Nineteenth Century Medical Guide

Chapter 360 356. Turning Intangible into Visible
Once the fierce fight to death between the two was taken as the comparison object, even though the three-hour emergency meeting of Carvey had constant arguments and noises one after another during the process, it still did not lose the dignity and harmony of the doctor's profession.

From rehydration to unobstructed airway to wound treatment, the meeting basically summarized several key points in burn treatment.

The first half is to reflect on their wrong theory, because it is contrary to the existing concept of treatment, and it is not easy to successfully transition to the next stage.But as long as they understand the failures in the early treatment, the second half will be much easier, and they can also teach some debridement techniques and the preparation process of fish skin dressings.

Kavi's preparation of fish skin is quite rough. Generally, it is washed with diluted acetic acid + soaked, and then rinsed with hydrogen peroxide + normal saline.The main thing is the choice of lotion. After being informed about the process, what they really need to learn and master is only some fish skin separation skills.

After all, the size, thickness, and integrity of the fish skin are directly related to the therapeutic effect. If the technique is not skilled, the permeability and coverage of the fish skin will be problematic.

This unavoidably disgusts the big-name surgical directors, who find it difficult to understand why they need to handle animals like fishermen and fishmongers.

"You can handle leeches, why can't you handle fish skin?"

"Leech is the core of bloodletting therapy. It is very difficult to breed and grow. Participating in bloodletting therapy itself is a very normal medical activity." "What's more, doctors in Paris used to use leeches, and few of them would raise them by themselves."

"No one asks you to raise fish, but I hope that everyone can put down the noble scalpel, pick up the skinning knife of a fisherman and fishmonger, and skillfully use dissection skills to prepare fish skin dressings by themselves."

Carvey has his own reasons for doing so: "Of course, if the hospitals have sufficient funds, I don't say anything. After all, the number of burn victims has exceeded 300 so far, and there are more than 100 people left after excluding the dead. Most of the burn area exceeds 20. %, some extreme cases have reached more than 50%, and the amount of fish skin required is quite exaggerated.”

"Does Dr. Carvey think that fish in Paris is expensive?"

"If the unique French cooking techniques are included, the value of the fish may be magnified. But now we only want raw fish. No matter how expensive raw fish is, it is still the cheapest kind of fish."

This is indeed the truth two days ago.

As the most important distribution center for ingredients in Europe, the Seine River and two artificial canals bring abundant fresh fish to Paris every day.Whether it is river fish or sea fish, as long as you want it, you can buy it in the fish market next to the pier on the river bank.

Even if you don't have enough fresh fish, you can ask the fish merchant for some skins that you don't need
"Don't have such ignorant thoughts!" Carvey emphasized again, "As I said before, the fish skin cut by the fishmonger and the fish skin dressing in the medical field are two different things. What you get is broken skin, which does not cover the wound at all. Also, don't expect to find cheap fresh fish in Paris in the next week."

"This, why is this?"

"As early as the night before yesterday, I almost bought the remaining fresh fish in several big wharf fish markets, and I searched for the second batch yesterday during the day."

Carvey is used to explaining some problems with numbers: "The price of sea bass has tripled, sea bream has doubled, and butterflyfish has five times. And this does not include their processing fees. As of now, I have entered Paris I went to the market before I went to college, and the number of fish sellers has obviously decreased by a lot, and the price has increased by three times. This price does not include the processing fee for door-to-door processing of fish skin."

The reason is actually very simple. It’s not that there are no fish. The size of Paris is not enough to cause a common commodity to be out of stock suddenly because of a fire.

The main reason is that there is a market that demands a large amount of fish skin. Fish merchants think it is profitable to raise fish and want to further increase the price.

"Of course, with your knowledge and ability, you can get a relatively normal price from those merchants." Carvey said, "But I always believe that medical treatment is a technical job, and we should spend time on technical excellence. Instead of thinking about how much money it takes to treat patients."

In the 19th century, the connection between medical care and money was not obvious. Hospitals were funded by benefactors and churches.

The rich and the poor spend a lot on medical care, but most of them focus on recuperation, diet and life.In fact, there is not much difference in serious medical measures, or even almost no difference, because the medical results are the same.

However, as Carvey introduced the concept of modern surgery, there is scarcity of drugs, equipment, and even surgical techniques themselves, and this scarcity represents money, but it also brings a huge gap in results.

