Nineteenth Century Medical Guide

Chapter 94 91. Please forgive me

Vienna's hospitals are generally divided into two categories.

The first category is the church hospital. At first, it was a simple church with some reconstructions, and it was mainly based on medical treatment and missionary work, and then it gradually developed under the impact of modern medicine.The most typical example is St. Mary's Hospital. The center of the entire hospital is neither the inpatient department nor the administrative department, but the Catholic Church. 【1】

When patients enter the hospital, they will go to the outpatient clinic, or they can be hospitalized if they are seriously ill, and then they will go to church to pray with the doctors who cannot cure them.

The Municipal General Hospital is also considered a church hospital, and it also has a church, but its location is remote and the area is small, which can be regarded as a spiritual comfort for patients.In terms of operation, it has been mixed with a lot of secular things, and the benefactor of the hospital is no longer limited to the church, and will raise a large number of donations and investments from nobles and capitalists through charitable organizations.

The purpose of the money cannot be pure missionary work, but something else, such as fame or more voice in the hospital.

If you look at the whole of Europe, the image of the Municipal General Hospital is actually more in line with the charitable voluntary hospital.Because the hospital itself does not earn fees, patients can receive free medical outpatient services and low hospitalization fees as long as they meet the poverty relief standards, so the number of disease sources is very large.

In fact, the number of disease sources in the Municipal General Hospital has become so large that it has to attract the attention of the ZF, and even its medical service results have directly affected the labor risk control ability in the west of Vienna.

Therefore, in recent years, the government's investment in hospitals has gradually increased, which also reflects the reason why the Municipal General Hospital can have such a scale and strength.

The second category is secular hospitals.

Many of their predecessors were church hospitals, but due to some reasons, they broke away from the control of the church and became self-sufficient medical institutions. Hartman and Graze are typical examples.Secular hospitals are completely open to capital, but medical expenses are high, and they basically reject the bottom poor.

For them, money is not an issue, talent is.

Unlike internal medicine, surgery is not enough to have medical theory, but also to have practical skills.Without enough disease sources, it is impossible to train first-class surgeons, and secular hospitals basically follow the upper-level route, so it is difficult to train strong surgeons on their own.

Poaching corners has become their main method.

In the eyes of Carvey and Ignatz, Hills' operation foundation is not solid enough, and his temperament is not stable enough. He is enough as an assistant, but he is still a bit weak as the chief surgeon of major surgery.

But in the eyes of Graze Hospital, Hills' resume is quite gorgeous.This time, in order to tie him down, the hospital also spent a lot of money, not only giving him the position of chief surgeon, but also giving him the opportunity to speak on stage and show his face.

Personnel changes are a common occurrence, and decisions that seem rebellious to others are actually a remedial measure after he can see himself and the situation clearly.

Carvey has seen many like him.

Think about it differently, if you were yourself, you might choose to leave in such an environment.

After all, one Ignac is a teacher who can support him, and the second Ignac will become a stumbling block blocking the ascending channel.Besides, the second "Ignatz" who appeared inexplicably was still a 17-year-old child, and anyone who changed it could not help but think more about their own future.

Young, with a high starting point, and quick upgrades, no matter what you do, you can hold yourself down.

After grabbing the first aid, it was time to grab the chief surgeon. In fact, Ignatz disappeared that day, and Carvey did snatch the position of the chief surgeon for the cesarean section.

After repeated tossing, Hills recognized the fact that he could only rank third, and also saw his future in the Municipal General Hospital.He didn't want to stay behind, and he didn't exceed Kawei's self-confidence, so there was only one last option left: leave.

In fact, Hills didn't expect that Carvey would come. Originally, he wanted to explain the reason for leaving with the teacher this time, and hoped to be forgiven.

But after seeing Carvey, he lost his motivation in an instant, and everything should be put in the operation report.

Hills was reporting on a complex eyelid surgery.

He didn't do the operation, it was Dr. Corrigo who wanted to talk about cleft palate surgery in the morning.Although people are a bit conceited, and the new suturing method of the cleft palate surgery is not much bright, but this eyelid surgery is a boutique that even Watman would nod repeatedly.

Ptosis of the upper eyelid combined with severe eversion of the lower eyelid. 【2】

In fact, since Ignatz's lithotripsy, the difficulty of reporting surgery has risen to a higher level, from a simple disease to a complex surgery with multiple diseases.

