Nineteenth Century Medical Guide

Chapter 114 111. Water

The main purpose of Carvey's amputation is to let Li Ben live a good life. It doesn't matter whether it hurts or not, at least he has to live.

At the same time, I also disgusted the theater by the way.

With the hardware configuration of the surgical theater, there is only a wooden table and a rest and preparation room, so I am not sorry for the part of the ticket money he took away.Modern hospitals can provide sterile operating rooms and all kinds of cleaned surgical instruments. There is nothing here, which is equivalent to empty gloves and white wolves.

But what Carvey can do is disgusting people, and it is the hospital that really needs to fight against the theater.

As long as the surgical expansion is completed and there is a venue, the hospital will be able to get back the right to perform its own surgery. At that time, Kawei will definitely be a brand, and he will also have the right to negotiate prices with the hospital.There is room for discussion on how to rebuild, how to add equipment, and how to select patients and audiences.

Of course, this kind of thing can only come slowly.
He's more interested in Hills' patients now than in operating room reform.

The original chronic abdominal pain seemed very strange.

Chronic abdominal pain is often not severe, and it passes after a while, but the patient still agrees to the operation, indicating that the symptoms have reached an unbearable level.Now that he had a severe cough before going on stage, Carvey had a bad premonition.

"The patient is in the preparation room?" Carvey asked, "Can you show me?"

Hills has been Ignatz's assistant for so many years, and he has finally survived until he is in charge of his own affairs. He certainly does not want outsiders to interfere.So seeing that Carvey wanted to intervene, he resolutely refused: "No, Dr. Carvey, that's my patient."

"I know, I'm just looking."

"It's nothing to look at." Hills' remarks on the stage were fairly fair, but once he met Kavey, his words were full of hostility, "I'll see it after the operation begins."

"OK then."

Considering Sears' ability, Carvey wanted to help make a diagnosis first, and didn't want the patient to be stabbed for no reason.Since the other party refused, he would not force it, and quickly put away the cleaned tools, and took Bergett and the others away from the operating theater.

He needs to go back to the hospital and explain the key points of nursing care to the nurses to prevent Li Ben from incision infection after surgery, and then go back to the theater to watch the surgery with Ignatz.

As for Li Ben's physical condition, Alphonse was most concerned: "Cut?"

"Yes, it must be intercepted, or I won't be able to live." Seeing him worried, he said, "Don't you have a grudge against him, why are you so worried?"

Alphonse said: "I'm just worried that he won't live. After all, amputation will kill people. If the person is gone, who should I fight with?"

"It's still a duel, and the legs are gone." Carvey said with a smile, "You should stop thinking about the duel as soon as possible."

"Huh? It's enough to have hands in a duel, and it has nothing to do with the legs." Alphonse didn't take it seriously at all, "The weapons for duel are not only swords, but also knives and guns. When his wound heals, he can Put him in a wheelchair, and we'll fight each other with one shot!"

Carvey was stunned for a moment, and then realized that he had a large-caliber percussion gun on his waist when he first arrived.

It's hard to persuade, and now he doesn't want to waste his saliva, he patted Alphonse's shoulder directly, and said, "I won't be your assistant by then, you should hire someone else."

"Don't, if you fight with a gun, you need two assistants."

"If you slip away, I'll have to cover my bag. I won't do this kind of thing." Carvey picked himself up cleanly, but he did not lose the responsibility that a close friend should have. "At that time, I will be a field doctor. Watching a play nearby, no matter who is injured, he can be taken to the hospital in a carriage."

"That's a good idea." Alphonse looked at Li Ben, who was grinning in pain just after being woken up by the nurse, "Can he really survive?"

"Don't worry, it's alright."

At ten o'clock in the morning, the audience began to enter the theater one after another.

For non-medical professionals, the name and purpose of the operation are secondary, and fun and stimulation are the most important.Sears' laparotomy gave them the feeling of opening a blind box, so even though they were ranked in the morning, there were still many people cheering.

There were more surgeons, apprentices and medical students at the scene. Apart from wanting to see the first performance of Hills after he went to Graze Hospital, they were mainly greedy for the ticket price in the morning.

