At that time, there was no concept of perioperative period in surgery [1]. Doctors were only responsible for the surgery without preoperative preparation. Postoperative recovery was also the patient's own business.
Ignatz is much busier than other surgeons. On weekdays, he only cares about surgery. His schedule basically alternates between the anatomy room and the theater. From time to time, he also has to see those noble gentlemen, and occasionally returns to the hospital. Go to the office for a break.
The daily care of the patients in the ward is taken care of by nurses, and the medical records are compiled by Kawei. Ignatz needs to enter the ward very rarely, and he only comes to check the ward and observe their postoperative recovery.
Ignatz has been busier and busier these days, and has been forced to skip several ward rounds.
However, even if he was exempted from ward rounds, he had to keep up with the postoperative observations as much as possible, so every time he was in a hurry and left after just two glances.
Of course, this is not a normal phenomenon. The ward is not on duty. Morning and night ward rounds are a key step in understanding the patient's physical condition and should not be omitted. So this morning Ignatz hoped to finish his rounds as soon as possible before going to the theater, but he didn't expect Alphonse's butt to hold him back.
I originally planned to come back and make up for the ward rounds first, then go to the anatomy room to remove the white cloth from the couple in Room 102, and then carefully cut their lips with Kawei.
But as soon as he entered the ward, Ignatz suddenly stopped.
He was in a hurry to do an examination in the morning and was pressed for time. He didn't think there was anything wrong here, but now he found that there seemed to be some changes in the ward.
The first thing that eluded him was the windows...
"Why is the window open?" Ignatz asked the nurse on duty as soon as he walked in. "It's only March, the weather is still a bit cold, and the air is full of turbid and toxic miasma..."
Before he finished speaking, the nurse pointed at Kawei behind him and said, "Your dear assistant gave this order."
"Yes, it's me." Kawei let the nurse pass and explained on his behalf, "I decided to let them do this after reading the battlefield nursing notes of British nurse Nightingale."
Ignatz had heard Nightingale's name for a long time, and his reaction was similar to that of the British gentlemen, a kind of disdain carefully packaged in politeness: "It's just a daily record of helping bring tea and water to wash clothes. It only counts women." Excellent essays for people in their spare time.”
"If it were just excellent essays, I don't think she would be admitted to the Royal Statistical Society as an exception. That place never accepts women."
Ignatz didn't know about this: "Oh? Those people in the UK have changed their behavior?"
"I think it should be because of her outstanding contribution during the Crimean War."
Carvey reminded: "She reduced the mortality rate of wounded soldiers in the British army from 42% to 2%, and then used the new Rose Chart [2] to make those tough military figures and even the Queen herself agree with her medical treatment reform plan.”
Ignatz took off his hat, his face full of doubt: "Can it really drop that much?"
"The New England Journal of Medicine has published several articles about her." Carvey took out the book from the cabinet nearby. "This should be an old book I bought in the middle of last year. I found it when I was sorting out the bookcase. It was originally Published some of her new nursing concepts.”
"Oh, it's this book... Those arrogant British guys, the whole book is written in English. I regretted buying it." [3]
Ignatz likes to go under the knife and is very receptive to new surgeries, but it is difficult for him to accept too advanced nursing concepts, so he translated a few pages and threw them aside: "There are many traditional practices in it. I don’t agree with anything that goes against it.”
"But these were all experiments on the lives of British soldiers. I think it's worth a try."
Ignatz thought for a while and found that it made sense. He couldn't help but nodded and asked, "Besides opening the window, what else is there?"
"For traumatic wounds, you can use strong alcohol to clean the wound and surrounding skin, and then use ointment [4] and cotton cloth to cover the surface to isolate the miasma in the air." Kawei took out the rest of the miasma in the air from the side. Brandy, "I specially got this bottle of brandy that has been distilled twice."
English really makes "alcohol" slip right under Ignatz's nose, because he simply can't be bothered to translate.
But similarly, Ignatz is unwilling to change his temper: "I still think it is a bit unconsidered to directly change the environment and nursing methods of the ward. This is the ward with the lowest mortality rate in Austria."
