Nineteenth Century Medical Guide

Chapter 11 11. The Cleanest Oil
[Starting from this chapter, the content of the author's words is moved to this chapter.

If you really like this book, you can choose to read it on the qd main website. There are a lot of pictures and notes in this chapter, as well as some trivial letters, news reports and messages. I guarantee that the subscription is worth the money.

Of course, the premise is that you like it.]

Carvey didn't know that Ignatz had another laparotomy because there were no such patients in the surgical complex.In the other two wards, ordinary fractures, sprains, and several pregnant women were treated.

Of course he hopes to be on the operating table. It is difficult for a surgeon who is full of operations to relax.

Going on stage can not only be addictive, but also mention Ignatz and make some improvements to the current surgical methods.But if he had any vision for this abdominal surgery, I'm afraid Ignatz would be disappointed.

The abdominal cavity was a forbidden area for surgery in the [-]th century, and if you really had the courage to do it, it would be a trivial matter.After all, the time left for surgical operations at this stage is very short, and the cutting and splicing of delicate organs are often handled very roughly.

Roughness represents a hidden danger. Swelling, necrosis, and collapse at the anastomotic site of the broken end of the intestinal tract will eventually lead to intestinal fistula and peritonitis, which is the inevitable outcome of almost every digestive tract operation.

This is not only a problem of knowledge reserve, but also the reason why surgical instruments, disinfection, anesthesia and suture methods are too crude.

In Carvey's view, there were only two types of surgery that Ignatz could do: appendectomy and inguinal hernia repair.Even so, the mortality rate of the two operations is still in the forefront of surgery under the haze of postoperative infection, about 45%, second only to 60-70% of cesarean section.

This is because of the extra points given to the chief surgeon. If it were someone else, I'm afraid I wouldn't even have the idea of ​​touching it, so what about the success rate and death rate?

In the anatomical atlas compiled by Ignatz, Carvey has seen the improvement of amputation and the failure of abdominal surgery.He can feel the pain of the author's continuous setbacks from the accompanying text and drawing lines, and he can also feel his perseverance to continue to actively explore forward after the setbacks.

I'm afraid this time is another new attempt by Ignatz.

As for where he got the patient, Carvey didn't care, maybe it had just been sent to the hospital.The only thing he cares about now is to do a good job in the wound treatment of the 11-bed child, so that he can leverage Ignatz's concept of postoperative care and achieve the goal of improvement step by step.

Of course, the premise is that he can really do well.

According to Carvey's method, the child's wound needs to be debrided first.The clean water that has been boiled, closed and cooled is used, and the dirt and other dirt on the surface need to be cleaned as much as possible.Some necrotic skin and flesh had to be cut off as soon as possible to prevent the infection from spreading.

Of course, severe pain and screams during debridement are inevitable, and ether is not cheap, so it cannot be used at this time.

The next step is sewing.

There is nothing wrong with the stitching itself. The needle and thread are just bigger and thicker. It doesn't look so delicate, but it is not difficult to operate.

The key difficulty lies in how to deal with exudation after wound infection. 【1】

Under the dual effects of strict debridement and preventive anti-infection, ordinary wounds will heal after suturing, and the amount of exudate is not much, which can be handled by ordinary gauze dressings.If it is a large-area degloving injury, the doctor will cover the injured with a VSD (closed trauma negative pressure drainage set) [2] to deal with exudation after the debridement operation.

Carvey has nothing in his hand, the only thing he can think of is the lint he asked for before.

Cotton cloth has good water absorption, but its function is still too single, lacking the ability to drain exudate and the necessary airtightness.

In terms of drainage, there is really no good way, the only thing that can be done is to change the dressing frequently every day.It is relatively simple to create airtightness. There is no film application in modern use, and Kavi can be replaced by oil-soaked cotton cloth.

There are many kinds of oils, including industrial oils, such as whale oil and kerosene, and edible oils, such as the French dish last night.

"Let's rent a carriage, the restaurant is quite far from here."

"No, it's much cheaper to go back and forth in a stagecoach [3]."

"Here you go"

When Carvey was about to leave the hospital, Ignatz suddenly went back to the ward and brought him money for the carriage.The two 1-kroner coins were given very readily, but his face was not very good-looking: "After discussions with the upper management of the hospital, your salary is not much, and you can only give 7 kroner a month."

"so little?"

In fact, Carvey is somewhat prepared for wages. Looking at the income of doctors trained in the hospital and formally enrolled, one should know that technology will develop with time, but things like money are hard to change.

However, being psychologically prepared and acting indifferent are two different things. Even if you don’t get a satisfactory answer, you should still ask: “Last night you said that you can pay about 12-15 kroner a month. How can you just cut half of it now? ?”

"7 crowns is indeed a little less, but you can eat the staff lunch here for free, which is considered to save some expenses."

Ignatz felt a little ashamed, avoided his sight, looked back at the cotton cloth wrapped on the boy's left leg, and said comfortingly: "Actually, the money is not much worse, I will give you a certain amount at work. as compensation. Just now you said you would give me a chance, and I gave it too.”

He cleverly sent the legs of bed 11 to Carvey, taking this opportunity to excuse himself.When the child dies, he dies. The main responsibility lies with the patient and his family members, not himself. At that time, we can observe Kavey's reaction to adapt to the pressure.

Kill two birds with one stone.

When it came to this point, Carvey's mouth was basically blocked: "Okay, 7 crowns is 7 crowns, but I have a request."

