Nineteenth Century Medical Guide

Chapter 116 113. Surgery is surgery, patient is patient

For surgeons, the use of drugs means that anesthesia is complete.

But for anesthesiologists, the use of drugs means the beginning of anesthesia.

"Anaesthesia" has been an accessory to surgery since its birth. Until the end of the 19th century, the United Kingdom began to divide medicine into different disciplines, and anesthesia became an independent discipline, and there was a matching London Society of Anesthesiology.

But before that, anesthesia was a small component used during surgery to put patients to sleep.

In modern times, the Department of Anesthesiology has developed rapidly (the country is still quite miserable), anesthesia has changed from pain relief at the beginning to intraoperative maintenance, and the decision-making power for critical surgery has slipped from the palm of the surgeon to the hands of the anesthesiologist .

Surgery cannot be performed as long as anesthesia is not permitted.

But in the 19th century, when there were not so many particularities, anesthesia in people's minds had little to do with people, and the key was the bottle of ether.It seemed to make little difference as to who got the ether into the patient's body.

Naturally, the chief surgeon cannot do such unskilled work.

Anesthesia then falls into the hands of assistants, nurses and medical students.Amor, who is working as an assistant for Hills today, graduated from the University of Innsbruck School of Medicine, and was asked to give anesthesia to patients just two weeks after working.

[Here, give you ether, let Mr. Edward sleep well. ]
This is the "anesthesia order" that Amor received. There is no dosage, no duration, no need to monitor any vital signs, and no need to consider the patient's underlying disease.He only needs to uphold one principle, falling asleep is equal to successful anesthesia.

The anesthesia before the operation was completed beautifully. Edward felt a little retched and fell asleep immediately.

Ether works quickly, but also loses its effect quickly, and the patient wakes up in less than an hour.

The second anesthesia during the operation was inherently risky, coupled with Amor's panic, the anesthesia did not go smoothly.But no one could say he was doing badly, because Edward did fall asleep again, and that was success in their eyes.

"Ms. Hills"

"Pull the hook, if there is anything I don't understand, I will talk about it when I close my stomach."

Hills immersed himself in the operation, and after the early stumbling, he felt that he had mastered the trick of cutting the mesorementum.The mesangial tissue at hand did not bleed much, and suturing and knotting became more and more handy.Sure enough, leaving the comfort zone is the right choice, and surgeons need to face crises independently in order to grow.

This may not be a perfect operation, but it is enough to make him a firm foothold in the position of the chief surgeon of Glaze.

At least that's what Hills thinks now.

"But teacher, the patient..." Amor's words reached his throat, and he really didn't know how to describe Edward's current state.

"What's up with him?"

"His pulse seemed, like, gone."

"Gone?"

Sears finally put down the knife, looked away from the cut stomach, and re-examined the patient's body.

The sallow-faced Edward's eyelids were closed tightly, and there was a touch of bruise on his cheeks and lips.Except for the blood and pink foam remaining at the corner of the mouth, it was the same as falling asleep after anesthesia before, and there was no other difference.

Hills glanced at his assistant, asked the nurse for a single-tube stethoscope and placed it on his chest.

"------"

There was silence in my ears, let alone my heartbeat, I couldn't even hear my breathing.Hills had already realized the seriousness of the problem, and carefully chose a new location to listen, but there was still silence.

"------"

In the next half a minute, the earpiece was changed several times, and there was nothing besides the sound of the earpiece rubbing against the skin.

Only then did he accept the reality, and he had to go to the audience and said to everyone: "I have to announce a very sad news to everyone. Just now, my patient Edward Bracha Mr. Sodder is dead."

There were a few more sighs at the scene.

"Survived the most complicated hour before the operation, and it was almost over, but died in the final sprint."

"What a pity."

Hills was just a little frustrated, obviously used to seeing patients who died suddenly on the operating table: "Mr. Edward has severe lung symptoms, and the hemoptysis just now may be the last straw that broke the camel's back. Unfortunately, we lost forever A fine tailor."

