Nineteenth Century Medical Guide

Chapter 493, page 489: Because your stomach hurts.
Kavi only showed the director the envelope; the contents of the letter remained inside. This was to protect his privacy and also to show basic respect to the Duke of Aosta.

The dean didn't dare to open the envelope to verify further without authorization, and even hesitated for a while before accepting the letter.

Moreover, the feel of the paper, the royal emblem embossed in gold foil in the corner, the wax seal and elegant font, and the text on the envelope all suggest the writer's extremely distinguished status.

The envelope itself is enough to prove its authenticity.

Upon seeing this, Alvaro recalled that the newspapers had previously published an article about the new king undergoing a remarkable surgery. The details of the surgery were unknown, only that it was performed by a brilliant surgeon, and that the procedure took place at the Palais Royal in Paris.

Newspapers at the time were more concerned with Nassan's surgery, and the Duke of Aosta could only barely squeeze into the bottom of the second tier among the royal family and nobility, so there was not much coverage of him.

Later, as the struggle for the Spanish throne intensified, the past of this Italian prince was brought up again.

The surgery was far more surreal than the world knew, and many criticized him for being too depraved, using any means to pursue pleasure, even surpassing the most dissolute socialites in Paris.

Many others, however, believe that his willingness to undergo such surgery while in good health is a testament to his extraordinary courage.

The throne is the best vessel for courage. In their eyes, once the Duke of Aosta ascends to the throne, he could bring about entirely new changes to Spain, allowing the former maritime superpower, after decades of turmoil, to rediscover the feeling of returning to its former glory as a great power.

Even if it can't do that, it's still better than those lifeless puppets whose end can be seen at a glance.

Even more extreme individuals believe that undergoing the Cavill surgery is equivalent to receiving a blessing from God. Amadeus's physical and mental abilities have been greatly enhanced, much like Nathan, who stopped France's decline shortly after his surgery.

This seemingly unorthodox surgery completely messed up the Spanish chessboard in the game between France and Prussia.

Some astute diplomats could even see the shadow of Austrian intervention outside the game, ultimately helping France to send the Duke of Ottas onto the chessboard, making him a very important piece.

Of course, the dean in front of him had no interest in European politics, and what kind of person the new king was was none of his business.

As a Spanish citizen, he certainly had to acknowledge this newly arrived king; someone even the king treated as an honored guest had no reason to be disrespectful. Moreover, the other party was a count, and such a young count was extremely rare in all of Europe; one could easily imagine his extraordinary status.
This was the first time in his life that Alvaro had encountered something like this, and he couldn't hide his nervousness. But after calming down, it wasn't hard to see that there was only one thing he needed to do, or rather, what the other party needed him to do.

Giving each other face will allow both sides to back down gracefully, so why not?

“Professor Kavi, uh, Professor Kavi Hines, I apologize for my rudeness earlier. I hope you won't take offense. That, that surgical theater…”

“It’s alright, your permission is enough, you don’t need to worry about anything else.” Kavi didn’t want to get entangled with him any further, and only gave the still surprised Secretary Ian a look. “Secretary, remember to give the 5000 francs consultation fee to Dean Alvaro, just like I said before.”

Kavi's identity shifted so quickly that Ian listened in a daze, only nodding blankly.

Alvaro, however, changed his tune: "No need, no need, how could I possibly accept this money?"

Kavi ignored him and turned to Antonio, calling out, "Director, if I may be so bold, it's you and your two assistants..."

"I'm willing! They're definitely willing too!"

Antonio: Anyone who doesn't want to is a fool!!!
Ugo's pneumothorax is not serious; the only problem is that the double-bottle water-seal drainage is not effective enough.

Without a negative pressure device, the negative pressure created by the syringe is too short-lived. Some gas and blood have come out of the drainage tube, and the previous symptoms have not yet disappeared.

To solve the problem once and for all, the water seal diversion bottle needs to be improved. Kavi has an idea, but it's not so easy to implement.

Ugo's vital signs are stable, and no other injuries have been found. Even if the pneumothorax cannot be relieved, the presence of the water-seal bottle will prevent it from getting worse. He only needs to be instructed to exhale forcefully, trying to squeeze out the air using the pressure inside his chest cavity, to maintain his stability.

In comparison, the nationally renowned bullfighter was not so lucky.

