Nineteenth Century Medical Guide

Chapter 23 23. Empty Exercises

In the eyes of every surgeon, cesarean section【1】is a major operation. From the moment the operation is performed to one month after the operation, the maternal mortality rate can be said to be appalling.

The most embarrassing point is that the mortality rate of other operations is greater than that during the operation, and infection accounts for a considerable proportion.The cesarean section is just the opposite. The mortality rate during the operation is much higher than that after the operation. It is their normal state to die on the operating table.

For the rest of the population with surgical conditions, they also have options.No one wants to lie on the blood-stained operating table unless the ending is inevitable.

But for pregnant women, they have no choice. Cesarean section is the only solution for women with dystocia and placenta previa【2】.If no surgery is performed, both dystocia and placenta previa hemorrhage will cause fetal death, and the death of a mother at this time becomes "good news".

The existence of cesarean section always reminds those surgeons who have a little sense of achievement from time to time. Although they have got rid of the dark age of soldering iron to stop bleeding, the light of the candle oil lamp they hold tightly in their hands is still limited, and the future is still chaotic.

Therefore, many people only dare to guard their one-acre three-point land, and are unwilling to have a cesarean section.

Of course, there will always be no shortage of retrogrades in this era.They knew that the ending was not good, but in the face of a certain death situation, they still put part of the pressure on their shoulders, hoping to take the pregnant women to a fight against fate.

Ignatz is one of them.

I have to say that courage is indeed commendable, but the reality is cruel.

Even he himself can't remember how many cesarean sections he has tried before. The most recent time, the pregnant woman died directly on the operating table.At that time, he vented his anger on the interns, but Ignatz knew in his heart that this kind of operation was a narrow escape.

In the absence of oxytocin [3], strong hemostatic agents, and proper uterine suturing techniques, cesarean section will cause unstoppable intraoperative bleeding.Even if the uterus and appendages are cut off, the weak body after heavy bleeding can hardly resist the attack of postoperative infection.

"So, our speed must be fast!"

While Carvey and Musil were bargaining with each other, Ignatz had already pulled Herman, Hills, and the three interns to do the dissection.In this rare practice, speed has become the primary focus he has repeatedly emphasized.

"My goal is to complete the process within 3 minutes." Ignatz looked at the five colleagues behind him. "There will be obstetric midwives to assist, but you need to practice as assistants and reserve assistants."

In order to treat the pregnant woman and successfully obtain the cesarean section, Herman and Hills made a lot of preparations.

"Teacher, the uterus is difficult to suture and the healing is very poor. Should the uterus be cut off after the fetus is delivered?"

Holding the scalpel in his hand, Ignatz looked at Rosa's body, shook his head and said, "Nora is still very young, only 19 years old, it's a pity to cut off the uterus directly, I hope to try to suture the incision of the uterus. "

Hills was startled, and quickly warned: "Two years ago, the cesarean section performed by Dr. Morrow next door was due to problems with sutures, and the pregnant woman lost too much blood. The one a few days ago was also due to problems with sutures and hemostasis. "

"I performed that cesarean section, of course I know." Ignatz didn't respond: "That's why I just said, the speed must be fast."

"I went to see him, and his speed is already very fast. It took less than 3 minutes to suture the uterus, and the total process was controlled within 10 minutes."

"Then we cut the sutured uterus down to 2 minutes."

Hills still felt uncomfortable, and continued: "No, it's not a matter of time. When the time comes, the swollen uterus will continuously pour blood into her abdominal cavity, and the crow's beak forceps【4】can't hold the whole Uterus. Your eyes are blood red, how do you stitch them up?"

"So I asked the hospital to buy a hand-cranked suction device [5], made in Germany."

"I've seen that tube. Although the flow rate is greater than the previous one, it's still not enough to cope with the amount of bleeding during the cesarean section. It only takes less than 10 seconds for her abdominal cavity to be filled with viscous blood. When"

At this time, Herman who was beside him gave him a slight push, and continued following the sentence: "At that time, you and Mr. Ignatz can just do it, and I'll just shake it by the side."

"Shake it too fast"

"You still don't believe me? I've been practicing recently." Herman smiled and showed his upper arm muscles, "It only takes half a minute to solve 1 liter of water."

Ignatz finally raised his head and glanced at Sears: "It's better to hurry up and practice after talking so much nonsense, God knows when that girl will be born."

No matter how graceful a girl is, it is difficult to keep her original appearance two days after her death.What's more, Rosa's face has long been rotten, and obvious bruises and scattered wounds can be seen.If it weren't for the warm weather in Austria at the end of February, those annoying little bugs would visit her cheeks one after another.

Two coarse cloths covered her upper torso, legs and feet, revealing only her flat and firm abdomen.

Ignatz's scalpel landed about 6cm above the umbilical cord, made a paramidline incision, and gently cut down to her lower abdomen.After three or two stabs entered the abdominal cavity, the thin fat and muscles were pulled away, and the uterus began to be searched.

