Appendiceal surgery comes and goes quickly. Once the appendix is caught, in the hands of a skilled surgeon, it usually takes no more than 10 minutes to remove and close the abdomen. 【1】
Appendiceal surgery in the 19th century was very bad, but one thing is still worthy of recognition, and that is the preparation before surgery.
Because there is no need to remind Carvey, and there is no need to worry about the doctors' last-minute whims, most people, including Morasso, Alphonse, and the priest, will have their intestines ready at any time to ensure that the surgeon can see them after cutting them off. What is there is a fresh tube cavity with some green medicinal residue, rather than feces pouring out like a mudslide.
At that time, enemas were indeed a very magical and common thing, and Father Schmidt was one of the representatives. His preoperative preparations went beyond the ordinary seriousness.
The priest believed that the abdominal pain was a treacherous and dirty trick of Satan. From the beginning of the illness, he increased the number of enemas he used to purify his body and mind from two to four times a day to ensure that he could drive away this demon.
For Schmidt, this is a holy war of his own.
Unfortunately, the concoction used for the enema was not strong enough, so Yingenatz and Kavi had no choice but to force their way in to help.
The severed appendix was indeed spectacular, and the actual length may be longer than Carvey predicted, probably 27-28cm. This was something he had never seen before before he traveled through time, and it was indeed a record.
"Herman, go on..."
Kawei picked up the suture left on the stump and the crow's beak forceps on the other side, and threw the entire appendix into the prepared container: "Don't throw it away in a hurry, keep it for use."
"It's for pathology."
"right."
Postoperative pathology is an important link.
Observing organ changes with the naked eye would become too subjective and lack specificity. Only by starting from the highly specific cellular level can we clarify what is wrong with these diseased organs.
It would be fine if it was just an ordinary inflamed and ulcerated appendix. Kawei did not insist on it, but this time the appendicitis bulged into a meat bag and needed to be cut into slices and carefully looked at under the microscope. This was also the reason Kawei came into contact with the Ingenac microscope. good opportunity.
After finding the appendix, cutting it out, and then suturing the stump, this was a task that was more difficult than good for Ingnatz. He certainly couldn't sew a purse in the modern sense, but he could still easily mend the gap with sutures. 【2】
When suturing, he had quite some experience: "The appendix has been removed, and now we need to suture the gap. Here, ordinary surgeons may think it is nothing, just do a simple suture, but I have been doing double ligation." Because catgut sutures are often not securely tied, resulting in intestinal fistulas and patient death after surgery.”
This is true, and purse-string suturing is no longer necessary in evidence-based medicine in the 21st century...【3】
Surgery is a team game, and its completion requires the efforts of everyone.
Even if the technical content required for the secondary anesthesia was low, Kawei could not hold the appendix with one hand for suturing while using his feet to anesthetize the priest. Moreover, anesthesia itself is dangerous. In addition to controlling the dosage, it is also necessary to pay attention to the priest's heart rate and breathing at any time and to prevent aspiration after vomiting.
Hermann's contribution was obvious to all, but after the operation, the audience's applause still went to Ingenac as the chief surgeon.
This is a period of silence and accumulation that every surgeon must go through. There is always only one surgeon, and it is always inevitable to do some odd jobs behind the scenes.
Therefore, compared to Hills, who wanted to be the surgeon, Herman, who could stabilize his mentality and practice silently to gain experience, satisfied Carvey more.
Kawei himself didn't care about the applause. Yesterday's cesarean section had already made him shine, so it wouldn't be a bad idea to give up some honors. And this kind of humility is not for nothing, he can definitely get some benefits from Yingenatz.
After all, Yingenatz himself knew that the reason why he got all the applause was because of Kawei's initial judgment on the position of the appendix.
These are all secondary. What really needs attention now is the postoperative treatment.
Ingnatz handed the priest with his belly open to Kavi's hands, meaning that he would do the final sutures. But in Kawei's mind, the operation was not over at all. There was one last step before closing the abdomen: cleaning the abdominal cavity.
