Nineteenth Century Medical Guide

For the environmental management inside the barracks, Carvey has been reduced to a minimum.

According to the hygienic standards of real troops, there are many places to take into account.In addition to the water source problem mentioned before, the most important thing is to prevent infectious diseases. After doing the necessary disinfection work, we must also prevent various mosquitoes and poisonous insects, and deal with bites. The last thing is to eliminate rodents.

In addition, there are many details to consider.

Military doctors not only deal with trauma, but also deal with diseases. They also need to do a good job in health protection in various situations.

Marching on foot, marching at night, excessive fatigue, long-term noise, the impact of gunpowder exhaust gas, pain in the waist and legs of artillerymen, damage from knocking sounds, smoke and dust in tunnels, moisture-proof and dehumidification, and manure treatment all need to be considered.In addition, there are nutritional problems of food, and a lot of wild poisoning and internal medical diseases emerge in endlessly.

Rodent eradication is the first and foremost project that Carvey has emphasized many times.

Although they didn't understand it, and even regarded the rats as an interesting part of life in the boring barracks, they complied at Carvey's request.

The mice in the real world are not Jerry in "Tom and Jerry". They will appear anywhere there is food, bite wildly and give birth to a bunch of children.

The war itself needs to store a large amount of food, so it is necessary to dig rat-proof ditches and ridges, build rat-proof walls, and lay thick sharp gravel cushions on the bottom and surrounding areas of the warehouse. 【1】

"I have done experiments before. As long as the wall is buried 30 centimeters deep and the surface is smooth enough, it can effectively protect food and equipment warehouses." Carvey drew a sketch and said, "If the bottom layer is paved with sharp stones, the outer ring plus the buried If the ditch of the water tank is closed, it should be safe."

Ignatz and Herman knew the importance of protecting food, because he had experienced food shortages during the Franco-Austrian War.

Even dried meat and vegetables were barely available, but there was a shortage of bread, a terrible shortage of bread, a considerable part of which was caused by rats.

But apart from warehouses, what Carvey requires is that all hospitals, barracks, and ambulances meet this level, and a rat trap needs to be placed every 15 square meters.This is a huge project and requires a large budget.

They didn't understand why they did it until Carvey said "Black Death".

In fact, there are many other infectious diseases related to mice, such as epidemic hemorrhagic fever, scrub typhus, typhus, forest encephalitis, leptospirosis and so on.But for Europeans, the Black Death is far more terrifying than those infectious diseases, and no disease can compare with it.

"The Black Death is related to rats?"

This overturned Ignaz and Hermann's understanding of the plague. After all, the discovery of Yersinia pestis in history would take another 30 years or so.Even if Carvey has already published microbiology, the response is not good, and it will take some time to understand bacteria.

"Tell me about the sickness rate of soldiers in the Imperial Army during the Franco-Austrian War." Carvey said while drinking coffee, "Should the teacher have done statistics?"

"Probably around 25%." Ignatz replied, "At that time, the number of patients in several central hospitals on the front line exceeded 4000. A major battle would not only increase the number of wounded and sick, but also increase the number of patients to a certain extent. .”

"It's normal." Carvey said, "Because a corpse is a corpse to us, but to mice, it is the most delicious food."

Ignatz recalled some not-so-good memories[2]: "I think the rodent control team at the General Hospital is now strong enough to keep the rats out."

"I hope so."

Carvey felt a headache when he thought of the four-month preparation time. It took a lot of time just to take over the management of the logistics of the Military Medical Office, and what he took over was a complete mess.

The various changes I have made in the Municipal General Hospital seem to have amazed many people, but if you let go of the scope, the impact of this change is very small.In Vienna, those who truly trust themselves and are willing to act according to their own ideas are concentrated in the Municipal General Hospital.

Eddinson's theoretical knowledge is still old, and his understanding of hospitals is still at the time of the Napoleonic Wars, and he didn't even refer to the idea of ​​​​the Crimean War.

The most important thing is that he perfectly inherited the steel-like character of the German people.This kind of personality can bring unusual long-term work efficiency, but it will encounter various difficulties when accepting new things.

He holds high the banner of miasma and does not approve of any changes to the hospital.

After more than half a month of quarreling, Franz simply separated the two.All the hospitals on the northern front were reformed according to Carvey's ideas, while Edinson was based in Vienna, and all the hospitals on the southern front and possibly the western front would stick to the original system.