Although he finished off the bull with his final strike and received enthusiastic applause for his indomitable spirit, which lasted for a full two minutes until he left the arena, the repeated collisions and trampling by the bull's hooves had caused him considerable injuries.

At this moment, Anders was sitting on a chair at the entrance of the operating room, with his hands at his sides, his right leg crossed, smiling as he watched several doctors walk by, seemingly without any major problems.

“Dr. Kavi, I really don’t need surgery. You see, I only feel a little pain where the bone is broken.”

As he spoke, he pointed to the position of the fourth and fifth ribs on the left side: "You checked before, I even know that, what's that called? What's Ugo's illness called again?"

"pneumothorax."

"Yes, yes, pneumothorax!" Anders patted his chest gently. "I don't even have pneumothorax, so why would I need surgery?"

“Your stomach hurts,” Kavi corrected him, then began to give instructions. “Call out all the assistant nurses. I need a lot of clean water, 10 liters first, which needs to be boiled and then left to stand. Also, a lot of gauze, washed clean, sterilized while it’s boiling.”

"Everything is ready."

Antonio stood beside him, his excitement growing: "The appendectomy was scheduled for this afternoon, and it was all done according to the instructions in your magazine."

"Okay, regarding the equipment."

"I have all the equipment here."

“I won’t trouble you with the instruments.” Kavi told Bergett to go ahead and prepare, then looked at Anders. “Mr. Matador, get on the operating table quickly. I don’t want to waste other people’s surgery time. Let’s get this over with as soon as possible.”

Anders could fearlessly engage in close combat with a fully grown bull for an entire day, but he wouldn't dare entrust himself to a surgeon. He had seen too many of his colleagues end their lives prematurely due to anesthesia and surgery, and he might end up like them, his eyes closing the moment he closed them.

Accompanied by a nurse, Anders slowly walked from the bench outside to the operating table, carefully sat on the edge of the bed, and tried to struggle a little longer:

"Doctor, I feel fine. That bull was very strong, but its horns weren't sharp, and it wasn't as dangerous as you might think. In fact, most of the impact was blocked by my strong muscles, and it didn't hurt me."

As he was speaking, he unbuttoned his sand-covered shirt, revealing his upper body. Just as he said, there were only a few old scars on his body, no new injuries: "Just let me go. If anything goes wrong, it's on me. It has nothing to do with you, the doctor. There's no need to be so nervous."

On the issue of whether or not patients should stay or leave, Kavi has his own principles and will never be led by the nose: "Why are you sitting if your stomach hurts?" "Sitting? I feel comfortable sitting, so I'm sitting. What's the reason for that?"

Kavi opened his suitcase, selecting the equipment he would be using as he asked, "There's a long bench outside. You've worked so hard to finish your bullfighting performance, you're exhausted, and your muscles are sore. Wouldn't it be more comfortable to lie down and rest?"

Anders had always felt that he was not injured, but he was taken aback by this inexplicable question.

He braced himself against the pristine white sheets, trying to turn to his side, wanting to quickly lie on the operating table and slap the young surgeon in the face. But his body instinctively resisted his mind; he simply couldn't lie down!
"How are you? Can't lie down anymore?"

"I just don't want to have surgery. If I lie down, wouldn't that be tantamount to agreeing to it?"

Before he could finish speaking, Kavi stepped forward and slapped him on the shoulder. Anders hadn't expected this, and his aching muscles couldn't withstand the force; his elbow buckled and he collapsed.

Lying down is indeed much more comfortable than sitting, as many muscles that maintain posture are relaxed. But this comfort lasts for less than a second, followed by abdominal pain, an indescribable, intense pain.

Anders felt like a frog suddenly thrown into a hot pot; his body jerked violently a few times before he sat up again. He clenched his teeth, gripped the sheet tightly with his left hand, and tried to cover his stomach with his right, but quickly pulled it away as soon as he touched it. He could only pinch his thigh muscles hard, hoping to endure the excruciating pain.

"Do you understand?" Kavi explained slowly, "Without surgery, you'll be in pain forever."

"What, what, is wrong with me?" Anders really didn't understand. He was fine just now, so why was he in so much pain that he couldn't even speak properly as soon as he lay down?

Kavi turned to Director Antonio: "Director, do you know why?"

“Yes, it’s muscle protection, caused by inflammation in the abdominal cavity.” Antonio answered quickly, recalling the description in the magazine, but soon had a new question, “But Anders only had an external injury, there shouldn’t be inflammation, right?”