Half an hour later, the host of the theater came to the stage and began to briefly introduce today's chief surgeon: "Ladies and gentlemen, the next one will be the representative of the younger generation of Austrian surgeons, the proud doctor of the fast knife Professor Ignatz. Protégé, now the mainstay of surgery at Graze Hospital: Dr. Hills Guderian."

Sears pushed open the door, stepped forward quickly, with a smile on his face:

"Thank you, host. Today I want to bring you a strange patient with abdominal pain. He has had intermittent abdominal pain for more than three months. He has constipation from time to time and has a particularly poor appetite. Without the slightest relief, I considered the possibility of intra-abdominal tumors and planned to do an abdominal exploration.

Now let's invite today's patient: Mr. Edward Sterling. "

As soon as the words fell, two assistants pushed the wheelchair and sent the patient into the theater.

"Mr. Edward is 32 years old this year. He is a serious and responsible tailor. The suit I am wearing is from his craftsmanship." Hills said, "Unfortunately, he is suffering from abdominal pain for a long time now, and he is in pain. In addition, he has recently Coughing and spitting up, not even touching a pipe much."

After that, he lifted the blanket from the patient, revealing Edward's thin body.

A tall man of 1 meters, with long brown curly hair, but with a thin torso and limbs, he needed the help of an assistant to get on the operating table, and the audience sighed.But if you record this sound and listen carefully repeatedly, you may be able to hear a doubtful voice with the opposite tone.

Others couldn't hear it clearly, but Ignatz, who was sitting next to him, could hear it clearly.He looked at Kavi at his side and asked, "What's wrong with you?"

"Teacher, I think there is something wrong with this patient."

Ignatz was puzzled: "Of course there is a problem, otherwise he wouldn't have been sent here for laparotomy."

"No, the problem I'm talking about is not that problem, but this one." Carvey was thinking about a bunch of differential diagnoses for abdominal pain. When he realized that he was speaking in a riddle, he quickly changed his words, "The patient's height is about the same as mine. , the whole body is very thin, the teacher can look at his stomach, isn't it a bit strange?"

"Stomach?" Ignatz narrowed his eyes and understood what he meant, "It seems a little weird."

Edward's arms and legs are thin, but his stomach is a little distended.

Just now I couldn't see clearly when I was sitting in a wheelchair, but when I stood up straight, a sense of disobedience appeared.

Unfortunately, it was short-lived, and he soon lay down on the operating table. His supine posture and loose abdominal skin hid all the swelling just now.Looking at it now, Edward's stomach is similar to that of ordinary people, nothing special.

Carvey still had a bad premonition when he heard the symptoms before, but now he saw the patient's appearance, thin body, sallow complexion, cough, abdominal pain, and abdominal distension, and the premonition was basically confirmed.

At this time, I don't know who started the first, pulled out a 10-kroner note, and said with a smile: "Since it's an open laparotomy, why don't we guess what's inside before the operation starts?"

This proposal hit the hearts of the audience around, and suddenly several voices came out: I guess it must be a tumor, the huge tumor should be the colon, colon cancer! "

"I guess it's an intestinal obstruction."

"I guess it's chronic appendicitis, which has suppurated and formed an inflammatory mass."

"Don't worry, let me write it down." At the beginning, the man took out a pen and paper, and scribbled a few words on it, "10 crowns per person, and the winners will share the prize pool equally."

"Interesting! I guess hepatitis!"

"Here, 10 crowns, I guess cholecystitis!"

"Gastroenteritis!"

"I also guessed it was a tumor, but it should be a tumor of the small intestine"

More and more people participated, some gave answers after serious thinking, and some were bored to join in the fun. Anyway, it doesn't matter whether you win or lose, it's just for fun.

They respected the rules in the theater and upheld proper gentlemanly etiquette, keeping their voices down as much as possible.But there were too many people discussing at the scene, which finally aroused Hills' dissatisfaction: "Everyone, the operation has begun, please try to restrain your impulse and keep quiet."

Everyone finally restrained themselves a bit, but it was only in terms of volume, and guessing the blind box became more intense.

"My 10 crowns, I think it's stomach cancer."

"I bet on hepatitis!"

"Where do so many tumors come from? I choose gastroenteritis."

"Chronic diarrhea."

"What diarrhea! He is obviously constipated, you said diarrhea?"

"Um, sorry, let's have intestinal obstruction!"

Ignatz did not participate in it, and sneered at this baseless and playful speculation: "What time is it, can you be more serious!"

