Typhus and typhoid fever have always been great killers of population control. It was not until the emergence of antibiotics strong enough to combat them that the development of infections in patients could be controlled. But there were no antibiotics in the 19th century. Even if antibiotics did exist, they were only for treatment. To truly effectively prevent the spread of infection, we must fundamentally eliminate its source.
The source of typhus is Rickettsia lice[1], which is transmitted to humans through body lice and rat fleas.
Carvey's military medical manual spent a considerable amount of space on regulating water use and personal hygiene in the army, and also made clear the extermination of rodents and pests. But apparently the Sixth Army doctor did not take his manual seriously.
The military doctors of the Western Front Army also received training from Kawei, but they were not bound by Kawei, and there was no point promotion and reduction system.
Besides, it was the physician here who treated Adams.
Carvey said goodbye to Adams and did not go directly to the doctor in charge. Instead, he made a rounds in the ward to see with his own eyes how far the situation had developed.
He tightened his collar and cuffs, wrapped himself in a black cloak, followed by his guards, opened the curtain and walked into one of the tents.
Suddenly, a strange smell in the air hit the tip of his nose.
Without alcohol and carbolic acid, Kawei hadn't smelled this smell for a long time. If I had to describe it, the air here was like that of an uncovered sewer filled with disgusting contamination.
At this time, two soldiers in military uniforms were carrying a body wrapped in fragments of a torn cloak and walking towards the door.
"Come on, give way!"
Kawei looked at the body and saw that there was no blood on it, so he asked more: "Excuse me, how did he die?"
One of the most basic questions in modern medicine has become a difficult problem for everyone in this tent: "You have to ask the doctor about this, and we don't know."
Kawei did not embarrass them, but followed the words and continued to ask: "Oh, where is the doctor?"
The soldier suddenly saw the half-covered collar badge under Kawei's cloak and shuddered in his heart: "We are dealing with patients inside."
"Thanks."
Kawei nodded and let the two of them go in.
[The place that can best measure the disaster of a war is not the battlefield, but the hospital], this is a passage originally written by Ignatz in "Memoirs of a Surgeon". Kawei couldn't fully understand the meaning of this sentence before, but now he fully understands it.
The temporary rescue center of the Sixth Army, which is what Etler mentioned before as the barracks hospital, has already fallen into a dilemma of tight medical resources.
Three of the four large tents accompanying the army are used to house trauma casualties, and the other is a temporary medical ward that handles mild patients. The truly severe ones will be moved to surrounding farmhouses for care.
However, except for slightly different treatment methods, the accommodation conditions for soldiers are not much different regardless of whether they are medical or surgical.
There are hundreds of patients living here, and there are so few beds that two people sleep in one bed. Many other soldiers can only lie on the ground wrapped in blankets. There were several corpses among them, and the one that had been removed just now was just one of them.
Dr. O'Rourke, the head of the internal medicine department, was standing at the back of the tent aisle, treating a patient: "Your forehead is a little hot. It's probably just a cold. I'll ask the kitchen to prepare leeks and rose petals for you." , mash it thoroughly and then add some milk, stir evenly, and then..."
"Will drinking that thing help?" The patient's nasal voice was indeed very strong.
"Drink?" O'Rourke shook his head and pointed his finger at his temple, "No, that's for wiping your head."
"Wipe my temples?"
"Yes, rub it for ten minutes. Only in this way can it cool the blood and relieve the headache." O'Rourke simply wrote twice, "By the way, remember not to drink strong drinks when you have a cold, especially the bottle of wine you have on you."
"All right."
O'Rourke handed the medical record in his hand to the nurse behind him, and then took another one: "The next one is..."
"Is this Dr. O'Rourke?"
"Huh?" O'Rourke looked back at Kawei who was walking in the distance, "I am, who are you?"
"Deputy Inspector of the Military Medical Department, Carvey Hines." Carvey smiled and introduced himself.
O'Rourke was stunned for a moment, looked at his collar badge, then looked at his face, and then remembered the name: "Dr. Kawei, aren't you supposed to be operating on the sick and wounded on the Northern Front? Why are you here here?"
