Nineteenth Century Medical Guide

Chapter 81. "Satan" moved

Appendectomy comes and goes quickly. Once the appendix is ​​caught, in the hands of a skilled surgeon, the time to remove it and close the abdomen is generally no more than 10 minutes. 【1】

Appendice surgery in the 19th century was terrible, but there is one thing to be sure of anyway, and that is the preparation before the operation.

Because there is no need for Carvey to remind, and there is no need to worry about the impromptu actions of the doctors, most people, including Moraso, Alphonse and the priest, will always prepare their intestines to ensure that the surgeon can see them after cutting them across the board. What's more is the fresh and tender lumen with a little green medicine dregs entrained, not the feces gushing out like a mudslide.

At that time, enema was indeed a very miraculous and common thing, and Father Schmidt can be called a representative of it.His preoperative preparations have gone beyond the scope of ordinary seriousness.

The priest thought that the abdominal pain was Satan's treacherous and dirty trick. From the beginning of the illness, he increased the number of enemas used for daily purification of the body and mind from two to four times a day to ensure that the demon could be driven away.

For Schmidt, this is his holy war.

It's a pity that the concoction used for the enema was not strong enough, so Ignatz and Kavi had to force their way into the arena to help.

The amputated appendix is ​​indeed spectacular, and the actual length may be longer than Carvey predicted, probably 27-28cm.This was something he had never seen before crossing over, and it was indeed a record.

"Herman, go on"

Holding the suture left by the stump and the crow's beak forceps on the other side, Kavey threw the entire appendix into the container prepared in advance: "Don't rush to throw it away, keep it for use."

"It's for medical treatment."

"Correct."

Postoperative pathology is an important link.

Observing changes in organs with the naked eye will become too subjective and lack specificity.Only by starting at the cellular level with extremely strong specificity, can it be clear what is wrong with these diseased organs.

It’s fine if it’s just an ordinary inflamed and festering appendix. Carvey doesn’t force it, but this time the appendicitis has bulged into a meat bun, which needs to be cut into slices and put under the microscope. This is why Carvey came into contact with the Ignatz microscope good opportunity.

Finding the appendix, cutting it off, and suturing the stump followed. For Ignatz, this was more than enough work than the next.He certainly couldn't do the purse-string stitching in the modern sense, but he could still easily patch up the gap with sutures. 【2】

When suturing, he has a lot of experience: "The appendix has been removed, and now what needs to be done is to suture the gap. Here, the general surgeon may think that it is nothing, just do a simple suture, but I have been doing double ligation. Because there are often cases where the catgut is not fastened firmly, resulting in intestinal fistula after operation, and the death of the patient occurs.”

This is true, and purse-string sutures are not necessary in evidence-based medicine in the 21st century.【3】

Surgery is a team game, and it cannot be accomplished without the efforts of all.

No matter how low the technical content required for the second anesthesia was, Carvey couldn't hold the appendix in one hand to suture while using his feet to anesthetize the priest.Moreover, anesthesia itself is dangerous. In addition to dose control, it is also necessary to pay attention to the priest's heart rate and breathing anytime, anywhere, and to prevent aspiration after vomiting.

Herman's contribution is obvious to all, but after the operation, the applause of the audience was given to Ignatz as the chief surgeon.

This is a period of silence and accumulation that every surgeon must go through. There is always only one chief surgeon, and it is always inevitable to do odd jobs behind the scenes.

Therefore, compared to Sears, who wanted to be the chief surgeon, Herman, who could calm down and practice silently to increase his experience, made Carvey more satisfied.

And Kavey himself doesn't care about the applause. Yesterday's cesarean section has already made him dazzled, so it's okay to give up some honor appropriately.And this kind of humility is not for nothing, he can definitely get some benefits from Ignatz.

After all, Ignatz himself knew that the reason for his applause was because of Carvey's initial judgment on the position of the appendix.

These are all secondary, what really needs to be paid attention to now is the postoperative treatment.

