Nineteenth Century Medical Guide

Chapter 288

In the eyes of others, the in situ urethral diversion mentioned by Carvey is not his own "conjecture", but more like an innovation based on the wisdom of the predecessors.It's just that the jumping range of this kind of innovation is really big, and people can't see the shadow of the springboard.

"There is a urology-related journal in the library of the medical school, which records a ureterocolonic anastomosis."

Carvey asked a young assistant standing aside to bring a set of abdominal cavity models, and said: "A French doctor named Simon chose to connect the ureter to the sigmoid colon after resecting the patient's everted bladder to form effective urination. Access."【1】

Watman nodded in praise: "Good idea."

"But I didn't notice at the time that the urinary system is different from the digestive tract," Carvey explained. "Urine is much cleaner than feces full of bacteria. Once connected, intestinal bacteria can invade the urinary system. "

After more than half a year of gestation, the concepts of "bacteria" and "infection" have taken root in Vienna.

Especially the Municipal General Hospital and the College of Surgery, which were directly transmitted by Carvey, except for the few hard-line opponents, most doctors have already acquiesced to these two important concepts.In comparison, Mosier, who was standing by the operating table, was still unable to accept this brand new idea.

"In the same year, another surgeon named Lloyd also performed a similar operation on a patient with bladder exstrophy."

Carvey has repeatedly checked the sutured surfaces in the pelvic cavity, protected them with wet gauze, moved up the surgical site, and started looking for a suitable bladder replacement:

If he knew that both Edward and Mick claimed to be hard-working people, then Li Ben, who had just escaped a catastrophe and was about to leave Berlin, would definitely slap the table and breathe out his mouth.

On the other side of the train station in Vienna, a train just arrived from Paris.According to the original plan, it will leave Vienna at 7 o'clock tonight and return to Paris, its previous starting point.

Ever since seeing this guy in the apartment, Li Ben has been very uncomfortable, because the bad things he committed have already crossed the bottom line of this immediate boss.

"By the way, let me introduce you." Edward smiled and turned sideways, looking behind him, "This is Mr. Alphonse, who has worked in the court for many years. This time it can be regarded as accompanying help, and the kitchen will be handed over to Him."

"That guy..." Mick didn't want to lose his temper at first, but when he saw that the other person talked about that person, he asked under pressure, "How do you do it? Can a stinky mouse trapped in an apartment be released?"

"Among the stomach, jejunum, ileum and colon, I choose the more moderate ileum."

"Long time, long time."

"How about I find my brother and look for it again?"

"Okay, I know."

"Go to the newspaper office later, and talk to the reporters inside about this young baron, and let him bask in the sun of Berlin."

Since then, lower urinary tract reconstruction has developed in three different directions [3]. Among them, the orthotopic neobladder surgery that began to appear in the 20s has gradually become the gold standard for clinical urinary diversion in a large number of clinical practices. .

Mick's letter has been delivered for two full days, no matter whether it is successful or not, he will find a reason to kill Li Ben, so as to vent the evil fire in his stomach.But at this moment, two messages from his subordinates made Mick's mood drop to the bottom.

Until the late 20s, medicine officially entered a period of rapid modernization, and clinicians began to discover various drawbacks of this type of surgery. 【50】

Edward's heart is not here at all, and even if he goes to Paris today, he has to rely on other people's faces: "I'm just going back to China this time, and the real protagonist is not me. After I send that person to Paris, I have to go as soon as possible." Come back. After all, Pu and Ao are still fighting, and anything can happen at this time."

"In principle, all the chefs on the train have no right to touch the dishes. This is not because they don't believe in their cooking skills, but for safety." After Edward finished speaking, he handed over the right to speak to Alphonse, "I am mainly responsible for Dr. Carvey and I have no time to care about the diet of the fellow surgical team.”

"Since getting on the train, Dr. Carvey has been in charge of all his diet."

If it were in Vienna, an informant like him with extremely unstable performance and countless previous convictions would only be able to do it for three days.The reason why Mick kept him and gave him a lot of money was simply because of his forged identity.

