Tracheostomy surgery was very rare in Europe at that time, and France did more. In Austria, which is extremely conservative in its approach, it would be great to meet two or three people who are willing to undergo such a bold surgery.
Ignatz's surgical style was bold enough, but he still maintained a conservative attitude toward tracheostomy. If Laszlo hadn't been too important to the country, he wouldn't have tried to take action as a last resort.
But even in France, doctors mostly describe the complications of tracheotomy as bleeding, violent coughing, tracheal tear, posterior tracheal wall injury or simple anesthesia accident, etc. There have never been reports of a face swollen into a pig's head. .
Moreover, the patient in Damirgaon had a problem not only with his face, but also with swelling from his face to his neck, all the way down to his urinary bladder and thighs, as if an inflatable needle had been inserted.
"Although he was already dead at that time, I still wrote down the process and symptoms..."
He turned to his record page and began to speak: "I was in a hurry because the patient was breathing very quickly and was in pain. I quickly cut his neck, separated the tissue all the way down, and then quickly cut the trachea. I don't care how much bleeding there is, or whether the tip of the knife accidentally hurts me, I just put the horn in first.
Because it was my first time to perform chitomy, really, it was my first time, and I only had one apprentice as my assistant. I saw that the patient had some relief, and then I started to suture the skin. It was during the sutures that he seemed to swell.
It starts on the neck and then spreads to the face. I looked a little confused and didn't know how to deal with it because I had never seen this situation before and it was never taught in the textbooks. But...but soon there will be no need to be confused. "
The patient died simply and as everyone expected.
If the fever does not improve for a long time, and then difficulty breathing occurs, in fact, even if the breathing problem is really relieved by tracheotomy, the patient will probably die of the disease in the end. What they don't understand is the swelling. Why does the body swell after the trachea is cut?
This curiosity prompted the prestigious doctors in the audience to ask questions.
"Is there any inflammation? Are there any rash patches?"
"Generalized subcutaneous mucositis?"
"I assume it's a hematoma?"
"It could also be miasma! If the fever is so severe, the miasma in his body must also be serious!"
Faced with a situation they had never seen before, Ignatz and Massimov, the two heavyweights in the anatomy world who had just stepped down, quickly had their own answer: "It should be air."
"Air may have penetrated under the skin, just like a pneumothorax where air enters between the pleura and the lungs."[1]
The two of them gave the same explanation. Faced with the conflict between theology and medicine, they just looked at each other without saying much. For them, the key point of contention is the line between human and divine, and there will be no dispute over a diagnosis that is already clear.
There is another person on the field who can be at the forefront of medical treatment and knows the truth clearly, Kawei.
He knew very well that this was one of the common complications of tracheostomy, subcutaneous emphysema. It's not uncommon, sometimes even pulling out a tooth can swell the face. As long as the sutures are tied loosely, the air will leak out within a few days, and no special treatment is needed. 【2】
However, each complication has specific factors. It is a common complication in modern times, but it was not necessarily the case in the 19th century.
Some complications cannot occur casually.
As the name suggests, subcutaneous emphysema occurs when air enters the subcutaneous layer and is trapped inside, unable to escape. This is why emphysema occurs. A considerable amount of emphysema occurs within 1-7 days after tracheotomy. At this time, the epidermis begins to heal and the air cannot escape, causing emphysema to appear.
But the patient in Damirgaon developed emphysema on the spot, which means that the skin was sutured tightly so that the air entering the subcutaneous area would accumulate under the skin.
Especially for such exaggerated emphysema, the skin must be sutured very tightly, so tight that not even a little air can leak out...
Kawei glanced at Ignatz, and then thought about Hermann, Bergert, and others who can be used in surgery now. In fact, their suturing skills are not very good, and there is no way to achieve this level. Could it be that Damirgan's suturing skills have surpassed Ignatz's?
And this is just one of them.
Because after tracheostomy, air should enter the trachea through the horn tube and tracheal incision and should not leak into the subcutaneous tissue. To form subcutaneous emphysema, in addition to preventing air from leaking out, you also need to give the horns and trachea a chance to leak air.
