Nineteenth Century Medical Guide

Chapter 96.
The time goes back to the week before Carvey entered the Municipal General Hospital.

Ignatz’s cesarean section is actually very similar to the one performed by Carvey. It is also an afternoon operation, and it is also a temporary additional operation. The ticket purchase situation is also very popular. Sold out.

Ignatz is the chief surgeon, and Hills and Herman are assistants. There are not many operations that allow the three of them to perform on the same stage, and cesarean section can indeed be counted as one.

"The operation was very difficult, really difficult. In order to seize the time, the speed of the knife was too fast. I didn't know what would be cut after the blade entered the uterus, and it was difficult to control the maternal bleeding."

Ignatz seems to have returned to the familiar theater of surgery, with trusted assistants beside him, curious audiences waiting for victory in the distance, and the uterus and children who are racing against time.

He sighed, not escaping defeat:

"I can still remember the appearance of the surgical incision at that time, the eyes were blood red, the hands were warm and sticky, and the bloody smell left on the tip of the nose was instantly ignited when I heard the phrase 'the pulse of the parturient has disappeared'. Everyone I should have felt that feeling, even if I tried my best, I still can only watch the fresh life slowly disappear in my hands."

"There's nothing you can do about it, Professor Ignatz."

"We have to learn to live with the pain."

"Stop blaming yourself too much"

The audience are all Ignatz's colleagues and competitors, as well as doctors, who have experienced it.They were deeply affected by this passage, and soon there were many voices of helplessness and approval.

"Okay, okay, at least it's a surgery seminar, not Professor Brentano's small emotional class [1]. Besides, surgery shouldn't involve too much personal emotion." Ignatz hurriedly played it up. The heavy atmosphere stepped on the brakes, "This is the end of the feeling, let's focus on the operation itself."

The parturient was an 18-year-old girl. Two weeks before the operation, a small amount of irregular bleeding began to occur. The amount was not large, but the bleeding persisted, so she was quickly diagnosed as placenta previa and admitted to the hospital.

At 12 o'clock on the day of the operation, the bleeding volume of the parturient suddenly began to increase. Ignatz was in the ward, quickly finalized the operation, and brought Hills and Herman, who had been training with him for a long time, into the theater together.

The exact time of the operation was 2:11 in the afternoon, and the anesthesia ended at 16, and at the same time Ignatz's scalpel cut open the mother's stomach.

However, every minute and every second that followed was a blow to Ignatz's confidence in the cesarean section.

"The maternal bleeding was too violent, and the visible range was full of dark red blood gushing out, and the visibility was 0. At that time, the suction rate of the aspirator was very low, and I couldn't find the bleeding point, and I couldn't do sutures. Sears I have been helping to expose the vision, and I am also trying to use suture needles for blind puncture, but several positions are not ideal, and the bleeding cannot be stopped.”

The more Ignatz spoke, the softer his voice, it was not easy to get rid of his personal feelings immediately.After he took a deep breath and made some adjustments, he said:
"The speed of fetal extraction is not slow. Although it can't be compared with those rare successful cesarean sections, please believe me, our speed is not slow at all. It is a pity that when the fetus was removed, the uterine bleeding became more serious. , I was not even given the chance to choose to have my hysterectomy.”

Although judging from the content, the tire removal speed has met Ignatz's expectations, but in fact, there are still some flaws in the whole process.

Caesarean section requires at least one nurse and one midwife. The nurse can help pass the surgical instruments, and the midwife helps to take the fetus and is responsible for the body of the fetus.

When the operation was about to start, only the nurse arrived, and the midwife never showed up.It was only later that she found out that she accidentally sprained her foot on the way because she was in a hurry to go home to take care of the elderly at noon, which was why she missed the time.

The staff in the maternity ward was really nervous, and the amount of bleeding of the parturient was not allowed to wait for others, so Ignatz dragged the three students to the surgery theater.

Getting a tire is a technical job.

The more secure the midwife is, the smaller the incision in the uterus and the less bleeding you will need to make.If the tire removal technique is not in place, a larger incision needs to be made. Maybe the incision is only 1-2cm longer, but the amount of bleeding is likely to double.