"The patient is a businessman, and he has had problems with the upper eyelid of his right eye since he was a child." Hills began to introduce the basic situation of the patient, "Not long after he was born, his right eyelid had drooping symptoms. It is because of the habitual squint after the vision is covered.

The drooping upper eyelid did not seriously affect his life, so he never sought medical attention.

Until the middle of last year, a lump appeared around the lower eyelid margin on the same side.The existence of the mass breaks the balance of the upper and lower eyelids, which not only makes the lower eyelids evert, but also makes the upper eyelids sag more seriously due to the traction effect. "

The upper eyelid is sagging, and the lower eyelid can actually be regarded as sagging, but the former can be ignored, and the latter will be much more troublesome.

"The tumor grew very fast and caused symptoms that were much more serious than those of the upper eyelid," explains Hills. "The patient had symptoms of chronic conjunctivitis, increased discharge, and this year also had abnormal thickening and hyperemia of the conjunctiva. Because the lacrimal puncta could not be close to the eyeball, the patient still had overflowing tears and dry eyes, which was extremely painful.”【3】

Originally, vision was already affected by the drooping of the upper eyelid, and now something happened to the lower eyelid. The patient couldn't bear it and went to the Municipal General Hospital.

"Coincidentally, I was the one who received the patient at the time." Hills said with a smile, "But considering the surgery at the Municipal General Hospital, as long as the patient does not have a knighthood, he needs to enter the theater for public display, so he flatly refused the surgery.

A week later, he was referred to Graze Hospital.

Dr. Corrigo gave him a detailed examination, and then drew up a plan that suits him: peeling and resection of eyelid tumor + lifting of upper eyelid + shortening of lower eyelid. "

For a 19th-century plastic surgeon, the operation was complex enough that Corrigo would have done well enough.

Carvey is not a plastic surgeon, but he often sees patients with everted eyelids in emergency surgery.They are often scar contractures caused by burns or chemical injuries. The general operation method is to perform skin grafting after the burns are controlled to stretch the contracted part of the skin.

It was the first time he saw upper eyelid ptosis combined with lower eyelid eversion, and he was also very concerned about the surgical treatment method.

It's a pity that Colrigo's operation was limited by the thinking of the 19th century, and all he could do was simple addition and subtraction.Lifting is done for sagging, and shortening is done for eversion.From a layman's point of view, it is already very good, but there is still a considerable gap with the method that Carvey can think of after decades of modern surgery.

"The first thing Professor Corrigo did was to remove the lesion."

Hills took out the drawing during the operation: "The tumor of the lower eyelid affects the patient the most. After incision of the eyelid skin, the soft tissue was separated. The professor quickly stripped, ligated the blood vessels, and then took out the tumor. After pathological analysis, it was found that It is a fibroma."【4】

It is not difficult to remove the tumor in the eyelid, and it is more delicate than the operation of subcutaneous tumor removal. What is difficult is the treatment after the cut.

Without the traction of the tumor, the lower eyelid seemed to temporarily return to normal, but that was just an appearance, just like when Ignatz had his cleft lip repair.

Corrigo, who has extensive experience in cosmetic eye surgery, is well aware that prolonged lower eyelid swelling has caused the patient's lower eyelid to loosen.After the incision has healed, the scar will continue to pull downward.Relaxation + pulling, the patient's lower eyelid eversion will definitely "relapse".

"In order to prevent eyelid relaxation, the professor performed eyelid shortening on the patient after tumor resection."【5】

Hills knew that this was the key point, and a guy who likes to criticize would definitely not let go of this flaw, so he took the lead in pointing out: "There are two wounds on the lower eyelid, so the postoperative edema is more serious. But the sutures during the operation are not There was a mistake, and on the fifth day after the operation, the edema began to slowly subside, and the wound recovered very well."

In comparison, upper eyelid lifts are simpler.

It is said to be lifted, but it is actually to remove a small piece of skin and then suture it. 【6】

This is a method of ignoring the cause and directly solving the symptoms fundamentally, that is, treating the symptoms but not the root cause.But even in modern times, only similar corrective surgery can be done for congenital ptosis of the upper eyelid.

Of course, "standard" and "ben" are not two completely binary opposites.

Congenital ptosis is better understood in modern times than it was in the 19th century.It is generally believed that congenital ptosis of the upper eyelid is due to abnormal development of the levator muscle, resulting in muscle fibrosis and fatty infiltration. 【7】

Modern medicine is still unable to cure the root cause in the true sense, but it can continue to approach the "root cause" on the basis of treating the symptoms.

