Chapter 245 241. Application of hens in internal medicine

If you want to understand high fever, you need to understand the standard body temperature. The time to determine the standard body temperature of humans is actually not far away, just 15 years ago [1]. So Kawei's article "Thermometer" has caught up with the trend, but it is still a matter of official promotion.

There is a long distance to go.

Because as Oluke said, high fever is not like low fever, and it can be judged entirely by the feeling in your hands.

In the face of high fever, doctors did not have much to do in the past, they were just symptomatic cooling. Because finding the cause requires basic medical theory, lack of theory, lack of cause diagnosis, and no treatment is possible.

On the road to cooling, doctors at each stage have different understandings. The 19th century was a watershed in the drastic changes in cooling methods, because the effect of salicylic acid cooling was discovered and clarified.

Oluke is not stupid, nor is he unaware of the effect of salicylic acid to reduce fever, but at this time the salicylic acid still has fatal defects. Many patients may not have their fever completely eliminated, and the gastrointestinal tract is burned out by this drug for several holes.

Gastric bleeding and perforation are definitely more difficult to deal with than high fever. Once it occurs, it is basically sentenced to death, so the best way is to question it loudly and choose not to use it.

As an internal physician who is responsible for the patient, Oluke has always been on the side of questioning and is extremely cautious about the use of salicylic acid. Of course, being cautious is not not to use it. When he encounters a patient's high fever and difficult to relieve his or her fever, he will still

There is a high probability that salicylic acid will be chosen.

However, the patient's situation in front of him is a bit special.

The high fever for the fourth consecutive day, the use of air repellent is ineffective, and the poor stomach and intestines have become a burden of difficulty in using salicylic acid. These are all indications for the use of "hens".

Kawei was very curious and could not think of how Oluke would deal with the hen, but the result was very simple and direct.

"This is the last resort. If it can't be cured," Oluk took over the hen tied up and took a scalpel from the nurse. "Please support his head."

The nurse pressed the patient's dry and hard hair upwards, exposed his forehead, and then stabilized his cheeks with both hands. Oluke lifted the hen in mid-air, turned his back to his forehead, and then raised his knife and pierced it through with one blow.

The muscles of the hen's back.

Kawei was not familiar with the anatomy of the chicken, but this knife could easily stir up the blood vessels without the heart.

I saw the hen screaming a few times, and his body struggled constantly. The warm blood began to gush out of the wound, slowly flowing out from the sharp blade, and fell on the patient's face: "The blood of the hen can remove it.

The effect of high heat, then wash it with cold water. Hope it will be useful."

Physical cooling?

But the temperature of the chicken is higher than that of the human.

Perhaps the cooling itself depends on the cold water that cleanses the blood.

Kawei looked at this scene blankly, and while complaining, he couldn't help but sigh: This is probably a biological product from the 19th century.

Such treatment obviously has no scientific basis, which is a bit too much for internal medicine who is still in chaos. But Kawei still can't say that Oluke is a quack doctor. The limitations of the times make it difficult for him to deal with many diseases, and also allows him to

Some areas handle better than Kawei.

After all, modern surgery is also a hoop stuck on the head that binds Kawei.

"The next one is the guard who was bitten by a snake yesterday." The nurse exchanged medical records with Oluke and said, "I was going to transfer to surgery, but the other party's bed was tight and he could only stay here."

"Oh, how are the wounds now?" Oluk asked.

"Somewhat red, but not serious." The nurse lifted a corner of the bandage and glanced at it, "The snake venom did not occur, and he did not have a high fever, everything went well."

"Yeah, OK."

Oluke wrote two randomly on the medical record book and looked at Kawei: "Doctor Kawei, you are a surgeon. He has three wounds on his ankle. Can you give me some advice?"

The guard was wrapped in thick bandages on his ankles, and the dark dry and hard blood that could be seen clearly. Unlike the two medical staff who disliked the wound, he bent down and completely untie the bandage. There were three obvious serious rays in front of him.

Sharp weapon injury, not snake bite.

Kavey immediately realized the reason why Oluke did this: "Doctor Oluke directly cut the skin and bleed?"

"The snake venom is too fierce, and ordinary antidotes are difficult to take effect, so they can only bleed as soon as possible." Oluke explained.

"This is not an ordinary blood cut."

"The success rate of ordinary bloodletting is very low. Only by completely removing the tissue around the wound and then using the fire pot method can we suck out a large amount of blood in a short time to alleviate the attack of snake venom." Oluke sighed, "Although my anatomical knowledge is not outstanding,

But it can still distinguish skin, muscles and blood vessels.”

"Pump?" Kavey heard a familiar word in it, "Doctor Oluk would cupping?"

"This is a serious internal medicine treatment method, of course!" Oluk knew that Kavi was a doctor halfway through, and said, "Just take a piece of paper dipped in the spirits, then light it in the wine glass and turn it down.

On the wound, you can quickly bleed and absorb toxins.”

