Nineteenth Century Medical Guide

Chapter 480 476. Two Types of Surgery
Since the successful completion of the abdominal aorta transplant operation, Landreth Formont, who had worked as Kavi's assistant for half a year, was dubbed the number one surgeon in France.

Even though he always felt that Sedillo was the one who deserved the title and that he was just a substitute, in the eyes of the public, Sedillo had already moved to Vienna and never returned to Paris, while Landreth remained at the Hôtel-Dieu and was a pure Frenchman.

Gradually, the whole of Europe seemed to agree with this statement. Not only the general public, but also the professional medical community pushed Landreth to the pinnacle of French surgery.

Who can resist being famous?

Landreth said that he didn't care, but he always felt comfortable in his heart.

Of course, if he could replicate Kavey's abdominal aorta transplant, his title of chief would be even more convincing. This feeling would become even stronger when many foreign science associations extended olive branches to him, hoping that he could give lectures and exchanges in their countries.

So at the beginning, shortly after the operation, Landreth rejected all those invitations.

My self-esteem doesn't allow it, and my strength doesn't allow it either.

The first assistant seems important and is the most important helper who assists the main surgeon in completing the operation, but he is not the leader of the operation after all.

In half a year, he learned preoperative preparation, vital sign monitoring, response to massive bleeding, anesthesia control, and postoperative recovery. However, he was still unable to handle many special situations.

Putting aside other complex surgeries, there are many vague aspects of this abdominal aorta transplant that make it difficult to draw a conclusion easily.

The abdominal aorta has too many branches, and the position and diameter of each person's blood vessels are slightly different. Any slight deviation will result in different treatments.

Which blood vessels only need to be clamped?
Which ones can be directly ligated with sutures?

Which ones need to be disconnected immediately?
Which severed blood vessels need to be re-anastomosed to the new aorta after the operation?

The aorta has many branches, many accompanying veins, and other tissues adhered to the surrounding area, making vascular dissection extremely difficult.

How to define the scope of divestiture?
To what extent should we strip away?

What should be done if the stripping causes accompanying venous bleeding? Should it be sutured? Should it be completely severed and ligated? Or should it be simply stopped?

What if the dissection causes ureteral damage, intestinal damage, or mesenteric damage?
The abdominal aorta is connected to the thoracic aorta above and the iliac arteries below.

If the aneurysm is only in the abdominal aorta, it is fine. But if it involves the thoracic aorta and iliac artery branches, how should the incision be made? Split the sternum? Extend to the lower abdomen? Or even the groin?

How should blood vessels be transplanted in this case? If the entire vessel is transplanted, how can the complete field of vision be exposed? What should be done if the size of the hemangioma changes between two surgeries?

There were so many questions that it was not enough to just follow Kavi through one operation.

Originally, Landreth wanted to do a brief review after the operation and ask some questions for Cavi to answer.

But after performing the vascular transplant operation, Kekawi left the Main Palace Hospital. He only came to check on Betha's recovery every now and then, and then disappeared again.

Some say he was invited to the palace by Emperor Nazianzu and became the court physician of France. Some say he left Paris and returned to Vienna after completing the stone surgery on Nazianzu. Others say he never returned to Vienna, but went to Switzerland, Italy, the Ottoman Empire, England, and everywhere except Paris.
If it weren't for Kavi, Landreth would probably have continued working as a country doctor in the village and spent the rest of his life in front of a simple small operating table.

But now, he is like an old locomotive that has been covered in dust in the warehouse for many years. Not only has he been carried out, but he has also shoveled a full furnace of coal, and he still wants to pull the French Surgery forward.
In the year after Bertha's surgery, he practiced hard and actually performed several abdominal aorta transplants on cadavers.

The preparation of the transplanted blood vessels was sophisticated enough, the anastomosis was perfect, and the entire operation time was even several minutes faster than that of Kavey, setting a record. It can be said that in terms of operation skills alone, he was absolutely confident that he could surpass Kavey at that time.

But a corpse is a corpse, not a living person, and he was never able to successfully replicate the operation on a patient.

The main reason was that Landreth was unable to accurately diagnose abdominal aortic aneurysm.

This is actually the same for Kavi. It's all based on guesswork. If you think there is a possibility, you need to perform an laparotomy.