Even ignoring the learning cost required for technology transfer, it is unrealistic to popularize this technology in all hospitals because money does not allow it.

In the case of a fixed hospital fund, if a certain item is too extravagant, it will cause an imbalance, and it will naturally be checked and balanced by the donors.

Carvey has seen it before and is used to this feeling. Sometimes he can control himself if he can, which saves not only the patient's money, but also the department's fine.Of course, if it is really modern, the use of fish skin dressings will obviously encounter more practical problems, and it is not necessary for both doctors and patients.

"If you really want to learn the skills of burn treatment and apply them to burn patients, then please learn to cut fish skin yourself. There are too many skills, and there is no distinction between high and low in technology itself."

"We're all going to be fish strippers."

Carvey turned around and looked at the key points on the blackboard, and reiterated his general direction for burn treatment: "Remember the fluid rehydration for the first two days, and the wound repair for two weeks after that. months of skin reconstruction work."

First save the life, then save the wound, and finally plastic surgery, this is a set of modern procedures for fighting burns, there is no rush, and no pity for money.

Originally, he wanted to talk about skin transplantation. After all, scar contracture brings not only functional loss but also aesthetic loss.As for the specific operation of the transplant, it has to be left to these French surgeons.

"I'm going back home in a few days."

Carvey is going to end up with skin grafts from burns and resection of Bizet's laryngeal cancer: "If the trauma recovery of the wounded allows, I may do a few autologous skin grafts after the surgical congress."

After finishing speaking, he glanced at the time: "It's getting late, the skin transplant will make a long story short, let's talk about the details on the day of the operation. First of all."

Just as he was about to continue speaking, a yellow-skinned young man suddenly rushed in from the door. He was not tall, and he was wearing a loose black dress and breeches that didn't fit well.After entering the door, he even said sorry, but his feet didn't stop for a moment, and he rushed to Kawei in two or three steps.

"How did you come?"

"problem occurs!"

Carvey immediately thought of several severely burned people who were still lying in the hospital, and their body surface burns exceeded 40%.Although the dangerous period of the first two days has passed, the shock has been corrected and the airway is unobstructed, but the body has also reached the second critical moment.

Next, because of the inability to eat, the pain of the wound, and the increased chance of infection, it is considered a dangerous period until the wound is completely healed.

Such wounded people may not be fully rescued in modern times, and sudden death in the 19th century was more normal.

"Who happened? 33 beds? Or 79 beds?"

"No no, no, no, not from the hospital. Uh, no, he is, he is from the hospital!!!" Shanwang ran too fast, was panting badly, and couldn't sort out the content of the report in his mouth, so he simply He reported his name directly, "Yes, it's the chef named Alphonse, your friend, the one with the burnt left arm."

"Alphonse. What happened to him?"

As a typical case with a small burn area, considering the other party's occupation and being a friend, Kavey will definitely be more meticulous in his response.He really couldn't imagine what big things would happen to Alphonse's wound, and the only thing that could be called a "big thing" was that one.

Looking at Shanwang who was out of breath, a certain disgusting name appeared in Kawei's mind, and at the same time, he thought of a noun that he still couldn't make the cook forget:

"Is he going to a duel?"

"Yep!!!"

Carvey took a deep breath and quickly turned around to pack his things.

He didn't expect Shan Wang, who had just studied western medicine, to be able to explain Alphonse's injury clearly. Just from the fact that he came to find him, it was not difficult to see that the cook was seriously injured.It happened that there was nothing left to talk about in the meeting, and it was time to say goodbye to these surgical directors.

"Everyone, I have a patient who needs to go back to the hospital now, so I'm leaving."

"Huh? Dr. Carvey, the meeting is over?"

"it's over"

So ended the session on burn management, which was quite informative but touching and shorter than a university course.

Whether these contents can enlighten these French surgeons, and how many people can be saved in the end, Carvey is not sure.But he did his best. The combination of rehydration + anti-infection + debridement + fish skin was the most cost-effective and effective treatment he could think of.

The meeting is over, but Alphonse's business here is not over.

On the way back to the hospital, Kawei learned some details of Alphonse's duel from Shanwang.

A pistol duel, unlike a sword duel, required a full four assistants.They need to always pay attention to the state of the gun and the person to prevent accidents other than duels, and at the same time, they can monitor whether the opponent is cheating.

This is an important reason why Carvey felt that Alphonse could not duel in a short time, at least not before he was discharged from the hospital.

