Nineteenth Century Medical Guide

Chapter 50 49. God's Kiss
After Morazo's hernia, Laszlo's gas cut and Alphonse's duel, the relationship between Carvey and Bergett is no longer just strangers.

In Bergett's eyes, after all, the two had shared adversity in Laszlo's manor, and their relationship belonged to both enemies and friends, but there were more elements of enemies.He has a very strong sense of competition in his heart, but because of the prominent status of his family, it doesn't seem to matter on the surface.

In Carvey's eyes, Bergett is just a child, at best comparable to the original intern, and even a little more "stupid".

Under the leadership of Ignatz, major events such as replacing assistants have become a matter of course.And the long-lasting applause told Bergett that on this stage, he didn't look at his background, he didn't look at the money in his pocket, he only looked at the blood-stained scalpel in his hand.

Both the chief surgeon and the audience are so realistic.

Carvey knew that Bergett was not reconciled, and any fool could see the displeasure on his face.

If Elina just took her to meet the dean and raise her salary, considering the friendship these days and Bergett's pretty good personality, Carvey would choose to feint and wait in the ward with peace of mind. Hemorrhoids in the afternoon.

Alphonse is a good friend, but he still doesn't feel at ease with Ignatz, so he has to go on stage and watch.

But Elina's soft and hard actions just now made Kawei feel a lot of crisis.He had no choice but to strive for opportunities to perform, try to make money and gain fame, anyway, he could earn whatever he had, and if he ran into trouble, he might be able to leave a way out for himself.

The operation was performed on a 30-year-old mother with bilateral cleft lip, which should be double degree II [1], without cleft palate [2]. The operation is not too complicated.

In the 19th century, cleft lip surgery was uncommon because of the high mortality rate of the procedure.The reason why this mother went to the Municipal General Hospital for surgery was entirely out of concern for her child.

Cleft lip not only affects the appearance, but also causes difficulty in pronunciation or slurred pronunciation due to incomplete closure of the lips.So after discovering that her child also had a bilateral cleft lip, she quickly judged his future based on her own experience.

In order to completely cure the child's cleft lip, she came to Ignatz.If your operation is successful, then consider sending your child here.

"Considering that Mrs. Gail is very sensitive to surgery, I will choose the more conservative Rose-Thompson method this time."【3】

Ignatz seems to be explaining the operation method to the audience, but in fact, he hopes to teach Carvey more: "We first deal with the uneven skin tissue on both sides of the split, trim them to the extent that they can be aligned, and then make a straight line. suturing. Because it is difficult to find the exact position, we generally use the mid ridge as a control."

Carvey is very clear that this method is far from modern plastic surgery [4], but he has never done this type of surgery, so he still focuses on learning and does not have much to say.

Before he returned to the theater, Ignatz had drawn a few lines with a quill on Mrs. Gale's cleft lip, pinpointing where it needed to be trimmed.Next, just cut off these parts according to the scribed path, and then do suture in accurate alignment.

In fact, the process is the same as woodworking splicing, except that in the hands of the surgeon is soft and tender skin tissue.

Mrs. Gail's bilateral cleft lip is a bit wide, and the tension on the joint is high, but the operation itself is not difficult.After a simple trimming and fitting, Ignatz took out the thing that opened Carvey's eyes the most: "Everyone, the operation went very smoothly, and now we are going to do the final suturing."

Carvey looked at the three silver needles with a length of 5-6cm and was puzzled: What is this for?

"You help me close the skin, and I will draw a few piercing points."

Ignatz gave Kavi the three lips in his hand, wiped the blood on his hands, and took the quill from Bergett.The nib made a few counterpoints on Mrs. Gale's three lips, and Ignatz said, "This is a suture needle for cleft lip closure."

Stitches? ? ?
Doesn't it look like an ordinary long nail?

Ignatz used a needle from left to right to pass through the three lips in turn, and then used a thin thread to wind three figure-eight shapes on the thread, and finally tightened, knotted, and fixed [3]: "You're done! The next step is to Just wait for the wound to heal, and then remove the long needle!"

Unlike Morazo's hernia surgery, in the face of plastic surgery such as cleft lip repair, Ignaz will let the audience in at the end, which will help them observe the effect of his superb surgery.

"This operation is nothing short of perfect, Dr. Ignatz."

