Nineteenth Century Medical Guide

Chapter 63 61. When~When~When~
These days, Kavi's focus is on the experiment, and he wants to get the experimental data as soon as possible to support his own medicine before Nora's cesarean section.But he didn't ignore the patients in the ward, he did rounds every day, and he never stopped postoperative observation.

Of course, it's just for observation.

Carvey has taken over or indirectly taken over five patients. Except for Laszlo, who has completely recovered, and Morazo, who has improved a lot, only Eston, Mrs. Gale and Alphonse are left to rest in the ward.

Seven days after the operation, Mrs. Gale's lip had the stitches removed. The wound has already healed, but it will take some time for the swelling to completely subside.Although Alphonse's buttocks were not completely healed, they were growing well, at least they did not fester like other postoperative patients.

Ignatz has already talked to Mrs. Gale about the idea of ​​a new cleft lip surgery, and only needs to perfect a few details before it can be used on Mrs. Gale's child.

Among them, the most gratifying thing for Carvey is Eston. After half a month of rest, his calf has subsided and the wound has healed well.It is unimaginable in the medical environment in the middle of the 19th century that such a long-distance suture with multiple stitches can maintain no ulceration.

And Eston's fracture is also developing in a good direction.

The fracture was hardly displaced. From the appearance, the lower limbs remained symmetrical, and the broken ends should fit together well. In addition, there was no neuromuscular damage.

This means that as long as Eston continues to lie in bed for a period of time and insists on rehabilitation training, he will have a pair of strong calves like other people of his age after he is discharged from the hospital.

At this point, Carvey ushered in his sixth patient after time travel.

Fernand, a 29-year-old butcher who sells meat, had quite severe bladder stones, which not only caused severe pain, but the huge stones also caused quite annoying urethral obstruction.The reason for seeing a doctor is to hope that once and for all, he can directly help him relieve the pain that is worse than death.

After a short examination, Ignatz found that apart from the stone symptoms, Fernan was also very dissatisfied with the appearance of szq itself.This dissatisfaction breeds intense anxiety, which seriously affects his status at home and his marital happiness.

Ignatz remains conservative about circumcision.

But after considering the health reasons, he decided to follow Fernand's wishes and set up a complete operation plan: first do stone crushing, and then do further circumcision.

This threw Kavi a little out of step.

Because the broken stones in the body do not need to be disinfected on the body surface, as long as the equipment is sterilized.Circumcision requires very thorough disinfection, otherwise such a critical part would fester, and the consequences would be disastrous.

And there is no need to bandage the broken stones in the body, but the bandaging after circumcision is very particular.
"Don't be too surprised, this is the preoperative preparation that my assistant, Mr. Carvey, has been improving. Alcohol and lye soap were used before, and now a more special thing, bleaching powder has been added. In addition, there are Cooked gauze, cotton bandages, and ointments used to cover wounds after surgery."

What Carvey brought into the theater of surgery was a complete set of medicine bottle boxes and dressing storage boxes [1].

In addition, like the laboratory, he also brought several wash basins to hold disinfection supplies.

There were many medical students and surgical colleagues in the theater, and washing hands caused a lot of discussion.But after Ignatz described the current situation of the five patients, regardless of whether they had any grudges in their hearts, they finally chose to keep silent.

"I don't think the circumstances of these five patients are a coincidence."

Ignatz also followed Kavey's example and disinfected his arms one by one:

"This is very rare in a surgery where the chance of wound ulceration exceeds 50%, even to an almost abnormal degree. Especially with the recovery of Count Morazo's inguinal hernia, it is difficult for me to describe in one or two words these days. I will publish an article about this operation in the Vienna Medical Journal.

Before that, I still hope that you can show as much scientific curiosity and desire to explore as possible, and encourage and tolerate this young man's attempt to actively explore the boundaries of surgery.After all, science is full of chance, but once chance becomes inevitable, it will bring surgery to a deeper level. "

The effect of disinfection, coupled with the new surgery for repairing the cleft lip that was sent before, allowed Kawei to get the endorsement of Ignatz.

