The development of amputation is actually a microcosm of the development of surgery, which can be roughly divided into four periods.
The earliest amputation was done with an ax and a saw, and the aftermath was done with a soldering iron and boiled oil. There is no myocutaneous flap embedding and no suturing. Cutting + burning is the entire process of amputation, and it will not take more than three minutes, because if it is delayed for too long, the blood will dry up.
Later, with the development of anatomy, legal hemostasis methods emerged, and sutures began to be used instead of soldering irons. At least secondary injuries were eliminated, and the speed of surgery also began to slow down. However, there is still no anesthesia during this period, and the doctor still has to consider the patient's heart-rending screams, and the operation needs to continue to be performed at a high speed, in and out quickly.
After the onset of anesthesia, "tree-cutting" began to slowly develop into "carving", and everyone, including Ignatz, who was known for his speed, was slowing down intentionally or unintentionally.
In modern times, surgery has long become synonymous with precision operations.
If someone carefully counts the infection rate of surgical incisions before and after the popularization of anesthesia, it should not be difficult to find that after the advent of self-proclaimed anesthesia, the chance of surgical incision ulcers has further increased.
Although rapid surgery is rough, it can reduce contact, thereby reducing bacterial colonization, and has a certain preventive effect on postoperative infections. Once the operation slows down and the doctor's dirty hands are in contact with the incision for longer, the chance of infection naturally increases.
That's why Ignatz, who performed the surgery quickly, was able to stand out among the dwarfs and control the mortality rate below 40%.
Of course, the doctors in the audience certainly couldn't understand the logical relationship and only thought it was purely a technical reason. Because Ignatz's surgery is indeed very entertaining, the range of movements, hand speed, frequency of explanations, and the amount of bleeding from the patient's incision are all controlled in a perfect dynamic balance.
Even Varela, who complained about his reluctance to innovate, must admit this.
There is really nothing to criticize about the surgical procedure. The only thing that can be criticized is his innovation.
But Kawei's surgery gave his colleagues a different experience, a sense of refinement after completely abandoning speed. After cutting off a huge left leg, the bleeding was only left in a few pieces of gauze. The floor was clean, the leather skirt was clean, the shirt was clean, and even the operating table was not stained with much blood... ..
But this experience seemed a bit advanced to another non-medical person present.
Since Varela missed Kavi's cesarean section last time, she has not lost her job but her status has dropped a lot. Now she is on an equal footing with the later junior Greg.
The number of reporters stationed in the surgical theater of the daily newspaper has become two, but the amount of expenses given is still one person. Greg was the one who was personally recommended by the editor, so naturally he couldn't lose his share. The two of them could only split the money in half and tighten their belts to get by.
With less money, Varela could not watch all the surgeries. Except for some must-see ones, he could only stay in front of the theater every day to pick up bargains.
After picking it up, who would have thought that he would pick up Kawei's amputation.
Extra surgeries early in the morning usually occur when little-known doctors need a large venue. For surgical celebrities like Kawei, performing surgeries at this time is almost like doing charity.
Because there were so few people watching, the ticket price was set at a flat price of 20 kronor, which was too cheap. And the most critical point is that Greg, whom Varela has been thinking about kicking out, is not here, and he writes exclusive reports.
"The speed is too slow..."
Since he was thrown out of the theater by Kawei last time, he has learned a lot and knows that some thoughts should not be spoken casually. But no matter how patient Varela was, he really couldn't appreciate an amputation that lasted more than 40 minutes.
Kawei used a large piece of gauze soaked in carbolic acid to cover Li Ben's stump, with Meren and Berg pulling it on both sides, leaving only a small section of the femur exposed.
The whole place was filled with the sound of files rubbing bones, sometimes high-pitched, sometimes low, sometimes making long sounds, sometimes being chopped into fine pieces. Kawei is like a carpenter, carefully polishing his work.
Varela felt panicked. He finally found an opportunity for exclusive reporting. Are you going to show me this?
He had a lot to say, but due to the situation, he could only find Ignatz and Hills in the end: "Professor Ignatz, don't you think Kawei's surgery is too slow?"
"It's indeed quite slow." Ignatz did not deny it.
"What do you think, Dr. Hills?"
