Nineteenth Century Medical Guide

Chapter 64. Circumcision
There were some twists and turns in the process of crushing stones, but overall it was fairly stable. The cracked big stones and small stones all shattered in response, and finally the curtain fell in the rhythm of everyone shouting.

The operation quickly entered the second stage, circumcision. 【1】

Carvey is not familiar with circumcision, having only helped with circumcision when he was young.If you put aside the circumcision device, the traditional circumcision surgery still pays attention to the knife technique. In my impression, the line of the knife needs to be prepared in advance. After all, it is considered half of plastic surgery.

In the 19th century, circumcision was not a very popular thing, and the acceptance of it in the West was also very low. After all, surgery is accompanied by the risk of bleeding and infection. Go for circumcision at the risk of small tubes of pus. Once the skin is not cut well, it may have to be completely cut.

Ignatz did refuse at first.

But Fernan seemed to have some secrets, and he kept emphasizing his family and spiritual needs, which made Ignatz decide to give it a try.

After several times of bladder flushing and removal of gravel, Carvey helped with a thorough disinfection with a cotton cloth soaked in alcohol.It is self-evident that alcohol stimulates sensitive parts, but it is no longer a concern.

Ignatz got a rare rest time, looking at the stones discharged from the bucket, he was in a very good mood:

"As we all know, circumcision is not an operation worth advocating, although a series of demonstrations have shown that circumcision can effectively prevent unrestrained masturbation and inattention. But it is not a leg or a hand, it is every man's The only one, bear the very heavy work pressure after adulthood.”

Carvey used long tweezers to hold Fernan's precious skin, and the other hand used long tweezers to repeatedly clean the inside and outside.

When the stone was crushed just now, in order to expose the urethral opening, Kavey had already seen many problems.

It was time for Fernan to cut it. The inner skin board had already partially fused with the head, and it was difficult to pull it up when it was turned halfway.The head has also developed secondary inflammation, the skin is red and swollen with a foul smell, and after the alcohol is mixed with volatilization, a strange smell is permeated in the center of the theater.

This situation is not uncommon in modern times, and exists in some middle-aged and elderly men.

If it is allowed to continue to develop, the skin and head will further adhere and fuse, leading to more severe inflammation and further narrowing of the urethra.Although the bladder stone is broken, it will definitely recur. At the same time, it will be accompanied by kidney and ureteral stones, and then further urinary retention.

In the fused part of the skin head, repeated inflammation will also breed growths, which are the prelude to cancer.

".For Mr. Fernand's privacy considerations, female audiences are not allowed to enter the venue today." Ignaz smiled and shook his head. "With all due respect, I still feel a little sorry, because what you are about to see is The history of the birth of the most spectacular ** in all of Austria."

"Teacher, the disinfection is complete."

"Pliers."

"."

"You fix both sides to expose the field of vision, and I will do blood vessel ligation." [2] Ignatz touched the epidermis with his fingers, felt the pulsation point of the blood vessel, then took the needle and thread, and suddenly asked, "Kavi, your father is not very good. Do this kind of surgery."

Carvey was taken aback: "I have done a few cases."

"Oh?" Ignatz said with a smile, "When you were doing cleft lip repair before, you said that he would try to avoid this kind of surgery, for fear that the wound would fester and the patient would lose his name."

"Because the situation of those people was more serious than that of Mr. Fernand at that time, it was impossible not to do it." Carvey argued.

"Serious." Ignatz's hands were fast, and he didn't seem to be affected by the previous failed surgeries. "How serious is it?"

Carvey shook his head helplessly, and could only bring out the worst result: "I didn't finish several of them, so I just cut them off."

"Has a bad change happened?"

"Ah."

"It's a pity." Ignatz gradually introduced his own topic through the conversation, "I think in order to avoid this from happening, we should learn from Dr. Hutchinson's suggestion in the UK and promote circumcision nationwide. Especially for adolescents who have already begun to develop , doing circumcision before puberty allows them to better cope with the upcoming puberty."

This passage quickly attracted many people's comments.

