Nineteenth Century Medical Guide

Chapter 474 470. Anatomy Record (2)

More than four hours later, when George Sand took the girl's body to the Hôtel-Dieu in a carriage and got Kavi's consent to enter the autopsy room, the admiration, surprise, various discussions, arguments, and countless applause from inside the door made her feel that it was too cruel to hand over her beloved Fenlina to these cold-blooded doctors.

She stood in the corridor, leaning on a cane, leaning against the middle-aged man, and couldn't help asking, "Flaubert, do you think I did the right thing? Should I really send her here?"

"It doesn't matter whether it's right or not. What matters is that Fenlina wants it this way."

Flaubert smiled and said: "I have been in the hospital for a long time and I know very well what these doctors are thinking and doing. Patients are to doctors just as readers are to us. Doctors enjoy the process of dissection, just as we enjoy the joy of weaving tragic stories."

George Sand perked up a little: "You mean dissection is just like collecting folk songs?"

"Well, maybe that's the case for you." Flaubert shrugged.

"It's quite romantic when you put it that way."

At this point, the door of the dissection room was opened, and the strange smell that had been lingering on the tip of my nose suddenly became clear. It was like the masks on the faces of the men who invited George Sand to dance at the masquerade balls when she was young. Once they were taken off, the longing and fantasy in her heart became a bubble.

The dissection room is still the dissection room. No matter how much mental preparation she has done, what she has to face remains the same.

The first body was pushed out, covered with a clean white sheet, but the chest cavity underneath had been cut open along with the ribs, the abdominal cavity had been completely opened, and the important transplanted blood vessels had been taken away in their entirety.

Other organs were examined visually and microscopically, and the tissue cells all had varying degrees of edema. The most serious case was that the two lungs felt twisted when pinched, and there was fluid exudation on the cross section. Microscopic examination of the heart revealed that the myocardium was severely ruptured and the cells were heavily congested and edematous.
All of this came together into the diagnosis of cause of death on the card: "anaphylactic shock from bee sting", hanging on his toe.

A young doctor at the door looked around but couldn't find the woman. He could only shout, "Who is Fenlina's family member? The autopsy is about to begin!"

"I!"

After a busy night, George Sand didn't eat much and felt light-headed. She tried to stand up straight and walked towards the dissection room step by step with Flaubert's support.

In fact, before Lex and Xiaona came to the manor, she had never thought about watching an autopsy. The dirty autopsy room and the quiet and comfortable artistic life had nothing in common, let alone any sparks. She only needed to help Fenlina fulfill her last wish and hand over the body to Kavi as soon as possible.

But when she realized that Fenlina was really going to leave her, the reluctance and unwillingness hidden in her heart for the past half year were infinitely magnified, and finally turned into the excuse of "accompanying her for the last journey."

"I'm sorry." The young doctor stopped Flaubert and said, "Doctor Kavi said that only one person can come in."

"I am also a family member." Flaubert blinked and looked evasive, but continued, "At least I am half a family member, and she has difficulty walking, so she needs someone to support her. In case she falls..."

"Don't worry, there are chairs inside, and there are doctors everywhere." The young doctor didn't take his words seriously at all. He easily squeezed out of his way, took George Sand's arm, and insisted, "The number of people entering is set by Dr. Kavi. Since you are here, please abide by the rules here."

Flaubert was a little shy and embarrassed, not knowing what to say in rebuttal. George Sand patted the back of his hand and comforted him, "I'm fine, wait for me at the door, I'll come out with the cause of Fenlina's death in a moment."

The young doctor nodded slightly to Flaubert, hung a sign saying "Working" on the handle, and closed the door.

Thanks to the access to Paris's new water supply system, clean and sufficient water sources are enough to support a large number of anatomical operations, and the dissection room of the Hôtel-Dieu has been completely transformed. It has been changed from the original single space of Dupont Itran to a combined suite of half teaching and half dissection rooms.

As soon as you enter the door, you can see a blackboard with hand-drawn pictures on the wall, as well as several dissection tables and matching tables and chairs. Then the doctors in black uniforms separated into a semicircle and walked to a slightly larger independent compartment, which was the dissection table today.

