Nineteenth Century Medical Guide

In the eyes of laymen, surgery may be a discipline that treats diseases with one hand, but it is only after entering this field that one can feel the sense of powerlessness.Even in modern times, with the support of a large number of medical devices and a large number of drugs, there are not many surgeries that can really make patients feel rejuvenated.

Many surgical options will bring inconvenience to the life of the patient, and some will cause many complications, such as infection, bleeding, organ perforation, weakened function, etc.
The reason why it is called a complication shows that this is a postoperative disease that has little to do with the operator.Perhaps superb surgical techniques can reduce the probability of occurrence, but they cannot truly reduce it to zero.

All the doctor can do is to avoid risks as much as possible before or during the operation.

The ventriculoperitoneal shunt to be done now is the choice made by Carvey after weighing the pros and cons. Perhaps this choice is not good in modern times, but the options in the 19th century were really limited.

In fact, ventriculoperitoneal shunt is not considered a modern operation, but it is closer to the 19th century when going back to history [1].However, in the diagnosis and treatment of modern craniocerebral trauma, it is still commonly used in the treatment of intracranial hypertension.

This treatment is a typical palliative, not a permanent cure, because it does not remove the cause of cerebral edema, but simply reduces intracranial hypertension.

But for Madame Santini, that was enough.

The reason why neurosurgery prefers palliative care is largely because nerve tissue is different from other organs, and a slight touch can cause nerve damage.Even a small amount of bleeding can endanger the patient's life. It is obviously not worth the candle to cause more trouble for a palliable disease.

Medicine is not only about eliminating pain, but more about making patients live like individuals.

This is especially true in the 19th century when there was no technology and no life-saving means.

From a purely surgical point of view, if it is handed over to a senior doctor specializing in psychiatric surgery, the operation of ventriculoperitoneal shunt is not difficult and the process is not complicated.But now that the main knife is in the hands of Kawei, the difficulty must rise a step.

It is not that emergency surgery has not done neurological surgery. In case of traumatic brain injury, especially when neurosurgery cannot allocate too many manpower, Carvey has to take the stage.But there is no small knife outside the gods. Compared with other surgeries, the error tolerance rate here is very low. It is not only the proficiency of surgery and the ability to avoid risks, but also the extremely precise operation technique.

Kavey's skills and proficiency will naturally not be a problem, but it's a pity that he has been away from the high-intensity emergency room for a long time, and his hands will definitely be rusty, so his current pressure is no less than that of Massimov.

This kind of pressure will be naturally reflected in his expression, behavior and language, coupled with the rare and quiet operating room environment, let him return to his original appearance in the emergency surgery department, the king of the operating room who is the only one who respects me.

"All surgical instruments must be strictly sterilized, as well as the catheter. I will use this tube later, and the other end must be inserted into the patient's abdominal cavity."

"."

"No! All lumens must be sterilized, not only the surface, but also the inside, all must be sterilized in place!

"

Although Kavi's voice is not loud, his temper is worse than the usual Massimov, and he doesn't like anything: "Don't show any gaps in the gloves, wrap them tightly for me. Wear the mask well. And disinfectant , this is not enough, bring over two more bottles! It's only past ten o'clock, cheer me up!" …

Since entering the operating room, Massimov felt something was wrong.

Not only Carvey's temper, but also this weird brain surgery that is about to start.

If it is said that cesarean section and breast cancer are the product of flashes of inspiration after the accumulation of parental experience, appendicitis is the result of persistence, and the repair of surrounding organs after hysterectomy is a collection of superb surgical techniques, then the current brain drilling seems very mysterious .

Because craniocerebral drilling is hardly seen in Vienna, in fact, not many surgeons in Europe can use drilling skillfully, because it requires a bunch of patients who need drilling for doctors to practice, in fact, it is almost impossible. possible.

If he still learned it from his father, then his father is too powerful and too invisible, why haven't he heard of such a character before?
Massimov had also discussed this issue with Ingnac, Olgi, and Wattman before.

