Nineteenth Century Medical Guide

Chapter 246 242. Operation "Preparation"

O'Rourke's treatment is mixed, but at least fasting is a good choice. Under normal circumstances, cholecystitis will slowly return to normal.But the patient's condition is not optimistic. According to the medical records, he has had high fever and abdominal pain for three days, and there is no sign of relief.

Now the diagnosis of cholecystitis can be basically clear, almost inseparable, the rest is the degree of the disease.

The course of cholecystitis directly affects the choice of treatment, whether it is conservative, surgery, or conservative first and then surgery.

Acute cholecystitis that has not been relieved by the third day is basically going to the operating table. Of course, the premise is to do a good job of diagnosis, that is, imaging examination.There is no imaging examination now, and the operating room of the temporary ambulance station is not up to standard. It will take a lot of time to transfer back, and accidents may happen halfway.

Everything can only be judged by Kavey's experience.

He touched the patient's upper right abdomen again, and confirmed that the location of the lesion was in the gallbladder: "Are you sure you want to operate now?"

"I'm sure." The patient nodded again and again, then tensed his muscles, turned sideways and forcibly avoided Carvey's palpation, "Stop pressing! I really can't stand it!"

"Ok."

O'Rourke is a typical 19th-century physician. In his eyes, the quality of a doctor is basically judged by the speed of diagnosis and the accuracy of treatment measures. In particular, the speed of diagnosis can best reflect the experience of a doctor.

A doctor who quickly judges a disease may not be excellent, but a doctor who hesitates for a long time and cannot make a diagnosis must be a quack doctor.

Although Carvey uses considerable palpation, direct contact with the patient's body, and is a dirty surgeon, his speed of diagnosis is excellent, even among the high-level experts of the Association of Physicians who are fast in diagnosis. to the forefront.

Many of them are suspected of pretending to understand, but after the suture just now, O'Rourke still believes that Carvey has really made a correct diagnosis.

It's just that the word "cholecystitis" is very strange in his mind.

"What does cholecystitis mean?"

"The gallbladder has inflammation, and the most common reason is the presence of stones in the gallbladder." Carvey explained, "From his body temperature and abdominal symptoms, it can be seen that the degree of inflammation is very serious, and he really needs immediate surgery."

O'Rourke didn't know much about surgery, but he still couldn't help asking: "How does surgery remove inflammation?"

Carvey made a simple cutting action and said: "The principle followed by surgery is to cut out whatever is unfavorable to the body. If there is inflammation of the appendix, cut out the appendix. If there is inflammation in the gallbladder, cut out the gallbladder."

"Is there any effect on the body after gallbladder removal?"

"Yes, but not much." Carvey said, "Removing the gallbladder will not affect normal life, but it will have a little impact on digestion. I personally think that this impact should not make him refuse the operation."

"It's okay, it's not a big deal at all!" The patient said, clutching his stomach, "I want to take a knife and cut my stomach open right now because of the pain, so hurry up and do the surgery, I can't take it anymore!!!"

"I need to make some preparations, and at the same time" Carvey glanced at O'Rourke again, "Dr.

O'Rourke nodded: "I am only responsible for the logistics and medical treatment of the ambulance station. I have no right to interfere with surgery."

"It doesn't matter, the interference resistance in surgery is much smaller." Carvey looked back at the guard captain behind him, "Go to Mr. Ignatz and tell him that I need an operating room, and I hope the surgeons here can cooperate. .”

"Doctor Ignatz should have gone to the center of Gablenz."

Kavi was taken aback, and nodded slightly: "I forgot about it, it seems that Lucius followed him, right?"

"Yes, there are more patients there, and everyone except your own first trauma team and two nurses followed."

"That's fine, let Herman negotiate, and Damirgang and Bergt will prepare for the most basic abdominal surgery as soon as possible." Carvey said, "Talk to Amor, the operation time is 1-2 hours, let He figured it out on his own. Then he asked the nurse to open the patient's vein and put a bottle of saline on it first."

"I see."

The captain of the guard left the internal medicine tent, and Carvey followed O'Rourke back to his office while others were preparing.

