Nineteenth Century Medical Guide

Chapter 91. This is the business
Originally, Kavey was supposed to stand on the podium together as an assistant, but after the commotion just now, the mood of the audience was unstable, so Kavey stopped joining in the fun.

Anyway, I need to go on stage twice in the afternoon, and there are plenty of opportunities to play.

Compared with the previous reports, Ignatz's new surgical method has returned to the high standard that the Royal College of Surgeons should have, and set the tone for the next meeting.

However, the "new trend" itself is some brand-new surgical attempts, suggestions, and an exploration of surgical possibilities, and it is not universal.The triangular flap method for cleft lip repair given by Carvey is wonderful enough. Judging from the process of dictation and the photo of the corpse repair given at the end, the effect of this new surgical method must be good.

But it is still an old problem, and there is a lack of examples that can be used to verify the effect of surgery.

"I have already contacted two cleft lip patients who are willing to try the new operation. If there is no accident, the two operations will be carried out next week."

Ignatz said: "At the same time, I will also start an attempt to repair the cleft lip in children. Repairing the cleft lip before the child grows up should be able to reduce the deformity and language barrier in the future."

Although there are no examples of surgery, the new triangular valve surgery method is attractive enough to draw the attention of the field from postoperative wound ulceration back to the surgery itself.

Next came Deputy Dean Edinson, who brought his own surgical instruments: "Everyone should have done the excision of suppurative tonsillitis. It uses a circular knife to cover the tonsils, and then uses a silver fork to pierce the tonsils." Among them, it is fixed, and finally it is cut.【1】

Of course, in small clinics in the countryside, we can still see the lancet used decades ago. No matter how the cutting tool is iteratively updated, the fixing method is the same, that is, a silver fork.Because using other tweezers or pliers will cause different degrees of slippage.”【2】

During this incision, the patient cannot lie on their back because congested tonsils tend to bleed profusely when surgically removed.Lying down will allow blood to choke into the trachea, causing surgical accidents.

So Addinson developed a tonsil-grasping tool of his own. 【3】

The effect of the tool is definitely good, but this is not uncommon in the new trend of surgery, and it will basically be regarded as a warm-up item and placed in the front position.

Being able to rank behind Ignatz now shows that Edinson has other things:

"Gentlemen, I have found in thousands of tonsillectomies that partially removed tonsils will continue to grow and the original infection symptoms will not subside. This makes me have to consider whether I should do a complete tonsillectomy, that is, including other tonsillectomy. The capsule is removed together."

Speaking of which, he brought up a simple hand-drawn diagram showing how to perform this new tonsillectomy.

"The 'guillotine' developed by the French from the eighteenth century is still available, but requires some little skill in operation."【4】

Edinson made a simple gesture: "After the tonsils are covered by the knife ring, we will not remove them first, but squeeze the palatoglossal arch with our fingers, and then remove the tonsils after the tonsils are completely exposed."【5】

"What's the success rate of the operation?" Someone from the audience suddenly asked.

"Among the 30 operations I tried, 12 were completely resected, and the success rate was 36-37%." Edinson knew that the success rate was not high, and argued, "Surgery requires some experience and skills, and I feel I'm getting the hang of it, and 10 of the last 5 surgeries have resulted in a complete resection."

"Will it not recur after complete resection?"

"Of course."

"I have also encountered the situation of tonsil re-growth, this method is necessary to try"

After the two vice presidents played in turn, they finally got Xinfengxiang back on track.

If it is said that from the repair of cleft lip and palate to tonsillectomy, Carvey has seen the efforts of these Vienna surgeons in fine plastic surgery, then the next case of resection of huge paracervical fibroid + postoperative repair has already had the embryonic form of modern plastic surgery .

The tumor has almost the same volume as the patient's face. In order to ensure postoperative recovery, the doctor specially reserved a piece of skin as the face.The tumor is removed first, and then the flap is left for skin suturing.

After going through a full three-hour long operation, she finally returned to the appearance of an ordinary person. 【3】

"This should be the largest face and neck tumor resection + plastic surgery in history, right?"

"Indeed, this fibroid weighs 4.5kg, which should set a new record."

"How was the recovery after surgery?"

"The fibroids did not affect the bones and muscles, and there was no problem with the occlusion. However, due to long-term compression, the patient's face still had some deviation. I didn't think of this when making the flap during the operation, so I still have some regrets. "

Immediately after neck plastic surgery, I came to the ophthalmology department.

