Nineteenth Century Medical Guide

Chapter 100 97. Let you mess up the situation, not let you mess with me

The whole regular meeting seems random, but Watman's small intentions are everywhere.

First, Lister and Nightingale introduced the new concept of surgical disinfection and nursing, and then arranged several seemingly good new trends in surgery, but they were not allowed to be selected for the afternoon surgery report because the patient died of postoperative infection.

Postoperative infection, ie ulceration of the incision is very common, and no one cares about it during this process.

So in the end, Waterman deliberately started with Ignatz's groin squeeze hernia, and then added fuel to his own mandibular suppurative osteomyelitis.Both patients had severe inflammation in their bodies. Generally speaking, conventional surgical incisions would inevitably fester, but more rotted and less rotted.

But both operations were successful, and there were some twists and turns in Morazo, but the situation was reversed in the end.Both patients' incisions healed and both survived.

The facts were already in front of him, there must be something that blocked the miasma in the air and prevented the incision from festering.

Seeing that the surgeons who only wanted to improve their surgical techniques had no response to the incision ulceration, Watman had no choice but to rely on Carvey to advance his intentions.

He knew that Carvey wanted to promote preoperative disinfection and various postoperative nursing work, which happened to coincide with his own ideas, and the other party was also a "master" in abdominal surgery.Let him be the vanguard to ask about disinfection care, and it can also help share some of the firepower of the conservatives.

Of course, the questioning method also requires some skills. According to Watman's vision, the best questioning content should be like this:

[Why do so many patients die from incision ulceration, while a syphilis patient who has always been weak can still avoid ulceration after undergoing such severe and complicated operations? ]
With a simple question and answer, Watman was able to point out that he was trying to do what Lister did, using carbolic acid-soaked cotton flannelette for wound protection. 【1】

Once the answer comes out, combined with the debridement of Earl Morazzo's groin, it can not only promote this nursing method, but also pave the way for Carvey's coming on stage
make a foreshadowing
bedding
How do you lay the groundwork now?

Foreshadowing a ghost! ! !
I asked you to come to disrupt the situation, but I didn't ask you to interfere with me.Such a sentence popped up out of nowhere, how do you want me to answer it?
Say you are right and save your face, but I am wrong.If you say you are wrong, you will lose all face, so what can I use as an excuse?
Watman listened to questions that were completely different from what he had expected, and his mind, which was full of disinfection methods, went blank when he was asked, almost restarting.

A mandible made of ivory?Return silver
Although he was surprised and didn't keep up with the train of thought at first, Carvey's modern idea of ​​using other materials to replace bones has never been mentioned, which is very fresh.This curiosity secretly activated his surgical thinking, thinking about the feasibility of this approach as if he was not under his own control.

Cut out the mandible and make a new mandible?

This is not rhinoplasty, just get some skin from the side and put it together.Bone replacement is unheard of, can it really be filled with other materials?
How to do?
Watman was stunned in front of the podium, and there were all kinds of discussions caused by this topic in the audience. Because the dean didn't reply to express his position, there was a lot of quarrel. "The price is expensive", "the inflammation of the wound will be more serious after filling", "what to do with the joint", and "how to fix it" are all the focus of the confrontation.

But Watman was extremely quiet in his mind, as if the quarrels of these people had nothing to do with him.

If you really want to make a replacement, you must first measure the length, width and height of the patient's mandible?
No, each patient's infection site is different, and the surgically removed site is also different.This machine happened to be undergoing complete mandibular excision, but many patients had infection limited to one side, or only within the distance of 2-3 teeth. At this time, precise excision should be performed.

Precise resection means on-the-spot carving?
Then do I still have to find a famous sculptor to wait in the operating theater?Wait for the mandible cut off during the operation, and then compare the size?
It would be even more outrageous if it was changed to silver. You have to make a mold first, and then
Years of surgical work have made him used to dealing with problems from various angles. Once he reaches a dead end, he will think of other ways.

