The regular meeting of the Royal College of Surgeons starts at 8:00 in the morning and ends at 18:00 in the evening, with a break from 11:30 to 1:30, which lasts for 8 hours. It may seem like a long time, but in fact, a lot of content has been compressed.
The morning is a new trend in surgery. 【1】
Although it is titled "surgery", it actually covers a very broad scope. It mainly introduces new operations that are applied in surgical operations, and is not limited to the surgery itself. Technology has its shortcomings, and some have very narrow applicability, but Kawei still has to marvel at their eclectic adaptability.
For example, Fermi, the first surgeon at St. Mary's Hospital, introduced a new anesthesia method to everyone:
"On January 16 this year, our hospital received a patient with maxillofacial trauma. At that time, I found that his facial injury was severe and he was not suitable for the conventional preoperative anesthesia administration mode, so I tried to use an enema pump." 【2】
Ether is put into the enema pump, heated slightly or shaken gently to inject ether gas into the rectum, and finally blocked with a cork to achieve anesthesia.
Of course, there is also the practice of mixing ether liquid directly into the enema solution, but it is difficult to ensure that the operating bed is clean enough after the patient falls asleep.
"Enema anesthesia is not limited to maxillofacial injuries. It can also be used for some patients who are afraid of masks. They don't like the feeling of their mouth and nose being covered, and will be irritable and suffocated. Enema can prevent this from happening."
Fermi is very confident in this method of drug delivery: "I believe it has broad room for development. The only thing that needs attention is the dosage issue..."
Dosage is the ultimate question that troubles general anesthesia. How long and how deep the anesthesia will be needs to be studied. Unfortunately, ether is just a passing guest in the history of anesthesia. It will be gradually eliminated as new anesthetic drugs appear, and this kind of enema, which is difficult to measure the dose, is just a flash in the pan.
However, Dr. Fermi did not leave the podium after finishing the anesthesia introduction, but instead started the demonstration session of the second technology.
Soon his assistant came to the podium with a simple combination of belts, cloth pads, and pressurizers: "The same patient just now, after using enema anesthesia, we used a brand new hemostatic kit , effectively curbed massive maxillofacial bleeding..."[3]
Ignatz watched their operation demonstration and was very interested in this set of belts: "It's good for facial bleeding. It's quite suitable for plastic surgery. No wonder it was chosen."
Kawei looked at it and just nodded, not interested in it.
Although it is effective to stop bleeding by pressing the epidermis, it is too limited and difficult to last for a long time, so it is generally used at trauma scenes and transport. Once you actually enter the operating room, you still need to quickly find the bleeding location and perform precise blood vessel suturing to stop the bleeding.
Finding broken blood vessels is not that easy, and many times the incision needs to be extended. It is easy to put on but difficult to remove, and then these straps will become an obstacle to hemostasis.
However, trauma rescue was poor in the 19th century, transport was basically zero, and the application conditions for the belt compression hemostasis method were too harsh. In comparison, the method of stopping bleeding in Game 3 is more reliable and has been used even in the 21st century.
"For lower limb amputation, especially high amputation of the upper thigh, it is not easy to stop bleeding during surgery."
This time it was Dr. Lockard from Glaze Hospital, who put on a set of abdominal anatomy models: "Just like cutting off a river, if we avoid those branches and choose to block the upper blood flow, we can completely achieve the goal." The purpose of stopping bleeding.”[4]
In fact, what he chose to amputate was the iliac artery, which supplies blood to the lower limbs. 【5】
When encountering leg trauma and rupture of the femoral artery, if there is no way to find the severed end of the blood vessel at the first time, opening the abdomen to block the iliac artery is always a backup plan. The same principle applies to airbag compression anti-shock pants for emergency situations involving lower limb trauma and massive blood loss.
To be able to think of this step, and to achieve this step in spite of abdominal infection, is a big improvement, but it is a pity that Ignatz is still worried about Hills' departure:
"Amputation surgery itself is already quite dangerous, and suppuration of the incision is normal. I remember last year their amputation mortality rate was 47%, which is too exaggerated! Just like this, you have to make an additional incision. Have you not thought about ulceration? Look? Look at the German guy in our Ward 3, how bad his legs are..."
