Nineteenth Century Medical Guide

Chapter 247 243. The First Cholecystectomy in History
Perhaps other doctors will choose to give up when encountering such resistance, especially after experiencing all aspects of constraints and education in the modern medical system, self-protection seems to have become a basic passive skill that all doctors should possess.

Although Kawei already has a good status, he is still very small in the military and political whirlpool.

Lamin has not only the title of deputy marshal, but also the personal connections of Archduke Brecht.And this kind of relationship is accumulated by generations of noble families, it cannot be a one-to-one single line, but a dense network of relationships that connects a large number of dignitaries.

From a rational point of view, approaching Lamin must be more comfortable than opposing him.There is no need for any surgeon to put his military and political resources on the gambling table for a civilian soldier, to face a gamble where more losers win less.

At least you have to stay neutral.

But Carvey's nature made it impossible for him to give up on this patient. In his cognition, since the examination had been done, he was his own patient.It's impossible for one's own patients to ignore it, even if they catch up with those things that others are very fancy.

Only his own medical skills and the sense of accomplishment after completing the operation are the source of his life.

This made Carvey a strange place in the hearts of others. Ordinary people thought he was weird, people like Lamin thought he was stupid, and fellow surgeon Donelson would think he was very stubborn.

"Are you willing to confront Deputy Marshal Lamin in order to struggle with the diagnosis and treatment of an ordinary soldier?"

In fact, Donilson was not too targeted at Carvey. He had the pride of a surgeon, and he would definitely feel uncomfortable if he was robbed of a patient and suppressed with medical skills.But more importantly, he needs to carry out Lamin's orders.

As long as Lamin nodded, he would let go without hesitation.

It's a pity that Carvey's operation took a sharp turn, and Donelson couldn't fix it.He didn't even talk nonsense with him afterwards, but handed over the matter to his guard captain: "Go and ask Deputy Marshal Lamin if he can pick a good soldier from his army to supplement my guard. number of people."

The captain blinked, looked up at the strange expression on Donelson's face, and asked in a low voice, "What if the deputy marshal refuses?"

Karvey cleared his throat and patted him on the shoulder: "Think about how your guards are formed, and then think about what orders you received and who gave them the orders. Do you understand what I mean? "

"Yes! Your Excellency Lieutenant General!!!"

The captain quickly lifted the brim of his hat, turned around and left the operating room, and Carvey also quickly chose to leave: "I won't disturb Dr. Donelson's operation, please leave."

The guards were ordered by Franz himself, and the only requirement was to protect Kavey's safety.This allowed Carvey to quickly complete the corner overtaking from the side that made the request or even the request at the beginning, and kicked Donielson out of the center of the whole incident.

If it's an ordinary operation, Donelson doesn't care, it's nothing to do with him.

But now Carvey proposed a brand new concept in front of him: cholecystitis, and also gave the cause and treatment.Before he even had time to use the patient's medical rights as a bargaining chip, Carvey left.

Donelson struggled internally.

He knew how powerful Kavey was. No surgeon would say that he was better than him after seeing Kavey's technique.So this made Donilson have a very strange mentality, he didn't want to be humble, but also wanted to learn some new ideas.

The blade of the bone saw got stuck in the bone for 15 seconds, and he chose to suspend the operation.

"Doctor Carvey!"

"Huh?" Carvey was surprised to see Donelson running out of the operating room, "Is there anything else?"

"I would like to ask you about your understanding of the so-called cholecystitis. Why did that patient have cholecystitis?" Donelson asked. "The gallbladder is rarely mentioned in textbooks, and the anatomical understanding of it is also very limited, so."

Carvey stopped him: "Aren't you undergoing amputation?"

"Uh, I saw that you were leaving, so I wanted to come out and ask." Donilson didn't pay much attention to this, but continued, "Can gallstones really cause inflammation? Could it be that the gallbladder itself has other diseases, So that's the inflammation? Or is there something else?"

"No matter what the cause is, if the cholecystitis develops to this extent, it must be removed." Carvey said very concisely and vaguely, because he didn't know what was going on in his stomach, so he couldn't draw conclusions easily.

"Is it too arbitrary for you to choose gallbladder removal?" Although Donilson's personality is at odds with Carvey, he still has his own understanding in terms of surgery. "Will cutting the gallbladder directly affect the patient's daily life? And the gallbladder and The anatomical structure between the liver is too complicated, blood vessels, bile ducts and connective tissue are messy, and it is very difficult to free these structures.”

Carvey agrees with him on these points.

In the late 19th century, in the days when cholecystectomy was achievable, it was debated whether or not to cut the gallbladder in case of acute cholecystitis.Even in modern surgery, with the blessing of technology, this is also the focus of debate in hepatobiliary surgery. 【1】

But standing in front of him was no ordinary old-time surgeon.

"These things have nothing to do with you." Carvey's tone was calm, and he didn't mean to slap him in the face, "I'm not targeting your attitude just now, but I really want to tell you a fact, a principle that a surgeon should keep in mind. "

"Principle? What principle?"

"Don't get off the operating table until the operation is complete!" Carvey looked him up and down, and warned, "Although I appreciate that you can abide by the disinfection concept I proposed, but you left the clean area in the center of the operating table, now your gloves, leather skirt , The masks are all dirty, you have to change them all when you go back.”

Donielsen was not familiar with the concept of asepsis, so he simply followed the procedure.Now that my attention was wandering, I finally realized: "Uh, I really need to change."

"A mature surgeon will not leave the patient on the operating table." Carvey sighed, "If you care so much about the treatment of cholecystitis, you can choose to come to Vienna to find me in the future. Graz is not far from the capital. Far."

The method that Carvey came up with was very effective.