Dr. Leido, who specializes in ophthalmology at Hartmann Hospital, brought his eyeball fixation technology to everyone. He used a metal fork to gently penetrate into the patient's conjunctiva and sclera, so that the eyeball no longer moves randomly during strabismus correction. . 【7】

The subsequent cataract extraction was an operation from Germany.

The earliest cataract extraction was extracapsular, without anesthesia, and the doctor and patient sat face to face.The doctor will cut the lower edge of the patient's cornea and expand it to 120 degrees, then cut the anterior capsule, and press the lower edge of the cornea with fingers to deliver the nucleus. 【8】

The cortex is scraped off, the cornea is reattached, and the eyes are closed, sutures are non-existent. 【9】

What Dr. Leido showed to everyone this time was a small transscleral incision lens extraction performed by a German doctor. 【10】

When anesthesia gradually reduces the hand speed of all surgeons, the refinement of operation has gradually become something for them to compare their respective skills.Small incisions and low bleeding have begun to become indicators of the success of surgery, so small incision surgery has aroused everyone's interest as soon as it is mentioned.

Because there is no phacoemulsification technology, the crystal nucleus is not a chyle-like liquid, and an incision matching its size is needed to remove it. Therefore, the incision size of ordinary cataract extraction is 6-8mm.

A small incision that is less than half of the classic surgery?
How should the hard crystal nucleus come out?

Is it magic?
"The German doctor's incision is only 3mm." Dr. Leido took out his hand-drawn manuscript and explained, "He first cut the crystal nucleus in the eye and cut it into four parts. Pull it out."

As soon as this remark came out, many people immediately admired it. They did not expect to give birth after the division.

But soon, some different voices of doubt appeared, which is the norm in the new trend: "Will intraocular cutting cause unnecessary burden on the eyes? For example, corneal edema? Capsular rupture?"

"It's not just the damage during the operation, I'm also skeptical about the vision recovery after the operation."

"Indeed, surgery should not pursue the beauty of the scene, but more importantly, whether the postoperative recovery can meet expectations. The small incision seems to be very exciting, and it probably won the applause of many audiences, but in the end it depends on whether the patient is satisfied."

Leido did not evade these questions, and answered them one by one: "Among the 20 small-incision cataract operations performed by this German doctor, 17 of them did have corneal edema, and 3 of them recovered on their own within 3 days, and the rest recovered. It took a little longer, around 5-7 days."

"The chance of edema is a bit high, what about the rupture of the capsule?"

"There are 3."

"How is the recovery of vision?"

"Five patients failed to recover, and the rest improved slightly." [5]

"There are actually five? The proportion is a bit high."

"And it's only a slight improvement, it should be the same as a normal extirpation."

Leido was a little embarrassed when he was said: ". After all, it is a small incision. It is a brand new attempt. These shortcomings still need to be overcome slowly."

"Small incisions and large incisions are the same postoperative treatment methods, and have no essential impact on the recovery of vision. I personally don't like to take such risks."

"Me too, such a high probability of corneal edema must be caused by too many cutting operations during the operation. It's better to use the classic operation mode safely to avoid unnecessary troubles."

Carvey benefited a lot from listening to these discussions, including subsequent syphilitic nose reshaping and dental disease-based upper and lower jaw resection + postoperative plastic surgery, which made him marvel at the strong plastic atmosphere of the School of Surgery.

The regular meeting in the morning wasted a lot of time because of the unharmonious "Nightingale".By the time the new wind direction ended, it was past 12 o'clock.

Kavey thought that he would have to sit on the bench for another two or three hours, and was going to take the dinner plate in the lounge to enjoy the delicious food in the college.Who would have thought that Ignatz took him to the dean's room during his lunch break. 【12】

Ignatz's father, Dean Waterman, was waiting for them in the room.

The old man sat quietly at his desk smoking a pipe, wearing glasses, with white hair back, and an old surgical report in his hand.

Seeing them coming, Watman was not polite but asked directly like an old friend: "How is the regular meeting in the morning?"

"There's a little trouble." Ignatz took Carvey to the sofa, "You actually moved the British set into New Wind, isn't it just to make them fuss?"

"What does it matter?" Watman was still looking at the operation report in his hand, as if everything was under his control, "Anyway, you and Edinson will have two brand new operations after that, and those people will definitely calm down of."

"It's just Corrigo's suffering."

"Hehe, his cleft palate repair is nothing more than that. He was the last one to squeeze in to make up for it." Waterman said with a smile, "According to Corrigo's irritable and conceited character, he must have left halfway, right?"

