Nineteenth Century Medical Guide

Chapter 148 145. Clean incision and uterine prolapse
If you look at infection from a macro perspective, it is a never-ending bloody battle between the human immune system and the army of microorganisms.Every immune cell and every complement protein is fighting for this war, and microorganisms will not stop dying to take down the human body.

At the beginning, Nora, as Carvey's first caesarean section and also his first surgical patient, enjoyed the bonus of preoperative disinfection.After the operation, her incision was very clean, with only a little redness and swelling, which was suppressed by her body's immunity.

There are many factors that can influence the outcome of perioperative infection.

Nora's ending like this has something to do with the operation.The operation time was very short, and there was not much bleeding during the operation. The process was turbulent, but it was all under Kawei's control.The smooth operation + disinfection + Nora's body is healthy enough, and only in exchange for the incision without infection.

In comparison, the situation of the peasant woman is completely different from her.

First of all, the peasant woman gained weight after pregnancy and was obviously obese, and the abdomen where the incision was located was the hardest hit area for her fat accumulation.Fat liquefaction is guaranteed after this type of abdominal surgery as long as there is even the slightest bit of infection. 【1】

Secondly, the trauma of this operation was much greater than Nora's at that time, the abdominal incision was large enough, and the operation time was also long.During the operation, not only the ureter was broken, but the bladder ruptured, and the fracture after the hysterectomy was also connected with the yd.

The most important point is that there is still a lot of bleeding.

Although the blood was reinfused into her body through the rubber tube, it could bring back some bacterial microorganisms after staying outside the body for a while.

Moreover, the large loss of blood is the actual loss of immune cells, which can be refilled through manufacturing later, but now it is only the first day after the operation, and it happens to be stuck in the window period, and the infection should have appeared.

Based on the pelvic foundation of her chronic gynecological diseases, even with pre-operative disinfection and clean rubber gloves, and cleaning of the dissection during the operation, the surgical incision should not be so clean.After all, this is a dirty surgical theater, and the doctors around the operating table did not wear masks.

It's not that Kavey doesn't believe in Olgi's judgment, but that he doesn't believe in his eyes, and he can't even believe his own eyes 100%.

On the first day after surgery, it took less than 24 hours for microorganisms to invade the body. If there is an infection, it has just begun, and it is not serious enough to be seen clearly on the body surface.Maybe the infection is hiding in the deeper tissues, it's just not showing.

At this time, you need to gently squeeze the skin around the incision to see if there is any leakage under the tissue
Nothing at all.

Carvey pressed the skin, and his fingers only felt the negative pressure drainage tube hidden under the skin, and there was no soft feeling after infection.

What's the situation? ? ?
"She was urinating very well and there seemed to be no signs of urine leaking from the abdominal cavity"

Olgi thought that Carvey came here to care about whether the ureter was sutured smoothly. At any rate, there was a metal tube in it, and anyone would be worried for a while.But Carvey only thought about the incision, as if there was no chance of failure in the ureteral suture: "Dr. Carvey, what's wrong with you?"

"Oh, nothing." Carvey looked at the peasant woman in good condition again, and asked Olgi, "I want to see her medical records."

"Medical records, go and get the medical records."

Kavey saved his own serious injury, and Kavey saved the soon-to-fail operation. Olgi has no airs of a director in front of him.Whether in public or private, he hopes to find the key to success from Kawei: "Remember to bring her previous medical records from the gynecology department."

Carvey's judgment was not wrong. Three years ago, the peasant woman had many symptoms of gynecological infections: abdominal distension, pain, itching, and increased secretions.

The doctor prescribed some herbal medicine, vegetable juice and intermittent hydrotherapy [2], but it may be because of the problem of the method of use, or the lack of pious faith, the inflammation of the peasant woman has not been cured.

Seeing this, Carvey had to lament that such a pair of reproductive organs did not cause a miscarriage, which can be said to be good luck, but it can be said that it was a miracle that the fetal membranes were not broken before the operation. 【3】

"Dr. Carvey, is there something wrong with her medical records?"

