"Ladies and gentlemen, good afternoon [1].
Today, a talented surgeon with rich experience is about to appear. He performed thousands of amputations and lithotripsys here, and his superb skills made him famous. He is Austria's most outstanding scalpel master and was named 'the great surgical man who brought miracles' by the Vienna Daily News.
The praise ends here, and the miracle is officially performed.
Let us invite this surgeon with extraordinary speed, Austria’s sharp knife in the night, Mr. Ignaz von Kern~”
As his name was shouted out by the host and echoed in his ears, the door was pushed open by Ignatz. In front of him were six rows of spectators, surrounded by oil lamps and candles. The flickering light and warm applause were accompanied by a faint smell of blood.
This was the realm he was familiar with: the operating room, or rather, the theater of surgery.
Ignatz is a famous actor here. He performs on stage every now and then, and he has long been used to such grand occasions.
But today, he still had to admit that he was nervous.
This is not the nervousness of a newbie on stage, his fingers are not trembling, and his mind is not blank. He could still pick up the scalpel steadily, and the hernia surgery performed by the famous British surgeon Astley Paston Cooper[2] during his tour in Austria was still playing over and over in his mind.
Ignatz's nervousness still lies in his uncertainty about the outcome of the operation.
The success rate of hernia repair surgery performed by Dr. Cooper is very high. Excluding postoperative infection, the mortality rate is controlled below 15%. Even in terms of the criticized postoperative recurrence rate [3], Dr. Cooper is among the best in Europe.
Among all hernia surgeries that survived, his recurrence rate was only 38%, much lower than that of Dr. Heisenbach in Berlin (47%) and Dr. Popat in Paris (44%).
Both of them were very knowledgeable people in hernia surgery. The former named the direct hernia triangle (Heide's triangle) [4] and the latter discovered the inguinal ligament. But surgery is a job that pays attention to technology after all. Once the academic gap cannot be bridged, the treatment effect becomes the most intuitive reflection of the doctor's value.
In this regard, Cooper's title as the first person to perform hernia surgery in the 19th century is well deserved.
It's a pity that the old man passed away more than ten years ago. Many people left behind can perform the surgery, but after all, only a few can truly get the essence of his suturing.
Ignatz specializes in limb surgery, and he has always been a wild man in operation. This technique of wide opening and closing can win a lot of viewers, and it is also very good for amputation, but when it comes to the groin, which has a very delicate and complex anatomy, it becomes a burden.
"Good afternoon, I'm really flattered that such a small trick can attract so many noble audiences."
Ignatz walked towards the nurse with a smile, took off his long cloak and hat to keep out the cold, and at the same time described what was about to happen in front of everyone: "The skills I will show you today are extraordinary. They are unique to the entire Vienna." Inguinal hernia surgery that no one dares touch.”
As soon as he finished speaking, the audience burst into applause again. Even if they don't understand what a "groin" is, it still doesn't affect the audience's excitement when watching the performance.
"Now please bring out today's patient, Count Morasso Heyrich Carl Franz~"
Ignatz directed everyone's attention to the door, watched a cart push people into the door, and walked to the corner to put on a surgical apron. It was a very historic white leather skirt, stained with the blood of patients who had undergone his surgery and never washed.
The reason is still an unfounded belief: the more blood stains remain, the more skilled the surgeon is.
This statement made sense at first sight, and there was nothing surprising about it, and it quickly spread among the general public.
Ignatz was very dissatisfied with this kind of thing, always thinking it was a gimmick that only incompetent doctors would come up with. But since I really couldn’t find a reason to clean my apron, I didn’t object and just kept it.
To him, an apron is just an apron, but the scalpel he holds in his hand is an extension of his fingers, the soul of the surgeon: "Today I will use the RB knife forging master Guozheng, who has made it tailor-made for me [5] scalpel to demonstrate this complex surgery.”
The golden knife box still smells like wood. Inside, there are seven types of surgical knives and two bone saws that are most commonly used in his daily operations.
Ignaz was like an excellent explainer, guiding everyone's attention: "Count Morazo, who is also an old friend of mine, suffered from inguinal hernia. He was in unbearable pain and even walking became very difficult. "
The assistant lifted the blanket placed on Morasso's body, completely exposing the mass on his lower right abdomen, and only covered some important areas.
"The cause of inguinal hernia is a hole in the abdominal cavity, and the intestinal tube falls in." Ignatz continued, "Twenty years ago, when I was a medical student, I had the honor to meet Dr. Cooper. This kind of surgery was performed. He separated the adherent intestines from the abdominal wall, and then sutured the hole with silk thread. The whole process was perfect."
After speaking, he looked up and looked at the audience: "Everyone, I will recreate this operation."
The anesthesia technology that emerged more than ten years ago has gradually matured, and the nonsense "ether patent" has become a piece of waste paper.