No, wait!
Why does this kind of thing have to be done on the spot?
Watman's thinking went back to the very beginning, measuring the length, width and height of the patient's mandible in advance, and then temporarily making the whole mandible according to this size.Then, after the surgery starts, a temporary interception will be made according to the removed part and size.

Yes, live interception!

In this case, the material is only ivory. 【2】

If ivory can fill the mandible, then the maxilla can certainly do it, and maybe those patients with bone and joint fractures can also use ivory joints to make brand new joints?
Mandible. Ivory
The mandible is not small, and the ivory is long. Is there such a thick ivory?
Or do it separately, half and half.

If the whole mandible is cut off, the left and right splicing is done. If only half of it is cut off, it can be used just right, and the remaining half can be reserved for the patient as a souvenir.If the other party does not want it, it can also be reserved for those poor people who have no money to make mandibles.

For poor people, it is definitely better to have a new mandible than an empty chin, and it doesn't matter whether it really matches their face shape.

In fact, as long as there are more materials accumulated, there will be more room for choices, which means that it will be more difficult when you first try.

It seems that you can try it! ! !

Under one of Carvey's problems, Watman had a new idea for cotton plastic surgery and even bone and joint surgery.Ignoring the chaotic situation in the audience, with a straight face, he quickly sorted out all the materials on his own, and then stuffed them into his bag.

Watman didn't say a word, just greeted the host on the side and hurriedly got off the stage and left the venue.Ignatz, Carvey, and all the surgeons on the field were considered air.

"The dean is so angry, you should be able to see how outrageous this statement is. It's ridiculous to think about stuffing a whole ivory in your mouth."

"What are you talking about? Wouldn't it be more ridiculous for someone to stuff an ivory nozzle into a steel door?"

"One is sewn into the chin and will not be taken out for the rest of the life, and the other is just for enema. Can this be the same?"

"I think it's pretty cool!"

"Cool P, think about it for a second, how would you feel if your butt was cut off, then ivory was stuffed into the butt, and then sewn with thread."

"It's such an exaggeration, isn't it still possible to make silver?"

"Silver? The weight is stuffed into your chin, you can eat something again! Oh yes, and the ass that my friend said, the ass is filled with silver, I'm afraid I won't be able to stand up for the rest of my life."

"What this stinky brat came up with is all weird things, which are not operable at all!"

"Actually, if you don't say a few words, the dean might not leave."

The only people in the audience who could really understand Watman were probably the two vice presidents. Ignatz looked at his father when he left, and said with a smile: "Maybe he really thinks that your approach is feasible."

Carvey didn't expect that he just tentatively threw out a concept similar to "artificial joints", and it became what it is now.

He didn't know when the earliest artificial joints were applied, and what materials were used. Anyway, in this day and age, there is no disinfection and postoperative anti-infection. There is still a long way to go before this kind of surgery can be done well.

Unfortunately, this certainty did not last long.

When the host called him to the stage to explain his cesarean section, Carvey found two manuscripts left by Watman on the podium.

It recorded in detail the various applications of carbolic acid by Dr. Joseph Lister, a famous British surgeon, not only limited to the application of incisions, but also sprayed carbolic acid spray on the entire operating theater with a pressure pump. 【3】

This greatly exceeded Carvey's expectations, because even he didn't expect to be able to reduce the amount of bacteria in the air in this way, which also reduced the infection rate of surgical incisions in disguise.

And this design is already moving closer to the operating room.

Carvey originally believed that the attitude towards surgical theater in the 19th century would not change much, and that it was almost impossible to set up a relatively sterile operating room.But who would have known that on the other side of the strait, someone had already started to introduce the concept of air disinfection.

Of course, if it is more rigorous, than "disinfection", Carvey prefers to use "corrosion" to describe the effect of carbolic acid.

However, carbolic acid is too toxic. If it is made into a spray, it will not only harm the surgical patient, but also the surgeon and other spectators present. Chronic poisoning will definitely not escape.

"Everyone, I didn't expect Dean Watman to leave." Facing the accusations from the audience, Carvey said with a smile, "If he guessed correctly, he should have thought of several ways to make ivory mandibular joints. Hurry up and go back and try.”

