Nineteenth Century Medical Guide

Chapter 341 337. A New Way to Deal with Fester
Perianal abscess has always been a common disease, the cause is nothing more than spontaneous anal crypt infection and secondary infection caused by various other diseases. 【1】

If you sit for a long time and do not pay attention to protecting the pg, an important weight-bearing part that often needs to bear more than half of the body's weight, affecting the surrounding blood supply and skin health, or causing the anal canal to rupture and bleed, the chance of infection will become very high.

With the physical fitness and living habits of the people of the world in the 19th century, it is not surprising to have a perianal abscess.Even those aristocratic friends who have been marching and fighting on horses for a long time can become an important part of this disease.

Faced with such a large base of disease sources, there are not many corresponding treatment measures, mainly due to the lack of means to fight infection and basic diseases.

Only when the abscess cavity is ruptured and a fistula is formed, will the surgeon come forward to treat it.

For the surgical treatment after the formation of anal fistula, the method is actually similar, that is, to cut the fistula.Whether it is to deal with low-level anal fistula directly and roughly with knives and scissors, or choose to deal with high-level anal fistula with hanging thread, the ultimate goal is to incise the fistula tract while ensuring drainage and healing of the incision.

But in this land of France, anal fistula treatment still has a unique historical sense.

"The great Sun King back then was witty, confident and brave. He loved riding horses and hunting, and made Europe submit to him. At the same time, he was also the record holder for 2000 recorded enemas, but this move made him On January 1686, 1, had a very severe perianal swelling."

The open surgery on the 19th was started by Professor Cedieu, the content was more like the introduction before the opening of the arena, which gave Carvey a sense of sight that he was going to cut the pg for Louis XIV:

"On February 2, the swelling began to spread and liquefy, and it was confirmed to be a severe buttock abscess. After nearly 18 months of persistent struggle with the abscess, the skin of the Sun King's buttocks finally couldn't bear it on the night of May 3 The enormous pressure in the abscess cavity causes it to rupture, releasing a large amount of pus.

The pressure disappears, the fever subsides, and the pain ceases, but the abscess cavity leaves a persistent fistula, the anal fistula.Then there is the legend of the doctor named Charles-François Félix de Taci.He cured the Sun King, and even made fistulotomy a fashion among the nobility.

At that time, more than 30 courtiers were willing to undergo a similar operation, and were willing to wear the same style of bandages on the pg and waist like the Sun King.But it is a pity that Dr. De Taci failed to pick up the sickle-shaped scalpel and retired early to the countryside for the elderly.”

Kawei has never seen such an opening statement linked to a historical figure. In his words, he can also hear that Sai Diyo's attitude is completely different from the previous discussion.

"Now this patient is also in the same predicament, but because of the rapid development of medical treatment, there is no need to wait for more than two months like the Sun King."

Cedieu finally handed over the right to speak to Carvey: "Next, the genius surgeon in Vienna, Carvey, will reproduce the superb skills of Dr. De Taci."

"Thank you Professor Cedieu for such a detailed preoperative introduction."

Carvey put his hands in front of him, put on clean gloves, and said: "My history is quite bad, and I don't know the situation of the Sun King's abscess back then. But I can be sure of one thing, that is, the abscess of this farmer friend has already disappeared. Very serious.

As you can see, the red and swollen area spread from the buttocks down to the left lower extremity, to the back of the knee, above the popliteal fossa.If you want to solve the abscess, you must completely cut and drain, and remove all the pus hidden in the body. "

The operation method is very simple, but the scale is much larger than the normal abscess incision, and there are many more openings, which does not conform to the clean and neat style of the 19th century.

The doctors present did not know much about cesarean section and could not open their mouths during the previous operation, but they had rich experience in the treatment of perianal abscess and anal fistula.

They didn’t understand Carvey’s method of incision when something happened: “Do you want to incision all? The incision is too big. Once there is ulceration after such a large incision, oh no! Ulceration will definitely occur, Such a large-scale ulceration is more terrifying than an abscess!"

Carvey argued: "So I chose to increase the number of incisions and limit the size of the incision to about 5cm."

"Small incisions are not too small. Even for ordinary post-war wounds, there is more than half the chance of death from festering."

"It's really too bold to do all the incisions."

