Nineteenth Century Medical Guide

Chapter 98 95. Some Complications Can't Be Made Randomly

Tracheectomy was very rare in Europe at that time, and it was done more in France.In Austria, where the style of behavior is very conservative, it would be nice to meet two or three people who are willing to perform such a bold operation.

Ignatz's surgical style is bold enough, but he still has a conservative attitude towards tracheostomy.If it weren't for Laszlo's importance to the country, he would not try to make a move if it was a last resort.

But even in France, those doctors described the complications of tracheostomy mostly as bleeding, violent coughing, tracheal tear, damage to the posterior wall of the trachea, or simple anesthesia accidents, etc. They have never seen a report of a face swollen into a pig's head. .

Moreover, the patient in Damirgang is not just a face problem. The swelling goes from the face to the neck all the way down to the yin sac and the thighs are also swollen, as if an inflation needle was inserted.

"Although he was dead at that time, I still wrote down the process and symptoms"

He turned to his journal page and began: "I was in a hurry because the patient was quite short of breath and it was painful. I quickly cut his neck, separated the tissue all the way down, and quickly cut the trachea. I don't care how much bleeding there is, and whether the tip of the knife is accidentally injured, I just stuff the horn tube in first.

Because it was the first gas cut, really, really the first time for me, with only one apprentice as my assistant.I saw that the patient had a little relief, so I started to do skin sutures.It was during the stitches that he seemed to swell up.

Start on the neck and then spread to the face.I looked a little confused and didn't know how to deal with it, because I had never seen this kind of situation, and it was not taught in the textbook.But...but soon there is no need to be confused. "

The patient died very simply, which was also expected by everyone.

The fever hasn't improved for so long, and then I have difficulty breathing. In fact, even if the breathing problem is really relieved by tracheostomy, I will probably die of illness in the end.What they don't understand is swelling, why the body swells up after cutting the trachea.

This curiosity prompted the famous doctors in the audience to ask questions one after another.

"Is there any inflammation? Are there rash patches?"

"Extensive subcutaneous mucositis?"

"I guess it's a hematoma?"

"It may also be miasma! With such a severe fever, the miasma in his body must be very serious!"

Faced with a situation they had never seen before, the two heavyweights in the anatomy world, Ignatz and Massimov, who had just stepped down, quickly had their own answers: "It should be air."

"Air may have penetrated under the skin, as in a pneumothorax between the pleura and the lungs." [1]

The two gave the same explanation, and faced the contradiction between theology and medicine just now, they just glanced at each other and didn't say much.For them, the crux of the debate is the boundary between man and god, and there will be no dispute over a definitive diagnosis.

And there is another person who can walk in the forefront of medical treatment and know the truth clearly, Carvey.

He knew very well that this was one of the common complications of tracheectomy, subcutaneous emphysema.It's not uncommon, sometimes pulling out a tooth can swell your face.As long as the sutures are tied loosely, air can leak out within a few days, and no special treatment is required. 【2】

However, each complication has its own specific factors. It is a common complication in modern times, but it may not be the case in the 19th century.

Some complications do not come out casually.

Subcutaneous emphysema, as the name implies, means that air enters under the skin and is locked inside, unable to escape, and emphysema occurs.A considerable amount of emphysema occurs within 1-7 days after tracheostomy. At this time, the epidermis begins to heal, and the air cannot escape, and emphysema appears.

But the patient in Damirgaon developed emphysema on the spot, suggesting that the skin was tightly sutured so that the air that had entered the skin would accumulate under the skin.

Especially with such exaggerated emphysema, the skin sutures must be quite tight, so tight that no air can leak out.
Carvey glanced at Ignatz, and then thought about Herman and Bergett, who can be used in surgery now. The suturing skills are actually not very good, and there is no way to achieve this level.Could it be that Damirgang's suturing skills have surpassed Ignac's?

And that's just one of them.

Because after the tracheotomy, the air should enter the trachea through the horn tube and the tracheal incision, and should not leak into the subcutaneous area.In order to form subcutaneous emphysema, in addition to preventing air from leaking out, it is also necessary to give the horn tube and trachea a chance to let the air leak out.

