Nineteenth Century Medical Guide

Chapter 90 87. Pride and Prejudice

The regular meeting of the Royal College of Surgeons starts at 8:18 in the morning and ends at 11:30 in the evening, with a break between 1:30-8:[-] and lasts for [-] hours.The time seems to be very long, but in fact, a lot of compression has been carried out for the various meeting contents.

In the morning, it was a new trend of surgery to look at the flowers on horseback. 【1】

Although it is called "surgery", it actually covers a very wide range. It mainly introduces new operations applied to surgical operations, and is not limited to the operation itself.Technology has various drawbacks, some of which have very narrow applicability, but Carvey still has to marvel at their eclectic talent.

For example, Fermi, the first surgeon at St. Mary’s Hospital, introduced a brand new anesthesia method to everyone:

"On January 1 this year, our hospital received a patient with maxillofacial trauma. At that time, it was found that his facial injury was serious and he was not suitable for the routine preoperative anesthesia administration mode, so I tried to use an enema pump." 【16】

Ether is put into the enema pump, after slight heating or light shaking, ether gas can be injected into the rectum, and finally blocked with a wooden stopper to achieve the purpose of anesthesia.

Of course, there is also the practice of directly mixing ether liquid into the enema, but it is difficult to ensure that the operating bed is clean enough after the patient falls asleep.

"Enema anesthesia is not limited to maxillofacial injuries, and can also be applied to some patients who are afraid of masks. They don't like the feeling of their mouths and noses being covered, they will be irritable and feel suffocated, and enemas can prevent this from happening."

Fermi is very confident about this drug delivery method: "I believe it has a broad space for development, the only thing that needs to be paid attention to is the dosage issue"

Dosage is the ultimate proposition that plagues general anesthesia. The duration and depth of anesthesia need to be studied.It's a pity that ether is just a passer-by in the history of anesthesia, and will be gradually eliminated with the emergence of new anesthetic drugs, and this kind of enema, which is difficult to quantify, is only a flash in the pan.

However, after the introduction of anesthesia, Dr. Fermi did not leave the podium, but took advantage of the opportunity to start the demonstration of the second technology.

Soon his assistant took a simple set of belts, cloth pads, and pressurizers and walked onto the podium: "The same patient just now, after anesthesia with an enema, we used a brand new hemostatic kit , effectively curbed the massive hemorrhage in the maxillofacial region”【3】

Ignatz watched their operation demonstration and was very interested in this set of belts: "It's good for bleeding on the face, it's very suitable for cosmetic surgery, no wonder it was selected."

Carvey just nodded and looked at it, not cold about it.

Although it is effective to stop bleeding by pressing the epidermis, it is too limited and difficult to last for a long time, so it is generally used in trauma scenes and transfers.In the operating room, it is still necessary to quickly find the bleeding location and do precise blood vessel suturing to stop the bleeding.

Finding broken blood vessels is not easy, and often requires lengthening the incision.It is easy to put on and difficult to remove, and then these straps will become an obstacle for hemostasis.

However, in the 19th century, the trauma rescue was poor, and the transfer was basically equal to 0, and the application conditions of the belt compression hemostasis method were too harsh.In comparison, the hemostasis method of the third game is more reliable, and it has been used even in the 3st century.

"With lower extremity amputations, especially high upper thigh amputations, hemostasis during surgery is not easy."

This time it was replaced by Dr. Locard of Graze Hospital, who moved a set of abdominal anatomy models: "Just like cutting off a river, if we avoid those branches and ends, we can choose to block the upper blood flow to achieve complete recovery." The purpose of hemostasis."【4】

In fact, what he chose to cut off was the iliac artery that supplies blood to the lower extremities. 【5】

When the femoral artery is broken due to leg trauma, if there is no way to find the broken end of the blood vessel in the first place, opening the abdomen to block the iliac artery has always been the last card.For the first aid scene of massive blood loss due to lower extremity trauma, the principle of airbag pressurized anti-shock pants is also the same.