"I received the military order from Archduke Brecht and came here to provide support."
"Oh." O'Rourke nodded and pointed outside the tent, "The surgical tent is not far away. If you go out, turn right and walk no more than a hundred meters, you will see the entrance. I won't send patients here as I still have them."
The types of diseases covered internally and externally are different, and the status is even more different, which cannot usually be overridden.
The other party said it very directly and his meaning was very clear, that is, he did not want Kawei to interfere. Kawei also knew that he lacked the "qualification" to intervene in internal medicine issues. All he could say was some methods of resisting infectious diseases: "I heard that Dr. O'Rourke was responsible for the construction of military hospitals?"
"Yes, what's wrong?"
"I have some hospital construction issues that I would like to discuss with you."
After all, Kawei holds the title of deputy inspector, so he has the authority to conduct inspections. Moreover, his current posture is not high, so he has no reason to refuse: "Dr. Kawei, if you need anything, you can go to my office. I have some here." A few patients, just come if you like them."
"Don't be anxious, don't be anxious, I happen to be interested in internal medicine, so I'm watching and learning from the side."
O'Rourke felt a little uncomfortable, but there was nothing he could say. He could only bite the bullet and continue the ward rounds: "Is bed 112 flatulent?"
"Doctor, my stomach is full of gas, it keeps gurgling, and it produces unbearable pain." The patient can't bear the pain now. "It's like thunder before a storm. I get nervous when it sounds." .”
"I gave you an enema last night. What was the result?"
"It's okay, I excreted some stuff, but it started again today."
O'Rourke quickly wrote a paragraph in the medical record, and then explained: "Flatulence is usually caused by indigestion. A large amount of gas is mixed with the liquid in the intestines to produce a turbulent noise. I guess it may be the bread these days. Too hard."
"Indeed, that piece of black bread was too hard to eat."
"You have a little bit of body temperature, but it's not serious." O'Rourke put the back of his hand on his forehead and said, "I'll give you a little carminative, and you'll be fine after two days."
"Carminative? What's in it?"
O'Lourke smiled and said: "Don't worry, it's almost the same as the mint water you usually drink [2]. If you don't like it, you can come to me and I will change it to another sweet ginger tea, but the effect will be different." Worse."
"I've had sweet ginger tea before, but it didn't do much good."
"Oh?" O'Rourke became vigilant, "Then it seems that the effect of simply using carminatives is very limited."
"What should we do?"
"It doesn't matter, this is not a troublesome disease for me." O'Rourke was very confident in his diagnosis and treatment ability. He crossed out the treatment method he originally wrote down and made two changes, "On the basis of carminatives, I also add a small spoonful of turpentine, a small amount of ether, agaric gum and analgesics, and the effect will definitely take effect within two hours after taking it." [3]
"Thank you doctor."
"You're welcome."
From a patient's perspective, O'Rourke is indeed a serious and responsible physician. Because his treatment is not limited to medicine, but also cares about the patient's diet: "Notify the kitchen to soak his bread in broth to help him digest."
"yes."
"By the way, the cabbage and cucumbers among the vegetables are not allowed on his table. All vegetable salads are cancelled, and the meat is reduced by half. Only salt is used for seasoning, and the after-dinner wine is replaced with diluted light brandy."
"OK."
"You can't get enough of these things." The patient suddenly heard something wrong.
"Why should you eat when you are so bloated? Let your stomach and intestines have a good rest." O'Rourke sighed and walked to the next patient, "Is this one still having a fever?"
"Yes, I've had a high fever for three days in a row."
"Alas, the terrible weather in Gablenz has caused everyone in the ward to contract a severe cold." O'Rourke looked at the patient's painful appearance and couldn't bear it, "Where is the hen I asked you to find?"
"He's in the kitchen."
"killed?"
"No, no, don't you want to live?"
"It's good that you didn't kill him." O'Rourke asked the nurse to get the hen, while he walked to the patient and repeatedly touched his forehead and armpits. "The body temperature is too high."
Kavi stood watching him.
