Surgical medicine in the 19th century had made great progress compared with the barbaric stage before it. Most unreasonable operations are only based on some wrong perceptions, and the overall operation direction is still correct. For those doctors who are skilled in surgery, their skills will be greatly improved with just positive guidance.
Perhaps in the eyes of outsiders, this improvement is difficult to detect through observation, but those who actually perform the surgery feel it the most.
This kind of improvement can make the scalpels, needles and threads, hemostats, hooks, and tweezers in their hands feel like they have become extensions of their own arms.
Bill Rotter and Bottini are typical representatives.
The former is 37 years old (there is an error in the above, he was born in 1829) and is in the preparation stage of developing abdominal surgery. In more than 10 years, he will come up with various abdominal surgeries to upgrade general surgery by two to three levels.
The latter is 29 years old, has his own unique understanding and persistence in technology, and is on the road to rapidly strengthening his surgical capabilities.
Even without Kavi, the two men would have followed their own surgical paths and reached their rightful place in medical history. Now with Kavi, just a little help can get them further than they already were.
This kind of progress does not require much theoretical foundation in the early stage, and the growth method is also leaps and bounds. You can easily learn the work that should have taken most of your life to complete.
Shotguns were not uncommon on battlefields in the 19th century. They were the last line of defense for artillery. They were the most common weapon encountered by infantry and cavalry when attacking artillery positions. They were also the direct cause of the death of many soldiers.
This type of firearm injury is not a difficult problem for modern surgery.
There has long been a consensus on the debridement, aseptic techniques, antibacterial treatment, hemostasis and blood volume replenishment required for treatment, and there are quite a few mature methods.
The shotguns at this time were simple to make and the explosive power was much smaller. They could not be compared with the fragmentation injuries caused by the numerous cluster bombs on modern battlefields. But for Billroth and Bottini, who had never experienced the battlefield, shotgun wounds were unknown territory.
For this purpose, they approached Kavi, and even went to the Royal Library to read the "Office Manual of the Royal Austrian Artillery" [1] left by the famous imperial artillery general Joseph Zamora, which described the characteristics of shotgun shells in detail.
The outermost layer of the shotgun is a cylindrical thin tin can, the bottom of the can is iron sheet, and the can contains hundreds of bullets with a diameter between 1-5cm.
The moment the projectile leaves the barrel, the tin shell will burst open, and the bullets will eject from it, forming a round pancake-shaped barrage that spreads outward in the space.
The texture and size of these bullets determine the strength and lethality of the barrage. From the second half of the 18th century, iron bullets began to be used to replace lead bullets. Iron bullets are fast and can ricochet after hitting the ground or obstacles, effectively increasing the killing efficiency.
In his work, Zamora compared shotguns from Austria, Britain, France and other countries and found that the spread diameter of shotguns was basically about one-tenth of their flight distance, and eventually formed a quadrilateral-like killing area.
If a team like the Klavov Infantry Battalion is attacked by artillery within an effective distance of 150 meters, almost every shot can cause varying degrees of damage to dozens of people.
"Fortunately, it's a light shotgun, and the diameter of the bullet is not too big." Billroth has followed the wound into the abdominal cavity and can clearly see the trajectory of the projectile entering the human body. "If the angle has not changed, the projectile should be near the liver. .”
In fact, due to the angle of entry of the projectile, the trajectory of the projectile is deflected after passing through the skin and muscles, passing the edge of the liver and then continuing to travel diagonally upward.
Due to poor penetration, the projectile ended up making a small hole in the diaphragm and almost entered the chest cavity.
But Billroth's exploration was not that extensive, let alone the state of the diaphragm above the liver. What he had to do was to ensure that there were no problems with the injured abdominal cavity. To put it simply, stop the bleeding if it occurred and sew the rupture if there was any.
if there is nothing
"This bullet is interesting. Where did it go?"
Billroth leaned against the chandelier with more than a dozen candles on the top, but still could not find the projectile that entered the wounded soldier's body. Even though the hands wearing rubber gloves moved back and forth in the stomach, passing through the intestines, stomach, liver, and spleen, they still came back in vain.
At this time, I recall the scene when the wounded soldier first entered the hospital. Although his clothes were stained with blood, it was mostly caused by ruptured peritoneal blood vessels and there was no active bleeding.
