The entire regular meeting seemed casual, but there was Waterman's little deliberateness everywhere.
First, Lister and Nightingale introduced new concepts of surgical disinfection and care, and then arranged several new surgical trends that seemed good, but they were not allowed to be selected for the afternoon surgical report because the patient died of postoperative infection.
Postoperative infection, also known as incision ulceration, is very common and no one cares about it during the process.
So in the end, Waterman deliberately opened the game with Ignatz's groin strangulation hernia, and then added in his own purulent osteomyelitis of the mandible. Both patients have severe inflammation in their bodies. Generally speaking, conventional surgical incisions are bound to ulcerate, but there is just more rottenness and less rottenness.
But both operations were successful. Morasso had some twists and turns, but the situation was reversed in the end. Both patients' incisions healed and both patients survived.
The facts are already in front of us. Something must have blocked the miasma in the air, which prevented the incision from festering.
Seeing that the surgeons who only wanted to improve their surgical skills had no response to the ulceration of the incisions, Waterman had no choice but to rely on Kawei to advance his intentions.
He knew that Kawei wanted to promote preoperative disinfection and various postoperative care work, which happened to coincide with his own ideas. The other party was also a "master" in abdominal surgery. Letting him be the first to ask about disinfection and care can also help share some of the firepower of conservatives.
Of course, the questioning method also requires some skills. According to Waterman's idea, the best questioning content should be like this:
[Why do so many patients die from incision ulcers, but a syphilis patient who has always been weak can still avoid ulcers in her large incision after undergoing such a severe and complicated operation? ]
After a simple question and answer, Waterman was able to point out that he was trying to imitate Lister's method of using cotton wool soaked in carbolic acid to protect the wound. 【1】
Once the answer comes out, combined with the debridement of Count Morasso's groin, it will not only promote this kind of care, but also pave the way for Carvey's upcoming appearance on the stage...
Make a foreshadowing...
bedding......
How to lay the groundwork now?
What a foreshadowing! ! !
You are here to disrupt the situation, but you are not allowed to disrupt me as well. This sentence came out of nowhere, how do you want me to answer it?
Saying that you were right saved your face, but what I did was wrong. If you say what you said is wrong, I will completely lose my face, so what can I use as an excuse?
Waterman heard questions that were completely different from what he expected, and his mind, which was full of disinfection methods, went blank and almost restarted.
What kind of ivory is the mandible made of? Still silver...
Although he was surprised and didn't follow the idea at first, Kawei's modern idea of using other materials to replace bones had never been mentioned before, and it was very new. This curiosity secretly activated his surgical thinking, and he began to think about the feasibility of this approach without his own control.
Cut off the mandible and then make a brand new one?
This is not rhinoplasty. Just get some skin from the side and piece it together. Bone replacement is unheard of, is it really possible to use other materials for filling?
How to do?
Waterman was stunned in front of the podium. There were all kinds of discussions caused by this topic in the audience. Because the dean never responded to express his position, it was so noisy. "It's expensive", "wound inflammation will be more serious after filling", "what to do with the joints", and "how to fix it" are all the focus of the discussion.
But Waterman's mind was unusually quiet, as if the quarrel between these people had nothing to do with him.
If you really want to make a replacement, do you have to measure the length, width and height of the patient's mandible first?
No, the infection site is different for each patient, and the site to be surgically removed is different. This machine happens to perform complete mandibular removal, but there are many patients whose infection is limited to one side, or only to the distance of 2-3 teeth. At this time, it is time to perform precise resection.
Does precision resection mean on-the-spot sculpting?
Then do I have to find a famous sculptor to wait in the operating theater? Wait for the mandible to be removed during surgery and then compare the size?
It would be even more outrageous if it were to be replaced with a silver one. You would have to make an inversion mold first, and then...
Years of surgical work have made him accustomed to dealing with problems from various angles. Once he reaches a dead end, he will think of other ways.
No, wait!
Why does this kind of thing have to be done on the spot?
Waterman's idea went back to the beginning. He measured the length, width and height of the patient's mandible in advance, and then temporarily made an entire mandible according to these dimensions. Then, after the operation begins, temporary cuts will be made according to the removed area and size.
