Chapter 208: Tension Pneumothorax

The patient has suffered from pulmonary tuberculosis for over half a year; all symptomatic medications for cough suppression and fever reduction proved ineffective; after this procedure was performed, hemoptysis ceased immediately, coughing decreased in frequency and severity the next day, and the patient reported improvement in chest pain and heat sensations...

When daily discussions centered almost entirely on what the next meal would be, a report bordering on the miraculous was circulated to the long table.

Roughly speaking, without anyone noticing, professors from Rivers University had mingled with the hospital's anatomy instructors, performing surgical treatments on tuberculosis patients at the graduating students' internal medicine clinic—with remarkable results.

This graduate, who deeply regretted his past academic imbalance, honestly documented the entire treatment process he witnessed, ending with a skeptical note: "Professor Kraft declares this procedure only delays disease progression."

The impact of immediate efficacy is always the most powerful; long-standing herbal formulations and folk remedies suddenly appeared meaningless, even absurdly clownish.

At first, clinic patient volume simply doubled; but when the second, third, and eventually dozens of cases emerged, rumors would not remain as restrained as university case reports.

A lengthy, meticulously qualified description spanning hundreds of words gradually degraded in transmission into a single, sharply focused question: Can it cure?

If yes? Then no further explanation is needed. The White Plague's advance was halted for the first time before a reproducible force—far more tangible than royal touch or divine blessing.

The tangible effect was that Dai Wei felt every patient in his vicinity—indeed, throughout the entire new urban district and beyond—was streaming toward the clinic, and those successfully treated further spread the word.

Many who arrived coughed, but not all had tuberculosis; even entirely unrelated ailments came to test their luck: various sores, abscesses, rashes, ulcers, chronic long-term coughs, cardiac palpitations, and chest pains—with infectious diseases being the most common.

The reasoning was straightforward: if tuberculosis can be treated, then surely other illnesses can too.

This sharply increased operational strain on the clinic, especially after witnessing patients enter coughing up blood and exit breathing steadily—thoughts had already shifted from faith in medicine to faith in the mystical.

The "royal touch" treatment was not metaphorical; in legend, it was considered one of the key healing methods, slightly more plausible than divine blessing, since those who saw the Heavenly Father likely needed no treatment, but those who saw the king still had a chance.

Now, this tendency had shifted toward a professor unwilling to reveal his name.

Some believed that merely rushing into the clinic, approaching the man who had cured the White Plague, and having him touch the patient's swollen lymph nodes and chest would cure the disease without medicine—a significant number held this view.

If it were now announced that biting a piece of him could cure tuberculosis, Kraft felt he might receive the same treatment as some western pilgrimage monk.

Of course, things hadn't improved much; initially he could still receive all kinds of infectious patients, gathering and analyzing data for commonalities, but two days later he had to wear masks and hooded robes to enter and exit.

The surge in patient flow forced Kraft to abandon his other purpose for coming here, devoting nearly all his time and energy to daily assessments, punctures, and insufflations.

According to half his soul's knowledge from that other world, even in developed regions, tuberculosis specialists might not see so many patients with such typical symptoms in a month; in underdeveloped areas, no such primitive treatment plan existed.

Saying "no" was extremely difficult; when a patient arrived with all his possessions, hoping for treatment, you couldn't tell him, "Today I've had enough tuberculosis cases—I need to check on others."

But sometimes circumstances don't depend on personal will.

"Your condition is unusual; I cannot treat you with my method." Kraft placed both hands on either side of the patient's thorax, feeling distinct friction and traction.

【Pleural adhesion】

Tuberculosis is not confined to the lungs; it spreads outward. The foundational structure for artificial pneumothorax—the pleura—is the closest thing to the lungs.

Fibrin deposits in pleural inflammatory exudate resemble two sheets of sugared parchment: water evaporates easily, leaving solid components to coagulate, forming viscous strands as the two layers move against each other, creating a rough inner surface.

When placing a hand on the chest wall, one feels this rough friction. In severe cases, like this patient's, portions of the two pleural layers have fused together, impairing respiratory motion.

At such times, insufflation is impossible.

"But they said you could cure it, and just now that man..." The patient, slumped over the chair back, strained to breathe shallowly; one could imagine each rise and fall tugged at the immobile pleura, inevitably causing pain—unless breathing ceased.

Inflammation was likely still active; forcing him to maintain an uncomfortable lateral posture to avoid triggering worse pain.

"I'm sorry, tuberculosis varies in severity; breaking a finger is fundamentally different from breaking a leg bone." Kraft was willing to explain further, but even explaining indications and contraindications of artificial pneumothorax to Dai Wei, who had basic medical training, took considerable effort; more words wouldn't change anything, only add confusion.

