Nineteenth Century Medical Guide

Chapter 103 100. The Big Wave
It took Kawei less than a minute to quickly complete the report in the form of a bad journal. He watched and talked about the whole process, but he didn't seem to say anything.

This practice deeply stimulated the nerves of those surgeons.

Not even the meanest anatomy professor in medical school would talk like that when it came to troublesome students.What's more, the person standing in front of Kavey is still a director-level doctor who has been cultivating in the surgical theater for so many years, and the report is still on the table surgery, how can he be so foolish?
You should clarify the details!
"End?"

"It's over." Carvey spread his hands, "It wasn't a good operation in the first place. It was Dean Watman who put me in this position. If you have any questions, please ask. If you have no questions, let's leave. I can see that everyone is quite tired after a busy day."

Saying this made the doctors in the audience very depressed.

If it was in the past, how could they bear such humiliation, if there were young people in the arena making such mischief, it would definitely cause huge criticism.At the least, they were sprayed off the podium, and at the worst, they were directly blasted out of the academy venue.

In fact, that's what they planned from the beginning.

An unremarkable lumberjack, by chance, went to work in the Municipal General Hospital, and by chance, he performed one or two surgeries at Ignatz's suggestion.

Small citizens will call him a once-in-a-century surgical genius after reading the report. Young surgeons may envy his surgical talent, but chief doctors who have already made some achievements feel differently.

As the front waves, they would also envy the back waves, but the back waves were so violent that they were about to become giant waves, and they might be able to swallow them up before reaching the beach.

Envy, therefore, quickly turns into envy.

Some were jealous of the complex surgery Carvey had performed, while others were more theological, envious of how much God had cared for him.

Of course, these two operations exist objectively, and the process is almost perfect. As senior surgeons, it is impossible to miss it.But their purpose is not pure. In addition to learning some details, they must also have some doubts.

It's a pity that the aristocratic certificate that Carvey just presented has quietly planted the seeds, subtly suppressing their thoughts in the bottom of their hearts.
The regular meeting of the College of Surgery is not about drinking and eating, chatting and joking among colleagues, but about communication and learning.The new trends in the morning were just a fresh look, but what really attracted them was the surgery report in the afternoon.

In the first half of the report, there was not much dry stuff, and many doctors chose to ignore it, because they were also doing those surgeries at ordinary times, and it was nothing more than the success rate and postoperative recovery issues, which were out of their control.The second half was different. It was a major operation that they rarely did, and the technical difficulty went up several steps.

For example, rhinoplasty + mandibular resection is not something that everyone can dare to do, and even if it is done, there are not so many successful cases.According to Carvey, the cesarean section depends on oxytocin, and the appendix depends on a little luck in finding it.

The technical threshold for these operations is very high, and the success rate is very low, but at least they know the operation process, and some have even done it, but the success rate and courage are not enough.

In contrast, the last on-site rapid hemostasis suture is really a blind spot for them, let alone doing it, they have never even seen it.

Those few who had been to the front line as military doctors stayed in the rear field hospital for surgery during the war.The difference between the front line and the rear is too far, and it must be too late to send it back by a field carriage.In case of serious limb trauma, they had to amputate on the spot, and the neck trauma disappeared halfway.

But the city is more troublesome, there is no emergency system, and the streets and alleys are intricate. Regardless of whether the road is big or small, it is rush hour in the morning and evening, and traffic jams are also the norm. 【1】

With such external conditions, severe trauma can only wait to die on the spot, and doctors have no chance to practice.

Many people have never even seen a patient with a ruptured jugular vein, let alone how to control the incision and suture it quickly before the blood flows out.And cricothyroid membrane puncture after neck hematoma is a fantasy for them.

The questions are all based on the complete report to check for omissions and fill in the vacancies. Now Kawei clearly does not want to talk about it, throwing away an answer, and not even letting the students think about it by themselves.

They have no way of asking, and after much deliberation, they still have to restore the entire scene from scratch.Since it was an on-the-spot first aid, it needs some on-the-spot feeling: "Can you describe Mr. Li Ben's basic situation at that time?"