Landreth's conservative personality hindered the implementation of laparotomy. Without laparotomy, the size of the hemangioma could not be truly understood, and preparations for blood vessel transplantation could not be made. If preparations for blood vessel transplantation were not made well, there would be no possibility of surgery, which would lead to a vicious cycle.

Landreth knew very well that to put it nicely, it was out of consideration for the patient, but to put it bluntly, it was a lack of confidence, and no matter how advanced the technology was, it could not completely eliminate this feeling.

Of course, his title as the Chief of France still forced him to undergo several abdominal explorations, but unfortunately even God was not on his side, so he became indifferent over time.

At the end of 68, Landreth finally accepted the invitation of the Italian Medical Association and gave his first lecture at the University of Padua. He mainly wanted to talk about the abdominal surgeries he had performed in the past two years after returning to Paris. The abdominal aorta transplant was only an additional topic and took up very little time.

The response was overwhelming, and soon invitations came from surgical associations in other countries.

He went to London in the spring of 69, Barcelona in the autumn, and Istanbul this summer. While he was in Constantinople Hospital for an exchange of surgeries, he received a letter from the Russian Surgical Association, hoping that he could take time to go to Russia.

Originally, Landreth wanted to avoid the cold winter in Russia and go there next summer. But Russian Prime Minister Gorchakov sent him a letter before he returned home, forcing him to board the train to Russia directly after completing the exchange operation in Constantinople.

It was rare for a prime minister to write to a doctor. Even the court doctors who only served the royal family received verbal messages. Formal letters represented status and respect, and even had a diplomatic nature. When Landreth received this letter, he also lost the opportunity to refuse.

He disliked Russians in every sense of the word.

Similarly, Gorchakov, who had been working in the whirlpool of European politics for 20 years, did not like the French. His first choice had always been the more capable and much younger Austrian surgeon, and he chose Landreth out of helplessness.

Just like the densely packed surgical associations across Europe, the invitation from Russia was never actually delivered to Kavi and was probably intercepted before it even reached his estate.

The Russians were unable to find Kavi, and the only reliable information was that he had left Vienna four months ago and had not been heard from since.

Because of this incident, Gorchakov received some "criticism".

"Dad won't let you get on his carriage because of this?" Maria couldn't understand the logic. "Just because of this little thing???"

"A small matter? It's not a small matter, Princess."

Gorchakov kept the secret, "Dr. Kavi is the man who made the suspicious French emperor put aside his suspicion and lie quietly on the operating table. His ability is enough for your father to lower himself and make an invitation."

Maria was puzzled. There was really no image in her mind of a young person instructing a group of old professors.

Gorchakov looked at the hall full of doctors and students, and even showed a hint of envy in his eyes. Turning back and seeing her puzzled look, he smiled and asked, "What's wrong?"

"I don't understand medicine or surgery, but based on my observations, I still can't understand. Even if the surgery itself cured the Third Emperor, it just happened to happen at this time. It's completely coincidental."

“Your Highness, you may not understand the impact this medical genius has had on real surgery.” Maria was always curious about unknown things, but her pride was also a little bit resistant: “Impact? What impact can it have? Doctors are indeed great, but at best they can only cure diseases.”

The old man shook his head slightly, knowing that her old problem had come back again. No matter how much she said, it would be useless: "Do you think the Prussian-Austrian War was a draw?"

"From the results, it was a draw, but the war situation showed that Austria lost." Maria didn't know much about the war, so she simply stated her own opinion. "At least the initiative in the later negotiations was always in Prussia's hands. If the war happened again, Austria would definitely lose miserably."

"What about the Crimean War?"

This question touched Maria's sore spot: "Grandpa Gore, why are you asking this?"

"The speech hasn't ended yet, so we're just sitting there doing nothing." Gorchakov pointed at the Tsar who was listening attentively, and said, "We are just looking back at history from an objective perspective and learning lessons from it."

Maria frowned and thought for a while before she said reluctantly, "We lost."

"I'll tell you a few numbers."

Gorchakov counted on his fingers: "The Crimean War was unprecedented in both scale and intensity. The casualties on both sides were about half. Of course, there were more casualties on our side, but the number was limited. This shows that when weapons are equal in strength, the lethality of modern weapons is enough to cause equal casualties on both sides."

Maria nodded.

