Nineteenth Century Medical Guide

Chapter 475 471. Anatomy Record (3)

Peon is one of the few doctors in this era who started from scratch. He relied on his ability and luck.

He was born in the countryside, his parents were farmers, and he could not escape the fate of farming for life. But by chance, Landreth quit his job and came here, and found that he had good learning ability and was interested in surgery, so after he graduated from high school, he wrote a letter of recommendation to the Paris Medical School.

The content of the letter was originally very short, nothing more than praising his excellent learning ability. With Landreth's limited writing skills, three or four lines would have been enough, but he managed to stretch it to a full page.

Peon was admitted to medical school as he wished.

The study of medicine is very different from that of other subjects. It requires not only careful logical thinking, but also a vast accumulation of knowledge throughout the entire career.

When Peang first entered medical school, he immediately realized the gap between himself and others. The economic disadvantage brought by his identity as a farmer was not only reflected in his dress, conversation, and etiquette, but also directly reflected in his knowledge reserves.

He had only learned the basics of physics and chemistry in a rural middle school, so there was definitely a gap in knowledge when he jumped directly to university. He couldn't understand a lot of biology and the detailed zoology and botany, not to mention mineralogy and physiology, which he had never come into contact with before.

Peon knew that a large part of the reason he was able to stay at the University of Paris was because of Landreth. This opportunity was rare, and it might only happen once in a lifetime. If he wanted to continue studying here, he had to work hard, so in the first two years of entering the university, his life was nothing but eating, drinking, defecating, urinating, and sleeping, and studying.

While receiving the scholarship, he also went to the Hospital Droit as an intern, one reason being to improve the living environment at home, and the other to become familiar with the surgery department.

In his third year at the University of Paris, Peon bought a small shop on the street for his parents. At first, he only helped the residents to mend clothes and repair shoes. After he had some capital, he gradually turned it into a decent clothing store.

Of course, what they sell are not high-end goods. The materials of the clothes and leather shoes are very ordinary, but Peon's parents can ensure that all the popular styles in Paris are made exactly as they are.

Within two years, they became famous and jumped from ordinary farmers to a small wealthy family. They could earn 4,000 to 5,000 francs a month from this store alone. If they were lucky enough to get a big order and work overtime, their income could go up even more.

Not long after, Peon's income did not change much, still three or four hundred francs a month, but his status in the family changed completely.

To be honest, he thought about giving up.

Surgery is inferior after all, and the gap between internal medicine and surgery is much greater than one might imagine. It’s not just the income, but also the status gap, which is also an important factor in his parents persuading him to go home and help.

Surgery can't bring class transition, he is still the son of a farmer. But the money he can earn by helping his family at home is definitely several times more than here, and the intensity of work is much less, at least he doesn't have to be with corpses all day, which smells bad.

The reason why he chose to go to medical school was not only because of a little interest, but more to change his family's current situation.

The status quo has changed, how long can the interest last?
Peon has been doing this for seven years and is now a capable surgeon who can handle many operations, including amputation, removal of superficial fibroids, radical treatment of tongue cancer, urinary tract lithotripsy, and enucleation of eyeballs.
He knows a lot, but it brings him nothing except some insignificant social status.

Without more income, without the sense of accomplishment of curing diseases and saving lives, and without the motivation to continue studying and working hard, he could not see any path for his future.

It was not until he first heard about Cavi's skilled tracheotomy and cesarean section, followed by appendectomy, bladder cancer resection, liver resection, spinal surgery, craniotomy, gastrointestinal tumor resection, ectopic pregnancy surgery, and countless other new operations he had never seen before.

These surgeries are accompanied by improved sphygmomanometers, thermometers, infusion systems, various types of hemostatic forceps, needle holders, improved intestinal and silk threads, urinary tract specula, various intraoperative incision fixators, and various emergency medicines.
Until he saw with his own eyes that Sadio gave up his title of chief surgeon and went to Vienna, watched Landreth hang around Kavi all day long, watched patients who were dying regain hope in Kavi's hands, and watched the nobles endure the smell of blood and stomach discomfort and squeeze their heads into the operating theater, just to show off the sense of superiority brought by witnessing the realization of cutting-edge surgical technology with their own eyes.

Peon felt that his future had never been so clear, because the future that was worth betting his entire life on was right in front of him, and that was Kavi.