As far as La Ming was concerned, as long as he was left alone, not to mention a single soldier, it didn't matter even if ten people were directly taken away from him.The key factor that really affected the operation was not him, but how to get from the barracks to the center of Gablenz.

"The cavalry must enter a state of combat readiness at any time, and there is no way to give up the horses."

This is Lamin's answer. It's not that he made things difficult for Carvey, but that the fighting situation on the western front is much crueler than he thought: "Where's your carriage? Did you come here on foot?"

"Patients need to lie down, and our carriage can't hold so many people." Carvey said, "If the deputy marshal really cares about the horses, I can ask the guards to send the horses back after I get to the city center."

Laming sighed: "Okay, let the cavalry give you two horses, please return them as soon as possible!"

"understood."

After all, everyone is working for the empire, and there will definitely be conflicts in personality and selfishness, but as long as they don't do things too out of line, Karvey can still bear it.Therefore, in the subsequent "small report" session, Carvey played down Laming's domineering and did not say anything dead. 【2】

But the road from the barracks to the city center was not peaceful, and even encountered robbers and bandits. Fortunately, there were guards to protect them.

When Kavi and others came to Gablenz, they realized that this kind of robbery and banditry was completely forced out by the war.

There have been several rounds of Prussian attacks here, and a large number of bomb craters can be seen on the streets. Although the destructiveness is not as good as modern war weapons, it is enough to make civilians lose their homes.And the Austrian garrison also directly broke his life, the houses were expropriated, and everything had to serve the war.

The carriage sent Carvey directly to this so-called "central hospital", which was actually similar to the temporary ambulance in the barracks.

The only difference is probably the accommodation conditions, but in fact the difference is not big, the dirty houses are no better than outdoor tents, and sometimes the indoors become even dirtier due to ventilation restrictions.

However, compared with Lamin's Sixth Army, the troops here are much more obedient.

The reason still lies in the identity of the commander-in-chief. Laming is the deputy marshal, so he naturally has the capital to ignore Kawei.A considerable part of the Osa coalition army in the city center is the army of the Kingdom of Saxony, which is not strong in itself, and the remaining Austrian troops have been disbanded early on, and there are no senior officers in charge.

In principle, they were also under Lamin's command, and the reason why they were placed in the city center was entirely because Lamin saw that Prussia was going to attack the city and was used by him to block the knife.

Unlike going to the barracks ambulance, Carvey got out of the carriage and went directly to the operating room, because there was no one in the way of Ignatz, the senior chief surgeon.In fact, as he expected, Ignatz completely took over the operating room here.

"Mr. Ignatz, how is the situation?"

"You're here." Ignatz knew it was Kavey from the sound, and his eyes were still fixed on the small intestine in his hand. "The situation is not very good, there are too many wounded soldiers."

Carvey looked around and saw that the room with only one operating table had been forced into three, which saved space costs and disinfection costs, which was the biggest change after Ignatz came here.

But as long as there are doctors who can go to the operating table, they are basically there, and there is already a long queue outside the room for the operation.

"Is there an operating table?"

"No more." Ignatz shook his head, and suddenly looked back at him, "Do you want to use it?"

"Yes, a soldier with cholecystitis needs an operation immediately." Carvey said, "The operation is not difficult, and I can do it in an hour."

Ignatz's mind is messed up, not only the abdominal firearm injury in front of him gave him a headache, but also full of question marks about the cholecystitis that Carvey said.It's so strange to be able to tell the time of operation with a word I've never heard before
But now he doesn't have the energy to care about these things: "Wait, maybe you can find someone else to spare you an empty seat. Lucius, how long are you here?"

"I just opened his thighs, it's going to be a while."

"Where's Bhutto?"

"Give me another half hour."

"Rick, go to the operating room next door and ask."

"Forget it!" Carvey didn't let the assistant leave the operating table, and he didn't want to engage in temporary queue jumping, "I'll find a bed."

"It's too crowded here."

"There is an open space outside the room, which can be used." Carvey said, "Salt water and carbolic acid are enough, give me some."

The air is full of all kinds of dust and bacteria, and outdoor surgery needs to bear considerable risks.But just like Fernan's surgery, Carvey now has reasons to choose outdoor surgery. The only difference is probably the number of spectators.

This operation is bound to be a great operation that no one watches.

The process from preparation to implementation of the operation is extremely difficult, but as long as the people around are willing to cooperate, it doesn't matter if the conditions are more difficult.In just 10 minutes, a temporary operating table was set up by soldiers using tables and door panels at the door of the operating room.

The required carbolic acid and brine were also sent.

The patient was lifted up on the door panel with all his strength. The lines on the surface must have made him sleep uncomfortable, but fortunately, the following anesthesia time would allow him to forget the pain in his body and sleep peacefully.

"What's your name?" Carvey washed his hands aside, and then put on a pair of gloves.

The soldier was trembling with pain, but he still answered: "Rogalo Scott, Your Excellency the Lieutenant General."

"I don't mean anything else, I just want to know the patient's name." Carvey asked Amor to put on an ether mask for him: "It shouldn't hurt so much when I wake up."

"thanks."

Watching him slowly enter the anesthesia period, Carvey took the scalpel from the nurse.

Before cutting open Luo Jialuo's abdominal skin, I still want to solemnly remind my assistants: "Because the environment is relatively harsh, in order to prevent serious infection, I will end the operation as soon as possible. This is nothing to me, but it is to you The requirements are very high. Please try to concentrate and don't waste your time."

Everyone: "Yes."

"We start with an incision in the upper right quadrant to access the abdominal cavity."

Carvey's scalpel cut along the lower right costal margin, and the first cholecystectomy in history officially began outside the operating room.

(End of this chapter)