Nineteenth Century Medical Guide

Chapter 51 50. Rose diagram ointment and triangular petal embedding method

At that time, surgery did not have the concept of perioperative period [1]. Doctors were only in charge of surgery without preoperative preparation, and postoperative recovery was also the responsibility of patients themselves.

Ignatz is much busier than other surgeons, and he only cares about surgery on weekdays. His schedule basically rotates between the dissection room and the theater, and he has to see those noble gentlemen from time to time. Go to the office for a break.

The daily care of the patients in the ward is taken care of by the nurses, and the medical records are sorted out by Carvey. Ignatz rarely needs to enter the ward, and he only comes to round the ward and observe their postoperative recovery.

These days Ignatz has become more and more busy, so he had to skip several ward rounds.

However, even if the ward rounds were avoided, the postoperative observations had to be kept up as much as possible, so every time he was in a hurry and left after just a few glances.

Of course, this is not a normal phenomenon. There is no duty in the ward, and early and night rounds are the key link to grasp the patient's physical condition, so it should not be spared.So this morning Ignatz hoped to complete the rounds as soon as possible before going to the theater, but he didn't expect Alphonse's butt to hold him back.

I thought I would make a ward round when I came back, and then go to the anatomy room to reopen the white cloth on the couple in room 102, and then cut their lips carefully with Kawei.

But as soon as he entered the ward, Ignatz suddenly stopped.

He was in a hurry to have an examination in the morning, and the time was short, so he didn't think there was anything wrong here, but now he found that there seemed to be some changes in the ward.

The first thing that confuses him is the window
"Why are the windows open?" Ignatz called the nurse on duty as soon as he entered the door. "It's only March, and the weather is still a bit cold, and the air is full of poisonous miasma."

Before finishing speaking, the nurse pointed to Carvey behind him and said, "Your dear assistant ordered so."

"Yes, it's me." Carvey let the nurse in, and explained on his behalf, "I decided to let them do this after reading the British nurse Nightingale's field care notes."

Ignatz had heard Nightingale's name for a long time, and his reaction was similar to that of British gentlemen, a kind of disdain carefully packaged by politeness: "It's just a daily record of helping to serve tea, pour water and wash clothes. An excellent essay in one's spare time."

"If it's just an excellent essay, I don't think she will be admitted to the Royal Statistical Society, which never accepts women."

Ignatz didn't know about it: "Oh? Those people in the UK have changed their faces?"

"I think it should be because of her outstanding contribution during the Crimean War."

Carvey reminded: "She reduced the death rate of wounded soldiers in the British army from 42% to 2%, and then used the brand new rose chart [2] to make those hard-line military people and even the Queen herself approve of her medical treatment. reform plan."

Ignatz took off his hat, his face full of doubts: "Can it really drop that much?"

"The New England Journal of Medicine has published several articles about her." Carvey took the book out of the cabinet beside him, "This should be an old book I bought in the middle of last year. I found it when I was sorting out the bookcase. Published some of her new nursing concepts."

"Oh, it's the group of arrogant Brits, all written in English, I regret buying it."【3】

Ignatz likes to use knives and has a high acceptance of new operations, but it is difficult to accept too advanced nursing concepts, so he translated a few pages by himself and threw them aside: "There are many and traditional methods in it." I don't agree with anything that contradicts it."

"But these are experiments on the lives of British soldiers, and I think it's worth a try."

Ignatz thought for a while, and found that it made sense, so he couldn't help but nodded, and asked, "Aside from opening the window, what else?"

"For traumatic wounds, you can wash the wound and the surrounding skin with spirits, and then cover the surface with ointment [4] and cotton cloth strips to isolate the miasma in the air." Kawei took out the leftovers from last night. Brandy, "For this reason, I specially got this bottle of brandy that has been distilled twice."

English does allow "alcohol" to slip through Ignatz's nose, because he doesn't even bother to translate.

But in the same way, Ignaz is also unwilling to change his temper: "I still think it is a bit ill-considered to directly change the environment and nursing methods of the ward. This is the ward with the lowest death rate in Austria."