Everyone was happy with the success of the operation, and returned to Paris with the car to complete the handover. Edward would be able to stay in Paris for a few more days before returning to Vienna in style.If you are lucky enough to get promoted, you may not come back this time.

After a brief exchange, Alphonse followed the conductor on the train, while Edward stayed in the waiting room on the platform anxiously waiting for the results of the operation.

Although the importance of Li Ben has been mentioned, in fact, it is Mick's personal grievances that silence him more. After all, he was embarrassed by Li Ben's false identity before.After becoming a pawn, he was also very restless, and even squandered operating funds wantonly.

The subordinate shook his head: "He doesn't live in a big place. We searched it several times, but we didn't leave any reliable information."

But the war between Pu and Austria tends to ease. If Edward misses this opportunity to perform, he doesn't know what will happen to him in the future.After all, the black information about him in the past few days has long been spread on the streets of Paris through the pervasive newspapers.

On the other side of Berlin, a middle-aged man who is enjoying his afternoon leisure time in a roadside cafe seems to have to call himself a "suffering man".

"Forget it, it's just a stinky rat crossing the street, let him fend for himself."

"Yes." Carvey said, "It is definitely not possible to directly connect the ureter to the colon, but those two operations were not useless and gave me a lot of inspiration. I believe that in the near future, my operation will also become an inspiration for others. , regardless of success or failure."

The subordinates were very surprised and couldn't help but look at Mick twice: "Leave tonight?"

From the very beginning, there were rumors that Edward, the ambassador to Austria, would take this train back home, along with a young doctor and his surgical team.So the train conductor specially vacated the first-class cabin, and provided a sumptuous French meal for the diplomatic minister.

The main reason for boarding this train today is for Kawei. After all, the other party has cured his hidden illness, and with such status, it is appropriate to help.Of course, he has many friends in Paris and Vienna, and he can make some contributions to the relationship between Fao and Carvey by his side.

"This"

There are thousands of miserable people in the world, and Edward is not the only one.

Mick sighed: "Don't think about it so much, go back and clean it up later, go back to China tonight, remember to clean it up."

But if something goes wrong with the operation, in principle, as diplomatic ambassadors and chief surgeons, both Edward and Carvey should stay here.

"Otherwise why stay here? Sightseeing?" Mick didn't let go of his guard for a moment, glanced at the many Prussians around, and said, "We can't do anything here except being surrounded by these 'enemies' every day. It's easy. It is better to return to the country as soon as possible to expose your identity. Even if the credit is gone, the material rewards will never be less."

"Excuse me."

Edward just stated his request conventionally, not asking for opinions.The train conductor sounded uncomfortable, but there was no other way: "What about the cooks on the train?"

The appendix is ​​not difficult to find. It didn’t take long for Carvey to pinch Edm’s ileocecal part: “The appendix is ​​here. We choose a section of ascending colon and a section of ileum, and keep the middle ileocecal valve【4】. , give me tissue forceps, the first step is to 'untie' the colon."

After the matter was accomplished, Li Ben had been thinking of escaping, and the knock on the door was just a not-so-coincidental opportunity.

Nearly 2 hours had passed since the operation, and the process was only halfway through, and bladder reconstruction was still going on intensely in the theater.

Alphonse also hasn't returned to China for a long time, and has been living in Vienna after making a big circle in East Asia.

Looking at the simple password letters on the letter paper, he hated in his heart, but unfortunately, no matter what, this kind of expression should not appear on his face: "The task is considered completed."

"Well, there's nothing to see in Berlin either."

"So you made improvements to the procedure?" Watman asked.

Having said that, in fact, in the hundred years since the ureterosigmoid anastomosis in 1851, urinary diversion has not changed much.

"No hurry, no hurry."

"When choosing a bladder substitute, the bowel is the easiest and possibly the only choice." Carvey, who was originally standing on the left side of Edham, changed positions with Mocier at this time, and the original bladder retractor It was removed and replaced with a normal retractor, "In the intestinal tract, no matter which intestinal tube you choose, it will have its own advantages and disadvantages."