"It's better to try a conservative treatment. Only the buttocks are incision and drainage, and the thighs can be temporarily put aside. If there is more severe swelling in the future, it is not too late to choose to incision."

Carvey listened to their advice, and stood aside and shook his head: "This kind of patient must eliminate all the pus cavities at once, otherwise the incision will never grow well. After a long time, the incision will still fester. Don't say it in the end." If you keep your left leg, you may still have to walk the old path of festering to death."

"It's true to say so, but isn't this the normal state of this disease."

"Yeah, it's normal for an abscess to fester so badly."

"Dr. Carvey, medicine can't go into a dead end. It is the disease that causes the death of the patient, not the doctor. Before treatment, we must calm down and not be too impatient. If it ends in death, it is not because of our poor medical skills, but because of abscess It was too violent on its own, and we tried our best."

Preaching is nice, a nice placebo, but that only applies to the current medical environment, not to Carvey.

"I'm here to demonstrate the operation, not to argue with you. I have no obligation or interest. I have my own attempt, and the patient has signed a consent form for the operation and is willing to bear all the consequences."

After showing a written agreement using money as a bargaining chip, Carvey continued: "If surgery wants to develop, it will inevitably incur a huge price, which is inevitable on the road of development, not something that can be avoided with a conservative treatment.

What we have to do is not to carefully avoid this kind of cost, especially when the existence of the cost has little to do with the final result, it is even more necessary for someone to stand up. "

The practice is very cold-blooded. From another perspective, it is to treat patients as experimental materials for surgery.But Kavey's treatment method has also passed the test of the times. If it is replaced by the surgeons in front of him, random innovation is definitely not advisable.

"Because it is a brand-new surgical method, the outcome is unknown, and it will cause some unpredictable risks to patients."

Carvey signaled Amor to perform anesthesia, and then counted the surgical instruments himself again: "So I gave a compensation proposal of 3000 francs, that is, the failure of the operation caused my death, and I am personally willing to pay 3000 francs. I personally suggest that if you have Such an innovative idea should also come with a compensation mechanism.”

This passage can be regarded as blocking the mouths of a small group of people who want to be kidnapped morally, but it is difficult for Cedieu on the side to understand.

With a smile on his face, he lowered his voice and said to Carvey in a low voice: "You are so rich, the sponge costing more than 2000 francs is not enough, yet you came up with such a compensation agreement."

Carvey also smiled: "The sponge should be paid by the main palace hospital."

".There is no reward after successful treatment?"

"Creating a new treatment plan, does it count?" Carvey asked rhetorically, and then comforted, "The professor's monthly income is nearly 2 francs, which is nothing. Moreover, as long as the preparations are made, after sufficient Animal experiments should be able to achieve the minimum safety."

The two began to wait for the final round of disinfection, covering the entire lower body and lower back of the patient, and the number of instruments needed was far beyond the imagination of other doctors.

Two full buckets of gauze and five jars are already exciting enough. I didn’t expect that there would be a large bundle of rubber tubes and several syringes. Of course, there is also the standard equipment for Carvey’s surgery—water, which has an appropriate amount of salt in it. .

"The scope of this operation will be very wide, so carbolic acid will be used as the main disinfectant." Carvey pointed to his mask and said, "Considering the toxicity of carbolic acid, I hope you all wear masks as much as possible."

Alcohol was sprayed on the surgical area, but now with the addition of carbolic acid, the smell became extremely pungent.

"Cough cough cough~~~cough cough~~~It's so choking."

"Mr. Bizet, if he feels that his throat is uncomfortable, he can choose to go to the top floor or leave here directly." Kawei specially asked Bizet to come in to find inspiration, and also hoped that he could see the development of medicine and come to the hospital for an examination as soon as possible, "After all This is the operating area."

"It's okay, I can bear it"

"Although I want to tell you that it may not be possible, because the next step is the highlight, but...forget it." Carvey glanced at him, "Don't forget the agreement between us."

"Don't worry, cough, cough, as long as you write this article, I will obediently go to your place for inspection. Cough cough cough~~~"

Carvey's words are not alarmist. The pus in this pus cavity doesn't smell very good.Ordinary people have not received "practice" in this area, and are easily affected by the double impact of vision and smell, causing nausea and vomiting.

But to the surgeons in the theatre, the stench was comparable to that of a rotting corpse.

"We started to expand the wound 2cm away from the anal verge." Carvey simply cut open with a scalpel, and then quickly shouted, "Suction device."