To achieve this, the tracheal incision must be opened wide first.When the diameter of the horn tube does not match the length of the trachea incision, the gas will leak out, which is also a common mistake made by novices like Damirgaon.

The other point, and the one Carvey was concerned with, was the separation of the soft tissue in front of the trachea.

Modern tracheostomy requires the separation of soft tissues. To avoid unnecessary damage, it is also necessary to ligate the blood vessels, which creates a soil for the generation of subcutaneous emphysema.But there was no such requirement in the 19th century, and even many surgeons seldom dissected soft tissues in order to speed up, or even did not do so at all.

For example, Ignatz didn't separate much at the beginning. Once he cut into the skin, he found the trachea and was ready to make the next cut.

In this case, after the horn tube is inserted, the soft tissue in front of the trachea actually covers it, which acts to lock the air.In principle, it is very difficult for air to escape.

There is soft tissue blockage inside, and the suture technique is not in place outside. The tracheotomy in the 19th century should not have subcutaneous emphysema.

Therefore, Damirgang must have separated a lot of soft tissues during the tracheotomy, which is a good practice in surgery.Especially for delicate operations, a lot of troubles are often encountered without separating soft tissues.

In addition, it only took him 3 minutes to cut the skin, separate the soft tissue, cut the trachea, insert the horn tube, and suture the skin.Leaving aside the emergency suturing of blood vessels at the time, in terms of time alone, it has even surpassed Laszlo's tracheostomy.

He has the courage to cut gash, his hands and feet are fast, and the skin is sutured tightly enough.
Perhaps in terms of medical experience and academic qualifications, Damirgang is incomparable, but these three points far surpassed Hills and Herman.Carvey suddenly agreed with Graze Hospital's approach. Poaching is indeed the fastest way to improve the soft power of his hospital.

"What's wrong with you?" Ignatz looked at Carvey suspiciously.

"Um, nothing." Carvey smiled, then looked up at Damirgang who was still stuttering on the stage, "Teacher, which hospital is he from?"

"I heard that it is a small clinic in the east of the city. There are usually no patients, and no teacher to take him. Only relying on the anatomy learned in the medical school and the skills I have explored, it is basically over."

Ignatz didn't mean to despise the other party, he just looked at Damirgang objectively from the eyes of a high-ranking person in the medical field: "They have already graduated with a master's degree, and they jumped off the car halfway to go to the clinic. It's better to stay there. It's a pity that there are so many research materials and medical practice data in the hospital, he"

"It's just a gas cutter that failed."

Carvey wanted to try to excuse him, but soon realized that Ignatz had the same experience, so he immediately put aside the topic: "Doesn't the teacher think that our surgery is short of people now? Mr. Hills is gone, can you It’s just me and Herman, it’s very tiring.”

"Isn't there still Bergert? I'll be back the day after tomorrow."

Carvey knew he'd say, "What if I go to medical school?"

"This"

Ignatz forgot about it.

At any rate, it is the Municipal General Hospital, the largest hospital in Austria, and even if there are not more than three surgeons, it is already the limit for surgical patients.And the medical school is full-time, even if Kawei can go back to the hospital to help at night, but Ignatz and Herman have to face it in broad daylight, which is obviously too difficult.

"You said you want to recruit people?"

"It must be recruited, and he has a cheap salary and can help to be the chief surgeon." Carvey raised his chin at Damirgang who had packed up the manuscript and was about to step down, "Give him half of the original salary of Mr. Hills , he will certainly accept it with pleasure.”

"It's hard to say. It's hard for the clinic to keep up with the rhythm of our place after being mixed for a long time."

Ignatz does not have such a keen sense of smell as Kawei. In his eyes, Damirgang is just a small doctor in the clinic. He wants technology but not technology, and he wants a degree but not a degree, so he hesitates: "This matter will be discussed later. Well, I'm on stage first, and the earl's groin next."

Kavi got up to get out of his seat, sent Ignatz away, and at the same time stopped Damirgang who had just come down: "Sorry, I have something I want to ask."

"Please teach me?"

"Well, about the trachea."

Damirgang was a little surprised, because in his opinion, everyone in the audience should look down on him.

