If you want to understand high fever, you need to understand standard body temperature. The time when human standard body temperature was determined is actually not that long ago, just 15 years ago [1]. Therefore, Kawei's article "Thermometer" can be regarded as catching up with the trend, but it is still a long way from being officially promoted.
Because as O'Rourke said, a high fever is not like a low fever and can be judged by the feeling on the hands.
In the past, doctors could not do much in the face of high fevers, other than to cool down the symptoms. Because finding the cause needs to be based on basic medical theory. Without theory, there is a lack of diagnosis of the cause, and it is impossible to treat the cause.
On the road of cooling, doctors at each stage have different understandings. The 19th century was a watershed in the rapid change of cooling methods, because the cooling effect of salicylic acid was discovered and clarified.
O'Rourke was not stupid, nor was he unaware of the fever-reducing effect of salicylic acid, but the salicylic acid at this time still had a fatal flaw. Many patients may have had several holes burned out of their gastrointestinal tracts by this drug before their fever went away.
Stomach bleeding and perforation are certainly more difficult to deal with than a high fever, and are basically a death sentence when they occur, so your best bet is to question them out loud and choose not to.
As a physician who is dedicated to his patients, O'Rourke has always been on the skeptical side and is extremely cautious about the use of salicylic acid. Of course, using it with caution does not mean not using it at all. When a patient has a high fever that is difficult to get rid of, he will still choose salicylic acid with a high probability.
However, the situation of the patient in front of me is somewhat special.
The high fever for the fourth consecutive day, the use of carminatives was ineffective, and the poor gastrointestinal condition made it difficult to use salicylic acid. These are the indications for using the "hen" trick.
Kavi was very curious and couldn't figure out how O'Rourke would handle the hens, but the result was very simple and straightforward...
"This is the last resort. If it can't be cured..." O'Rourke took the tied hen and then took a scalpel from the nurse's hand, "Please hold him up." head."
The nurse pushed up the patient's dry hair to expose his forehead, and then held his cheeks steady with both hands. O'Rourke lifted the hen into the air with her back to his forehead, then raised the knife and pierced the muscle of the hen's back with one blow.
Kawei was not familiar with the anatomy of chickens, but this knife could easily destroy the major blood vessels even if it missed the heart.
I saw the hen screaming a few times, her body struggling continuously, warm blood began to gush out of the wound, slowly flowing out from the sharp blade, and falling on the patient's face drop by drop: "The hen's blood can remove The effect of high heat, and then washing with cold water... I hope it will work."
Physical cooling?
But the body temperature of chickens is higher than that of humans...
Perhaps the cooling itself relies on the cold water that finally cleans the blood.
Kawei stared at this scene blankly, and while complaining, he couldn't help but sigh in his heart: This is probably a biological product from the 19th century.
Such therapy obviously has no scientific basis and is a bit excessive for internal medicine, which is still in chaos. But Kawei still can't say that O'Rourke is a quack. The limitations of the times make it difficult for him to deal with many diseases, and it also allows him to handle it better than Kawei in some areas.
After all, modern surgery is also bound by a hoop stuck on the head.
"The next one is the guard who was bitten by a snake yesterday." The nurse exchanged medical records with O'Rourke and said, "I was originally going to be transferred to the surgery department, but the hospital's bed space is tight, so I can only stay here."
"Oh, how is the wound now?" O'Rourke asked.
"There is some redness and swelling, but it is not serious." The nurse lifted a corner of the bandage, took a look at it and said, "The snake venom did not attack, and he did not have a high fever. Everything is going well."
"OK, all right."
O'Rourke casually wrote two things in the medical record and looked at Kawei: "Dr. Kawei, you are a surgeon. He has three wounds on his ankle. Can you give me some advice?"
The guard's ankle was wrapped in a thick bandage, and dark hard blood could be clearly seen oozing out. Unlike the two doctors who disliked the wound, he leaned down and completely untied the bandage. There were clearly three serious sharp injuries in front of him, not snake bites.
Kavi immediately realized why O'Rourke did this: "Dr. O'Rourke directly cut open the skin and bled?"
"Snake venom is so powerful that ordinary antidotes cannot work, so we can only bleed it immediately," O'Rourke explained.
