Chapter 144: Movement

"Is there a problem?" Seeing the examination process stall, Professor Feiernan approached to ask.

Kraft did not respond immediately; instead, he extended the percussion range further downward, comparing it with his memory. However, except for the spot directly below the inferior angle of the scapula, the sounds from the other percussion sites were basically consistent with the previous results.

This made absolutely no sense. If it were due to slight positional differences caused by respiratory movement, that would be one thing, but if the percussion results for the same spot were completely opposite on two occasions, then either his memory or his common sense had been insulted.

"I cannot understand it; the sound produced by tapping this spot is inconsistent with before."

"What does this mean?" As the internal affairs officer, Wilbert appeared far more anxious than the Duke himself. Whether out of confidence in his own body or simply not caring, the patient merely emitted an "Oh?"

Kraft realized he should explain the purpose and principle of the examination to his colleagues and the patient's side, so that the information gap would not create the illusion that "this is no big deal."

"It is similar to judging whether there are secret doors and chambers behind a wall by the echo of tapping; different components produce completely different sounds when subjected to appropriate tapping techniques."

"Generally speaking, as a loose and light organ, the lung should feedback a clear sound when percussed, but not so clear as to be nearly empty. To be precise, like this." He tapped outside the Duke's still-intact lung area, demonstrating a pleasant, clear sound.

"But pulmonary consumption is a terrible disease; it gradually erodes the lungs, forming large lesions within them. After rotting, dissolving, and being expelled, they become cavities, which are the 'secret chambers behind the wall.' When tapped, they produce sounds like hollow objects, such as drums or jars."

【To be honest, I've been using a source-switching app to read and follow updates recently. Switch sources, multiple narration voices available.. huanyuanapp works on both Android and iOS.】

Selecting another detected cavity, Kraft tapped out the sound representing the disease.

Finally, he pointed to the area below the right inferior angle of the scapula, "And this area was the same during the first examination; a cavity with an inner diameter at least the length of a finger bone, absolutely not small."

"But now it is not."

A turbid, solid sound rang out beneath the percussing knuckles. Compared to the previous two, it was like a barrier filled with sand and gravel, turning the vibration into a dull, low reverberation. "I call this dullness."

"Do you mean... something has filled this cavity?" As a scholar with strong comprehension, Feiernan quickly grasped the meaning through the word formation, yet this did not bring him clarity; instead, he fell into a deeper confusion tinged with an indescribable emotion. "Just during the time of the recent onset?"

Kraft returned a slow and firm nod; he could not believe this either, but the objective result was so, leaving no room for refusal.

Taking the teapot from a servant, Wilbert carefully filled the Duke's second cup of throat-moistening hot tea. Having understood Professor Feiernan's summary, he interjected, "But what does this indicate? Could it be something like phlegm filling it?"

"Fluid should not produce this kind of sound." Compared to Professor Feiernan, it was precisely because of his deeper understanding of the disease that this change brought Kraft a feeling that was more bizarre and unreasonable.

Although "patients do not get sick according to the books" had been proven countless times as a classic trope, this development was still too far beyond cognition.

Come to think of it, there was actually another saying heard later: "Even the hardest questions can be found with corresponding answers in books." The great editors of books could always stuff unimaginable content into the most obscure corners.

He sifted through the details in those texts, searching for content related to tuberculosis: pneumothorax, empyema, hemorrhage, airway stenosis, atelectasis, pulmonary aspergillosis, cor pulmonale. Each term carried paragraphs or even pages of text; perhaps one of these hid the answer explaining the "impossible event."

There could be many forced explanations. For instance, if it were truly some liquid injected into the cavity during movement, causing an especially strange sound due to a special position; or if airway stenosis caused by the lesion accidentally formed a valve, like a tension pneumothorax but in the opposite direction, ultimately resulting in a very specific atelectasis.

Whatever the possibility, it all boiled down to one sentence: Do you believe this nonsense?

There could also be an extremely simple and crude direction to explain it, though he did not want to do so without clear evidence prompting it.