It just made a hole in the fat layer, and a large amount of dark red liquid hidden in it poured out with a very strong smell of feces.Even though Bergett and Damirgang were standing by, and even if Kawei had reminded them in time, there was still no way to completely stop the pus from flowing out.

Immediately, the entire operating area was filled with stench, and it quickly spread to the surroundings.

Bizet, who said just now that he could hold back the pungent smell, was like a deer startled by the gunshots of a hunter. He retched his upper abdomen. He quickly covered his mouth and nose with his sleeve, picked up his manuscript and pen with the other hand, and quickly ran to the top of the auditorium.

He didn't sit down in a hurry, but chose to open the window closest to him, sucking in the fresh air outside the window.

The pus was more viscous than they thought, and the suction of the artificial aspirator was not smooth.Regardless of whether it was Kavey who controlled the position of the nozzle, he finally passed by stumbling.

After the pus hidden between the superficial muscles left, the dark red color gradually turned into flesh red, the smell became more pungent, and the hiding place became more hidden: "It's almost bottomed out."

"Remove the suction device and give me the gauze." Carvey put his fingers into the incision with his left hand to explore, and took the gauze forceps from Kallen with his other hand. "There is still some pus in the muscle gap of the thigh. The same goes for the perianal muscles." Fortunately, the abscess did not spread upwards, otherwise it would slowly seep into the abdominal cavity or even the retroperitoneum. Bring clear water.”

Originally, it was necessary to clean all the areas before rinsing, but now the entire incision is contaminated with pus, and Carvey does not have qualified antibiotics, so repeated rinsing and disinfection are needed to ensure the cleanliness of the surrounding tissues as much as possible.

Everything is a helpless move under the lack of antibiotics.

"The water is not enough, go get some more."

Carvey continued to explore the scope of the abscess cavity in the buttocks: "The abscess cavity pierced the levator ani muscle from the side, and a finger-sized ulcer was formed on the rectal wall about 7cm from the anal edge. Although it did not directly enter the abdominal cavity, the invaded The range is larger than we imagined, reaching inward near the tip of the coccyx and outward to the ischial tubercle.”

This was the most exaggerated perianal abscess that Carvey had ever seen. The pus was viscous and covered the entire buttocks. A 5cm incision alone could not achieve the drainage effect.

"Pause for the lower limbs, let's get rid of the necrotic tissue around the buttocks first." Carvey took a pair of scissors and tweezers, "Herman, go and cut a piece of sponge, the size is 7*5cm, and then use two rubber tubes to make a few small holes. Then insert it into the sponge and use it later."

"Understood, it's negative pressure drainage."

"Bergett will also go, soak the gauze in vegetable oil, and then prepare the ointment. Later, the incision will be sealed."

"understood."

Carvey wanted to make a simple vsd negative pressure drainage device by himself with natural sponge, rubber tube, airtight jar that sucked out a lot of air, and gauze coated with ointment.

As long as the abscess cavity is cleaned well to ensure that the cavity is as clean as possible, the negative pressure drainage will be able to suck away all the subsequent exudate and air, keeping the cavity in a relatively sterile state.The healing effect of this device is much better than that of open drainage, and of course the price is much higher.

If the effect of vsd is significant, it only takes two days after the operation for the fistula to grow new tissue, and there is no need for antibiotics after that, as long as regular debridement and dressing changes are enough.

"I leave it to you here." Kavi put the scissors and the gauze forceps stained with pink paste into Cedieu's hands, and then said, "Continue to trim the necrotic tissue, be sure to remove them, otherwise You'll have to relapse in a week or two."

Just as he was about to continue making incisions on his swollen left lower limb, Amor suddenly said, "Dr. Carvey, the patient's heart rate has increased!"

"How many?"

"114."

"What about blood pressure?"

"Still testing"

"Blood pressure 106/58, not bad."

Carvey shook his head, the operation has just begun, and it is not a good thing to have heart rate and blood pressure problems now: "It looks like an early stage of shock, Karen."

Karen took the infusion bottle from the preparation table beside her: "There's adrenal gland extract."

"Control the amount well."

"rest assured."

Kawei looked at the second assistant next to Cedieu: "Damirgang, go to the office to get the medicine, this extract may not be enough."

"it is good."

(End of this chapter)