. She just looked back at her old friend and put forward her own request. "As you can see, I don't want money, and I'm not short of money. I do this just to help Fenlina fulfill her last wish, so I hope you can meet a few of my requests."

Theoretically, Lex and Xiaona have no decision-making power, and if they have any requests, they need to talk to Holt.

But considering that the body was of similar age and gender to Bertha, and had just died, he could listen to it first. As long as the content was not too extreme, he could agree to it first, and then find Holt to make a decision when he returned to Paris. If he could not meet the other party's requirements, he could just call a carriage to send the person and the body back.

It sounds outrageous, but it's exactly what Kavi would do.

The two looked at each other and said, "Tell me, what are your requests?"

"I need Dr. Kavi to help find the cause of her death." George Sand recalled every detail of the past, feeling more unwilling than willing to give up. "She was only seven years old! She only lived a healthy life for six years. In the middle of last year, around this time, she began to fall frequently when walking, and then she had problems speaking, as if Satan had taken everything away from her."

"This" Lex and Xiaona were used to seeing the deaths of the lower classes, drug abuse, alcoholism, poisoning, starvation, violence, and countless others. Fenlina in front of them was definitely not one of them. She was very well protected and obviously died of illness.

It was very difficult to find the cause of the disease, and the two had no professional intuitive feeling about Kavi's strength. They only knew that he was a very good and great surgeon.

I can definitely help, but whether I can find the cause is still an unknown: "I can only guarantee that given Dr. Kavi's character, he will do his best to find the cause of her death. It can be said that every doctor involved in the autopsy is interested in the cause of their death. However, medicine is an extremely complex and mysterious field, full of unknowns, and the final result may be..."

George Sand nodded before he finished speaking, very satisfied with the answer: "The second request is that I hope to witness the entire process of the dissection."

"what?"

Xiao Na cried out in confusion, and immediately covered his mouth and stood awkwardly behind Lex. This caused the old woman to look cold: "What's the problem?"

"No, I'm sorry."

Negotiation is not his strong point, so Lex has to handle it: "This may be a little difficult. Dr. Kavi regards autopsy as work and is generally not open to the public."

"Heh." The old woman slowly walked to Fenlina's bedside, stroked her long golden hair, and said lightly, "Isn't surgery his job? Surgery is open to the public, but dissection is not? It's because the money hasn't been paid in place. Tell me, how much does it cost?"

"Ms. George Sand, these are very strong words."

6◇9◇Book◇Bar

Lex was glad that he still remembered Kavey's original words: "The subjects of the operation are human beings, and their opinions can be sought. The subjects of the dissection are corpses, and not opening them to the public is a respect for the corpse."

"But I'm her guardian!"

The old woman understood what he meant, but she was still a little unhappy: "She saw the report about Bertha in the newspaper, the report about Dr. Kavi, and the report about the Surgical Association, and she wanted to do something for them after her death. Dissection is also a part of her life. I just want to accompany her on her last journey. Is that not okay?"

Four hours later, in the autopsy room of the Hospital Main, Landreth had successfully removed the first aorta of the day. After removing the branch arteries, he performed a simple anastomosis, then expertly removed the vascular endothelium, soaked it in carbolic acid and paraffin oil, and sterilized it and isolated it from the air.

“Why do we need to remove the lining of the blood vessels?”

"It's troublesome to peel off the inner membrane, and the whole process of peeling it off is immersed in carbolic acid, which requires too high a level of technology."

"It's not only time-consuming and laborious, I think the blood vessel walls are already thin, and removing the lining will also reduce the toughness of the blood vessels. What if they rupture after surgery?"

This is a question that almost everyone asks, and it is also a key discussion point in the entire transplant. Landreth asked this question before when doing a canine vascular transplant, and it almost caused an argument. But for Kawi, who is familiar with vascular surgery, stripping the intima is the foundation of the foundation.

Because in allogeneic vascular transplantation, vascular endothelial cells will stimulate the host's immune system and become the "target" of the immune response. Even in modern times, it is necessary to use a combination of freeze-drying and gamma-ray irradiation to barely eliminate the antigenicity of allogeneic blood vessels. However, for safety reasons, immunosuppressants will still be used after surgery.

This is why artificial blood vessels have basically replaced allogeneic transplants.

In the 19th century, freeze-drying was enough to make Cave rack his brains, and gamma rays were a black technology that completely belonged to the category of science fiction.

As for immunosuppressants, doctors of this era did not understand microorganisms, and their understanding of immunity only stayed at the level of "disease resistance", and there was no concept of rejection reaction. Otherwise, there would not be the outrageous surgery of inserting sheep testicles into the scrotum, nor the strange operation of transfusing animal blood into the human body.

Since there is no way to solve the rejection reaction, then we should solve the thing that causes the rejection reaction. Direct physical means of peeling off the vascular endothelium is the most convenient and effective method.

In fact, it is not difficult to explain. The difficult part is how to make up a story to make yourself "discover" this phenomenon: "I have performed hundreds of vascular anastomosis on the Prussian-Austrian battlefield and found that the inner membrane and outer membrane of the blood vessels are both unfavorable factors affecting vascular anastomosis. Many soldiers developed complications within one or two months after the operation. After death, it was found that the previous vascular anastomosis had very serious vascular stenosis."

"narrow?"

"How can it be narrow? This is so weird!!!"

"Shouldn't it be expansion? After all, the blood flow speed and pressure in the arteries are very exaggerated. After a long time, the inner membrane will tear and the wall will naturally not be able to withstand it. Just like the cause of aortic aneurysm you explained before, the pressure directly tears the inner membrane, and the lumen begins to expand outward. Over time, the wall will become thinner and thinner, and finally cause rupture and heavy bleeding."

Cavey explained: "That was actually the extremely high arterial pressure caused by violence. It wouldn't happen under normal circumstances, at least the lining wouldn't tear so easily."

“Why is it narrow then?”

"I don't know. Existing medical theories can't explain it." Cavey could only say, "But this is what I observed."

The huge contrast between the conclusions before and after made everyone confused, and vascular stenosis itself was far beyond everyone's understanding.

"You all probably know about mitral valve stenosis and pulmonary artery stenosis. I don't know if you've heard of them, but you may have even seen them by chance during an autopsy."

Kavi asked Peon and Albaran to turn over the body, while he explained to everyone: "Of course, this is just an objective phenomenon that can be observed during the autopsy, and what I observed is similar. It feels like the embankments on both sides of the river. Whether they collapse or leave behind mud and garbage depends on the flow rate and impact of the river itself."

In the past, there has been much debate about these kinds of observations and descriptions.

Because everyone can dissect a corpse and see the appearance of the organs, blood vessels, and nerves inside the corpse. When objective facts are colored by subjectivity and then modified by the pen, the conclusions drawn by different people are often different.

But the conclusion that Kavi stated is so unique that one cannot help but believe it.

"What are you mumbling about? It's as if you've also performed vascular anastomosis and seen the bodies of patients after vascular anastomosis. What's the point of discussing a phenomenon you've never seen before?" Landreth scraped the inner wall of the blood vessel clean and finally solved the first blood vessel. "Instead of dwelling on this topic that we have already concluded, why not talk about the cause of his death."

"The cause of death should be allergies, very severe allergies. Edema blocked his airway, just like a patient I treated before." Kavi had already discovered a round dark red wound on the back of the neck. "If I'm not mistaken, he should have been stung by a bee."

(End of this chapter)