There are indeed many famous surgeons in Lombardy, but I have never heard of anyone who is so proficient in abdominal surgery.There are few people who can perform cesarean section. He has to have appendectomy, hysterectomy, bladder and ureter repair, and breast cancer resection. Now he has to do cranial drilling.

Because he was preoccupied with Mrs. Santini's surgical treatment plan, the feeling was not too strong.

But when the operation plan was determined and he followed Carvey into the operation theater, seeing him directing his assistants to do things like a doctor with decades of operation experience, the indescribable sense of separation became more and more severe. Obvious.

Who is his father? ? ?
A surgeon who specializes in abdominal surgery can still think of shunting after brain drilling. Is there really such a powerful guy in Italy? ? ?

The last neurologist known to Massimov was the French doctor Char, but his research was limited to peripheral nerves.For example, hysteria, muscular dystrophy, multiple sclerosis, agitators, etc., do not reach the point of the brain. 【2】

If it has anything to do with the brain, could it be that Broca?

The age is right, and he is also a surgeon. He has dissected many brains, but the other party is an authentic French who graduated from the University of Paris.Moreover, the scope of surgery he is proficient in is actually similar to that of Watman, and it is only limited to the maxillofacial area. He may touch some gynecological surgery, but Massimov knows very well that he does not know abdominal surgery at all【3】

No, it's Italy, his father is Italian!

Judging from how familiar Kavi is with the brain, he can rely on many anatomists. After all, he is an adoptive father, and it is normal for his age to fluctuate.

The Lombardy region of Italy was indeed the first to study and establish psychiatry and neurophysiology. Milan, Naples and some surrounding areas have built madhouses. 【4】

Could it be Lombroso? 【5】

It is true that a lot of brains have been cut, and the research on brains is indeed very in-depth, but I remember that he is only 30 years old.It may seem that he is not young now, but he was only 17 years old 13 years ago, and he was still in middle school. How could he adopt Kavey? ? ?

and many more!

The razor in Massimov's hand was getting slower and slower.

Why don't I think about Lombroso's teacher?
Anyone.
Morselli?people in Naples. …

Biffy?The last time I saw him was in Pavia, so he probably wouldn't be going to Milan.

Bellingeri?Alas, poor Bellingeri, died 18 years ago.
Who else? ? ?
By the way, what is the name of the one who proposed the ventricles? It seems that there are some studies on the stomach.
Massimov knew many Italian surgeons, but there were too many of them, and some names might not be remembered.Among these people, it seems that none of them has research on the brain and is also proficient in abdominal surgery.

But that's not the weirdest thing.

The most unacceptable thing to Massimov is that he has read a lot of medical books related to the brain. No matter who the book is, the surgical treatment for headaches basically has only one step, which is to drill holes to release pressure.

He didn't know why a tube was used for shunt after the hole was drilled, let alone why the shunt must enter the abdominal cavity.

It is true that there is some fluid in the ventricles of the brain, and removing that fluid does reduce intracranial pressure, but is surgery necessary?And can this kind of fluid diversion operation really be done by surgery?

He had a headache thinking about it, and felt that if he pursued the operation and the name of Kawei's adoptive father, he would become a madman.

"Mr. Massimov, what's the matter with you?"

It was only when facing Massimov that Carvey realized that he was still an ordinary surgeon, not the original director of emergency surgery: "The operation is almost ready, let's start."

"Oh." Massimov carefully shaved off the last lock of Mrs. Santini's hair, "Is it enough to shave all of it?"

"Um"

Carvey glanced at the bare scalp, and soon found the left temporal bone. The bone under the scalp was different from other skull bones.The tumor not only squeezed the brain tissue inward, but also eroded the outer temporal bone outward.

Massimov also saw Carvey's prompt and found the place: "Is it here?"

Carvey nodded, but did not say a word, but came to Mrs. Santini with a smile on his face, and comforted him: "Madam, the operation will be completed soon, and the headache should be better by then."

"real???"

Santini has been suffering from headaches for a week, and his spirit is already on the verge of collapse.What tortured her even more was the fear hidden deep in her mind about the mental hospital: "They all said I was crazy, I really couldn't control myself, I didn't want to go to the Tower of the Madman."【6】

"Don't worry, I won't send you there."