Yes, intercepted on the spot!
In this case, the only material is ivory. 【2】
If ivory can fill the mandible, then the maxilla can certainly do the same. Perhaps patients with bone and joint fractures can also use ivory joints to make new joints?
mandible... ivory...
The mandible is quite large, and the ivory is long and strip-shaped. Are the tusks that thick?
Or do it separately, half on the left and half on the left.
If the entire mandible is cut off, then the left and right parts are spliced. If only half of the mandible is cut off, it can be used, and the remaining half can be left as a souvenir to the patient. If the other party doesn't want it, it can be reserved for those poor people who don't have money to make mandibles.
For poor people, it is definitely better to have a new mandible than to have an empty chin. As for whether it really matches their face shape, it is no longer important.
In fact, as long as the more materials are accumulated, there will be more room for choice, which means it will be more difficult when you first try.
It seems like you can try it! ! !
Under a question from Kawei, Waterman had a new idea about cotton plastic surgery and even bone and joint plastic surgery. Ignoring the chaos in the audience, he kept a straight face and quickly sorted out all the materials, then stuffed them into his bag.
Waterman didn't say a word, he simply said hello to the host on the side and hurried off the stage and left the venue. Ignatz, Kavi, and all the surgeons on the field were dismissed as air.
"The dean was so angry that he left. You should be able to see how outrageous this statement is. It's ridiculous to think about stuffing an entire ivory into your mouth."
"What are you talking about? Isn't it even more ridiculous that someone stuck an ivory nozzle into the steel door?"
"One is sewn into the chin and will never be taken out for the rest of his life, and the other is just an enema. How can this be the same?"
"I think it's cool!"
"Cool P, think about it for a second, how would you feel if your butt was shaved off, then stuffed with ivory, and then sewn shut with thread."
"It's such an exaggeration, can't it also be made of silver?"
"Silver? That weight is stuffed into your chin, you go and eat something and try it! Oh, by the way, there is also the butt that my dear friend said. If the butt is filled with silver, I'm afraid I won't be able to stand up for the rest of my life."
"What this brat comes up with is all weird stuff, and it's not practical at all!"
"Actually, if you stop saying a few words, the dean might not leave..."
The only people in the audience who could really understand Waterman were probably the two vice-deans. Ignatz looked at his father as he left and said with a smile: "Maybe he really thinks that your approach is feasible."
Kawei also didn't expect that he just tentatively threw out a concept similar to "artificial joints" and it became what it is now.
He didn't know when the earliest artificial joints were applied and what materials were used. Anyway, in this era, there is no disinfection and postoperative anti-infection. There is still a long way to go before this type of surgery can be done well.
It's a pity that this determination did not last long.
When the host called him to the stage to explain his cesarean section, Kawei discovered two documents that Waterman had left on the podium.
The above records in detail the various applications of carbolic acid by the famous British surgeon Dr. Joseph Lister, which is not only limited to the application of carbolic acid at the incision, but also uses a pressure pump to spray carbolic acid spray on the entire surgical theater. 【3】
This was far beyond Kawei's expectations, because even he did not expect that the bacteria content in the air could be reduced in this way, which would in turn reduce the success rate of surgical incisions.
And this design is already moving closer to the operating room.
Carvey originally thought that attitudes toward surgical theater would not change much in the 19th century, and that it would be almost impossible to set up a relatively sterile operating room. But who would have known that on the other side of the Taiwan Strait, some people have already begun to introduce the concept of air disinfection.
Of course, if he is more rigorous, Kawei prefers to use "antiseptic" to describe the effect of carbolic acid rather than "disinfection".
However, carbolic acid is too toxic. If it is made into a spray, it will not only cause damage to the surgical patient, but also the surgeon and other spectators present. Chronic poisoning will definitely not be able to escape.
"Everyone, I didn't expect Dean Waterman to leave." Facing the accusations from the audience, Kawei said with a smile, "If I guessed correctly, he should have thought of several ways to make ivory mandibular joints. I’m anxious to go back and try it.”