Moreover, no matter what guess he made, he could not verify it without imaging examination results.

That unbearable feeling of being entangled, like losing vision, climbed up his brain again. Kraft felt a craving spreading wildly in the gyri like a subarachnoid hemorrhage, bringing stimulation and urgency no less than pain.

The Spirit made a suggestion, and he found it hard to refuse.

"This shouldn't affect my treatment plan, right?" Yet someone still remembered his treatment plan. The old Duke wrapped himself in a fur coat, not a precious breed; the fur color was probably from some beast hunted in the nearby mountains.

He bent his fingers and gestured at his chest, obviously unimpressed. "A hole the length of a knuckle doesn't seem very wide; I still have that much lung available. If there are no other problems, let's start preparing for the treatment as soon as possible."

"..."

Silence. Silence is today's Westminster.

Not only Kraft, but even Professor Feiernan fell into a speechless state of being struck. Fortunately, Feiernan was probably not facing such a request for the first time and was not completely thrown off track.

"Your Grace, this is a very dangerous act; no one knows what accident an 'active' lesion might cause during treatment." He added extra emphasis and stress on the word "active," making it clear that this word should not be applied in its common literal sense; applying it here made things even more uncomfortable, as if admitting that something capable of movement could exist within the lungs.

"I think Knight Kraft's therapy makes a lot of sense; perhaps we can just flatten this lesion together?" The previous treatment description emphasizing risks seemed to have failed to intimidate; instead, it gave the patient some overly brave notions.

Feiernan had no choice. As the Duke's long-time attending physician, he knew the Duke's character well. He could only give Kraft a look that said, "Your suggestion, you handle it," and let someone else take over.

The original purpose was to find a new approach for the Duke's nearly unsolvable condition. Now that purpose was achieved, unfortunately not in the expected way.

"I agree with Professor Feiernan's view; we need to discuss this more cautiously." Kraft did not think he could change the Duke's mind on the spot, but he could provide a buffer time, along with more things.

"Preparation for the artificial pneumothorax equipment takes time, and before that, the subject needs to adjust their physical condition. During this period, I would like to trace the detailed medical history, such as the people the Duke my lord has contacted, the food consumed, or the places visited before the new symptoms appeared."

Of course, there was also one special examination.

"Wilbert will satisfy your requests; you can tell him about the tools needed to be made and the medicines to be used." Regarding this expense, the Duke didn't even have the interest to raise a hand. "But the menu and the list of audiences... never mind, this doesn't matter much either."

【For the sake of the budget and curiosity】

After careful consideration, Kraft decided to use the Spirit Sense once, after all, this truly belonged to a completely incomprehensible special situation.

Just an instant, like a teetotaler twitching his nose at the bottle mouth, just to satisfy the craving. It relieved the suppression of the Spirit's instinct and could also solve an especially exquisite medical puzzle, providing assurance for the upcoming treatment. Killing three birds with one stone.

He convinced himself. No, Kraft was not quite sure if he had convinced himself, but the shield blocking the Spirit Sense did indeed lift for an instant.

Consciousness greedily absorbed the information gathered at this moment, like meeting a timely rain. That perforated lung mapped into his mind in a three-dimensional, transparent form.

Attention concentrated on the area near the right inferior angle of the scapula, the superficial layer beneath the chest wall, locking onto the mystery wrapped in confusion, curiosity, and a hint of fear. There was a strange pleasure in peeking at the answer.

The first percussion was not wrong; that was indeed a tuberculous cavity, the size as estimated, with an inner diameter slightly longer than his middle phalanx. The sense of distance under the Spirit's vision was particularly good.

Now calling it an "empty" cavity seemed a bit inappropriate. A roughly spherical filling occupied the internal space, its volume slightly smaller than the inner diameter, leaving a crescent-shaped narrow cavity gap. Thus, the surface not adhering to the cavity wall could also be distinguished when focused.

It was a strange, delicate spherical surface resembling hairy velvet, displaying a vigorous and flourishing sense incompatible with this increasingly weak respiratory organ.