Nineteenth Century Medical Guide

Chapter 207 204. Semi-Teaching Surgery

[Today is late, I always slack off for two days when I ask for leave at the beginning of each month when I am rich]

Half an hour had passed since the old butler was sent out of the bedroom by Kawei, and the maids waiting at the door were anxiously waiting for the result.

They have no medical knowledge, and have no feelings about the episode in the bedroom just now. The only thing they worry about now is the danger of the operation.The old marshal was the pillar that supported the whole family. Albert had just died. If something happened to him, the family would probably go downhill.

The main reason is that the other sons are in an embarrassing position in both the military and the government, and the old marshal needs to continue to shine to pave the way for them.Servants are very realistic, except for some sense of belonging brought by work, the rest are all considerations of prosperity and loss.

Even if the nobles fell, the remaining wealth was enough to maintain their livelihood for a long time.But the maids will lose their jobs including room and board immediately. It is not so easy to find a stable job in Vienna these days.

In this case, Ludwig's health is very important, and it will naturally become their only topic now.

"My lord will not."

"Don't talk nonsense!"

"The operation was scary. One of my neighbors had an amputation and died within two days."

"The doctor who performs the surgery is different. I heard that the doctor today is very good."

"Is it great?"

"I'm too young, and I said before that I need to prepare salt and sugar, making it like a kitchen, which always feels a bit suspenseful."

"But there are many chief doctors around him, and His Majesty the King is present, so it should be fine."

The whispered chat lasted for a while, and suddenly someone knocked on the bedroom door.This strange situation made the butler startled, and he hurriedly stepped forward to open the door, and Hills' head poked out of the door.

I saw him standing by the door with his hands in front of him, looking like a modern surgeon: "The water is running out."

The butler glanced in through the crack of the door and asked, "Do you want it hot or cold?"

"Just the same as before, warm is fine." Hills hesitated for a moment, then said, "We also need some clean gauze and towels, because we need to wash the wound, and it's not good to stain the carpet. Oh, yes, if If possible, can you speak in a lower voice, the sound insulation effect of the door is not very good."

The butler was a little embarrassed by what he said, so he could only nod his head.

"Hurry up, we can't do anything without water." Sears turned and walked towards the operating table, "I can't touch things with my hands, you close the door."

"understood."

The butler helped close the door, and looked back at the maids who were talking in low voices, and was immediately annoyed: "Didn't you hear what Dr. Hills said? Do you want me to repeat it?"

"Dr. Hills said not to be too loud"

"Ahem." The housekeeper lowered his voice, "You have the energy to go gossip about Master's operation, why not spend more time thinking about what Master will need after the operation, and prepare things first, so as not to make a mess."

The maids fell silent and scattered in twos and threes.

Some went to the kitchen to get hot water and prepare food, while others went to the laundry room to get gauze and some bedding.Others were asked by the housekeeper to go to the living room: "You can't just take care of the master, the living room is also very short of manpower, you guys go there to help, I just keep an eye on it here."

"it is good."

"Remember, don't talk nonsense, especially the master's operation."

"kindness"

At this time, the reception room also became tense as the operation progressed.The topic of the new commander-in-chief was still being discussed just now, but it gradually turned to Ludwig's operation time and possible physical condition.

"It's been about an hour since the surgery started."

"Ah."

"Why is there no news at all?"

"Dr. Carvey's operation is like this, and he can't come out within two hours. And this is not a theater of surgery, how can there be news before the operation is over."

"You said that if something went wrong in the old marshal's operation, wouldn't that be?"

"Bah! What nonsense are you talking about? How could the old Marshal who fought in the battlefields, big and small, fall on the operating table!"

"Just talking casually, what's the matter, it's a private discussion."

"Whether the operation failed or not, he has already rejected His Majesty's invitation, and it is impossible to become our commander-in-chief. To be honest, what's the point of the operation result? The reason we are chatting here is nothing more than waiting for the new The commander-in-chief is determined."

This sentence can be regarded as setting the tone for Ludwig's old age. Missing the post of commander is basically equivalent to staying away from the center of power.But this kind of concluding speech will definitely attract criticism, and soon someone will stand up and explain the importance of Ludwig.

"You look down on the old marshal too much."

Jedion dislikes this kind of self-proclaimed rational speech the most: "Why do you think His Majesty the King must ask him to take the position of commander-in-chief? Is it because he has been on the battlefield? Isn't it because he can stabilize the morale of the army and let him be at the critical moment?" The soldiers fought bravely regardless of life and death. Guess what impact it will have on the army if it is reported that the old marshal failed the operation?"

