Modern medical examinations can be roughly divided into two types.
One is laboratory examination, which relied entirely on microscopes in the early years. Now you can also rely on various instruments to distinguish cells and other components in blood, urine, feces, various sliced tissues, etc.
The other is imaging examination, which started with various peepscopes. After the advent of X-rays and B-ultrasounds, the options for imaging examinations have become more and more abundant.
For the differential diagnosis of hematuria, the first and most important step is to do laboratory tests, which is why Kawei chose to go to his own laboratory.
Since there is no shooting device now, the appearance of cells in urine under the microscope should be given to those in the laboratory to take a closer look to improve their experience. At the same time, he can also take a good look at what Koch has discovered in the past month.
From the beginning of the preparations for the Austro-Prussian War, the future father of microbiology encountered some troubles.
In fact, his study tour time in Austria is very limited, and he is scheduled to return in July. But because of the relationship between the two countries, it was actually time to leave at the end of May.
After returning to China, Koch will be able to obtain a doctorate from the Medical School of the University of Göttingen. He is not too fond of clinical practice and should be able to work at the Institute of Chemistry in Berlin through connections.
The Institute of Chemistry was just a compromise between clinical medicine and scientific research. His interest was not strong. Compared to it, it was more relaxed and comfortable to stay with Kawei, and he could see some things he had never seen before.
But the war was imminent, and the country would inevitably put itself above science. Koch decided to return to the country, at least to get his diploma first.
Unexpectedly, as soon as he returned to Göttingen in June, he received a reply from the chemical research team [1]. The general content is that he did not graduate with a chemistry major and had to start as a basic researcher in the research institute. At the same time, the institute also hopes that he can focus more on chemical research rather than medicine.
This was a bit hard for Koch to accept.
Historically, he had little choice but went to work for six months at the Berlin Institute of Chemistry. Finally, he gave up on the advice of Virchow, the father of cytopathology, and returned to clinical practice. Starting from clinical practice and relying on work accumulation, he slowly found his own research direction.
And now, Koch has a Kawi in front of him.
Kawei had been trying to retain him from the beginning. Even though he knew the hostile relationship between the two countries, Kawei was still willing to vouch for him, just like the Italian surgeon Bottini.
When he returned to Göttingen and found that his future was bleak, the first thing he thought of was Kawei.
There was no need to exchange letters, because relations between the two countries were already very tense at that time, and it would probably take several months before a reply would reach his desk. So after receiving his diploma, Koch picked up his bags and set off for Vienna again.
When he returned to Vienna in mid-July, Kawei was so happy that he left him two papers and a sentence.
One article was a paper on anthrax published by French microbiologist Casimir Davina in the French Medical Journal in 1863. He mentioned that anthrax can be directly transmitted between cattle, rather than individual individuals becoming ill.
Another article is from the United States on the other side of the ocean. A veterinarian named York also published in 1859 about the suspected infection of anthrax among cattle.
"I think anthrax is caused by bacteria, but I don't have time to research, so I'll leave it to you."
Kawei's words and the two papers he gave him allowed Koch to skip the "torture period" of more than ten years in the middle and stay on his favorite path from the beginning.
Now three months have passed, and the seeds Kawei sown in early summer have already taken root and sprouted. When he returned to the laboratory again, the harvest was right in front of him.
"Dr. Kawei, why are you back?" Koch wore a mask and could not feel any atmosphere of war between his brows. "I have already figured out the anthrax you gave me. Thank God, here is what I need most. With a microscope and enough experimental materials, my results will surely surprise the whole world!!!”
Kawei took several experimental reports he brought and had no time to read them for the time being: instead, he looked at the young man behind Koch and asked, "Who is he?"
"The assistant I hired," Koch said, "just graduated from the University of Vienna Medical School. His name is Auerbach."
Kawei nodded: "Where are the others?"
"Savarin is at the Municipal General Hospital, and Mattik should be in class. After all, school has just started."
"Oh, time is not urgent anyway. You can take him to the hospital with you when he comes back." Kawei said, "By the way, why did Savarin go to the hospital?"
"He saw me researching anthrax before, so he could only start with it, but he always felt uncomfortable. Later, I suggested that he start a subject of his own. After searching around, he became interested in typhoid fever and typhus. Recently, he has been collecting cases in the hospital. .”