Alphonse has always been a loner. Whether he is returning home for vacation or working in Vienna, he doesn't have any decent friends, let alone get four people together in a short period of time.Assistants have great responsibilities, and now that the anti-duel law has been introduced, helping others to duel would have taken huge risks.

The reduction of the number of assistants is obviously not in compliance with the rules, and Alphonse, who originally wanted to use a programmed duel to resolve his depression, would definitely not be able to reduce the number of assistants.

"So how did these four people come here?" Carvey couldn't figure it out. "By the way, who sent them to the hospital? Was it the four assistants?"

"No, it's the police. The duel attracted the police there, and all the assistants were taken away." Shanwang explained, "Mr. Alphonse came to the hospital in a police carriage, and he was accompanied by two policemen. When people arrive, they leave.”

Alphonse saw Li Ben by chance while listening to an opera in the theater, and brought him to the hospital after being burned, and never left the hospital.

"These four must be people from the hospital." Carvey suddenly thought of some annoying guy, "No way, why did the two of them get together?"

"What's wrong?" Shanwang didn't know Mick, and didn't know who Kawei was talking about.

"It's nothing." Carvey sighed, and began to care about Alphonse's injuries, "How is he injured? Where did the bullet hit?"

"Probably in the lower abdomen." Shanwang pointed to the lower part of the stomach, "I don't know the specific situation, I only know that there is a lot of blood. After seeing it, Professor Cedieu and Herman said there was no way Deal with it, let me call you over as soon as possible."

"The bullet wound in the lower abdomen can't be treated???"

Sediyo was originally a military doctor. Herman, Damirgon, and Bergett all participated in the Prussian-Austro-Prussian War, and bullet injuries are too common.As long as there is no danger of life, a simple bandage can always be done. Even if life is really in danger, they have already learned fluid replacement and autologous blood transfusion, and it is impossible to reach the point of "unable to handle".

Facts also proved Carvey's conjecture.

After rushing back to the hospital, he found that Alphonse's vital signs were very stable, and he could even vividly describe the scene of the duel that just ended.After seeing Kawei, the fat man's first sentence was: "Li Ben is dead! He is finally dead! God is on my side, and I have won!!!"

Carvey is definitely not as excited as him, let alone applaud his courage and persistence: "Well, you don't think I will applaud your courage, do you?"

"Uh, hehe." Alphonse remembered Carvey's advice before, smiled and said, "I'm really sorry, I can't help it. Anyway, I use a gun. I hold the gun with one hand, and my injured left arm is well protected. good."

"and then?"

Carvey took the inspection report from Herman and asked, "I remember telling you, at least don't mess around before you leave the hospital. During the hospitalization, your arm not only belongs to you, but also bears the burden of showing the burn to other doctors. Responsibility for dealing with results."

Alphonse doesn't understand medicine, and he doesn't quite understand the logical relationship here, but he knows that he did promise Carvey at the time: "I'm sorry, I broke my promise, and it wasted your care and care for me."

"Ok?"

Carvey looked back at him again, and explained: "Don't get me wrong, I'm not interested in your duel, I'm just following the hospital procedures, and I hate your disobedient behavior. Because it It will completely destroy my medical achievements, that's all."

"Uh, hehe, okay, okay, I'm wrong."

Alphonse, who had just finished the duel, was in a good mood, and even forgot the pain in his arm and where he was shot.It's just that Carvey's next words completely changed his mind: "Do you think that violating the hospital's regulations is also an act of insulting my job?"

"."

Carvey looked at Alphonse whose eyes were dull for a moment, and knew that he had spoken seriously.But now is not the time to celebrate the victory of the duel with him at all, and the more serious thing is yet to come: "Also, you need to take a good look at the result of the duel."

"result?"

"Do you know where the bullet was shot?"

"Um, it's probably a little lower in the lower abdomen." Alphonse still pretended to be calm, "I'm sorry, I don't know the exact location, even if I am injured in such a duel, I can't feel the pain. "

"The location of the shot is not very good, it's your exogenous weapon!"

Carvey lifted the blanket covering him, revealing the blood-stained area: "The bullet accidentally hit your exogenous organ, and it broke."

"broken.?"

"Oh, I didn't express it clearly enough. I shouldn't have used 'broken'." Carvey used tweezers to carefully turn over some clothing debris, and then took a basin of warm saline and poured it down. "To be precise, it should be It was shattered by an exploding bullet."

(End of this chapter)