This is a heavy statement, but the implementation of new methods will definitely encounter resistance.

And Carvey is not just playing lip service, since the data and the report of the New England Magazine are not enough to impress him, it can only be proved by facts: "Teacher, remember the little boy last time, the one whose leg was crushed .”

"Bed 11, remember."

"The surface of the wound has largely healed."

"Oh, it's nothing unusual." Ignatz didn't care.

"But he's just a malnourished child from a poor family, not a well-built aristocrat or celebrity, and his recovery speed is completely incomparable." Carvey asked suddenly, "Count Moraso's groin is not recovering so smoothly, right?"

Ignatz sighed: "Indeed, ulceration appeared on the surface of the wound."

"I think we can learn from the 11th bed and do some cleaning work on Earl Moraso's groin, remove the rotten skin and rotten flesh, and make it easier to grow and recover." Kavi knew that he was a bit presumptuous, so he quickly said with a smile, "Of course, this is just my personal suggestion. It is entirely up to the teacher to decide whether to adopt it or not."

Ignatz is a self-centered person, of course he will not easily accept other people's suggestions, not to mention that Kavey is just an assistant, not yet on an equal footing with himself.

But Morazo was his good friend, and he didn't want to watch the count die like this. If there was a chance, Ignatz would still listen to some suggestions.

"Take me to bed 11."

Eston has lost the depression he felt when he was first admitted to the hospital, and is delighted with his recovery every day.Seeing Ignatz and Kavi, his excitement was written all over his face: "Doctor, Mr. Kavi~"

"How do your legs feel?"

"Very good, doctor."

"I need to see the wound."

Ignatz took another two steps forward, reaching out to untie the knot on the cloth strip.Eston was a little surprised and scared, but after seeing Kavey nodding, he still kept a part of his smile and didn't avoid it.

On weekdays, Eston's leg is taken care of by Kavey, and this is the first time Ignatz has seen the stitched wound.

After opening the slippery cloth strip, the scent of linseed oil mixed with brandy comes out.

There were several blood bruises all over the calf, and there was swelling under the skin, which was caused by the fracture and large pieces of torn skin after suturing, but the degree of swelling was much better than he expected.Compared with the other healthy calf, this one is only slightly thicker.

The sutures were done by Ignatz, and the stitches and holes are still visible.

After so many days, the original incision is still very good, there is no leakage or decay, and obvious healing can be seen.

This is the appearance of wound healing that every surgeon most wants to see, and it's not that Ignatz has never seen it, but he has seen it too rarely.What surprised him the most was not only the healing, but also the small cuts on the skin of the legs.

"These cuts are"

"Oh, I cut it out temporarily to deal with leg swelling." Carvey said, "When my father encountered this kind of wound, especially a wound with a large area of ​​skin detachment, he would choose this small incision to relieve it." Pressure from swelling." [5]

"Isn't this hurting again?"

"No, the wound is not deep, it just releases pressure to prevent necrosis."

The 21st century orthopedics treatment method for avulsion injury with fracture deeply stimulated the brain of this 19th century surgeon. He couldn't understand why someone could come up with such a method, so many small wounds, regardless of good or bad , Aren't you afraid of festering?

Yes, aren't you afraid?

So the question came back to the original point, why didn't Eston's calf fester!
When he asked Bergett, Sarsson, and Melen, all three said that the wound would definitely fester and gangrene, and Ignatz himself felt that the possibility of gangrene was more than 90%, which was almost inevitable.

But there are irrefutable facts in front of you.

This was a large wound that was run over by a carriage wheel. It was supposed to be amputated, and Ignatz had 24 stitches.It can be said that no matter which hospital in Vienna Eston is sent to, and no matter how much money he can spend, he is facing amputation and has no other options.

Ignatz handed the cloth and the wound to Carvey again, and gave up the bedside position: "You mean that with alcohol and ointment, this kind of patients won't need amputation in the future?"

"That's not true, it's just that the child is lucky, the fracture is not dislocated, and the chance is very small."