"So that's it...you need to prepare the microscope and stain first. You need to do a few experiments in the evening. The hospital doesn't have enough microscopes." Kawei glanced at the report in his hand and said, "I have to rush to France now. The embassy, I’ll take a look at things on the way.”
"good."
...
Ten minutes later, Kavi left the medical school and got on the carriage again.
The three people on the carriage didn't know why Kawei came to the medical school. This man was always mysterious and his words were always vague. But both Mosier and Massimov were clinicians and had no interest in military affairs, but they were sensitive to various documents in the academy.
After seeing a few extra documents that suddenly appeared in Kawei's hand, both of them became interested: "Dr. Kawei went to the school to get the manuscript?"
"Oh, it's the laboratory's experimental report these days." After getting in the car, Kawei put down the equipment box, put the file on his lap, and opened a page, "After all, it is my own laboratory, I need to see their research Got something."
Mosier didn't know much German, but Massimov sitting next to him could still understand: "Anthrax?"
"Oh, yes, anthrax." Carvey said, "There have been many reports recently saying that anthrax is contagious and can be transmitted from cattle to cattle. But I personally doubt that human anthrax may also be transmitted from cattle or even cattle. It was infected in the land, but there is no evidence..."
"Is anthrax contagious?"
Mosier felt strange, "How did you, a surgeon, start studying internal diseases?"
The other party's question was a bit edgy, but Carvey just buried his head in the report and said with a smile: "Bacteria are the enemy of surgery. As long as it is related to bacteria, I think it has research value. Even Mr. Pasteur should know it." It’s only right to agree with this statement.”
"I have nothing to do with Pasteur, and Pasteur is not that popular in France." Mosier snorted, "I believe in science, and I don't believe it until there is no clear experimental results to support it." Growing small things has an impact on humans.”
Kavi, who had been accustomed to this argument since his days in the surgical academy, shrugged and said nothing more.
Massimov on the side is also a surgeon. He has only seen anthrax patients and does not know the connection between this disease and microorganisms. But he believed in Kawei and was quickly attracted by Kawei’s statement.
Anyway, he was bored on the road, so Maximov asked aloud: "Can you let me take a look?"
"Well..." Kawei quickly flipped through the first experimental report, closed it and handed it over, "Judging from the first experimental results, anthrax is caused by bacteria."
Massimov took the report and started reading it.
In fact, Koch's experiment seems very simple now. He smashed the spleens of cows that died of anthrax and then extracted the tissue fluid. After the bacteria were discovered under a microscope, the tissue fluid was injected into healthy mice using a syringe.
The result was already as expected by Kawei. The vaccinated mice soon became infected with anthrax like the cow.
After the mice were dissected, the dissection was performed again, and the visceral tissue fluid of the mice was extracted for microscopic examination again. Just like the previous cow spleen extract, a large number of bacteria were also found in the mouse viscera extract.
This series of experimental processes made Massimov unbelievable: "The results are shocking. To be honest, I still can't believe my eyes."
"It's just grandstanding." Mosier was a little dissatisfied.
"No, Doctor Mosier!" There was no need for Kavi to explain, Massimov himself would explain for him, "The process of this series of experiments is very rigorous, and I can't find any mistakes or omissions."
Mosier looked at him, then looked at Kawei who was reading the experimental report opposite, and took the handed report. The content was exactly what the other party said. The contagiousness of anthrax was further confirmed, and the bacteria discovered by microscopy were also drawn by Koch with a pen, and then marked with an equal sign by a series of explanatory texts.
Mosier couldn't believe it: "This..."
"This is just the beginning, two doctors." Carvey smiled and took out the second and third experimental reports. "Koch's subsequent reports are based on the first report and continue to prove that anthrax is not the only Anthrax can only be spread by cattle, and the bacteria can even persist in the soil for a long time."
"soil?"
"Yes, soil." Kawei explained, "Some patients with anthrax have not come into contact with sick animals, and some have not even touched living animals. So it only proves the relationship between animals and between animals and people. It’s not really understanding how contagious it is.”
Koch's subsequent experimental report subverted their understanding.
