Nineteenth Century Medical Guide

Chapter 101 98. You have nothing!

Women in patriarchal society have always been weak and useless representatives, beautiful but also very fragile, that is, vases that can bear children.The fact that a girl of such a petite stature can fuck two men is more storytelling in itself than cesarean section.

Carvey was surprised to find that these surgeons have always held a skeptical or negative attitude when faced with a reasonable disinfection model.But when they heard the successful deeds of a woman who overthrew two men, they agreed that all of this was a real fact.

In the end, they just believe what they want to believe.

As an eyewitness, Carvey briefly described the process of Nora's "assault". The exaggerated range of motion and the rhythmic stabbing process gave this cesarean section a layer of legend.

"Is she really only less than 1 meters?"

"Well, a little over 1 meters."

"It's so strange. Unless a girl of this height is full of muscles, she is severely lacking in strength. Moreover, she is wearing a skirt, which makes it very inconvenient to move. Even if she is a sneak attack from behind, without strict military training, there is no way to simultaneously Deal with the two men."

"Is she a veteran?"

"She's a girl! A girl!!!"

"You are too ignorant, and there is no precedent for women disguised as men to sneak into the military camp."

"Would the Austrian army want a soldier under 1 meters?"

After their analysis, Carvey suddenly realized that he seemed to help Nora create a space for revenge unknowingly: "I think the oppressed anger is her best source of strength, and the rest is classified as the blade is sharp enough. Bar."

"In a narrow space, if the weapon gap is too large, it is not impossible."

"Wait, are you ignoring an important question?"

"what is the problem?"

"No matter how sharp the knife is, it must hit the person. She just had a cesarean section and she is very weak and short. Why should she cut someone? Especially that part." The man tried to imitate what Carvey said. Recalling the process of Fleurney turning into a sieve, "Such a large upper and lower waist movement, the vertical incision in the abdomen is easy to collapse."

The so-called interest is the best teacher in learning, and soon their interest in Nora gradually shifted to surgery.

Because this result is the product of various coincidences, Carvey still needs to explain it carefully: "The incision is actually not bad. The one who sewed up the incision itself was Dr. Heman from our hospital. The operation was stable and delicate, and there was no problem with the alignment. After the operation I did a cleansing of the incision and then put a lot of bandages on the abdomen to prevent it from opening."

"Doctor Herman? I remember that his suturing skills are only average, and he probably hasn't reached this level yet."

It's true that Herman's stitches weren't great, but they underestimated the role of facilitators.As long as he helps to close the incision, then determine the position of the needle, and then stabilize the suture knot, even if he is an intern who has just learned how to tie a knot, Carvey can directly lift him to the standard level of surgical suture.

What's more, Heman performed a lot of operations, so he already had a solid foundation, and he was far from being so unbearable.

Carvey naturally omits these processes, emphasizing instead the high concentration of alcohol used:
"There is one thing worth noting to all of us. The dehiscence of the incision is not only a problem of suturing, but also a problem of healing. Under the interference of miasma, the incision will soften and fester, so I will use high-concentration spirits before the operation. The brandy after the second distillation cut off the miasma."

This is an attempt by Kavi, hoping to use Nora's bravery to help him open the situation.

The effect was not bad, and some doctors finally became interested: "Alcohol can block miasma?"

"Correct."

Carvey smiled and told the reason he made up at the beginning: "Miasma and festering have an unpleasant smell, and alcohol has a fragrance, which can resist the invasion of miasma. If everyone can let go of their prejudices, look at Liszt The carbolic acid used by Mr. is actually the same as the alcohol I used, because carbolic acid also has an aromatic smell."

"."

The stage was silent.

They are old stubborn people who grew up in the swamp of Austrian conservatism, and they are unwilling to easily believe in all new theories and discoveries that are contrary to "common sense".

But their profession is surgeons who must be at the forefront of technology. Compared with internal medicine with unknown effects and obstetrics with insufficient data, surgery with immediate surgical results is more likely to expose problems and needs to be solved.

These surgeons said that the ulceration of the incision is a matter of probability and has something to do with piety, but they still hope to change the status quo.Who would like to have a painstakingly performed operation and a painstakingly stitched incision, and finally turn into a large piece of rotten flesh?

Carvey gave them an opportunity to re-understand surgery.

Of course, Nightingale's bold attempt, Dr. Lister's innovation, and Waterman's persistence are also included here.Coupled with the incision infection rate of less than 20% and the mortality rate of 0% in Carvey's hands, it is enough to explain the problem.