"There's blood all over the place, and there's blood on people too, so I'm not good at describing it." Kawei thought for a while, and said, "If you insist on making a comparison, let's put it together with dozens of leeches on your body." His face turned pale when he was sucking blood."

"Excessive bleeding?"

In this day and age, doctors are worrying about the amount of blood. If there is too much blood, it is natural to use bloodletting therapy, but if it is too little, it will not work.It is obviously impossible for dozens of leeches to eat together. It is conceivable how exaggerated Li Ben's blood loss was at that time.

In history, many people have tried to stop bleeding, from the earliest physical pressure on the body surface to later turning into a large area of ​​boiling oil with a soldering iron, and now returning to the embrace of physical pressure, the sutures can be made more precise and detailed.

In fact, in the not-too-distant future, when electrical equipment enters medical treatment, hemostasis methods like soldering irons will return to the hands of surgeons.It's just that compared with the middle ages, modern electric knives can also be more precise and detailed, and can even replace some of the functions of scalpels.

However, the theory of four liquids has always had a blind spot. There has always been only bloodletting, but no blood transfusion.

If the doctor really judges that the patient's blood is insufficient, he can only rely on the prepared herbal medicine to replenish the blood slowly. More direct blood transfusion has always been a problem. 【2】

Carvey can't do blood transfusion now, what he can do is to stop the bleeding in a short time and reduce the risk of death, and this is what the doctors in the audience want to hear most: "Dr. Carvey, in the face of such a wounded person At that time, there were wounds everywhere, bleeding everywhere, how do you judge?"

"Because the neck incision is very long and the bleeding is the most, considering the carotid artery, I must check the neck wound first. Of course, before checking, I have to see if the thigh wound has injured the femoral artery. These two must be more The arm is important and needs to be dealt with first."

Karvey's two simple sentences sounded like a bible to them: "How do you check this?"

"Of course I checked."

"The bleeding in the neck is very serious. Once it is opened, can it be stopped?"

Doctors who have undergone cesarean section know how violent this bleeding is. The uterus leaks out continuously in a large area, and the veins themselves flow out like a broken water pipe.Their concept of hemostasis is still passive observation and large-scale oppression, and they are not familiar with fine suture ligation.

"If you don't open it, how will you know whether it's a broken artery or a vein? If you don't open it, how will you know where the injury is? How can you stop the bleeding if you don't open it?" Carvey asked three times in a row, leaving the audience speechless. It’s just a matter of speed, once you open it and see serious bleeding, you need to look for the bleeding point immediately.”

"and then?"

"Use the crow's beak forceps to clamp and close the blood vessels to cut off the blood flow."

".Can you be more specific?"

Carvey was a little helpless: "It's already very specific."

"Dr. Carvey, you may have misunderstood. What we can't understand is how you can find the bleeding point in a neck wound that is overflowing with blood with only a candle lamp. You must know that although the wound is ten centimeters, but It wasn't too long, and you were alone at the time."

"It's incredible."

"Although it is not very polite, I still have to doubt the authenticity of the case."

After hearing these words, Carvey finally "followed" their train of thought: "Oh, this is what you are asking, I asked Mr. Li Ben to pull the hook."

After speaking, he imitated Li Ben's actions at the time and made a two-sided look: "He helped to pull the hook, exposing enough vision, and I can provide light with a candle in my mouth. Next, I only need to use my fingers Block the gap in the blood vessel, suck up the blood, and then follow up with the crow's beak forceps, and the bleeding can be stopped."

"I see."

"This is probably the young man's on-the-spot reaction."

"It's amazing, kind of makes me dream back to the era when there was no ether more than ten years ago"

"The patient was lying in the hospital, and the situation at that time was also recorded at the police station. If you don't believe me, you can go and investigate." Carvey was also tired, and he didn't bother to talk to them about things other than the operation. "It's the same sentence, Believe it or not, I don't care anymore."

"We just find it incredible because we've never seen it done before."

In Carvey's eyes, hemostasis of large blood vessels is only the basic skill of emergency surgery, because this is often the case in traumatic accidents. If even the hemostasis of large blood vessels cannot be done well, at least half of the emergency wounded will die in the debridement room.