Of course there are problems, a bunch of them!Even in his eyes, this simple diagnosis and treatment record is not a medical record at all.

Carvey smiled and shook his head: "No problem."

"She saw a well-known gynecologist in our hospital." Olgi explained, "There may be some differences in the effects of the treatments prescribed, but his diagnostic ability is first-rate, and the conclusion is definitely not wrong."

"So it was caused by her disorderly life?"

Olgi nodded, and at the same time pulled Kavell into the corridor, and whispered: "Although the patient has always denied that this happened, who knows the truth, the newborn child does not look like her husband."

The "disorderly life" hat does carry a heavy weight, and is a stain on any woman's chastity.

But Carvey didn't have the energy or the energy to change the diagnosis, because the gynecologist's judgment on the "infection" was correct, and it was indeed some "harmful substance" in the environment that invaded the peasant woman's body to produce these symptoms.

What he wants to know most now is why the infection didn't affect the surgical incision: "She didn't improve before the operation?"

"Always like this."

"Doesn't that mean that none of these treatments are effective for her?"

"It can't be said that it is invalid." Olgi explained, "At least she lived until she became pregnant and gave birth, at least she lived until now, and has not deteriorated further. From my own experience, her body is recovering."

After hearing this passage, Carvey didn't know what to say, so he could only continue to move the topic to another surgical incision: "By the way, how about the suture in the YD?"

"The stump is pretty good, too."

"Not even there."

Carvey was lost in thought, and really couldn't figure out why this happened.

Having experienced so many cesarean deliveries, Carvey also has some understanding of the physical conditions of these impoverished women.

If the peasant woman had a good body like Nora and was able to fight the infection, then the pelvic infection should not have been delayed until now, and it must have returned to normal long ago.But if the body's resistance is worse than Nora's, the surgical incision will not be so beautiful.

These two are contradictory in themselves, where is the problem? ? ?

Carvey pointed to the signature on the medical record and said, "Dr. Olgi, I would like to see this gynecologist if possible."

The infection cannot disappear for no reason. Carvey did not use any special means during the operation, and the pre-operative disinfection was limited to the body surface, so the problem should lie before the operation.However, Kawei didn't see any problems in the medical records, so now he can only ask about the formulas of those herbal medicines.

"Herbal medicine?" The gynecologist named Besim was making a pessary for uterine prolapse in his office. "The one you asked about was bought from a medicinal herb shop. It's nothing special."

"What kind of drugs were put in?"

Seeing that he was in the same company and brought by Olgi, he did not shy away from the effects of the herbal medicine itself: "I don't know how to do it, but the ingredients should be calendula, burdock and some plantains, as I remember That's about it. As for whether they added ingredients to it, I don't know.

Anyway, many patients feel that it is effective after taking it, as long as the patients feel that it is effective. "

"Can it really work?"

"Of course, some patients with lower abdominal pain can be cured by drinking three bottles, and some patients with increased secretions can also be cured." Besim's tone of affirmation was high and low, and soon softened, "But the medicine still depends on the person. Some patients just aren't as effective."

Carvey looked at the small medicine bottle he handed over, which contained a slightly orange-red potion, and intuitively told him that the color was not simple: "Can I buy a bottle?"

"Just give me money, 3 crowns a bottle." Besim suddenly thought of something, raised his head and asked, "By the way, where are you a doctor? Why are you so interested in gynecological medicine?"

"He's Carvey, Dr. Carvey Hynes." Olgi introduced with a smile, "Obstetrics and Obstetrics is a family, you should have read the report."

"Oh, it's Dr. Carvey." Besim put down the tools in his hand and got up to shake hands. "People around you say you are very young. I didn't expect you to be so young when I saw you today. It's really good to be good at cesarean section at such an age." It's rare, compared to that, my student is far behind."