In fact, Carvey is very clear that Ignatz's purpose is nothing more than to achieve the purpose of promoting surgery through large-scale surgery with scientific significance.It's the same as the maternity department was able to grow after the national promulgation of the childcare fund.

Perhaps the degree of promotion is not so high, but at least it is promoted.

It is a pity that the majority of Austria believe in Catholicism, which prohibits religious circumcision and only takes a neutral attitude towards non-religious circumcision.

Ignatz's career represents a non-religious meaning, and at least some scientific basis can be found, but such a large-scale circumcision, and it extends down to the youth population, it is difficult to make the vast majority of Catholics on the field doubt its purpose .

It was Varela who was the first to raise doubts, a daily reporter who specialized in tracking and reporting surgical operations: "Doctor Ignatz, are you sure you want to promote this 'circumcision' with obvious religious meaning in this land?"

"Mr. Varela, this is the 19th century, not 200 years ago."

Ignatz skillfully finished the ligation of several blood vessels, took the scalpel from Kavi, opened the epidermis and began to do further adhesion peeling: "Look at Mr. Fernand's baby, the skin is dead. stuck together, I had to cut them with a knife"

"It's different, doctor, regardless of the feasibility of preventive circumcision, after all, there are not so many surgeons like you in Austria."

Varela first complimented Ignatz, making himself seem to be discussing the matter from an objective and neutral point of view, and then launched a counterattack: "But the part of your remarks just now wants to spread the rare circumcision. How is this different from 'circumcision' in those barbarian lands?"

"Of course I have my own arguments, and the UK is already doing it." Ignatz had definite news in his hand, "The United States on the other side of the ocean is also preparing to follow suit."

"Is this a scientific basis?"

"Dr. Hutchinson once specifically studied the incidence rate of xing disease among Jews, which is indeed much lower than the overall incidence rate in Europe. Dr. Lewis Seyle, who is now planning to promote circumcision in the United States, is the American medical doctor. One of the founders."

Ignatz chose the method of dorsal median incision and peeling off the two sides【3】, just like peeling grape skin with a scalpel. The knife technique is extremely rough, but at least most of the epidermis was separated.

After the skin is completely separated
"Scissors."

"Give."

Carvey supported the small thing, Ignatz clamped the skin with forceps, made arc cuts on both sides along the bloody coronal groove, and finally chose to cut off the ventral frenulum.The wrinkled leather was pulled and spread out in Ignatz's hand: "Kavi, record it, it's about 4cm long."

".Forehead."

"Complete!"

The next step is the daily interview work.

Perhaps out of respect for the surgical operation, Varela did not refute aloud during the final cutting stage just now.But when the operation was over, his rhetoric surged again: "Dr. Ignatz, if you insist on doing this, I have to put you on the headlines again."

"Thank you."

"But the headlines this time are not positive. Once the newspaper is published in the hands of the citizens of Vienna, you will also be criticized by them."

"Borrow it first."

Ignatz didn't care about this kind of thing at all, and squeezed through the crowd to the preparation area and began to wash his hands: "Mr. Varela, you scolded me for not being innovative more than ten days ago. I still remember the report, 'Only Dare to work like an old machine in the safe range drawn by others', is that what you said?"

Varela sighed: "Indeed."

"Thank you for your previous reminder. I am now listening to your opinions and trying to change my work attitude."

The corners of Ignatz’s mouth were full of smiles, and he seemed to have come out of many previous failed surgeries: “I tried to change the way of repairing cleft lip, and I also tried to change the way of suturing blood vessels during amputation. Now the new lithotripsy machine 's first attempt was exceptionally successful, look at the blood-stained gravel in the barrel, that's the result of innovation."

"Lithotripsy was indeed successful, but..."

"There is no 'but', Mr. Varela." Ignatz is determined to seek change, "My next goal is circumcision, not only the body and age range of the operation, but also the suturing technique and Improvements in surgical instruments."

Varela was completely silent.

He is very clear that once the opponent holds the weapon called "science" tightly, he has no chance of winning.So Varela quickly changed the target and led the topic to Nora's cesarean section: "Let's talk about the cesarean section that will be on stage."

Ignatz soaped his hands with lye: "You've asked me many times."

"But you didn't answer me directly for many questions."

