Nineteenth Century Medical Guide

Chapter 456 452. Plan 1 or Plan 2
Perhaps it was a gift from his trip to Vienna that Sediyo was no longer the self-important emperor of surgery at the Hôtel-Dieu. He was much smarter than Landreth thought. Not only did he hide Kavi's atlas, but he also kept a watchful eye on him when he returned to Paris.

"What does this 'rhinorrhoea repair' mean?" Sediyo looked at the small words and the corresponding time on the theater sign, "Today at 2pm, to be confirmed?"

"It just means it hasn't been decided yet." Landreth said perfunctorily, skipping the previous question and directly focusing on Kawi. "He just told me something like this and asked me to set an approximate time, and then he disappeared."

Sediyo was not misled: "So what does this rhinorrhoea repair mean?"

"Well, there is a patient whose nose has been leaking." Landreth couldn't avoid it, so he could only tell a small part of the truth. "It's actually nothing, probably there's something wrong with the nose. When the time comes, we'll know after cutting open the nose and taking a look."

If Fisher had been placed in front of Sedie from the beginning, he would never have guessed in the direction of cerebrospinal fluid. Neurosurgery is a very unfamiliar and dangerous field, and Sedie's slightly conservative medical philosophy would have aggravated his tendency in diagnosis.

Unfortunately, the anatomy book and the corpse betrayed him. At least Sadio was sure that the operation was related to the brain.

Otherwise, with Landreth's personality, how could he be in the dissection room early in the morning, dealing with rotting corpses? If this guy really worked so hard, Teacher Dupont Itron would not have scolded him so much that he almost changed his career.

"If cutting open the nose can solve the problem, why do you need to open the skull of a corpse?" Sediyo said with a smile, "I've known for a long time that Dr. Kavi is also very knowledgeable about the skull and brain. He also performed the craniotomy on Shebasto before. I really want to stand next to him and take a closer look."

Landreth knew he couldn't trick him, so he stopped pretending and admitted that what Kavey was going to do was most likely a cranial surgery, but he still had to question the feasibility of the surgery: "To be honest, injuries are inevitable in such a large-scale craniotomy, and the chances of not getting an infection after the surgery are also very low."

"Then there was encephalitis, seizures and death."

Although the two of them were scheming against each other, they were still able to agree on the topic when they got back to the point. This was especially true now that Sediyo had long since given up on fame and fortune:

"The more you understand the structure and function of the brain, the more you will know the harm of opening the skull. Kavi's understanding has a lot in common with the miasma theory. Opening the skull is adding burden to the body."

"But he still chose to open the skull." Landreth frowned very tightly, and his eyelids could be seen twitching slightly. It was obvious that he didn't sleep well last night. "Last time, he said that cranial surgery was too dangerous and it should not be done if it could be avoided."

"It means we have to do it now!" Sediyo asked, "What are his symptoms?"

"In addition to cerebrospinal fluid leaking from his nose, he also has headaches, dizziness, and sometimes nonsense." Landreth briefly reviewed his medical history. "Oh, he was also one of the victims of the explosion. One of his eyes was removed. The incision didn't heal well because the eye socket is also leaking."

Sediyo has been working on the front line of surgery without any break, so his anatomical knowledge is naturally much better than Landreth's, and he immediately thought of skull base fracture.

But the same question remains: the skull base is so large, where exactly is the fracture? And how to repair it? With these two answers, they can think about the specific surgical approach and process.

However, these two answers are not easily obtained, at least they could not think of them before Kavi took action.

Seeing that Sediyo couldn't guess the approach, Landreth decisively returned to his original state. Instead of continuing to waste time on corpses and anatomical diagrams, it would be better to rest well and get enough energy to prepare for the surgery in the afternoon.

After knowing the time of the operation, Sediyo did not stay in the hospital for long. He returned to his home in Paris and went to his study after a simple wash. There were neurosurgery anatomical atlases that he had collected for many years, as well as a well-preserved skull.

This is the physical model left behind by DuPont Itron, which outlines the safe area for skull drilling.

The source should be a small auction that is not well-known, where there are always some strange things. Originally, a notebook was given with the purchase of the skull, but it was later burned in a fire.

"What a pity." Whenever he thought of the notebook, Sediyo always felt regretful, "It's just as pity as the parasitic twins whose heads were connected recorded in it."

[A pair of craniopagus twins described in a manuscript by John Hunter. The twins showed some affection when the other twin ate. Both died at the age of four from a venomous snake bite. —Excerpt from Hunter's manuscript A Treatise of Blood, Inflammations, and Gunshot Wounds, London, 1794]
"It's better to go home. There are some useful tools at home. It's best to use them for practice." Sediyo took out two small suitcases from the wooden box. Inside were tools for dealing with skulls.