"This is not an ordinary incision and bleeding..."
"The success rate of ordinary bloodletting is very low. Only by completely removing the tissue around the wound and then using the cupping method can we suck out a large amount of blood in a short time and alleviate the snake venom attack." O'Rourke sighed, "Although my anatomy knowledge is not excellent, But skin, muscles and blood vessels can still be distinguished.”
"Cupping?" Kawei heard a very familiar word among them, "Doctor O'Rourke also does cupping?"
"This is a serious internal medicine treatment method, of course you have to know it!" O'Lourke knew that Kawei was a doctor by the way, and Miata said, "You only need to take a piece of paper dipped in strong liquor, then light it in the wine glass, and turn the glass upside down. On the wound, it can quickly bleed and suck out toxins."
This was probably the best way to deal with snake venom in the 19th century. It perfectly matched the bloodletting method, and was much simpler and more thorough than using herbs and sucking it out by mouth.
If it were Kawei himself who encountered such a patient, he might have done the same in the end, but there would have been some ideological struggle in the process. In the face of snake venom, time is life, and a short pause may have missed the best opportunity to deal with it.
"Doctor O'Rourke handled it very well..." Kawei looked at the wound in front of him and asked, "By the way, was there any disinfection after the bloodletting?"
This is what he is most concerned about, and it is also the only thing O'Rourke has learned in this training: "I completely followed the requirements of the Military Medical Manual for disinfection, using carbolic acid instead of the soldering iron. Then I used half a cup of brandy, each Pour it on the wound once every 15 minutes. Finally, choose mustard ointment or a piece of cotton soaked in ammonia and place it on your chest to resist the drowsiness caused by snake venom."
"What are the ammonia and mustard paste used for?"
"Protect his heart."
"...Okay." Kawei nodded slightly, "The surgical treatment was well done."
"That's good."
Although the ammonia and mustard paste at the end seemed redundant, the previous steps were still correct. In the absence of alcohol, using brandy can be considered an inefficient substitute. Anyway, it is quite good to have carbolic acid as a backing.
This also made the soldier's wounds appear less serious.
"However, the wound is too wide and will be difficult to heal without suturing."
"We don't have needles and threads for suturing in the internal medicine department."
"It doesn't matter, I usually use what I brought." Kawei looked back at the guard captain behind him and took the box of surgical instruments he handed over, "It just needs a little suture and then wrap it with a carbolic acid bandage. "
O'Rourke is a very pure physician, conservative, stubborn, and full of disdain and hostility towards surgery. But at this time, Kawei was better than him in terms of military rank and position in the Military Medical Department, so the flattery he should say was: "Sorry for your trouble."
"It's just a simple stitch, no big deal."
Kawei’s surgical suturing needles were hung with silk threads from the beginning, so they could be taken out and used immediately. With the help of tissue forceps, these three wounds were solved within two minutes: “One of the wounds had a relatively high tension, and the suturing affected the blood supply. , making it more difficult to heal, cover it with oily gauze coated with turpentine and wait for it to recover slowly."
O'Rourke stood by the bed the whole time and did not move to the next bed. He saw Kawei's suturing skills in his eyes: "Dr. Kawei's skills are indeed superb."
Kawei simply rinsed the suture needle and tissue forceps, wrapped them in gauze and put them in the drawer at the bottom of the instrument box: "It's just the most basic suturing, it doesn't explain anything."
"I also have a surgeon by my side, and I can tell the difference between good and bad." O'Rourke said very implicitly, and quickly looked at the last bed. "The last one should have severe high fever and abdominal pain. How do you feel today?"
"No... not very good." The patient's voice was weak.
"Show me the results of the enema."
The nurse got the enema record sheet, which stated the enema time, enema solution formula and excretion volume: "The excretion volume is acceptable, but the body temperature and abdominal pain have not disappeared."
"Ginger liqueur and barley tea are ineffective [2]?" O'Rourke was a little puzzled, "Warm wine and tea should be able to relieve abdominal pain."
"It feels a little better just after drinking it, but it will hurt again soon." The patient held his stomach and looked very bad. "It hurts too much. Do you want to give me some calomel to try? Sweat a little and vomit all night." Maybe it will be good.”
