Nineteenth Century Medical Guide

When abortion is not possible, placenta previa has become a nightmare for all mothers, and more than half of the deaths are related to it. It is also the main reason why obstetrics need to perform cesarean section.

But sadly cesarean section is only an intervention, not a panacea.

There are various risks in modern surgery, not to mention the 19th century.Kawei has been able to persist until now to maintain a zero death rate, even he himself feels miraculous.Even if he really has the hand of God bestowed by God, even if the magic of cesarean section can continue, there will still be situations that cannot be solved by surgery.

For example, the woman who is lying in the preparation room of the operating theater now falls into this category.

"Bleeding, but not much"

The mother was flustered, but the nurse Kallen was only taken aback, and her face remained calm.While judging the amount of bleeding, she asked calmly, "How many babies are you in?"

Maternals are very sensitive to abdominal pain, and persistent high-intensity abdominal pain is likely to mean labor.But she couldn't really judge whether she was really in labor, and whether it was a good time to give birth at this time.I was about to face an operation that I didn't know the fate of, but now it's hard not to feel anxious.

But after hearing Karen's calm voice, for some reason, the mother's mood gradually stabilized: "It's the third child."

"It's okay, don't worry." Karen touched her hair, took her pulse with the other hand, and after confirming that her heart rate was fine, she asked again, "How long did it take for the last child to be born?"

Perhaps the time since the last child was not long, but the mother remembers it clearly: "I came to the hospital after a good meal in the evening, and gave birth before twelve o'clock. It should be five hours."

Karen nodded and asked again, "Does it still hurt now?"

"It's just passed for a while, and it may hurt again later. I know this feeling, it's about to give birth."

After noting the time, Karen patted her on the shoulder lightly, and comforted her: "It doesn't look like much bleeding now, it should have just started, so don't worry too much. I'll call the doctor, they will take care of it."

"I'm the only one here?"

Karen smiled: "The doctors are preparing for the operation in the theater. It's next door. I'll be right back."

"OK then."

Ever since she got the job of delivering the equipment, Karen has been with Kawei, and she is also one of the three nurses who came back from the front line of the Pu'ao battlefield.Having experienced many caesarean sections in Vienna, as well as front-line rescue, even if she has not received systematic medical studies, she is very clear that the current abdominal pain is not a good thing.

Abdominal pain means that the uterus is contracting and, once regular, it is the first stage of labor.

If it is just a normal labor, the bleeding is normal, as long as the amount is not large.But she has a placenta previa, and a natural delivery should be avoided as much as possible, because there is no room for hemostasis, and it is difficult to stop the bleeding once.

And the most important thing is that she is a multipartum woman. According to the birth rate of the previous birth, this birth will never take more than five hours, and it may not even take three hours.

Karen glanced at the wall clock before going out. It was not past ten o'clock, and it was 3:1 p.m. in three hours. The surgery probably wouldn't be over.Even if he could endure until he was on the operating table, hemorrhage was very likely to occur before.

In just a dozen or so steps, she clearly realized that what she wanted to do was not simply "call a doctor", but to find Kawei.Although she doesn't know the obstetrics capabilities of France, she has witnessed the strength of Kavey in the past half a year of work.

If even this man can't do anything, then the only chance is to wait for God to come.

At this time, the Second Surgery Theater was preparing for surgery according to the usual procedures.

Considering that this is Paris, not the familiar Vienna City General Hospital, the assistants who accompanied Carvey on stage for the first time were a little nervous when facing the French surgical community.And this tension was reflected one by one in the requirements for item preparation.

Thanks to Paris, France, there are enough manpower and materials to meet Carvey's so-called sterile plan. There were no omissions during the inspection, and some unsatisfactory places were also handled reasonably.If it is replaced by other small countries or small cities, I am afraid it will not be so easy.

"Is the clean water you asked for yesterday ready?"

"Ready, 5L."

"It's clear water."

"Don't worry, it's real clear water. After boiling, it precipitates and removes impurities."

"Have the gauze and instruments been fumigated at high temperature?"

"Each piece of gauze has been fumigated at high temperature for half an hour, and we have prepared a whole bucket. Equipment."

