Nineteenth Century Medical Guide

Chapter 195 192. This liver is so weird
Surgery was in a state of rapid development in the 19th century as a whole, but if you disassemble 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, the operation time was short and most of them stayed in the limbs, so surgical diseases were basically equivalent to fracture trauma.At that time, the school of empiric surgery was popular, and one could become a surgeon by experience alone without a diploma.

War is the hotbed for the growth of surgeons, and anesthesia is the accelerator for the development of surgery, so Britain, France, and the United States led the development of surgery in the first half.

Especially the British, 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, Britain is the first country after the United States to apply anesthesia to surgical clinics, which greatly stimulated the development of surgery.

But in the second half of the 19th century, France first began to go downhill due to some internal and external troubles, and the United Kingdom still insisted on relying on Lister's antibacterial method.However, the United States is playing the role of a catcher because it has almost eaten its anesthesia capital and is at a disadvantage in terms of surgical innovation.

During the period before the old United States gradually became the world's medical leader by virtue of borrowing and social stability, the main achievements of surgery were more biased towards German-speaking countries.

Germany began to exert its strength in the second half of the year. Industrial production capacity, economy, and scientific research all went together. Relying on extremely advanced medical reform plans, such as the first national medical insurance system [1], Germany took the leading position in medicine in one fell swoop.

However, Austrian surgery has always been lukewarm, and it was able to rise in the second half of the year entirely because the achievements of an independent individual were too dazzling. 【2】

It's just that in 1866, when the second half just started, this development trend was not obvious in the eyes of many authorities in the medical field.

"I don't understand why there are so many bottles on his arm?" When Fernand first came into people's sight, the Frenchman Mosier, who just complained about Kawi's ability, couldn't sit still, "I see you for 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.

"Still alive after blood transfusion?" Mossier, boasting of his seasoned surgical experience, had to sigh at this moment, "This prisoner is really lucky."

"luck?"

Ignaz, who was almost in a fight with the other party 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 safe blood transfusion. He has received blood from 7 people , and did not experience any discomfort."

This is nothing short of a miracle for surgeons who are hesitant to transfuse.

"Seven people? How did you do it?" Bottini, an Italian who was sitting next to Mosier, was also very curious. "My teacher once used blood transfusion, and the effect was really good, but it was also very dangerous, and the chance of success was less than 7%."

"By a simple experiment."

Ignatz didn't want to talk too much, not because he didn't want to share, but because the Englishman Ferguson just jumped out: "Look, he actually chose carbolic acid? Why did he use this kind of thing? "

He was a conservative antiseptic doctor, at least at this time in 1866. 【3】

But in Bottini's eyes, carbolic acid is the savior to save the high mortality rate of surgery, and it is an important bargaining chip in the development of surgery.

However, his French is not good, so he can only reply in extremely awkward German: "Even Austrian doctors who had always opposed anesthesia began to use carbolic acid. It’s been a long time to be so conservative.”

"What a long time to see you, you are only 30 years old!" Ferguson was a little displeased.

"I am 29 years old."

Bottini adjusted his bow tie, took out an Italian publication, and said proudly: "I firmly support Dr. Lister's method of using carbolic acid, and I have published "Surgical Application of Carbolic Acid" in the "Medical University Annals" in my country. ". It focuses on the research results of the value of carbolic acid as a surgical field disinfectant. If you are interested, you can take a look."

"Hmph, a mere Italian publication"

Ferguson's status is much higher than his, and he doesn't care about Italian surgical guidance: "The Lancet in this country is the first-class surgical journal."

"It doesn't matter. Dr. Liszt'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 "Lancet."

"Let's talk about it after he publishes it!"

Perhaps because of 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 it is flammable. , and is somewhat corrosive.”

"Of course, a low concentration is chosen when using it."

"Is the effective performance of low concentration guaranteed?"

"sure."

All three were top surgeons, and the debate over sterilization didn't affect the others any further.Before the quarrel came to a head, the next operation of Carvey and the three assistants blinded them.

"What is this doing?"

"Why do you wear gloves during surgery?"

"It's not just gloves, they also specially covered their mouth and nose."

The appearance of gloves and masks even caused Bottini, a carbolic acid advocate, to fall into deep thought: "From the perspective of his surgical disinfection method, he has done a pretty good job. In a sense, it is better than Dr. Lister and I." Thoroughly. In my opinion, the area around the surgical field of view is already very clean, is it really necessary to do this?"

"This is to disinfect and eliminate demons."

"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 have never watched Carvey's operation, nor have they been exposed to his aseptic theory, so they don't know the significance of doing so, but they can still perceive the weirdness in it through the keen surgical thinking of the three.

We all perform surgery on the stage, and we know what kind of people are qualified to stand on such a large-scale surgery plaza.If Carvey had no ability, no ability to be recognized by those chief surgeons in Vienna, there would be no way to walk on the operating table, and no way to show his research results.

So they naturally looked at the doctors in Vienna beside them.

The one who has the most say on this should be Olgi, whose abdominal surgery was performed by Kavey.

Although no gloves and masks were used at the time, it can also explain the importance of sterility to 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. Generally, conservative treatment is used, that is, waiting for death.

But Dr. Carvey did it miraculously, and the postoperative recovery is quite good.The incision was just a little red and swollen, and there was almost no serious infection. "

"That's the magic of carbolic acid." Bottini looked excitedly at the incision on Orgi's stomach.