Kawei asked inappropriately at this time: "Teacher, what was our amputation mortality rate last year?"
"Emm...38%."
"It doesn't sound like it's much lower."
Ignatz knew that this number was still on the high side, and quickly explained: "Perhaps it is the physical condition of those patients. When I amputated several generals, I found that their chance of ulceration after surgery was not high, about 10%. about."
"I don't think it has much to do with the physical constitution." Kawei hopes to lead Ignatz to the cause of the infection instead of focusing on the physical constitution. "The reason should lie in the hospital environment."
Ignatz looked at his assistant in disbelief, remembering the hospital environment he had discussed with him, and immediately became alert: "I remembered that you valued that British woman's research report before. Her research Although the report is somewhat convincing, he is actually a lunatic at heart!”
madman?
Kawei didn't understand what he meant: "What crazy person?"
"Her new idea is to tear down all the city hospitals and move us to the countryside to open small clinics! This is a ridiculous suggestion that I would not have thought a surgeon would agree to. But... "
Ignatz stood completely opposite to Nightingale and tentatively asked Carvey: "Do you also want to demolish the Municipal General Hospital?" [6]
"How is that possible?" Kawei explained. "The hospital is innocent. It is just a pile of stones and bricks. What really needs to be improved is our concept. Doctors need to wash their hands and clean the incision site before and after surgery. At least The wounds of the patients I participated in all recovered pretty well.”
"Where's Mr. Li Ben?"
"Li Ben was just an accident." Kawei's face was solemn, regretting his mistake. "The situation was urgent at first, and the carriage would not arrive for another hour. I thought he was about to die and had to be sutured."
"I think his legs can still be saved, just like the Earl."
"I hope he can get through it. If he still doesn't get better tomorrow, I can only debridement him."
Having known Kawei for more than half a month, Ignatz has seen everything with his eyes, and has gradually come to agree with hand washing and cleaning before and after surgery.
He was not one of those stubborn obstetricians who was hypersensitive to patient mortality. Even a 5% difference is already considered a huge gap, but the reality is that the probability of wound ulceration of patients who have been prepared for surgery by Kawei's hands is about 20%, and none of the patients died.
Although the sample size is not large, Ignatz has a hunch that Kawei’s postoperative myth will continue.
The method of compression and hemostasis of the common pelvic iliac artery received some applause, but as a name appeared, the applause gradually became more enthusiastic: "Next is the famous British surgeon, Dr. Lister, the medical pioneer who fought against Nightingale. At the right time, our Vice President Edinson will read out his latest research report to us."
Because of some comments related to surgery, Nightingale has become the target of surgery.
She has indeed received a lot of recognition in the UK, but she is "notorious" abroad, especially the Austrian Department of Surgery, which has always been conservative.
Originally, Ignatz only classified her into the ranks of ordinary women, with at most some small achievements, and his basic attitude was disdain. Now, because of the increasingly outrageous "hospital demolition theory", Ignatz had to oppose Nightingale, because no one wanted to move to the countryside and be surrounded by mountains, rivers and farmland every day.
Without cadavers, no medical school teaching sites, and not enough sources of disease, leisure will be the chronic poison of every surgeon striving for the top.
Therefore, the voices of opposition are rampant. Unfortunately, in Vienna, Austria, they can only live with their mouths. It is the British surgeons who really have high hopes for the entire surgical community.
And Liszt is the most famous one.
"What I bring this time is the judgment made by Mr. Lister after reading the public research of a French chemist..."
Edinson looked at the two report papers in his hand with a particularly complicated mood. Narrating the next paragraph may be more difficult than reading the Austrian defeat report: "Everyone, Mr. List, he still admitted that the surgical trauma in the big hospital was caused. The chance of ulceration is extremely high.”
"What?"
"What a joke!!!"
"Even he backed down? Doesn't this just allow that crazy woman to succeed?"