Perhaps due to the deviation of the concept of gynecology, Besim still classified gynecology into the category of internal medicine, and the diagnosis and treatment still focused on taking medicine and some strange treatments.

On the contrary, the student he was talking about thought of using surgical methods to treat some gynecological diseases that could not be cured by medicine.

"The kid Denever likes to do some novel things. He just graduated from medical school, and he hasn't learned the basics of medicine."

Olgi had an impression of this young gynecologist: "You mean that Belgian boy? I still remember him. He came to me a week ago and asked some questions about the anatomy of the uterus, saying that he would use surgery to remove it." Treatment of uterine prolapse."

Besim sighed and shook his head: "I felt strange when I heard this idea, so I didn't promise him."

"Haha, no wonder he came to me for the opportunity to dissect the corpse, saying that he only touched the uterus and not other organs." Olgi had a good impression of him, "If it wasn't for the preparation for the cesarean section, maybe I really gave him the body."

"I made you laugh."

"I heard that his academic performance has always been good, and he also loves gynecology. He will definitely become a good doctor."

"Well, I hope so. In fact, if no one wants to do gynecology, I wouldn't recruit him as a student."

Strictly speaking, Deneve and Bergett are graduates of the same class. They have followed Besim to study gynecology since the master's degree, and the most studied thing in the doctoral degree is uterine prolapse.This may not be common in modern times, but it was common in the 19th century. 【4】

The solution is nothing more than making a pessary to support the loose and falling uterus. The effect is limited, but at least it can prevent the cervix from being exposed.

Bessim is willing to follow this concept of therapy, but in Denever's eyes, doing so is not a cure for the symptoms.Looking at the women in the ward suffering from uterine prolapse, he was eager to find a good solution once and for all.

I have to say that he has good surgical thinking. Since taking medicine can't cure it, and the pessary can only delay the development of symptoms, let's start with the anatomical structure.He found that the uterine prolapse may be caused by the relaxation of the broad ligaments on both sides of the uterus. If a part of the loose broad ligaments is cut off, the falling uterus may be lifted up again.

After having this wild idea, it was this operation that Denever had in his mind.

This idea took shape during the doctoral period and was opposed by almost all gynecologists, including my own teacher.But none of these voices of opposition could dispel his thoughts. Finally, after watching Kavey's cesarean section, he completely strengthened his determination to take action.

Besim looked up at the time: "It just so happens that the two of you are here today, do you want to go and see his surgery together?"

"Surgery? What surgery?"

"Uterine Prolapse Repair."

"What? Dr. Bessim, are you kidding me, did you really let him go for surgery?" Olgi smiled and praised, but at this time he definitely felt wrong, "Surgery is not a joke. , every chief surgeon needs to undergo long-term and arduous training, not to mention that this is a complicated laparotomy."

"I know"

"Didn't you just say you didn't agree? Why did you agree again?"

"He has practiced on sows more than a dozen times, and has had two opportunities for dissection operations on cadavers, and the results are not bad."

These are just excuses from Bessim, the real reason is that Denever's determination also inspired his desire to cure this disease: "He has been discussing with me the possibility of uterine prolapse surgery since he graduated. sex, and spent so much time doing exercises, it is impossible for me as a teacher to dispel his enthusiasm."

"Anatomy is anatomy, surgery is surgery, it's different."

Olgi saw that he was looking at Kavey, and immediately said: "No, Dr. Bessim, Kavey is different. It is difficult for the whole of Austria, perhaps the whole of Europe, to have such a surgical genius again."

Besim has made up his mind, and as the chief doctor of the gynecology ward, he has the right to make this decision.

He looked at Carvey and Olgi and knew that the opportunity was rare: "Both doctors have successfully performed a cesarean section and are very familiar with the anatomy around the uterus and appendages. If possible, I would like to invite both of you to watch this treatment Broad ligament shortening for uterine prolapse."

(End of this chapter)