Nineteenth Century Medical Guide

Chapter 164. 161. The Real Panacea
[This chapter is a bit much, I have to write slowly, you can read it tomorrow]

The blue vial is the dye that Carvey has been using before.

After the trip to the palace, its antibacterial test was upgraded to the highest level.Three days is not enough to give a conclusion, but it is not difficult to see from the bacterial growth on the petri dish that the blue dye does have a certain antibacterial effect.

Coupled with the nitrite-like toxicity of the neutralized herbal medicine, Carvey is almost sure that the bottle of dye is methylene blue. 【1】

Methylene blue is widely used in the modern medical field. Although it has certain toxicity, as long as the dosage is controlled, it is a very useful and safe dye, which can be well distinguished from blood in the body.At the same time, he is also a good reducing agent, which can treat nitrobenzene poisoning, nitrite poisoning, and cyanide poisoning.

But now, Carvey is looking at other properties of methylene blue.

For Carvey, who has gone through the era of lack of medical care and medicine, this dye can definitely be called a panacea in the 19th century, and he is more excited than completing a complicated operation.

The first is the antibacterial ability that has been experimenting.

Modern antibiotics emerge in endlessly. In order to cope with the escalating drug-resistant bacteria, human beings also need to continuously upgrade their weapons.This is the inevitable result of evolution in the era of scientific development. When people rethink antibiotics, methylene blue has already retreated from the environment before it emerged. 【2】

In fact, before it was opened, there was a domestic precedent of using the pharmacological effect of methylene blue excreted by the kidneys to treat urinary tract infections.When it first appeared in foreign countries, it also studied the usage of treating bacillary dysentery, but it was only quickly submerged in the ocean of various antibiotics at that time.

In the field of antibiotics where you sing and I are on the stage, methylene blue has lost its necessity. People still see it displayed on various counters as a fish tank fungicide in ornamental fish shops in the flower and bird market.

In addition to detoxification and antibacterial, Carvey also knows the third role of methylene blue: anesthesia.

If we say that the modern antibiotic environment has its own characteristics, and each has its own antibacterial spectrum, no one will accept the other.The anesthesia environment is the top of the pyramid, with general anesthesia, local anesthesia, muscle relaxation, and pain relief, each with its own method.

Because everyone is human, it is difficult to find opportunities to choose unpopular anesthetics except for some special cases that require anesthesiologists to make fine-tuning of drugs.

The simplest example is ether, the originator of general anesthesia that squeezes out laughing gas, and the magic drug prescribed by chloroform notoginseng. Now it has long lost the right to anesthetize humans, and can only enter the animal laboratory to continue to glow. 【3】

In contrast, the earliest penicillin is still active in the first line of clinical practice.

Methylene blue anesthesia was first used in the 70s and is a clinical application based on practical medicine.Its anesthesia usage cannot be found in the drug instruction manual, because its anesthesia mechanism is in the column of side effects.

It can affect the conduction of nerve excitatory impulses, and can even cause a kind of nerve medulla damage.Subcutaneous injections of large amounts can cause peripheral nerve necrosis, large injections into muscles can cause tissue necrosis, and intrathecal injections can cause paralysis.

However, this damage is reversible at low doses and low concentrations, so long-term pain relief can be produced as long as the dose is well controlled.

Since it is an injury, there will definitely be many side effects. In addition to the blue-green color of the urine [4], many functional changes caused by nerve medulla damage are also very important.

In the anorectal department, where methylene blue is used the most, it is often used to relieve severe wound pain caused by dressing changes and defecation after surgery.

However, once this reversible damage exceeds the safe dose and concentration, it will produce irreversible numbness, and in severe cases, it will also affect the function of the sphincter, causing fecal incontinence ranging from about half a month to a month, and even permanent necrosis of the sphincter.

But local anesthesia is actually better for many surgeries than ether, which is immobile and lethal [5].Especially in the upcoming Prussian-Austro-Prussian War, mild to moderate injuries to limbs can often achieve very good analgesic effects with only local anesthesia.

