Bleeding, pain and infection are three difficulties in the evolution of modern surgery.
Bleeding can be countered by violent means such as mechanical compression and cauterization. Pain can also be overcome by relying on the patient's endurance and the speed of surgery. Only infection cannot be transferred by will, and there is no effective way to deal with it.
Infections that have been hidden in the shadows for thousands of years have claimed so many lives that after learning the cause of the infection, surgeons have tried their best to fight the infection. Preoperative disinfection, intraoperative masks, hats and gloves, postoperative disinfection, and preventive use of antibiotics are all effective measures to fight infection.
The concept of conventional skin preparation also emerged from the breakthrough of this concept. 【1】
Kawei also wants to adhere to the modern surgical concept and do not prepare skin as long as it does not affect the surgical incision. But Fernan's hair is thick, and after anesthesia, in addition to necessary cleaning, it also needs to be cleaned.
Logically speaking, a razor should not be used [2], but Kawei had large scissors at hand, which were inconvenient to operate. There was also a lot of residual hair after trimming, which was not conducive to the operation. The most important thing is that he has learned the craft from the leather preparation master before and has confidence in his own skills.
Kawei took the razor, lifted the small object with one hand and pulled it in front of him, making the same gesture as peeling sugar cane in reverse.
Five minutes later, after a brief cleaning, Fernand was pushed into the operating theater.
Because the proportion of doctors in the audience has far exceeded that of ordinary people, the host was cancelled, and everything was left to the surgeon himself: "Everyone, what I want to introduce today is a rare case caused by Gao pill cancer. Bilateral breast hyperplasia.”
As soon as they finished speaking, Hermann and Koch lifted the blanket covering Fernand's body, revealing the swollen left vagina and the obviously hyperplasia of the breast.
The two of them cooperated with Amor, who subsequently entered the hospital with anesthesia equipment, and began to perform preoperative disinfection work, while Kawei stood in front of the operating table and introduced the cause of the disease, the purpose of the operation, and the general process.
But before that, he needed to explain the specific situation of the patient.
Because Fernan had previously undergone lithotripsy for bladder stones at the Municipal General Hospital, from a modern medical perspective, failing to detect Gaowan cancer in time was also a mistake. Even considering that basic imaging equipment is not available and the patient does not mention any specific complaints, the doctor should be able to glean some clues from the history.
The patient belonged to Ingenac, and Kawei only went to the assistant's desk to participate in the surgical treatment. He was not responsible for the reception and follow-up.
But Kawei still talked about his shortcomings in the medical response process:
"The patient had undergone cystolithotripsy in our hospital. At that time, the size of the bilateral vagina had changed. However, I did not have any further suspicion, nor did I ask the patient about other discomforts. Now it seems a little inappropriate. I hope everyone can Take this as a lesson and be as detailed as possible during your medical history, and be as detailed as possible.”
In the 19th century, medical history collection was very brief. Even physicians who paid great attention to the detailed history of illness often summarized all the patient's experiences in just a few sentences, sparing words like gold.
But this is obviously contrary to the complex human body structure and physiological and pathological phenomena.
"I have been fortunate enough to see the pathological sections after Gao Wan cancer resection. The entire tumor is very hard." Kawei began to prepare for his surgery again, "The main symptom of the patient is the enlargement of the vagina, and the Gao Wan. The presence of induration, stinging, and swelling was a perfect match for my patient.”
The four surgeons in the four-corner VIP seats have long been accustomed to Kawei's rich experience in the medical field, and are not in the mood to ask questions. Their attention is entirely focused on bilateral breast hyperplasia.
But before watching the operation, one thought kept lingering in their minds: "Is there a connection between Gao pill cancer and breast hyperplasia?"
"I personally think there is a close connection." Kawei looked back at the disinfection progress and explained, "The reason why men are men is because of their unique organs. The reason why women are women is also because of women's unique organs. "
"You mean the uterus, ovaries and vagina?"
Kavi nodded, gave them some time to think, turned around and started washing his hands. When there was a lot of discussion around him, he put on sterilized rubber gloves and held up Fernan's vagina: "His testicles were hit by tumors and gradually lost their function of maintaining a male appearance, so he appeared. Signs unique to women.”
"The function of Gao Pill..."
Doctors in the 19th century did not have the concept of hormones. They only had a visual understanding of the internal organs of the body. They only understood some relatively simple functions, such as the heart pumping blood, the lungs breathing, the gastrointestinal tract digesting food, and the gallbladder storing bile. The womb gives birth to a child.