The midwife was not there, so Ignatz could only try to get the fetus by himself, so the incision would be longer and the speed was also slightly lacking.

During this period, the three students not only slowed down the rhythm when passing blood-sucking sponges and gauze strips, but also accidentally kicked over the glass bottle containing blood, making the scene a mess.

They were inevitably scolded afterwards, but Ignatz knew very well that even if the midwife arrived and the three students made no mistakes, the operation would hardly be successful.The amount of bleeding from the uterus was too overbearing, and he couldn't reason with himself at all. Even if the fetal retrieval speed was 30 seconds faster, it would be difficult for him to stop the bleeding from the incision.

"I think the core of the problem is hemostasis and the subsequent suturing of the uterus," Ignatz explained. "As long as these two difficulties can be solved, the difficulty of cesarean section will change fundamentally."

This is the experience he summed up after experiencing multiple cesarean section failures and repeated discussions with Carvey.

However, as another surgeon on stage at the same stage, and also as a typical representative of cesarean section failure, his views are different from Ignatz: "Dr. Ignatz's ideas are too idealistic. After [-] years, I feel more and more that surgery is not a panacea."

Ignatz, who was still on stage at this point, was held back by a chair of the moderator.

He could vaguely hear something different from this sentence, but considering the importance of the meeting, he still didn't point it out: "Of course it's not a panacea, but in the case of abnormal fetal position, placenta previa and narrow birth canal, if you can Finding another way to give birth would surely save many women's lives."

"Can it really be saved? If it can improve the survival rate at the beginning, I might still believe it, but now it doesn't seem to be the case. I hope everyone will jump out of the original frame, don't think about how to improve the operation, but think about doing it." Did it really bring the desired results.”

Ignatz always thought that Carvey was the spoiler of this regular meeting, but after hearing the statement of the doctor in front of him, he suddenly found that the other party was more like a spoiler: "Doctor Massimov, what are you saying? What's the meaning?"

"I have also performed no less than 20 cesarean sections. Except for the fluke success of three in the early years with the preservation of the uterus, the rest all failed."

Massimov is over 50 years old, and his declining surgical skills may not be as good as Ignatz, but his surgical experience is quite sophisticated, and he can be regarded as a prominent surgeon.After all, before Ignatz graduated, he had already started performing amputations at St. Mary's Hospital.

It’s just that so many years have passed, and his thinking has also undergone some changes. It is not difficult to hear his pessimistic attitude towards the future of surgery from the lines:

"Surgical operations still need to have a degree. You can't cut wherever you want, and make a hole wherever you want. Cesarean section has now broken through the limit of surgical capabilities, and it is an act against the sky."

"Is this how you look at a pregnant woman?"

Ignatz wanted to refute, but was immediately robbed by the other party: "The words you want to say have been repeated for hundreds of years, and I am tired of hearing them. Looking at the development over the years, it took A lot of manpower and material resources, even "human" power in the literal sense, but we have been unable to solve the problem of the high mortality rate of cesarean section."

"Doctor Massimov, I don't know why you're saying this all of a sudden."

Ignatz said: "Even if you really want to express your point of view, you shouldn't choose to come to the surgery seminar to output 'surgery is useless' after a perfect cesarean section has appeared in Vienna." Argument'."

"So what if it happened? Look at Britain, France, and Germany. Which one of them has no news of a successful cesarean section? Then? Has the success rate of the operation really increased? It's not all random events, it's all about it." Life!"

Massimov still bad-mouthed the entire industry: "When the success rate of a surgery has not changed at all after a hundred years of development, don't you think it's strange? Don't you have a little awe? We are all too stubborn They think they are the God of the sick, but only God can be the God of the sick.”

Ignatz was powerless to complain about this: "As expected of a doctor at St. Mary's Hospital, (such a guy with a dual major in theology and medicine, even his speech has a smell of praying before meals)."