"Stop bragging about this. What you say casually is unconvincing."
"Yes, instead of arguing with us here, why not just talk about your cesarean section. We didn't come all the way to watch you chatting, but we wanted to really learn some cesarean section techniques. Otherwise, who would Are you willing to sit in the audience and watch you act so arrogant and be annoyed by you?"
"That makes sense, let's just talk about surgery."
Kawei also wanted to do the surgery, but Waterman left these two pieces of paper not just for decoration, but with an obvious intention: You have to continue causing trouble for me!
Thinking that the other party was holding his admission letter of recommendation in his hand, Kawei had to continue working hard: "Before reporting on my cesarean section surgery, I think I still have to put an end to Dean Waterman's surgery."
"Isn't the dean gone?"
"The host has called you, can you please stop wasting time?"
Faced with the doubt, Kawei ignored it and just replied: "The question I just asked is indeed a bit wild, but if you want to say it is completely meaningless, that is not the case. Faced with mandibular resection, the patient's appearance will change. Many changes have taken place. For those who love beauty to the extreme, this method can be tried.”
"Don't be kidding. It's not difficult to resect the mandible. You just need to cut off the muscles and then use the bone saw. It just requires some experience in resection, otherwise you will accidentally damage the surrounding tissue. But you said that you want to rebuild a mandible and put it on It's stuffed in. According to my experience, the operation time will definitely be extended indefinitely, and the incision will definitely ulcerate after the operation."
"So what Dean Waterman is really all about today is pre- and post-operative care."
Carvey took out the two pieces of paper and pointed out Dr. Lister's achievements in this area: "That rhinoplasty must have used similar carbolic acid, using carbolic acid to protect the incisions and prevent them from ulceration."
"It's Liszt again!!!"
"This guy seems to be getting worse and worse since he met Nightingale!"
"It must be another British trick."
Seeing them like this, Kawei still felt that the data should speak first: "Dr. Lister's hospital has regained its vitality, and the mortality rate after surgery has plummeted. Especially for his amputation, the mortality rate has dropped to less than 10%."
"That low?"
"Black and white."
"Impossible! How can the mortality rate of ulcers be so low?"
"So I said, he used carbolic acid to smear the incision and sprayed carbolic acid on the entire operating theater." Kawei knew that they were going to deny Lister again, so he compared it with Waterman's operation, "The director's The patient didn’t show any signs of ulceration, the key is that the girl is thin and weak.”
As long as another person does the same thing, the perception will be completely different.
Of course, Waterman is not strong enough to make them surrender, and everyone is still in a peer-competition relationship. It is up to them to decide whether they agree or not. Medical regulations are not rigid standards in modern times, let alone written into systems and laws.
"Since you want me to talk about cesarean section, I have to mention the incision of cesarean section."
Kawei took out the operation diagram he had prepared and said: "The incision made by Mr. Hills first was in the middle, and the length was more than 10cm. This kind of long incision is usually done on the legs and other parts. The nightmare in the ward lasts for four days and will end with collapse and collapse."
Everyone agrees that the larger the incision is, the more likely it is to become infected. This is why the College of Surgery specifically divided plastic surgery into one.
Because plastic surgery generally focuses on the frontal face, the incisions are small and the blood supply is rich. As long as it is left to an experienced surgeon, the operation time generally does not exceed 20 minutes, and it has a better preventive effect on incision ulcers.
But if there is extensive damage to the limbs and trunk, things are completely different.
"My cesarean section was successful. The main reason was not my surgical skills, but the preparation before the operation."
Kawei explained all the procedures, and then talked about the post-operative care. But the doctors in the audience are still not interested. They firmly believe that they are the most correct, and these useless efforts will only delay their work.
This further aroused Kawei's desire for debate and made this regular meeting go further and further in a strange direction: "Okay, okay, you definitely don't know what my pregnant women did after receiving all this care. .”
"What did you do?"
"A 19-year-old girl who is less than 1.6 meters tall can already chop down two big men with a knife in less than two days after her stomach was cut open!"