"Instruments also have to be fumigated, wiped with alcohol or carbolic acid, and then stored with clean gauze to isolate the air. Aren't all the instruments we bring like this?" Heman couldn't think of Shanwang's name for a while, so he had to go back and forth Patrolling the scene, looking for someone directly, "I asked that who...what's his name. Hey, Chinese! Come here!!"

"what happened?"

Shanwang knew that he was low in seniority and ability, so he didn't repeat his name immediately: "Dr. Kawei said before in terms of equipment, but we don't have a Vienna cauldron here, and many large equipment like pull hooks can't be put in." After entering, it can only be disinfected by cleaning + wiping, and then stored separately."

"So that's how it is." Herman glanced at him, "What's your name? I was thinking about today's operation yesterday, but I forgot."

"Good Hope, Good Hope Bell."

After the equipment is the operating bed. Compared with the adjustable bed frame that has been popularized in Vienna, it is still a piece of wood.However, the French side responded fairly well, and quickly changed the tiltable bed board with the cushion to fight against heavy bleeding.

"I can only do this first. If there is a need in the middle, let's work together to change the direction of the tilt."

"It is to prevent outsiders from entering the operating area, so Dr. Kawei moved his mind on the operating table."

"At worst, we also wash our hands and wear gloves and masks. As long as the angle of the bed can be solved, everything else is fine."

Unsatisfactory hardware is also very common. They have also experienced the rough environment of the battlefield, so there is no need to be too demanding: "Okay, that's the only way."

The three of them each prepared their own things, and finally got together to go back to the entire operation process of the cesarean section, for fear that some inconspicuous links would be missed and cause problems in the operation: "Is it almost the same?"

"Disinfection, hemostasis, instruments, infusion, and newborn care seem to be almost done."

Bergert suggested: "There is still a lot of time, why don't we simulate it together before lunch?"

"Well, good idea, who should be the chief surgeon this time?" Damirgang asked, "I remember that I was the chief surgeon on the appendicitis on the train, and it should be next."

"It's Bergert." Herman sighed, "otherwise, why would he be so active."

"No wonder." Damirgang glanced at Bergett who was secretly laughing, and then at Shanwang who was not far away, and asked softly, "Then do you want him too?"

"Don't! Stop it." Bergett was the first to object. "It's already very difficult for three people to take the lead. If there is another one, there is no point in not having one turn in two or three days."

The simulated surgery was something they created after they came back from the front line. At first, it was just a boring way of playing, but later they found that the improvement effect was good, so they kept it.Once outsiders intervene in anything, the original balance will be broken, and resistance will definitely be encountered.

As the initiators of resistance, they naturally have to fight against the "invasion" of outsiders.

But when Karen pushed open the door of the surgery theater, the three realized that some sudden things couldn't be stopped at all, not even a shrinking stomach could stop it.

"Bleeding? Is the abdominal pain serious?"

"It's very serious. It's my third child, so I don't think it's wrong. And the time is limited, so it's impossible to wait until the afternoon for surgery."

"How much blood is there?" Herman hurriedly called two assistants from the main palace hospital, "Hurry up and prepare hot water and gauze, and call Professor Hujill, right! Let him bring his own forceps .”

The assistant was dumbfounded, but in front of him was Kawei's assistant. He didn't have the power and ability to raise objections, so he could only nod.

"The best thing to do right now is to have an immediate operation and terminate the pregnancy," Bergert said.

"Surgery? Who will do it?"

"Time is running out." Bergett rolled up his sleeves. "After so many simulations, now everything is ready and no one is here. If you don't dare to go, then I will come!"

Herman was startled, and quickly pulled him back: "Are you crazy?"

"Calm down, think about what Kavey said before." Damirgang also stood by Herman's side, "If we were capable enough to perform this kind of operation, Kavey would have let go."

Bergett had his own reasons: "We have been with him for so long, but we were not given the chance to perform a cesarean section. Now he is not at the scene, the situation is urgent, and the operation is unavoidable."

This is the reason, but Herman still disagrees: "Don't look at who he teaches, how long have you been in surgery?"

