Nineteenth Century Medical Guide

Chapter 7 7. Warming the "old" and knowing the "new"

The manager of the restaurant is the head chef, who used to serve the French royal family full-time.Now that he is suddenly asked to cook for a commoner, it is inevitable to mind.

In the face of Carvey, in the face of the rare food take-out situation, although his words are not forgiving, he still does his best in terms of follow-up service.

The restaurant uses a set of gold-plated and silver tableware that is commonly used by the royal family, similar to cooking pots and lunch boxes for food.For the convenience of use and carrying, and to reduce the cost, the craftsman changed the material to copper and silver-plated, and removed many original decorations and unnecessary carvings. It looks simple and natural, and more approachable.

Because airtightness is not guaranteed, you need to be accompanied by a waiter when you take out food.

Of course, the huge deposit of 4 crowns was still paid by Ignatz.

There is not much light on Basinger Street after nightfall. For most people who live here, night means darkness, a time to rest after a hard day's work.They need to seize the rare opportunity to sleep, conserve energy, and prepare for the long work of the next day.

What's more, light is not free, and wasting candles is quite a luxury.

A carriage came from the west, and with the fast-paced sound of horseshoes kicking, the carriage stopped at the door of No. 73.Using the kerosene lamp beside the car, a young man quickly got out of the car and took the lunch box and bread bag from the car.

"Mr. Carvey, I will retrieve these things at this time the day after tomorrow. Please make sure that the tableware and lunch boxes are not damaged."

"I see."

In late winter and early spring, as long as the method of preservation is proper, three dishes, one soup and a bag full of baguettes are enough for him to eat for two days.By the time the food is finished, he should have eaten the working meals of the Municipal General Hospital, at least he no longer has to worry about eating.

Carvey looked forward to the next life for a while, and went upstairs with a lunch box and a large bag of bread in both hands.

When he got home, he realized that after he left, the police had sealed off his home, just like Room 302 next door.Thinking about it, Detective Witt didn't intend to let him back from the beginning, even if he was really innocent, the other party wanted to keep him for a while.

If he hadn't met Ignatz by chance, he might have lived in the police station for several days.Now even Werther has decided not to make trouble anymore, the matter basically has nothing to do with him, and Carvey doesn't need to worry about these anymore.

The man in black called "Mick" appeared again in his mind, couldn't help but slander, tore off the seal, opened the door and entered the house.

After entering the house, Carvey tidied up the room a bit, collected the drawings and clothes scattered on the floor, and tossed the bed clean.Then moved an empty space by the window, put the lunch box there, and tried to keep the temperature low by the cold wind constantly blowing into the window.

In the era when there were no refrigerators, covering the food immediately after it was prepared could play a role in isolating airborne bacteria.The air inside will also be relatively sterile due to the continuous high temperature of the steam.

Anyway, it's always right to wait until you eat before moving.

Since traveling here, Kavey's brain has been working at a high intensity, and he hasn't stopped to rest.Now that he finally has free time, he needs to make a good plan for his future.

Medicine in the nineteenth century was a mess.

This kind of confusion is not only about medical care itself, but also because its matching medical system is also extremely chaotic.

In fact, the word "chaos" is not appropriate here, because there is no complete system to support the development of medical care.

Kavey is a modern person. Although he has studied medicine for half his life, he doesn't know much about medical treatment more than 100 years ago.The memory of the original owner has nothing medically related to it, apart from painting and gardening work.He didn't understand some details until he met Ignatz just now.

The occupations occupied by the entire medical system can be roughly divided into internal medicine, external medicine, medicine and nurses.

Among them, physicians have the highest status and high requirements, so the number of physicians is naturally the least.

Physicians need to go through advanced studies in orthodox medical schools, at least a bachelor's degree.In the Vienna Municipal General Hospital, physicians are often graduates with a master's degree and have undergone at least one year of clinical work and training.

In comparison, the status of surgery is much lower, and surgery is not included in the orthodox medical service, but a kind of entertainment for the public.

Surgical operations were born out of barbers. They are crudely operated and cheaply charged. They need to rely on theater performances to earn appearance fees.

This setting seems outrageous to modern people, but it actually had certain advantages at the time.Because compared with amputating a leg directly, using physical anesthesia to stun and then amputating a leg is obviously more attractive to the audience.

If it is accompanied by a well-designed commentary at the same time, it can add a lot of sense of substitution.

When a mediocre surgeon who saws a leg sees his peers earning a lot of money with a well-designed process, he will try his best to put more effort into his own operation process.

This undoubtedly played a certain role in promoting the surgery itself. Even if sometimes the new surgery introduced is useless or even counterproductive, the surgeon will still enjoy it.
In any case, the status of surgeons cannot be compared with that of internal medicine in a short period of time.