Detoxification, dyeing, antibacterial, and anesthesia are the important reasons why Carvey called it the panacea of ​​the 19th century.

Today, however, methylene blue appears as a simple surgical stain.

"Countess, the operation will be over soon." After taking the stage, Watman walked directly to the operating table, comforting the patient first according to his usual style, "When you wake up, you will find that the tumor has already left your body .”

Justina took a deep breath, and managed to pull herself together: "I hope that's true."

"Don't worry, with me and Dr. Carvey here, nothing will happen."

"Thank you."

Justina turned her face to look at her husband again, and took his extended hand: "Kamiyi, if there is a problem with the operation, or the tumor is too serious, or... Anyway, if I don't wake up, please You must be with Illya."

"This..." Kamiyi was stunned, "You know everything?"

"Illya is much gentler than Edita, and that Angie only cares about your money."

"Eh, I see."

Justina glanced back at the theater, and continued: "This is just my suggestion, no matter who you end up with, please remember me."

"Of course!" Camille had tears streaming down her eyes, "You will always be my favorite woman."

"Thank you." Justina nodded to him with a smile, then opened her hands lightly, lying calmly on the operating table, looking at the nurse beside her, "Let's get started."

Only then did Watman turn his face to the auditorium and utter the first sentence of introduction today: "Honorable His Majesty the King, the Prime Minister and the French Diplomatic Ambassador, and colleagues who are willing to spend an afternoon watching the operation , what Mr. Carvey Hines and I are going to show you today is a brand new mastectomy.

Breast cancer has always been a killer of women, and for the past [-] years, surgery has been useless.It's not that it can't be removed, but it will recur.

Some experts believe that the breast cancer patient's body is at fault, while others believe that the tumor tissue was not completely removed during the operation.Dr. Carvey and I are more inclined to the latter, but after studying the records of dozens of breast cancer surgeries, we found that... Ahem, Dr. Carvey found that the recurrence of breast cancer may be related to the metastasis of lymph nodes.

Therefore, this operation is different from simple excision in the past. We also included lymphatic dissection near the armpit in the operation process. "

The right to speak fell into the hands of Carvey, who was preparing the dyed syringe: "Many of the surgical records I read before contained the description of "the patient's axillary lymph nodes were enlarged", and I thought of the breast cancer written by Dr. Rudolf in Germany 2 years ago. The relationship with lymph immediately aroused my interest."

After all, he showed the syringe in his hand: "This is a very perfect dye, inject it into the subcutaneous, intradermal, subcutaneous, and surrounding tumors, and you can see the clear direction of the lymphatics."【6】

Not everyone reads papers and reports as often as Carvey. The vast majority of surgeons prefer to do it themselves, and prefer to bury their heads and do it alone.

Therefore, most of the doctors in the audience have never heard of Rudolph's name, and they have no impression of this article.But no matter what the content of the paper is, and no matter whether the relationship between lymph and breast cancer is correct or not, since Carvey said it, it must be written down.

In fact, long before he successfully completed the cesarean section, there were already signs of this in the operation theater. After more than a month of consolidation, everyone has developed the good habit of taking notes during his operation.

The sound of turning pages and writing in unison surprised the four people watching.

"Directly recording the surgical process with words and images is the best way to deepen the impression."

Edinson didn't seem to understand where they were surprised, until Franz pointed it out, and he said helplessly: "Dr. Carvey can always come up with some innovative new ideas every time he performs an operation, and he has never heard of it before. method, we will reflexively choose to ask and record it.”

"He's too young."

"Mozart had already written more than 17 symphonies at the age of 20." Franz cited several Austrian geniuses to prove that Carvey's strength was just right, "Czerny and Schubert were both young fame, which is not uncommon in Vienna."

Edward frowned, and his heart beat: I admit that you are good at music, but this is a doctor. Don't doctors rely on hard work to learn, and they also talk about talent?
Waterman's introduction and the dye in Carvey's hands whetted everyone's appetite. The audience looked at the anesthesia mask on Giustina's mouth and nose, waiting for the operation to officially begin.