"That's not how calomel is used." O'Rourke denied the patient's own judgment, and then said to the nurse, "Let the kitchen add some sweet angelica to his bread." [3]
"Okay, I took note of it."
"Then put a few more pieces of sweet radish juice [4] in his wine." O'Rourke prefers dietary therapy for abdominal pain. "Try it first. If it doesn't work, I'll think of a solution for you."
The patient had a breakdown when he heard about carrots: "I want to eat other things, I can't just eat a piece of bread and half a bottle of wine three times a day!"
"Your abdominal pain is very serious. You cannot eat anything until it is relieved." O'Rourke said, "Please trust my judgment."
"I feel so uncomfortable..."
"I know, but please bear with it for a few more days until the abdominal pain subsides."
O'Rourke did not write much in the medical record, but continued to give instructions to the nurse, "He drank too much and his bad breath is very bad. Let him chew some orris root later and rinse his mouth with soda water after chewing it." .”
"OK."
After dealing with more than a hundred soldiers in the tent, O'Rourke finally breathed a sigh of relief: "Dr. Kawei, I'm done here. If you have anything to discuss, just go to my office."
Kawei was standing next to him, but what he was looking at was the patient just now.
Abdominal pain is more surgical in modern medicine. As long as gastrointestinal inflammation is ruled out, most cases of abdominal pain are urgent and require surgical treatment to relieve them. So when he saw this patient with abdominal pain, the first thing Kavey thought of was some common acute abdominal diseases.
"Can you let me see it?"
The two had already gotten to know each other, and Kavi knew that although the other party was a bit stubborn, the degree was far less serious than that of Fatolad. O'Rourke also knew that although Kawei was young, at least he had solid basic medical skills.
The most critical point is that both of them know that the other person truly cares about the patient.
In front of patients, the disputes between medicine and surgery seem insignificant.
Kawei got the consent and went forward to do the most basic abdominal examination - palpation. The initial pressing position was in the middle of the upper abdomen that he had just held: "Does it hurt here?"
"It hurts!" The patient raised his body slightly, trying to stop him from pressing down with both hands, "Be gentle... be gentle."
Kawei didn't give him a chance and immediately moved to his lower abdomen: "What about here?"
"It's okay here." The patient breathed a sigh of relief.
"Here?" This time it was to the right lower abdomen.
The patient shook his head: "It doesn't hurt."
Kawei nodded, and quickly switched the palpation point to the upper abdomen again. This time, he was obviously rushing for diagnosis, so the patient cried out as soon as he touched it: "It hurts, it hurts so much!
! "
O'Rourke, who had always followed the principle of not touching patients, looked at the patient yelling and did not understand the reason for Kawei's actions. But he did not interrupt Kawei's diagnosis, and just stood beside the hospital bed and watched.
The nurse couldn't help but whispered: "Doctor, he did this..."
O'Rourke put his fingers in front of his mouth and shook his head: "He is a student of Chief Surgeon Ingenac, so there is always a reason for him to do this."
However, the patient's screams did not stop. After the tenderness was positive, his Murphy's sign was also positive. As Kawei quickly removed his right hand that was pressing on his stomach, pain swept through his body again. This time it was so painful that I couldn't speak. It took me a long time to get over this wave of pain.
"Tenderness and rebound pain in the right upper quadrant. Did your shoulder hurt before?"
The patient wanted to curse, but Kawei got it right: "Yes... my shoulder hurts too."
"It should be cholecystitis caused by gallbladder stones." Kawei gave his diagnosis.
The diagnosis was given so suddenly that O'Rourke didn't even have time to react: "How to treat this condition?"
"You can choose surgery or conservative treatment." Kawei said, "But in this case, even if you survive these days with conservative treatment, it will turn into chronic inflammation and recurring pain."
"What about surgery?"
Kawei immediately considered the transport conditions and the rear hospital, but still felt it was inappropriate: "The operation is also very troublesome. The conditions here are too bad, and accidents are likely to occur."
"I think conservative treatment is better."
Unexpectedly, at this time, the patient who was in excruciating pain said, "Can surgery cure it?"
"Yes, but the probability is not high."
"I don't want to be in such pain in the future, so I'd better have surgery!"