This is probably the best way to deal with snake venom in the 19th century. It perfectly suits bloodletting therapy, which is much more straightforward than drafting medicines and sucking it out with your mouth.

If Kawei had encountered such a patient, he might have done this in the end, but there would have to be a struggle of thought in the middle. In the face of snake venom, time is life, and a brief pause may have missed the best time to deal with it.

.

"Doctor Oluke handled it very well," Kavey looked at the wound in front of him and asked, "By the way, is there any disinfection after the bloodletting?"

This is what he cares most about, and it is the only thing that Oluke has learned in this training: "I disinfected completely according to the requirements in the "Military Medical Manual" and replaced the soldering iron with carbolic acid. Then I used half a cup of brandy, each time I went to

Once every 15 minutes, pour it on the wound. Finally, choose mustard cream or cotton sheets soaked in ammonia to place them on your chest to resist the drowsiness caused by snake venom."

"What are ammonia water and mustard paste used for?"

"Protect his heart."

".Okay." Kawei nodded slightly, "The surgical treatment is done well."

"That's good."

Although the treatment of ammonia water and mustard paste seems redundant in the end, the previous steps are still correct. Without alcohol, using brandy is also an inefficient alternative. Anyway, it is quite good to have carbolic acid for the bottom.

This also made the soldier's wound appear less serious.

"However, the wound is too big and it will be difficult to heal without suture."

“We don’t have needles and threads for sutures in our internal medicine.”

"It's okay, I usually use what I bring." Kawei turned around and looked at the captain behind him, took the surgical instrument box he handed over, "Just do a little suture and then bandaged it with a carbolic acid bandage.

”

Oluke is a very pure internal medicine doctor, conservative, stubborn, 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 he still had to say flattering words: "Let you

I've had some trouble."

"It's just a simple stitching, no big deal."

Kawei's surgical suture needle was hung with silk thread at the beginning, and it was taken as soon as possible. With the help of tissue forceps, these three wounds were solved in less than two minutes: "One of them had a higher tension, and suture actually affected blood supply.

, increase the difficulty of healing, cover it with an oily gauze covered with turpentine oil and wait until it recovers slowly.”

Oluke stood by the bed all the way and did not walk to the next bed. Kawei's suture skills were all in his eyes: "Doctor Kawei's skills are indeed superb."

Kawei rinsed the suture needle and tissue forceps briefly, wrapped it in gauze and put it in the drawer at the bottom of the instrument box: "It's just the most basic suture, it doesn't explain any problem."

"I also have surgeons around me, and I can tell the difference." Oluke said implicitly and quickly looked at the last bed. "The last one should be severe high fever and abdominal pain. How do you feel today?"

"No, no, no." The patient's voice was very weak.

"Show me the results of the enema."

The nurse received an enema record sheet, which stated the enema time, enema fluid formula and excretion: "The excretion is acceptable, but the body temperature and abdominal pain have not disappeared."

"Either ginger sweet wine nor barley tea work [2]?" Oluke was a little puzzled, "Warm wine and tea should be able to relieve abdominal pain."

"It's just finished drinking, but it hurts a little soon." The patient covered his stomach and looked very bad. "It hurts so much. Do you want to give me some calomele? Sweat a little and vomit for another night

Maybe that's all."

"Calomele is not used this way," Oluke 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've written it down."

"Then put a few more pieces of juice squeezed from sweet radish in his wine [4]." Oluk's treatment of abdominal pain is more inclined to diet therapy. "Try it first, I'll think of a solution for you if I can't do it."

The patient was a little devastated when he heard the radish: "I want to eat other things, I can't eat only one piece of bread and half a bottle of wine three meals a day!"

"I have severe abdominal pain and can't eat randomly until it's relieved," Oluke said. "Please trust my judgment."

"I'm so uncomfortable"

"I know, but please bear with it for a few more days before the abdominal pain is relieved."

Instead of writing too much on the medical record, Oluke continued to instruct the nurse, "He has drunk too much and has a serious bad breath. I will chew some orris roots later, and rinse his mouth with soda after chewing it.

.”

"OK."

After dealing with the more than one hundred soldiers in the tent, Oluke finally breathed a sigh of relief: "Doctor Kavey, I'm done with work here. If you have anything to talk about, go to my office."

Kavi was standing beside him, but he was looking at the patient just now.

In modern medicine, abdominal pain is more inclined to surgery. As long as gastrointestinal inflammation is eliminated, most abdominal pain is urgent and requires surgical treatment to relieve it. So when I saw this patient with abdominal pain, the first thing that came to mind was

Several common acute abdominal symptoms.

"Can you let me see?"

The two had already touched each other. Kawei knew that although the other party was a bit stubborn, the level was far less serious than Fattorad. Oluk also knew that although Kawei was young, at least the basic skills of medicine were very solid.

The most important point is that both of them know that the other party is really considering the patient.
To be continued...