Both traditional Chinese medicine and Western medicine, which have not evolved into modern medicine, believe that the properties of urine are closely related to human diseases, and thus have developed their own urine testing methods. But before modern medicine matured, Western medicine's urine testing was more like a carnival of various chemical reagents, with little exposure to the microscopic world under the microscope. 【1】
Of course, being rare does not mean there is none.
Carvey was not the first doctor to put urine under a microscope. After all, microscopes had existed as early as the 17th century, and there was no shortage of "boring" scholars in the Enlightenment era. However, throughout history, countless people have found fun out of boredom, and only one person in a million can truly demonstrate it scientifically.
It was not until the 19th century that this kind of playful observation slowly got on the right clinical track, taking advantage of the rapid development of medicine. 【2】
Like other medical developments, the so-called "getting on the right track" of microscopy did not happen overnight. It took a long time that seems to be quite long now. It had to wait until the end of the 19th century for it to be fully accepted by clinicians.
Considering that the quality of the hospital's microscopes could not be compared with modern ones, and the urine sedimentation was not as clean as a centrifuge, Kawei asked Edem to drink more water so that he could prepare more materials. By the time he returned to the hospital, it was already 7 p.m., and Koch, Savarin, Mattick and Auerbach had been preparing for a long time.
"What do we need to check?" Savarin asked.
"This." Kawei put several test tubes filled with red urine on the tube rack. "You should have heard that a patient came to the French Embassy. He had hematuria and the color was like this. We He needs to be diagnosed clearly and then cured.”
"The color is really obvious."
"There is already precipitation. When the precipitation process is completed, we will take out the sediment below for microscopic examination." Kawei asked them all to sit down, while he was still standing. "We still need to wait for a while, so we can talk about this first." Time Koch’s Experimental Results.”
Koch had made sufficient preparations for this series of experiments on anthrax, and in his opinion the experimental process was very rigorous. With infection, culture, and controlled experiments, there should be no loopholes.
Moreover, they were originally convinced that anthrax was caused by bacteria. The experiment was on the road of truth. The results were consistent with the conclusion and could not be wrong: "I have thought about it for a long time and there is no problem with the experiment. In the end, as long as the relevant papers are written, it will be done." It can be published in the Vienna Medical Journal."
"Of course I believe that the experimental results are correct, because the experimental results are my guesses." Kawei said, "I just took a quick look on the carriage. The design and process of the experiment are good, but there are still some flaws. .After thinking about it, I feel that there are two points that need to be corrected.”
Koch admired Carvey's ability very much. Just being able to propose that Bacillus anthracis caused anthrax infection was already very advanced.
After hearing that there was a problem with his experiment, he felt a little disappointed, but more importantly, he was still curious about knowledge. He has already devoted all his energy to anthrax, and as long as there is still something worthy of improvement, he must make it up in time: "What two points are they?"
"The first point is a small flaw in the experiment."
Kawei opened several experimental reports and found the experimental process column, and said: "The inoculum you chose is not pure bacteria, nor can it be pure bacteria, but tissue extracts, blood and exudates mixed with bacteria. Liquid. This will make people doubt whether these bacteria cause anthrax, or whether it is another substance carried by these liquids that serve as carriers, a disease-causing substance that no one knows."
Koch is like a passer-by who is unaware of the situation.
Before hearing these words, I was still walking on what I thought was the right path, thinking that it was a steady path, and firmly believing that the end was right in front of me. But after hearing this, a secret door suddenly appeared next to the road he originally took: "It makes sense, it makes sense! Why did I forget that there is this variable!"
"Do you know how to control it?"
"...It's okay, I already have a way." Koch said, "These extracts can be diluted to reduce their concentration. Although the content of bacteria will also decrease, bacteria are living creatures and they will continue to Breed.”
Seeing that he could think of a solution so quickly, Kawei couldn't help but sigh at the other party's scientific research ability, which could be achieved with just a little bit of on-demand.
"How to dilute it? With water?"
"This... I'm afraid water won't work." Koch thought for a while and said, "Bacteria need nutrients to grow, but water may stop growing soon."
