Nineteenth Century Medical Guide

Chapter 156 153. The Gate of the New World
Bleeding, pain and infection are the three obstacles in the evolution of modern surgery.

Bleeding can be counteracted by violent means such as mechanical compression and cautery, and pain can also be overcome by the patient's endurance and operation speed. Only infection is not transferred by will, and there is no effective coping method.

The infection hidden in the shadows for thousands of years has killed so many people that after learning the cause of the infection, surgeons have tried their best to fight the infection.Preoperative disinfection, intraoperative masks, hats and gloves, postoperative disinfection, and preventive use of antibiotics are all effective anti-infection measures.

The concept of conventional skin preparation also came into being in the breakthrough of this concept. 【1】

Carvey also wants to uphold the modern surgical concept, as long as the surgical incision is not affected, the skin will not be prepared.But Fernan's hair is thick, and after anesthesia, in addition to the necessary cleaning, he also needs to be cleaned.

Logically speaking, a razor should not be used【2】, but Kavey always has some large scissors at hand, which is inconvenient to operate, and there are many residual hairs after pruning, which is not conducive to the operation.The most important thing is that he has learned the craft from Master Beipi before, so he has confidence in his skills.

Carvey took the razor, picked up the small thing in one hand and pulled it in front of him, and gestured with the other hand like peeling sugarcane in reverse.

Five minutes later, Fernan, who had been cleaned briefly, was pushed into the theater of surgery.

Because the proportion of doctors in the auditorium has far exceeded that of ordinary people, the host has been canceled here, and everything is left to the surgeon himself: "Everyone, what I want to introduce today is a rare case caused by gao pill cancer. Bilateral breast hyperplasia."

As soon as Herman and Koch finished speaking, they lifted the cloth blanket covering Fernand's body, revealing the swollen left vagina and the very obvious breast hyperplasia.

The two cooperated with Amor, who came in with anesthesia equipment, to start the preoperative disinfection work, while Carvey stood in front of the operating table and introduced the cause of the disease, the purpose of the operation and the general process.

But before that, he still needs to specifically explain the specific situation of the patient.

Because Fernan had performed bladder calculus lithotripsy in the Municipal General Hospital before, from the perspective of modern medicine, it was also a mistake not to detect gao pill cancer in time.Even considering that there is no basic imaging equipment and the patient did not mention specific discomfort, the doctor should also see some clues from the medical history.

The patient belonged to Ignatz, and Carvey just went to the assistant's seat to participate in the surgical treatment, and the reception and follow-up were not under his control.

But Carvey still spoke out about his shortcomings in the medical response process:
"The patient had undergone bladder lithotripsy in our hospital. At that time, the size of the bilateral penis had changed. But I didn't doubt it further, and I didn't ask the patient about other discomforts. It seems a little inappropriate now. I hope everyone can Taking this as a lesson, we should be as detailed as possible in the process of asking the medical history, and then be more detailed."

The collection of medical histories in the 19th century was very brief. Even physicians who valued the detailed course of the disease often only used a few sentences to summarize all the experiences of the patients, and they spared words like gold.

But this is obviously contrary to the complex human body structure and physiological and pathological phenomena.

"I had the honor to see the pathological section after resection of gao pill cancer, and the whole tumor was very hard." Carvey began to pave the way for his operation again, "The main symptom of the patient is the enlargement of the vagina and the swelling of the gao pill. There are indurations and tingling and swelling, which is a perfect fit for my patients."

The four surgeons in the four-corner VIP seats have long been accustomed to Carvey's rich experience in the medical field, and they are not in the mood to ask questions. Their attention is all focused on bilateral breast hyperplasia.

However, before watching the operation, there was a thought that kept lingering in their minds: "Is gao pill cancer related to breast hyperplasia?"

"I personally think there is a close connection." Carvey looked back at the disinfection progress and explained, "The reason why men are men is because of their unique organs. The reason why women are women is also because of their unique organs. "

"You mean uterus, ovary and gao pill Yin?"

Karvey nodded, gave them some time to think, and turned around to wash his hands.When there was a lot of discussion around him, he put on sterilized rubber gloves and held up Fernand's penis: "His testicles were hit by a tumor, and they gradually lost their ability to maintain a masculine appearance, that's why they appeared." Signs unique to women."

"Function of gao pills"

Doctors in the 19th century did not have the concept of hormones. They only had a visual understanding of the internal organs of the body, and what they understood was some relatively simple functions, such as heart pumping, lung breathing, gastrointestinal digestion of food, gallbladder storage of bile, The womb bears the child.