"Can it put 'clothes' on itself? What the hell?"
"It should refer to the spores produced on the surface of bacteria." Kawei spread his hands and said, "Although this is not the first time that it has been discovered, it is the first time that its role and the life history of anthrax have been mentioned... ..There are thousands of types of bacteria, and if you make a bolder guess, maybe many of the diseases we get are related to these little guys.”
Without these experimental reports in hand, both of them would think that this young man was talking nonsense.
Are diseases related to microorganisms?
How could a person be defeated by such an invisible thing? It is simply denying the meaning of human existence!
But in front of the painting manuscript of the stick-like anthrax bacillus slowly turning into round spores, the two could not find any evidence to refute it. They never imagined that they would see such an incredible discovery just by following Kawei to the University of Vienna.
"Okay, let's put the report aside for now." Kawei took back the experimental report and continued the topic of Edem just now, "Mr. Edem's body is more important."
"Forehead......"
"...You still remember this," Mosier complained. "Did you know that you bypassed the embassy and went back to the medical school to get the lab report first?"
"No, no, no, Dr. Mosier, these are just things I took away by the way." Kawei explained, "I went to the medical school mainly to find my colleagues in the laboratory. Next, I want to do a test on Mr. Edem's urine. Several tests and I need their help.”
...
What Kawei wants to do is the most routine urine sediment microscopy.
First, the urine is centrifuged and sedimented, and then the sediment is selected for smear microscopy. The target is red blood cells, white blood cells, proteins, casts, epithelial cells and this time the target: tumor cells in the urine.
When he heard about gross hematuria, the first thing that popped into Kawei's mind was bladder cancer.
The elderly male has a history of smoking and bladder stones for many years, and he is also a painter who has been exposed to paint for a long time. He has all the high-risk factors and the early symptoms are consistent with the condition. However, bladder cancer surgery is complicated and difficult to treat. It is impossible to make a diagnosis and then cut open Edem's belly just by relying on these things.
Therefore, he hoped to find exfoliated tumor cells through urine sediment examination to confirm the diagnosis of urinary tract tumors.
Then, a cystoendoscope is used to take a closer look inside the bladder to determine the location of the tumor.
"Uncle, I'm here."
After Justina walked into the embassy, she first saw Edem who was observing flowers and plants in the yard, and then happily introduced Kavi who was walking behind her: "This is what I mentioned to you before. Dr. Carvey Hines has very good surgical skills. When he heard that you were sick, he rushed back from the front battlefield without stopping."
Edem does not have the airs of his brother, the French Marshal. Even in the French Embassy, every move he makes is very decent.
However, when he saw Kawei, a trace of surprise flashed across his face unnaturally: "Nice to meet you, Dr. Kawei."
Kawei knew that this was a cognitive bias that occurred when matching his age and experience. He had seen it often since he traveled here. It's just that Edem hid it better than the others, and the expression quickly dissipated into his smile.
Kawei looked him up and down: "The old gentleman is in good physical condition and very energetic."
"Not bad, not bad, but the color of the urine is a bit scary." Edem did not think about the bad things, but just laughed at himself, "I always feel like there are several leeches living in my bladder, and I am given free bloodletting treatment every day. .”
Kawei laughed twice without retorting.
Under the guidance of the embassy servants, he and others entered the living room and sat down. The first sentence he spoke made people confused: "I wonder if the old gentleman has changed in weight recently?"
"Weight?" Edem shook his head, "Probably not. I have always had a good appetite. I just ate several plates of oysters at lunch."
"Wait!" Justina, who was sitting nearby, suddenly spoke, "After you mentioned it just now, I can see it. Uncle, you have indeed lost weight, much thinner than when I first left Paris."
"Really? Maybe the waist circumference is a little smaller, but I don't care about that." Edem touched his belly and asked Kavey, "Does Dr. Kavey think there is any relationship between this and my hematuria?"
】
"It does have something to do with it." Kawei quickly changed the subject, "If the old gentleman doesn't mind, you might as well drink more water."
"Oh, I've been drinking." Edem pointed to the milk tea cup that had just been placed on the table, "This is already the third cup today."
"Drink more." Kawei also gave him his milk tea. "Drink more to pee more. I need to take your urine for a test."