Carvey thought that he might be able to come up with things like internal fixation in the future, but he said something else: "In terms of fractures, once there is dislocation or exposure to the air, amputation is still safer, but We now have at least one other option, and the same applies to Count Morrazo."

Ignatz is still thinking about the patient in his bones, and just now in the theater, Carvey blew him up, and his mental height, which was not low, was raised by a few centimeters.

It is impossible for him not to recognize Eston's leg now, but the process of admitting is more troublesome: "I just don't know if the Earl can accept these things."

"I really want to promote this combination in the ward, and do some experiments for Mr. Earl first." Carvey said in a high-sounding tone, "but now time is running out, and there is not much alcohol left, as a replacement for each dressing Necessities, but also need to spend money to find someone to distill.”

Ignatz struggled mentally, watched Carvey help Eston wrap the cloth strips again, and finally made up his mind: "I'm going to the Earl's house for a follow-up visit tonight, you are more familiar with the amount of ointment and alcohol. , so come with me. As for whether the count is willing to use it, that is his own business."

Alcohol disinfection has taken another step forward. During the discussion, the two intentionally or unintentionally regarded Morazo as an experiment before promotion.

Eston's calf was not infected, and it was not rigorous enough to verify the effect of oil and alcohol.And the earl's groin has begun to rot, and if even his wound can heal, the persuasion will be stronger.

Once the Count recovered, Ignatz would have reason to use this wound care kit for the entire ward.

But there are two more things Carvey needs to address before alcohol can be used on a large scale on the ward.

One is the production of alcohol. It is impossible for him to ask the owner of the pharmacy to distill it. The amount is too small.The second thing is the issue of hand washing, which also needs to be combined with the awareness of puerperal fever and microorganisms next door.

Really solving these two things is a big step forward, and it can also lay a solid foundation for a large number of surgeries in the future.

Ignatz quickly finished the rounds, and then took Carvey into the autopsy room.

Since the two people in room 102 were brought to the hospital, the corpses hadn't left here.Less than two hours after Ignatz invited Musil to take over the autopsy, the two of them miraculously returned to Ignatz's hands.

Both committed suicide by taking poison, and they were sent to the hospital first. Musil had no reason to take them as his own under the temptation of 20 crowns.

As long as the autopsy report is slightly modified, a lot of formalities and procedures can be saved. Anyway, he only earns 20 crowns when the corpse enters the police station, which is no different.

Now the two corpses are still lying on the dissecting table, covered with dirty white cloth, and the whole room smells of corpse odor, perfume and turpentine.

"You said before that the deformity of the orbicularis muscle needs to be considered during cleft lip repair?" Ignatz lifted the white cloth, revealing a woman's face, "She is a little younger than Mrs. Time, let's start with her."

Although Carvey feels that a corpse with normal lips still cannot show the appearance of a cleft lip, but seeing Ignatz's excitement, he can only make use of it first.

First of all, he needs to make the teacher understand: "I personally think that the deformation of the straight line sutures that Varela said is because it looks like the operation when it is still, but once the muscles contract, the scar tissue on the lips will also be deformed." It will shrink along with it, and then the shape will change."

"I know this."

Ignatz also looked through a lot of surgical atlases and materials: "The reason you said is similar to what Milott proposed back then. He cut out a Z-shaped flap from the affected side and did a kind of oblique suture. It is said that This shrinkage can be prevented.” [6]

"But he still missed the shape of the orbicularis muscle, which is a progressive arc with a narrow top and a wide bottom." Carvey said, "The straight line suture did not consider the arc at all, but the Z-shaped skin flap did. Too much, not smooth enough."

"So what's your idea?"

Throwing out the two concepts of "curve" and "flap", what Carvey now wants to teach Ignatz is the lower triangular flap embedding method announced by Tennyson in 1952 [7], which is still an introduction to cleft lip repair even in modern times. and commonly used clinical procedures.

Speaking of teaching, in fact, Carvey himself has never done this kind of operation, it can only be said to be learning together and encouraging each other.

"Teacher, how about we make a small triangular flap above the red lip?"

(End of this chapter)