Nineteenth Century Medical Guide

Chapter 13 13. Theater of Surgery
"Ladies and gentlemen, good afternoon [1].

Today, a talented surgeon with rich experience is about to appear on the stage.He contributed thousands of amputations and lithotripsy here, and his superb skills made him famous.He is the most outstanding scalpel master in Austria, and was named "the great surgical man who brought miracles" by "Vienna Daily".

The praise ends here, and the miracle is officially staged.

Let us invite this extraordinary surgeon, Austrian Night Blade, Mr. Ignaz von Kern~"

As his name was called out by the host and kept echoing in his ears, the door was pushed open by Ignatz.There were six rows of spectators standing in front of them, surrounded by oil lamps and candles. The flickering lights and warm applause were accompanied by a faint smell of blood.

This is the kingdom he is familiar with: the operating room, or more precisely, the theater of surgery.

Ignaz is a famous actor here, and he will perform on stage every now and then, and he is already used to such big scenes.

But today, he still had to admit that he was nervous.

This is not the nervousness of a novice on stage, his fingers are not trembling, and his mind is not blank.He can still pick up the scalpel steadily, and his mind is still replaying the hernia operation performed by the famous British surgeon Astri Paston Cooper[2] when he was touring in Austria.

Ignatz's nervousness still lies in the uncertainty of the outcome of the operation.

Dr. Cooper's hernia repair surgery has a very high success rate, except for postoperative infection, and the mortality rate is controlled below 15%.Even in the postoperative recurrence rate that deserves to be criticized [3], Dr. Cooper has achieved the top in Europe.

Of all hernia surgery survivors, his recurrence rate was only 38%, far lower than that of Dr. Heisenbach in Berlin (47%) and Dr. Popart in Paris (44%).

Those two are very insightful people in hernia surgery. The former named the direct hernia triangle (Hay's triangle) [4], and the latter discovered the inguinal ligament.But after all, surgery is a job that pays attention to technology. Once the academic gap cannot be widened, the effect of treatment becomes the most intuitive manifestation of the value of a doctor.

At this point, Cooper deserves the title of No.1 hernia surgery in the nineteenth century.

It's a pity that the old man passed away more than ten years ago, and many people who left behind surgery can do it, but after all, only a few can really get the essence of his suture.

Ignatz specializes in limb surgery, and has always been wild in operation.This wide opening and closing technique can win many audiences, and it is also very good for amputation, but it becomes a burden when it comes to the groin, which has a very delicate and complex anatomical structure.

"Good afternoon, I am really flattered that such a small skill can attract so many noble audiences."

Ignaz walked towards the nurse with a smile, took off his long cloak and hat to keep out the cold, and at the same time narrated what was about to happen in front of everyone: "The skills I will show you today are extraordinary. Inguinal hernia surgery that no one dares to do.”

As soon as the words fell, there was another thunderous applause in the arena.Even if you don't understand what a "groin" is, it still doesn't affect the excitement of the audience watching the performance.

"Please name today's patient, Count Moraso Herich Karl Franz~"

Ignatz directed everyone's attention to the gate, watched a cart push people through the gate, and walked to the corner to put on a surgical apron.It was a very historic white leather skirt, stained with the blood of the patients he had operated on and never washed.

The reason is still an unfounded point of view: the more residual blood, the more skilled the surgeon.

This remark made sense as soon as it was heard, and there was no reason to find it. It quickly spread among the general public after dinner.

Ignatz was very disapproving of this kind of thing, always thinking that it was a gimmick that those incompetent doctors would come up with.But since I couldn't find a reason to clean the apron, I didn't object, so I kept it.

For him, the apron is just an apron, but the scalpel in his hand is an extension of his fingers, the soul of the surgeon: "Today I will use the RB knife master Guozheng tailor-made for me【5】 Scalpel, to demonstrate this complex operation."

The golden knife box still smelled of wood, and inside it were the seven most commonly used surgical knives and two bone saws.

Ignatz is like an excellent commentator, guiding everyone's attention: "Count Moraso, who is also an old friend of mine, suffers from an inguinal hernia, and the pain is unbearable, and even walking has become very difficult. "

The assistant lifted off the blanket placed on Moraso's body, completely exposing the lump on his lower right abdomen, and only covered some important places.

"The cause of an inguinal hernia is a hole in the abdominal cavity, and the bowel in the cavity fell into it." Ignatz continued, "20 years ago, when I was a medical student, I had the good fortune to see Dr. Cooper He did this kind of surgery. He separated the sticky intestine from the abdominal wall, and then used silk to suture the hole, and the whole process was perfect."

After speaking, he looked up at the audience on the field: "Everyone, I will reproduce this operation."

The anesthesia technology that emerged more than ten years ago has gradually matured, and the nonsense "ether patent" has become a piece of waste paper.

In the initial ether anesthesia, the simplest way is to cover the nose, a piece of cotton cloth is covered on the metal triangular three-dimensional bracket, and then the nose is covered.As long as the air circulation is ensured, a few drops of ether on the cotton cloth can make the patient fall asleep in a moment.