Before, Billroth was afraid that the bullet would cause the internal organs in the abdominal cavity to rupture, causing uncontrollable internal bleeding. However, after entering the abdominal cavity, he found that there was no semi-coagulated blood inside, and after flushing it twice with normal saline, no new overflow was found. blood.
So after searching for half an hour to no avail, he decided to close his abdomen: "Suck all the water out of the stomach, put the intestines back in place, and do sutures."
Bottini on the side was still nervously suturing a large blood vessel on his thigh. Seeing that Billroth was about to withdraw, he asked: "Didn't you find the projectile?"
"This guy is very lucky. I looked around and couldn't find him." Billroth glanced at the wounded soldier's face, hoping to get more good luck from him. "I guess he flew to some other insignificant place." .”
"Is there no bleeding?"
"No."
"Well, as long as the person lives, just keep the bullets."
Both of them strictly followed the principles of firearm injury treatment advocated by Carvey [2], making the surgery as simple as possible to reduce damage to surrounding normal tissues. Regarding retrieval, in principle, the injury should not be aggravated. If there is no obvious impact on the human body, there is no need to remove the bullet.
"If we could still see his posture and the angle of entry when he was attacked at the scene, we might be able to directly determine the location of the projectile without even cutting open his stomach."
Billroth asked the wounded soldier's vital signs again. After confirming that the values were stable, he decisively gave up and continued the operation: "Do you want any help here?"
"No need, just sew up the blood vessel break." Bottini felt the dorsalis pedis artery again, "The pulse is not bad, the leg should be saved."
Billroth stepped forward and took a look. After he felt that there was no problem, he handed over the operating table to the three assistants and ran to the entrance of the operating room alone to see if there was another operation. But in fact, as soon as he turned around, Hills, who was also rushing for surgery behind him, sent him a bunch of wounded soldiers.
"The door is full of bullet wounds. Fifty or sixty people have been sent here. Some of them are already dying."
"I gonna go see."
Billroth took off his disposable rubber gloves and apron and wanted to walk towards the door, but was suddenly stopped by Hills: "No, let's take a look at the man at my hand first. He is also seriously injured. "
"what's the situation?"
"One shot to the right thigh, the left thigh was directly broken, and the left hand was also cut open by shrapnel." Hills moved away from the angle, allowing Billroth to "appreciate" the left hand connected to the wrist by a layer of skin. , and the exposed bones of the stump of his left leg, “but the heaviest thing now is his neck.”
This is no longer a question of whether the injury is serious or not. It is simply a miracle that this wounded soldier was sent here and that he is still conscious even now.
"I clearly knew I was knocked down!"
The wounded soldier used his only intact right hand to cover the thick gauze covering the wound on the left side of his neck, and said at a very fast speed: "The hateful Prussian shell exploded directly at my feet. I was lying on the ground. My body was covered with dark red liquid spurting out of my mouth. I felt like my head had been run over by a carriage wheel, but at that time I didn’t know how badly I was hurt until I tried to wipe the blood off my face with my left hand. Only then did I discover it” [3]
"Okay, we all know it. Stop talking about it, Major Klavov. Your neck is starting to bleed again!" Hills asked the anesthesiologist to cover his face with an ether mask. "Hurry up and calm down, Mr. Major." .”
"Listen to me, you must have never personally experienced what it feels like to lose a leg." Klavov had no intention of stopping and continued, "That was a cannon shell. I knew when I saw it explode. It's over. God bless, God bless, I'm still alive!"
Hills couldn't stand listening anymore, so he helped put the ether mask on his face: "Major, please be quiet, the Empire's surgical team is protecting you now!"
Klavov finally became quieter, and a trace of sadness appeared on his face after being overly calm: "Are you going to amputate my left hand?"
"Yes, it is impossible to keep the left hand. The bandage on the stump of the left leg is too dirty and messy. It needs to be amputated upward." Hills briefly introduced the surgical procedure. After all, the other party was a major. "If you are lucky enough, You should be able to see the moon tonight.”
"It's okay, come on!"
