Nineteenth Century Medical Guide

Chapter 157 154. Question and Answer Time Begins

The diet structure of the peasant women who had cesarean section did not change much during the year, and the family members lived together all the time, and they ate the same things.The only difference from my family is that I received the herbal treatment at Grace Hospital, and then I got pregnant + cesarean section.

The medical history given by Bessim and Orgi did not mention the specific symptoms of the peasant woman, but the "curative effect" of the herbal medicine is objective.

Carvey just went to see the patient in the morning. Her body has fully recovered, and her previous symptoms have almost disappeared.This can be explained by breaking away from the source of herbal poison, but it is too outrageous that the incision is not infected.I also thought that some operation during the operation solved the infection before, but Kawei has never dared to believe it.

Now he realizes he neglected an important surgical step: staining.

Carvey was doing pathological slides in his hands, thinking about the whole operation process in his mind.

The whole operation is divided into upper and lower parts.

The first half was a cesarean section, and everything from the surgical incision approach, delivery of the baby to hemostasis was exactly the same as Carvey's requirements.The liquid used is normal saline, the anticoagulant used is bought by Kavey Pharmaceutical Factory, and the oxytocin used is also bought by Kavey Pharmaceutical Factory.

The second half is the hysterectomy, and the main surgeon is Carvey. The instrument used is nothing but a copper tube. The only variable that can be regarded as a variable is dyeing.

When it comes to dyes, we actually have to start with Olgi's serious injury a month ago.

At that time, Olgi violated the principle of confidentiality between doctors and patients, which led to his death. In the incident, the father of the woman opened a dye factory.From the reaction of the lovelorn man, it can be seen that this dye factory is not small, and this bottle of blue dye was made by a young man in the factory.

As far as Carvey knew, there were only two blue dyes that could alleviate the symptoms of poisoning clinically.

One is Prussian blue, which treats heavy metal thallium poisoning.

Carvey had studied 19th-century chemistry in college textbooks and knew that thallium had not yet been discovered.If there is no discovery, there will be no industrial application, and the probability of heavy metal poisoning in herbal medicine will be very low.Moreover, the peasant woman's symptoms were somewhat different from those of thallium poisoning, lacking neurological symptoms such as limb numbness.

The other is methylene blue, which treats nitrite poisoning.

Nitrite is very common. It is usually produced after the decay of green plants, and it is normal to appear in herbal medicines.As for whether methylene blue can be used in the treatment of antibacterial infections, Carvey has no impression.

Because there were all kinds of antibiotics when he was working, and not many doctors would learn how these antibiotics were invented.

Carvey is also a pragmatist and not interested in history. The only history of antibiotics he has come into contact with is penicillin during World War II.But even if you have been in contact with it, you can only see the level of introduction. You only know that the inventor is Fleming, and you don't know the rest of the date and process.

Now that there are compounds that may inhibit the infection phenomenon, we must seize the opportunity and do enough experiments to verify it.

"As expected of the operating room of the Municipal General Hospital, there is a whole set of specimen making materials hidden."

Koch is very familiar with pathology and specimen preparation. He has already taken out fixatives, glass slides, dyes, paraffin, wax models, alcohol lamps and microscopes from the cabinet, and is waiting for Carvey to hand over the excised gao tissue to him. Fixed dye embedding and sectioning: "Dr. Carvey? Dr. Carvey, what's wrong with you?"

"Oh, nothing, I was just thinking about the specimen."

After all, he was undergoing surgery now, so Kavey put aside the matter of the dye for the time being. He dug out Fernand's medical records that he had prepared earlier, and gave a brief description of the gao pill【1】.

Then he handed over the several specimen materials that had just been cut to Koch: "This is the tissue of the gao pill itself——specimen 1, followed by the tumor tissue——specimen 2, and then the two junctions. Slice - Specimen 3."