But in the 19th century, this basic skill was a brand-new technology that overturned everyone's thinking.

The technique cannot be learned overnight. If you want to be proficient, you need to memorize the detailed neck anatomy first, and then practice it slowly with a large number of neck trauma patients.When the fingers are familiar with the touch of the skin and muscles, the feeling of blood flowing will become more and more obvious.

It's really out of line for them.

In order to quell the discussion, and to cool himself down and keep a low profile, Carvey had to draw a cross on his chest, and then gave half of the credit for stopping the bleeding to God.

"Maybe God blessed me with a pair of skillful hands that could save people at that time. Anyway, the whole process of stopping the bleeding was like this. After I found the opening and found that the blood clot had blocked the opening, I didn't do it again. Vascular suturing."

Speaking of this, Carvey suddenly remembered cricothyroid membrane puncture: "Oh, by the way, Mr. Li Ben had a severe hematoma around his neck due to neck compression to stop bleeding. The swelling compressed the trachea on the inside, causing breathing problems. Difficult. In order to facilitate first aid, I first performed a small operation similar to a tracheotomy to reopen the airway."

Everyone only knew that it was a complex knife wound hemostasis suture, plus Laszlo's gas cut, but they never thought that there was a gas cut at the murder scene at that time.

"You said tracheostomy is a minor operation?"

"The tracheostomy itself is not a small difficulty." Carvey made adjustments considering the factors of the times, and explained, "Because the time for hemostasis is limited, I just used a needle to make a hole in Mr. Li Ben's neck."

"A gas cut can also be used to open a hole?"

"Is opening a hole useful?"

"Where is it?"

"The cricothyroid membrane above the trachea." Carvey touched his neck, "here."

"A gas cut can also be performed here?"

"Yes, but there are certain dangers, and it must be used only in unavoidable situations." Cavesuo put Laszlo's tracheectomy together and said, "For example, Mr. Laszlo's laryngeal edema at that time, it was just You can do cricothyroidotomy. Because the cutting speed is fast enough, the recovery is also fast, but the disadvantage is that it cannot last long.”

The strange hemostasis followed by the never-heard cricothyroid membrane puncture, all of which seemed so simple under Carvey's understatement, so that those surgeons with high self-esteem had the illusion of entering a magical world.

The regular meeting didn't officially end until six o'clock in the evening.

Carvey's first participation in the conference was almost zero, but he had made troubles with several doctors. For this reason, he had to go to the dean's office immediately and ask Watman for the admission letter: "Dean, I've said everything I need to say, have you sent the letter?"

"You are really studious, always thinking about this matter." Waterman gave him a blank look, and said, "I have already handed it over to the postman."

"That's good."

A big stone landed in Carvey's heart. With Watman's letter of introduction, coupled with his current achievements, it was not difficult to enroll: "Dean Watman, are you particularly familiar with Dr. Lister from England?"

Watman looked up at him: "It's not particularly familiar, what's wrong?"

"Can you give me his address?"

"Why do you want his address?"

"I want to write him a letter about carbolic acid."

"I don't have the specific address, why don't you send the letter directly to his hospital." Watman wrote a specific address by hand, ".It's a hospital in London. By the way, do you speak English?"

"Yes, I am very interested in two medical journals in the UK. One is BMJ and the other is Lancet, so I have learned a little bit about it."

Watman frowned: "British Medical Journal? You can publish the operation records in an Austrian medical journal."

Carvey shook his head: "Look at today's regular meeting, I'm afraid it will attract a lot of accusations."

"Hey, a bunch of stubborn people." Watman couldn't help it, and said with a wry smile, "Are you interested in his carbolic acid? It's much cheaper than your alcohol."

"Carbolic acid is indeed much cheaper." Carvey first affirmed Lister's disinfection method, but immediately changed the subject and said, "But I think carbolic acid still has many hidden dangers. There are many reports claiming that it is toxic. If If you want to use it in the clinic for a long time, you need to switch to a safer disinfectant."

"It's hard to find a substitute."

"Oh, I already have an idea, and that's one of the reasons I'm writing this letter."

(End of this chapter)