Amor became Kavey's anesthesia assistant again. According to the previous judgment standard, after the orbital pressure and eyelash reflex disappeared, he reported in time: "Dean, Dr. Kavey, the countess' anesthesia is complete."

"disinfect."

When Kawei gave an order, Damirgang behind him came to the operating table with a disinfection basin and a watering can, and Amor also became the third assistant to complete the preoperative disinfection with Damirgang.Carbolic acid disinfection covered the entire right breast, right shoulder, underarm, and right side of the trunk, while air disinfection with alcohol spray covered the entire surgical field.

The needle quickly pierced Justina's skin, and the pre-diluted blue dye slowly flowed into it.

"Just wait for 5-10 minutes, and the dye will flow to the surrounding lymph nodes step by step along the lymphatic channels. At that time, we can clearly see how the tumor metastasizes through the lymph."

After the introduction by two surgeons, Ambassador Edward also had a question: "Dr. Edinson, what exactly is the lymphatic vessel that Carvey just mentioned?"

"It is a pipeline system in the human body, and there is clear lymph flowing in it, which is called white blood by Hippocrates." Edinson explained, "And there will be lymph nodes between the pipelines, which should be used for producing and storing this blood."

"Then what is the function of lymph?"

"According to the theory of four fluids, lymph fluid can be classified as a kind of blood, which is a purer blood." Other doctors, including Edinson, also have a very shallow understanding of lymph, "Since the tumor has invaded the lymph, , indicating that the condition is very serious."

"I see." Edward was very interested in Carvey's staining method. "Although the seats are a little far away, it is conceivable that such staining must be very intuitive, but is there really a relationship between lymph and tumor?"

"I'm not sure either."

Edinson looked at Carvey on the stage, and suddenly thought of the suggestion he had made to Franz before, and changed the topic: "According to Dr. Carvey, lymph is actually like a railway, and tumors are materials. As long as you have With an efficient and convenient railway system, we can continuously send material resources to all parts of the front line."

Edward nodded again and again: "This metaphor is good, I like it. If I remember correctly, France now has the largest railway network in the world."

These words not only helped him regain a victory, but also reminded Franz of the embarrassment that he was almost surrounded during the Franco-Austrian War.For this reason, Prime Minister Karl had to stand up: "Although the railway can help with transportation, it is really on the battlefield that we rely on the brave and fearless Iron Knights."

Edward didn't find it strange, but said instead: "I don't think France will be inferior to others in this respect."

Since the conversation involved railways and soldiers, Franz stopped hiding and asked directly: "In this case, how does not only the French emperor react to Prussia's current aggressive preparations for war?"

"His Majesty the Emperor still hopes that the European continent can live in peace, and the British cannot take advantage of it."

"Prussian railways have been built to the border, steel factories are making guns day and night, and soldiers are constantly gathering." Franz sighed, "This makes us very nervous."

"Isn't that the case in Austria." Edward slapped his hands well, "How about we sit down and talk?"

Although Franz talked about peace, peace was just an excuse. What he really wanted was the land of Prussia, not peace.Seeing that the other party responded like this and threw the question back again, he had to answer it, and he couldn't answer it randomly.

Although he was reluctant at this time, Franz still had to advocate the Prussian threat theory: "We will eventually have a war with Prussia. This is a matter of German ownership. But once Prussia wins the war, the next step will definitely be against France. Bismarck The cunning fox has been watching you from the beginning, and will never give up the land of France."

"Couldn't it be Austria?" Edward didn't put Prussia in his eyes, "France has long been used to it."

After a few rounds of tit-for-tat confrontation, Richard quickly smoothed things over: "Okay, let's put the state affairs aside for now, let's see the surgery."

The dyeing before the operation has achieved initial results. Even without incision of the skin and subcutaneous fat, Watman and Carvey standing on both sides of the operating table can vaguely see the pipes dyed blue.Just as Edinson said just now, they spread outward from the center, forming a spectacular network.

Seeing that Kavey nodded, Watman immediately looked at the nurse: "The dyeing has been successful, give me the scalpel."

(End of this chapter)