Fenlina's body had been disinfected and cleaned and was moved to the dissection table.

George Sand's heart trembled slightly, but before her feelings showed on her face, she suppressed them.

She didn't know Kavi, didn't know any of the doctors here, and hadn't even read much of Kavi's coverage.

Her intuition told her that the middle-aged man standing next to the dissection table, wearing a black leather skirt and holding a scalpel in his hand should be the famous Kavi. However, the obvious standing positions and the gazes of the crowd reminded her that the young man who was about the same age as his grandchildren was the one.

She rarely used honorifics: "Are you Dr. Kavi?"

"Good morning, Ms. Arlo."

Cavey did not know George Sand's pen name, but only learned the name from Holt: "If you feel any discomfort during the dissection, please let me know. This is a normal reaction and there is no need to feel embarrassed. Of course, if you feel unacceptable, you can stop watching at any time."

"I've heard him say all this." George Sand pointed at Holmes beside him.

"Anything else you need?" Kavi changed his cold tone and said, "As long as it's something I can do."

"that's all, thanks."

"Then let's start now."

Having performed a lot of public surgeries, it was common for Kavi to be watched by others during his operations. However, this dissection was different from the so-called public dissections, as the onlookers were the family members of the deceased, which added to the sadness.

If it were modern times, he would never agree, but in the 19th century with its clear social classes, and encountering a rare corpse of a peer, Kavi was willing to make concessions.

"Autopsy number 7-19-2, female, 7 years old, 122cm tall, well-developed and well-nourished." Landreth didn't have as many concerns as Kavi, and directly cut open Fenlina's stomach with a scalpel, "Let's start with the digestive system first."

Unexpectedly, Kavi shook his head and said, "No need, just take the blood vessel directly."

"Huh? Do you know the cause of death?" Landreth looked up at Kavi.

"I don't know the details, but the location is clear." Kavi looked at the medical history provided by George Sand. "The patient has had weak limbs and unstable walking for a year, accompanied by slurred speech and increased difficulty in swallowing for more than two months. He also has drooling, night terrors, inability to raise his head, lack of energy, slow reaction, inability to open his eyes, and inability to close them."

"Impaired mobility, impaired perception, sounds like a neurological problem."

Like other doctors, Landreth only knew the relationship between symptoms and corresponding body systems, but did not know how to further locate them or how to treat them: "Like Fisher, is it the brain?"

"Correct."

George Sand guessed several possibilities, but he didn't expect Kavi to be able to identify the cause right away. He immediately asked, "What is the disease? What disease does Fenlina have?" "I only know that the problem is in the brain." Kavi explained, "The specific cause needs to be opened by craniotomy to know."

George Sand's head buzzed, and he subconsciously avoided the question and asked, "Will the craniotomy you mentioned affect the anatomy? If so, then..."

"It doesn't affect it."

Kawi's straightforwardness didn't leave her any way out. The choice was back in her hands before she even gave it up: "Do we have to open the skull to find out the cause of the disease?"

"of course."

"That"

George Sand hesitated as she looked at Fenlina's beautiful blonde hair, and this hesitation turned into a tooth mark and a deep cut on her lips. Tasting the blood in her mouth and seeing Landreth's skillful and unscrupulous dissection techniques in her eyes, she finally compromised.

"After the craniotomy, can it be restored to its original state? At least put the bones back and sew up the scalp."

"I would have done it even if you hadn't told me."

Kavi took off his coat, rolled up his shirt sleeves, and when he was dressed, he picked up the craniotomy tool: "In order not to damage the appearance, we open the craniotomy along the hairline and cut the entire skull together. Although the operation is not as strict as surgery, it still needs to be delicate enough to prevent excessive damage to brain tissue and misdiagnosis of the cause of death."

It was still a combination of a hand drill and a wire saw. It only took a few minutes, and the cut skull and blonde hair were removed from the body.

6◇9◇Book◇Bar

Kawi cut out the entire brain and weighed it: "580.8 grams, which is heavier than the brain of a child of this age."

"Are you suffering from edema?"

"There's still congestion, but the two cerebral hemispheres are symmetrical. Is there something wrong with the blood vessels?"