Although the treatment methods just used to deal with flatulence patients are fancy, they remain true to their basic principles and cannot escape the three main approaches of internal medicine: symptomatic treatment + cause treatment + stimulants.
Flatulence is also known as hyperactive bowel sounds, and there are many things that can be identified from a modern medical perspective. If abdominal pain is included, it can be roughly divided into three conditions: inflammation, intestinal obstruction and intestinal bleeding.
If the patient has no diarrhea, inflammation can basically be ruled out, and there are no symptoms of internal bleeding, and bleeding can be temporarily ruled out. The most suitable diagnosis for him now is intestinal obstruction. It seems that the treatment given by O'Rourke is generally considered to be in line with the condition.
However, this patient had taken laxatives such as rhubarb before, and it seemed that the obstruction was not optimistic. It was difficult to say how effective the treatment plan would be.
"Dr. Kawei, what do you think of my diagnosis?" O'Rourke suddenly asked.
"I really can't comment on internal medicine diagnosis." Kawei smiled and said, "But I have seen Dr. Fatorad's ward rounds, and I personally think the way you handled it just now was very inspiring to me."
"oh?"
Fatorad's status in the Austrian medical community is unquestionable, basically equivalent to Ignatz in surgery. O'Rourke was secretly surprised by Kawei's words: "Dr. Fatorad's knowledge of internal medicine is much deeper than mine, but the treatment of such a simple disease is similar."
Flatulence fell right into the trap of medical treatment based on catharsis. What really made Kawei feel strange was the hen he just mentioned.
Regardless of whether this patient has a cold or another disease, what role can hens play at such a high body temperature?
The key is that it is still alive!
"What is the hen you mentioned just now used for?"
"A method used to lower the temperature." O'Rourke could not hide his distress and sighed. "This is a relatively extreme method. Generally, patients do not need to do this. But he has had a high fever for three consecutive days. I really There is no other way.”
Kawei really didn't understand what cooling had to do with hens, so he didn't bother to ask.
Now that he was close to him and his wariness was gone, Kawei slowly walked towards the hospital bed and asked, "Do you mind if I take a look?"
"It doesn't matter, let's see."
Judging from the temperature from the patient's forehead, the body temperature may have exceeded 39 degrees. The continuous high fever has basically nothing to do with the cold: "Has Dr. O'Rourke used a thermometer? This is very helpful in disease diagnosis."
"Thermometer? That one is too troublesome." O'Rourke shook his right hand, "The back of my hand is the best thermometer. Sometimes machines make mistakes, but it doesn't."
"All right."
What Carvey is most concerned about now is the typhus found in Adams. If there is such a patient in such a ward environment, there will inevitably be more patients of the same type.
So his first step was to lift the quilt and look at the patient's torso skin. The reason why typhus has the word "rash" is because it produces many rashes.
This bright red rash is the most common characteristic of typhus, occurring in more than 90% of patients. The earliest appearance is on the chest and back. The involvement of the limbs varies from person to person. Some people do not spread to the surroundings and face.
Even if the rash goes away, pigmentation will eventually remain.
It doesn't matter if Kawei doesn't lift it, but it's like opening up a bug's nest. Suddenly, several black spots jump in front of Kawei: "There are so many fleas!"
"There must be a lot of fleas in the wards of the field hospital."
O'Rourke has long been used to this, but the red spots on the patient's chest made him a little strange: "Huh? Why does he have a rash? I didn't find any rash during my previous examination."
"Dr. O'Rourke only examined the first day?"
"yes."
"The rash usually appears three or four days after the onset of the disease. You need to lift your clothes and take a look every day." Kawei stepped forward and said, "The rash is bright red. It should have appeared not long ago. How long has he been sick?"
"It's been four or five days." O'Rourke already had a vague premonition, "Could he be?"
"It's typhus."
“What bad luck!!!”
"You need to clean up the fleas here."
"Fleas? What do fleas have to do with typhus?"
As soon as he said this, he realized that O'Rourke did not know that typhus was related to fleas. But there was no need for him to deliberately explain, because the nurse's voice came from the door: "Doctor, doctor, the hen you wanted is here!"
(End of chapter)