Ignatz handed the priest with his stomach open to Carvey, meaning to let him do the final abdominal closure.But in Carvey's thinking, the operation was not over at all, and there was a final procedure before closing the abdomen: cleaning the abdominal cavity.

The failure of surgery in the 19th century was largely due to the lack of disinfection of wounds, coupled with the lack of masks and gloves, which completely exposed surgical incisions to bacteria.

In this surgical environment where the protection is close to 0, and such an exaggerated 17cm large incision, there is still a risk of infection even under the blessing of modern antibiotics and strict disinfection, so the postoperative wound and abdominal cavity cleaning work becomes especially important.

Cleaning the abdominal cavity is a routine operation in abdominal surgery.

The pus is hidden in the abdominal cavity, which can infect the appendix incision at any time and cause peritoneal irritation. If the abdominal cavity is not cleaned, the operation is the same as not performed.

Even aside from these, the bleeding and exudate from the incision are petri dishes for bacteria, ready to form new foci of infection at any time.

Cleaning is nothing more than pouring a large amount of normal saline and pumping back and forth a few times.

But for the 19th century, washing the stomach was a very strange practice, and there was no real sterile saline solution here.

There is no normal saline, so Carvey can only prepare it by himself. Fortunately, the people who enter and leave the theater are the upper-class celebrities, and the water flowing out of the water pipes is the snowmelt water from the sacred Alps, which is at least cleaner than pus.

Taking advantage of Ignatz's opportunity to accept the applause while he was doing the finishing work himself, Carvey found Herman: "Herman, go, get a basin of clean water."【4】

Herman was a little surprised, but it was just a surprise.Working as a handyman behind Ignatz all the year round, his body moved faster than his brain.When he realized that Kawei's request was unusual, he had already turned around and walked to the preparation room.

All the people who entered and left the theater were the nobles and celebrities in the society, and the water pipes flowing in the water pipes were all snowmelt water from the Alps.If you add the salt in the audience lounge, it can be converted into a substitute that is comparable to normal saline.

Of course, in theory, warmed saline is better, but the conditions are limited, so it can only be used for survival. 【5】

At this time, Ignatz was wiping his bloody hands and enjoying the applause of the audience. .

After answering several medical-related questions, Greg, the new reporter who replaced Varela, squeezed in front of the crowd and grabbed the right to ask questions:
"Dr. Ignatz, congratulations on another successful abdominal operation. I'm a surgical columnist for a daily newspaper and I want to interview you with a few questions."

"Greg?" Ignatz was a little surprised to hear the strange name, "Where's Varela?"

"I'm not feeling well, so I'm resting at home."

"Oh, just ask if you want to."

"Is there not much research on appendicitis in the European surgical community?" Greg asked a very strange question. "I have checked a lot of literature, and there are very few case reports in this area."

"That means you are looking in the wrong direction." Ignatz explained, "The surgeons in England, France and Germany mostly classified appendicitis into the category of 'pericecal inflammation'."【6】

"This"

"Do you think there will be more cases all of a sudden?"

"Indeed, this is a very common medical term that can be seen often."

Ignatz sighed and said with a smile: "You can ask these medical students and doctors around you. In today's surgical field, most people support peri-appecal inflammation. This term is written in It has been included in the textbook, and it is passed on to the ears of countless medical students every year.

But in fact, its authenticity remains to be verified. After all, the phenomenon of "pericecal inflammation" found in the autopsy is often only the edema around the cecum, and the really serious lesion area is the appendix.And I have always been an 'appendicitis' faction, an absolute minority. "

Greg nodded again and again: "I didn't expect there to be such anecdotes, but today's operation can somewhat restore some disadvantages for Dr. Ignatz."

"It's hard to say." Ignatz didn't think so deeply.

Greg is still young and does not have the profound accumulation of surgical knowledge as Varela, so he can only start with interpersonal relationships.And his approach is far softer than that of his colleagues at The Times and the Free Press:
"Dr. Carvey completed the cesarean section last night. Objectively speaking, it was as wonderful as today's operation. It is rare for the two of you to be on the same stage. As his teacher, can you comment on Dr. Carvey's surgery for us?" ability."