"After arriving at the General Hospital, I will have a thorough inspection." Carvey said, "I don't care about the other front-line ambulance stations, but at least this General Hospital cannot have rats."

"understood."

"Next is the prevention and treatment of those plagues." Carvey once again explained the diseases he classified into the plague category, "Dysentery, typhoid, cholera, encephalitis, hemorrhagic fever, typhus, I will talk about these first. Before I’m talking about the basic operations, and what I need to explain next is the more detailed parts.”

Herman must have listened to Carvey, but Ignatz was different. He was much more assertive: "You said these were caused by microorganisms?"

"After all, I wrote the paper, and I naturally agree with the paper's point of view." Carvey argued, "According to the microbial diversity described in the theory of microorganisms, each microorganism has its own unique way of life, and will also follow the way of life. produce a unique disease disease."

"So there's a microbe for every disease?"

"At least infectious plagues are like this, such as cocci in surgical incisions, streptococci in puerperal fever, and these have been confirmed by Koch and I's experiments." Carvey said, "We should be grateful that Koch did not because of This war goes back to its own country."

Now everyone, including the Berlin Institute of Chemistry, only regards Koch as an ordinary medical student, and only Carvey knows the value of Koch.

Ignatz couldn't help but looked up and glanced at the empty compartments around him, hoping to find some traces of microorganisms in the transparent air, but it was definitely impossible: "It is only necessary to stop those microorganisms to reduce the occurrence of diseases ?”

"Theoretically, yes"

"The prevention and treatment of diseases is too simple."

"In fact, that's not the case." Carvey sighed and glanced at the wall clock. "After talking about this, I have to talk about some special battle wound infections. Time is limited, hurry up."

The level of battlefield medical care in the 19th century was completely incomparable with that of military medicine after World War I and World War II. Historically, the Austrian military medical system could not be seen at all, but it also represented the average level in Europe.

It is a bit behind the more advanced Britain and France, but it is already ahead of most countries.

The vast majority of doctors only learned a little superficially in the training, but even so, Kavina's four months were not in vain. His medicine and surgical skills are deeply affecting the team.For those surgeons who can act alone, the progress brought about by these four months is something they may not be able to obtain in several years.

Bill Roth is the best example.

At the age of 35, he has become the vice president of the School of Surgery, relying on his excellent surgical knowledge and rich clinical work experience.Of course, the most important thing is his innovative ability to constantly challenge himself, and his courage to try new surgeries.

Bill Roth is not without flaws. In Carvey's eyes, he is the originator of abdominal surgery and created a series of general surgery. But at the same time, because of his different views on microorganisms, he "opposes" Carvey on many issues. .

For example, in terms of the military hospital model, he resolutely opposed the new model proposed by Carvey, and he also opposed the old model insisted by Edinson.

Bill Roth proposed to divide medical resources into parts and only make independent hospitals for each infantry regiment or even infantry battalion, rather than a large hospital like the Army General Hospital.The reason is actually very simple. The death rate of the general hospital is much higher than that of such independent small hospitals.

He summarized this concept in "A Brief Introduction to the Medical History of the Austrian Army in the Franco-Austrian War", and set up the basic medical supplies needed by a mature independent hospital. 【3】

[In every place, you can see hospitals that provide patients with a comfortable place to recuperate. You don't have to worry about the route being interrupted during transfer, nor do you have to worry about the bad mood of wounded soldiers seeing the crowded central hospital. ]
This is the view held by Bill Roth, and the death figures and death rates counted by Ignatz in "Memoirs" are the best evidence.

But in fact, to realize his vision requires not only huge medical supplies, but also a more important key factor, the doctor.After all, there are still a small number of people who are willing to give up the superior working and living environment. The average number of doctors assigned to the infantry regiment is very limited, and their ability to practice medicine cannot be guaranteed.

All three were surgeons, and they had had a big fight in the surgical academy two months ago.

In the end, Bill Roth couldn't compete with Carvey and Edinson, and he didn't even get a response to the letter he wrote to Franz [4], but he still agreed to Carvey's invitation to become the leader of the second shift of the trauma emergency team.

Because he knew that he could learn a lot by staying with Carvey.

"Excessive blood loss, open the venous access first." Bill Roth is one of the few doctors who can thoroughly understand the first-aid guidelines of Carvey, which is why he can stand on the second shift as the chief surgeon, "Give me a bandage, You squeeze the two bleeding spots on your lower limbs, squeeze them tight!!!"

