Nineteenth Century Medical Guide

Chapter 476 472. Anatomy Record (4)

James and Wade originally thought that they were seeing things wrong. The large blood vessels directly connected to the heart can contain fat, plaques, various body tissues, wood, metal, and even bugs, but there should not be air. However, the plump blood vessels and the sparse blood clots kept reminding him that there was indeed air in the blood vessels, and a lot of it.

Shouldn't air only exist in the lungs?

Moreover, after entering the lungs, it will be separated by large and small bronchi, and the amount of air entering each alveolus is very little. After cutting open, it cannot be seen with the naked eye and there will be no feeling in the hand.

Janeway swore that he had never seen such a corpse, not in the United States, not in Paris. He could also swear that he had never seen such a report in any textbook or magazine. Maybe he was the first to discover this strange phenomenon?

but

As the discoverer, you have to prove its existence.

He sutured both ends of the aorta, but the air had already escaped from the lumen. The lower aorta had been removed by Landreth, and the lumens of other blood vessels were too thin to visually see the cavities. How could he prove it?

Oh, right, the heart! The heart is where blood is collected and pumped out. If there is air in the aorta, there should be air in the heart as well.

But compared to the aorta, the space inside the heart is much larger, and the larger the space, the more difficult it is to operate. How to make the cut is a difficult point. Moreover, the body has only been dead for five or six hours, and there is blood flowing in the aorta, so there must be more blood in the heart.

How to prove the existence of air in a soft cavity mixed with gas, liquid and solid?

According to the usual method, the blood needs to be drained, leaving the heart cavity empty for subsequent dissection. But if the liquid is drained, wouldn't the air be drained as well? James and Wade's thoughts got stuck at this point. Looking at the dissection instruments at hand, they felt that the answer was on the tip of their tongue, but they just couldn't say it.

His autopsy was certainly not as exciting as Kavey's, his operation was clumsy, and his skills were even lower. The doctors who were allowed to enter the autopsy room were all elites from all walks of life, and they had more or less professional pursuits. No one would be uninterested in the cause of death.

Once they have expectations, they may be able to suppress their curiosity for a while like Kawhi did, but when James and Wade, who have been making a lot of noise, suddenly become quiet, their attention is still drawn away.

Especially his good friend Holmes, who was the first to notice James and Wade put down the scalpel and stared at the heart. He occasionally glanced around the corner, which inspired the people around him, including Kawhi, of course: "What's wrong? Did you find the cause of death?"

"Forehead"

There was no reason for James to not answer Kavey's question, and he told him exactly what he had found. He was sure that there was air in the lumen of the blood vessel when the ascending aorta was cut.

"Air? How can there be air in the blood vessels?"

"I remember that there is air in the blood vessels, but the amount is very small and it has all dissolved in the blood."

"No! It's the air that is free from the blood. You can feel the cavity before cutting. You can see and feel the gas!!!" The reactions of these people made Janeway believe that his discovery was correct. "Dr. Kavey, since there is air in the aorta, there should be air in the heart, but I don't know how to verify this idea."

Kavi had already made his own judgment. He turned back to look at Landreth who was taking out the artery and asked: "Didn't you find any air when you took out the abdominal aorta?"

Landreth was only thinking about the work at hand: "I cut the blood vessels and directly cleaned and disinfected them. I didn't pay attention to such things."

Kavey left the dissection table, found a syringe from his box, and handed it to Janeway: "Since all the blood vessels of the heart have been clamped with hemostats, find a place where you think there is air accumulation and insert the needle."

"Yes, yes, syringe!" Janeway suddenly woke up, "How could I forget it."

Kavey was like a tour guide. Wherever he went, the doctors who were watching also went. After getting Kavey's support, many people gathered around James and Wade, all wanting to see if it was really as he said.

“How do I find a location?”

"Air is light, so it must be above the liquid. Let it sit for a while and then pierce the top of the liquid."

"It's not that simple. The blood has already partially coagulated. No one knows how the gas, liquid, and solid are distributed."

"There are four whole chambers. If there is really that much gas, you can always find it by inserting more needles."

James and Wade were not disturbed by these comments. While recalling the feeling of kneading the aorta just now, they felt the surface of the heart. After comparing the surface morphology and force changes of the four chambers, he chose the right atrium: "It is very obvious that it is full here, so I chose this place."

