This is not a symptom that you expected before you came.

Most of the fever types of tuberculosis patients are a low-grade fever, and even some patients do not show fever symptoms or do not feel significant. And this fever, the fever that made Professor Brimmer hesitate in his discussions, arises from the body without apparent cause, and appears imperceptibly when Kraft concentrates on the examination.

"Your Excellency, can you hear me?" Kraft stretched out two fingers and moved them left and right in front of the Duke's eyes, and noticed that his eyeballs were tracking his fingers at a narrow angle, and at the same time there was an uncontrolled tremor and dissociation, as if some variable sensory stimuli were acting on the vestibular receptors, inputting information that the eyeballs could not adjust to their corresponding position anyway.

“.” Behind the lips are unformed words, disintegrating into meaningless syllables before exiting, mixed up in an irreducible disorder into an unsettling mantra-like scrambled disorder.

Without a thermometer, Kraft placed his hand on the patient's forehead to estimate. Although the fever is menacing, it is still in the moderate heat range, and it has not risen enough to cause such a sharp impairment of consciousness and function, and there should be no such synchronization.

This overturns the previous first reaction, that impaired consciousness is not the result of fever, but two concurrent symptoms.

In the face of change, Wilbert and Fernand did not show a panicked and unexpected attitude, obviously this is not the first time that such an attack has occurred, and it is self-limiting. Kraft pressed the artery of his wrist, the sudden throbbing of which was rapid and weak, just as a decaying respiratory system tried to maintain compensation by increasing the rate of relaxation.

It's a stupid strategy to go from compensated to decompensated soon after all the margin has been used, and then the organ will play itself to death without intervening.

The fever is getting worse, and the twitching of the trunk and limbs seems to have acquired their own independent will, and they are carrying out high-frequency contractions that do not form effective movements, similar to shivering in the ice and snow of winter, which is exactly what happened. This means that the body temperature is moved upward, the body perceives the current body temperature as hypothermia, and the skeletal muscles produce a large amount of heat by trembling, both of which behave similarly.

In that case, there must be something affecting the thermoregulatory center. There are many of them, infectious factors, non-infectious factors, but generally speaking, acute fever is more common than the former.

Kraft thinks so, although it is far-fetched, lacking the rigor and various laboratory tests on which he depends, and agreeing with Professor Lyndon's lesion theory, which he has just despised.

But this is what made him realize a sense of déjà vu, the presence of one or more foci of infection, the repeated release of exogenous pyrogens such as endotoxins or the pathogen itself, and then through a series of "specifically annoying to death, but anyway, white blood cells release endogenous pyrogens, cross the blood-brain barrier, and act on somewhere in the hypothalamus through a series of reactions" to cause fever.

This is very reasonable, not only tuberculosis, but also the immunity is weakened under long-term consumption, and a concurrent infection occurs in this body.

What is it?

In the absence of etiology, no one could answer this question for him, and another question followed, what was the impaired consciousness, which did not seem to be the result of a fever, but another manifestation of the cause in this body.

Kraft tried to change his title, "Lord Duke, can you hear me?"

The call was answered, and the Duke of Westmin's eyelids lifted slightly, signaling that he was still able to react to the outside world and not lose consciousness completely. He even tried to wrestle with his disordered body, manipulating his tongue and tongue to prove his normality, but what he was sending out was still something that no one could understand, and the preface did not match.

This made the old duke feel a little indignant, and he raised his still trembling hands and tried to write something, and the magnitude of the inaccuracy seemed to be a struggle against some invisible enemy, but these actions did not achieve his purpose after all, as if the words were cursed and could not be conveyed.

"We've tried to document that, and Brimmer thinks we'll be able to analyze it for information about the disease." Fernand couldn't help but remind. Seeing that the internal affairs officer had a look of uncertainty on his face, he said something to prevent him from continuing to guide the duke, "But there has been no progress in his research so far, it may really just be that the disease has blinded the spirit, and there is no meaning." ”

"No, I just don't think so." Kraft finished the examination for the time being, rearranged the patient's shirt and positioned, and completed the work of the servant who was about to come forward.