It is no small progress to think of this step, and to do it in order to ignore the abdominal infection, but it is a pity that Ignatz is brooding about Hills' departure:

"Amputation surgery itself is already quite dangerous. Incision festering is normal. I remember that their amputation mortality rate was 47% last year, which is too exaggerated! Just like this, an extra incision is required. Don't you think about festering? See Look at the German in our No. 3 ward, how rotten his legs are."

Carvey asked inappropriately at this time: "Teacher, what was our amputation death rate last year?"

"emmm 38%."

"It doesn't sound like it's much lower."

Ignatz knew that the number was still too high, and quickly explained: "Maybe it's the physical problems of those patients. When I amputated several generals, I found that the rate of ulceration after the operation was not high, about 10%. about."

"I don't think it has much to do with physical fitness." Carvey hoped to lead Ignatz to the cause of the infection instead of spinning around physical fitness. "The reason should lie in the hospital environment."

Ignatz looked at his assistant in disbelief, remembered the hospital environment he had discussed with him, and immediately became alert: "I remembered, you valued the research report of that British woman before. Her research Although the report is convincing, it is actually a lunatic at heart!"

madman?

Carvey didn't understand what he meant: "What madman?"

"Her new idea is to tear down all the city hospitals and let us move to the countryside to open small clinics! This kind of suggestion is ridiculous. I thought a surgeon should not agree to it. But"

Ignatz completely stood on the opposite side of Nightingale, and tentatively asked Carvey: "Do you also want to tear down the Municipal General Hospital?"【6】

"How is it possible?" Carvey explained, "The hospital is innocent, it is just a pile of stones and bricks. What really needs to be improved is our concept. Doctors need to wash their hands, clean the incision site before and after surgery, at least The wound recovery of the patients I participated in is pretty good."

"Where is Mr. Li Ben?"

"Li Ben was just an accident." Carvey's face was solemn, and he regretted his mistake. "At the time it was an emergency, and the carriage had to wait an hour to arrive. I think he is dying and can only be sutured."

"I think his leg can still be saved, just like the earl back then."

"I hope he can get through it. If he still doesn't get better tomorrow, I can only do debridement for him."

It has been more than half a month since I met Carvey, and Ignatz has seen everything in his eyes, and has gradually agreed with washing hands and cleaning before and after surgery.

He was not one of those stubborn obstetricians who are very sensitive to patient mortality.Even if the difference is 5%, it is considered a huge gap, but the reality is that the probability of wound ulceration in patients who have been prepared by Kawei for surgery is about 20%, and none of the patients died.

Although the sample size is not large, Ignatz has a hunch that this postoperative myth of Carvey will continue.

The pelvic common iliac artery compression hemostatic method received some applause, but with the appearance of a person, the applause gradually became more enthusiastic: "The next is Dr. Lister, a famous British surgeon and medical pioneer against Nightingale. In time, our Vice President Edinson will read his latest research report to us."

Because of some comments related to surgery, Nightingale has become the target of surgery.

She has indeed gained a lot of recognition in the UK, but she is "notorious" abroad, especially for the always conservative Austrian surgery.

Originally, Ignatz only classified her into the ranks of ordinary women, at most with minor achievements, and her basic attitude was just disdain.Now, because of the increasingly outrageous "hospital demolition theory", Ignatz has to oppose Nightingale, because no one wants to move to the countryside to be with mountains, rivers and farmland every day.

Without cadavers, without medical school teaching points, and without enough disease sources, leisure will be the slow poison of every surgeon as he strives to get ahead.

Therefore, the voices of opposition are raging. Unfortunately, in Vienna, Austria, they can only live their mouths indiscriminately. It is the British surgeons who really place high hopes on the entire surgical community.

And Liszt is one of the most famous.

"This time I bring Mr. Lister's judgment after reading the published research of a French chemist."

Eddinson looked at the two report papers in his hand, feeling very complicated. It may be more difficult to describe the next paragraph than to read the Austrian defeat report: "Mr. The chances of festering are extremely high."

"what?"

