Nineteenth Century Medical Guide

Chapter 80 77. Satan Hiding in Front of the Sanctuary

Carvey did not back down, but easily found the appendix hidden in the cecum.Regardless of whether his suspicions were right or wrong, the texture of this slightly hard and thick texture was indeed quite different from the soft and thin walls of the cecum.

Now before Ignatz is a fork in the road.

One is stable and conservative, and there will be no major mistakes. As long as the appendix is ​​not found, according to the practice of Western European surgeons for intra-abdominal operations, the operation can be ended by quickly suturing the priest's stomach.

Although the process was dull and hardly exciting, at least the doctors did not make mistakes. Outsiders see the surgery as a thrill, so they are not qualified to be picky about the surgery itself.

The other is full of thorns and needs to challenge the authoritative consensus.

Of course, Ignaz prefers the first option, because his surgery has always been fast and stable, and he attaches great importance to the mortality rate during and after the operation.In his eyes, when the patient dies after the operation, the operation itself is meaningless, and even if it is done beautifully, there are flaws.

That's why he was willing to believe that Carvey's disinfection could indeed bring about some changes.

But at the same time, this idea has certain limitations.

He likes to show off his skills with classic surgical techniques, as long as the death rate is reduced on the basis of predecessors, it is a success.Instead of choosing to find another way, take patients to create a new surgical method, which fundamentally changes the difficulty, success rate and duration of surgery.

Although this conservative attitude towards surgical procedures can stabilize the evaluation of the outside world, it is inevitable that some people will criticize it.

Varela is one of them.

The priest’s abdominal pain will not be relieved if the abdomen is closed now, but this has nothing to do with the operation itself. It can only show that Schmidt has a rare disease, or the disease can be classified as a trial of God or another kind of gift.

Of course, if he wanted to clarify the cause, Schmidt Jr. could choose to send the priest's body to the autopsy room.

No matter how you look at it, it's a win-win thing, and Ignatz will be very happy.

It's just that the chances of an autopsy are low because the Catholics of the church would have stepped in to dissuade them.In order to save the priest's life, it is understandable for him to undergo surgery.But it is different to send it for autopsy after death, it is a blasphemy to the soul of the priest.

But in any case, the priest's death had nothing to do with Ignatz's operation.

But if the cecal serosa is really cut, it's fine to find the appendix. If he can't find it, his surgery under the eyes of everyone will become the target of public criticism, and it will consume all the popularity that Kavey gathered last night.

Moreover, Ignatz will definitely be accused of "accidental injury". Even the headline in the newspaper helped Varela draw up it, which is called "careless and ignorant, ruined the priest's cecum!"

Ignatz was unwilling to take any chances.

Kavi also knew that he didn't want to take risks, so he sounded the alarm immediately: "Teacher, don't you forget, the priest was tricked into the operating table by us. If you go back after the operation, let him know that you cut it." But the stomach didn’t do anything, and he was pushed back to the ward to continue to suffer double the pain, this”

Appendicitis + wound, it is indeed double the pain.
This whispered reminder immediately woke up Ignatz a lot.

"Everyone, a reporter friend once criticized me for not daring to innovate and being timid in the face of innovation. I have to give the necessary response now, and I don't know if Mr. Varela is on the scene."

He scanned the operation theater back and forth, not realizing that the old acquaintance was watching behind him, and could only say disappointedly: "If anyone can contact him, please pass on the message. Today, for the health of the priest, The authority of the European abdominal surgery community must be challenged."

After a passionate statement, the audience's reaction gradually became enthusiastic.

As a loyal fan of Ignatz, many people responded positively to the courage to dare to challenge: "Good! Smash the so-called authority in Western Europe!"

"Varela knows a little bit about surgery, and can only write some articles."

"come on!"

Amid the applause, Ignatz picked up the scalpel again, and continued: "From Carvey's judgment just now, this inflamed appendix should be surrounded by the serosa layer of the cecum. I have used I have judged it with my fingers, and it is indeed different from the normal cecum wall tissue, and it is very likely to be the appendix."

Making up your mind requires repeated consideration and a lot of courage, but it only takes a few seconds when it comes to actually doing it.