"The alignment between the human ridge and the red lips is very precise, there is no sense of discrepancy, and it is no different from normal people."

"I think Mrs Gale will look in the mirror and laugh out loud when she wakes up"

"That's a mistake." Ignatz put away the scalpel and crow's beak pliers, and corrected with a smile, "After cleft lip surgery, you can't laugh, even smile [6], otherwise the wound will tear Crack. Pain and bleeding come second, and it would be a pity to tear apart such a perfect alignment."

After listening to these advices, many people around applauded and saluted.

However, there were some discordant voices besides the praise: "Doctor Ignatz, I don't understand one thing."

The one who asked the question was Varela, a daily reporter who specialized in reporting on surgical operations.Ignatz has dealt with him for many years, and the reports he made have always been based on praise and praise, so he didn't make too much mental preparation: "What's the matter?"

"I remember that the first time you did cleft lip repair was 8 years ago, and you used straight sutures at that time."

"You have a pretty good memory." Ignatz could only vaguely recall some episodes, but he had long forgotten the time. "I was still young at that time, so I wasn't very proficient."

"Um, that's secondary." Varela didn't focus on the surgery. "At that time, I was just a young intern reporter. After the surgery, I had nothing to do and did some follow-up reports."

"Uh, then what?"

"I'm afraid Dr. Ignatz hasn't seen their wounds after they've been fully repaired." Varela flipped through the notes in his hand and said, "Although the alignment is pretty good, it can only be a static situation. Lower, when speaking or smiling, the upper lip is completely crooked."

Ignatz sighed: "There is no way to do it. It is difficult to be perfect in today's surgery."

"I know that." Varela finally revealed the real purpose of his question, "But it should have been 20 years since the linear suture was proposed. Has Dr. Ignatz considered innovation?"

"."

"If there is a new surgical method that can further change the appearance of this lady, maybe tomorrow's headlines will be reserved for you." Varela looked at the patient who was lying quietly on the operating table and said, "But you There really isn’t anything innovative that can come up, and I think it’s lacking in that regard.”

This is a sore spot for Ignatz.

His technique is by no means inferior to anyone else, and those surgeons from Britain, France and Germany, who are known as the top in Europe, may not be as proficient in various operations as he is.But the reason why Ignaz's fame could not go out of Austria is because there is no surgical procedure named after him.

This is the flaw he is least willing to mention, and it is also a black spot that he usually tries his best to avoid.

But now this rotten scar was torn apart in public, overflowing with pus and dripping with blood.

There was a deathly silence in the arena. They didn't expect that the reporter who had praised Ignatz for so many years would instantly change his style of writing because of Laszlo's angry accident.After all, these media people just tasted the sweetness after others fell.

"This is Mr. Varela?" Carvey suddenly said.

"Correct."

"I think your understanding of the teacher is biased."

"Oh?"

"It is said that only children who have been kissed by God will have cleft lips." Carvey said, "The traces left by God are not so easy to erase."

Varela smiled: "I didn't expect Mr. Carvey to be so devout."

Carvey didn't have the time to play around with him: "Although Mr. Ignatz is not innovative enough in your eyes, not bright enough, he is a conservative traditional doctor. But you have ignored the most important point of being a doctor. The reason why a doctor is called a doctor , saving lives is the first priority.”

"I admit this, but it does not conflict with innovative surgery."

Carvey looked a little annoyed, and said while packing up the equipment: "Mr. Reporter, you may not realize that what you questioned just now is a surgeon who has been working hard for more than ten years and has been performing operations for the people of Vienna wholeheartedly.

His surgical mortality rate and surgical speed are among the highest in Europe, and continuous improvement of technology for patients is not a kind of innovation. "

"This"

This time it was changed to Varela and there was no sound.

Such an impassioned statement once again ushered in a big wave of applause.

Varela's skin was thick enough, stuck there like a piece of brown sugar, and he had no intention of leaving.After taking notes of Carvey's speech, he asked a new question: "I heard that Dr. Ignatz plans to try another cesarean section?"

"Yes, there is indeed a woman who needs a cesarean section."

"Is there any chance to avoid surgery?" Varela's purpose became more and more obvious, that is, to make Ignatz look ugly, "because everyone in Vienna knows that cesarean section is extremely dangerous, and it seems that if you insist on surgery, it will be easily taken away." The life of the pregnant woman is contrary to the reason Mr. Carvey used to defend you just now."