When he thought of the completely fixed-specification surgical instruments in the Municipal General Hospital, he felt a headache: "Alas, what kind of surgeon would I be without my own customized instruments? I have no soul. It's better to use instruments that you bring with you."

[Dupont Itron's travel skull perforator kit is compact and easy to carry, and comes with replaceable drill bits of different sizes. It is not difficult to see that this perforator kit shows obvious signs of use. Dupont Itron has always believed that this mark is a medal of surgery, so Sediyo kept it]
[Sedillo’s own craniotomy kit is a more sophisticated design that includes not only drill bits but also different styles of manual circular saws. Unlike his teacher, he washes his tools thoroughly, but only twice, following Kawi’s rules of no-contamination surgery.]
Neurosurgery in the 19th century, like general surgery, was in a period of transition. Historically, neurosurgery in Britain and France has always been in an absolute leading position, and they are on par with each other. But with the birth of anesthesia and Lister's antiseptic technique, Britain began to exert its strength, and craniotomy for the treatment of cerebral hemorrhage and brain herniation gradually became the standard procedure for British trauma surgery.

Paris, France has always called itself a surgical center, and there is indeed a reason for it.

From the middle of the Renaissance to the end of the 18th century, Paris surgery was once the standard for the whole world. Even the London Medical School in the UK taught French textbooks. Even in the mid-to-late 19th century and even the early 20th century, this impression still existed in the minds of most medical workers.

[Henri Francosi Le Dran (1685-1770) gained extensive surgical experience as chief surgeon of the French army. His Observations on Surgery, Le Dran's Textbook of Surgery, was reprinted many times. This is the title page of the English edition of the book, Paris, 1749.]
But in fact, by the mid-to-late 19th century, French neurosurgery had fallen behind that of Britain. This misaligned relationship can be attributed to the fact that surgical classification was not detailed enough, and neurosurgery itself was dangerous, mysterious, and unfulfilling, so specializing in it was not an option for most people.

After all, by the late 60th century, a surgeon specializing in head trauma had only about a % success rate in treating intracranial hemorrhage through craniotomy.

Including deaths caused by postoperative infection, the success rate can be reduced to less than 30%. If the patient is left to develop on his own, the survival rate can actually exceed 15%.

Those who survived may have various sequelae, such as headaches, epilepsy, and various perceptual and cognitive disorders, but at least they do not have to face fatal encephalitis. If we take into account misjudgments and accidents during surgery, the difference in survival rates will only be smaller.

This is why both Sediyo and Landreth are reluctant to perform craniotomy. Without risky practices, there will be no development in surgery.

But now with Kawi, things seem to be changing.

Two o'clock in the afternoon arrived in the blink of an eye, and the Hôtel-Dieu was once again crowded. It seemed that the news of the operation had spread from the beginning, and all of Paris knew about it. For Parisians who are always chasing new trends and are extremely forgetful, the train station explosion is a thing of the past. Now the hot spot belongs to only one person, Kavi Hines.

But something went wrong with Kavi.

"The surgery is going to be cancelled?"

Landreth didn't understand what he meant. "The operating theater is now full of people, not just doctors, but also many medical students, reporters who have sneaked in, and even idle people like the Prince of Wales. You say you want to cancel it now? What will they do?"

Cavi has his own set of standards, and canceling the surgery is not what he wants to see. But the simulation data is not good. In the case of foreseeable failure of the surgery, canceling the surgery and only doing conservative treatment is also an option, or even a better option.

"Mr. Fisher, the choice is yours." Kavi threw the responsibility back to the patient. "Of course, you can leave it to me, but the initial choice must be in your own hands."

Fisher was already on the verge of collapse from his headache and his nose, and after listening to what Kavey had just said, his mood became very unstable. He twisted his body irritably, his fingers clenched the bed sheet fiercely, and after struggling for a while, he asked, "Is the success rate of the operation really that low?" "It seems so now." Kavey did not deliberately hide it, "The success rate of plan one may be less than 50%, and the success rate of plan two will be higher, but there is a high probability of causing paralysis of the whole body."

"Okay, this is so troublesome, why do I have to go through this, why me."

Feeling the liquid coming out of his nasal cavity, Fisher wiped his nose with the dry gauze prepared by the bedside: "What if I don't have surgery? What will happen if I don't have surgery? Will it be like this for the rest of my life?"

"Your rhinorrhoea has been going on for more than a week. It may have improved a little at first, but a few sneezes during the recovery period caused the torn meninges to tear even more severely."