Professor Corrigo's simple skin incision and suture did not affect the abnormally developed levator muscle, and there is a possibility of recurrence or upper eyelid eversion after surgery.This is not the case with the modern shortening of the levator muscle. With the help of electrocoagulation and new silk threads, it can be cured radically.

Only one eye was cut three times. The operation itself is not difficult, but it is not easy to achieve the expected effect.

"The patient's wound did not grow well after the operation, and the expected effect was not achieved."

Hills admits this, but in his and his colleagues' view, it is inevitable.It would be mean to deny the merits of an operation for this reason alone: ​​"This complex eye surgery is also considered to be the first of its kind in Austrian plastic surgery."

After finishing speaking, he packed up the content of the report in his hand and glanced at the host: "My report is over."

"Well, it is indeed an excellent eye surgery. In my impression, it seems that no one has dealt with two deformities on the same stage. I must boast: bold and careful." The host also affirmed the advantages of the surgery , "Next is the Q&A session."

Since Ignatz's lithotripsy, the number of questions has increased significantly, and Hills' operation has also received many good questions.

Some asked about the suture method, some asked about the angle and length of lower eyelid shortening, some asked about the length of the incision, and some asked about the specific incision area of ​​the upper eyelid skin.Hills answered as much as possible, but some of the questions were too detailed, and Corrigo didn't write down the data, so he had to give up.

"I've said everything I can say."

Hills shook the report paper in his hand, and said with a smile, "I have told you everything the professor wrote, most of which are his experience during surgery, and only represent his personal opinions."

"We understand, it's just a reference when we ask."

Hills nodded.

If he packed up his things and left the stage, his debut surgery report at the Academy of Surgery would be considered a successful conclusion.

But unfortunately, the relatively smooth process gave him the illusion that the operation was perfect enough.Coupled with the unhappiness of the past few days, Hills couldn't hold back his little self-esteem for a while, and named Kavey's name.

"Dr. Carvey has always been very active before, so don't you have anything to ask about Professor Colrigo's eye plastic surgery?"

Hills' slightly provocative tone quickly attracted the attention of many people in the audience.Everyone is in the same city, and they are all doctors in the same circle. The news of Hills' sudden job-hopping must have reached everyone's ears.

Now look at Kavey sitting next to Ignatz, the reason for leaving and changing units is ready to come out.

Carvey didn't want to embarrass him, so he didn't speak from the beginning to the end. Anyway, there are many opportunities to make troubles, so there is no need to get into a stalemate with Sears.Moreover, he is not very familiar with plastic surgery, he has many ideas, but few opportunities to actually practice it, so he dare not talk nonsense.

"Ms. Hills is awesome. I don't know much about plastic surgery, so I really don't know what to ask."

Carvey lowered his profile by the fact, wishing to fast-forward to the next scene.The next game was two failed cesarean sections, which was his home field.

But Hills didn't want to let go of this golden opportunity: "Dr. Carvey is good at hemostasis and uterine sutures. Maybe he doesn't know much about fine plastic sutures, which is normal. It's just chatting. Understood, I can also answer you for Professor Colrigo."

This is simply an internal struggle in the Municipal General Hospital.

The doctors in other hospitals took a break, and the host knew that he couldn't stop him, so he simply followed to watch the play.

At this time, no one but Ignatz could persuade Hills, but when he was about to speak, Carvey opened his mouth first: "Then I will just ask any one, if the question is not good, please ask Hills Teacher Si must forgive me."

"please say."

"My first question is the choice of incision for lower eyelid lumpectomy."

"What's wrong with the incision?"

"The tumor is round, right?"

"Correct."

"Then why did Professor Colrigo perform the transverse incision?"

"In this way, the creases around the eyes can be used to hide the surgical incision of the lower eyelid as much as possible after the operation, and it looks more beautiful."

"That's it." Carvey nodded and asked again, "Then why did you have the lower eyelid shortening?"

"Didn't you listen to the report just now? It's to prevent recurrence."

"Oh, what incision is used for the lower eyelid reduction?"

"Of course it is a longitudinal incision, which requires cutting off a part of the lower eyelid for eyelid shortening."

"In this case, why not make a longitudinal incision in the lumpectomy at the beginning, and shorten the eyelids by the way?" Carvey asked a question that no one could think of, "Reducing the number of incisions not only It reduces the postoperative edema and reduces the damage to the eyelid”【8】

(End of this chapter)