Surgery was in a state of rapid development in the 19th century as a whole, but if you break down the years in detail, you will find that this development is not coherent.
In the first half of the 19th century, because there was no anesthesia and the operations were short and mostly limited to the limbs, surgical diseases were basically equivalent to fractures and trauma. At that time, the school of empirical surgery was very popular, and one could become a surgeon by relying only on experience without a diploma.
War is a hotbed for the growth of surgeons, and anesthesia is an accelerator for the development of surgery. Therefore, Britain, France, and the United States led the development of surgery in the first half of the century.
The British in particular, the Crimean War and the American Revolutionary War, as well as countless colonial wars, brought them a lot of surgical experience. At the same time, the UK was the first country after the United States to apply anesthesia to clinical surgery, which greatly stimulated the development of surgery.
But in the second half of the 19th century, France began to decline due to some internal and external troubles, while the United Kingdom continued to rely on Lister's antibacterial methods. The United States has almost exhausted its anesthesia capital and is at a disadvantage in terms of innovation in surgical techniques, so it has played the role of a catch-up.
During the period before the United States gradually became the world's medical leader through borrowing and social stability, the main achievements in surgery were more focused on German-speaking countries.
Germany began to exert its efforts in the second half of the year, with industrial production capacity, economy, and scientific research all taking off. It relied on extremely advanced medical reform plans, such as the first launch of the national medical insurance system [1], and gained a leading position in medicine in one fell swoop.
The Austrian Department of Surgery has always been lukewarm, and its rise in the second half of the year was entirely due to the achievements of an independent individual that was too dazzling. 【2】
However, in 1866, when the second half of the year had just begun, this development trend was not yet obvious in the eyes of many authorities in the medical field.
"I don't understand why there are so many hanging bottles on his arm?" When Fernand first came into view, the Frenchman Mosier, who had just complained about Kawei's ability, couldn't sit still. "I'll see the infusion." But, I’ve never seen someone lose so much... By the way, is that red bottle blood?"
"It's blood," said a Viennese doctor on the side.
"Can you still live after a blood transfusion?" Mosier boasted of his experienced surgical experience, but at this moment he had to sigh, "This prisoner is really lucky."
"luck?"
Ingnatz, who almost had a fight with him just now, suddenly laughed: "Doctors in Vienna don't do things by luck, and my students don't do things by luck. This is a real and safe blood transfusion. He has already received the blood of seven people. , and no discomfort occurred.”
For surgeons who are afraid of blood transfusions, this is nothing short of a miracle.
"Seven people? How did you do it?" Bottini, an Italian sitting next to Mosier, was also very curious. "My teacher once used blood transfusion. The effect was indeed very good, but it was also very dangerous. The chance of success was less than 40%.”
"By a simple experiment."
Ingnatz didn't want to tell too much, not because he didn't want to share, but because Ferguson, the Englishman just now, also jumped out: "Look, he actually chose carbolic acid? Why did he use this kind of thing? "
He was a conservative anti-disinfection doctor, at least at this time in 1866. 【3】
But in Bottini's eyes, carbolic acid was the savior to save the high mortality rate in surgery and an important bargaining chip for the development of surgery.
However, his French was not good, so he could only reply in extremely awkward German: "Even the Austrian doctors who had always opposed anesthesia have begun to use carbolic acid. The British, who first used ether, now oppose the outstanding discoveries of their own surgeons and show that If you are so conservative, you will live a long life.”
"What a long time to see, you are only 30 years old!" Ferguson was a little unhappy.
"I am 29 years old."
Bottini adjusted his tie, took out an Italian publication, and said very proudly: "I firmly support Dr. Lister's method of using carbolic acid, and have already published "The Surgical Application of Carbolic Acid" in the Annals of the Medical University of my country. ". It focuses on the research results on the value of carbolic acid as a disinfectant for surgical fields. If you are interested, you can take a look."
"Humph, just a small Italian publication..."
Ferguson's status is much higher than him, and he doesn't care about Italian surgical guidance at all: "The Lancet in this country is the first-class surgical journal."