But the significance of the existence of some substantial organs is too advanced for them. Pancreas? spleen? liver? thyroid? prostate? Gao pill? Ovary? Brain?
Don't know anything.
Because they do not understand the functions of substantial organs, Kawei's two sentences are equivalent to opening the door to a new world.
The first person to react was Waterman: "Do you mean that the two oval things in our lower body are constantly working to maintain male characteristics?"
"Indeed."
Orji nodded repeatedly and agreed with Kawei's statement: "I heard similar arguments more than ten years ago."
"Has anyone suggested it?"
"It's just similar. I remember it was a doctor in France. He was not talking about Gao pills but liver." [3]
"This is the first time I have heard this explanation." Massimov found the point of view very strange, but also very interesting. "If it is like what you said, how does Gao Pill usually work? And how does it rely on work to maintain it? Our physical characteristics?”
"Referring to the internal tissue structure of the human body, I prefer proteins."
Protein was still a very novel concept in the 19th century. It was first proposed by a Dutch chemist. After years of experimental demonstration, it has finally become a consensus recently. This has just become a point of medical knowledge, and Kawei has already made great strides forward on this basis.
"Gao pills produce a protein that the human body needs to maintain our male characteristics..."
"It sounds so weird, my brain can't keep up."
"After you said this, I always feel that these organs are too powerful, and my spine feels cold when I hear them."
The effect of this paragraph is good, at least it can arouse the interest of many people in the audience. If someone can continue to delve deeper with this "discovery" and discover various hormones in the human body for the first time, then they will really enter a new world.
But before that, Kawei still had to draw everyone's attention back to the operating table: "These are just my conjectures. We really shouldn't label the properties of that substance before we have actually isolated it."
There are finally some different voices on the stage.
The source of the voice is Greg, the youngest surgical reporter of the daily newspaper: "But the 'gao pills that determine the male executive thoughts' that you have decided on now are actually labeling the Gao pills with functions."
"You don't think it's due to Gao Wan's work?"
"Although I have never studied medicine, I have read a lot of anatomy atlases and medical textbooks." Because the Municipal General Hospital has newly established a surgical theater, Greg successfully became a full-time employee six months ago and became a resident reporter and observer here. "At least I I don’t think it’s absolute enough.”
"Then how to explain the relationship between Gao pill tumors and breast hyperplasia?" Kawei asked rhetorically, "It is precisely because tumors grow on Gao pills that affect the production of this special substance, and eventually the breasts take over. peak."
"But you still don't have any examples to prove it..." Greg maintained Varela's approach and marked it in the record book, "I'm sorry I can't report it."
"It doesn't matter, the British and German medical journals will publish it."
Waterman saw them going back and forth, refusing to give in to each other, so he could only come out to smooth things over: "Okay, today is a surgical theater, not a surgical academic conference. If you have a dispute, you can continue it after the operation is over. Don't do it now. It’s a waste of everyone’s precious time.”
At this time, the preoperative disinfection has been completed, and we are waiting for Kawei's explanation: "The surgical process: We first deal with the swollen vagina, and then explore the surrounding tissue to determine the boundaries of the tumor to see if it has invaded the right side. After the resection, the surgery It will continue to move to the chest and deal with the hyperplasia of breast glands on both sides.
At the patient's request, I chose a small incision no longer than 5cm to perform mastectomy. "
Fernand's posture was the classic lithotomy position, with Carvey standing in the middle, with Hermann on his left and Koch, who came to intern for work, on his right. The surgical instruments were placed in a metal round basin and placed on the patient's belly.
"The operation has officially begun."
The reason why Kawei sent Fernan to the operating table was entirely because today's gallbladder resection is still at a relatively low-level stage. No matter the incision selection, operating skills, or medication maintenance, they cannot be compared with the 21st century.
In modern times, the chemotherapy drug cisplatin alone can treat the vast majority of cancers. As long as it is discovered early, the 5-year survival rate exceeds 95%.
In the 19th century, the only thing that could potentially cure Fernand was the scalpel. In order to improve the success rate of the operation, Kawei needs to show the most standard gallbladder resection so that the doctors observing around him can make as few detours as possible.
"Today I will choose an incision location that no one else has chosen before: the left inguinal incision."
Kawei found Fernand's left groin and drew a long arc with a knife: "If the patient is undergoing bilateral gallbladder resection, then a midline incision in the vagina should be used. Considering the recovery after the operation, I still choose a unilateral inguinal incision.”[5]
The scalpel points downward, first incises the skin, and then begins to separate the subcutaneous muscles.