"any request?"

"I can't afford the rent, and I can't keep asking you for money, or let me stay in the hospital."

Ignatz thought that Carvey would ask him to ask for rent money, and he wanted to agree, but he didn't expect this result: "In the hospital? Where do you live?"

"There is no dormitory here?"

"No."

"Then do whatever you want, as long as you have a place to sleep."

"Why don't you sleep in my office." Ignatz gave a good offer, "Sometimes I need an assistant when I dissect the corpse at night, can you be on call?"

"no problem."

"It's decided."

After leaving the hospital, Kawei quickly got into a carriage and rushed to the Rosh Shuyat restaurant.

The owner and chef is a fat man, a little taller than Carvey, with a very French name, Alphonse Françoise Rochesuart.He has aristocratic blood. After his family became lonely, he relied on his superb cooking skills to serve as the royal chef of the French royal family. He came to Vienna two years ago to open this high-end French restaurant.

As Carvey, without Ignatz, he would definitely not be able to enter the main entrance, so he could only find an opportunity to sneak in through the back door used by the back kitchen.

Anyway, he didn't come to eat, it's the same everywhere.

For chefs, the main hall where guests dine is an exhibition place for dishes, while the back kitchen is a battlefield.Before every big battle, the chef, especially the head chef, needs to check the preparation of various ingredients to prepare for the upcoming lunch market.

"Potatoes, onions, pork, steak, lamb chops, loin of lamb, flounder, butterfly fish, chicken, duck, quail, partridge, pigeon, snail, black fungus, mushroom, asparagus, lily, pepper, tomato, banana leaf and mouse Where's Tail Grass? Didn't deliver it?"

"There are still a lot of unused ingredients in the warehouse."

"when?"

"It was delivered at noon yesterday."

"Throw it all away tonight."

"Yes."

"Where's the lobster? Where's the lobster I specifically wanted yesterday?" Alphonse flipped the cooking table, feeling a little anxious, "You probably haven't stocked it!"

"Austrians don't eat seafood very much, and the transportation of lobster is very difficult. It is really impossible to reach Vienna today."

"If there is no lobster, what about cold dishes? Today's main dish is Parisian-style lobster cold dishes, and the brand has been posted!" Alphonse saw that everyone was silent, so he could only make his own decision, "Forget it, there are still chicken and quail. If there’s too much, switch to Portuguese stuffed chicken and warm quail pate.”

"Ok."

"Finally, let's review the menu of the Three Emperors' Banquet [4] again, listen carefully to me, and don't make any mistakes."

The menu came from the "British Cafe" [5] during the World Expo in Paris, France at that time.So after inspecting the ingredients, Alphonse only ordered a few details, and then got into his private kitchen.

Although he is a loyal fan of classical French cuisine, but because he has been to the far east and tasted a lot of local southern specialties, he is not conservative at all in the development of dishes, even a little weird.

"Where is the dried salted fish I asked you to prepare half a month ago? And where is the bottle of honey char siew sauce I brought back?"

"It's here. Damn, where did the thief come from!!!"

"what happened?"

Alphonse ran out following the sound, and the first thing he saw was the young man named Karvey last night.Immediately, what Ignatz said before he left was stirring in his mind, forming a sharp contrast with the current picture.

He agreed to become a surgeon and come to eat again, why did he go to the back kitchen to steal things after a day?
"Aren't you the poor boy from yesterday?!"

"I'm not a thief, I just want to ask you for something."

Alphonse didn't pay attention to Kavey at all, and watched the chefs in his hands grabbing his clothes tightly, and sighed: "Your hands are used for cooking, so you don't think it's dirty when you pull his clothes? Use your feet to understand." Don’t understand? Kick me out!!!”

"Alas, wait!"

"What are you waiting for, I don't want to see this guy again!"

"Master Chef, I just want to ask you to borrow something to save lives."

The title Chef should have made Alphonse feel at ease, but the person who spoke was too lowly, and it had the opposite effect: "Only you? Save people?"

Alphonse shook his head. Hearing the roar of laughter from the whole back kitchen, he said, "Doctors, especially those who can cure diseases and save lives, are all well-educated gentlemen. Don't think that having a meal with Ignatz will make you feel better." As a doctor, you can ask your teacher if he can enter the Royal Society of Physicians before you speak such big words in front of me."

What he said was the truth, the surgeon was indeed of low status, but it had nothing to do with the bottle of oil that Kavi asked for.

"It doesn't matter whether I'm a doctor or not, but I'm sure that you must often have dull throbbing pain or swelling pain in your upper right abdomen."

Pain is a very fuzzy concept. In the process from the patient's narration to the doctor's completion of the medical history record, there are three points that need to be improved: location, nature, and degree.But Kavi summed up all three points in just half a sentence, using the simplest and most direct method to make Alphonse change his mind.

"Why are you coughing, you all go to work, I will handle it myself."

From the look in his eyes, Kavi already knew that he had guessed the answer, and a big stone in his heart finally fell to the ground.

Alphonse dismissed the chefs under his command, pulled him into his room, and closed the door: "How do you know that I often have cramps and pains in my upper right abdomen? It's also vague that I haven't mentioned it to anyone. , you don’t know any witchcraft, do you?”

"This is medicine, it's science, it's not witchcraft." Carvey had the card of "health" in his hand, and his tone hardened, "I tell you it's okay, but I need to borrow a bottle of oil, your place is the cleanest oil."

(End of this chapter)