"It's also a liquid, and it's also harmless to humans. It can also provide them with the nutrients they need to grow."
Kawei put his eyes on the test tube rack just now, and soon everyone else, including Koch, also looked at the test tube rack: "Yes, urine! There is protein, blood, and mess in the urine. Piling things will definitely support the growth of anthrax!" [3]
“Remember that diluting it once is not enough, you need to dilute it two more times.”
"Well, it does need to be diluted twice more, so that the original extract content can be completely removed, but the bacterial content can be maintained to ensure the absolute objectivity of the experiment." Koch was a little excited, "If this experiment is successful, then Bacillus anthracis It’s the only causative factor of anthrax.”
"right."
After fixing this loophole, Koch couldn't think of any other shortcomings and asked, "What's the second point?"
"The second day is about worldliness." Kawei sighed, "Don't just think about studying the subject, sometimes you still have to look at the outside world."
"Huh? People are so sophisticated? Look outside?" Koch was still young and didn't understand what he meant. "I'm a researcher. Of course I usually do research. As for the outside world, as long as it allows me to survive, the rest has nothing to do with me. What a relationship.”
"You may be mistaken, that's not what I meant."
Kawei turned to a sentence in the third experimental report: "It is very problematic for you to say that you are the first person in the world to discover spores. As far as I know, the French microbiologist and chemist Pasteur was The spores were discovered last year.”
Koch was a little surprised by the development of world technology: "Has someone discovered it yet?"
"But don't worry, he just mentioned it, and did not elaborate on the role of spores or the life history of the bacteria studied." Kawei comforted, "You can mention this scholar in subsequent papers, and then express your own opinions Found it, but I personally hope you can read his published articles."
"This... this may be a bit difficult," Koch said. "It is still at the war stage to transport journals from Paris to Vienna. It will take at least one or two months. If something unexpected happens, the railway will Transports are also likely to be bombed.”
"Don't worry, I've asked the French Embassy to handle it. Of course, the premise is that Mr. Edem's hematuria must be cured..."
Kavi finished solving his experiment and looked at Savarin sitting aside.
Savarin sat next to Koch, with the medical records he had just collected in front of him. It seemed like he was mobilizing a lot of people, but he actually didn't have much confidence. The initial enthusiasm had long been worn away by the complicated collection process and uncertain results.
"I thought you would help Koch do those experiments." Kawei teased, casually taking out one of the medical records and reading it.
Savarin knew that he did not have the research acumen of Koch, but he also graduated in medicine, and he was older. He really did not want to be second to others: "I just want to know what you think of typhoid fever?"
Kawei briefly read the medical records written by the physician in a few strokes. After putting down the booklet, he said: "I don't have any opinion. Typhoid fever is a medical disease and I don't see much of it."
"But that's not what you said about Koch's anthrax." Savarin was obviously not mentally balanced.
"I used to see anthrax from time to time in small towns in Lombardy. Some of the skin ulcers had to be amputated, but in the end it didn't help." Carvey said, "Typhoid is different. It has nothing to do with surgery. side."
He knows Savarin's mentality. He helped you Kawei first, why would he favor Koch who came last?
Regardless of first come first served, or his clinical qualifications and Austrian nationality, he should be ranked first. Not only was he unconvinced by giving up the most important results to Koch, but even Mattick beside him felt strange.
Competition is a good thing, but too much competition can cause headaches.
"If you really want to work on microbiology, you can first deal with puerperal fever."
Kawei stopped him from opening his mouth and said: "Don't worry, listen to me first. What we did before puerperal fever was just a preliminary experiment, just like what Koch did before. You only have a simple experimental report, There was no bacterial culture and no paper on it."
】
When the subject enters a field that you are familiar with, especially if you have handled it before, your confidence will naturally increase greatly.
"Once you and Mattick have solved puerperal fever together and have the ability to design experiments and write papers on your own, I think you can consider typhoid fever." Kawei said, "You asked me just now what I think of typhoid fever. I think it would be better to look through medical journals from other countries.”