They were all routine incision operations. After the internal oblique and external oblique aponeurosis were opened, and with the help of two hooks, the first difficulty in the operation was encountered: "Next, I need to separate the spermatic cord."
Inside the spermatic cord are complex communication channels bundled together with arteries, veins, lymphatic vessels, nerves, cremaster muscles, and vas deferens, which together form the blood pathway of the pill.
Since the spermatic cord needs to be cut off, this spermatic cord must also be cut off.
Cavella opened the external oblique muscles and separated the spermatic cord until near the internal inguinal ring. The vas deferens is first separated, ligated, and cut off slightly below the inner ring, and then the spermatic vessels are clamped and cut with a new type of vascular forceps, and chromium-containing chromium catgut is used for penetrating sutures to prevent the blood vessels from slipping and bleeding. 【6】
Orji specializes in urology and has some objections to Kawei's pill removal method: "Why take the long route to the groin?"
"Personally, I prefer to cut off the back route first and then lay siege." Kawei applied the hormone analogy to tumors again, "Tumors also grow in our bodies, so why aren't they a different kind of organ? But its work will have many side effects.”
In an environment where the understanding of tumors has not yet entered the microscopic field [7], this view once again refreshed everyone's understanding.
"Can tumors control our bodies?"
"It's not impossible. Cancer patients are often very weak and will lose their lives in a short period of time." Kawei's fingers followed the exposed and separated spermatic cord all the way down into the vagina, outside the tunica vaginalis on the testicular wall. Separation, "Just because they have the properties of organs, you must be careful whether cutting or separating..."
As he spoke, he pulled the entire contents out of the incision. "Give me the vascular forceps." Kawei took the forceps, and Herman pushed down the empty vagina, exposing the connecting tape between the penis and the bottom of the vagina. "Fortunately, the tumor is not too large. There is no adhesion around the vagina. If adhesion occurs, this part of the vagina needs to be removed together." [8]
The operation quickly came to an end under Kawei's superb operation.
"After the resection, we still need to briefly observe the internal space to see if the tumor has invaded the other side of the gao pill... Fortunately, no tumor has been found on the right side yet, and the gao pill resection operation was successful."
Then came the three-piece set of hemostasis, suturing, and drainage performed by Hermann.
He needs to first make a small incision at the bottom of the vagina, put in a small piece of rubber tube, and then suture the external oblique aponeurosis and skin incision in the groin. 【9】
Kawei and Koch happily came to the pathology examination table with the freshly cut left ovary pellet. Pathological examination is the gold standard for determining the final diagnosis. Pathology must be performed as soon as possible after removal of a suspected tumor.
Kawei used a knife to make pathological tissue sections, while Koch on the other side set up the microscope at the beginning, and then rummaged through the cabinet on the side: "Dr. Kawei, where is the stain?"
"It's in my suitcase."
Koch quickly found a bottle of blue dye inside: "Hey? Why is it blue?"
"Oh, the blue dye I got from a girl is of pretty good quality." Kawei looked back at Orji and asked with a smile, "What's wrong?"
"Can blue dye also stain tissues?" Koch had a strong interest in chemistry. Even his job after graduation was at the Berlin Institute of Chemistry, so he was familiar with dyes. "They are all used in Germany." The artificial dyes used are generally yellowish or purple-red." [10]
"Oh, HE staining." Kawei had no idea about the history of the dye, but it was easy to tell from the color that it should be HE staining. "Actually, it was originally prepared to find hidden ruptures during the surgery, but later it was discovered that it was can also......"
"Huh?" Seeing Kawei suddenly interrupting him, Koch couldn't help but stepped forward and asked, "What can it do?"
Kawei looked down at the pill tumor in his hand, but what he was thinking about was the massive hemorrhage from cesarean section that he had received on stage at the Lakeside Theater a few days ago. During the operation, the peasant woman suffered severe bleeding, her uterus was cut off, and her bladder and ureter were ruptured by Orgi.
Kawei once used this bottle of blue dye to find a broken ureter, and also used it to test the tightness of the suture between the bladder and the ureter.
It looks fancy, but it is actually just a basic operation in modern surgery. After so many days, there is no need to think about it.
In the past few days, Kakawei had been thinking about the peasant woman who was recovering very well after the operation. She got rid of the post-surgery infection that may have been caused by pelvic inflammatory disease, and also got rid of the chronic poisoning of herbal medicine.
I originally thought that everything was due to the peasant woman herself, but now I look back and re-examine the operation process. Perhaps this bottle of dye is the key to all the problems?