"Stop bragging about this, casual words are not convincing."

"Yeah, instead of arguing with us here, it's better to just talk about your cesarean section. We came all the way here not to watch you chat, but to really learn a little cesarean section technique, otherwise who Are you willing to sit under the stage and watch your high-spirited look and be angry with you?"

"It makes sense, let's just talk about surgery."

Carvey also wanted to talk about surgery, but Watman left these two pieces of paper not for decoration. His intention was obvious: You have to continue to make trouble for me!
Thinking that the other party was holding his own admission recommendation letter, Carvey had to continue to work hard: "Before reporting on my cesarean section, I think we still have to put an end to Dean Watman's operation."

"Didn't the dean leave?"

"The host has already called you, can you stop wasting time?"

Facing the doubt, Carvey didn't pay much attention to it, but just replied: "My question just now is indeed a bit wild, but if you say it's completely meaningless, that's not necessarily the case. Faced with mandibular resection, the appearance of the patient will change. A lot has changed. For those who love beauty to the limit, this method can definitely be tried."

"Don't be kidding, it's not difficult to resect the mandible. You just need to cut off the muscle and then saw the bone. It just needs some experience in resecting, otherwise you will accidentally injure the surrounding tissues. But you said that you want to rebuild the mandible and put the It is stuffed in. According to my experience, the operation time will definitely be infinitely prolonged, and the postoperative incision will definitely fester.”

"So Dean Watman's real purpose today is the pre- and post-operative care."

Carvey took out the two pieces of paper and pointed out Dr. Lister's achievements in this area: "That rhinoplasty must have used similar carbolic acid, and carbolic acid was used to protect the incisions and prevent them from festering."

"It's Liszt again!!!"

"This guy seems to be getting more and more wrong since he met Nightingale!"

"It must be another Brit trick."

Seeing them like this, Carvey still thinks that he should speak with data first: "Dr. Lister's hospital has been rejuvenated, and the mortality rate after surgery has plummeted. Especially for his amputation, the mortality rate has dropped to less than 10%."

"So low?"

"In black and white."

"Impossible! How can the death rate of festering be so low?"

"So I said, he used carbolic acid to smear the incision, and sprayed carbolic acid on the entire operating theater." Knowing that they were going to deny Liszt again, he compared Watman's operation again, "The dean The patient did not show any signs of festering, the key is the girl with a thin physique."

The same thing, as long as another person does it, the perception will be completely different.

Of course, Watman is not strong enough to make them succumb, and everyone is still in a competitive relationship of the same generation.They have the final say on whether to agree or disagree. Medical regulations are not rigid standards in contemporary times, and it is impossible to write them into systems and laws.

"Since you want me to talk about cesarean section, I have to mention the incision of cesarean section."

Carvey took out the operation diagram he had prepared, and said: "At that time, the incision that Mr. Sears made first was in the middle of the side, and the length exceeded 10cm. This kind of long incision is usually on the legs and other parts. The nightmare in the ward lasts for four days, and it will end in collapse."

The larger the incision, the more likely it is to be infected. This is the consensus of everyone, which is why the Academy of Surgery specially divided plastic surgery.

Because plastic surgery generally stays on the frontal face, the incision is small and the blood supply is rich.As long as it is handed over to an experienced surgeon, the operation time will generally not exceed 20 minutes, which has a good preventive effect on incision ulceration.

But if there is a large area of ​​damage to the limbs and trunk, things are completely different.

"My caesarean section was successful. The main reason is not how skilled I am in the operation, but the preparation before the operation."

Carvey went through the whole process, and then talked about the post-operative care.But the doctors in the audience are still not interested, they firmly believe that they are the most correct, and these useless efforts will only delay their work.

This further fueled Carvey's desire for debate, and it also made the regular meeting go in a strange direction: "Well, well, you must have no idea what my mother does after receiving all these nursing jobs .”

"What did you do?"

"A 1-year-old girl with a height of less than 6 meters was able to cut down two big men with a knife in less than 19 days after her stomach was forcibly cut open!"

(End of this chapter)