With that, the needle was inserted into it.

The 20ml syringe was filled with air in the blink of an eye, and the originally full right atrium also collapsed partially.

"It's definitely air!" Janeway pointed at the glass window on the side of the syringe and asked excitedly, "Doctor Kavey, this should be the first time you've discovered this strange phenomenon, right?!!"

"Probably not."

Kavi pondered for a moment and said, "I heard my father mention this before. It was an old story. There was a mine near my home back then, and several miners had symptoms of muscle pain and convulsions. Some died soon after and were bought by my father for dissection. Their hearts and blood vessels were like this, full of air."

"So someone discovered it a long time ago?"

The beautiful expectation was like a beautiful glass product, colorful and exquisite, but it only stayed in James and Wade's mind for less than ten minutes before being smashed to pieces by Kavey's rational hammer. He quickly recognized the reality and his face was calm, but the sudden feeling of disappointment in his heart made him feel uncomfortable: "What caused this phenomenon?"

"I don't know. I was still young at that time. He just said it was an occupational disease of miners, and many doctors knew about it. I couldn't understand him if he went into more detail. Of course, it is also possible that my father simply didn't find the cause of the disease."

Kavi was not interested in whether he was the first to discover the phenomenon of "air in the heart", he only cared about how to explain this phenomenon. His surgical skills were already eye-catching enough, and it was inappropriate to show off himself. Using his father as a shield could at least help share some of the pressure.

"Since there is so much air in the right atrium, there should be a lot of air in other chambers. And the coronary arteries that cover the surface of the heart should also have air."

Following his instructions, everyone turned their eyes to the coronary arteries on the surface of the heart. The thin coronary arteries certainly could not be compared with the aorta, but the impact of the air was more obvious.

The answer is obvious after careful observation: "The coronary arteries are filled with little sections of air."

"There is a blood clot in the lower half, but"

Kawi carefully cut open the coronary artery with a scalpel, took out the blood clot inside, and then used a magnifying glass to take a closer look: "This is not a complete blood clot. There are small bubbles inside."

On the other side, James and Wade drew out a whole tube of air from the right atrium and right ventricle. The difference from before was that the last 5ml of air slowly turned into foamy blood: "Dr. Kavey, there is at least 40ml of air in the whole heart. This is too weird!"

"When we were doing the autopsy on Fenlina just now, we mentioned that there is air in the blood. This 'existence' means combination." Kavi explained, "A normal person's blood combines oxygen and carbon dioxide, but the amount of this combination is not large."

"Where does the air in the blood come from?"

Instead of answering, Kawi asked, "Besides oxygen and carbon dioxide, what else is there in the air?" "Nitrogen."

"Nitrogen can't be used for breathing, so it can't combine with blood. Isn't it all exhaled through breathing?"

Kavey interrupted the questioning again and carefully helped Janeway remove Carl's lungs. After carefully cutting them open with a knife, he said, "The lungs are dark red, and the pleura is smooth and fine, but there is a lot of pink foamy fluid flowing out of the lungs."

"Pulmonary edema?"

"Yes." Kavi continued to explain, "Because the heart is no longer working, the left ventricle cannot pump blood out, causing blood to accumulate in the lungs. This pressure forces the blood into the alveoli, where it mixes with the gas just inhaled into the alveoli to form foam."

"So the cause of death was due to air bubbles in the blood vessels dividing the blood vessels, causing lack of oxygen to the tissues and organs?"

"Yes." Kavi asked Peon to put down his work and help with the pathological sectioning. "Three locations: the myocardium of the heart, the alveoli of the lungs, and the lumen of the small blood vessels of the liver."

"it is good."

"We were talking about nitrogen just now. Is it possible that the air was injected into the body maliciously?"

Kavi shook his head. "Who would inject air into the veins of such a tall and strong young man? If you have the time, why not just poison him directly? And it's not that easy to find blood vessels from the skin surface. Even the most skilled nurses can rarely find blood vessels in a corpse with one shot.

Look at the skin on his limbs and neck. There are no needle holes near the large blood vessels on the surface of the body. Besides, it is rare to find a syringe that can easily pierce the skin. "

"So where does this gas come from?"