Standing on both sides of the open abdominal cavity are two very popular surgeons, and their cooperation with each other is much tacit than that of the first inguinal hernia repair.Carvey used his fingers to tighten the cecum wall, and Ignatz's tweezers caught a serosa. With a pick of the knife tip, his fingers were bluntly separated, and the light red appendix embedded in it was soon seen.

"It's the appendix, everyone, I dare to assert that this is the appendix of the priest!"

Fortunately, Ignatz listened to Carvey's advice and quickly separated the remaining serosa, slowly exposing the root of the appendix to everyone.

"This is undoubtedly a major discovery in the surgical community."

"The Austrian surgical community finally has something of its own?!"

"The Institute of Surgery established by the king at the beginning cost so much money and studied for so many years. What is the result?"

"As a result, apart from the plastic surgery inherited by the current dean, there is no one who can perform abdominal surgery!"

"Professor Ignatz still dares to do things. Mr. Varela's comments are still too arbitrary. Wasn't he the one who performed the first anesthesia operation? Instead, it was the former dean of the School of Surgery. Block it."【1】

A moment of success can bury most of the mistakes. At least in the eyes of these audiences, Ignaz is still an Austrian surgical legend.

He also made similar remarks to his father, thinking that anesthesia is optional, which will not only hinder him from observing the patient's operation, but also has the possibility of killing the patient.However, due to some public opinion and academic pressure, he still performed the first anesthesia operation in Austria.

No one can escape the law of true incense, even top surgeons are no exception.

In comparison, missing last night's cesarean section contributed to Kavey's rise, after all, it was just a trivial matter.

However, it didn't take long for the argument similar to "Ignatz is still great", and the progress of the operation poured cold water on everyone's heads: "My lord priest's appendix is ​​too long."

Ignatz made a separation along the incision, hoping to pull out the appendix hidden in the cecum.

It's a pity that the appendix and the cecum are closely attached, and the serosa layer tightly presses the appendix.They are like a symbiotic relationship, embracing each other and extending upward along the direction of the incision.

If things happen in modern times, I am afraid that the chief surgeon will extend the incision again without hesitation.After all, the most troublesome appendix has already been found, and it is impossible to close the abdomen without a compromise. 【2】

But in the 19th century, the longer the operation was performed, the more resistance it encountered.

One's own reputation, the next day's newspaper, the audience's reaction on the stage, and the operation process without a template will all bring endless pressure to the surgeons.In the era when giving up was not a medical malpractice, shutting down the abdomen was definitely not a good thing, but at least it could let people put down the burden and get a breather.

After all, if you want to continue the operation, you don't want to continue on the original basis, but you need to expand the incision, continue to free the cecum and even go up to the position of the ascending colon.

The wax table chandelier and portable oil lamp in the operation theater illuminated the operation area brightly, but inside the incision, the priest's upper right abdomen was completely dark.Without stable anesthesia, without emergency measures, and without Kavey's God's perspective, the risk will increase exponentially if the incision is continued to expand.

"Teacher, the current incision is 12cm, which is already the limit. I am afraid that there are few abdominal operations with such a large incision in Austria." Herman suddenly mentioned, "If the incision is extended, it will be 17cm."

"17cm"

Even Kavey, who has experienced thousands of operations, knows the dangers of the operation, but he considers it more comprehensively.

Although ether anesthesia sounds simple, you can fall asleep just by smelling it, but in fact, the grasp of the anesthesia dose is quite complicated technical work.Once the dose exceeds the threshold, ether will inhibit the respiratory center, destroy the patient's spontaneous breathing, and finally suffocate to death on the operating table.

Therefore, the operation time in the 19th century was very short, and many patients could not withstand the second anesthesia.

During the preparation period before the operation, Carvey knew that the priest had a severe reaction to ether, and several adverse reactions such as retching, coughing, and salivation appeared immediately after using it.The possibility of another anesthesia failure is very high. In this case, there is indeed a considerable risk in continuing the operation, and he is ready to give up at any time.

Because Carvey is not confident in convincing Ignatz again, it is also a very unwise choice to fall out with his "teacher" in front of so many fans.