Although the method is simple, there are many uncertain factors.

In such a venue where candles and oil lamps are used everywhere, exposure to ether is not a good thing, so when anesthesia first emerged, "surgery coma" and "small fire" became an indispensable part of surgical complications. member.

In order to solve these troubles, there are now very practical ether inhalation devices.

Ether vapor is delivered from the glass vessel and enters the patient's body through the cortical nasal mask, and the airtightness is guaranteed throughout the process.Not only does it avoid exposure to ether, it is also more convenient to use, but the grasp of the inhaled amount is still somewhat lacking.

How much ether should be used depends on the experience and luck of the anesthesia assistant.

Fortunately, Earl Moraso's luck is not bad.

"Mr. Ignatz, the anesthesia is complete."

"Okay, the operation will now officially begin."

Just after Earl Moraso fell asleep, a black carriage galloped across the street from the theater on the Vin River and stopped at the gate of the Municipal General Hospital.

The one who got out of the car was a young man under the age of 20, with a thick black coat fluttering in the wind, but what attracted the most attention was the tan glass bottle in his hand.Those who don't know it will think that it is a clerk from a grocery store who is delivering oil to the hospital kitchen.

"I'm back, where's the cotton cloth?"

The nurse looked up at him, pointed to the bed behind him and said, "It's right next to the patient."

"Okay, thank you~"

The debridement nursing method that Carvey said is a fantasy to others. No one will really believe it. In fact, neither does Ignatz.But because it was the insistence of the patients and their families, and the sudden reduction in salary made him feel a little sorry, he still gave Kawei a certain amount of support.

After all, he is a well-known surgeon, so he still has to be open-minded.

But this kind of support came too inexplicably in the eyes of outsiders, coupled with the previous debates with three medical school graduates, so that Carvey became a "man of the hour" in the hospital that day, and various gossip related to him The news was flying everywhere.

There is also the blessing of underdeveloped information in the [-]th century. Any talk is so precious that it is enough for others to chew on it for several days.

Carvey hesitated for a while between the two bottles of cooking oil, but he chose linseed oil first.There is no particular reason, it is the result of purely choosing one of the two.

He needs to soak the cloth with oil, wring it out, and wrap it around his bandaged left leg.The wet oily cloth can isolate the bacteria in the air, so that the interior forms a relatively sterile space.

Hygroscopic inside, insulating outside.
It seemed perfect, but Carvey always felt that something was missing.

"You made the wound greasy, can this leg really be cured?" The nurse I met at the door just now came over, and after watching his operation, I still felt strange in my heart.

"It shouldn't be a problem, as long as you change the dressing frequently." Kavi looked around, but couldn't find Ignatz, "Where's the teacher?"

"Dr. Ignatz? You've already gone to the theater." The nurse said, "This afternoon's operation is very important, so he went after lunch. He always acts very calm and calm during operations, but today he seems to be a different person." Same."

"What kind of surgery?"

"It seems to be a hernia repair. The patient is an earl. He has been visiting for treatment."

"No wonder." Carvey said casually, "The anatomical structure of that place is complex, including ligaments, blood vessels, spermatic cord, fascia, and muscles. Everyone has to come together to express themselves. Surgery is not easy."

The nurse saw that he was speaking eloquently and had nothing to answer, so she could only ask, "Aren't you going to the theater for the operation? It should have been on for a while now."

Of course Carvey wants to go, but what is in front of him now is a left leg that keeps leaking oil to the ground.Reason told him that this matter was only half done, and he couldn't leave it alone: ​​"Does the hospital have thicker paper?"

"Yes, what's the matter?"

"Get me some here."

"How many things do you want? You can finish it all at once."

"Better get some more cotton."

The nurse was a little speechless: "You use cotton cloth and paper, the cost is not low."

"Don't worry about it, Mr. Ignatz will settle the bill then."

Edible oil will leak, and long-term exposure to air will oxidize and dry out, which will affect the insulation effect.Carvey had to keep it moist, at least for 24 hours, until the next dressing change.In order to achieve this goal, the first thing he thought of was paper.

Carvey doesn't have any special requirements for paper, he just needs to wrap one or two layers of paper outside the tarpaulin to slow down the drying speed.

It is not difficult to operate, but it needs help and takes a lot of time.

With six layers of cotton cloth, two layers of paper, and two splints, the slender left leg of the 11-bed boy had become "swollen" into a mallet.Carvey inquired about comfort, checked the pulsation of the dorsalis pedis artery and the range of motion of the toes, and then heaved a sigh of satisfaction.

"At 14:42, if it is placed in modern times, it may already be sewing skins. I don't know how Ignatz is doing. I hope it will be successful."

He found a tap water pool, washed off the oil with alkaline soap, shook his hands and said to himself: "Forget it, let's go and have a look, where is that theater?"

(End of this chapter)