Massimov glanced at Kavey who was sitting under the stage, and then at Ignatz: "It is indeed a pleasure for your student to have a successful cesarean section, but I still have to pour cold water on you. The baron should Don't think it was just a fluke, that this young man who didn't go to medical school can become the founder of cesarean section."

The founder of surgery must have created, or at least standardized, an entirely new procedure for a related disease.

If Carvey's cesarean section can be promoted and the mortality rate after cesarean section can be greatly reduced, it is not an exaggeration to call him the founder.

But in Massimov's eyes, cesarean section has entered a dead end, and the success can only be the result of the patient accidentally touching God, and has little to do with the surgeon.

Science and religion have been arguing for hundreds of years. Ignatz knew that he could not convince him at all, and he certainly could not convince himself, so he was too lazy to argue and just wanted to speak with facts: "By the way, why did your cesarean section fail? of?"

The original questioning session turned into a dialogue between two heavyweight chief surgeons: "It's the same as yours, what's wrong?"

"I'll just ask casually." After all, Ignatz is much younger, and there is a gap between the two of them. Even with the title of baron on his back, he can't speak harshly at will. "If religious factors are removed, Dr. Massimov should Can you agree with me?"

"What do you say?"

"The two keys to cesarean section are hemostasis and uterine suturing."

Massimov considered for a long time, then nodded: "I admit that this is a difficult point, but I don't think it can be solved by hand."

"This statement is too absolute. As long as you change your mind, there will be room for improvement in all surgeries. The eye surgeries performed by Professor Corrigo just now are a good example."

Ignatz dragged Hills out and flogged the corpse once, but Massimov didn't like it, so he flogged the corpse again while refuting: "Don't confuse the concept, it's just an improvement, and You can’t die without losing an eye, and it’s not comparable to cesarean section in terms of difficulty, and it’s far from the upper limit of surgery.”

"But at least it shows Kavey's ability." Ignatz pointed to Kavey in the audience, and said, "It's not accidental that his cesarean section was successful. I read the operation report, and it clearly stated how Solve the two major problems of hemostasis and suturing."

"How to deal with it?"

"The uterus can be sutured in multiple layers with silver thread. The muscular layer and the serosa layer have their own suturing methods, and the most important hemostasis requires the use of a drug." Ignatz gave a brief introduction.

"Medicine? The dignified surgeon doesn't solve the problem by himself, but instead turns to the internal medicine department to find a solution?"

Massimov sputtered, and suddenly realized that maybe he hadn't kept up with the development of internal medicine pharmacy, and quickly asked: "No, can medicine stop bleeding? Now those people in internal medicine are not studying bloodletting and enemas, but playing hemostasis? Say the pharmacist found something new to get you high?"

Although Carvey thought it was nothing, but after being said so many things, he had to give some response: "The teacher is wrong, the ether used for anesthesia is also considered a drug, but now it has become a necessary thing for surgery. "

"It's the work of a surgeon, it's different."

"My medicine is also made by the surgeon."

Massimov was a little surprised: "Who? Which surgeon?"

"Me." Carvey pointed to himself, "I performed a cesarean section and performed a tracheotomy. I should be a surgeon."

".Calculate."

Massimov is the most typical old stubborn, still not looking forward to Kavey's solution.

But winners and losers, even if their operation failed, they are not qualified to judge others: "No matter what your solution is, I still think that the success or failure of a mother's childbirth is given by God, and excessive intervention is not good. Even if you really find a solution , I think it is also a huge harm to the body of the mother."

"The teacher means that the success of childbirth depends on the condition of their stomachs?"

"You could say the same."

"I heard what the teacher meant. Abdominal surgery is the limit of surgery?"

"Yes! A qualified surgeon should not rush into the abdominal cavity!"

"I don't care if God gave birth or not, but if you only read the teacher's words, it's still biased." Carvey retorted unhurriedly, "God can give a pregnant woman a good belly, isn't it? Can't God give me something else?"

Massimov didn't respond: "Other? What else?"

Carvey made a movement of raising his hands after washing his hands, and said with a smile: "For example, a pair of hands that can help women with difficult labor out of the sea of ​​suffering."

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(End of this chapter)