The reason why surgery collapsed in the 19th century was largely due to the lack of disinfection of wounds and the lack of masks and gloves, which completely exposed surgical incisions to bacteria.
In this kind of surgical environment with close to zero protection and such an exaggerated 17cm large incision, even with the support of modern antibiotics and strict disinfection, there is still a risk of infection, so the cleaning of the postoperative wound and abdominal cavity has become Particularly important.
Cleaning the abdominal cavity is a routine operation in abdominal surgery.
Pus is hidden in the abdominal cavity, which can infect the appendix incision at any time and cause peritoneal irritation. If the abdominal cavity is not cleaned, the operation will be the same as not having been done at all.
Even putting these aside, the bleeding and exudation caused by the incision are a petri dish for bacteria, and new infection foci may form at any time.
Cleaning is nothing more than pouring in a large amount of saline and pumping it back and forth a few times.
But for the 19th century, washing the belly was a very strange practice, and there was no real sterile saline solution.
There was no saline solution, so Kawi had to prepare it himself. Fortunately, the people entering and leaving the theater were all upper-class celebrities, and the water flowing out of the water pipes was melted snow water from the Holy Alps, which was at least cleaner than pus.
Taking advantage of Yingenatz's opportunity to accept the applause and do the finishing work himself, Kawei found Herman: "Herman, go and get a basin of water." [4]
Herman was a little surprised, but only surprised. Working behind Yingnaz all year round makes his body move faster than his brain. When he realized that Kawei's request was unusual, he had already turned around and walked to the preparation room.
Those who entered and exited the theater were all aristocrats and celebrities, and the water flowing in the water pipes was melted snow water from the Alps. If you add the salt from the audience lounge, you can make it a substitute that is comparable to normal saline.
Of course, in theory, warmed saline is better, but conditions are limited, so we can only make do with it. 【5】
At this time, Ingnatz was wiping his bloody hands and enjoying the applause of the audience. .
After answering several medical-related questions, Greg, the new reporter who replaced Varela, squeezed in front of the crowd and grabbed the right to ask questions:
"Dr. Yingenatz, congratulations on successfully completing another abdominal surgery. I am the surgical columnist of the daily newspaper and I would like to interview you with a few questions."
"Greg?" Ingnatz was a little surprised when he heard this unfamiliar name. "Where's Varela?"
"I'm not feeling well, so I'm resting at home."
"Oh, feel free to ask."
"Is there not much research on appendicitis in the European surgical community today?" Greg asked a very strange question, "I have checked many literatures and there are very few case reports in this area."
"That means you are looking in the wrong direction." Yingenatz explained, "Most surgeons in Britain, France and Germany classified appendicitis into the category of 'pericecalitis'." [6]
"this......"
"Do you think there will be more cases all of a sudden?"
"Indeed, this is a very common medical term that is often seen."
Ingnatz sighed and said with a smile: "You can ask the medical students and doctors around you. In today's surgical community, the majority of people support pericecalitis. This term has been officially written into It has been included in textbooks and spread to the ears of countless medical students every year.
But in fact, its authenticity has yet to be verified. After all, the phenomenon of 'pericecalitis' found in autopsies is often only edema around the cecum, and the real areas with serious lesions are the appendix. And I have always been an 'appendicitis' fan, an absolute minority. "
Greg nodded repeatedly: "I didn't expect there to be such interesting stories, but today's surgery can help Dr. Yingenatz regain some of his disadvantages."
"This...it's hard to say." Yingenaci didn't think so deeply.
Greg is still young and does not have Varela's profound accumulation of surgical knowledge, so he can only start with interpersonal relationships. And his approach is far gentler than that of his two colleagues from The Times and Free Press:
"Dr. Kawei completed a cesarean section last night. Objectively speaking, it was a wonderful operation as good as today. It is rare for two people to share the same stage. As his teacher, can you evaluate Dr. Kawei's operation for us? ability."
Ingnatz knew that this kind of question would come up sooner or later, so he had already thought of a set of response plans from the beginning:
"Kavi is one of the most talented children among the many children I have seen. He has learned a lot of surgical experience from his father, and his surgical ability is beyond doubt. And in obstetrics, he already has overwhelming success. strength."
