Nineteenth Century Medical Guide

Chapter 113 110. New genre

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 a soldering iron and hot oil were used to deal with the aftermath.No musculocutaneous flap was used for embedding nor sutures.Cutting + scalding is the whole process of amputation, and the time will not exceed 3 minutes, because the blood will be drained after too long.

Later, with the development of anatomy, a legal hemostasis method appeared, and sutures were used instead of irons. At least there was no secondary injury, and the speed of surgery began to slow down.However, there is still no anesthesia during this period, and the doctor still has to take into account the heart-piercing screams of the patient. The operation needs to continue to maintain a high speed, fast in and fast out.

After anesthesia, "cutting trees" began to slowly develop into "carving", including Ignatz, who is known for his speed, slowing down intentionally or unintentionally.

In modern times, surgery has already become synonymous with fine manipulation.

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 anesthesia, which claims to be improved, the probability of surgical incision ulceration has further increased.

Although the rapid operation is rough, it can reduce contact, thereby reducing bacterial colonization, and has a certain preventive effect on postoperative infection.Once the operation slows down and the doctor's dirty hands spend more time in contact with the incision, the chance of infection naturally increases.

That's why Ignatz, who had a quick operation, was able to stand tall among a group of dwarfs and keep the death rate below 40%.

Of course, the doctors in the auditorium certainly couldn't understand the logical relationship, and only thought it was purely technical.Because Ignatz's operation is indeed very entertaining, the range of motion, 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 has complained about his reluctance to innovate, has to admit it.

It is also true that there is nothing to criticize during the operation, and the only thing that can be criticized is his innovation.

But Kawei's operation gave 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 kind of experience seemed a bit advanced to another non-medical person present.

Since Varela missed Carvey's cesarean section last time, he didn't lose his job, but his status dropped a lot. Now he is on an equal footing with the later junior Greg.

The number of daily reporters stationed in the surgical theater has become two, but the amount of expenses given is still one person.Greg was the one who was put up by the editor himself, so naturally he couldn't lose his share, so the two could only split the money in two and tighten their belts to live.

With less money, it was impossible for Varela to watch all the operations. Except for some must-sees, he could only stay at the entrance of the theater every day to pick up bargains.

Picking up, who would have thought of picking up Kavey's amputation.

The early-morning extra session is usually the case when some unknown little doctors need a large venue. A famous surgeon like Kawei is doing surgery at this time, which is almost the same as doing charity.

Because there are so few people watching, the fare was set at a uniform price of 20 crowns, which is too cheap.And the most important point is that Greg, who Varela has been thinking about kicking off, is not there, and what he writes is an exclusive report.

“The speed is too slow”

Since he was thrown out of the theater by Kawei last time, he has learned a lot, knowing that some thoughts cannot be said casually.But no matter how patient Varela was, he couldn't appreciate a 40-minute amputation.

Carvey used a large piece of gauze soaked in carbolic acid to cover Li Ben's stump, and both sides were pulled by Mellen and Berger, only a small femur was exposed.

The sound of the file rubbing against the bone is everywhere, sometimes high-pitched, sometimes low-pitched, sometimes making a long sound, and sometimes being chopped into fine pieces.Carvey is like a carpenter, carefully polishing his work.

Varela panicked, and finally found an exclusive report opportunity, so you just show me this?
He had a lot to say, but due to the scene, he could only find Ignatz and Hills in the end: "Professor Ignatz, don't you think Carvey's operation is too slow?"

"It's really slow." Ignatz didn't deny it.

"What do you think, Dr. Hills?"

"very slow."

"If this is spread, won't Austrian surgeons lose face?" Varela felt bored and couldn't help but fire at Ignatz, "Professor Ignatz, he is your student."

The implication is too obvious. It is really unreasonable for a surgeon known for his hand speed to 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 surgery, you don't understand."

don't know? ? ?

Varela has seen too many surgeries, and he claims to have no skills but has a vicious vision.Since Ignatz wants to protect his weaknesses, then find a breakthrough from Hills.He has just been squeezed out of work by Carvey, so he will definitely have a different opinion: "Doctor Hills, what do you think?"

"Me?" Hills thought for a while, "I agree with Mr. Ignatz's opinion, laymen can't understand Dr. Carvey's operation."

Varela didn't understand: "I've never seen an amputation that slow."

"Mr. Varela, you still haven't figured out the meaning of the speed of surgery." Ignatz has the most say on this, "Why does surgery have to be fast?"

"The faster the surgery, the better."

"How do you define beauty? And how do you define surgery?" Ignatz continued to ask, "In your eyes, is surgery just a process of using a 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 simply by increasing the speed. In the case of unstable anesthesia, slowing down will be very troublesome. A lot of other troubles would arise, like bleeding."

"Doctor Carvey has given up his speed now, and instead put all his energy on stopping the bleeding." Sears stood up and repaired the knife at this time, "It can be regarded as taking a road that we have never walked before."

Only then did Varela discover the weirdness of Carvey's surgery.

and many more!

The blood vessels at the root of the entire thigh are extremely rich. Can amputation really prevent bleeding at all?
"So, it's not that Carvey is slow, it's that the surgical content that needs to be dealt with is much more than traditional amputation, so it looks slow." Ignatz said the essence, "The fact is the opposite. Carvey is not slow at all when it comes to delicate sutures for hemostasis."

Varela finally understood what the two of them meant.

These two think from the perspective of doctors, and I look at the operation more from the perspective of patients and audiences.