"The intensity of the Austro-Prussian War was much lower. The weaker side would withdraw as soon as the two sides came into contact, and there were very few major army group battles. Of course, this was also related to the short duration of the war. But no matter what, the casualty rates on both sides should be equal."

"of course."

"In fact, Prussia's casualties were around 15%, while Austria's"

Gorchakov paused for a moment, subtly, and simply looked at Landreth, who stood at a podium in the distance and explained the details of abdominal surgery.

"How many Austrian casualties?"

"23%."

"It is quite comparable to the battlefield situation and the strength of the weapons of both sides."

Maria felt something was wrong as soon as she said this. The Prime Minister she knew would not say useless nonsense for no reason: "No, the casualty rate is not the point, right?"

Gorchakov nodded appreciatively. "The casualty rate includes both injuries and deaths. If we only look at the death rate, Prussia's is close to 10%, while Austria's is only 8%."

"what?"

Maria was a little surprised.

According to previous estimates, Austria's mortality rate should have been more than 15%, but the actual number was nearly halved, far exceeding the field medical level of major countries.

But Gorchakov had not finished speaking: "This figure includes the three Austrian fronts. If we only look at the Olmütz Fortress on the northern front, which Kavi was responsible for, the mortality rate will drop further to 4.3%."

At this point, his speech speed gradually increased, and he seemed a little hysterical: "This also includes soldiers who died directly on the battlefield, and the wounded who died before they could receive treatment. If we only count the mortality rate of the wounded who received treatment, it may be less than 2%."

"This is impossible!!!"

The sound broke the silence of the hall, and everyone looked over. Only then did they realize that the emperor and the princess were standing outside the door, and they all turned around and bowed.

"Your Majesty the Emperor~"

Alexander didn't want to interrupt the speech, he just came to watch the fun. After the speech, he invited Landreth to his carriage and then slowly discussed the future cooperation matters when they returned to the Winter Palace.

But things have come to this, even if he himself is unwilling, others present will try their best to maintain the necessary royal etiquette.

He glanced at his daughter who was covering her mouth as she retreated behind the Prime Minister, then smiled and greeted Landreth who was walking off the stage: "Dr. Landreth, welcome to St. Petersburg."

Landreth separated the crowd and came to the Tsar respectfully, bowing respectfully and saying, "Your Majesty, how come you are here?"

"You were invited by our Prime Minister himself. Now that you are here, I have to come and see you."

"My schedule was a bit tight, so I came directly to the medical school after getting off the train. I'm sorry for not going to the Winter Palace to see you first." Landreth bent his waist even lower.

"It's more important to get down to business." Alexander smiled and helped him up. "The speech was very good. It's worthy of being a surgical lecture by the chief surgeon of France."

After chatting casually for a few words, several college leaders around him tensed up. After a brief glance, someone immediately said, "I think Professor Landreth is tired after just arriving in St. Petersburg. Today's speech has come to an end. The rest of the content will be discussed in the anatomy class and the exchange surgery later."

"Yes, many surgical details are too delicate to be understood by just looking at diagrams. You still need to see the real thing to help you understand."

"Since the dean has said so, let's stop here for today."

"Your Majesty, this way please."

Landreth's lecture was inexplicably ended. His luggage, books, handouts and atlases were packed up by a special person, and in the blink of an eye he left the teaching building with the Tsar's entourage.

Maria, who disrupted all this, just followed the Prime Minister with her brain still in a state of shutdown.

If what Gorchakov said is true, then the value of Kavi is far beyond the reach of ordinary guns and ammunition.

She couldn't imagine that if Kawi had been born fifteen years earlier, in Russia, and if Kawi had participated in the Crimean War, Russia would not have suffered such a disastrous defeat. Without this disastrous defeat, Russia would not have completely lost control of the Black Sea, and the country would not have been in turmoil for so many years.
She called out to Landreth in French: "Professor!"

Everyone stopped in the snow and looked at the two of them.

Landreth was a little surprised by the voice. Seeing that the Tsar didn't say anything, he turned around and asked, "Your Highness, what do you want?"

"What kind of person is Dr. Kavi?" Maria's mind was filled with doubts. She really wanted to know the answer. "Is he really as powerful as the legend says?"

She couldn't find a suitable word in French to describe the man. Fortunately, Landreth was tired of hearing these questions and replied with a smile: "Your Highness, there are two kinds of surgery in the world. One is called surgery, and the other is called Kavi Hines."