Nineteenth Century Medical Guide

Bladder foreign bodies have always occupied a place in emergency surgery, and it is not uncommon, but a case will be encountered from time to time.

The general treatment method is to use bladder endoscopy through the urethra for exploration. If you can take it, you can take it. If you can’t take it, you can only do suprapubic cystotomy like Carvey is doing now.In principle, foreign bodies that can enter the urethra can be removed in reverse. Modern urological instruments include forceps, small hooks, and various dissolving solutions, which are sufficient for most cases.

But there are always accidents. Patients can do whatever they want when inserting foreign bodies, but doctors still have to follow the most basic anatomical structure of the human body when taking them out.For things that are too large or difficult to grasp, the last thing to do is to cut them open.

"The total length of the rat tail is 8.6cm." Carvey showed it in front of everyone.

"Dr. Carvey is really well-informed. It seems that a live mouse is really good enough."

"It's too exaggerated. Is this really something humans can do?"

"I guess it was just about to pull it out after it was used up. Suddenly, he encountered an accident. He chose to dock the tail directly. As a result, he didn't reserve the length to take it out, and the sinking became deeper and deeper."

"Let's put aside his identity and his miserable life, and just talk about the logic of the whole thing." A medical student asked, "Why do you want to dock the tail at this time? Isn't it better to just pull it out? If the mouse is out of the restraint , wouldn’t it be faster to just pull it out?”

Another medical student followed his train of thought and said, "Isn't this the forced tail-docking, but he took the initiative to cut off the tail?"

"Maybe, maybe, maybe you need to think about it?"

"No wonder I have to say it, it's too perverted!"

"Shame on the French!"

"Oh, don't pour dirty water on your own country, this guy might be an Englishman." The medical student just now described it very disdainfully, "Look at his face, he looks dissatisfied, I haven't Seeing someone who smokes ether can enjoy it like that."

"I can't imagine whether his purpose is self-torture or..." Sediyo couldn't bear to look directly at the 100 francs he paid, and only hoped to end the operation as soon as possible. To prepare 13 beds for rectal cancer."

Carvey's surgery was done neatly, and Ender's bladder was extraordinarily wonderful, not only because of the rotting rat tail, but also because of other things.

"Professor, I'm afraid it won't work." Carvey's tweezers touched something else in the bladder. "This pocket is not that simple."

"No more, right?"

As soon as the words fell, the tweezers picked up another thinner thing: "It looks like a plant, and its texture is soft, it should be after a long time of soaking."

"Looking at the shape, it should be the stem of a plant."

"Do all the plants and animals have to come here?"

Carvey put it on a metal tray, unfolded it carefully with tweezers, and explained: "I have to thank Professor Bertus of the University of Vienna Medical School. The botany he taught is still fresh in my memory. It can be accurately recognized that this is a dog's tail grass."

"."

"Oh? It's that fluffy dogtail grass?"

Someone suddenly mentioned it, causing the others who were still immersed in the shock of the live rat tail to gasp: "It's fluffy. This is too exaggerated."

"Outrageous."

"Unbelievable! Absolutely disgusting!"

"When will the Lord Palace Hospital get rid of this kind of patients? They are just discrediting this church hospital. Before the Renaissance, they will be beaten to death!"

The reason why they took half a breath was because the remaining half had to be left for the next thing, something that even Kavey, a surgeon who has been tempered by modern foreign bodies for decades, could not distinguish it with the naked eye. .

He frowned, looked at the foreign object caught by the tweezers, and repeatedly searched for items for comparison in his mind. After hesitating for a long time, he could only choose a similar object: "Is this cotton?"

"It's also possible that the bladder has grown on its own."

"No, I have never seen this kind of growth." Carvey shook his head and said, "My father took over hundreds of patients with bladder stones and urinary retention in Italy. Whether it was what I saw with my own eyes or what he recorded, It's never been the case."

"What would that be?"

"Cotton is less likely because it doesn't hold its shape when it gets into tight spaces."

"This is not a problem for people who are used to stuffing things." Carvey explained, "Just wrap it on a hard and thin wire to send it in."

"Oh yes, there is another way"

The surrounding of the foreign body is in the shape of cotton wool, and the end is still somewhat adhered to the bladder wall.After a simple separation, Carvey spread it on a metal plate, rinsed it with clean water, and began to calculate its length:
"The size of the foreign body was about 3*4*1cm when it was taken out, and it was in the shape of a 12*1cm long strip after unfolding, similar to cotton cloth. It may not be cotton cloth! Dr. Albaran, please take it for a pathological examination."