"This is the Lithotripsy Theater."

"But for a lithotripsy, there is really nothing to write about except for the special lithotripsy equipment used just now."

"What about circumcision?"

"It's too shocking, I can only take it as your own self-esteem." Varela didn't care about his feelings at all, and continued, "Even these washing steps, I personally don't see any merit, It can only be counted as someone grabbing the attention of the audience."

Many people around Carvey were asking about the solvent composition of the hand sanitizer. After hearing what Varela said, most of them chose to leave the theater with a laugh, and only a few stayed there waiting for an answer.

"Bleach powder and high-concentration alcohol are used." Carvey gave a brief introduction and explained further before Varela said, "This is not a random choice. I have tried hundreds of reagents before I am sure. Only bleach and high-concentration alcohol can eliminate miasma and isolate miasma."

"An experiment?"

"I will write the experimental data in my report. As for whether it can be published in a journal, more postoperative results are needed." Carvey looked at Varela and said, "I personally think this is also a kind of innovation. exploration."

Varela nodded, and even though he was gagged, he still did not forget to sneer at him to retaliate: "If the bleach powder used by weavers and the alcohol drunk by alcoholics are considered innovations, I don't seem to be able to refute them."

In fact, whether Varela can report on the disinfection process is irrelevant to Carvey.

Sometimes public opinion building can play a role in fueling the flames, but what he wants now is to completely reverse everyone's concept of disinfection. Relying on public opinion alone is very unreliable.Semmelweis' failure was due to his eagerness to convince everyone with a mortality gap of less than 10% in obstetrics, which aroused public outrage, and Carvey did not want to repeat the same mistakes.

What he wanted was the accumulation of surgical data and enough medical status to make everyone believe in him.

Nora's cesarean delivery was the first step.

"Mr. Varela, the success of innovation cannot be judged by just a few words. It takes time to prove it."

Carvey began cleaning surgical equipment, saying, "If five patients doesn't tell the story, then ten, twenty, hundreds. I'm 17, and I believe by the time I'm 37, it's now called innovation." It may have become the habit of all surgeons."

Including Kavey's preoperative preparations, the operation took less than an hour, and Ignatz used his "sharp knife" to the extreme.

Considering the repeated entry and exit of Fernand's urethra during the operation, Carvey also wanted to discuss with Ignatz how to deal with the stricture of the urethra.But as soon as he walked out of the theater, he hurried into a carriage and left alone.

"He didn't say where he was going?"

"I didn't say it."

Alina stood at the door of the ward, staring blankly at Kavey who just came back, not knowing what to say: "He didn't tell you and you didn't ask?"

"I asked. He said he was going to meet an old friend. He didn't say the specific address, so let me come back first."

"You just came back like this?"

"Yes, Mr. Fernan has just finished the operation, so he needs to clarify the nursing matters with the nurses. I will also be responsible for changing the bandages and gauze afterwards."

"You know what I mean."

Carvey sighed that women are really troublesome, and continued to reply: "Mr. Alina, I am just an assistant at work, not his son. It is impossible for Mr. Ignatz to take me everywhere."

"I got the lab for you!"

"Yes, yes, I will stay in the laboratory and wait for him to return to the anatomy room. Even if the teacher leaves in the middle of the night, I will follow up quietly. But the method you mentioned is too infeasible, and it is too easy to be discovered." Carvey saw She was really anxious, but she still didn't forget to explain, "Besides, the teacher has gone home these days, maybe he will be back soon."

Alina nodded first, but quickly shook her head and said, "No."

"what happened?"

"The cesarean section is approaching, and he needs to find his status. The failure rate of the previous surgery was so high, he won't be indifferent." Alina seemed to remember something, and hurriedly ran out of the ward, "I have to find him."

"Don't worry."

Carvey stopped in front of her: "There is no way to find this way, we still have to solve the problem from the source."

"What do you mean?"

"After the teacher comes back, the carriage he is riding in usually stays at the entrance of the hospital for a long time. And there is another carriage at the entrance. The driver sitting on it will definitely ask him for the 5 crowns I gave before. Where did it come from?"

(End of this chapter)