Bergett also didn't have Kavey's ability and self-confidence. He knew how much he weighed, and he didn't have Kavey's courage to overcome.Moreover, surgery is a team game. If Herman and Damirgang disagree, no matter how strong Bergett is, he will not be able to perform a cesarean section.

Excluding the option of immediate surgery, according to the current practice of obstetrics, since the parturient is in labor, let nature take its course, if you can live, you can live, if you can't, there is no other way.But this is obviously not suitable for the current situation. It is really unacceptable for the mother to die before the operation.

But they can't handle this situation, and the obstetrics department here is even more unreliable: "Where is Kavi now?"

"I remember that I should give a speech at the University of Paris in the morning."

"Go get him back!"

"Do you know how to get to the University of Paris?"

As one of the largest and oldest institutions of higher learning in France and even in Europe, it is very difficult to find someone's location in the first place.It would be a waste of time if the parties had little interaction with other people.

In the end they had to find Shanwang: "I know, it's the first lecture hall of the university. It's not in the medical school, but in the law school next door, on the second floor."

Carvey naturally didn't know that something happened to his patient, halfway through the speech, the atmosphere gradually became warmer.The medical history report mentioned earlier caught the attention of many medical students, and even made them forget Carvey's age.

"Reporting is just the foundation, the basis for maintaining the delivery of medical information."

Carvey thought about what he was going to say next, hesitated for a moment, and wrote on the board, [Focus on Details]: "It's the same young female patient just now, she suffered from abdominal pain for two days, and the diagnosis changed from appendicitis to abnormal The main reason may be my judgment, but as a medical student, I still need to pay attention to some details.

Sometimes the details can remind you, or help you have reasonable doubts, and even deduce similar answers in the end.

Here you need to pay attention, I do not insist that you must make a clear diagnosis, because the disease is in the abdominal cavity, if there are no physical symptoms, it is difficult to make a clear diagnosis.We only need to deduce the answer of 'laparotomy'. Even if the operation fails in the end, it is a technical problem. At least we have tried our best. "

Carvey first briefly introduced the concepts of pregnancy and ectopic pregnancy. In fact, the principles of surgical diseases are easy to understand, as long as you have learned some knowledge of physiology and pathology, you can get a general idea.

And the abdominal pain it produces is the focus today.

"There are many kinds of abdominal pain, and the causes are also different." Carvey briefly cited a few examples, "For example, the enteritis and appendicitis that have occurred in this case are one of the major categories, inflammation."

The audience jotted down this knowledge point.

"Inflammation in the abdominal cavity cannot be distinguished by the naked eye, but other symptoms, such as diarrhea and vomiting." Carvey turned around and made a brief note, "And this, [fever]."

Thermometers are not popular, and it can even be said that except for the Municipal General Hospital where Carvey is located, few doctors use them.

Firstly, it is expensive, secondly, it is not as easy to operate as modern thermometers, and finally, there is still doubt about the diagnostic value of the body temperature displayed by the thermometer.

"I have a paper in Germany. If you have time, you can read it. It is written in Latin and you should understand it." Carvey said, "It doesn't matter if you don't have time. There is a considerable relationship between the existence of inflammation and body temperature." complicated relationship.

I don't know whether the description of these relationships in that paper is necessarily correct, but I can be sure that after severe inflammation occurs in most people's bodies, there will inevitably be a rise in body temperature.

Now let's look back at this young female patient. She has always been in good health. Except for eating some bread that may have expired, she has no other diseases.Under this premise, there should be changes in body temperature when appendicitis occurs.Even if this change comes slowly, it is impossible to persist until the third day.

In fact, as far as I have observed, acute appendicitis produces signs of elevated body temperature within half a day. "

Carvey started with body temperature, and slowly drew the attention of these young listeners to the differential diagnosis of abdominal pain: "After eliminating the major category of inflammation in advance, what is left?"

"And a tumor in the abdominal cavity."

"Intestinal fistula?"

"Internal bleeding."

There were endless answers, and although some of them sounded inaccurate, at least these students were using their brains.Carvey gave them some time to sort out their knowledge. Just as they picked up the teacup to moisten their throats, a figure suddenly appeared at the door of the lecture hall.