"It doesn't matter. Dr. List's approach is safer than mine. His carbolic acid paper will be published at the end of this year or next year." Bottini said with a smile, "I heard it will be published in "la"."
"Let's wait until he publishes it before talking about this!"
Perhaps due to the forward thinking shared by his peers, the 55-year-old Mosier does not agree with carbolic acid, or prefers to consider the issue from a neutral perspective: "The safety of carbolic acid needs to be considered, at least I know that it is flammable. , and it is corrosive to a certain extent.”
"When using it, of course, choose a low concentration."
"Is the effective performance at low concentrations guaranteed?"
"sure......"
All three were top surgeons, and the controversy over antisepsis had no further impact on other areas. Before the quarrel could be resolved, the next step of Kawei and his three assistants blinded them.
"What are you doing?"
“Why do we need to wear gloves during surgery?”
"It's not just gloves, they also cover their mouths and noses."
The emergence of gloves and masks even once made Bottini, a carbolic acid advocate, think deeply: "Judging from his surgical disinfection methods, he has done a pretty good job. In a sense, he is better than Dr. Lister and I." It has to be thorough. In my opinion, the area around the surgical field is already very clean. Is it really necessary to go to this point?"
"This is disinfection and demon elimination, right?"
"I don't understand the purpose of doing this." Mosier was more rational than Ferguson. "Gloves will greatly reduce the accuracy of the operation, and covering the mouth and nose is also very uncomfortable, which greatly limits the doctor's performance... "
They had not watched Kawei's surgery, nor had they been exposed to his sterility theory. They did not know the significance of doing so, but they could still detect the weirdness through their keen surgical thinking.
Everyone has been on stage to perform surgeries, and we know what kind of talents are qualified to stand on such a large-scale surgery square. If Kawei didn't have the ability to be recognized by the chief doctors of the Vienna Department of Surgery, he wouldn't be able to step onto the operating table or show off his research results.
So they naturally looked at the Viennese doctors beside them.
The person who has the most say on this should be Orji, whose abdominal surgery was completed by Kawei.
Although gloves and masks were not used at that time, it can also explain the importance of sterility for surgical operations from the side: "Just a month ago, I was shot in the stomach. According to the considerations of abdominal surgery by military doctors in the past, even from Based on my own experience, surgery does not have much chance of success. Usually, conservative treatment is adopted, that is, waiting for death.
But Dr. Kawe miraculously did it, and the postoperative recovery was quite good. The incision was only slightly red and swollen, and there was almost no serious infection. "
"This is the charm of carbolic acid." Bottini was very excited looking at the incision on Orgi's belly.
"If these are true, then the operation can be said to be very beautiful." Mosier still shook his head and said, "But this does not justify the use of a large number of props in the operation. At least I think the mask will seriously interfere with my operation."
"Can 0% mortality be an important reason?"
"I'm sorry, it was too noisy around. I didn't hear you clearly." Mosier heard the numbers, but couldn't believe his ears, "What did you just say?"
"Since Dr. Kawei demonstrated the first Cajun cesarean section, he has completed more than 30 operations so far, and no patient has died." Orji looked back at Ingnatz, wanting to confirm whether this number was Correct, "On this point, as his teacher, Dr. Yingenatz should have more say."
"I can't remember exactly. It should be 33, maybe 34."
Ingnatz turned to look at Massimov again: "Did he go to your place for a breast cancer resection before?"
Massimov was staring at the operating table with a telescope and chewing on the vegetable rolls in his hand, not paying much attention to the discussion around him. Now after Ingnatz said it, he replied: "The breast cancer patient is dying. The tumor has metastasized to other places and no resection was performed."
Ingenac nodded and replied: "That's Taiwan 33."
"No, he just didn't have breast cancer removed." Massimov explained, "He did ventricular drainage...well, no, it seems to be called ventriculoperitoneal drainage."
"what???"
Before those people could digest the 0% mortality rate, a more shocking word immediately entered their minds. In fact, not to mention the three of them, other local doctors here have never heard of this term.
