Nineteenth Century Medical Guide

Chapter 54 53. Debridement
The manor of Earl Moraso's family is in the outskirts. Although it is not so magnificent, it was bought by the king himself after returning from the war.

Different from the atmosphere at the Laszlo's dance two days ago, the atmosphere here is more peaceful and slightly depressing.The etiquette of the servants and the butler when dealing with the guests is very decent, but the smiles are very shallow, and the voice, wording and hospitality gestures are very restrained.

As long as you pay a little attention, you can see something unusual from their words and deeds, as if something big is about to happen.

"Lord Baron, I'm really sorry." The butler bowed slightly and apologized, "Today is an important day for the master, please wait in the living room first, and I can see you before dinner."

A trace of haze flitted across Ignatz's face, and he asked quickly, "Is he not feeling well?"

"It's okay. I ate half a steak, a bowl of vegetable soup, and two bites of cake for lunch." The butler smiled. "Actually, he asked someone to paint a portrait for him. He has been talking about it for a long time. Today I finally caught the opportunity and invited Mr. Hans over."

"Oh, it's okay, I'll just sit here and wait."

The butler ushered him to the sofa, and then said to Bergett behind him, "Master Bergett, if you want to see the master, I can do it for you."

"No, I'll just accompany the teacher." Bergert walked over together, "Anyway, Mr. Hans doesn't want other people to stay by his side when he is painting, and he will throw him out if he goes."

The butler nodded: "Those three please go ahead, the tea will be here soon, so I won't bother you."

"Uh, I'm sorry." Seeing that he was leaving, Carvey said quickly, "Where is the kitchen?"

The butler didn't understand what he meant for a moment: "If this gentleman is hungry, we will bring you pastries later."

"Oh, no, I'm not hungry, you misunderstood." Carvey explained, "I just need to use the kitchen and laundry room to prepare some necessary things for the earl's wound."

"It was so"

The housekeeper seemed to understand what he meant, but his feet did not leave their original places.He looked sideways at Ignatz on the sofa, until the baron nodded, and then turned to lead Carvey: "Sir, this way please."

The living room is much smaller than Laszlo's, and the furniture and decorations are not gorgeous.In fact, even if you hire the best architect and decorator in Austria and spend [-] kroner, it will be difficult to steal the attention of the guests in front of the two portraits on the wall.

One is the late old king, the other is the young Morazor.

The earl was dressed in a military uniform with a saber and three military medals on his chest, and he was much more energetic than lying on the bed sickly.

"It's been a long time since I competed swords with my uncle." Standing in front of the portrait, Bergett recalled how he received swordsmanship instruction when he was a child, "I don't know if he can survive it."

As a good friend, Ignatz is already mentally prepared: "Today we need to clean up the rotting meat outside, and then use Kawi's wine. If we still can't figure it out, then there is nothing we can do."

"Teacher, is the half bottle of brandy in Carvey's hand really useful?"

"I do not know either."

Ignatz sighed, but quickly explained: "He only said that the nursing process was clearly written in the New England Journal. I don't think it is a medical journal that makes fun of patients. After all, the medical treatment of the Crimean War The data is still very clear, the death rate of wounded soldiers in the British army dropped very obviously in the later period of the war, and there were reports even in China.”

"Cut off the carrion, use alcohol to debride the wound, and then cover it with an ointment dressing." Bergert asked suddenly, "Everything is here, why is he still going to the kitchen?"

"I heard that cloth bandages still need to be steam-treated at high temperature before they can be used."

"Steam? That's too much to ask!"

Of course, Ignatz also felt too much. He remembered that at the beginning, Carvey only talked about oil and ointment, and then a high-concentration alcohol popped out.Later, he found that not only the skin of the patient, but also his own equipment had been cleaned by Carvey.

I thought this was complicated enough, but who knows that even the cloth bandages that are washed daily need to be reprocessed at high temperature.

How can there be so many steps, can these really relieve wound ulceration?

Ignatz's doubts were quickly interrupted by Bergett, who was rarely able to get along with the teacher, and he wanted to ask something about surgery.Ignatz was not in the mood, but he couldn't hold back Bergett's interest, so he had to replay all the previous operations.