"Knock? Why are you knocking?"

But no matter how hard they scolded, they still missed the target after all, and scolding was useless: "Do you know where he went?"

For him, what bothers him now is actually the fork in the road before him.

At the beginning of the year, he fled debts all the way from Berlin to Vienna, but he quickly went from Vienna to Berlin again. Now finally, all the German-speaking places can't accommodate him.There are too many coincidences and bad luck, if it weren't for the French cook, or the doctor, or...
Mick! ! !

"Sigh, the news didn't go through our hands. This trip is in vain." The man in black picked up the cup, put it on his lips, and took a sip carefully, "Berlin's coffee is really bad."

"I don't even know where to go." Mick smiled bitterly, "This guy is really slippery, and he has a lot of our secrets, if..."

"God, please help me, a poor man."

"Sir, where are you going?"

His body trembled slightly, knowing that he had said something wrong, he could only explain: "He is too sensitive, we just knocked on the door lightly to arouse his suspicion. When he came back to his senses, he had already turned over the window and left Lost the apartment and couldn't find it again."

While talking, he was looking for one of the important signs of the operation, the appendix.

"The former lived for one year and died of infection. The latter lived for only one week and died of peritonitis caused by suture leakage. In the next ten years, surgeons from all over the world tried this operation, but the result Not too good”

However, there are many difficulties in the selection, treatment, and anastomosis of the intestinal tube with the ureter and urethra. Even if you watch this operation at close range and repeatedly, you may not be able to grasp the key points.

"Boss, if they handle it like this, we won't get any credit for it."

"Oh, that's right"

Carvey began to look for the junction of the ileum and colon: "The mobility of the ileum is large enough, and the blood supply is rich. The colon cavity is large, although the position is relatively fixed, but it is easy to loosen and move to any part of the pelvic cavity. But no matter which one you choose , will produce corresponding complications, which is inevitable.”

But he has the wealth and lives of more than a dozen members of the team, and several "threads" hidden in Berlin, so he must weigh the pros and cons.

After all, if you want to achieve autonomous urinary continence, you need to preserve the integrity of the yin nerve, and at the same time, you must handle the urethral sphincter carefully. Any accident will cause difficulties in postoperative recovery.

"Didn't you learn how to pick a lock in the library? Wouldn't you secretly unlock the door in the middle of the night? Even if you couldn't, wouldn't you just kick the door in and shoot him? Even if he slipped through the window, you would Have you never thought about watching the door and windows downstairs?"

"What credit do you need for serving the empire?" Mick stared at him. "As soon as this news comes out, the Prussians in Vienna will get in touch with our upper echelons. As long as the emperor is not a fool, the war will soon be over." End with 'successful completion of the peace talks' and nothing will happen to the French."

"Mr. Edward, it's a great honor to send you back to Paris." The train conductor smiled and walked towards Edward who had just arrived on the platform. "The first-class cabin is already vacant, and you can get on the train now."

Carvey has improved the maturity of this operation for more than 100 years at one time. Against the background of insufficient hardware and soft power, it may not be possible for anyone to replicate this operation at the end of his life.

At this moment, another piece of bad news suddenly came to mind: "By the way, boss, what about that guy?"

Mick asked a series of questions, so that the other party had no room to resist.

"Boss means"

"Let's go wherever we go, I won't renege on my debt."

Li Ben now still has the 2000 Thalers (Prussian currency) that Mick gave earlier, a passable set of luggage, and a forged Prussian Baronial Certificate. He seems to be able to make ends meet, but the places he can go are Already very few.

Russia in the east is too cold, Britain has to take a boat, and Italy in the south has a pleasant climate, but unfortunately he can't speak Italian, and the only way he can go now is to the southwest, France.

go to france!Go to romantic Paris to do my old job!Those stupid rich people will be fooled by me
After making up his mind, Li Ben knocked on the car window: "Take me to Berlin Central Station."

(End of this chapter)