"Oh, it turns out that the British are unreliable."
"Is he still a man? Where is a man's ambition???"
Kavi, who was born in modern times, has difficulty understanding their way of thinking.
It was just an admission of a fact that had already been confirmed, but the situation got out of control. It felt like a boxer they had supported for a long time suddenly gave up on the eve of a decisive battle with his destined opponent, which was hard to accept.
"Everyone, please be quiet! Please be quiet!!!" Vice President Edinson tried his best to maintain order in the venue. "We still have to face this reality objectively. There is actually room for change and things have not become worse. .....”
"Oh forget it, Edinson, the truth is already bad. I feel like the hospital in Vienna will be demolished soon to make room for those factories."
"Are we, the most prestigious surgical professors, allowed to open barber shops in rural areas?"
"I don't want to go to the countryside..."
Facing the doubts of his colleagues, Edinson had to raise his voice: "Although Mr. Lister temporarily acknowledged Nightingale's point of view, he raised another possibility. As I said just now, he was I said this after reading a research report by a French chemist."
"Who? What's your name?"
"Um..." Edinson glanced at the name scrawled on the report paper, "named, Louis Pasteur."
"do not know."
"Chemist? Is there any connection between chemists and surgery?"
"We are neither pharmacists nor physicians. How can chemists control our scalpels?"
These were just objections based on existing theories. Soon these voices became less harmonious: "After reading a French research report, an Englishman actually admitted that a woman was crazy. , you taste it, taste it carefully!!!”
"It's over. The right to speak in the Department of Surgery has actually fallen into the hands of these people..."
"sorrow!"
"I feel like surgery is going to be over."
Edinson was afraid of this situation, so he strongly opposed Waterman's inclusion of this report in the program.
Facts have proved that his judgment was correct. It is difficult for these men who wield scalpels every day to accept the guidance of a woman, let alone the submission of other male doctors: "Please be quiet, can you wait until I finish speaking?"
The title of deputy dean still gave him some time.
"Don't easily substitute nationality into scientific research. This will narrow our vision. We still need some different remarks. This is good for both parties. At least Mr. Pasteur also believes in Catholicism."
The sense of identity brought by religion provided Edinson with the opportunity to quickly explain the main content of the paper: "Dr. Lister was looking at a copy of Pasteur's "Records on Lactic Acid Fermentation" published a few years ago. He first It was proposed for the first time that 'the essence of fermentation is actually the metabolic activity of microorganisms'."
"microorganism?"
"What microorganism?"
"It's the smallest creature in nature."
“He overturned the theory of spontaneous generation of microorganisms.”[7]
Edinson said: "Obviously, Dr. Lister also agrees with this view, believing that the closed environment of the hospital caused the growth of microorganisms in the air, and finally formed a toxic miasma. Although this has brought huge controversy, it also takes time and a lot of experiments to verify it, but at least it gives us a chance!”
It is better to keep windows open for ventilation in the hospital than to demolish the hospital directly.
This rhetoric somewhat stabilized some public opinion in the court, at least letting them know that Liszt had not completely compromised. He's still looking for a breakthrough, and the battle between surgeons and nurses is far from over.
But they are also human beings, and they are also affected by their inner feelings, which greatly affected the subsequent "Cleft Palate Repair" speech. 【8】
The speech was almost interrupted until the surgeon from Graz Hospital left the venue angrily, causing the venue to become quiet.
"Who's going to call Dr. Heydrich back?"
"Forget it, it's just a cleft palate repair..."
"Time waits for no one, let's finish the report quickly."
"Who's next?"
Edinson glanced at the program list and said: "Next, we invite Professor Ignatz from the Municipal General Hospital, who is also the deputy dean of the College of Surgery. What he brought to us was a program composed by himself and his assistant Kavi. A new cleft lip surgery technique developed together. It is said that this new technique can further reduce scar contracture after surgery."
－－－－－－Digression－－－－－
The content of these two chapters is a bit difficult, 88 should be in the middle of the night, or tomorrow morning
