[This chapter is a bit long, I have to write it slowly. I can read it again tomorrow]
The blue vial is the dye that Kawei has been using before.
After the trip to the palace, its antibacterial experiments were upgraded to the highest level. Three days is not enough to draw a conclusion, but it is easy to see from the bacterial growth on the petri dish that the blue dye does have a certain antibacterial effect.
Coupled with the nitrite-like toxicity of the herbal medicine, Kawei was almost certain that the dye was methylene blue. 【1】
Methylene blue is widely used in modern medical fields. Although it has a certain degree of toxicity, as long as the dose is controlled, it is a very easy-to-use and safe dye that can be well distinguished from blood in the body. At the same time, it is also a good reducing agent and can treat nitrobenzene poisoning, nitrite poisoning, and cyanide poisoning.
But now, Kawei is interested in other characteristics of methylene blue.
For Kawei, who has lived through the era of lack of medical treatment and medicine, this stain can definitely be called a panacea in the 19th century, and he is more excited than completing a complicated operation.
The first is the antibacterial ability that has been tested.
Modern antibiotics are emerging in endlessly. In order to deal with the ever-escalating resistance to bacteria, humans also need to constantly upgrade their weapons. This is an inevitable result of evolution in the era of scientific development. When people reflect on antibiotics, methylene blue has already retreated from the environment before it has made its mark. 【2】
In fact, before the reform, there was a domestic precedent of using the pharmacological effects of methylene blue excreted by the kidneys to treat urinary tract infections. When foreign countries first appeared, they also developed methods to treat bacillary dysentery, but they were quickly submerged in a sea of various antibiotics.
In the antibiotic world where you sing and I take the stage, methylene blue has lost its necessity. People still see it displayed on the counters as a fish tank bactericide in ornamental fish shops in flower and bird markets.
In addition to detoxification and antibacterial, Kawei also knows the third function of methylene blue: anesthesia.
If the modern antibiotic environment has its own characteristics and antibacterial spectrum, no one will accept it. The anesthesia environment is the top of the pyramid, with general anesthesia, local anesthesia, muscle relaxation, and analgesia, each with its own rolling method.
Because everyone is human, it is difficult to find opportunities to choose unpopular anesthetics except for some special circumstances that require fine-tuning of drugs by anesthesiologists.
The simplest example is ether, the originator of general anesthesia that squeezes out laughing gas, and the miracle drug prescribed with chloroform notoginseng. Now it has long lost the right to anesthetize humans and can only continue to shine in animal laboratories. . 【3】
In contrast, the earliest penicillin is still active in the clinical frontline.
Methylene blue anesthesia was first used in the 1970s and is a clinical application based on practical medicine. I can't find its anesthesia usage in the drug's instructions for use, because its anesthesia mechanism is listed in the side effects column.
It can affect the conduction of nerve excitatory impulses and can even cause damage to the nerve medulla. Injecting a large amount into the subcutaneous tissue will cause peripheral nerve necrosis, injecting a large amount into the muscle will cause tissue necrosis, and if injected intrathecally, it will cause paralysis.
However, this damage is reversible at low doses and concentrations, so as long as the dose is controlled well, long-lasting analgesic effects can be produced.
Since it is an injury, there will definitely be many side effects. In addition to the blue-green color of the urine [4], many functional changes caused by damage to the nerve medulla are also very important.
In the anorectal department, where methylene blue is used the most, it is often used to relieve severe wound pain caused by dressing changes and defecation after surgery.
However, once this reversible damage exceeds the safe dose and concentration, it will produce irreversible numbness. In severe cases, it will also affect sphincter function, causing fecal incontinence for about half a month to a month, and even permanent sphincter necrosis.
But compared with ether, which is always fatal, local anesthesia is actually better for many surgeries [5]. Especially in the upcoming Austro-Prussian War, only local anesthesia can often achieve very good analgesic effects for mild to moderate injuries to the limbs.
Detoxification, staining, antibacterial, and anesthesia are the important reasons why Kawei called it the panacea of the 19th century.