"This is a decision made out of desperation." Ignatz defended, "The mother has a very obvious narrow birth canal, and she will definitely have a difficult delivery. Only a cesarean section can save her."

"Then, are you sure?"

".Have."

Ignatz regretted it after he finished speaking, because he had no way to deal with postpartum hemorrhage in his mind.

The large incisions will drain a steady stream of blood out of the uterus, and this will only get worse when the placenta comes off.Ordinary crow's beak forceps can't deal with such a large area of ​​bleeding points, and many previous cesarean sections have failed here.

But there is no possibility of taking back the words, so I can only bite the bullet and finish, "I have introduced brand-new suction instruments and more reliable crow's beak forceps, and practiced the entire process of cesarean section repeatedly during dissection. Do everything you can to the best of your ability.”

"Would you consider cutting out the uterus directly like the British doctor did?"

"My principle is to cut it if you can. After all, the mother is still very young."

"I hope it won't be like last time." Varela sighed and didn't continue, "I'll make a note of it."

The audience retreated one after another, and Carvey helped carry the toolbox and followed Ignatz out of the theater.

He didn't expect that Laszlo's gas cut would bring about such a chain reaction, and the newspaper reporters would not consider the true feelings of the interviewees at all, they only thought about sales.No matter what industry you're in, it's never easy to be at the top, and the Vienna Daily is no exception.

"Actually, Varela is right."

Ignatz, who got into the carriage, suddenly started talking: "I really don't have any new surgical techniques that I can bring out. After working for so many years, the only things I can be proud of are the speed of surgery and some newly developed surgical instruments."

“These are already very”

"Not enough! It's not enough at all!!!"

Carvey could feel his unwillingness and pressure. The previous failed cesarean section and the upcoming cesarean section weighed him down: "Teacher, you need to rest."

"Rest. Nora's stomach won't let me rest." Ignatz rubbed his eyes and said, "But the two corpses you sent before did help me a lot, at least my cooperation with Sears and the others is even better. There is a tacit understanding."

"The problem still lies in the hemostasis?"

"Yes, cesarean section bleeding is very difficult to control, and success depends on stopping the bleeding." Ignatz asked, "Did your father do it?"

"He's just a little doctor, and he hasn't done it before." Carvey didn't dare to brag, for fear of revealing his truth in the future.

"Originally, there were many bleeding points and it was difficult to find. We tried with crow's beak forceps in the previous operation, and it was impossible to stop it without five or six." Ignatz said more and more headaches, "Secondly, there are sutures, the uterine body It is not easy to suture, and the teeth of the forceps can easily slip off, making the operation very troublesome."

"Have you considered taking medicine to stop the bleeding?"

"The medicines in the pharmacy are dizzy and have vomiting and diarrhea. What else can they do?" Ignatz smiled wryly. "The only thing that can really stop bleeding is a branding iron."

Speaking of this, he suddenly stopped, his eyes looked out of the window, and his mind had already returned to the bustling barbershop two or three hundred years ago.

"Teacher, using a soldering iron is no different from total hysterectomy."

Kavi reminded him abruptly, and Ignatz was relieved: "That nasty Varela has led me astray."

"Teacher, I actually have my own ideas about hemostasis." Carvey thought of the subsequent experiments, and it would be meaningless to hide oxytocin, so he might as well take advantage of the showdown now, "My father made a medicine before, which seems to be specially Used to stop bleeding."

"Oh? And this medicine?"

"It's just that I moved away a long time ago, and I don't have a finished product in hand."

"Is there a recipe, I can make it myself!" Ignatz was very excited, but soon realized that he was a little impulsive, and immediately changed his words, "Ahem, since it is your father's medicine, even if there is a recipe, it must be you do it."

"I don't know if there is a formula. I have to go back and look for it."

"Okay, I'll wait for your good news."

Speaking of this, Ignatz was in a slightly better mood.

However, Carvey's surprise didn't stop: "Teacher, are the two previous corpses still there?"

"Yes, what's wrong?"

"The reporter friend just reminded me that I think the reason why there has been no innovation in cleft lip repair may be related to the fact that we always ignore the anatomical structure of the lip."

(End of this chapter)