But Carvey knew that even in the face of so much evidence, they still couldn't pass the hurdle in their hearts.

So he didn't force it, put the anti-infection aside, and introduced his new oxytocin drug first: "Forget it, let's talk about the operation first. At that time, the patient's uterus was bleeding severely, and we could only use crow's beak forceps and hands to stop the bleeding. .”

This is a problem with all cesarean deliveries.

In the 19th century, cesarean section was difficult to obtain a fetus, and the uterus was a long longitudinal incision similar to the abdomen, so it was quite difficult to stop bleeding.The vast majority of cesarean deliveries who died on the operating table were related to heavy bleeding, and most of the mothers who died after surgery also suffered from heavy bleeding.

"Several seniors present at the scene should have gone to the surgery site at that time. I used a new obstetric drug from the East." Carvey dug out his pocket and took out a tube, "This colorless and transparent liquid can be used in the original On the basis of uterine contraction, further violent contraction allows the uterus to stop bleeding by itself in a short time."

"how to use?"

"Into the muscular layer of the uterus with a syringe."

"Is it really that amazing?"

"It's really amazing, and the effect is remarkable"

It always seems flimsy for a person to boast, and the surgeons who went to the scene had to admit the effect of oxytocin after seeing Kawei’s sight: “It is indeed a very useful drug, I forgot how many injections were given. , but the swollen uterus quickly shrunk by half, and the bleeding soon stopped."

"I can also testify that the hemostatic effect is almost like magic. Although as an excellent surgeon, I should not describe it like this, but it is really difficult for me to find a suitable analogy to describe this thing."

"The hemostatic effect is indeed good, but some long-term verification is needed for the side effects."

Carvey heard a different voice, and immediately followed up and said: "I have used medicine on voles, and there is probably only one side effect, which is increased blood pressure."

"Blood pressure? How did you measure your blood pressure?" [1]

"You know, even with the most advanced blood pressure monitors, there is no way to accurately record the readings. Blood pressure is a very vague concept. Please be sure to explain it in detail."

There really wasn't a blood pressure monitor handy at City General Hospital, and Carvey sacrificed quite a few voles in order to be able to test the limits of oxytocin.Now he needed an old concept to explain the new concept of elevated blood pressure. The first thing Carvey thought of was the theory of four fluids: "Another way of saying it is probably to increase blood."

Hearing this sentence, the puzzled eyes in the audience instantly understood everything.

"The old blood pressure measuring machine in the General Hospital was too big to work on hamsters, but I chose a more ancient method, such as the carotid artery puncture blood column method in the 30s."【2】

Carvey sighed: "I later learned that there is no need to record any detailed readings at all, because as long as a large dose of oxytocin is injected, the blood pressure will increase sharply. If the dose continues to increase, the voles will die in a short time. Caused severe internal bleeding."

The theory of four fluids, which can be passed down for thousands of years, can indeed be justified under certain circumstances, and now it has finally become an important tool for Kawei to promote his own medicines.

Compared with "helping to shrink the uterus" and "stop bleeding in a short period of time", the increase in blood is not a particularly harmful side effect.For cesarean women who have lost a lot of blood, there is no harm in adding extra blood and raising blood pressure.

"Dr. Carvey, have you tried to put the drug into production?"

"It will take some time to officially go into labor." Carvey said, "However, considering that there are still several pregnant women who need cesarean section sleeping in the ward, I made another batch of drugs for subsequent use."

"Have you considered the price of the drug after it was put into production?"

"Due to problems in the production process and raw materials, the cost of the drug is quite high, and the price will naturally not be too cheap."

The current crude chemical industry level makes Carvey very helpless. The production time of natural leaching is long and the operation is cumbersome, which is much more difficult than the synthetic method in the future.But right now there is only one way to leaching, and the only way is to use pig brains later to suppress the cost.

"On the premise of protecting the patent, I will try to reduce the cost as much as possible, so that at least all women who need cesarean section can use oxytocin."

After talking about oxytocin, Carvey began to go over the details of the operation from beginning to end, including abdominal incision, uterine incision, fetal retrieval method, how to obtain the placenta after fetal retrieval, how to further stop bleeding, how to suture the uterus, and the final abdominal cavity exploration, etc. Wait
Although Watman added the adjective label "nearly perfect" to this cesarean section, in Carvey's eyes, it was not perfect, because the first half of the operation was always in the hands of Hills.Moreover, obstetrics itself is not Kawei's strong point, and there must be room for optimization in the process.