Today, however, methylene blue is used as a simple surgical stain.
"Countess, the operation will be over soon." After Waterman came on stage, he walked directly to the operating table and comforted the patient in his usual style. "When you wake up, you will find that the tumor has already left your body. .”
Justina took a deep breath and managed to cheer up: "I hope this is true."
"Don't worry, as long as Dr. Kawei and I are here, nothing will happen."
"Thanks."
Justina turned sideways and glanced at her husband, holding his outstretched hand: "Kami Yin, if there is a problem with the operation, or the tumor is too serious, or... anyway, if I don't wake up, please You must be with Yin Liya."
"This" Kami Yin was stunned, "You all know this?"
"Yin Liya is much gentler than Edita, and that Anji only cares about your money."
"Uh-huh, I get it."
Justina glanced back at the theater and continued: "This is just my suggestion. No matter who you end up with, please remember me."
"Of course!" Kami Yin burst into tears, "You will always be my favorite woman."
"Thank you." Justina smiled and nodded to him, then gently let go of her hand, lying calmly on the operating table, looking at the nurse aside, "Let's get started."
Until then, Waterman turned his face to the audience and said the first introduction of the day: "Your Majesty the King, the Prime Minister, the French Ambassador, and all colleagues who are willing to spend an afternoon to watch the operation. , what Mr. Carvey Hines and I are going to show you today is a brand new breast cancer resection.
Breast cancer has always been a killer of women, and surgery has been ineffective for the past hundred years. It’s not that it can’t be removed, but that it recurs.
Some experts believe that the breast cancer patient's body is at work, while others believe that the tumor tissue was not completely removed during surgery. Dr. Kawei and I prefer the latter, but after studying dozens of breast cancer surgery records, we found. Ahem, Dr. Kawei found that the recurrence of breast cancer may be related to lymph node metastasis.
Therefore, this operation is different from the previous simple resection. We also included dissection of lymph nodes near the armpit during the operation. "
The right to speak fell into the hands of Kawei, who was preparing a dyeing syringe: "Many of the surgical records I reviewed previously contained descriptions of "swollen lymph nodes in the patient's axilla", which reminded me of breast cancer written by German Dr. Rudolf 2 years ago. The relationship with lymph immediately piqued my interest."
After that, he showed the syringe in his hand: "This is a perfect dye. If you inject it into the subcutaneous, intradermal, subcutaneous, and around the tumor, you can see the clear direction of the lymph." [6]
Not everyone reads papers and reports as often as Carvey does. Most surgeons prefer to be hands-on and work alone.
Therefore, most doctors in the audience have never heard of Rudolph's name, and they have no impression of this article. But no matter what the content of the paper is, no matter whether the relationship between lymph nodes and breast cancer is correct or not, since it was Kawei who said it, it is correct to write it down.
In fact, even before he successfully completed the cesarean section, this trend had already appeared in the surgical theater. After more than a month of consolidation, everyone developed a good habit of taking notes during his operation.
The four people watching the excitement were very surprised by the sound of turning pages and writing in unison.
“The best way to deepen the impression is to directly record the surgical process with words and images.”
Edinson didn't seem to understand what they were surprised about. It wasn't until Franz pointed it out that he said helplessly: "Dr. Kawei always comes up with some innovative new ideas every time he performs an operation. He has never heard of it before." method, we will all reflexively choose to ask and record it.”
"He's too young."
"Mozart had written more than 20 symphonies when he was 17 years old." Franz gave several examples of Austrian geniuses to prove that Kawei's strength was just right. "Czerny and Schubert were also teenagers. Becoming famous is not uncommon in Vienna."
Edward frowned and thought: I admit that your music is great, but this is a doctor. Don't doctors rely on study and study, as well as talent?
Waterman's introduction and the dye in Kawei's hand whetted everyone's appetite. The audience looked at the anesthesia mask on Justina's mouth and nose, waiting for the official start of the operation.