"If it doesn't work, tell me earlier, I, I really don't want to live anymore, it really hurts too much!"

"It's okay." Carvey knew that this feeling was uncomfortable, "Give me an hour, and it will be over in an hour."

"it is good"

Amor was not around, and Carvey was worried about the nurses and assistants here, so he had to do it himself: "Counting the anesthesia time, the operation may take more than an hour. Everyone cheer up, and you can go home early to rest as soon as possible."

Carvey has always been a surgical director who loves to teach. Although his attitude towards the group of "students" in front of him is not very good, he still hopes to let these people gain more knowledge and learn more about brain surgery.

"First of all, we still need to understand the basic anatomy of the brain before the operation officially begins."【7】…

Carvey asked them to prepare an anatomical map in advance, hung a blackboard in front of the operating table, and said while undergoing anesthesia: "The inside of the brain is not all solid, but there are certain cavities. The anatomist confirmed and named it the ventricle. The ventricle is the cerebrospinal fluid, which is also the target we need to shunt this time."

While speaking, Mrs. Santini had fallen asleep
"Give me carbolic acid and alcohol, I need to sterilize Madam's body." Carvey took the disinfection basin and wiped her head with a cotton ball, "This operation is very extensive, and the scope of disinfection is from the head to the abdomen. to full coverage”【8】

In addition to disinfection, there are also drapes for surgical preparations. Unfortunately, St. Mary’s Hospital does not have the disinfection sheets of the Municipal General Hospital. In order to prevent infection, Carvey can only operate directly on Mrs. Santini’s head after disinfection.

However, before the operation, the patient's eyes and ears need to be protected to prevent the drill bit from slipping, bleeding, bone powder splashing or other accidental damage to the eyes and ears.

"Here, scalpel."

Massimov took a box of drill bits and acted as Carvey's assistant【9】, and also asked, "In the past, only the craniotomy was done. Why did it take so much trouble and so many links this time?"

"The headache is due to intracranial pressure, and the method is to open a hole to release the intracranial pressure." Carvey took the scalpel, and first marked Mrs. Santini's posterior horn with a quill[10], "But the drill There are many problems with opening the head, most commonly infection, and brain tissue that bulges outward due to pressure."

Although Massimov is skeptical about the infection, many operations in Corey have begun to try to fully disinfect.

What does it mean just bulging brain tissue?
"It's actually quite understandable."

Carvey put down the quill, cut a 3cm incision with a blade, and then pressed the drill bit against the marked position, and began to choose the drilling angle: "The brain tissue is like a very loosely beaten meat paste, which was originally wrapped in a cloth bag. , very good. But now the pressure on the cloth bag is increasing, once a gap is opened in the bag, what will happen?"

". The meat paste will be squeezed out by this pressure."

"Yes."

Carvey held the skull drill in one hand, and carefully placed the other hand on the top of Mrs. Santini's head, holding his breath as if opening a hole in the young coconut: "Once the outward movement is restricted, the brain tissue will naturally press outward, and it will definitely It will damage the patient's neurological function."

This is actually an unintentional remark, because in this day and age, no one knows what the function of the brain is.

The first doctor to clarify the functional division of the brain was the German neurologist Brodmann. The division time was in 1909, also known as the Brodmann division.Carvey certainly knew the zoning law, which was the foundation of the foundation, but he didn't know the time.

Earlier in the mid-to-late 19th century, the divisions of the brain were replaced by the 42 divisions of the skull, known as phrenology. 【11】

However, Brodman's brain division was not accomplished overnight. His achievements were based on the brain theories of many anatomists and surgeons.And among these people, one name suddenly jumped into Massimov's mouth.

"That's what your adoptive father taught you, too."

Carvey was stunned for a moment, but he didn't take this seriously, and nodded without thinking too much: "Yes, he has experience in cranial drilling and tried it."

Massimov suddenly interrupted him and asked: "Is your adoptive father Verga?" [12]