With his endorsement, Carvey's unique disinfection method was completely recorded in the record book by many viewers.Of course, many people will put a question mark next to it, and there will be people who directly cross, but in line with the principle that black and red are also red, being remembered is a kind of progress.

Alcohol and bleach have no major disadvantages except that they are a bit pungent. They made a few complaints before entering the real operation.

"Since the 18th century, surgery has made amazing developments, surgical methods have been continuously innovated, and surgical instruments have also been constantly changed."【2】

Ignatz brought a set of surgical instruments related to the urinary system [3], opened the cover, and took out a long curved tube [4]: ​​"To deal with huge bladder stones, we have been popular since the 18th century. Lithotomy, to the early crushing of stones more than 20 years ago, is now able to achieve precise stone crushing.”

"Teacher, can I ask a question?"

"Excuse me."

"What method was used for early crushing?"

Ignatz smiled, shaking the metal urine tube in his hand, "It's just turning the tube at a high speed, hitting the brittle stones with the hard end, the process is painful, but it's better than nothing." Lithotomy under anesthesia is much better."

"That's it?" The student put his hands together and made a gesture similar to spinning a bamboo dragonfly.

"Yes, knead quickly and repeatedly to get the curved ends to wiggle."

"."

"It's really rough, so we quickly thought of a new method, which I will describe in detail later. For now, let's help Mr. Fernan guide out the urine that has been stored for most of the day."

Carvey helped Fernand's baby up, and Ignatz slowly inserted the catheter into it: "When using this catheter, you will definitely encounter resistance from the urethral wall. At this time, you can consider Using an ointment mixed with essential oils to lubricate the tube wall reduces resistance and reduces damage to the urethral wall."

While speaking, some resistance was encountered in front of the catheter.

Seeing this, Carvey straightened the baby as much as possible to reduce the bending of the urethra. With the lubrication effect, the resistance was quickly broken through, and the tube entered the bladder smoothly.

Looking at the gurgling yellow urine, Ignatz couldn't help but said, "Although Mr. Fernand has already fallen asleep, I still have to congratulate him here, the catheterization went well, and there is no need for a bladder puncture. "【5】

Fernan's urethral obstruction lasted for a long time, and the urine output should be more than 1200 ml.

In the 19th century, there was no limit to the amount of urine for catheterization [6], and Carvey also knew that once the bladder bleeds, it would be considered as an inadvertent bloodletting, and it would become an advantage in the process, so he didn't talk too much.

"Very well, bleeding after catheterization." Ignatz smiled slightly, "The operation went very smoothly, and God is helping Fernand."

Carvey took out the urethral dilation tube (see 17-2) newly made by him from the equipment company from the side: "Teacher, number 6?"

"Not enough, just give me the biggest."

Ignatz took over the No. 12 dilation tube with a smile and continued: "Although the original plan was lithotripsy, we still need to try to remove the stone first in the spirit of being responsible for the patient. If the stone is too large, We only choose crushing stones as a last resort, after all, crushing stones will cause damage to the urethral mucosa."

In fact, urethral dilation is a kind of injury, because of the inflammatory response after injury, this kind of dilation will only aggravate the postoperative urethral stricture.

Perhaps it was because of the inflammatory reaction of the urinary tract infection that Fernan stimulated the urethra, which led to the narrowing of the urethra first, and the narrowing of the urethra would further put him in a state of chronic urinary retention.Over time, the urine retained in the bladder formed a large number of crystals, and finally condensed into stones.

But there is no way, it is impossible for Carvey to tell Ignatz such a lot of incomprehensible truths on the operating table, everything still has to be done slowly.

Take the stone [7] first, and then talk about it later if it becomes narrow.

However, the stone removal process was not smooth. Even with the thickest 12-gauge expansion tube, Fernand's urethra still couldn't bear the huge volume of the stone, and finally had to crush the stone in the bladder.

According to the size of bladder stones, the equipment used for lithotripsy is slightly different.