Armor once again became Kawei's anesthesia assistant. According to the previous judgment standards, after the orbital pressure and eyelash reflexes disappeared, he made a report in time: "Dean, Dr. Kawei, the countess's anesthesia is completed."
"disinfect."
Kawei gave the order, and Damirgang behind him came to the operating table with a sterilizing basin and watering can. Amor also became the third surgical assistant and completed the preoperative disinfection with Damirgang. Carbolic acid disinfection covered the entire right breast, right shoulder, armpit, and right side of the torso, while air disinfection with alcohol spray covered the entire surgical area.
The needle quickly penetrated into Justina's skin, and the blue dye that had been diluted in advance slowly flowed into it.
"Just wait 5-10 minutes, and the dye will flow step by step along the lymphatic channels to the surrounding lymph nodes. By then, we can clearly see how the tumor metastasizes through the lymph."
After the introduction by the two surgeons, Ambassador Edward also had a question: "Dr. Edinson, what exactly are the lymphatic vessels that Carvey just mentioned?"
"It is a duct system in the human body, in which clear lymph flows, which Hippocrates called white blood." Edinson explained, "and there are lymph nodes between the ducts, which should be used to produce and store this blood."
"What does lymph do?"
"According to the four-liquid theory, lymph can be classified as a type of blood, which is purer blood." Other doctors, including Edinson, also have a very superficial understanding of lymph. "Since the tumor has invaded the lymph , indicating that the condition is very serious.”
"I see." Edward was very interested in Kawei's staining method. "Although the seats are a bit far away, I can imagine that such staining must be very intuitive. But is there really a relationship between lymph and tumors?"
"I'm not sure either."
Edinson looked at Kawei on the stage, and suddenly thought of the suggestion he had made to Franz before, and changed the subject: "According to Dr. Kawei, lymph is actually like a railway, and tumors are materials. As long as you have With an efficient and convenient railway system, we can continuously deliver materials to various front lines."
Edward nodded repeatedly: "This is a good metaphor, I like it. If I remember correctly, France now has the largest railway network in the world."
These words not only helped him win back a victory, but also reminded Franz of the dilemma when he was almost trapped in a siege during the Franco-Austrian War. For this reason, Prime Minister Karl had to stand up: "Although railways can help with transportation, the real battlefield depends on the brave and fearless cavalry soldiers."
Edward did not find it strange, but said: "I think France will never be inferior to others in this regard."
Since the topic involved railways and soldiers, Franz no longer tried to hide it, but asked directly: "In that case, how would the French emperor react to Prussia's current aggressive war preparations?"
"His Majesty the Emperor still hopes that the European continent can live in peace and not give the British an opportunity to take advantage of it."
"Prussian railways have been built to the border, steel plants are manufacturing guns day and night, and soldiers are constantly gathering." Franz sighed, "This makes us very nervous."
"Isn't that the case in Austria?" Edward said, doing Tai Chi on his hands, "How about we sit down and talk together?"
Although Franz talked about peace, peace was just an excuse. What he really wanted was the land of Prussia rather than peace. Seeing that the other party responded in this way and threw the question back again, he could not refuse to answer it, nor could he answer it randomly.
Although he was reluctant at this time, Franz still had to advocate the Prussian threat theory: "We will eventually have a war with Prussia. This is the issue of Germany's ownership. But once Prussia wins the war, the next step will definitely be against France. Bismarck The cunning fox has been watching you from the beginning and will never give up the land of France."
"Isn't Austria the same?" Edward did not take Prussia seriously, "France has long been used to it."
After several rounds of tit-for-tat, Richard quickly smoothed things over: "Okay, okay, let's put the state affairs aside for now and watch the surgery."
The dyeing before the operation has begun to show results. Even without incision in the skin and subcutaneous fat, Waterman and Kawei standing on both sides of the operating table could vaguely see the blue-dyed pipes. Just like Edinson said just now, they spread from the center outwards, forming a spectacular network.
When Waterman saw Kawei nodded, he immediately looked at the nurse: "The dyeing has been successful, give me the scalpel."