"Nurse, is the anticoagulant ready?"

"Ready."

"Okay, one for blood collection and one for blood matching!"

"Where's the anesthesia assistant?"

"coming!"

"Get anesthesia directly, and bring me a basin of salt!"

"coming!"

"Is there any warm one?"

"The water is already boiling."

"No matter, prepare to wash the abdominal cavity."

The soldier sent to him had several wounds, two in the abdomen, one in the shoulder, one on each arm, and two on the left leg. Judging from the condition of the wound, it was a shot from the front.

However, because of the long distance, the penetrating power of the projectiles in the shotgun is not strong.Billrot immediately judged that the arm wound was not serious, and the wound on the shoulder had basically stopped.The serious ones are the two places on the left leg and the two places in the abdominal cavity that got drilled into nowhere.

Almost at the same time, Bill Roth and Bottini made the same decision:
"I work on the stomach." / "I work on the thighs."

"You work on the thighs." / "You work on the belly."

One spoke blunt French with a thick German accent, and the other also spoke French, but smacked of pizza.

Fortunately, the difference in language did not affect the tacit understanding between the two. Bill Roth cut the wounded soldier's clothes, while Bottini checked the bleeding of the lower limbs while stopping the bleeding.

Immediately afterwards, the two exchanged scissors and gauze. Billroth picked up the scalpel and cut open the wounded soldier's abdominal skin regardless of the anesthesia's ineffectiveness. Bottini cut open his socks with scissors. and pants.

The first operation in the second shift was the complex left lower extremity bomb extraction.

If it was placed four months ago, the two of them hadn't learned Kavey's first aid strategies and techniques, and they didn't have the desire to use a scalpel when facing such a wound.Even if the projectile is really taken out, the soldier will die from excessive blood loss, which is almost 100%, otherwise the shotgun would not be called a big killer for infantry.

But now they are very confident in completing the operation, injecting a boost to the nervous general hospital.

For Bottini, what the lower limbs need to do is to minimize bleeding, and preserving blood vessels is more important than anything else.As long as the blood vessels and the distant blood supply of the thigh are preserved, the function of the thigh can be preserved, and there is no need for amputation.

For Bill Roth, the celiac situation was much more complicated.

Just like Olgi's abdominal injury, the shooting angles of the projectiles scattered by the shotguns are already messy, and they will become unstable and turn over after entering the human body.If you can find all the bleeding points, it is half the success. If you can find all the ruptured parts of the organs, it is considered a basic success.

If you can't find it, you can only look at the luck of the wounded soldier.

"Two more people, hold him down!" Billrot was like a cold machine, ignoring the violent reaction of the soldier who hadn't really fallen asleep, and quickly melted his peritoneum, "Give me the hemostat, gauze, Rinse with saline!"

"coming!"

At this time, the surgical operating room of the General Hospital has begun to fully operate, and the benefits of the early assembly have also emerged.Facing the wounded brought about by this battle, the surgical team and medical supplies that had been prepared for a long time in the hospital seemed to be able to do a job with ease.

But war is always full of various uncertainties, Hills dare not bet.

"I don't know what Locard is doing in front. It is agreed that the military department will deploy an ambulance station at any time to deal with some wounded soldiers who can be treated on the spot, so as to reduce the pressure on the general hospital."

Hills was in a bad mood, and after complaining, he had to continue to focus on the wounded soldiers.He has now become the real material distribution officer. As the person in charge who replaces Ignatz and Kavi, he must ensure that there are sufficient medical resources to face the unknown situation: "Are the three groups preparing?"

"Already preparing, do you want them to go?"

"It's stable for the time being." Hills said again, "Someone go to the Medical Committee Office and try to find as many people as possible."

"it is good."

"Then the warehouse in the third ward of internal medicine was emptied, and basic disinfection was done. The operating room is almost full, and another room must be vacated."

"it is good."

"There is also a supply box, hemostatic agent, anticoagulant, and bandages. By the way, there is also water. The operation needs a lot of clean water, and the water must be guaranteed! Infusion bottles, water basins, these operations are all used! "

"It's already being prepared. Dean Carvey has been emphasizing it before, don't worry."

Thinking of this step, Hills finally breathed a sigh of relief, and took off his coat: "Where is my surgical instrument box, bring my box here."