About half of the people don't even know what the ventricles are, because the anatomy of the brain at that time was too shallow.
"I just served as the first assistant on the operating table, and the operation was decided in a hurry. I only knew some basic principles..." Massimov did not expect that they would be so surprised. He put down the telescope and said Then he said, "Let's watch the operation first. The scene is more exciting than my dictation. I won't talk about anything else until after watching it."
At this time, Kawei's scalpel had already cut open Fernand's abdomen and entered the abdominal cavity layer by layer.
The incisions of abdominal surgery will change depending on the surgical site. Some special surgeries will make special incisions to create a better surgical field. The incision on Fernan's abdomen was rather strange, it was a double-costal herringbone incision [4] with a total length of more than 30cm.
The main reason for choosing such an incision is that the surgical area is not limited to the liver, but also needs to be extended to the vicinity of the spleen to completely resolve esophageal and gastric varices.
In order to perform liver and spleen surgery under one incision, and considering that there was not much information in the abdominal cavity, Kawei had to choose such an incision to ensure the completion of the operation.
"We have separated the skin, superficial fascia, rectus abdominis, and oblique muscles layer by layer, and are now ready to enter the abdominal cavity." On Kawi's right is second assistant Damirgang, and on his left is a loudspeaker supported by a metal bracket. , "We slowly cut open the peritoneum..."
Kawi and Hermann used forceps to lift up the peritoneum, then cut a small opening with scissors. Damirgang picked up the suction device and inserted it directly. Berget could only serve as three assistants in such an operation, and he also did unskilled hard work - hand-cranked suction.
"The prisoner had a large amount of fluid in his body, which is evidence of liver failure."[5]
The yellow and slightly turbid ascites left Fernan's body through the rubber tube under Berget's suction, and the total volume was finally fixed at around 800ml. The ascites was not thrown away, but slowly added to a hanging bottle under Berget's operation, and continued to enter Fernand's body through the infusion tube.
"The operation is very expensive and will also lose a lot of blood." Kawei checked the organs in the abdominal cavity and said, "Fluid reinfusion can greatly improve this situation and stabilize the patient's vital signs... ."【6】
Having said this, he paused to explain the meaning of these four words: "The vital signs I am talking about include heart rate, blood pressure and respiratory rate. These three can directly reflect the patient's physical condition. I know that everyone is very concerned about blood pressure. It is interesting and the most difficult to measure, so I need to introduce the results of the latest research here."
A nurse wearing a mask appeared in front of everyone holding a blood pressure monitor.
She walked directly to Fernand and tied the cuff on his arm skillfully.
"The brand new sphygmomanometer does not require cutting blood vessels, very short measurement time, very simple operation process." Kawei roughly saw the size of the spleen and began to observe the liver close to him. At the same time, he said, "Even if you have not learned Physics and medical knowledge can be used proficiently in less than half an hour of short-term training.”
"Dr. Carvey, the patient's blood pressure is around 110/70."
"Thank you. Please measure his blood pressure every 10 minutes while continuously monitoring his heart rate."
"OK."
The sudden appearance of the blood pressure monitor brought the already warm atmosphere of the venue to a whole new level. According to Kawei's description, this was not just a medical instrument, but something that could be used by everyone.
In an era when personal identification is extremely scarce, some people are even considering whether blood pressure should be added to identification information.
Kawei is accustomed to this kind of reaction, and his focus is always on the operation itself.
Esophageal and gastric varices are a problem of the portal vein, and this will definitely be reflected in the spleen, which is as huge as he had expected. The spleen, which was originally hidden in the left upper abdomen, actually reached the navel.
In fact, Fernand's enlarged spleen was ignored by Kawei during the previous examination due to body position and other reasons. It was not until upper gastrointestinal bleeding occurred that Kawei did another complete physical examination, which basically clarified the location of the spleen.
Giant spleens are not uncommon, and general surgeries often perform giant splenectomy. What really surprised Kawei was the piece of liver in front of him.
"This liver is so weird..."
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