Half an hour later, Carvey entered the living room with a paper bag, just as there was a sound from upstairs, and the three of them went upstairs accompanied by the housekeeper.

The last time Karvey saw this painter was at the entrance of Alphonse's restaurant, and he had no chance to meet him. The atmosphere of this meeting was too depressing, so he just nodded and skipped it.

"My lord, I wish you a speedy recovery."

Hans smiled and packed up his drawing board and brushes, put on his hat and dressed, and before leaving, he did not forget to whisper a few words to Bergott: "There is a game tonight, do you want to go?"

"what match?"

Hans waved his fist lightly: "I have a ticket."

Although Bergett faces the bloody operating table every day, he can't stand this kind of movement, and always feels as uncomfortable as being pulled in his heart: "Don't go to that kind of place."

"What are you afraid of? I also called Sarson and Meren. It would be boring without you." Hans said, "I didn't find the inspiration for the opera yesterday, and the French cuisine failed again. You have to agree to this matter. .”

Bergert struggled for a while before nodding: "All right."

"Then I'll wait for you downstairs."

While the two were still discussing at the door, Ignaz had already helped remove the cloth bandages on Moraso's groin.

It has been almost a week since the hernia operation. If it was sutured normally, the wound should be almost healed.Considering that Ignatz had left it open at the end, if it was taken care of properly, there should be a layer of fresh granulation, and the cloth strip was stained with a light red color mixed with tissue fluid.

But what Carvey saw now was tan.

Staphylococcus aureus?
It doesn't look like it.

Carvey stepped forward and took a sniff. He could smell the obvious smell of feces. It should be Escherichia coli, a frequent visitor to the general surgery department. It touched the wound during the anastomosis of the small intestine. 【1】

Anyway, no matter what kind of bacteria it is, brandy is used in the end, I just hope the alcohol concentration is enough to sterilize it.

"How do you feel today?" Ignatz's face was calm, and there was even a smile on the corner of his mouth, "I heard from the butler that you have a good appetite."

"It's okay." Moraso looked at the wound and sighed, "It's just this wound that hurts badly, isn't the situation not good?"

"You are in such good health, there will be no problem." Ignatz threw all the cloth bandages on the ground, and took out scissors and a scalpel from the box: "But if you want to get better soon, you still have to endure it." Forbearance, you understand."

"Understand"

Berget stepped forward to help put the blood-proof towel on, then picked up a corner of the quilt and handed it to his uncle.Moraso bit the quilt, pinched the sides of the pillow with both hands, took a deep breath, and shouted in a low voice: "Come on!"

Debridement, as the name suggests, is to clean the wound surface.

First of all, the scabs on some wounds must not be left, and secondly, there is yellow and white carrion around them.They cling to fresh granulation, and Ignatz sometimes has to cut them off to get rid of them.

This is a brutal cut of flesh. 【2】

The whole process lasted 8 minutes. Even Morazo, who has been fighting on the battlefield for many years, could not bear the pain for a while. His back and hair were already soaked just as he started.However, as an imperial soldier, he would never cry out in pain, even if he accidentally groaned, it would be a shame.

"OK?"

"Yeah." Ignatz put away the knives and scissors, and heaved a sigh of relief, "I'm fine here."

Moraso thought he was dizzy from the pain, so he didn't hear clearly, so he asked again: "Huh? What. What do you mean?"

"After the debridement is completed, we still have the next step." Ignatz let Carvey pass by, "This... well, I'm afraid you don't know this one, he was the assistant during the operation."

"Assistant? Isn't the assistant Dr. Hills?"

"Oh, this is a long story."

Ignaz glanced at Bergett, who could only tell what his mother and he had done: "It's embarrassing anyway."

"Then what?" Moraso slowly recovered.

"Then it's his job." Ignatz is still a layman in nursing, and he is in front of his old friend, so he really dare not do it himself. Boys with wounds were healed by him."

Moraso just looked at Carvey and nodded, but still didn't get the answer he wanted: "So, what are you going to do to my wound next?"

"Use wine, my lord."

Carvey smiled and took out the small half bottle of brandy: "I don't know what your taste is, so I can only use this bottle of cheap goods to make ends meet today. If the effect is good, in the next one to two weeks, I will I'll change it up for you."