Ludwig's becoming commander-in-chief was the product of a compromise, which showed Franz's absolute trust in him.

Now the news that the commander-in-chief is undecided has spread, "the need for absolute rest after the operation" and "the death of the operation failed" are completely two concepts, and the impact on the imperial army is also completely different.

"The old marshal's tactical style is calm and he will not let soldiers make unnecessary sacrifices. He is indeed the spiritual pillar of the army."【1】

"So" Jedion looked back at Brecht, who was beside Franz, and said, "Grand Duke Brecht was too fierce in battle, and even dared to rush into the enemy's line to participate in the fight. In fact, to put it bluntly , his abilities are more suitable for being a front-line commander rather than the commander-in-chief of the entire army."

"But he is well appreciated by His Majesty the King."

"Because I have fought a few big victories." Jedion was a little jealous, and felt that he was unfair to himself in this regard, "I am only the chief of staff, and sometimes I can only give opinions, and the real command is not in my hands. superior."

"really."

The seemingly reasonable discussion and his current position made the people around him agree, but the final result after their discussion did not help in determining the commander-in-chief.After all, the Austrian Empire is still in the hands of that man, and the command of the army does not belong to the army, but has always been held in his hands.

"Viscount Jedion." Franz and Brecht made room for each other on the sofa, "Come, come and sit."

"Your Majesty the King." Jedion stepped forward and gave a military salute, carefully sitting in the empty seat between the two.

Franz got straight to the point: "If you became the commander-in-chief of the entire army and commanded an entire army of 50, how would you respond to the two-way approach of the same number of Prussian troops in the north and 30 Italians in the south?"

"The north defends firmly, and the south attacks." Jedion gave the basic strategy discussed with the old marshal without hesitation. "The Prussian army is coming fiercely, but the strategic preparation is insufficient, and it will be defeated if it is dragged into a protracted war. And the Italians It's never been used very well, it's pizza in your mouth for us."

"Is it really possible to win against Italy?"

"I discussed it with the old marshal. If there is no accident, we have a [-]% chance of winning." Jedion said, "As long as they eat them, the Prussians will definitely choose to retreat if they are unstable, and then the initiative will be in our hands .”

"Why not go both ways?"

"Advancing on the northern front is risky, and it would be safer to choose to stick to Bohemia." Jedion's level is indeed not bad, and the French are also included. Into Berlin within a month, we will be held back by the French with small victories."

Franz nodded, and suddenly asked: "If there is no French restraint, at least the French will not come forward to restrain them before they invade Berlin."

Jedion frowned slightly, not understanding what he meant: "The French will never let us win easily, they will definitely"

"They will remain neutral." Franz said, "There is an agreement between Nassan and the Emperor, and there is also an agreement between Nassan and I. France is a bystander, and at most it will come forward to mediate."

"If this is the case, and with the support of the South Prussian Federation, we can give it a try." Jedion thought that Franz asked this question to give himself a chance, and quickly stated, "I am willing to replace the old marshal to lead the northern front." Combat troops, crush Prussia."

Franz did not respond, but continued to ask: "What if there is no support from South Prussia?"

"They've been trying to get rid of Prussia, and we should be able to get their help when the war starts."

"I mean, could we have won against Prussia without their help?"

"This..." Jedion, like Marshal Ludwig, was very conservative in combat. After thinking for a while, he shook his head slightly. "Without the help of friendly troops, entering the hinterland of Prussia will become very dangerous, and the winning rate is less than [-]%."

Franz smiled, got up and patted him on the shoulder, and said, "Our goals are the same, but the position of commander should be given to Brecht."

This was something that Jedion had expected before, no matter whether it was military merit or title, he had no chance of winning.Jedion was upset, but his mouth quickly changed direction: "In this case, please transfer me to the southern front. Even if you only give me [-] soldiers, I am sure to defeat Italy."

"The southern route?" Franz shook his head, "You are not familiar with Italy, so it's better to stay on the northern route."

These words gave Jedion a bad feeling.

Franz said with a smile, "The troops on the northern front are directly facing the attack of Prussia, and they need Brecht's command. Grand Duke Brecht needs a chief of staff who can give detailed analysis at any time. You are the best." Candidate."【2】

At this point, the king's determination has been fully explained, and Jedion has completely lost his chance.