To achieve this, the tracheal incision must first be opened wide. When the diameter of the horn does not match the length of the tracheal incision, gas can leak out, a common mistake that novices like Damirgaon make.
The other point, which is also the point that Kawei is concerned about, is the separation of the soft tissue in front of the trachea.
Modern tracheostomy requires the separation of soft tissue, to avoid unnecessary damage, and also requires ligation of blood vessels, which creates a basis for the occurrence of subcutaneous emphysema. But there was no such requirement in the 19th century, and many surgeons rarely separated soft tissues in order to speed up the process, or even did not separate them at all.
For example, Ignatz didn't do much separation at the beginning. He cut into the skin with one knife, and when he found the trachea, he was ready for the next knife.
In this case, when the horn tube is inserted, the soft tissue in front of the trachea actually covers it, which plays a role in locking the air. In principle, it is difficult for air to escape.
There is soft tissue sealing on the inside and inadequate suturing technology on the outside. Subcutaneous emphysema should not have occurred during tracheostomy in the 19th century.
Therefore, Damirgaon must have separated a lot of soft tissue during the tracheotomy, which is a good practice in surgery. Especially for those delicate surgeries, there will often be a lot of trouble if the soft tissue is not separated.
In addition, he only spent a total of three minutes from incising the skin, separating the soft tissue, incising the trachea, inserting the horn tube, and then suturing the skin. Leaving aside the emergency suturing of blood vessels, in terms of time alone, it has even surpassed Laszlo's tracheostomy machine.
He has the courage to perform a tracheotomy, his hands and feet are quick, and his skin is sutured tightly enough...
Perhaps in terms of medical experience and academic qualifications, Damirgaon is incomparable, but these three points far surpass Hills and Herman. Kawei suddenly agreed with the approach of Graz Hospital. Poaching was indeed the fastest way to improve the soft power of his own hospital.
"What's wrong with you?" Ignatz looked at Kavi suspiciously.
"Um, it's nothing." Kawei smiled and looked up at Damirgang, who was still stuttering on the stage. "Teacher, which hospital is he from?"
"I heard it's a small clinic in the east of the city. It usually doesn't have many patients, and there's no teacher to take care of him. I just rely on the bit of anatomy I learned in medical school and the techniques I've learned on my own, and that's basically it."
Ignatz did not mean to despise the other party. He just looked at Damirgang objectively from the perspective of a high-ranking person in the medical field: "You have already graduated with a master's degree, and you jumped out of the car to go to the clinic. Even going to Hartmann Hospital is worse than 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 failed air cutter."
Kawei wanted to try to excuse him, but soon realized that Ignatz had the same experience, so he immediately dropped the topic: "Teacher, don't you think we are short of people in the Department of Surgery now? Teacher Hills is no longer here, can you?" It’s just me and Herman, it’s very tiring.”
"Isn't there still Berget? He'll be back the day after tomorrow."
Carvey knew he would say this: "What if I go to medical school?"
"this......"
Ignatz had forgotten all about it.
After all, it is also the Municipal General Hospital, the largest hospital in Austria. Even if there are not more than three surgeons, the number of surgical patients is already the limit. And the medical school is full-time. Even if Kawei can go back to the hospital to help at night, Ignatz and Herman need to face it all day long, which is obviously too difficult.
"You said you want to recruit people?"
"We must recruit someone with a cheap salary and who can help with the surgery." Kawei raised his chin to Damirgang, who had packed up his manuscript and was about to step down. "Give him half of Teacher Hills's salary." , he will definitely accept it happily."
"It's hard to say. If the clinic stays busy for a long time, it will be difficult to keep up with the pace here."
Ignatz did not have Kawei's keen sense of smell. In his eyes, Damirgang was just a small clinic doctor who needed skills but no skills and a degree but no degree, so he was still a little hesitant: "We'll discuss this later. Well, I’m on stage first, and next is the Earl’s groin.”