For the initial ether anesthesia, the simplest method is to cover the nose, covering a piece of cotton cloth on a metal triangular three-dimensional support, and then covering the nose. As long as air circulation is ensured, a few drops of ether on cotton cloth can make the patient fall asleep in a short time.
Although the method is simple, there are many uncertain factors.
In such a venue where candles and oil lamps are used everywhere, exposure to ether is not a good thing, so when anesthesia first emerged, "intraoperative coma" and "small fires" became an indispensable part of the surgical complications. member.
In order to solve these troubles, there are now very practical ether inhalation devices.
The ether vapor is delivered through glassware and enters the patient's body through a transcortical nasal mask, ensuring airtightness throughout the entire process. Not only does it avoid ether exposure, it is also more convenient to use, but the control of the amount of inhalation is still lacking.
How much ether should be used actually depends on the experience of the anesthesia assistant and a bit of luck.
Fortunately, Count Morasso was lucky.
"Teacher Ignatz, the anesthesia is complete."
"Okay, the operation officially begins now..."
...
Just after Count Morasso fell asleep, across the street from the Theater on the River Venn, a black carriage sped from a distance and stopped at the gate of the Municipal General Hospital.
The person who got off the car was a young man who was less than twenty years old. His thick black coat was fluttering in the wind, but what attracted more attention was the tan glass bottle in his hand. Those who didn’t know him would think he was a clerk from a grocery store delivering oil to the hospital kitchen.
"I'm back, where is the cotton?"
The nurse looked up at him, pointed to the bed behind her and said, "Put it next to the patient."
"Okay, thank you~"
The debridement care method mentioned by Kawei is a fantasy to others, and no one will really believe it. In fact, Ignatz does not believe it either. But because of the insistence of the patients and their families, and the sudden reduction in salary, which made him feel a little embarrassed, he still gave Kawei some support.
After all, he is a surgeon with a good reputation, so he still needs to be open-minded.
But this kind of support came out of nowhere in the eyes of outsiders. Coupled with the previous debate with three medical school graduates, Kawei became a "man of the hour" in the hospital that day, and various gossips related to him The news was flying all over the place.
This is also blessed by the underdevelopment of information in the 19th century. Any conversation materials are precious and enough for others to chew on for several days.
Kawei hesitated for a long time between the two bottles of cooking oil, but chose linseed oil first. There is no special reason, it is just the result of choosing one of the two.
He needs to soak the cloth with oil, wring it out, and wrap it around the bandaged left leg. The damp, oily fabric can isolate bacteria in the air and create a relatively sterile space inside.
Moisture absorption inside, insulation outside...
It seemed perfect, but Kavi always felt like something was missing.
"You made the wound greasy. Can you really heal this leg?" The nurse I met at the door just now came over. After watching his operation, I still felt strange.
"It should be fine, as long as the dressing is changed frequently." Kawei looked around and found no sign of Ignatz, "Where's the teacher?"
"Doctor Ignatz? He has already gone to the theater." the nurse said. "The surgery this afternoon is very important. He went right after lunch. He always behaves very calmly during normal surgeries, but today he seems to be a different person. Same."
"What kind of surgery is it?"
"It seems to be a hernia repair. The patient is an earl, and he always comes to the clinic for treatment."
"No wonder..." Kawei said casually, "The anatomical structure of that place is complex, with ligaments, blood vessels, spermatic cords, fascia, and muscles. Everyone has to come together to express themselves, so the operation is difficult. "
Seeing that he was speaking eloquently, the nurse had nothing to say, so she could only ask: "Aren't you going to the theater for the operation? It should have been opening for a while now."
Of course Kawei wanted to go, but what was in front of him now was a left leg that kept leaking oil on the ground. Reason told him that this matter was only half done and he could not leave it alone: "Does the hospital have thicker paper?"
"Yes, yes, what's wrong?"
"Bring me some."
"How much do you want, you can tell it all at once..."
"Better get some more cotton."
The nurse was a little speechless: "You use both cotton and paper, so the cost is not low."
"Don't worry about it. Teacher Ignatz will pay the bill when the time comes."
Edible oil will leak, and long-term exposure to air will oxidize and dry out, all of which will affect the insulation effect. Kawei must keep it moist, at least for 24 hours, until the next time the dressing is changed. In order to achieve this goal, the first thing he thought of was paper.
Kawei didn't have any special requirements for the paper. He only needed to wrap one or two layers of paper outside the oilcloth to slow down the drying speed.
It's not difficult to operate, it just requires a helper and takes a lot of time.
Six layers of cotton, two layers of paper, and two pieces of plywood made the boy's slender left leg in bed 11 swollen into a mallet. Kawei inquired about the comfort level, checked the pulse of the dorsalis pedis artery and the mobility of the toes, and then relaxed with satisfaction.
"At 14:42, if it were placed in modern times, he might have been sewing the skin. I don't know how Ignatz is doing. I hope he can succeed..."
He found a tap sink and used alkali soap to clean off the grease. He waved his hands and said to himself: "Forget it, let's go over and have a look. Where is that theater?"