As the chief physician of internal medicine of the Sixth Army, O'Rourke has a separate farmhouse as a rest room, and his treatment is much better than that of officers of the same level.Just after leaving the stinking internal medicine ward, stepping here again is like stepping directly across the world and entering heaven from hell.

This place is not as spacious as the Laming command post, but it is a little more delicate under the layout of O'Rourke himself. It is hard to believe that this place was an ordinary farmhouse two days ago.

"Doctor O'Rourke seems to like art very much." Carvey glanced at the small portrait on the wall, then glanced at the corner of the frame, and said, "Is this Mr. Hans' painting?"

"Yes, when I went to Vienna for a meeting two years ago, I took the time to commission him to paint." O'Rourke changed his military uniform and hat, and put on a more comfortable coat, "Why? Dr. Carvey also likes Mr. Hans' works? "

"It's okay, I'm also a friend of Mr. Hans." Carvey found a chair and sat down, "But I've never seen him paint such a small portrait, today is an eye-opener."

"I spent a lot of money at that time." O'Rourke picked up a rag beside him and carefully wiped the picture frame. "Only this size can be carried with you, or you can only keep it at home."

"I do think you should consider using a camera."

"Photography is amazing, but it's not artistic," O'Rourke said. "I still like the lines drawn by painters. What would you like to drink?"

"Oh, don't bother." Carvey quickly returned to the topic, "I'm mainly here to clean the ward."

After hearing this, O'Rourke regained his senses. The person in front of him was not only a surgeon, but also a deputy inspector of the Military Medical Department, responsible for the supervision of military hospitals and military ambulance stations.

Theoretically speaking, each army group will have a deputy inspector in charge to supervise the work of the medical staff, and the Aussa coalition army and the sixth army are no exceptions.It's a pity that the deputy inspector who was originally on the Western Front disappeared inexplicably. Now that the position is vacant, it seems reasonable for Carvey to fill the vacancy with a telegram from Archduke Brecht.

But O'Rourke still wants to struggle: "Deputy Marshal Lamin has taken over the position of deputy inspector. If you have any questions, you can find him."

After hearing this, Carvey felt a little helpless: "I have looked for it, but I can't compete with him. So now I am not ordering you as a deputy inspector, but as a doctor at the same level, I want to discuss with you about the cleanliness of the ward. "

O'Rourke knew that the environment of the tents was very bad, but there was nothing he could do about it. The conditions of the army were like this, so he could only overcome it as much as possible: "As you can see in terms of the environment, we don't have decent houses in our station. We can only rely on tents to centrally manage those Wounded and sick soldiers, otherwise the ward rounds alone would have taken half a day."

The suburbs are different from the city center, and the farmhouses are very scattered, which greatly limits the efficiency of the farmhouses in the temporary rescue.

"But that's not why the tents are unclean," Carvey said. "Rats, bugs, fleas and lice on the soldiers' bodies should all be removed."

"Of course I like cleanliness too. Believe me, no one likes these things," O'Rourke explained. "Especially fleas and lice. We don't have enough hands. They're not dust on the ground. They're so easy to clean."

"That's why there is typhus," Carvey murmured.

"What did you say?"

"I said that the latest research found that typhus may be related to fleas and lice." Carvey said, "I have strictly exterminated rodents and insects in the Olmitz Fortress Hospital on the northern line, and I have only seen seven cases of typhus so far. , and there is no sign of transmission."

"But we are in the wild here, and the conditions are limited." O'Rourke was a little excited, "I don't necessarily want me to light a pile of straw to fumigate the entire ward, right?"

"I know it's not easy to get rid of fleas and lice in an outdoor environment, but spraying carbolic acid, kerosene, creosote, brine can all work," Carvey said. "At the same time, we can also start from the patient's body. .Wash your body with diluted carbolic acid solution and soap every week, and change your exposed clothes and bedding frequently.”

"There is no creosote, and kerosene is rarely used for lighting. Carbolic acid is something specially used for surgery." O'Rourke said, "We can try concentrated saline, but I don't know if it will work."

"It's important to wash your body and clothes with soap."

"let me try."