But the significance of the existence of some substantial organs is too advanced for them.pancreas?spleen?liver?thyroid?prostate? gao pill?ovary?brain?
I don't know at all.

Because they don't understand the function of the substantive organs, these two words of Carvey opened the door to a new world.

It was Watman who responded first: "Do you mean that the two oval things in our lower body have been constantly working to maintain masculine characteristics?"

"Indeed."

Olgi nodded again and again, agreeing with Carvey's statement: "I heard similar arguments more than ten years ago."

"Someone suggested it?"

"It's just similar. I remember it was a doctor in France. It wasn't gao pills but the liver."【3】

"It's the first time I've heard this kind of explanation." Massimov found the point of view strange, but also very interesting, "If it's what you said, how does the gao pill usually work? And how is it maintained by work? Our physical characteristics?"

"Referring to the internal tissue structure of the human body, I am more inclined to protein."

Protein was still a very novel concept in the 19th century. It was first proposed by a Dutch chemist. After years of experimental demonstration, it finally became a consensus recently.This has just become a point of knowledge in medicine, and Carvey has already made great strides forward on this basis.

"Gao pills will produce a protein needed by the human body to maintain our masculine characteristics."

"It sounds weird, my brain can't keep up."

"When you say it like this, I always feel that these organs are too powerful, and I feel chills down my spine,"

The effect of this passage is good, at least it can arouse the interest of many people in the audience.If someone can follow this "discovery" and continue to delve deeper, and discover various hormones in the human body in the first place, then it is really entering a new world.

But before that, Carvey still had to bring everyone's attention back to the operating table: "These are just my conjectures, and it really shouldn't be given a property label before the substance is actually separated."

Finally, there were some different voices on the stage.

The source of the voice is Greg, the youngest surgical reporter of the daily: "But the 'gao pills determine the male executive's thinking' you have set now is to put a functional label on the gao pills."

"You don't think it's because of Gao Wan's work?"

"Although I have never studied medicine, I have read a lot of anatomical atlases and medical textbooks." Because of the new operation theater in the Municipal General Hospital, Greg successfully became a regular reporter half a year ago and became a resident reporter observer here, "At least I I don’t think it’s absolute enough.”

"Then how to explain the relationship between tumors in gao pills and hyperplasia of mammary glands?" Carvey asked rhetorically, "It is precisely because of the growth of tumors on gao pills that the production of this special substance is affected, and finally the mammary glands take up the majority peak."

"But you still don't have an example to prove it." Greg maintained Varela's style and marked it in the record book, "Sorry I can't report it."

"That's all right, the British and German medical journals will publish it."

Watman saw them coming and going, not giving in to each other, so he could only come out to smooth things over: "Okay, today is a surgical theater, not a surgical academic conference. If you have any arguments between you, you can wait until after the operation is over. Don't do it now." Waste of everyone's precious time."

At this time, the preoperative disinfection has been completed, and we are waiting for Carvey's explanation: "Surgical process: We first deal with the swollen penis, and then explore the surrounding tissue to determine the boundary of the tumor to see if it has invaded the right side. After the resection, the operation It will continue to move to the chest and deal with the breast hyperplasia on both sides.

At the request of the patient, I chose a small incision no longer than 5cm for mastectomy. "

Fernand's posture is the classic lithotomy position, with Carvey standing in the middle, Herman on the left, and Koch on the right.Surgical instruments were placed in a metal round basin and placed on the patient's stomach.

"The operation has officially begun."

The reason why Carvey sent Fernan to the operating table is entirely because the gao pill removal is still at a relatively low stage.Whether it is incision selection, operation skills, or drug maintenance, there is no way to compare with the 21st century.

If placed in modern times, the chemotherapy drug cisplatin alone can treat most of the gao pill cancers. As long as it is detected early, the 5-year survival rate exceeds 95%.

In the 19th century, the only possible cure for Fernand was a scalpel.In order to improve the success rate of the operation, Carvey needs to demonstrate the most standard gao pill resection, so that the doctors around him can avoid detours as much as possible.

"Today I will choose an incision site that no one else has taken: a left groin incision."

Carvey found Fernan's left groin, and drew a long arc with a knife: "If the patient has bilateral gao bolus resection, then the median vulva incision should be used. Here, considering the post-operative recovery, I still choose a unilateral groin incision."【5】

With the scalpel down, the skin is cut first, and then the subcutaneous muscle is separated.