"Ok."

The three large objects left the bladder, eclipsing the two iron nails that were salvaged next, and finally the bladder and lower abdominal incision suturing, which is worth learning for all medical students, was also submerged in the saliva discussing the strangeness of foreign bodies.

In fact, even Juyong and Cedieu were attracted by Ender's bladder. The only one who noticed the difference in Kawei was Kaushik who was sitting next to them: "Dr. Kawei's technique is really special."

"Huh?" Cedieu came back to his senses, "What's so special?"

"Didn't you see? His stitching is not just with his hands, but with the help of a pair of short-nose pliers to tie the knot. The artistic perception may be a bit poor, and it is not as ornamental as knotting with both hands. But if you consider For the patient, his movements are faster, his hands are more stable, and the knot is not easy to slip."

Kaushk got up and put on his hat, lifted the cane that was leaning on the side, and said with satisfaction: "It seems that I didn't come in vain this time."

"you are leaving?"

"The surgery is over, of course I have to go back."

"I have rectal cancer surgery in the afternoon, and he will also participate."

Kaushik said with a smile: "There is a specialization in surgery, and there are many things worth studying in the urology alone. Why bother to torture yourself with complicated rectal cancer. I have something to do in the hospital, so I will leave first." Oh, by the way, I hope Professor Cedieu can send me a message."

Cedieu's eyes were still searching for the so-called short-nose pliers, but Ender's incision had already been stitched up.After searching for two back and forth, he still chose to give up: "Can't you say it yourself?"

"You know I'm not sociable." Kausch looked at Carvey who was doing aftermath work in the audience, and said, "Please tell Dr. Carvey, I will definitely prepare a few suitable cases for him to choose from."

The operation was over, and there was really nothing to see. Cedieu also stood up and prepared to leave: "Although I want to say that missing the operation for rectal cancer is a big loss for you, but...forget it"

At this moment, the door of the surgery theater was rudely knocked open.

The one who rushed in quickly was Dr. Peon, who was on the ward rounds with him last night, but his face had long since lost the calmness that should be seen in the top surgical department of the Main Palace Hospital: "Dr. Kawei, something serious happened to Dr. Kawei!"

Just one sentence left everyone in the venue.

"What's wrong?" Carvey had already guessed most of it, but he still had to confirm, "Isn't it the girl from bed 97?"

"Yes, that's her!"

"Isn't it because of abdominal pain that you fainted?"

"Yes! You guessed right!!!"

Kaushik, who was about to leave on the stage, did not expect that there would be a sideshow. After hearing the conversation between the two, he became interested, and turned to look at Cedieu: "What's wrong with your 97 bed? You look very nervous. "

"Severe abdominal pain, mild vomiting, and no diarrhea." Cedieu briefly said the chief complaint, "Our diagnosis was enteritis and appendicitis, and we planned to have a resection today. Later, Dr. Kavey thought it was a problem with obstetrics and gynecology. , called the old stubborn. As a result."

"Hehe, people were robbed."

Kaushik also knew Hujill. The three of them are all students who graduated from the University of Paris Medical School. They are only one or two years apart from each other. ?”

"I don't know that."

Although the girl's symptoms are very vague, further examination is needed in modern times.However, considering the basic concept of acute abdomen, it is necessary to appropriately expand the indications for laparotomy without imaging studies.

Regardless of whether the previous judgment of ectopic pregnancy was right or wrong, an exploratory laparotomy must be done now.

"Where's Professor Hujill?"

"He is already undergoing treatment, but the effect is not good, and the girl didn't respond. I think he is also very hesitant, and he doesn't know what to do next." Paion erased it, "He sent someone to come to you and Teacher Cedieu , but didn’t say to have an operation, I just hope you go and see.”

"People are like this, what is he waiting for?"

Kawei took off the leather skirt, followed Paion and ran out of the theater before washing his hands.Seeing that the situation had changed, other people in the venue stayed, including Kaushik who wanted to leave just now: "I feel like there is another surgery to see."

"Don't you think abdominal surgery is too complicated, so you have to go?"

"It's not the same." Kaushik sat back to the seat just now, "What I'm mainly looking at is not the operation, but the conflict between this young man and that stubborn old man. Of course, it would be more fun if the two could perform the operation together .”