But what puzzled him was that there were only a few candidates who could participate in the commander-in-chief, and those present were him and Brecht.Even if he can't get the commander-in-chief, he can at least be the deputy commander-in-chief of the southern front. As long as the southern front wins the battle, there will be enough opportunities for promotion in the future.

But what is it like to put him and Brecht together now?
"Are you asking about the southern route?" Franz put it off, "I have my own arrangements for the southern route."

In the living room, the candidate for the commander-in-chief of the entire army has basically been decided. If no one stands up to object, Brecht will replace Ludwig as the commander-in-chief.But to the five doctors in the bedroom upstairs, it didn't matter who was in command. What really mattered was the little square on the spine.

After pulling away the paraspinal muscles, only the ligamentum flavum and nerve roots remained between the broken intervertebral discs.

The ligamentum flavum is a very important anatomical structure in the spine, and it is also the focus of this operation [3].It participates in forming the posterior wall of the entire spinal canal, and is also responsible for connecting the adjacent upper and lower vertebral arch plates.

If you want to find the herniated intervertebral disc all the way inward, you must do a good job of stripping and dissecting the ligamentum flavum.If you want to do a good job of stripping and dissecting the ligamentum flavum, you must first cut the lamina.

Carvey used an osteotome and a percussion rongeur.

The former is a traditional orthopedic appliance that Watman used when working on the upper jaw.The latter was newly made by Carvey at the foundry: "This is a new thing that I spent a lot of money on. It uses a very elastic steel sheet. It is much more convenient and safer to cut than a bone chisel. "【4】

Compared with other surgical instruments invented by Carvey, this rongeur is more suitable for modern surgery, and the whole body exudes the charm of modern surgery.

He first used a rongeur to remove the surrounding lamina. During the removal, attention should be paid to the falling bone debris and the extent of the removal.

"In fact, we have reached a conclusion on the corpse before, which is to plan according to the attachment point of the internal ligamentum flavum." Carvey explained while cutting off the lamina, "The resection of the lamina is also for the next treatment. The ligamentum flavum technique is used as a bedding and physiological saline, I need to rinse it.”【5】

Hills hadn't worked as a handyman for a long time, so he didn't notice the bottomed water basin: "I'll find someone to get some water."

The interruption of the continuity of the operation made Carvey very uncomfortable, which is also the inconvenience of home surgery
Carvey brought a spatula from the side: "Then let's deal with the superficial ligamentum flavum first, and first separate the attachment point inside the caudal lamina. The attachment point here is very thick. Be patient when operating, and try not to damage the joints." Capsule."【6】

The ligamentum flavum is divided into superficial and deep layers. Removing the superficial layer is equivalent to thinning the ligament to prepare for the complete stripping of the ligament. [7] As long as the ligamentum flavum is peeled off, the intervertebral disc can be seen when the nerve root is pulled apart.And the treatment of the intervertebral disc must be done by Carvey, so now is the last chance.

Among the four, it was Watman who couldn't hold back the first. As the dean of the School of Surgery, it was only normal to rank first: "Let me try."

Carvey handed over the spatula: "It's more troublesome than working on the facial muscles."

"Um"

Watman has solid basic skills, and he mastered the basic technique of stripping the ligament after a few tries: "It's quite strenuous, but it's very refreshing when stripping."

Looking at the spatula in his hand, Olgi and Massimov couldn't bear it anymore.In the final analysis, they came here to learn techniques, and if they want to learn techniques in surgery, they must get started, so it is very important to win the opportunity to operate from Kawei.

"Didn't you practice on corpses?"

"Can it be the same?" Olgi was a little depressed.

"What's the difference? The marshal is also a human being."

"You compare a dead person with a living person?" Massimov was violent, and he had already squeezed another spatula in his hand, and cursed, "Old man, you know how to take advantage of both of us, why do you do plastic surgery every day?" Grab the chance of surgery with us!"

"There is no harm in learning more techniques." Suddenly Watman loosened his hand, gently lifted the superficial ligamentum flavum, and quickly picked up the scissors, "No hurry, the next deep ligamentum flavum will be handled by you at the head office Bar."

Olgi and Massimov were instantly discouraged.

The ligament has been thinned, and under the thinned ligamentum flavum is the nerve root, which is not easy to deal with.Even if Kawei really handed over the operation to them, they would not dare to directly operate it. 【8】

As Massimov himself said just now, using a knife on a dead person is completely different from a living person, not to mention that this living person is the Marshal of the Empire.

[Set a flag, I will strive to complete the additions of several leaders before the end of the year, I hope it can be completed]

(End of this chapter)