Surgeons like Ignatz are definitely one of the few who need to combine several conditions at the same time.Including the hereditary baronetship, completing his undergraduate and master's studies at the University of Vienna Medical School, and having the best surgical technology in Austria.

This made him a big man who existed like a star. While bringing a lot of wealth to the hospital, he also won for himself the right to speak about the hospital's decision-making.

Carvey has the technical and theoretical knowledge of modern medical care, but these things are deeply tied to modern science and technology.

In the [-]th century, there were no blood analysis instruments or X-ray CT machines. Surgical instruments were limited to crude tools such as metal knives, saws, scissors, pliers, and hammers.

With the most modern medical equipment and one or two rookie assistants who only understand human anatomy, Carvey can directly operate the most complicated surgical operations in his department.But if the types of instruments are locked, the scope of surgery will become very narrow.

In addition, the risk of ether anesthesia that has just begun to be popularized is not low, and the poor hemostasis technique basically relies on the pressure of the assistant's fingers, without even a decent hemostatic forceps. Carvey even once doubted how those amputations were done to keep the patient alive of.

Is it really relying on the contraction of the blood vessels produced by the physiological reflex after the blood vessels are disconnected to stop the bleeding?

As for the infection after surgery, it is even more troublesome. The editors of pharmacology will not include how to make medicines in their textbooks.Carvey knows how to use antibiotics, and knows when to use them, but he can't make antibiotics out of thin air, at most he has dabbled in the history of this area.

What was in front of him was actually a mess that was completely contrary to modern medical theory, and the conditions were worse than the crudest clinic.

And these crude conditions can't be improved by simple money, and what Kawei has to do is far more than he imagined when he first traveled here.

A clever woman can't cook without rice is vividly expressed at this moment.

“First of all, you need to familiarize yourself with the surgical procedure”

He picked up Ignatz's anatomy book and looked through it for the first time with a learning attitude.

The first 2/3 of the collection are pure anatomical atlases, including explanations of all named anatomical terms.Many anatomical nouns have been used until modern times, only the internal organs of the torso have a lot of ambiguity.But in the current medical environment, the abdominal cavity is still a forbidden area for surgery, and these differences can be made up with time.

The last 1/3 of the collection is a simplified diagram of some surgical operations, which are divided into four parts: eyes and ears, limbs, maxillofacial, and vulva.

From the perspective of the process, the purpose of a small number of operations is actually very close to the modern understanding, but it is difficult to make breakthroughs due to the precision of the instruments.

For example, cesarean section during maternal dystocia, and incision and drainage of perianal abscess.Although the success rate of the two is not high, intraoperative bleeding and postoperative infection are commonplace, but there are no major problems in the indications and principles of the operation.

There are many operations because the diagnosis is unknown, and when internal medicine cannot treat it, surgery can only be used as a "one size fits all" treatment.

Among them, the most representative ones are direct amputation after open fracture, and ophthalmectomy for strabismus.

The reason for the amputation is that if the open fracture is not strictly debrided, even if it is fixed and reset, it will cause wound infection.Even if infection is avoided by chance, it is very difficult to fix well in this age.Without fixation, it is difficult to establish a stable blood supply to the broken bone, which eventually leads to necrosis of the distal extremity.

Necrosis will lead to secondary infection, and in the end, not to mention the loss of limbs, even life will be lost along with it.

But it is undeniable that the original amputation operation has managed to retain part of the muscle flap for stump embedding, and the understanding is quite in place.

The essence of ophthalmectomy is also similar to the method used in the modern treatment of strabismus, but the real reason behind the strabismus has not been clarified, and the method is too rough.Anyway, there are quite a lot of eye muscles, and cutting off one or two can indeed relieve strabismus to a certain extent.

The current approach is to target the problematic part of the eye muscles and do fine muscle shortening and retreat. (1)

It really runs counter to modern surgery, and it is rare to have a completely counterproductive surgery. The only thing that Kavey can't stand is some negative pressure suction devices specially made for bloodletting.
What awaits him the next day will be the apprentice recruitment test at the City General Hospital, as well as some formal written assessments.Although Ignatz has long regarded him as his real student, and the admission work has been negotiated, and the test and assessment are just a formality, but the habit he has developed over the years still allows Carvey to roughly read the entire collection of paintings.

He blew out the candles, closed the cover, and thought about it for a long time before going to bed.

　(1) Ocular muscle retrograde surgery for modern strabismus: Before cutting off the ophthalmic muscle tendon, pre-set loop sutures on both sides of the site 1.5 mm behind the ophthalmic muscle attachment point.Snip the tendon at the point of attachment.Then measure the setback distance.Then the preset sutures are passed through the attachment points respectively, the eye muscles are pulled, and the sutures are ligated.

　　
　
(End of this chapter)