Next comes placenta previa, which is more dangerous for bleeding. Carvey still has a long way to go on the way to cesarean section.

"At the end of this cesarean section report, I still want to talk about another patient in advance."

Cavet specially prepared the negative teaching material of Li Ben: "He is a survivor of the murder case. If you have the program list in your hand, you should be able to see that the patient with compound trauma at the end of the whole regular meeting is him.

I didn't mean to disrupt the flow of the meeting, I just wanted to use him as a negative example when it comes to preoperative preparation and postoperative care.

Among the surgical patients I took over, he was the only one who did not have preoperative preparation and postoperative care.The other is Earl Moraso. Everyone has listened to Mr. Ignatz's report before, and it is clear to what extent his large wounds have festered.

However, Li Ben's wound was more serious! "

Li Ben's bed was poorly ventilated, and he did not receive strict nursing care, and all four stab wounds were infected.

Especially the obliquely long wound on the leg, which was already swollen and festered, with yellow-green pus leaking out every day.According to Ignatz's approach, this situation must be amputated immediately, otherwise his life will be killed in a few days.

But Carvey still wants to wait a little longer, and do a thorough debridement to see if there is any possibility of recovery.

Of course, when facing Li Ben, he would definitely not treat the experimental mice in this way.Li Ben's heart was full of hope for conservative treatment with just a few words and a few words.

After all, no one wants to spend the rest of their lives with prosthetics and crutches.

"Mr. Li Ben was stabbed four times. Because there was no qualified equipment at the scene, I could only help him to stop the bleeding and suture at the first time."

Carvey avoided all the details of the operation, and went straight to the topic of anti-infection: "It's only been a few days now, all the incisions are festered, the sutures on the legs are half broken, the wound is open, and the stench is emitted every day. Considering that Mr. Li Ben is strongly With a conservative treatment attitude, I decided to use Mr. Lister’s carbolic acid to give the most thorough debridement.”

Just when he was about to continue talking, Hills' voice suddenly sounded from the audience: "Kavi, don't waste any more time."

Kavi was stunned, glanced at the other people who had been silent until now, and asked, "What's wrong?"

"First of all, I would like to make a statement. I am not jealous that you took away the cesarean section. I know that I am not strong enough. If I persist, it will inevitably lead to disaster, and I will not be as safe as Nora's mother and child."

"In Austria, it's not easy to prove that what you and Mr. List are doing works, and what you're doing doesn't work," Hills said.

"Why doesn't it work?" Carvey was puzzled. "Just because I didn't go to medical school? Don't have a diploma and a corresponding degree?"

"This is one of them." Hills said helplessly, "The second is that you are at best a qualified young surgeon with no experience, no qualifications, and no social status. Except for one or two successful operations that were inexplicably performed , nothing. Even if you have one, I wouldn’t talk to you like this.”

"I am telling the truth!"

"How can you convince us it's true? Just rely on a dozen patients who are safe and sound?"

"Isn't that enough?"

"Which of the surgeons present has never been successful? It's just the result of God's temporary gift!" Hills continued to persuade, "Wait for you to be the surgeon in the surgery theater for a whole year, with the postoperative recovery of hundreds of surgical patients. Let the data come here again to brag about that nursing process. Maybe by then, some people will believe you."

Carvey sighed, gaining a more direct awareness of contemporary notions of class.

No wonder Watman, who is in a high position, dare not act recklessly. With the conservative style of this group of people and the internal power struggle, if they are a little tougher, they will inevitably divide the college into two factions: disinfection and non-disinfection.

It would be much easier to bring it up by Carvey, and no one would take him seriously.Even if there is a split between the two factions, it will not be too late for Watman to mediate again.

Thinking of this, Carvey did not anger Sears, on the contrary, what Sears said saved him a lot of unnecessary saliva: "I would like to ask everyone here, if I were replaced by Professor Ignatz, the content just now is terrible. Is the reliability much higher?"

"Of course."

"At least there is a need to try."

"Even if it's Vice President Edinson, who made Ignatz a Baron?"

"The baron. In the end, we still have to see who we are." Carvey wanted this sentence, "If I am also a baron, will it be all right?"

"Stop joking, how could you be a Baron?"

"Isn't your father a barber? How could he have a title?"

I saw Carvey took out a certificate that had been prepared for two days from his pocket, it looked crumpled, but it was indeed the royal seal: "I am the eldest son of Baron Anderson Edmund, this is my hereditary certificate. "

(End of this chapter)