Ignatz knew that this kind of question would be raised sooner or later, so he had already thought of a solution from the beginning:
"Kavi is the most talented child among the many children I have seen. He has learned a lot of surgical experience from his father, and his surgical skills are beyond doubt. In terms of obstetrics, he already has overwhelming strength. .”

In just three sentences, Carvey was promoted to a high position, which aroused many people's discussions.

"Overwhelming strength?" Greg said, "There are also sporadic examples of successful cesarean sections around the world. A single success should not be enough to prove this sentence."

"Don't worry, all the women who need cesarean sections in Graze Hospital, St. Mary's Hospital, and Hartman Hospital have been sent here, and you will see many cesarean sections in the future." Wei is quite confident, "As for whether it has overwhelming strength, it only needs to look at the success rate of the final operation."

"I see."

At this time, most of the eyes in the surgery theater were focused on Ignatz, and some audience members who didn't need to ask questions chose to leave early.The surgery was over, the fun was over, and there was no point in staying in this place any longer.

Although everyone in the discussion group was talking about Carvey, only a very few people really focused on Carvey.

Varela, who has been watching surgery in the preparation area, is one of them.

"What are you doing?"

"Wash your stomach." Carvey lifted a small basin and poured the light salt water into the priest's open stomach. "It can wash away the residual blood, tissue fluid and pus, and it can also help the incision heal quickly."【7 】

It sounds reasonable, but no one ever asks, "Who said that?"

"Who?" Carvey thought for a while, pointed to himself and said, "I, I said it."

"Is there any basis?"

"Yes, I have."

Carvey made up a random basis and said: "The lithotripsy operation was just done yesterday afternoon. The patient's name is Fernan, and he is a butcher who sells pork. He said that when cutting meat from a whole pig, he wanted to ensure that The pork is fresh enough, so you have to wash the rest, otherwise it will stink within two days."

"Is there such a thing?"

Carvey shook his head in his heart, but said, "Yes."

"But what he's holding is a dead pig, but the priest is a living man."

"It doesn't matter, it's all internal organs are meat, and the wounds are all going to stink." Carvey instilled a set of fallacies into the senior reporter without blushing, "and the priest has been through for so long. Surgery, the body is very dehydrated, and I do this as a compensation measure."

Varela became more confused the more he listened: "What measures did you just say?"

"Oh, don't worry, I know it." Carvey didn't bother to explain to him, put down the basin gently, then took the suction needle [8] handed by Herman, and stuffed the suction port into the clear water, "Only in this way Multiple cleanings are required to ensure that the abdominal cavity is clean enough."

Herman beside the operating bed squatted down slightly, still playing the role of a hard worker.When Kavi gave the command, he quickly turned the hand-operated suction device to suck out all the clear water in his stomach.

"It worked well, let's do it again."

"it is good."

Varela is still skeptical about this weird scene.Just as he was thinking about whether to communicate with Ignatz on the sidelines, a shrill scream suddenly sounded from the preparation area behind him.

The cry came from a surgical nurse, a veteran of the surgical theater.If it is placed in modern times, this level of work experience can at least be a itinerant nurse.

But she was so frightened by everything in front of her that she backed away again and again, and she couldn't say anything other than shouting.

"what happened?"

Varela, who was closest to her, walked over first, and saw the nurse covering her mouth, sobbing and pointing to the preparation area, her face was full of horror but she couldn't say anything.

Varela didn't know what happened, so he could only move forward slowly.

There are many surgical instruments on the table in the preparation area. In addition to Ignatz's usual medical toolbox, Carvey also brought his own set of things.The most conspicuous among them was the iron plate in the middle of the preparation area, which contained the super-long appendix just taken out of the priest's body.

Apart from these things, it's just some disinfection supplies and dressing supplies, nothing special.

"It seems to be fine"

Varela looked at the appendix in the iron plate again, and was about to say "nothing", when suddenly something in his vision squirmed: "Wait!"

"what happened?"

Everyone in the theater looked at Varela: "The priest's appendix moved just now."

(End of this chapter)