Nineteenth Century Medical Guide

Chapter 386 382. The Strongest

I am used to seeing the large theaters of the Municipal General Hospital and the Main Hospital, but the one at the University Hospital of Zurich seems much smaller. There are only four rows of auditoriums around, with no seats. The surgical area in the middle is not spacious, and the connected preparation room is smaller than the outpatient clinic.

Queen Elisabeth of Switzerland was quite happy to have a rare visit, not only because of the specially arranged Bavarian atmosphere, but also because of the "reason" why Geiser was injured.

In what she heard, there were no words such as "teasing", "playing", and "being bitten". Instead, they were "hunting in the mountains", "accidentally falling" and "fighting bravely", all of which fell into Elizabeth's mind. In my heart. Coupled with Gezer's original identity, it is reasonable to be invited to support him.

Considering that the surgery scene was somewhat bloody, her special box was set up in the first row on the left. This angle was directly above Gezer's head, and he could clearly see the operating table, as well as Kawi and Sediyo standing on both sides and their hand operations.

But because he was seated differently from others, the angle of view was slightly raised, and the only thing he couldn't see was Gezer's penis, which successfully avoided embarrassment.

In fact, Elizabeth didn't even know that the injured part was such a place until Rossiter named the location of the operation. Once she found out, it was just like that. Her naturally rebellious character always helped her do extraordinary things to relieve the pressure when she was far away from Vienna.

"It's rare that we have given three seats." Elizabeth looked at the empty seats beside her and felt a little disappointed. "Neither Ferenczi nor Mathilde are here."

"Matilde is writing a letter to her family. Ferenczi doesn't like this kind of occasion." Lily smiled and comforted her, "You still have me, I'll accompany you to the surgery."

"You, your heart has been stolen by that baron a long time ago."

When Elizabeth thought about the future, she didn't know whether to bless her or pity herself: "When the time comes, you will have to stay in Vienna all year round. Mathilde is not in good health and may not be able to stay with me for long. I will only have Ferenczi when I travel." Man, alas”

Elizabeth knew what she meant and nodded: "Okay."

Dai was wearing a cloak and holding a saber. He looked straight ahead, but he was thinking about something else. It wasn't until Lily pushed her that she realized: "Ah? What's wrong?"

"Yesterday, he checked off the names of several old friends without authorization and sent each of them an almost identical letter of introduction, telling them to return to the army in a few days."

"It's not that urgent, I have to stay with you for a while." Lily quickly changed the subject, "Would you like to try some snacks made by Swiss civilians? When I came in, I saw someone selling them at the door. They were quite exquisite. "

"Don't forget the wine, red wine!" Lily felt strange and asked another guard, "What's wrong with him? He's been unconscious since morning."

The guard standing next to the queen is called Mihawi. Both he and Dai are Hungarian elites selected from the army. They have been with the queen for many years and have a very good relationship. Mihawi looked at Dai's retreating back and explained in a low voice: "It's not Mick yet."

"Dayi, help me get it."

"I heard that we will be looking for mercenaries locally in Switzerland."

"What are you thinking about?" Lily was a little angry, "Go and get some snacks for Her Majesty the Queen. They are right at the door."

There was no sound from the two of them.

The more Mihawi talked, the more uncomfortable he felt: "The idea is to cleanse the Hungarians in the escort. If you can't touch your maids, they will attack us. I just want to drive the Hungarians away from the queen as much as possible."

At this time, Dai came back with a dinner plate and immediately joined the conversation: "I heard that Cusper said that Switzerland is a neutral country with clean wealth. The mercenaries here only talk about work and money, and they have nothing to do with Prussia, Hungary, or France. It’s best to use it as a guard.”

"What's wrong with Mick?" Elizabeth was a little curious.

Lily called the guard beside her and wanted him to get some snacks, but she didn't know whether it was because the surroundings were too noisy or because she was watching the operation too carefully. The Hungarian guard named Dai didn't respond: "Dai? Dai??? "

Seeing that Lily still wanted to say something, Elizabeth stopped her, gave some smiles to the Swiss people around her who were waving to her, and then said: "At least he kept you two captains and deputy captains, and still kept your The position shows that he can't find your shortcomings and still trusts you."