"Um"

"It ends at 12 o'clock, a little later than the scheduled time." Watman took off his glasses and asked, "What do you think of Dr. Lister's point of view?"

"Surprisingly, I have never linked wound ulceration with microorganisms." Ignatz shook his head, "The idea is very novel, but I haven't seen the experiment report of the French chemist, and I think it's better to wait for a new experiment Good conclusion."

"If you haven't seen it, take it and have a look."

Watman handed the report just now to Ignatz, and then looked at Carvey beside him: "You can take a look together, after reading it."

"I've seen it, don't read it."

"Seen?"

The father and son looked at him together: "Are you still concerned about the chemist's experiment report?"

"I was a little bored at the time, so I flipped through it casually."

Carvey knew that he would ask himself sooner or later, so he took this opportunity to try the dean of the surgical academy's attitude towards infection: "I think the views of Mr. Lister and Mr. Pasteur have some truth, and my father insisted on preoperative infection. There are similarities in the preparation work.

Inspired by Mr. Pasteur, I realized that microorganisms may be everywhere, and only our skin can prevent them from invading the body.This also proves from the side why the wound will fester when the skin is opened.At the same time, it also proves why puerperal fever occurs after childbirth, because childbirth temporarily opens up the channel between the body and the outside world. "

"What does that have to do with the hand washing you have been insisting on before?"

Watman was a little surprised when he saw Carvey, and explained: "Don't be surprised, my son often shares with me some things about the hospital, and sometimes I also go to the theater to watch surgery."

"I think this is related to the concentration of microorganisms. The concentration of microorganisms in the air is thin, and the concentration on the hands is much higher." Carvey has evidence in his hand, "Semmelweis, an obstetrician at the Municipal General Hospital, once It has been proposed to wash hands, which can effectively reduce the chances of puerperal fever and surgical wound ulceration.”

"I have read the reports of those operations, and I am very clear about the current situation of the patients in your hand." Watman said, "Don't worry about my attitude, because I believe that the preoperative preparations you mentioned really played a decisive role. effect."

"thanks."

"Don't be in a hurry to thank me, and thanking me is useless."

Watman picked up the pipe again and stuffed it into his mouth: "It's not me you have to convince, but those old stubborn people. You also saw in the regular meeting just now, how difficult it is for them to change the status quo. Washing hands and cleaning wounds means It is a blasphemy against their sacred profession to admit that they are unclean and that the incisions they perform are unclean.”

Carvey nodded: "Indeed, Dr. Semmelweis was driven away under such circumstances."

Watman is not interested in Semmelweis, he only cares about the surgery he is in charge of: "I especially want to know now, in the meeting in the afternoon, you will use some of your surgical experience to refer to Dr. Lister's Opinion?"

Carvey felt that there was something wrong with the programming of the conference content at the beginning, but now it seems that everything has a purpose.The old man is not only thinking about expanding abdominal surgery, but also seeing the poor chance of postoperative infection. After all, the average surgical mortality rate of 40%+ is really outrageous.

The doctor can be said to be caused by the environment, but he, the dignified dean of the college, can't.

Watman wants to directly solve the two major troubles in the development of surgery. His ambition is not small, and of course the resistance will not be small, so he hopes to throw Kawei, who has no interest disputes, out to explore the way.

Carvey was somewhat prepared, but he was still unspeakably awkward before going on the field. This old fox was much more difficult to deal with than his son.He couldn't help but glanced at Ignatz who was sitting beside him, and said half-jokingly, "I thought it was just a report on two surgeries."

"After the report is over, you can continue to talk about some new ideas." Waterman smiled nonchalantly, and said, "I would like to put your preoperative theory into the new wind direction in the morning, but if it is next to Liszt If you publish the doctor's opinion together, I'm afraid those people will run away on the spot, and your surgery report in the afternoon will be yellow."【13】

The three of them looked at each other and were silent for a long time. In the end, it was Kawei who spoke his mind first.

In fact, after learning about Semmelweis, his thinking has always been simple, just wait.

"My father often warned me that actual actions and objective facts are the best evidence, and there is no need to persuade others, because verbal persuasion is meaningless. So I firmly believe that as long as the postoperative mortality rate of my patients is much lower than other Surgeons, over time they will follow my example."

“How come you see?”

"Because this is a business, no patient will take his own life as a joke. Without patients, there will be no income from theater tickets, and they will not make it difficult for the so-called 'sacredness', 'cleanliness' and money."

　This chapter is too difficult
　　
　
(End of this chapter)