"No." Kavi briefly checked the anterior, middle and posterior arteries and the basilar artery. "But when I cut off her brain, I found that she had brain herniation. To be more precise, it should be cerebellar tonsil herniation."

Landreth, who had gone through that craniotomy, had a certain understanding of brain edema and brain herniation caused by craniocerebral trauma. After hearing Kawi's description, he immediately stopped what he was doing and asked, "Is it the cerebellar tonsils embedded in the foramen magnum?"

"Yes, that's why it's called foramen magnum herniation." Kavi pointed to the medulla oblongata. "When the cerebellum is squeezed and falls into the foramen magnum, it squeezes the medulla oblongata next to it, causing a sudden interruption of breathing."

"Breathing interruption?"

"Why is the breathing interrupted?"

Although many surgeons did not believe in phrenology, they had not systematically learned the relevant knowledge about brain function. Many of them were keen on cutting open the abdomen to explore organs, or dealing with urinary system diseases and amputations, and knew very little about the brain.

Medical schools rarely offer courses on brain anatomy, and they don’t teach much about the functions of cranial nerves, because anatomy professors don’t know much about the brain, and even if they do, they think it has little to do with clinical medicine and is just a formality.

"You haven't read Professor Magendie's "Report on the Anatomy and Physiology of the Brain" or Professor Fluran's "Experimental Studies on the Nature and Function of the Nervous System." At least you have attended Professor Fluran's anatomy class and seen Dr. Cave's surgery, right?"

Landreth couldn't believe his ears. "'The medulla oblongata controls breathing and is the center of human breathing' has been a settled anatomical and physiological knowledge for thirty years. How dare you still ask questions here? Are you worthy of Professor Flulan, who just passed away half a year ago?"

Several people lowered their heads.

Kavi, who only required knowledge from his assistants, said to George Sand while performing a sagittal incision: "The only cause of foramen magnum herniation, besides brain damage, is a brain tumor."

"She has a brain tumor?"

The old woman wiped away the tears from her eyes, stood up tremblingly, and took two steps forward while resisting the nausea: "Where is it? Where is the tumor???"

Kavi had cut Fenlina's brain lengthwise.

With the before-after comparison, the incarcerated cerebellar tonsils and the compressed medulla oblongata appear more obvious than in the overall view.

[It's just a specimen picture, please don't be so kind as to report it]
In the brain stem above the medulla oblongata, there appeared an extremely obvious enlarged gray-white tumor.

"This is a typical brainstem tumor," said Cavey. "The sagittal view showed diffuse and symmetrical enlargement of the pons, which was firm and grayish white. The tumor was widespread and had completely invaded the entire brainstem, from the midbrain to the medulla oblongata."

Peon was making the anatomical notes, while the doctors watching stood around Fenlina's brain and drew its sagittal plane in full and detail in their notebooks.

In the entire dissection room, the only sound besides the sound of the pen tip rubbing against the paper was George Sand's sobbing.

Almost without her being prepared, Kavi completed the cause analysis. With reason, evidence and pictures, he gave George Sand a perfect answer. But for her, the answer came too quickly and straightforwardly, so that the end of Fenlina's life, which was originally imagined, appeared too "hasty".

"It's over." George Sand slowly returned to his chair, then relaxed all his muscles and sat there slumped. "It's over?"

"ended."

Kavi asked Holmes to prepare the sutures and start the final repair work: "Fenlina's life is over, but her blood vessels will still be 'alive' in the freezing machine, in the maintenance fluid, and even in Bertha's body. Even if the blood vessels fail to meet the requirements, her brain will be made into an extremely important study specimen."

"specimen???"

George Sand had never heard of such a thing before, but when he thought of what he had just signed at the Surgical Association, he realized what the "final right of disposal" meant: "You promised to preserve her appearance."

"Of course."

Kavi was already threading the skull: "You can rest assured about my suturing skills. I will minimize the needle holes on the scalp as much as possible, and with the hair covering her, she will be as beautiful as before.

Of course, if you have such a need, you can still take her home and bury her after I finish stitching her up."

This chapter is a bit late, sorry