They were all routine incisions. After opening the internal oblique and external oblique aponeurosis, and with the help of two hooks, I encountered the first difficulty in the operation: "Next, I need to separate the spermatic cord."

Inside the spermatic cord is a complex traffic channel bundled together with arteries, veins, lymphatic vessels, nerves, cremaster muscle, and vas deferens, which together constitute the blood passage of the gao pill.

Since the spermatic cord was to be cut, the spermatic cord must also be cut off.

Kavela opened the external oblique muscle and separated the spermatic cord until it reached the inner ring of the groin.Slightly below the inner ring, the vas deferens were first separated, ligated, and cut off, and then the spermatic cord blood vessels were clamped and cut off with a new type of vascular forceps, and the chromium-containing catgut was used for penetrating sutures to prevent the blood vessels from slipping and bleeding. 【6】

Olgi focuses on urology, and has some objections to Carvey's gao pill removal technique: "Why do you have to take the long way to the groin?"

"Personally, I prefer to cut off the back road first and do a siege." Carvey applied the analogy of hormones to tumors again, "Tumors also grow in our bodies, so why is it not a different kind of organ? But its work has many side effects."

In the environment where the understanding of tumors has not yet entered the microscopic field [7], this point of view has once again refreshed everyone's cognition.

"Can tumors control our bodies?"

"It's not impossible. Cancer patients are often very weak and will lose their lives in a short period of time." Carvey's fingers followed the exposed and separated spermatic cord all the way down into the penis, outside the sheath of the testicular wall Separation, "Because they have the properties of organs, so be careful whether you cut or separate"

While speaking, he pulled the entire contents out of the incision. "Give me the vascular clamp." Carvey took the forceps, and Herman pushed down the empty penis immediately, exposing the gao pill and the connecting lead at the bottom of the penis, "Fortunately, the tumor is not too large. And there is no adhesion around the penis. If there is adhesion, this part of the penis needs to be removed together.”【8】

The operation came to an end very quickly under Kawei's superb operation.

"After the resection, we still need to briefly observe the internal septum to see if the tumor has invaded the gao pill on the other side. Fortunately, no tumor has been found on the right side, and the gao pill resection was successful."

Then came the three-piece set of hemostasis, suturing, and drainage performed by Herman.

He needs to make a small incision at the bottom of the vulva first, put in a small section of rubber tube, and then suture the external oblique aponeurosis and skin incision in the groin. 【9】

On the other hand, Carvey and Koch happily brought the left gao pill that had just been removed, and came to the pathological examination table.Pathological examination is the gold standard for determining the final diagnosis, and pathology must be done as soon as possible after resection of the suspected tumor.

Carvey used a knife to make pathological tissue sections, while Koch on the other side set up the microscope at the beginning, and then turned over the cabinet next to him: "Dr. Carvey, where is the stain?"

"It's in my suitcase."

Koch quickly found a bottle of blue dye inside: "Hey? Why is it blue?"

"Oh, the blue dye I begged from a girl is of good quality." Carvey looked back at Olgi and asked with a smile, "What's the matter?"

"Can blue stain also stain tissue?" Koch had a strong interest in chemistry. He even worked at the Institute of Chemistry in Berlin after graduation, so he was familiar with stains. The synthetic dyes used are generally yellowish or purple." [10]

"Oh, HE dyeing." Carvey has no idea about the history of the dye, but it is not difficult to judge from the color that it should be HE dyeing. can also"

"Huh?" Seeing that Kavey suddenly interrupted himself, Koch couldn't help but stepped forward and asked, "What can it do?"

Carvey looked down at the gao pill tumor in his hand, but what he was thinking about was the cesarean section hemorrhage that he took the stage at the Lakeside Theater a few days ago.During the operation, the peasant woman suffered massive bleeding, had her uterus removed, and Olgi broke her bladder and ureter.

Carvey used this bottle of blue dye to find broken ureters and to test the tightness of the bladder and ureter sutures.

What looks gimmicky is actually just a basic operation in modern surgery, and after so many days, there is no need to think about it.

Ke Wei has been thinking about the peasant woman recovering very well after the operation these days. She got rid of the post-operative infection that may be caused by pelvic inflammatory disease, and also got rid of the chronic poisoning of herbal medicine.

At first, I thought that everything was caused by the peasant woman herself, but now I look back at the operation process again, maybe this bottle of dye is the key to all the problems?

(End of this chapter)