"If these are true, then the operation can be said to be very beautiful." Mosier still shook his head, "But this is not a reason to use a lot of props in the operation. At least I think the mask will seriously interfere with my operation."

"Can a 0% mortality rate be an important reason?"

"Sorry, it's too noisy around here, I didn't hear you clearly." Mosier heard the number, but couldn't believe his ears, "What did you just say?"

"Since Dr. Kavey showed the first Caesarean section, he has completed more than 30 operations so far, and no patient has died." Olgi looked back at Ignatz, wanting to confirm whether this number Correct, "On this point, as his teacher, Dr. Ignatz should have more say."

"I can't remember, it should be 33, maybe 34."

Ignatz turned to look at Massimov again: "Did he go to you for a mastectomy?"

Massimov was staring at the operating table with a telescope, while nibbling on the vegetable roll in his hand, not paying much attention to the discussions around him.Now after Ignatz said it, he replied: "The breast cancer patient is dying, the tumor has metastasized to other places, and no resection was performed."

Ignatz nodded and replied, "That's 33."

"No, he just didn't have a mastectomy." Massimov explained, "He did a ventricular drainage. Well, no, it seems to be called a ventriculoperitoneal drainage."

"what???"

The 0% death rate has not yet been digested by those people, and a more impactful word immediately entered their minds.In fact, not to mention the three of them, the other local doctors present have never heard of this term.

Even about half of the people didn't even know what the ventricles were, because the anatomical research of the brain was too shallow at that time.

"I was just the first assistant at the operating table for the first time, and the operation was decided in a hurry, and I only know some basic principles." Massimov didn't expect them to be so surprised, so he put down the binoculars and said, "It's better to go to the hospital first." Let’s watch the operation, the scene is more exciting than my dictation, and I will talk about other things after watching it.”

At this time, Carvey's scalpel had cut through Fernan's abdomen, and entered the abdominal cavity layer by layer.

The incisions for abdominal surgery vary depending on the surgical site, and some special operations require special incisions to create a better surgical field of view.The incision on Fernan's stomach is rather peculiar. It is a herringbone incision [4] under the double costal margin, and the total length exceeds 30cm.

The main reason for choosing such an incision is that the surgical area is not limited to the liver, and the front needs to be extended to the vicinity of the spleen to completely resolve the esophageal and gastric varices.

In order to perform liver and spleen surgery under one incision, and considering that there is not much information in the abdominal cavity, Carvey 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 now we are ready to enter the abdominal cavity." On the right side of Karvey is the second assistant Damirgang, and on the left is a loudspeaker supported by a metal bracket , "we slowly cut the peritoneum"

Carvey and Herman used tweezers to lift up the peritoneum, then cut a small opening with scissors, and Damirgang picked up the suction device and inserted it directly.Bergert can only do three assists in this kind of operation, and what he does is also unskilled hard work-hand pumping.

"There is a large amount of fluid in the prisoner's body, which is also evidence of his liver failure."【5】

Under the suction of Bergett, the light yellow and slightly turbid ascites left Fernand's body through the rubber tube, and the total amount was finally fixed at about 800ml.The ascites will not be thrown away, but will be slowly added to a drop bottle under the operation of Bergett, and continue to enter Fernand's body through the infusion tube.

"The operation consumes a lot of money, and a considerable amount of blood will be lost." Carvey inspected the organs in the abdominal cavity, and said, "Fluid reinfusion can greatly improve this situation and stabilize the patient's vital signs."【6】

Speaking of this, he paused and explained the meaning of these four words: "The vital signs I mentioned 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. Interesting, and the most difficult to measure, so here I need to introduce the results of the latest research."

A nurse wearing a mask appeared in front of the crowd with a sphygmomanometer.

She walked directly to Fernan's side, and expertly tied the cuff around his arm.

"The brand-new blood pressure monitor does not need to cut blood vessels, the measurement time is very short, and the operation process is very simple." Carvey roughly saw the size of the spleen, and began to observe the liver near him, and said at the same time, "Even if you haven't learned it before, Knowledge of physics and medicine can be proficiently applied in less than half an hour of short-term training."

"Dr. Carvey, the patient's blood pressure is around 110/70."

"Thanks, please check his blood pressure every 10 minutes while continuously monitoring his heart rate."

"Ok."

The sudden appearance of the sphygmomanometer brought the already enthusiastic atmosphere to a whole new level. According to Carvey's description, this is not just a medical instrument, but a thing that can be used by all people.

In the era of extreme lack of personal identification, some people are even considering whether blood pressure should be added to the identification information.

Carvey is used to this kind of reaction, and his focus is always on the operation itself.

The esophageal and gastric varices are the problem of the portal vein, and this must also be reflected in the spleen, which is as huge as he had expected.The spleen, which was originally hidden in the upper left abdomen, unexpectedly reached the position of the navel.

In fact, Fernand's enlarged spleen was ignored by Karvey in the previous examination due to his posture and other reasons. It was not until upper gastrointestinal bleeding occurred that Karvey performed a complete physical examination, which basically clarified the location of the spleen.

It is not uncommon to have a giant spleen. General surgery often undergoes a giant splenectomy. What really makes Carvey feel strange is the liver in front of him.

"This liver is so weird"

(End of this chapter)