"Why is he like this?" Lily looked at Elizabeth, longing for justice.

The queen actually had no choice. Just after the Austro-Prussian War, Mick was deeply appreciated by Franz. Now that Prussia is worried about playing tricks, Mick has become a must-have security measure for the trip to Paris. According to Elizabeth's personality, she should have refused, but the emperor and ministers persuaded him, and then they agreed to send him elsewhere after returning to the country.

Lily immediately thought of vulgarity, brutality, and disobedience, not to mention elegance: "How can this be done? How can these people get close to Her Majesty the Queen?"

"If he hadn't gotten sick on the way back to Budapest, he wouldn't have stayed with me for so long." Elizabeth asked, "There are more than 20 people in the escort team. With so many kicked out, if there are not enough people, who will supplement them?"

Lily was puzzled: "Ah? What do you mean?"

"Oh okay, I know."

"Mick's approach is radical, but he doesn't go beyond his authority to manage the escort team. He must have his reasons, and he should have shown you his reasons, right?"

The queen was indeed right about this. The main reason why Kawi didn't find Mick last night was because he went to meet the two captains.

On the one hand, it was to announce the personnel adjustment plan of the Guards and the reasons for this decision, and on the other hand, it was to express admiration for the loyalty and ability of the two people because they could not find any flaws.

"Those people do have many minor problems, but they are still loyal to the queen."

The two stated their interests and hoped that the queen could help: "Although Mick has not exceeded his authority, his attitude cannot tolerate our refusal. Even if he refuses now, he will send a notice to Vienna, and maybe next month we will be They will all be kicked out together."

"Okay, okay. I know everything."

Elizabeth's heart was toward Hungary, believing that she could become the Queen of Hungary and lead them to merge with Austria. But now the situation is very complicated, and he still needs to wait for a reply from Franz and Andrassy before he can make a correct judgment. Now as long as Mick doesn't make the matter a big deal, she will choose to be perfunctory: "Now the operation is about to start, do you have anything else to do?"

Dai and Mihawe knew the queen's temper and looked at each other: "No more."

Throughout the surgical theater, in addition to Elizabeth, who was troubled by the treacherous politics, Kavi also had a headache. After a day and a night, Guy's penis, which had a gap in it, showed signs of ischemia in his head.

Fortunately, the blood supply to the penis is rich enough, with several sets of deep, medium, and superficial blood vessels. The blood supply is not completely cut off, and there is still hope.

Kawei was just a little angry, so he picked up the opening lines he had learned in Vienna again and vented his anger.

"Everyone, people sometimes encounter such unfortunate situations. Such a beautiful and perfect penis was bitten and severed several blood vessels and urethra due to an accident."

Kawei followed the meaning of the mayor and old Knisel and was vague when talking about the word "bite": "The scene was terrible at the time. After repeated cleaning, we trimmed off part of the prolapsed urethral mucosa. , and then insert a urethra to drain the retained urine. The urethra is the only passage from the bladder to the outside world, and it is a place that needs attention at all times.”

Debridement, disinfection, and catheterization have been listed as routine preoperative preparation operations by Kawei. He had introduced them to the doctors in the hospital before, but Kawei emphasized them again and answered questions from several doctors.

The main focus is still on catheterization and debridement.

Urinary catheterization is necessary, not only to discharge urine, but also to protect the damaged urethra and lay the foundation for subsequent repair. Debridement after penis injury is different from other traumas, mainly because the penis has a rich blood supply. Excessive debridement will stimulate the cavernous body and blood vessel ends, affecting the effect of repair.

After addressing these contents, he introduced today’s focus:

"The wounds caused by the bite of this kind of animal were very difficult to repair in the past. The result was often cut off and thrown away, or left hanging waiting for it to fester step by step, and finally cut off and thrown away reluctantly. Now, I want to Let me tell you, as long as you do careful stitching, you can recreate the charm of a man as Mr. Rossiter said.

Now let me introduce it to you! "

Uncharacteristically, Kawei handed over the leadership to Sedieu, but stepped aside: "Professor Sedieu de Paul Cavendish from the Palais-Dieu Hospital in Paris, France, one of the world's top surgeons , he will do the cavernous body suturing first.”

Cediyo was surprised, but looking at the crowd of spectators around him and the presence of Kawi, his hands had already moved first: "Give me the hemostatic forceps."