"Idle is idle, why don't you guess one too, Professor?"

"Yeah, guess one."

"Our level is not enough, it still depends on you in the end."

Ignatz was so urged that he had no choice but to take out his pocket and handed out a 10-kroner note: "I also think it's a tumor, the exact location is hard to say."

"Must say a location!"

"Yes, there must be a place, otherwise there will be too many people with tumors."

"Must I say it?" Ignatz thought for a long time, and finally choked out the answer, "...then let's go to Xiaochang."

"Okay, small intestine tumor +1!!!"

At this time, Hills had already gone under the knife. With the help of his assistant, he gently cut open the skin, and imitated Kavey, and started anatomical separation and hemostasis layer by layer: "Today's operation, we will start by dividing the epidermis. start."

It was the first time for Carvey to see his operation so "delicate", and he couldn't help laughing: "Teacher, what happened to Hills today? Chepi cut so carefully."

Ignaz lost 10 crowns for no reason, and felt a little uncomfortable, so he thought about Rakavi and went into the water together: "Don't look, where is your answer?"

"Huh? What answer?"

"What is in this patient's stomach, we have already given the answer, but you haven't said it yet."

At this time, everyone remembered that Carvey hadn't participated in it yet, and they couldn't help booing: "Even Teacher Ignatz participated, and Dr. Carvey had to guess one."

"Yes, I have to guess one."

"10 crowns?" Kavi didn't want to refute their face, and took out the money from his wallet, "I guess it's water."

"water?"

"Why water?"

"Can you hold water in your belly?"

The medical level of the audience is uneven, and only a small number of doctors who have experienced many clinical cases can really understand what he said.Carvey didn't give a reason either, because the explanation couldn't keep up with Sears' knife, so he could only give a general color first: "Well, it's a belly full of yellow-green water."

At this time, Ignatz understood what he meant: "You mean ascites?"

"Yes, ascites." Carvey said, "I haven't touched the patient's stomach, but from the visual volume, it is estimated to be 200-400ml."

Just finished talking here, those who guessed the answer are still in a state of confusion, Hills has already cut the peritoneum here.After all, his delicacy is just pretending. A knife into his abdomen is like piercing a dam on a river, and the black ascites leaks out of the hole: "Hurry up and get the gauze. Oh, forget it, let's do this first."

The amount of ascites cannot be calculated, but the color is very obvious, which is the yellow-green that Carvey said.

"How did Dr. Carvey know it was ascites?"

"Because this kind of thin body means that the disease is exhausted, and the bulging stomach can't be protein or fat, it can only be ascites." Carvey can't talk to them about some pathophysiological things, so let's talk about it in general for the time being. Introduced an inaccurate concept, "The ascites is strange, there must be something else in the stomach."

Hills's surgical technique is not bad, but it is a bit difficult for him to make a diagnosis like an internal medicine doctor.In the eight years of combined undergraduate, master, and doctoral studies in clinical medicine, half of them are anatomy, the rest are pathology, and then other basic medical theories. There is very little content that actually teaches clinical medical judgment.

In fact, it is difficult for even physicians to judge the disease by inspection. After all, only a small group of people are at the forefront and frantically submitting articles to magazines.

"Everyone, I made a mistake in my judgment and let everyone see such a joke."

Hills was covered with yellow-green ascites water stains, and his cuffs and trousers were also soaked.He hurriedly corrected the previous accident, and quickly stated the plan for the next operation: "Next, I will empty the patient's ascites, and then continue with the intra-abdominal exploration."

At this time, his assistant suddenly called out: "Mr. Hills, come and take a look."

"What's the matter?" Hills, who was facing the auditorium, suddenly looked back at the patient, "What happened?"

"Teacher, take a look at the patient's stomach. It's densely packed." The assistant swallowed, unable to bear the goose bumps on his body, and dodged his sight. "It's full of small white bumps. I just can't stand it anymore."

"Little lump?"

These are small milky white particles the size of a finger. If you look carefully, you can find that they have already been densely hidden in the patient's abdominal cavity, and they are all on the omentum, peritoneum, and intestinal mucosa.

Just when Hills was in a daze and didn't know what to say, a voice suddenly came from the audience: "This is tuberculous peritonitis!"

(End of this chapter)