Kawei stood up and made way for his seat, sending Ignatz away. At the same time, he stopped Damirgan who had just come down: "I'm sorry, I have something to ask you."
"Please teach me?"
"Well, it's about pneumothorax."
Damirgang was a little surprised, because in his opinion, everyone in the audience should look down on him.
It's not like he hasn't competed with Kawei before, and he's prepared to use this to comfort himself. But surgery always only looks at the results. Kawei's tracheotomy was successful, but his ended in failure. What's more, Kawei not only has a tracheostomy, but also a cesarean section and the last compound trauma suture.
"I have said everything I can say." Although he was still a little evasive in his words, he naturally sat next to him under the guidance of Kawei. "Doctor Kawei, what do you want to ask?"
Kavi lowered his attitude first: "Dr. Damirgaon's suturing skills must be very good."
"Huh? Why do you say that?"
"It was just my intuition. The tracheostomy incision was sutured in three minutes, which is already very good."
"I don't know if it's good or bad. Anyway, many places in the east of the city are not peaceful. There are fights every day. The injured will come to me to stitch their wounds." Damirgang explained with a smile, "Maybe practice makes perfect."
Ignatz on the stage has already started to talk, and Kawei is also unequivocal here.
The question about tracheostomy surgery was just an introduction. What he wanted to ask next was the core: "By the way, how long has it been since you graduated?"
teacher?
This was the first time that Damirgaon was called teacher. His attention was instantly attracted by this title, and he answered simply: "Five years... uh, no, it's been six years."
"I remember that the teacher had a master's degree at the beginning. He should be able to graduate with a doctorate in one or two years. 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 had no choice, "By the way, why do you always call me teacher? I'm just guessing, Ka Why is Dr. Wei asking me this?"
"Oh, I'm just asking."
Damirgun sighed, quickly took out his notebook and began to listen to Ignatz's speech attentively. In just half a day of meeting, he had already recorded a lot of things in his notebook. In comparison, although Kawei also had a notebook in his hand, the pages were much deserted.
This studiousness once again impressed Kawei: "By the way, I'm actually quite curious...
"Shh~~~"
Damirgang made a silent gesture and said softly: "The following surgeries are both difficult and exciting. Professor Ignatz speaks too fast, so I have to take careful notes. .”
Kawei smiled when he saw his answer and suddenly asked: "Are there also inguinal hernia patients in small clinics?"
"Of course there are, there are quite a few." Damirgang replied while looking at the drawings that Ignatz took out, "This is not a rare disease, I have received four hernias this month alone. "
"It's indeed quite a lot...So, you also want to have hernia repair done in the clinic?"
This stopped Damirgaon.
Groin surgery is not tracheostomy. The clinic facilities are simple and the venue is much smaller. The key is that there are no assistants. Without nurses and interns, it would be impossible for just two people to treat inguinal hernias. This would be difficult for modern general surgery, let alone the 19th century.
Putting these factors together, Damirgaon had a zero chance of having inguinal hernia surgery and a zero success rate.
Unless he is as lucky as Ignatz, and not only has a fearless patient like Morasso, but also an assistant like Kavi, can he barely complete this operation, otherwise... .
"It can't be done. I definitely can't do it alone."
Unknowingly, Kawei's questions began to become more pointed, and until the end they were slightly questioning: "If this is the case, why do you need to learn these things?"
"I'm just curious about a surgery I've never had."
Kavite knew too much about medicine and surgery. Without a suitable source of disease, it would be difficult for doctors to maintain their technical level. If you want to maintain your ability at a high level, you must rely on a lot of practice. Curiosity alone cannot sew up subcutaneous emphysema.
"That's it. It seems that Mr. Damirgaon 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?"
Damirgaon hesitated for a moment and nodded: "I don't have that ambition."
"Don't be ridiculous, I have never seen a surgeon who is not ambitious." Kawei smiled and exposed his lie, "Besides, if you have no ambition, why do you have a gas that is almost impossible to use in a small clinic?" What about cutting the horns? Most of the horns on the market are made of silver, which is not cheap."