"You're still so nasty." Cedieu sighed, "It's so unscrupulous."

"What's the matter? Are you upset to see him being slapped in the face?" Kauschk took out a pipe from his pocket, pressed a handful of tobacco leaves, and asked Guyon to take a candle and light it lightly. "It was he who denied it first. Surgery, break away from surgery, belittle surgery, say that surgery is a barbaric act. Why, you are not allowed to watch the show after being beaten in the face?"

"And what if he wins?"

Sedieu looked at his old friend's face and asked, "It is all thanks to him that the obstetrics department of the Main Palace Hospital has developed so far. After so many years, if he hadn't been advocating not to perform cesarean section, I don't know if there is any How many women are dying on the operating table."

Kaushik exhaled two puffs of smoke rings, and said indifferently: "I'm not a woman, it's none of my business!"

Sediyo knew that he had committed an old problem again, and his face turned cold: "Be careful, old classmate, I am different from you. I have a wife and a daughter."

"That's really embarrassing." Kaushik took a deep breath and continued his yygq, "But I want to remind you that when a man is suffocated to death by urine because of the prostate, no one has come out to stop it Operation."

The topic of the two started from old friends and ended with men and women. Although they have different ideas, they have the same enthusiasm for surgery.

Things developed in the direction that Kauschk had guessed just now. Fifteen minutes later, Kavey and Hujill appeared together in the theater of surgery.Carvey and Paion, who came to the theater together, prepared surgical instruments, and the opening speech was presided over by Hu Jill, the director of obstetrics.

But just as he was about to speak, he saw Kaushik waving at him with a smile, and his mouth felt as uncomfortable as if he had eaten a fly.

When the matter reached this point, it was impossible to regret it. He would never allow others to take away the girl from his department, let alone allow her to die in his own hands because of obstetric problems.

Of course, Hu Jier was not always stubborn. For the sake of self-esteem and avoiding unnecessary embarrassment, he still made some changes to his rhetoric:

"The next operation was a temporary operation, which was first diagnosed by the chief of surgery, Professor Sedieu. Because the diagnosis was unknown, I was found for a follow-up visit last night. At that time, it was considered that the patient had already had an x-lived life, and there was no obvious indication for abdominal surgery. symptoms, so it is temporarily classified under the management of the maternity ward.”

The ordinary two sentences, but the responsibility was inexplicably pushed to Cedieu's shoulders, which made Cedieu, who had been speaking for him, unbearable: "Old man, didn't you take this patient away?"

"Professor Cedieu, you are in the surgical theater now, not your surgical ward, please respect yourself."

"If you hadn't blocked me, she would have had surgery last night!"

"Don't be kidding, you dare to have an operation without a clear indication of appendicitis? What if there is nothing in the stomach after the operation?" Hu Jier argued hard, and retorted, "In the end, will you really stand up and be the chief surgeon? I’m afraid I’ll throw the blame on Dr. Carvey, who just came to Paris not long ago, on the grounds that I had a not-so-successful gastrectomy in the afternoon.”

"You!" Cedieu directly broke the defense and asked back, "You haven't used a knife for more than ten years, can you still use a scalpel now?"

"You don't have to worry about it, at least I dare to go on stage!"

"Come on stage and kill the patient?"

"You already killed one yesterday afternoon."

"."

The theater was full of mutual criticisms between the two, as well as Kaushik's hearty laughter.

This is not the first time that the directors have quarreled. In the eyes of the surrounding medical students, the scolding battle between the two seems to be more beautiful than the new opera at the Paris Theatre. It is thrilling and exciting, and at the same time, it satisfies their desire to spy on the privacy of their superiors. .

However, this kind of excitement is short-lived, and no matter how bad the relationship is, it is impossible to bring it to the operating table.When Carvey prepared the ether and the equipment, the mouths of the two stopped at the same time.

Hu Jier took two deep breaths, calming down the excitement just now, and calming down the nervousness that he had not been on stage for a long time.

He elaborated on the necessity of this operation: "The patient's abdominal pain intensified one hour ago, and he soon progressed to a fainting state. Considering the previous diagnosis of appendicitis and obstetrics, an exploratory laparotomy was performed after obtaining the consent of the family members. I worked with Dr. Karvey from the Austrian Municipal General Hospital."

"Give me the scalpel."

The opinions in this chapter belong to the characters themselves, not to the author