This is a strong statement, but when implementing new methods, you are bound to encounter resistance.
And Kawei is not just talking. Since the data and the New England magazine report are not enough to impress him, then he can only prove it with facts: "Teacher, do you remember the little boy last time, the one who had his leg crushed?" .”
"Bed 11, remember."
"The surface of the wound has basically healed."
"Oh...there's nothing surprising about this." Ignatz didn't take it seriously.
"But he is just a malnourished child from a poor family, not one of those strong nobles and celebrities, and his recovery speed is completely incomparable." Kawei suddenly asked, "Count Morasso's groin did not recover so smoothly."
Ignatz sighed: "Indeed, there are ulcers on the surface of the wound."
"I think we can learn from bed 11 and do some cleaning work on Count Morasso's groin to remove the rotten skin and flesh to make it easier to grow and recover." Kawei knew that he was overstepping a bit, so he quickly said with a smile, "Of course, this is just my personal suggestion, and it is entirely up to the teacher to decide whether to adopt it or not."
Ignatz is a self-centered person, and of course he will not accept other people's suggestions easily. What's more, Kavi is just an assistant, not on an equal footing with him.
But Morasso is his good friend, and he is not willing to watch the count die like this. If there is a chance, Ignatz is still willing to listen to some suggestions.
"Take me to see bed 11."
Eston is no longer in the depressed mood he felt when he was first admitted to the hospital, and is happy about his recovery every day. Seeing Ignatz and Kawei, his excitement was all written on his face: "Doctor, Mr. Kawei~"
"How do your legs feel?"
"Very good, doctor."
"I need to see the wound."
Ignatz took two more steps forward and reached out to untie the knot on the cloth strip. Eston was a little surprised and scared, but after seeing Kawei nodding, he still retained part of his smile and did not hide away.
Kawei usually takes care of Eston's legs. This is the first time Ignatz has seen the stitched wound.
After opening the oily cloth, the scent of linseed oil mixed with brandy hit your nostrils.
There were several blood bruises all over the entire calf, and there was swelling under the skin. This was caused by the fractures and the suturing of large pieces of skin that had been torn off, but the swelling was much better than he expected. Compared with the other healthy calf, this one is only slightly thicker.
The sutures were done by Ignatz, and the sutures and holes were faintly visible.
After so many days, the original incisions still fit very well, with no leakage or decay, and obvious healing can be seen.
This is what every surgeon most wants to see when a wound heals. It’s not like Ignatz has never seen it before, but he has seen it too little. What surprised him most was not only the healing, but also the small incisions on the skin of his legs.
"These cuts are..."
"Oh, I made a temporary cut to deal with the swelling in the leg." Kawei said, "When my father encountered this kind of wound in the past, especially a wound with a large area of skin detached, he would choose to use this small incision to relieve it. Pressure from swelling.”[5]
"Isn't this another injury?"
"No, the wound is not deep. It just releases pressure to prevent necrosis."
The 21st century orthopedic department's treatment of avulsion injuries and fractures deeply stimulated the brain of this 19th century surgeon. He couldn't understand why anyone could come up with such a method. There were so many small wounds, regardless of whether they were good or bad. , aren’t you afraid of ulceration?
Yes, aren't you afraid?
So the question comes back to square one, why isn’t Eston’s calf ulcerated?
At the beginning, he asked Bergt, Sarson and Mellen, and all three of them said that the wound would definitely fester and gangrene. Ignatz himself also felt that the possibility of gangrene was over 90% and almost inevitable.
But there is an irrefutable fact in front of me.
This was a large-scale wound caused by being run over by a carriage wheel. The leg was originally going to be amputated, so Ignatz needed 24 stitches. It can be said that no matter which hospital in Vienna he was sent to, and no matter how much money he could spend, he was faced with amputation and no other option.
Ignatz handed the strip of cloth and the wound to Kawei again, and gave up his seat beside the bed: "You mean that with alcohol and ointment, patients like this won't need amputation in the future?"
"That's not true. It's just that the child is lucky and the fracture is not dislocated. The chance is very small."