"very slow."
"If this spreads out, wouldn't it disgrace the Austrian Department of Surgery?" Varela was so bored that he couldn't help but offend Ignatz, "Professor Ignatz, he is your student. "
The implication is too obvious. It is really unreasonable that a surgeon who is famous for his hand speed should teach such a slow student.
But judging from Ignatz's expression, he didn't feel too uncomfortable: "Mr. Varela, you have never studied medicine or had any surgery, so you don't understand."
don't know? ? ?
Varela has seen too many surgeries, and he prides himself on being unskilled but with a sharp eye. Since Ignatz wants to protect his shortcomings, he should find a breakthrough from Hills. He had just been squeezed out of his job by Kawei, so he would definitely have a different perspective.
"Dr. Hills, what do you think?"
"Me?" Hills thought for a while, "I agree with Teacher Ignatz's opinion. A layman cannot understand what Dr. Kawei did."
Varela didn't understand: "I've never seen an amputation that slow."
"Mr. Varela, you still don't understand the meaning of surgical speed." Ignatz has the most say on this, "Why does surgery have to be fast?"
"The sooner the surgery, the better it will be."
"How do you define beauty? How do you define surgery?" Ignatz continued to ask, "In your eyes, is surgery just a process of going under the knife?"
Varela was confused again: "Isn't it?"
"Of course not." Ignatz said with a smile, "The reason why the speed is increased is because some accidents can be avoided by simply increasing the speed. When anesthesia is unstable, slowing down will be very troublesome. But at the same time, increasing the speed will also There are a lot of other troubles that can occur, like bleeding.”
"Dr. Kawei has now given up speed and focused all his energy on stopping the bleeding." Hills stood up and performed the surgery. "This is a path we have never taken before."
Only then did Varela discover the strangeness of Kawei's surgery. There was no blood at all.
etc!
The entire thigh root is extremely rich in blood vessels. Can amputation really prevent bleeding at all?
"So, it's not that Kawei's speed has slowed down, but that the surgical content that needs to be processed is much more than traditional amputation, so it seems slow." Ignatz said the essence, "The fact is that On the contrary, Kawei's speed is not slow at all when doing fine sutures to stop bleeding at a specific point."
Varela finally understood what the two meant.
These two think from the perspective of doctors, but they view the surgery more from the perspective of patients and viewers.
"Everyone, half an hour has passed since the operation. I have smoothed the broken end of the femur. It will not cause too much stimulation to the myocutaneous flap at the anastomosis." Kawei handed the file to Sarson and took the suture. thread, continuing his narration mode, "Next, I will suture the muscles and skin layer by layer. This amputation has come to an end."
As soon as he finished speaking, Kawei lowered his head and started suturing again, wrapping all the severed femur, blood vessels, and nerves inside.
"Spending so much time grinding your femur just to reduce irritation?"
"At that time, there was a problem with the choice of amputation plane. If the entire femur was removed directly, there would be no need to grind the bone." Hills still had a different view. "In the end, he just wanted to be able to wear a prosthetic limb in the future, so that the residual limb would be It needs to bear the weight of the body, and it’s really not good for the bones to be too sharp.”
"Hiles, you missed the swelling at the incision after surgery."
"Well...it's true that the swelling after surgery will also touch the fracture."
In Varela's understanding, surgery is a treatment method to cut off the diseased area, and it is also a form of performance. As long as it is cut quickly, sewn well, and wins the applause of the audience, that is the true meaning of surgery.
He had never thought that in amputation, the ability of the residual limb to use a prosthetic limb should be considered, as well as the patient's post-operative pain in the residual limb. Likewise, he had not thought that surgery would need to control hemostasis to such an extent.
Isn't surgery the art of cutting? Does it still need to be so forward-thinking?
An amputation often takes forty minutes. Half of the time is spent on stopping the bleeding and half on grinding the bones. What else is there to enjoy?
What the audience wants is the splash of blood when the flesh is cut, the blood is like the sand in the hourglass. The surgeon's face was solemn, and he was racing against time every step of the way. At the same time, he had to find time to explain to the audience. There was a tense atmosphere inside and outside the theater...
But now?
The blood is gone.