"It is not only the content of the words that should be noted, but the fact that the patient can still speak at this time, but the words do not make sense."

[Wernicke's aphasia]

It's time to look at the dysfunction and guess the damaged part the most, and it turns out that the Duke's brain dysfunction at this time is not extensive and indiscriminate. On the contrary, the monolingual functional area retains a part, showing a state of being able to hear, not understand, and express confusion.

"We've had cases where patients who have injured 'here' in their skull, unlike other people who have been dumb by skull, who still retain their ability to pronounce but can no longer speak the right words." Pointing to the posterior pole of the superior edge of the temporal bone, Kraft explained.

Well, Wilbert's face was no longer restrained with dissatisfaction, as the castle's housekeeper, he did not lack the brain to think of the origin of this knowledge, and now this brain felt a little uncomfortable to continue to stay with Kraft, and inevitably showed a slight look of rejection and horror on his face.

Fernand nodded noncommittally, he was past the age of being confined to the interdisciplinary portal, he also had an understanding of anatomy, and he was willing to accept that this kind of lesion caused some kind of corresponding symptom.

"This suggests that this area of the patient's skull was damaged during the seizure, and it was temporary and reversible." But this made it impossible for him to explain why there was an intermittent dysfunction of a specific area, parallel to the symptoms of fever. And it seems that the limb motor functional area is also affected at the same time.

"So what is going to be done?" Wilbert didn't really understand much, and he looked at his master worriedly. The Duke of Westminster's symptoms were menacing, but the neurological dysfunction did not last as long as a simple febrile seizure, and after a while he was already able to control fine motor skills well, reaching for the steaming chamomile tea, Wilbert hurriedly approached to help him stabilize the cup.

"It's complicated, it's not just wasting." Kraft's words froze the atmosphere in the room, but he didn't want these people to think that he could do anything, "I think there is another disease infection on top of the original lung wasting disease, and multiple lesions in the skull. ”

"I need to know how often these episodes are and how long each one lasts."

"Well, it's about once a week, and the duration and length of the attack are basically the same as this one." Fernand replied without hindrance, his observation record consciousness far exceeded that of other people of his generation, "I guess this attack is imminent, and it is just right to bring you here." ”

"What about the severity? Has there been a change? Kraft touched the Duke's forehead again, and the heat was still there, out of sync with the neurological symptoms, "Also, have you monitored the duration of this fever?" ”

"It's difficult, it's often mixed with the heat and dryness of the wasting disease itself, which lasts for at least half a day, and the beginning and end are unknown."

Indeed, pyrogens released into the bloodstream are not removed so quickly. Kraft was deep in thought, he had ideas, but they were all speculation. And it is to be expected that there will be no answer if he continues to think like this.

The scene was a bit stiff, the experts were discussing, the family members were full of sorrow, and the patient was struggling to wake up from the chaos and poured a sip of chamomile licorice tea with honey into the throat dried by the hot dry air.

"Knight Kraft, it seems you haven't learned much from your fathers." The dry and hard voice comes from the duke, who has taken back control of his vocal cords and mouth. The two professors, who were obsessed with thinking, hurriedly apologized.

"I understand. You're saying I have two diseases, one is a lung wasting disease that will kill me, and the other is not going to be for the time being. ”

"Yes, but the other one could actually be more deadly, and I'm not sure if it's related to lung wasting disease or some sort of independent disease. It may form a lesion in your body that periodically releases toxins," and despite not quite understanding what the Duke meant, Kraft recounted his findings in a good manner.

However, the patient interrupted him nonchalantly, "I want to treat lung wasting disease first." ”

"But it's not clear if the other will affect the treatment," Craft thinks he should think again, starting treatment hastily is too risky.

"Cure the disease of wasting first."

"It could even lead to more serious consequences," this must be stated.

"I can decide my own body."

Well, the Duke understood what he meant, but still stubbornly persisted.