"What a joke!!!"

"Even he flinched? Doesn't that let that crazy woman succeed?"

"Oh, sure enough, the British are unreliable."

"Is he still a man? What about the ambition of a man???"

Kawi, born in modern times, has trouble understanding their way of thinking.

It's just acknowledging a fact that has been proven long ago, but the situation has developed to the point where it was once out of control.It feels like the boxer they have supported for a long time suddenly abstained on the eve of the decisive battle with their fateful opponent, which is unacceptable.

"Everyone, please be quiet! Please be quiet!!!" Deputy Dean Eddinson tried his best to maintain the order in the venue, "We still have to face this reality objectively. In fact, there is still room for improvement, and it has not gotten worse."

"Oh, come on, Edinson, the facts are already bad. I have a feeling that Vienna's hospital will be demolished soon to make room for those factories."

"Should we let these prestigious professors of surgery go to the countryside to open barbershops?"

"I don't want to go to the country"

Facing the doubts from his colleagues, Eddinson had to raise his voice: "Although Mr. List temporarily admitted Nightingale's point of view, he raised another possibility. As I said just now, he was I said this after reading a research report by a French chemist."

"Who? What's the name?"

"Um..." Edinson glanced at the name scrawled on the report paper, "It's called Louis Pasteur."

"do not know."

"Chemists? Is there any connection between chemists and surgery?"

"We are neither pharmacists nor physicians. How can chemists control our scalpels?"

These were only objections based on existing theories, and soon these voices became less harmonious: "After reading a research report by a Frenchman, an Englishman actually admitted a woman's crazy talk , you taste, fine taste!!!"

"It's over, the right to speak in surgery has fallen into the hands of these people."

"sorrow!"

"I feel like the surgery is over."

Eddinson was afraid of this situation, so he strongly opposed Watman's inclusion of this report in the program list.

Facts have proved that his judgment is not wrong. It is difficult for these men who wield scalpels every day to accept the guidance of a woman, let alone the submission of other male doctors: "Please be quiet, can you wait for me to finish speaking?"

The title of vice president still gave him a little time.

"Don't easily substitute nationality into scientific research. This will narrow our horizons. We still need some different speeches. This is beneficial to both parties. At least Mr. Pasteur also believes in Catholicism."

The sense of identity brought by religion provided Edinson with the opportunity to quickly explain the main content of the paper: "Dr. For the first time, it was proposed that 'the essence of fermentation is actually the metabolic activity of microorganisms'."

"microorganism?"

"What microorganism?"

"It's the smallest creature in nature."

"He overturned the theory of spontaneous generation of microorganisms." [7]

Edinson said: "Obviously, Dr. Lister also agrees with this point of view, believing that the closed environment of the hospital caused the growth of microorganisms in the air, and finally formed a toxic miasma. Although this has brought huge controversy, it will take time. And a lot of experiments to verify, but at least give us a chance!"

It is better to keep the windows open and ventilated in the hospital at all times than to tear down the hospital directly.

This set of rhetoric somewhat stabilized some public opinion in the venue, at least let them know that Liszt has not completely compromised.He's still looking for a breakthrough, and the battle between surgeons and nurses is far from over.

But they are also human beings, and they are also influenced by the inner world, which greatly influenced the next lecture on "cleft palate repair". 【8】

The speech process was almost interrupted, and it was not until the surgeon from Graze Hospital left angrily that the hall became quiet.

"Who's going to call Dr. Heydrich back?"

"Forget it, it's just a cleft palate repair."

"Time waits for no one, let's end the report quickly."

"Who's next?"

Eddinson glanced at the program list and said: "Next, I will invite Professor Ignatz from the Municipal General Hospital, who is also the vice president of the School of Surgery. What he brought us was made by himself and his assistant, Carvey. We developed a new cleft lip surgery together, and it is said that this new surgery can further reduce the scar contracture after surgery.”

　The content of these two chapters is a bit difficult, 88 should be in the middle of the night, or tomorrow morning

　　
　
(End of this chapter)