"There is even a description and number of the specimen." Koch was very excited. "I have seen a lot of operations, but I have never seen such a meticulous treatment of specimens by Dr. Carvey."

"Can you do pathology specimens?"

"Yes, I used whiskey as the fixative solution in the laboratory. The color is a bit weird, but now it seems that it is unnecessary." Koch looked at a bottle of transparent liquid marked with [alcohol], "With a higher concentration The disinfectant alcohol seems to be more reliable than the amber wine."

"It's not just the color, this bottle of alcohol has a higher concentration of ethanol, which fixes it better."

Koch nodded, remembered what he had learned, and hurriedly asked, "Then what is this bottle?"

Carvey looked at another bottle of solution labeled [xylene], and said, "This is a clearing agent for microscope examination that I also found in the dye factory. It can quickly bring paraffin into tissue cells. You fix it with alcohol first. Minutes, washed with water, dyed, washed with xylene, and finally embedded in paraffin molds.”【2】

Pathology has developed from the last century to the current level, and has gradually revealed the clues of clinical diagnosis. More and more surgeons have begun to use the results of pathological examination to judge the type of disease.

Especially when encountering tumors, the special variation structure of tumor tissues and cells can make it easy for people to draw conclusions.

Of course, limited by the production level of pathological specimens, it takes luck to see the cells in the specimen clearly.The cutting plane is not neat enough, the tissue section is not thin enough, the staining is insufficient, the staining is too heavy, the dehydration is not enough, the fixation failure, etc. can affect the imaging of the specimen under the microscope.

Waterman was a little surprised: "This thing can quickly bring in paraffin?"【3】

"Correct."

The other three chief surgeons, including Massimov, were also surprised: "Is there such a good thing???"

It is quite difficult to master advanced surgical pathology, and ordinary doctors only know to do pathological biopsy.The production process is often to cut off a small piece of tissue, and then slice it as thin as possible. What can be observed depends on the skill of the knife.

However, the human hand must have a limit, and human tissue is very soft.It is no problem to cut a small piece with a knife, but it is an impossible task to cut into a thin slice and maintain the arrangement structure between cells.

So there is paraffin embedding.

It takes time for general paraffin embedding to penetrate into the cell tissue. If the time is not enough, the central area of ​​the specimen tissue will often become very messy under the cutting of the knife edge.

The xylene discovered by Carvey seems to have solved this problem perfectly.

Xylene is soluble in ethanol and paraffin. It can quickly enter the tissue after dyeing to bring out the residual ethanol, and then bring in the paraffin added from the outside to support the specimen tissue and ensure that it will not be squeezed during cutting.

"If there is such a good thing." Olgi, who was sitting beside the operating table, couldn't sit still, stood up and walked to the pathology preparation table, "Can you sell me a bottle."

"Dr. Olgi is so impatient?" Carvey smiled and told Koch some precautions when making specimens, looked back at him, and explained, "Whether xylene is useful or not can be seen after the specimens are finished." , if you are satisfied, I will give monthly members a chance to buy at a special price, and members who pay annual fees can receive a free bottle of gift.”

"There is still a discount?"

"Is it too late to buy a membership now?"

It has been more than ten years since xylene was first discovered, and there is still no mass production plan suitable for the current industrial production level.Even if it does appear, it will be difficult to achieve mass production in the first place with Austria's low industrial production level.

Basic materials that have been sold by ton in the 21st century were purely rare in the 19th century, and the amount of less than 100ml can be sold for hundreds of crowns.

Carvey gave a rare generosity, and also hoped to take this opportunity to advertise his own pharmaceutical company: "If you are concerned about the xylene, high-concentration alcohol, and stains used in pathological sections, oxytocin, and antibiotics used in operations If you are interested in coagulants, you can go to the Karachi pharmaceutical factory located in Baden Town, a suburb of Vienna, and the quantity is large."