Kawei thought that maybe something like internal fixation could be developed in the future, but he said something else: "In terms of fractures, once they are dislocated or exposed to the air, amputation is safer, but We now at least have another option, and it works for Count Morasso as well.”
Ignatz still considers his patients at his core, and when Kawei blew him off in the theater just now, his already high mental level was raised a few centimeters.
Now it is impossible for him to deny Eston's legs, but the process of admitting them is more troublesome: "I just don't know if the earl can accept these things."
"I really want to promote this combination in the ward and do some experiments on Mr. Earl first." Kawei said grandly, "But now time waits for no one, and there is not much alcohol left. As a change of dressing every time For necessities, you also need to spend money to find someone to distill it.”
Ignatz did some mental struggle and watched Kavi help Eston wrap the cloth again, and finally made up his mind: "I will go to the Earl's house for a follow-up consultation tonight. You are more familiar with the dosage of ointment and alcohol. , so come with me. As for whether the count is willing to use it or not, that is his own business."
...
Alcohol disinfection has taken another step forward. During the discussion, the two of them regarded Morasso as an experiment before promotion, intentionally or unintentionally.
Eston's calf was not infected to begin with, so he was not rigorous enough in testing the effects of oil and alcohol. The earl's groin has begun to rot. If even his wounds can be healed, the persuasiveness will be stronger.
Once the Count recovers, Ignatz will have reason to use this wound care package on the entire ward.
But there were two things Carvey needed to address before alcohol could be used on a large scale in the ward.
One was the problem of alcohol production. It was impossible for him to ask the drugstore owner to distill it. The amount was too small. The second thing is the issue of hand washing, which also needs to be combined with the understanding of puerperal fever and microorganisms next door.
Really solving these two things is a big step forward and can lay the foundation for a large number of surgeries in the future.
Ignatz quickly ended his rounds and then took Kavi with him into the autopsy room.
Since the two men in Room 102 were brought to the hospital, the body has never left this place. Less than two hours after Ignatz invited Musil to take over the autopsy, the two of them were miraculously back in Ignatz's hands.
They both committed suicide by taking poison and were sent to the hospital first. Musil had no reason to seize them as his own under the temptation of 20 kronor.
As long as he slightly changes the autopsy report, he can save a lot of formalities and processes. Anyway, he will only earn 20 kronor after the body enters the police station, so there is no difference.
Now the two corpses were still lying on the autopsy table, covered with dirty white cloths, and the whole room smelled of a strange mixture of corpse odor, perfume and turpentine.
"You said before that the deformation of the orbicularis oris muscle needs to be taken into consideration during cleft lip repair surgery?" Ignatz opened the white cloth, revealing a woman's face, "She is slightly younger than Mrs. Gale, let's hurry up Time, let’s start with her.”
Although Kawei felt that a corpse with normal lips would not be able to show the appearance of a cleft lip, but seeing Ignatz's excitement, he could only make do with it first.
First, he needs to make the teacher understand something: "I personally think that the reason why straight sutures undergo the kind of deformation Varela said is because when they are still, they look like they did during surgery. But once the muscles contract, the scar tissue on the lips will also become deformed." It will shrink together, and then the appearance will change."
"I know this."
Ignatz also read a lot of surgical atlases and information: "The principle you mentioned is similar to what Milot proposed back then. He used the affected side to cut out a Z-shaped skin flap and made a diagonal suture. It is said that This shrinkage can be prevented.”[6]
"But he still missed the problem of the shape of the orbicularis oris muscle. This muscle is a progressive arc that is narrow at the top and wide at the bottom." Kawei said, "The straight suture did not consider the arc at all, while the Z-shaped flap did. Too much, not tactful enough.”
"So do you have any good ideas?"
Throwing out the two concepts of "curve" and "flap", what Carvey now wants to teach Ignatz is the lower triangular flap embedding method announced by Tenison in 1952 [7], which is still an introduction to cleft lip repair even in modern times. and commonly used clinical procedures.
Although it was said that he was teaching, Kawei himself had never done this kind of surgery before. He could only say that he was learning and encouraging together.
"Teacher, how about we make a small triangular flap above the lipstick?"