He made a vague circular gesture over the patient's chest: "My art is insufficient to relieve your pain. May the Heavenly Father bless you."

Without instruction, Kup skillfully helped the patient up and led him out, then called in the next patient from outside.

As he turned to leave, Kraft stopped him: "Kup, have someone outside handle patient calls; you'll help Dr. Dai Wei with the ether bottles later."

"Huh?"

"Me?"

Two highly synchronized questions rose; Dai Wei glanced around nervously, searching for a second person named this in the room. Though the traditional master-apprentice system was no longer mainstream in medicine, learning someone's proprietary technique after only a few days still seemed implausible.

"Yes. After watching so many days and hearing the procedure explained repeatedly, even a puncture needle should know which intercostal space to target. You two will handle the next patient." Kraft plunged his hands into lime water; a faint sting seeped into the thin skin of his knuckles.

Days of nonstop procedures had strained the distilled alcohol supply, with much wasted on low-yield ether production; continuing to use it for handwashing was no longer feasible—he had to dig out an old, long-abandoned method.

As planned, one person couldn't do everything; it was time to begin teaching—certainly not because artificial pneumothorax had been sufficiently validated, but because he simply couldn't endure the dual strain of mental and physical labor.

"Don't worry—I'll be watching you." Kraft relinquished the center seat, which had always belonged to Dai Wei, and moved aside, settling comfortably into the audience chair: "Wash your hands first!"

Dai Wei's mind went blank; he performed handwashing by conditioned reflex, silently reciting "look, listen, tap, feel" as he sat on the still-warm cushion. Kup returned to his familiar attendant position, though now the object of protection was the surgery itself.

Fortunately, this patient was extremely "standard"; merely imitating the most frequently observed procedures sufficed to grasp the essentials.

Kup, slightly nervous, recalled the proper technique for holding the ether bottle—found no additional requirements beyond steady hands, which was simple enough for a man who wielded a mallet.

Relieved, the attendant turned his attention to Dai Wei's fragmented questioning: time, symptoms, nature—sporadic, disjointed, nothing like the coherent, story-like flow of Kraft's own interrogations that guided listeners through logical sequences.

Upon hearing certain illogical questions, he even felt he could predict the next question—and which one shouldn't come next.

【I could do it too】

An outrageously arrogant thought. Kup quickly banished it, his life alongside Kraft having given him a basic understanding of these complex academic institutions.

How could a half-trained attendant, plucked from the sludge of Salt Tide District, compare to a graduate of the Kingdom's highest academy? He glanced nervously at others, fearing his fleeting thoughts might be overheard.

Dai Wei finally finished his interrogation; after Kraft corrected his technique, he completed the physical examination step by step and concluded "suitable for procedure." Next came the part even the needle knew: locate the puncture site, disinfect, insert.

The patient's nutritional status was good—advantageous for pneumothorax—but this also meant he wasn't as bony as the first patient; subcutaneous tissue was notably thick.

Dai Wei sweated under scrutiny, his fingers tracing the chest wall twice, finding inconsistent rib counts.

Something was wrong—he should recount from the second rib. But under everyone's gaze, after Kraft had personally demonstrated the method moments ago, he couldn't imagine making such a basic error; the more he panicked, the more confused he became.

Kraft crossed his arms, seemingly intending to let Dai Wei retrace his steps—this only made Dai Wei more anxious.

Those familiar with Kraft knew this held no malice; it was simply a willingness to grant ample thinking time.

Until this impasse lasted five or six deep breaths, Kup, holding the ether bottle, finally couldn't hold back—he extended one hand and roughly indicated two small points on the patient's chest, then held up five fingers.

"Fifth intercostal space?" Dai Wei remembered Kraft hadn't called this attendant a "disciple."

"Correct." Kup confirmed; this was practical knowledge he'd been forced to memorize during bone studies, "The apex of the heart lies along this line—I recall it."

He looked up and saw Kraft give a slight, surprised nod.

The remaining steps proceeded smoothly under close supervision; the patient awoke, ecstatic with gratitude, promising Kraft he'd return for follow-up visits.

The clinic continued; Dai Wei's technique gradually grew proficient. Just as he carefully prepared for his third puncture, a frantic cry and shouts of protest interrupted the procedure.

Before he could reprimand the apprentice for poor management, Kraft had already rushed out of the examination room in three strides, and in the most densely packed part of the crowd, he used brute force to push aside the idle personnel who, though bewildered, kept squeezing in.

The man, whose body was stiff and turned sideways, was being supported; his face, already pale, had lost all color, sweat pouring down, veins bulging and prominent on his rigid neck, as some rapidly progressing illness expanded within his body.