"Take me a drink?"

"No, buy it a drink."

Carvey uses a more crude debridement method, which is generally used to deal with large-area trauma, such as burns and degloving injuries.But compared to modern times, Ignatz's suitcase is still a lot shy, and there is no such thing as a brush [3]. In the end, Kavi can only choose a thick sponge that is usually used to suck blood.

The scene made it impossible for the three people around, including Moraso himself, to comment. I only remember that the process was very fast and lasted about 4 minutes. 【4】

"That's about it." Carvey said, looking at the base of the wound covered with bleeding points, "Next, we still need to use some clean cloths, such as the ones I just brought from the kitchen."

He opened the paper bag, took out a clean handkerchief with his hands moistened with alcohol, folded it into a square, and carefully covered the wound: "Then the cloth is fixed."

Wound care is the basis of surgery. After this debridement, Ignaz and Moraso made a new appointment: "After this time, the next time will be the morning of the day after tomorrow."

"Okay, morning is morning."

"As long as the wound is unharmed, I won't come here." Ignatz said, "He found the things, and he learned the method first. Experiments. These things still have to be done by him."

Fortunately, with the tincture of YPian, the pain did not subside quickly. Moraso didn't catch what he said just now: "Let's go after dinner."

"No, I still have things to do." Ignatz declined politely, "There are still things to do in the hospital."

Seeing this, Karvey remembered about Elena, and said, "I'll go back with you, I just happen to be fine at night."

"No need, it's nothing serious."

Not a big deal?
Carvey was a little concerned, and tentatively said: "Last time you said that you need helpers to dissect the corpse, and I am completely competent."

"Those two corpses are almost used up." Ignatz still insisted, "I'll go back to the hospital to write a record of today's surgery and wound care, and then go home. Do you still want to go to my house for dinner?"

Carvey said "Oh, that's it".

But the doubts in my heart deepened.

Really?

Bergert on the other side didn't want to stay. Seeing that Carvey was still pestering the teacher, he immediately helped: "Mr. Hans is waiting for me downstairs. He and I are going out for dinner, or you can come with me."

"I?"

"Yeah." Bergert was in a good mood, "The working hours are over, and it's time for relaxation and entertainment. Don't worry about surgery. Besides, young people have to be with young people, and teachers have to go home."

Kavey was a little embarrassed.

It's no problem for him to have a relationship with these nobles and celebrities. Relationship is an exchange of interests, as long as you give the other party what they need.But really wanting to get along with Bergett is really against his usual living habits.

"Forget it, I don't have that much money."

Carvey made an excuse and wanted to leave, but Bergett quickly answered: "It's okay, I will trouble you to come and help me next time, treating guests to dinner is nothing, it's nothing more than normal."

"But."

"Don't do it!"

Bergert was much taller than Carvey, grabbed his shoulders, opened the door and walked out: "Mr. Hans! I found you another friend!"

Hans was sitting downstairs drinking tea and reading the newspaper when he suddenly heard a voice and looked up: "Mr. Carvey? Coincidentally, I also want to talk to you about the duel last night."

"Duel? The duel is over, right?"

"It's over? But that's not what was written in the newspaper!" Hans got up and handed over the newspaper at hand, "If Mr. Alphonse doesn't pursue it anymore, then the Vienna Evening News is lying!"【5】

Carvey frowned as he looked at the words in the corner of the front page: "They didn't lie."

"Mr. Carvey, did you really send the letter?"

"Alphonse was pressing hard at the time, and I couldn't help it."

"Can you persuade him?"

Carvey actually didn't want to persuade him, because there would be trauma if there was a duel, and he could move once like last night, and then move a second time, which was all income.So when faced with this problem, he could only shrug his shoulders and spread his hands, saying: "He is just stubborn, and he can't be persuaded."

"This is troublesome!"

"what happened?"

"Mr. Li Ben is gone."

Carvey didn't know the stakes in it: "Isn't it good to be gone, to avoid a fearless fight."

"No, Carvey, you don't understand duels." Bergert suddenly interjected, "If the original duelist insists on not appearing, then his assistant should bear his honor and accept the duel."

(End of this chapter)