The cesarean section they performed is very different from the modern improved one, which is called the classical cesarean section by modern people【6】. The earlier "ancient style" cesarean section.Taking the incision is similar to the classical style, but because the operation techniques are too rough and there is no decent practice, the process will appear very messy.

If the subject of the operation is replaced by a corpse that has been dead for two days, the blood will coagulate, the tissue will lose its elasticity and temperature, the scene will look abnormally empty, and the picture will be more fragmented.

"The non-pregnant uterus is too small and there is no blood yet, so it is difficult to simulate the feeling during the operation."

Hills pushed away the cold intestines, trying to make room for the chief surgeon.Herman crouched on the side, blushing, and frantically shook the suction device: "It's been 2 minutes, can it be sutured?"

"Sew."

Ignatz fished out a ball of cotton cloth from the small womb, threw it on the ground, and then took the needle and thread handed over by Hills: "The suturing of hollow organs should first suture the inner membrane and muscle layer, and then is the outer serosal layer"

While saying these words, he inserted the needle in the muscle layer, using simple continuous sutures, and then continuous mattress inversion sutures in the serosa layer [7].

For Ignatz, who has undergone anastomosis of the small intestine, it seems that there is no difficulty in suturing the uterus.From entering the abdominal cavity to suturing the uterus, the time has only passed 5 minutes, which is already quite fast.

But they know that these are not enough.

"Again!"

Ignatz cut open Rosa's uterus again, stuffed the cotton cloth back on the ground, imitated the appearance of a baby, and practiced again according to the sequence just now.

Faster this time.

"4 minutes 43 seconds."

Ignatz shook his head: "Go on!"

"4 minutes 39 seconds."

"4 minutes 28 seconds."

For the fourth time, Ignatz closed Rosa's womb, the tiny uterus covered with stitched incisions.The time is shrinking, but he still doesn't seem satisfied.

"Mr. Ignaz is amazing. This should be the best speed in Austria."

Bergett, who was standing by the side, just had an embarrassment yesterday, and today he wanted to rely on words of praise to stand back on the operating table and re-whitewash his image of a top student.

Seeing him like this, the other two students were not to be outdone, and stepped forward one after another: "The teacher's stitching is very stable, much better than the French boasted Master Duran, I think I can book the front page of the Vienna Daily gone."

If these words were placed after the operation yesterday afternoon, there would be no problem.But now the three people on the dissecting table are still full of sadness. The smoother the practice process is, the more it reflects their inner anxiety, because the content of this kind of practice can't reflect the real situation during the operation at all.

The more unknown the more fearful.

"If you have time to talk nonsense, why don't you go to the meat factory and ask for a pig's bladder." Ignatz looked at the stitched uterus and thought of an unsolvable solution, "Fill it with water and stuff it into her stomach , Does this look like that?"

Herman rubbed a circle in the air with his hands, nodded: "It's really quite similar."

Hills also agreed with this approach: "It must be hot water, which can also solve the problem of amniotic fluid by the way."

"Go soon?!" Ignatz yelled at the three interns again, "Do you want to wait for me to give each of you a lunch before stuffing the travel expenses into your hands?"

The three of them looked at each other, knowing that they had said the wrong thing, they could only follow his wishes and leave the dissecting room.

Unexpectedly, as soon as they arrived at the door, a nurse hurried in, followed by a flatbed cart: "Doctor Ignatz, the police station has sent another corpse, I hope you can sign for it."

"Oh? Delivered?"

Ignatz was very excited and satisfied with Carvey's efficiency.Now there was another male corpse. Although he was a little fatter, the abdominal fat and the enlarged pig bladder made it easier to simulate the appearance of a pregnant woman.

However, what he didn't expect was that a policeman who came in after him suddenly mentioned the matter of money: "Doctor Ignatz, the corpse has been safely delivered to you. According to the verbal agreement, you need to pay Ours is 25 crowns, thank you."

"Huh? 25 crowns?" Ignatz knew the verbal agreement between himself and Musil, but he still didn't understand what he meant. "What 25 crowns? Hasn't the money been paid?"

"This is what Dr. Musil told me." The policeman was also confused.

"Didn't I give him the money?"

"I don't know, Dr. Musil told me to come here to get back 25 crowns, and then go back to report."

At this time, Carvey had already entered the pharmacy. He had no idea that the police station would make a decision so quickly and send the corpse to the hospital as soon as possible. 25 crowns to pester.

He is now "indulging" in front of the colorful medicine cabinets, trying to find out some things that he can use for himself: "Boss, I often feel pain all over. Do you have any recommendations?"

The boss, an old man in a black suit, was sitting behind the counter.

Wearing a pair of gold-rimmed glasses, he looked at the tattered book in his hand, and seemed to have lost patience with his question: "I suggest you go to the hospital, either the City General Hospital or Grize. Although I think it's nothing Useful, but at least it's better than staying with me."

"Huh? Isn't there any medicine for pain here?"

"Yes, yes." The old man adjusted his glasses, licked his fingers lightly and turned a page, and said lightly while looking at the pages, "But this medicine can't treat the cold, sprain, headache, etc. you just mentioned at the same time." Vomiting and diarrhea."

(End of this chapter)