"Sir, let's call each other by our names. It will make it easier to communicate during the surgery."

Kavi changed his form of address and then answered his question: "Muscle guarding is caused by irritation of the peritoneum. Inflammation can irritate the peritoneum, and other things can also irritate the peritoneum. Trust your body's natural response to irritation; if you get pricked by a needle, it will hurt; if you eat something bad, you will vomit."

"So that's it."

Kavi pointed to Anders: "I don't know if you've encountered this in your work, but this one is pretty classic. You can give him a try."

No need to ask any other questions; just the word "try" is enough to reveal Antonio's true abilities.

People who haven't read the magazine or haven't actually used it certainly won't understand what "try it" means.

The so-called "trial" refers to abdominal palpation. While modern CT scans may have replaced some palpation examinations, and the final diagnosis tends to favor CT results, abdominal palpation is merely an initial screening. However, in the 19th century, palpation was the sole indicator for diagnosing acute abdomen; it was of paramount importance and directly affected subsequent treatment and patient prognosis.

Antonio knew this very well and immediately went to the operating table, gesturing for Anders to lie down.

The pain had made Anders very nervous, like a child who had been thoroughly teased, clutching his vulnerable stomach tightly, not wanting anyone to come near. But the pain also made him restless, shifting his position as if hoping for help: "Can't we just examine him like this?"

Antonio gently touched his stomach. Apart from the feel of the abdominal muscles, the entire abdomen was quite soft, unlike that of a standard muscle guard.

Just as Bergett was about to remind him, Antonio realized what was happening: "An abdominal examination requires you to lie flat with your knees bent, Mr. Anders."

Anders even seemed hesitant to shake his head, stopping after a couple of simple tremors: "I don't want to, I don't want to lie down. Sitting like this is fine too."

“You have to lie down.” Antonio didn’t give him a chance, pushing his shoulder with one hand and shielding his back with the other. “I’ll help you, take your time.”

Anders had no leverage to refuse; the struggle itself was too painful for him to move, so he could only slowly lie back down on the operating table. As soon as he lay down, the abdominal pain returned. Fortunately, this time the movement was small, and the pain was much less intense; he could grit his teeth and bear it.

Antonio's movements weren't perfect, but the general direction was correct, and he did everything he was supposed to: "There was tenderness, and muscle guarding was also very obvious, distributed throughout the entire left abdomen, but rebound tenderness was not obvious."

“That means the inflammation isn’t obvious; it’s probably bleeding.” Bergert looked at Kavi. “Let’s start the examination directly.”

"Yes, proceed directly to abdominal surgery."

Upon hearing the word "open abdomen," Anders' head nearly exploded: "No, Dr. Kavi, I don't want surgery!"

"Are you just going to wait to die without surgery?!"

Spending time with Kavi, Bergert began to resemble him somewhat, his attitude towards uncooperative "die-hards" hardly any better. Coupled with his Spanish disguised by an Austrian accent, and his often overly forceful muscle contractions, his expression became particularly menacing.

"Look at you now, do you think you can even go to the bullring? A newborn calf could probably knock you over."

"What do you mean by this?" Anders was so agitated that he twisted his body, which strained his abdominal muscles, making him wince in pain. "Dr. Kavi, just let me rest for two or three days. If I'm not better by then, we can have the surgery later."

"Two or three days? I'm afraid you won't be able to wait that long."

Kavi didn't want to perform any invasive procedures; patients who clearly needed open surgery didn't need to endure another needle prick. But seeing how adamant he was now, he had to do it anyway: "Go, bring me the puncture needle."

"it is good."

Berg nodded and turned to open another box.

"Piercing?" Anders' brow relaxed slightly. "What do you mean by piercing?"

“A normal person’s abdominal cavity is clean and there is no blood, but you are different. You are very likely to have internal bleeding due to an impact to your internal organs, so we can puncture and extract non-clotting blood.” Kavi stepped forward and pointed out the location with his gloved fingers. “You don’t need to lie down anymore, just sit and have it done. The location is in the lower left abdomen.”

"You mean to make a hole in my stomach?"

“Yes, it’s a very small hole.” Kavi took the syringe from Bergett. “But I must warn you, Mr. Anders, this is the last time. I’m not a bull, and I don’t have any darts stuck in my body. I don’t have that much time or patience to keep playing with you.”