The two had a lot of discussions on the patient's high fever, and they had diametrically opposed ideas in terms of cooling.

Carvey clearly prefers salicylic acid, which, while it has rather annoying side effects, can still be used by doctors as long as the dosage is controlled.O'Rourke, on the other hand, still insists on keeping salicylic acid on the shelf, preferring his own approach to this dangerous drug: "If the blood of the hen can't bring down the fever, I will choose aniline."

"Aniline. What is aniline???"

"A friend who is a pharmacist recommended it to me and said it is useful for reducing fever."

Carvey couldn't react for a while: "Has it been tested?"

"He should have tried it, otherwise he wouldn't be so confident."

Carvey felt strange, but was interrupted by a knock on the door just as he was about to speak again.The one who came was the captain of the guard who just went out to spread the message: "Doctor Kawei, the news has been brought, but"

"Just what?"

"There are only two farmhouses serving as operating rooms, and they are all full."

Carvey has long been prepared to wait: "It doesn't matter, traumatized soldiers are more important, I can wait."

"But they said that the operation has been scheduled until noon tomorrow, and they have to wait for more than 20 hours to use it."

Carvey frowned, not because the other party deliberately targeted him, but because he was thinking about whether the soldier could survive until then: "No, he can't stand it for such a long time, and he will have surgery tonight at the latest."

"But."

Carvey stood up: "What's the name of the surgeon in charge? Where is he now?"

"It's Donelson, he should be undergoing surgery now."

Donilson objected not only to the use of the operating room, but also to the surgical procedure that Carvey said.After Carvey found him, the two had an "intense" discussion about the operating room, the patient's diagnosis, the operation method, and the right to treatment.

"As you can see, the operating room is very busy." Donelson only stared at the operating table, without even looking at Carvey.

"The operating rooms are all temporary, and I can find any place to operate." What Carvey really wants is the medicines and equipment here. Disinfect with some carbolic acid."

"The amount of carbolic acid is very small, so I can't give it to you."

Donelson's refusal was quite blunt, almost showing the difficulty on his face: "I think Dr. Carvey should give up this operation. The patients in the internal medicine department will naturally be treated by the internal medicine doctor. There is no need for our surgery department to go through the muddy water."

"He has cholecystitis, which has developed for three days. He won't live long without surgery."

"What cholecystitis? The gallbladder can also be inflamed? You're just talking nonsense, I think he just has an ordinary abdominal pain." Donelson took the scalpel and cut the skin of the soldier's calf, "Take some medicine and give an enema. gone."

Carvey was not in the mood to discuss the diagnosis of the disease with him, so he just said: "As the deputy inspector of the Military Medical Department, I will requisition the right to use surgical supplies from you."

"I don't agree." Donilson didn't pay attention to Carvey's military rank and title at all, "Don't ask why, it's very simple, this is the Sixth Army, not the Third Army on the Northern Front. You also Don't say I'm presumptuous, the inspectors of each army are different, this is the rule set by the Military Medical Office."

"Even if I can't take over the temporary relief facility, I still have the power to supervise your medical practice."

"No, it's up to Deputy Marshal Lamin to decide." Donelson's hand speed was not slow at all, and the scalpel in his hand had been replaced with a bone saw. "As for whether you listen or not, that's your business. If there is no order from Deputy Marshal Lamin, I will not allow other people to intervene in the medical work of the Sixth Army Temporary Rescue Station, let alone sell any medical supplies to outsiders."

"I have a telegram from Archduke Brecht in my hand. I am here to support the work."

"Oh? Deputy Marshal Lamin agrees to your intervention?"

Deputy Marshal Lamin was walking around, and Carvey sighed: "Forget it, I don't want surgical supplies, and I won't use your operating room. I will take the soldiers away."

"You don't have the power!" Donelson finally turned his head to look at Carvey, and the young man in front of him ignited his anger, "Soldiers of the Sixth Army must die in the Sixth Army's temporary ambulance. There is no right to take him away."

"Of course I have the power." Carvey said, "A lieutenant general always has the power to promote a soldier to become his own guard, and I will go to Gablenz next, and he will follow him as a guard." I'll go there together."

(End of this chapter)