The audience also bowed their heads one after another, expressing their condolences symbolically.

"I didn't save his life, but the operation itself didn't fail."

Hills had no intention of leaving the operating table, nor did he announce the termination of the operation, and the assistants were still standing by his side: "Now I need to continue to complete this operation and leave something worth learning for later generations. I think Edward If the master is aware of the soul, he will agree with me to do this and give me a scalpel."

Faced with these on-the-spot remarks, the audience still gave some sporadic applause.The death of the patient does affect the mood, but this should not be a reason to blame Hills, at least he is still working hard on the operation.

Of course, there are quite a few people who are not so easy to fool, such as Varela who can't afford the front row fee and can only watch from a distance in the last row.

Having just finished watching a boring amputation, and watching Sears' laparotomy should have sparked some excitement.But after the operation started, he always felt that something was wrong, it was just a very uncomfortable feeling anyway.

After a long time, he realized that it was actually because he saw two surgeries in a row and compared them subconsciously.

Although Carvey's amputation was boring, the process was smooth and the blood vessels and muscles were handled neatly.After watching "quick suturing and ligation, suturing and ligation" for more than half an hour, and then watching Hills' operation, the eyes will feel that there are incongruities everywhere.

Of course, he can't step on it. Carvey's new genre is against surgical performances and must be stopped.

In his opinion, Hills' operation was just that. There was nothing to praise or criticize.But now that the patient died suddenly, Varela seemed to have found the point again: "Dr. Hills, your knife is indeed fast enough, but it's a pity that the speed of suture and ligation is too slow."

Hills disagreed with this statement: "My speed is indeed not comparable to that of Professor Ignatz, but it should never be described as 'slow'."

Judging from the objective facts, Sears' speed is indeed not slow, and the fact that he has achieved this level of abdominal "surgery" has already demonstrated his ability.Although many of the treatments were very rough, and there was almost no separation of the blood vessels, so that Kavey wanted to scold people when he saw it, but at least the results of the cuts could barely pass the test.

Of course, these evaluations are limited to pure surgical techniques, not surgery, because Carvey never thought it was an operation.

Looking at so many doctors on the stage, not everyone can do what Sears did. Many of them even dare not open the patient's abdominal cavity.If you only look at technology, Hills can already be regarded as the middle-level level of Vienna surgery.

But Varela just wanted to say a few words about him: "Since it can't be described as 'slow', let me put it another way, it should be that the operation time has been delayed for too long."

Hills obviously felt his malice, and put down the scalpel again: "Mr. Varela, if there is really a problem with my operation, so many fellow doctors on the stage will definitely question it immediately, and you don't need to say it. .”

"I remember what Dr. Carvey said just now."

"But after I explained it, he stopped talking immediately."

"I'm just expressing my feelings from the perspective of an audience." Varela remained unmoved, and continued to use his venomous tongue mode, "If Dr. Hills' hands can be faster, before the patient wakes up After the operation is completed, I don't think Mr. Edward will die on the operating table."

Hills made a timely excuse: "The patient's health is very bad, and sudden death is inevitable."

"What if there is no second anesthesia?"

"Anesthesia is safe, and ether is also safe. These have been proved by hundreds of operations, so I don't need to say more."

Hills looked at the assistant in front of him, and comforted him: "Amor, don't listen to the rumors of some non-medical people. You don't need to be responsible for this matter. The patient's physical foundation is too poor, and he will die at any time. It is also the main reason why I am actively undergoing surgery.”

"So, it's still your problem."

Hills took a long breath, turned around and looked at the voice: "Please pay attention to your words, Mr. Varela. Although the theater does not expressly stipulate that you cannot ask questions during the operation, it gives the surgeon the right to clear the scene. If I remember correctly, you had a taste of this not too long ago."

Varela immediately thought of the reason for his downfall, and couldn't help glancing at Kavey during the banquet, and finally shut up.