[Jules-Émile Payon was a famous surgeon in history. He specialized in oophorectomy in the middle of his career and was extremely skilled, although the operation itself was of little value. In his later years, he also tried to remove uterine fibroids through the vagina. The operation was not perfect overall, but he was the first person to try this procedure, which laid the foundation for later.

He is probably best known for inventing the simple hemostatic forceps. This picture is "Before the Operation" painted for him by the famous painter Henri Gervais in the late 19th century, and is now in the Musee d'Orsay.]
However, in this timeline, Peon did not change his focus on gynecological surgery because of the monotony of surgery.

At this moment, holding the autopsy record book in his hand, listening to Kavi's speculation and explanation of the cause of illness and death, he was full of energy and felt like he was back to the time when he first entered the University of Paris at the age of 17.

"Hurry up, next one."

"His name is Carl Crowells, he's 34 years old, 1.72 meters tall, weighs 76 kilograms, and I heard he's a traveler."

Peon asked Albaran and Holmes to move the body to the dissection table. He lowered his head to glance at the tag on the toe. After confirming the name, he introduced: "He died alone in the hotel in the middle of the night. Because he had no other family members and owed the hotel a lot of room money, the boss happened to see the report in the newspaper and called us."

Kavi nodded, and couldn't help complaining that Hott dared to take any corpse, but he had to admit that the "quality" of this corpse was indeed high enough.

The body was intact and well developed, with no bleeding or trauma on the skin. The scalp was also intact, the eyelids were not swollen, and there were tiny hemorrhages on the conjunctiva. However, the pupils were dilated and equal in size and round, and there was no abnormal secretion in the two external ears and both nasal cavities.

What really puzzled Kawi were the lymph nodes throughout his body.

In any case of death, there will be some changes in the lymph nodes on the body surface. Inflammation and tumor metastasis will cause lymph node swelling, but the corpse did not have this phenomenon. In addition, his thyroid gland was normal in size and he had no incontinence. The only thing worth discussing was his nails.

"The cyanosis is very obvious." Kavi lifted his hand. "Just like Fenlina just now, the nails are blue-purple. The lack of oxygen causes the hemoglobin in the blood that should have bound oxygen to become reduced hemoglobin, causing the lips, nails and other parts full of capillaries to show a bluish-purple change."

"Excuse me, Dr. Kavi, what protein did you say?"

"Hemoglobin." Kavi looked at him and several confused doctors with a puzzled look on his face, and asked, "You don't know hemoglobin?"

"I don't know."

"never heard of that."

The remaining doctors who said they knew about hemoglobin had only heard of it and could not explain it. Perhaps because he was tired of dissecting the two corpses, Kavi did not want to explain everything by himself, so he said, "Cyanosis is a physiological phenomenon that was discovered in the last century, but it was not until recent years that several doctors, physiologists, chemists and physicists in the UK and the US explained this phenomenon clearly."

In fact, it will take several more decades to thoroughly study hemoglobin, but the basic framework of the research has been established. For doctors of this era, at least at the medical and physiological level, it can be described as "clearly explained."

"Dr. Hope-Seller, um, he should be called a physiological chemist. Five years ago, he founded the Journal of Physiological Chemistry, which published his research on hemoglobin, including spectroscopy, crystallization, and the discovery that hemoglobin controls oxygen. Two years later, Mr. Stokes from the UK."

Kavi paused and said to Janeway beside Holmes: "Mr. Stokes here is not your mentor, but a physicist. He discovered the spectrum of reduced hemoglobin three years ago, which indirectly verified the principle of the appearance of cyanosis. Before these two, countless scientists reported the distribution and measurement data of various gases in breathing air, the distribution and measurement data of various gases in blood, the preparation of hemoglobin crystals, and so on."

Advances in physics and chemistry promoted the development of those disciplines that were particularly dependent on them, and two new disciplines, physiological chemistry and pathological chemistry, came into being in the mid-19th century.

However, medical schools still only teach basic physics and chemistry, basic physiology and pathology, and do not teach these two emerging courses. Especially for doctors who have already entered clinical positions, there is no intersection with these two subjects dedicated to scientific research.

"Ladies and gentlemen, although France has strong medical strength, it has gradually lost its leading position in cutting-edge scientific research. We are doctors and we can choose not to do research, but we must read other people's research. In our spare time, we should pay more attention to the research reports of doctors in other countries."