As Kavey watched Payon and Janeway remove Carl's liver, he said, "I thought of a possibility."

"What's the possibility?"

"Imagine when Watt invented the steam engine," Carvey said without saying it directly.

"Watt? Steam engine?"

"Is Dr. Kavi talking about the scene where the steam from boiling water pushes the lid off the kettle?"

Kavi shook his head: "What Watt observed was boiling water, the relationship between the water vapor and the lid of the kettle, but what we want to observe is the state of the water before it boils, and we are looking at the bottom of the kettle."

"Bottom of the pot?"

Given the backgrounds of the people present, not many of them had ever cared about such daily trivialities, and some had never even touched a kettle in their lives. However, they had never boiled water or touched a kettle at home, but they had boiled various reagents in flasks in the laboratory. They immediately realized that what Kavi was talking about was the bubbles that overflowed from the bottom of the flask before the water boiled, and these bubbles were caused by the reduced solubility of air in water during the heating process.

"Doctor Kavi is talking about the solubility issue?"

"Correct."

"But the temperature changes throughout the four seasons are not drastic. Even if there is a big temperature difference between morning and night, it won't cause so much air to escape."

"No, of course not the temperature. Humans are warm-blooded animals." Kavi examined the slices of liver, spleen, lungs and myocardium made by Peon one by one, and then put them into the microscope one by one. "Think about the principle of the refrigerator outside the ward."

"Change the air pressure?"

"It's a rapid change in air pressure."

"But Paris is flat, how can the air pressure change? It's not like you can climb directly from Paris to the top of the Alps in just a few minutes."

James, Wade, Holmes, and other doctors all understood the principle, but they could not combine the principle with reality. Instead, Landreth, who had not participated in the discussion, thought of the key to the problem: "Your thinking is wrong. How can blood in a normal state dissolve so much gas? It is obvious that it enters the blood in an abnormal state, such as the miners mentioned by Kavey."

"The high pressure in the mine causes the solubility to increase. But there is no mine here."

"Dead brain! It's water! It's the Seine!"

"I heard before that he was a traveler? Maybe he likes diving, which puts him in a high-pressure state for a long time, so that a lot of gas dissolves in his blood. Once he leaves the high-pressure environment quickly, the pressure drops suddenly and the gas will overflow."

Landreth looked at the fourth prepared blood vessel that had just been taken out and could not help but nod his head in appreciation of his own skills. "But there is a prerequisite for this situation. The gas leakage must be diffuse, that is, it must be present throughout the body, including the smallest and thinnest blood vessels. It cannot be limited to the heart and large blood vessels. This is also the reason why Kavi asked you to do tissue slices of various organs."

Janeway stared at the microscope and saw the answer in his field of view, and he was excited: "There are indeed a lot of vacuoles in the small blood vessels."

At this time, the morning dissection was still in progress. After the five blood vessels were taken out, they were cleaned, the inner membrane was stripped, disinfected, and cleaned again. Then they were all put into the refrigerator for rapid freezing, and finally put into the vacuum box for sublimation drying.

When everything is done, the morning's work comes to an end.

After lunch, they would take a short rest before starting the afternoon work. After being screened by Hott, the bodies prepared by Lex and Xiaona would be continuously sent to the Main Palace Hospital.

The entire preparation work lasted until the morning of the 21st, and the tight schedule also strained everyone's nerves.

Amadeo, who had left the hospital early in the morning, gradually regained his composure.

Half an hour ago, his carriage had arrived at 24 Kusel Street. He had originally planned to start a conversation with Princess Mathilde about a sad past, then slowly move on to Venetia and his unpromising little thing, as well as Kavi's superb surgical skills.

It's not very smooth, but at least the change of topic will not seem so abrupt.

Who would have thought that as soon as she entered Mathilde's private studio, the mentally devastated princess skipped all the foreplay and brought the topic directly to the end: "Duke Aosta, why are you here?"

"Uh, I just thought." Amadeo glanced at the princess's drawing board and the model in the distance, and his heart skipped a beat.

"Let me introduce you to my new model, Mr. Geiser Kniesser." Mathilde reached out and called him over. "Don't put on your pants. You'll have to take them off later. Aren't you tired?"