"Young knight, I even thought you were older than Fernando." The Duke stood up on the shoulders of the Interior Officer, and it was only then that Kraft noticed that he was much taller than he had imagined, "Simpler, I only need a cure, a chance to bet, and bet on the possibility of living until the next winter." ”

"Your Excellency, I must point out that it is unlikely that you will win in the presence of complications." Kraft seems to understand the logic of this idea, he has not seen this kind of behavior in Old Wood, and sees his relationship with physical obstacles as a kind of duel, and uses overcoming obstacles to achieve goals as the criterion of victory, including but not limited to lame bear hunting.

Regardless of the risk-benefit ratio, as long as there is a possibility, they will definitely do it.

To say that it sounds brave is to be brave, but to change the perspective is reckless. But it's easy to understand why they chose that way, the people who have survived to this position are all senior members of the Survivor Deviance Association, and their bodies have never let them down.

"And there is a risk of losing life expectancy under current palliative care."

"Your role is only to make workable recommendations for me, not to recommend options, Knight Kraft. I will bear the consequences and consequences of my decision. ”

Speaking harder than armor, I know that I will definitely not be able to run without handing over the treatment plan today.

"Okay." Kraft took a deep breath, holding his breath like he was before opening the attic of some old object and removing the dusty antiques, "Let me introduce you to artificial pneumothorax." ”

【Artificial pneumothorax】

This is really one of the old antiques.

"This treatment is based on current surgical human findings. Our lungs are actually surrounded by membranes on both sides, and normally the spaces between them are sealed, like a shriveled bladder that is tightly plugged into a wooden stopper. ”

"The risk is that you have to inject air into the space between these two membranes, causing it to expand and compress the lungs." In the narrative, Kraft's hands move toward the center from the sides, signaling the process "until the lungs collapse, the range of motion is compressed and rested, the fluid circulation is sluggish to limit the spread of the disease, and the eroded cavities of the lungs are squeezed and healed." ”

"There is no doubt that this is a risky, traumatic, incurable therapy. If you must persevere, then I will continue to complete the examination and plan the treatment for you. This is the first time he hopes that the risk notification will scare off patients.

"Why not?"

It seems that the first time is always hard.

At the insistence of the duke, the inspection continued.

With the mentality of "this is the case" and "I can't help it anyway", Kraft began the rest of the physical examination, he had to carefully assess the situation in the lungs that were riddled with holes, indirectly understand the cardiopulmonary function, and if the results were not good, it was inevitable that he would have to consider using his mental senses.

Because of the lack of tools, he had to put the pinna on the patient's chest to listen, and this inconvenience prompted his desire to work overtime to make the original stethoscope within the auscultation of the three intercostal spaces.

[Go back and count this in their tuberculosis project funds]

In order not to use the mental senses, Craft carefully compares the results of auscultation and percussion, striving to approximate the greatest degree of certainty. However, the objective effect still proves that the pursuit of new machines by the ancestors of radiology for many years is indeed because there is an insurmountable gap between machines and people.

Kraft still wanted to hold on for a while. Note the results of another auscultation, move to the other side, lean under the right shoulder blade, roughly the position of the seventh and eighth intercostal spaces, which is a sound between the skin drum and the hollow urn in the percussion just now, indicating that there may be a cavity near the chest wall, and its size needs to be vigilant.

Listen with your ears on, a musical rales break into the ear canal. He didn't quite recognize the voice.

To be honest, it is too difficult for a person who rarely sees this level of tuberculosis to make an accurate judgment. Kraft hesitated for two breathing cycles, still puzzled.

To be on the safe side, he decided to knock again. As usual, attach the second segment of the middle finger of the left hand and tap it with the middle finger of the right hand, waiting for the sound feedback that echoes in the empty space.

There was a low, dull sound, muddy and thick, but it was not the drumming sensation of the empty urn echoing in my memory.

"What's the situation?" Kraft knocked again in disbelief, still in a solid voice, "How can it be solid?" ”