"Everyone, it's been half an hour since the operation, and the broken end of the femur has been smoothed by me, so it won't cause too much irritation to the musculocutaneous flap at the anastomosis." Carvey handed the file to Sarson, and took over the suture line, and continued his narration mode, "Next, I will sew up the muscles and skin layer by layer, and this amputation has come to an end."

As soon as the words fell, Carvey lowered his head and started suturing, wrapping the broken femur, blood vessels, and nerves inside.

"Spent so long grinding the femur just to reduce irritation?"

"At that time, the choice of the amputation plane was a problem. If the entire femur was directly removed, there would be no need to grind the bone." Hills still had a different opinion. It needs to bear the weight of the body, and it's really not good for the bones to be too sharp."

"Sills, you left out the swelling from the post-op incision."

"It's true that the postoperative swelling will also touch the fracture."

In Varela's perception, surgery is a treatment method to cut off the lesion, and it is also a form of performance. As long as the cut is fast, the stitches are good, and the applause of the audience is the essence of surgery.

He never thought that the ability of the residual limb to use the prosthesis should be considered in the amputation, and the pain of the residual limb after the operation should also be considered. Similarly, he never thought that the hemostasis should be controlled to such an extent during the operation.

Isn't surgery the art of cutting? Is it necessary to look forward and backward like this?
An amputation usually takes four to ten minutes, half of the time is spent on hemostasis, and the other half on bone grinding, so what is the rest to watch?

What the audience wants is the blood splash when the flesh is cut, the blood is like the sand in the hourglass.The face of the surgeon was solemn, every step was a race against time, and at the same time, he needed to find some free time to explain to the audience, and there was a tense atmosphere inside and outside the theater.
But now?

The blood is gone.

I don't know where to start with the dignified, at least Kavey's face is calm, like dissecting a corpse, without any pressure.

"The operation is complete."

Carvey sighed softly, and he gently threw the suture needle into the disinfection basin: "The skin fit is perfect, the sutures are tight and tight, give me carbolic acid."

After washing with a large amount of carbolic acid, Bergett and Melen both bandaged the stump of Li Ben's left leg.A somewhat boring amputation ended in this way, and when the cleaner entered the theater, he thought he had gone to 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 is really no need to wash it." Carvey put the bloody gauze into the cloth bag, "But there is some blood on the bed sheet, so it should be changed and washed."

"I do not mind."

Sears walked out of the auditorium, wanting to talk to Carvey about the operation just now, but Varela jumped out first: "Dr. Carvey, how do you evaluate the amputation just completed?"

"Evaluation?" Carvey didn't expect him to ask such a question, "It's okay, it's just an amputation, it's not difficult."

"No, you probably didn't understand me," Varela emphasized. "What I want to ask is, why do you treat an amputee like this? Why do you work so hard to stop the bleeding? And the final stage of grinding." Bone, it takes too much time."

"Patients need a lot of nutrition to recover after surgery, and blood loss is not suitable for postoperative recovery." Carvey explained while washing his hands, "Bone grinding is for artificial limbs and to prevent swelling of the stump, which will further cause The festering of the incision."

All the doctors around nodded their heads.

But Varela still disagreed: "Just for this?"

This time I changed to Kawei, I don’t understand: “Otherwise?”

"You are too slow."

"Oh"

In fact, in Carvey's heart, since he came to the 19th century, his operation speed has also become much faster.In the past, it was good enough that the amputation was controlled within one hour, but now it took only 1 minutes for one amputation to be completed, which has become faster.

"Slowness has its benefits."

"Haven't you ever thought about the feelings of the audience?" Varela said, "Those nobles, those famous people, they didn't come here to watch you grind your bones, nor did they come here to watch you suture your blood vessels one by one."

Carvey shook his head: "Could you be mistaken? Surgery is for treating patients, not for performance. I also have my surgery style, whether they like it or not."

"."

Varela said it very bluntly, but this is a true portrayal of the surgical environment in the 19th century. If Carvey's surgical methods were followed, the income of surgeons would plummet.No one wants to pay a hundred crowns to see several heads being moved back and forth through a small incision.

It's so boring.

"You are mistaken, Mr. Varela."

Carvey threw the used surgical instruments into the carbolic acid basin and slowly cleaned them: "There is a public opinion on whether the surgical treatment is good or bad. No doctor would deliberately reduce the patient's surgical effect for the ticket revenue. What's more, the ticket More than half of the income does not go into our pockets at all."

Originally, many people, including Varela, wanted to see if Carvey would create the fastest amputation record again.It is entirely possible for a young man with such a talent to learn from Ignatz, the sharp swordsman, to surpass his teacher's hand speed.

But now a small amputation has been played by Carvey in a different way, which not only makes 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 arrangement.Should the incision be in the upper or lower abdomen?Is the central longitudinal incision, or directly choose the transverse incision?Should he stop the bleeding along the way when entering the route, or should the knife be inserted directly into the abdomen as it is?

He is now looking at the clean operating table, listening to the interview with Carvey, and his mind is full of hemostasis.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 theater at this moment, "Do you want to go and have a look first?"

"Oh, ok, I'll be right there."

"He's coughing badly now, do you want to give him some tincture of ya tablets for cough?"

Before Sears could respond, Kavey, who was still entangled with Varela, suddenly turned around and asked, "Huh? Mr. Sears, isn't your patient going to have a laparotomy? Why is there a cough?" ? Is it an elderly patient? Or a regular smoker?"

(End of this chapter)