Klavov once again showed the calmness that a commander should have, and even turned to look at the nurse holding ether, "It is the responsibility of every officer to dedicate one's body to the empire. Complete your surgery quickly and wait until I wake up." I have to count the number of casualties and make a report."
The ether quickly passed through his lungs and finally shut down his brain after half a minute.
Hills didn't know much about neck anatomy, or had much experience with it. Klavov's neck was bleeding profusely and was difficult to stop, leading one to think there was an arterial problem.
But as long as the wound is expanded and the anatomical structure is carefully found, it can be found that the cut wound on his neck was caused by the fragments shot from the side directly cutting the skin and severing his anterior jugular vein.
There are abundant blood vessels around this superficial vein, and it is almost impossible to stop the bleeding in a short time with a gauze bandage.
But if hemostatic forceps and suture needles are introduced, and the bleeding point is sutured directly regardless of the integrity of the blood vessels, the difficulty of the operation will decrease exponentially. Even in the end, there was no need for Hills to stay on stage.
It has to be said that the first two injured players Bill Rotter took over lacked "quality", which cost him 40 minutes.
As for the other seriously injured patients waiting for surgical treatment at the door of the operating room, a large number of them did not need to dispatch the second shift. Because their injuries were on the limbs, either a broken hand or a broken foot, there was no need to leave them alive with current surgical methods.
The Fortress Hospital has a considerable reserve of surgeons. This 1,400-bed hospital is equipped with nearly 30 surgeons and more than 200 assistants, which can fully cope with current amputation surgeries.
The only limiting factor limiting their ability to complete treatment is the limited number of operating rooms.
But after hearing that there was still fighting at the front, Hills had already vacated several temporary operating rooms, and the entire fortress hospital was working at full capacity to digest the wounded who were constantly being sent through the door.
After stabilizing the treatment capacity of the fortress hospital, Billroth had the opportunity to select the wounded suitable for his team.
Letting each medical staff appear where he should appear and avoid wasting medical resources is an important part of the triage system, and it is also the original intention of Kawei to create the trauma emergency team.
"The left forearm is missing and needs to be amputated; the right calf is broken and needs to be amputated; he was shot in the abdominal cavity and his face is not good." Billroth checked the wounded at the door and made a simple judgment, "Hiles, there is a person here. If you want to explore, there may be internal bleeding, so come on."
"Okay, send me to the operating room now."
"Next, the right leg suffered a severe open fracture and was amputated; the chest was shot. It seems that the sternum was broken?" After a brief examination, Billroth finally became interested, "Botini, there is a man here who was shot in the chest."
Bottini has also gotten off the operating table and is now checking the other side of the aisle at the door: "I'm afraid that one needs to be put away."
"What's wrong?"
"I have a heavier one here." Bottini walked up to a wounded soldier, gently untied the bloody cloth blanket wrapped around him, and then shouted: "The left shoulder is rotten The left arm is hanging there, I can even see the chest muscles and ribs!"
Billroth was in disbelief after hearing this, and even asked: "Are you still alive?"
"Alive, but the situation is not good." Bottini simply did a heart rate monitor. "The heartbeat is very fast, and the breathing is not very good."
"Send him to the operating room quickly." Billroth refused to give up. "Cut off the damaged muscles and stop the bleeding. There should be a chance!"
At this moment, another group of carriages rushed into the hospital gate, and soon the stretcher bearers rushed into the hospital carrying the wounded soldiers. The most concerning thing is the stretcher "team" composed of five people rushing to the front: "Come on, give way, give way! This is Major General Maciej! He has been shot!!!" "
"He was shot? Where was he shot?" asked a doctor's assistant at the door who was responsible for confirming the location of the trauma.
"Left calf!" said the soldier carrying the stretcher. "He needs surgical treatment now! Hurry!"
Since the battle began, there has never been a single gunshot wound here. The assistant knew that the rank of the wounded soldier in front of him was not low, but he still followed the hospital's grading system and asked: "What else?"
"What else is there?"
"Where else were you shot?"
He was holding a receipt in his hand, and after drawing the picture of the location where the left leg was shot, he wanted to start writing. Unexpectedly, the other party shook his head: "Only the left calf was injured, but it bled a lot. The major general is in terrible pain. The situation is quite critical. Need surgery immediately!"