After Kawei said this, he gestured to the assistants on both sides.

Just like before in Paris, before the operation, anatomical diagrams of the surgical site had to be hung around the surgical area. 【1】

"This is the arterial system that maintains the blood supply to the penis. The dorsal artery and urethral artery were severed. The remaining deep artery and surrounding branches are still intact, barely ensuring sufficient blood supply to the head."

Kawei held a long stick in his hand and became the commentator. "After the cavernous body is sutured, we will suture the urethra and urethral artery first, and then suture the dorsal artery." [2]

"Next is the vein, which runs basically the same as the artery. The huge bite force destroyed the deep dorsal and superficial dorsal veins, and a cavernous vein was partially torn. But the vein branches are very rich, and the anastomosis depends on the repair situation. , excessive stitching is a burden.”

Kawei glanced at Rost, who was entertaining several business figures in the corner, and complained: "Due to the postponement of the operation, there is still a lot of bleeding, and now Mr. Gay has mild anemia. In order to ensure that the operation proceeds normally, he needs to be Intravenous crystalloid fluids are administered to maintain blood pressure and heart rate.”

The time in Switzerland was not long, so Kawei could only talk briefly and instill in them some basic concepts and operations that must be done in surgery in the easiest way to understand.

Practical surgery is the easiest way to understand.

"Professor Sedieu's suturing skills are very good." After Kawei explained the anatomy, he came to the operating table, took a pair of forceps from the nurse's hand, pointed to one place and said, "As long as the continuous suture is extended Once you get to this place, you’re basically done.”

Sedillo, who had been a little confused before, suddenly became enlightened and started to speed up his hands. After Kawei put on his surgical leather skirt, the upper part of the transverse cavernosal anastomosis was basically completed.

"Come on, turn it up and pull out the urinary catheter first. After repairing the dorsal side of the urethra, insert and suture the ventral side. Come on, make a retractor to expose the field of view, and then give me the scissors

Please note that all blood vessels, ureters, ureters, and intestinal anastomoses need to be dissociated. For example, in current urethral anastomosis, the proximal and distal urethral ends must be fully mobilized. Kawei used tweezers to carefully lift the broken end of the urethra, and carefully trimmed it with scissors. "The proximal end is not seriously injured, and it can be freed by about 1cm. The distal end often needs to be freed by 2-3cm."

Then cut the dorsal and ventral sides of the free broken end about 1cm apart, and perform an oblique anastomosis. Here we need to use the thinnest catgut” [3]

Kawei picked the thinnest one from the busy nurse and handed it to Berget, who quickly inserted it into the curved needle and handed it to him:

“When suturing, pay attention to find the urethral capsule, make it go in and out, tie a knot on the dorsal side, insert the urethra, continue to go in and out, and finally anastomose completely on the ventral side through the abdominal wall. Pay attention to leaving a knot. outside the urethral cavity to prevent postoperative urethral stricture.”

After the needle and thread changes, the overall smoothness has been improved to a higher level. At least in the eyes of outsiders, Kawei's stitches are done without any hesitation or confusion. It seems that when doing the previous stitch, he has already thought of where the next stitch should land.

The subsequent vascular anastomosis is not much different from that of the urethra. The broken ends are trimmed first, then the membrane is stripped, and then sutured. However, because of the equipment, Kawei only performed a simple anastomosis of one urethral artery, and all the dorsal arteries and other veins were ligated.

It is also unknown whether the urethral artery can really be unobstructed. Fortunately, the blood supply is rich enough and maintained by the deep arteries. At least half of the penis will not be scrapped directly like Alphonse did.

However, Kawei never expected that the skin suturing that he delegated to Berget would have some trouble.

Berget looked at the "work" in front of him, then glanced at the rather embarrassed Sediyo, and had to call back Kawi who was washing his hands and preparing to leave: "Doctor Kawi."

"Huh? What's wrong?" Kawei said with a smile, "Mr. Gezer is awake? If he is awake, you can let him appreciate his intact penis and take a closer look to see if there is any holy light surrounding it. , has it become the world?”

However, his words stopped abruptly as he looked at him: ".This time, I have truly become the strongest penis in the world."

(End of this chapter)