In just three sentences, Kawei was promoted to a high position, causing many people to talk.
"Overwhelming strength?" Greg said, "There are sporadic cases of successful uterine-preserving cesarean sections around the world. A single success should not be enough to prove this statement."
"Don't worry, all the women who need cesarean section at Graze Hospital, St. Mary's Hospital, and Hartmann Hospital have been sent here. You will see many cesarean sections in the future." Ingnatz seemed to be worried about Ka. Wei is quite confident, "As for whether it has overwhelming strength, it just depends on the final success rate of the operation."
"I see......"
At this time, most of the eyes in the surgical theater were focused on Yingenatz, and some audience members who did not need to ask questions chose to leave early. The surgery was over, the fun was gone, and there was no point in staying in this place.
Although everyone in the discussion group was talking about Kawei, only a handful of people really paid attention to Kawei.
Varela, who had been watching the operation in the preparation area, was one of them.
"What are you doing?"
"Wash your stomach." Kawei lifted up a small basin and poured the salt water into the priest's open stomach. "It can wash away the remaining blood, tissue fluid and pus, and it can also help the incision heal quickly." [7 】
This sounds reasonable, but no one has ever asked: "Who said this?"
"Who?" Kawei thought for a moment, pointed at himself and said, "I, I said it."
"Is there any basis for it?"
"Yes, I have."
Kawei casually made up a basis and said: "The lithotripsy surgery was just completed yesterday afternoon. The patient's name is Fernand, and he is a butcher selling pork. He said that when cutting meat from a whole pig, he wanted to ensure that If the pork is fresh enough, you have to clean the rest, otherwise it will smell bad within two days.”
"Is this happening?"
Kawei shook his head in his heart, but said: "Yes."
"But what he has in his hands is a dead pig, but the priest is a living person."
"What does it have to do with it? The internal organs are all flesh, and the wounds will become smelly when they are rotten." Kawei, without a red face and a heartbeat, instilled a set of fallacies to the senior reporter, "And the priest has been through it for so long. After the surgery, my body was very dehydrated, so I did this as a compensation measure."
Varela became more and more confused as he listened: "What measures did you just take?"
"Ah, don't worry, I know it well." Kawei didn't bother to explain to him anymore, and gently put down the basin, then took the suction needle [8] handed over by Herman, and stuffed the suction port into the water, "That's the only way Do multiple cleanings to ensure that the abdominal cavity is clean enough.”
Next to the operating bed, Herman squatted down slightly, still playing the role of a diligent worker. When Kawei gave the order, he quickly turned the hand-cranked suction device and sucked out all the water in his stomach.
"The effect is good, let's do it again."
"good."
Varela is still skeptical about this strange scene. Just as he was thinking about whether to discuss this matter with Yingenatz on the sidelines, a shrill scream suddenly rang out from the preparation area behind him.
The cry came from a surgical nurse, a veteran who often came to the surgical theater to help. If placed in modern times, this level of work experience would at least be enough to be a traveling nurse.
But she was so frightened by what she saw that she backed away repeatedly. She couldn't say anything except shouting.
"What's wrong?"
Varela, who was closest to her, walked over first, and saw the nurse covering her mouth, sobbing and pointing to the preparation area. Her face was full of panic but she couldn't say anything.
Varela didn't know what happened, so he could only move forward slowly.
There were many surgical instruments on the table in the preparation area. In addition to Yingenatz's commonly used medical tool box, Kawei also brought his own set of things. The most eye-catching one is the iron plate in the middle of the preparation area, which contains the extra-long appendix that was just taken out of the priest's body.
Apart from these things, there are just some disinfecting supplies and bandaging supplies, nothing special.
"It seems like nothing happened..."
Varela looked at the appendix in the iron plate again, and was about to say "Nothing" when suddenly something in his field of vision squirmed: "Wait a minute!"
"What's wrong?"
Everyone in the theater looked at Varela: "The priest's appendix moved just now."