"Let me reiterate that anesthesia is safe, and surgery is also safe. The vast majority of deaths during surgery are caused by diseases." Hills continued to emphasize, "If you have any objections, you can discuss them after the surgery is over. Now please Let me finish this operation as soon as possible."

The auditorium stopped talking. In the next 10 minutes, Sears focused all his attention on the operation, and rarely explained.

It was not until he removed all the mesentery and omentum that he pronounced the result of the operation: "After 1 hour and 23 minutes, the operation of the size omentum + mesentery + partial peritoneum was finally successful. It's just that Mr. Edward couldn't help it. Enjoy this body again, may his soul rest in peace." [1]

These two sentences are fine as a concluding statement after the surgery.

But the word "success" is too harsh.

Carvey didn't understand why the operation was judged successful even after the patient died. Where did it succeed?
Doesn't surgery depend on the patient's life or death?

And what is the significance of cutting off these tissues?
If the intestinal tract is not detected, the intestinal obstruction problem of the patient is not solved, because the intestinal obstruction caused by the adhesion between the intestinal tracts will only become more serious after the operation without the mesenteric omentum.
Looking at the whole operation, there are flaws everywhere, and I can't even find any redeeming points.

"What's the matter with you?" Ignatz noticed Kawei's strangeness.

"Uh, nothing." Carvey smiled and said, "It's just a little uncomfortable."

Everyone is a doctor, and Ignatz has nothing to ask: "You are really too busy recently, why don't you go back and rest?"

Carvey nodded: "It's really time to take a break. I want to take half a day off. I will go to see Mr. Li Ben's situation first, and then I will take Savarin's experiment report and go to Mr. Laszlo's home."

"I'll let you go home and rest."

"Don't worry, I'll go home after delivering the report."

The modern surgical treatment process is a well-planned hunt.

The start time of the operation, the location of the battle, and the hunting target all need to be clarified. How to conduct a frontal charge during the operation, how to cut off the enemy's retreat on the flanks, how to prevent fish from slipping through the net, and how to clean up the battlefield are all drawn up before the war begins.

All aspects should be considered in the whole process, and corresponding remedial measures should be prepared. Any uncertain factors that may cause accidents should be stifled in the cradle as much as possible.To deal with each disease, surgery has its own treatment routines, and these routines are summed up by tens of thousands of surgeons over decades.

With such complete preoperative preparations, as long as the doctors in front of the operating table have qualified skills and memorized all the routines, the rest is to do their best and obey the destiny.

However, in this era, there is a lack of medical theory, practice, and surgical instruments, and surgeons can do very little.

Carvey really wanted to wake Sears up in the audience, even if he was expelled and cleared, he would at least be open-minded.

But he didn't do this, because he knew that doing so would not do any good except to dissuade Sears and lower the audience's favorability.

No one can prove that tuberculous peritonitis should be treated according to Carvey's method, and no one can prove that the patient died of double aspiration after anesthesia, vomiting and hemoptysis, and no one can prove that this disease full of white nodules is the It's called tuberculous peritonitis.

Carvey sat in the carriage, thinking about the operation just now: "The technique and purpose of the operation are secondary, and the most important thing is to propose the concept of anti-infection. The paper on incision infection in my hand must be published as soon as possible." Get out, right to be a stepping stone."

From the perspective of body temperature, this paper introduced the infection status of several patients in detail, among which Li Ben was listed as the main research object.

Infection is a very broad concept, which needs to be closely linked to three basic themes, one is symptoms, the other is etiology, and the third is prevention and treatment.

The symptoms are very common tissue inflammation and ulceration, which have been described in detail in medical books, but they have not been linked to microorganisms.But doctors tend to forget about another symptom, an elevated temperature.

After satisfying the two symptoms of inflammation and body temperature, Carvey decided to focus on explaining the cause, that is, microorganisms, and then use the disinfection in the operation to explain the method of preventing infection.

As for treatment
At this time, the coachman's voice came from outside the window: "Mr. Carvey, Laszlo Manor is here."

(End of this chapter)