"French?"
"England and Prussia will do, too."
"Okay, I'll try."
...
Uncovering the role of microorganisms in various plagues was an important discovery in medicine from the late 19th century to the early 20th century. Although modern medicine has been able to control most bacteria, at the beginning it was a major project that could save tens of millions of lives.
Nowadays, when surgical technology is absolutely invincible, the laboratory is one of Kawei's main directions, followed by the medical device factory and pharmaceutical factory in Laszlo.
Among them, pharmaceutical companies have the absolute upper hand. Several drugs have already made a lot of money through the empire's own acquisitions. The same cannot be said for equipment factories. The dissemination of surgical procedures is not that simple, and its difficulty is not comparable to that of using theory to determine the use of drugs.
The equipment factory is more like Kawei's private equipment manufacturing factory. If it hadn't been for the large orders received during the Austro-Prussian War, it must have been a transaction unilaterally subsidized by Kawei.
Now that Edem has hematuria, Kawei feels that this is a good opportunity to contribute to the equipment factory.
"This urine sediment examination mainly examines tumor cells." Kawei asked a teacher to inform him of the precautions before the examination, "You have to find them from a pile of red blood cells, white blood cells, and epithelial cells. Sediment This is the amount, you will have to ask Edem for it tomorrow after you use it up, so it’s best to end the battle at once.”
The sedimented tissue is gently smeared on a glass slide, then stained with methylene blue and placed under a microscope. 【4】
“The red blood cells are biconcave disk-shaped with a diameter of 8 μm. The consistent shape indicates non-renal bleeding [5];
White blood cells are spherical in shape, with a diameter of 10-14 μm, which is larger than red blood cells. After staining, the particles in the cytoplasm will be clear [6];
The remaining irregular cells that are larger than white blood cells are epithelial cells. They are larger than white blood cells, irregular in shape, with edges and corners, and the nucleus can be seen [7];
In addition, you can also see the casts formed after protein polymerization, which are cylindrical protein aggregates formed by solidification of proteins, cells and their disintegration products in the renal tubules and collecting ducts. They are the most valuable pathological components in urine sediment. . Sometimes there are also red blood cells, white blood cells, epithelial cells, etc. gathered around [8];
The last step is the crystal, which appears as a shimmering octahedron or envelope, with two diagonal lines crossing each other, sometimes in a variety of shapes such as a rhombus, and occasionally in the shape of a dumbbell or pancake [9]
Of course, there are also bacteria in urine, and it is not difficult to see them [10]. But I hope you are still looking for tumor cells, which are much larger than epithelial cells. Their cell bodies vary in size and are piled or scattered to form suspicious cell clusters. The size is several times, ten times or even hundreds of times that of normal white blood cells. "
Kawei talked about many knowledge points in succession, and at the same time drew a sketch on the paper: "Come to me when you see tumor cells, they are the key to diagnosis."
Koch was the fastest, and soon his eyes left the microscope: "I saw it, it is very different from epithelial cells, and the shape is weird. But after using the high-power microscope and staining, I can see it clearly."
"What about the rest?"
"What I have here are all red blood cells. There are too many...but I saw two in the corner." Savarin said, "The cell body is very large, the nucleus is also large, and the cytoplasm is very rich... .."【11】
"I have it here too."
Kawei nodded: "I don't need to say more about the theory. You all know it well. Tumor cells are found in urine, indicating that there are tumors in the urinary tract. And tumors can easily fall off and rupture, which basically means hematuria. source."
"Do I need surgery?" Savarin asked.
"We have to determine the location first." The microscopic examination report was not over yet, and Kawei's questions continued, "How are the red blood cells? What I mean is the shape of the red blood cells? Are there any irregular deformations or ruptures?" 【12】
"Maybe not."
"I didn't see it here either."
"Let me take a look." Kawei leaned over Koch's microscope. Under the mirror were large red blood cells, regular in shape, and indeed not deformed. "It seems that the location can be basically determined. It should be in the lower urinary tract. Just wait until tomorrow." for further inspection.”