Kavi saw that Landreth had already taken out the blood vessel, so he summarized it with a name, "You all know Baron Eustis von Liebig, right? He is a member of the National Academy of Sciences of many countries. Reading his works will give you a completely new understanding of physiology."

Landreth carefully removed the blood vessel and placed it in the maintenance solution, then asked, "So how did he die?"

"Lack of oxygen." Kavi roughly concluded, "It should be a problem with the heart and lungs. We need to open the chest to find out."

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This sentence threw the choice back to Landreth: "Let me open my chest?"

"I'm the lead surgeon, so I have to conserve my energy. There are several more bodies to be operated on, and I have to do it for two days in a row. If I want to find out the cause of death for each one, I will be exhausted to death." Kavi declined, "If you want to know the cause of death, of course you have to open the chest yourself."

"Forget it then." Landreth refused very straightforwardly and waved his hand at Peon, "Hurry up and get the next one."

Just when everyone thought it was over, a voice suddenly emerged from the crowd: "Me! I want to know the cause of his death! I can open his chest."

When everyone's eyes were focused in that direction, the young man's voice quickly fell back, and the tone became much deeper. But he did not regret it, instead he slowly walked forward and nervously said everything he wanted to say: "But I need bone shears, and in order not to delay Dr. Kavi's work, I have to borrow the teaching dissection table outside."

Holmes couldn't believe his ears.

James and Wade?

Didn't you say you were just looking at it? Why did you want to get started? You are so cunning!!!

Holmes wanted to do the autopsy himself. This was a free corpse, and he was doing it under Kawi's watch. No matter what the result was, he would get a generous reward. He only hated himself for attaching too much importance to his current job and the observation position closest to the autopsy table. He did not speak up immediately, and after a little hesitation, his best friend got the upper hand.

Kawi nodded directly: "Take it. If anyone else wants to participate, feel free to come over. Just let me know when the results are out."

If there were people who had thought about taking on the job of dissecting Carl like Holmes did before, then from the moment James and Wade got Kavey's permission, no one was willing to leave.

Those who could come here were all famous surgeons from other hospitals, all carefully selected by Holt. James and Wade, a young man in his early 20s, had no status or identity, and was not even considered a doctor at the Hospital Main, and was an American. Being his anatomy assistant would be embarrassing if it was spread out, but it would be a big deal if Kavey looked down on him.

Even Holmes had no intention of helping him. He just patted him on the shoulder and said, "Come on."

James and Wade are very clear about their positioning.

Unlike Holmes, he had just been kicked out of the internal medicine department and had almost no surgical knowledge. Although Kavey's explanation was interesting, it would be better to boldly pursue his own medical path and do it himself than to stay at the back of the crowd and watch Landreth perform vascular dissection in the gap.

"Doctor Kavi, can I see the abdominal cavity first?"

"Oh, whatever you want."

Now that the body was in his hands, there was no need for James and Wade to rush. A thoracotomy could be performed at any time, so it would be better to carefully observe the abdominal cavity that Landreth had processed first.

There were no sutures on the abdominal cavity, and the organs were still in their original positions, except for a section of the aorta in the middle.

He carefully removed the liver and spleen for weighing and observation. The cross-section showed no abnormalities except for some congestion. He also removed the stomach, pancreas, and gallbladder one by one, and cut the intestines in sections, but there were no abnormalities. This middle-aged man named Carl seemed to have really died of heart and lung disease, just as Kavi said.

Half an hour later, James and Wade finally used the bone cutters to bite open the ribs on both sides one by one, and flipped the entire chest upwards to expose the heart and lungs.

The heart and lungs looked full, larger than those of an ordinary corpse, and had a strange shape, especially the heart. When the lung tissue wrapped around it was turned over, it could be seen that the heart, which should have been more triangular in shape, looked like a sphere.

Apart from that, there were no other abnormalities. If I had to say anything, the dark red color observed under the oil lamp was one of them. But the dark red color didn't mean anything. As Kawi said just now, the lack of oxygen in the dead body would make the organs more or less like this.

So what was the problem? Was it heart failure?

James and Wade planned to start from the heart, find the ascending aorta above, pinch both ends and cut it open with scissors. However, the aorta felt a little weak, and what he saw after cutting was not blood and blood clots filling the whole blood vessel, but a ball of gas.

How can there be gas in blood vessels???