It's not that he hasn't compared with Kawi, and he is planning to comfort himself with this.But surgery has always only looked at the results. Carvey's gas cut was successful, but his was a failure.What's more, Carvey has not only one tracheotomy, but also a cesarean section and the last compound trauma suture.

"I've said everything I can say." Although there was still some evasion in his words, he naturally sat beside him under the guidance of Carvey, "What do you want to ask Dr. Carvey?"

Carvey still lowered his stance first: "Dr. Damirgang's suturing skills must be very good."

"Huh? Why do you say that?"

"It's just my intuition. The trachea incision was sutured in 3 minutes, which is already very good."

"I don't know whether it's good or bad. Anyway, many places in the east of the city are not peaceful. There are fights every day, and those who are injured will come to me to stitch their wounds." Damirgang explained with a smile, "Perhaps practice makes perfect."

Ignatz on the stage has already started to move his mouth, and Kavi is not ambiguous here.

The question of tracheostomy is just an introduction, and what he wants to ask next is the core: "By the way, how long has it been since you graduated?"

teacher?

It was the first time for Damirgang to be called a teacher, and his attention was instantly attracted by this title, and he answered very simply: "Five years, uh, no, it has been six years."

"I remember that the teacher had a master's degree at the beginning, and he should be able to graduate with a doctor's degree in a year or two. Why didn't he stay and continue his studies?"

"Something happened at home, and I have to go home and take over the clinic." Damirgang was also quite reluctant to give up on college life, but unfortunately he couldn't help it, "By the way, why do you always call me a teacher? I'm just guessing, Kaka Why did Doctor Wei ask me these things?"

"Oh, I'll just ask."

Damirgon sighed, quickly took out his notebook and began to listen attentively to Ignatz's speech.In just half a day of the meeting, he had already recorded a lot of things in his notebook. Compared with Kawei, who also had a notebook in his hand, the page was much deserted.

This studiousness once again moved Carvey: "By the way, I'm actually quite curious.
"Shh~~~"

Damirgon made a silent gesture, and said softly: "The next surgery will be very difficult and exciting, Professor Ignatz's speech is too fast, I have to make a careful record .”

Carvey smiled when he saw his answer, and asked suddenly: "Does the small clinic have patients with inguinal hernia?"

"Of course I have, there are quite a lot." Damirgang replied while looking at the sketches Ignatz took out, "This is not a rare disease, and I have already taken over four hernias this month alone. "

"It's quite a lot. So, you also want to do hernia repair in the clinic?"

This stopped Damirgang from asking.

Groin surgery is not a tracheotomy. The clinic facilities are poor and the venue is much smaller. The key is that there are no assistants.Without nurses and interns, two naked people cannot do a good job of inguinal hernia. This is not enough for modern general surgery, let alone the 19th century.

When these factors are reconciled, Damirgang has a zero chance of undergoing inguinal hernia surgery and a zero success rate.

Unless he is as lucky as Ignatz at the beginning, not only has a fearless patient like Moraso, but also has to meet an assistant like Carvey, it is possible to barely complete this operation, otherwise
"I can't do it, I can't do it alone."

Unknowingly, Carvey's questions became sharper, and at the end he had a slightly questioning attitude: "If this is the case, why do you want to learn these things?"

"I'm just a little curious about an operation I've never had."

Carvey knows too much about medicine and surgery. It is difficult for doctors to maintain their technical level without a suitable source of disease.If you want to maintain your ability at a high level, you must rely on a lot of practice. Curiosity alone cannot suture subcutaneous emphysema.

"So that's the case. It seems that Mr. Damirgang wants to learn as much surgery as possible, so as to prepare for leaving the clinic and changing hospitals in the future."

However, Damirgaon's answer again denied this view: "No, I am not interested in going to other hospitals."

"Do you want to stay in that clinic for the rest of your life?"

Damirgang hesitated for a moment and nodded: "I don't have that ambition."

"Don't be kidding, I have never seen a surgeon without ambition." Carvey smiled and exposed his lie, "Besides, why do you have a gas that is almost impossible to use in a small clinic without ambition?" What about cutting horns? Most of the horns on the market are made of silver, which is not cheap.”

(End of this chapter)