Kavi explained: "If you don't have surgery, you may get some relief in a month or two, but the chances are very low. The reality is more likely to be like what you said, you will have to live with gauze for the rest of your life. Of course, the length of 'this life' will be shortened a lot. Maybe it will take a few years, maybe not just a few days."

Fisher understood what he meant: "If the operation is successful, how long can I live?"

"Success will naturally not affect your life span, but surgery can have complications and can fail, as I said before."

Fisher had been lying on his side, feeling very dizzy. Every time he tried to lie flat, the leaking cerebrospinal fluid would divert from his nasal cavity into his throat and be swallowed, leaving a salty taste in his mouth.

He felt bad, but still wanted to think about it again: "Dr. Kavi, even you are not sure about the surgery. I need to think carefully about such a low chance of surgery."

"No hurry, think about it carefully."

Kavi had no objection, but Landreth got anxious and pulled him out of the ward: "Hey, what are you thinking about? He's just a coachman. Can't we just waive his surgery fee and take him in for surgery?"

6◇9◇Book◇Bar

"Forced surgery? I can't do it."

"Haven't you always been like this before?" Landreth felt strange.

"Don't talk nonsense. I forced the surgery because I was sure I could cure them. But I'm not sure about this surgery." Kavi shook his head. "The chance of surgery is so low. He has to make his own judgment."

"They judge? They are not doctors, how can they judge?"

Landreth didn't understand Kawi's modern surgical thinking and thought he was trying to pass the buck: "Doctors are supposed to give patients advice and help them make judgments. Are you afraid that the operation will fail and ruin your reputation?"

"Hmm?" Kavi glanced at him. "I've failed hundreds of operations on the Prussian-Austrian battlefield. For a large-scale craniotomy like this, half of the successes have to thank God, and only half have to thank doctors like us. What does it have to do with my reputation?"

Landreth knew the surgery carried significant risks, but he didn't expect them to be so high.

The audience in the theater were the obstacle in his mind. If it weren't for them, the surgery would be cancelled and he wouldn't have such a big problem with it: "If it's really cancelled, how can I explain it to them???"

"Who?"

“The audience.”

"Oh, just say that I, the chief surgeon, am incompetent." Kavi gave his advice.

"Ah?" Landreth's face was very ugly. "Are you kidding? Am I this kind of person in your mind? I can't do such a thing. And if I really say that, with your current status in Paris, those reporters can write me to death. Do you believe it?"

"I believe."

"You believe it and you still say that???"

"."

Fisher actually wanted to have the surgery, but he hoped to get funding from Kavey before the surgery, just like the gambling rewards given to patients during the previous surgery tour. If he failed, he would get a good reward to compensate the patient's loss.

He has now lost his previous job, and although his employer has given him some medical expenses, it cannot sustain him for long. If the operation fails, his wife and children will completely lose their source of income.

But if he didn't have the surgery, in his current condition, Fisher would not be able to work and support his family.

He was in great pain, feeling as if he was at a fork in the road in the fog, and choosing left or right seemed like a dead end.

"Dr. Carvey!" Fisher called Carvey back in. "If, I mean if, I am willing to have surgery, which option do you think is better?"

"I've said before that no matter which one you choose, it's all gambling. There's actually no difference." After thinking for a moment, Kavi said, "Maybe I'll choose option 2. Of course, your choice can also influence my choice. I've already told you the whole process."

Fisher picked up the sketch drawn by Kavey again. Although the lines were a bit thicker, the processes of the two plans were still clearly presented in front of him.

He didn't understand everything, and he was even more confused when listening to Kawi's explanation just now. He only knew that no matter which plan was used, the skull had to be pried open, and the danger came from this step.

If that were all, what difference would it make to him?

Fisher picked up the wet gauze, found the dry end and wiped his wet nose again: "Okay, Dr. Kavi, I've made up my mind. I agree to the surgery, and I'll use the option 2 you mentioned."

Landreth felt relieved when he heard these words, and he turned around and ran out, calling the nurse into the ward. At the same time, he asked Peon, Albaran and the intern to prepare, at least to use this news to calm the audience.

On the other side, Carvey put away the sketch and gave Fisher the promise he had always wanted: "I know you have been thinking about the income of your family after your death. I also know that your family is in a difficult situation, with two elderly people and four children to support. But I don't want you to take risks for money, because this is a real risk and you may die at any time.

Since you have made your choice now, I am willing to give you 2000 francs in funding after the operation fails. You must remember that this is a reward for your help in showing the operation process in front of outsiders, not compensation after death. "

I deleted and revised some of it in the middle. It’s a bit late.