As the world-recognized father of microorganisms, Koch, who is about to graduate with a Ph.D., has very solid laboratory technical capabilities.Whether it's fixation, staining, or final embedding of sections, he does a great job.

Even if it is the first time to get xylene, he can quickly understand how to use it, and perfectly embed this step in the entire specimen making process.

Carvey put a lot of trust in Koch and handed over all the pathological work to him, and he started the second round of surgery with Amor and Herman:
"The next step is small incision bilateral mastectomy. In fact, the surgical effect is similar to that of ordinary breast cancer resection, but the incision is much more beautiful. The first thing we need to do is to determine the location of the incision. My choice is on both sides of his head. Below, make an arc-shaped incision."

"Under your head? That's ruyun."

Corrigo couldn't help but nodded: "If you want to hide the incision on the wide chest, there is only one place, just like two oases in the Sahara desert in North Africa."

"But the problem is how to get it."

The operation is actually quite simple under the modern electrosurgical operation, no large blood vessels are involved in the middle, as long as the normal treatment is an outpatient operation that only needs local anesthesia.After entering the era of minimally invasive surgery, this kind of minor surgery has developed into the Anke Rotary Cutting Machine [4] which destroys and absorbs all in one, and there is no need to make percutaneous scalpel incisions anymore.

Of course, even without such a machine, the operation can be easily completed with only some basic surgical instruments.

But before the operation, Carvey still needs to explain something to them, so as not to end the operation too quickly and not see the process clearly.

"Although his bilateral mammary glands seem to have obvious hyperplasia, they are about 10cm in diameter, and it seems difficult to remove them. But we should pay attention to that, even if the male breasts hyperplasia, they are very thin, and the arc-shaped incision next to the head is more like a small fan. The window, and the surrounding skin is elastic enough, so the operation is almost not difficult.”【5】

That is to say, but when it comes to operation, there are still many details that should be paid attention to.

A small incision will bring a satisfactory postoperative appearance to the patient, but at the same time, a small incision can also cause a series of problems.

One of the most important questions is whether the blood supply of the head itself will be affected after the skin under the head is cut.And how does ruyun's skin heal after excessive arc-shaped incisions?How to grasp the incision length?
Corrigo and Watman, who specialize in plastic surgery, have already thought of similar questions, and Carvey answered them in a timely manner:

"We choose the incision below your head. In order to ensure the blood supply, the length of the incision should not be longer than 1/2 circle." Carvey took the scalpel, cut it at the position he said, and said naturally, "And in the When making the incision, you should also choose the lower incision instead of the upper incision, do you know why?"

Herman was stunned, and looked at Amor beside him.

Amor is a newcomer. He just graduated from medical school. How could he know that he still needs to answer questions on the operating table, so he was at a loss: "No, I don't know."

"Herman, what about you?"

"I, I guess."

"Guess?" After a few words, Carvey had already made the incision, "I don't know if other people here know? Since it is a public display operation, everyone can speak freely. It doesn't matter if you are wrong. If you are right, today The surgery ticket fee will be refunded in full.”

Herman obviously didn't know why.

Because according to the growth direction of the breast after hyperplasia, the operation of the upper incision is definitely more convenient, but Carvey still chose the lower incision.The only thing that can be explained is that the most important blood supply in the operation is the blood supply.

"To prevent damage to Ruyun's blood supply?"

"Well, not bad." Carvey looked up at Koch who answered the question not far away, affirmed his answer, but was still not satisfied, "But this kind of statement is too panacea to be considered an answer."

While talking, Carvey has exposed the breast tissue below the incision, pulled the gland with his left thumb and middle finger, touched the gap with his index finger, and slowly cut the surrounding fascia with scissors: "The operation time on one side is up to 20 Minutes, after the operation is over, the question and answer will also end, everyone must seize the precious time."

[Yechu just took a nap in the afternoon, and my head is a little dizzy. I will write this chapter after I have something to eat. Forgive me]

(End of this chapter)