I don’t know where to start talking about dignity. At least Kawei’s face looked calm and calm, as if he was dissecting a corpse, without any pressure.
"The operation is complete."
Kawei sighed softly, and he gently threw the suture needle into the sterile water basin: "The skin is perfectly aligned, and the sutures are tight and tight. Give me carbolic acid."
After washing with a large amount of carbolic acid, Bergert and Mellen both bandaged the stump of Li Ben's left leg with a bandage. A somewhat boring amputation ended in this way, and when the cleaning staff entered the theater, they thought they had entered the wrong room.
They had never seen such a clean operating table and floor. It was so clean.
"If Dr. Hills doesn't mind, there's really no need to wash it." Kawei put the bloody gauze into the bag, "But there are some blood stains on the sheets, so they should be changed."
"I do not mind."
Hills walked out of the auditorium and wanted to talk to Kawei about the surgery just now. Unexpectedly, Varela jumped out first: "Dr. Kawei, how do you evaluate the amputation that was just completed?"
"evaluate?"
Kawei often made self-evaluations in the past: "It's not bad, it's just an amputation, it's not difficult."
"No, you may not understand what I mean." Varela emphasized, "What I want to ask is, why do you treat an amputation like this? Why do you work so hard to stop the bleeding? And the final stage of grinding Bones, it takes too much time.”
"Patients need a lot of nutrition to recover after surgery, and blood loss is not suitable for postoperative recovery." Kawei explained while cleaning his hands, "The bone grinding is for the prosthesis and to prevent the stump from swelling, which will further cause The ulceration of the incision.”
"That's all?"
This time it was Kawei who didn’t understand: “What else?”
"You're too slow."
"oh......"
In fact, in Kawei's mind, since he came here, his operation speed has also become much faster. In the past, the amputation speed was controlled to be within one hour, which was already very good, but now it has been reduced to 50 minutes.
"Slowness also has its advantages."
"Have you never thought about the feelings of the audience?" Varela said, "Those nobles, those big and famous people, they are not here to see you grinding bones, nor are they here to see you suturing blood vessels one by one."
Kawei shook his head: "Are you mistaken? Surgery is to treat patients, not for performance. I also have my own surgical style, whether they like it or not."
"..."
Varela said it very bluntly, but this was a true portrayal of the surgical environment in the 19th century. If Carvey's surgical methods were followed, the surgeon's income would plummet. No one wants to pay hundreds of kronor to see several heads operating over a small incision.
So boring.
"You misunderstand, Mr. Varela."
Kawei threw the surgical instruments he had just used into the carbolic acid basin and slowly cleaned them: "The quality of the surgical treatment has its own public opinion, and the patient's post-operative recovery is the best answer. At the same time, I also feel that no doctor will We deliberately reduce the patient's surgical results for the sake of ticket revenue. What's more, more than half of the ticket revenue never goes into our pockets."
...
Originally, many people, including Varela, wanted to see if Kawi would set another record for the fastest amputation. It is entirely possible for a young man with such talent to learn from the sharp knife player Ignatz that his hand speed exceeds that of his teacher.
But now a small amputation was performed in another way by Carvey. This not only made Varela confused about the future of surgery, but also Hills on the side.
Hills had to admit that Carvey's amputation deeply affected his original surgical plan. Should the incision be made in the upper abdomen or lower abdomen? Is it a midline longitudinal incision, or is it a direct transverse incision? During the approach, should you stop bleeding along the way, or should you keep it as it is and go straight into the abdomen?
He was now looking at the clean operating table and listening to Kawei's interview on the side, and all he could think about was stopping the bleeding. Just like a game player who is eager to try a new way of playing, he can't hold back his hands.
"Dr. Hills, the patient has arrived in the preparation room." The host walked into the operating theater at this time, "Do you want to go and take a look first?"
"Oh, okay, I'll be there right away."
"He has a bad cough now. Do you think we should give him some yam tincture to relieve his cough?"
Before Hills could respond, Kawei, who was still struggling with Varela, suddenly turned around and asked: "Huh? Teacher Hills, isn't your patient going to undergo laparotomy? Why is there a cough?" ?Is he an elderly patient? Or a frequent smoker?"