However, Ignatz withstood the pressure and made a timely decision: "Continue to extend the incision upwards and give me a scalpel!"

This was a rather bold decision, which surprised Carvey: "Teacher, further up is the liver area."

"I know."

Ignatz's scalpel did not hesitate, and carefully cut up the skin and muscles, exposing a large section of intestinal tube again: "The operation is quite difficult, we have already reached the ascending colon, and the tail of the appendix is ​​still not visible here The whole appendix drilled out of the cecal serosa layer here, and completely entered the retroperitoneum in the liver area.”

Anyone can hear his helplessness.

The abdominal cavity is a forbidden area for surgery, and the liver area is the forbidden area of ​​the forbidden area.

Even in the off-limits, a considerable number of surgeons are still taking risks with appendectomy and inguinal hernia repair.But no one dared to do liver and gallbladder surgery, no one even touched it, and there was not even a decent report.

For priests, God's sanctuary is far away in heaven.

For abdominal surgery, the sanctuary of God is in this palm-sized liver area.

The entire ileocecal area has been completely dissociated, and the surgical area has entered the peritoneum from the outside of the peritoneum at the beginning, and now it has jumped out of the outside of the peritoneum.The separation of Ignatz is still going on, and more than 50 minutes have passed since the beginning of the whole operation, which is not far from the usual recovery time of ether anesthesia.

"Come on, teacher."

Carvey is like a prophet, helping Ignatz speed up with his hands, and giving him hope in his mouth: "I have a hunch that the appendix is ​​in front."

"Um"

Ignatz's hand speed is not slow, but his voice is getting lower and lower, very much like the way he did Moraso's groin.

He was prepared for the operation to fail.

But things in the world are afraid of persistence. Persistence will always reward those who persevere. It's just a matter of time.

Suddenly, moving forward along the middle of the appendix, Ignatz saw a purple-red irregular ball, but in Carvey's eyes, it looked more like an upside-down gourd. 【3】

Everyone's first reaction is the gallbladder, because in the liver area of ​​the upper right abdomen, the only organ with this color and shape is the gallbladder.But the appendix in Carvey's hand is always reminding everyone that this is not a gallbladder, but an appendix.

Because you only need to gently push it away, you can see the liver not far away and the normal gallbladder under the liver.

"AMAZING FIND!"

"This appendix is ​​the best in the world in terms of its position, length and shape of the end!"

Ignatz got a little angry, and his voice was dull. Everyone could feel the pressure on his shoulders, and at the same time, he could hear his excitement: "Kavi, calculate how long it is? I guess It has to be 30cm!"

Carvey made a rough comparison with his fingers: "It's about 27cm, very long!"

"Father, it turns out that the Satan you mentioned is not our scalpel, nor the medicines Fatolad prescribed to you, but this appendix! Give me the crow's beak pliers!"

Ignatz took the pliers from Herman, cut off the tissue and blood flow at the root of the appendix, and then he and Kavey started the suture: "Everyone, the key point of appendix surgery is to find the appendix. Now to find the appendix It’s much easier to do, you only need to suture the blood vessels and cut off the appendix.”

"Teacher, the priest seems to be awake!" Carvey held the intestinal tube and needle thread in his hands, bent down, and pressed his elbow on the priest's thigh.

"Well, I saw it." Ignatz nodded, and then pressed his elbow on the swinging arm, "Herman, go, get the second anesthesia, the operation is almost over, the dosage is reduced by half."

"it is good!"

"It is also necessary to keep an eye on the priest's heart rate and breathing."

"it is good!"

After the lessons learned from the last groin surgery, Ignatz realized that long-term surgery will definitely be the mainstream in the future, so during the period after the surgery, he has been training the cooperation of the second anesthesia during the operation.

The chief surgeon and the first assistant cannot be separated, so the second assistant and the nurse need to complete the second anesthesia together.

Herman practiced the most diligently, and the anesthesia process had already been etched into muscle memory.

The training made him very experienced in this crisis. While doing a good job as an equipment nurse, he also kept an eye on the priest's movements with the nurses around him.As soon as the priest regained consciousness, the long-prepared ether mask was pressed on his face.

(End of this chapter)