If it is a small stone, Ignatz has a gravel forceps [8] in the box, because the jaws need to be opened to use, so there are certain restrictions.If it is a large stone, the jaw size of the gravel pliers is not enough, then you need to use some big guys.

Without a B-ultrasound, no one could estimate the size of the stone. Considering that large instruments would cause certain trauma to the urethra, Ignatz chose to use forceps first.

I have to say that Carvey's homemade ointment helped a lot during this surgery.Continuously and repeatedly going in and out of the already narrow urethra did not produce much resistance, and Ignatz used it very smoothly.

This smooth feeling will be fed back to the chief surgeon, making him more relaxed and making the operation more comfortable.

"Kavi is ready, help drag those two small things, I seem to have caught one, it's quite big." Ignatz's posture is like pinching coal balls, holding the handle of the tongs tightly with both hands , only heard a crisp sound, the jaws closed, "I'll find out if there is anything else, and crush these small ones by the way."

Carvey knew very well that if it was only a small stone, it would not be enough to make Fernan feel so uncomfortable.

If Ignatz could do some lower abdominal palpation with his hands, he should be able to estimate the size of the stone, but he didn't.Like those physicians, Ignatz also regards trying not to touch the patient before the operation as the yardstick of the doctor's superb skills.

He prefers to observe directly than to touch with his hands, so this kind of "downgrading" has to be done by Kawei: "Teacher, his bladder is so hard."

Ignatz looked up at Carvey, his hand "coincidentally" placed on Fernan's lower abdomen: "Can you feel the stone here?"

"I don't know if it's a stone or not." Carvey gave up his seat and gave a gift in return, "It just feels different from the lower abdomen of a normal person. According to the teacher, it really feels similar."

These words are suspected of being flattering. Although they are useless, Ignatz listens to them.

After emptying the bladder, the shrinking bladder wall wraps around the surface of the stone, and the stone can be felt with a little force.The volume is beyond the scope of the lithotripsy forceps unless the urethra can be dilated to the thickness of two fingers.

"It's too big, let's replace it with a new type of rock crusher."

Ignatz was talking about a fixed-compression shatter device that, instead of applying lateral force with lithotrippers, applies longitudinal pressure to the stone.Because the force is longitudinal, there is no need to expand the urethra, but the source of force is slightly different from that of the lithotripsy forceps.

"Everyone, to be honest, I don't really want to use it." Ignatz reluctantly took out a long metal rod with inner and outer main and auxiliary rods and a small hammer from the box. The masterpiece of a lithotripsy master, it can not only easily clamp large stones, but also exert a force at the end to shatter the stone.”【9】

The instrument is very long, and in order to increase the force transmission, the tail end does not have a very strong locking device, so it needs to be fixed by Kawei and Ignatz together.

"Okay, clamp it, this stone is definitely the top three in my career for many years." The two held the handles from left to right, and needed to judge the position of the stone before breaking the stone, and Reduce the pressure on the bladder wall, "Move out a little more, okay, this is a good position!"

Ignatz turned sideways and held the small hammer firmly: "The next step is to crush the stone. In order to protect the patient's delicate internal structure, it will take some time. Because I heard that in the UK where it originated, the operator used too much force. It even caused the patient's bladder to perforate, so it's very dangerous to use."

Then, there was a rhythmic knocking sound in the whole theater.

Don't be too fast or too heavy, let the impact just fall on the stone, and dissipate around as soon as possible to reduce the impact on the bladder.

when~when~when~
Crushing stones has always been a delicate job. Ignatz had to restrain the urge to crush the stones as soon as possible without making the stones feel too easy. How to choose the strength of the hand required experience and talent.

Even for a surgeon like Carvey, it is difficult to fully control the strength without using it.

Perhaps this sound is too characteristic, or it may be that the musical cells of the Vienna people are at work. At the beginning of the stone crushing process, some echoing human voices can be heard in the theater, followed by rhythmic applause.

Until the end, the surgery site became a brief concert, and even Ignaz himself was taken away, and even some shadows of Beethoven's Symphony of Destiny could be heard from the percussion.

"Everyone, the stone is broken~"

(End of this chapter)