Nineteenth Century Medical Guide

Compared with the barbaric stage before, surgery in the 19th century had made great progress.Most unreasonable operations are only based on some wrong perceptions, and the overall direction of operation is still correct.For those doctors who are proficient in surgical operations, as long as they have positive instructions, their skills will be greatly improved.

Perhaps in the eyes of outsiders, this kind of improvement is difficult to find through observation, but the people who actually perform the operation feel the deepest.

This kind of improvement can make the scalpels, needles and threads, hemostats, hooks, and tweezers in their hands all have a faint feeling of becoming an extension of their own arms.

Bill Roth and Bottini are typical representatives.

The former is 37 years old (there is a mistake in the front, he was born in 1829), and he is in the preparation stage of developing abdominal surgery. In more than 10 years, he will come up with various abdominal surgery to improve the general surgery by two to three grades.

The latter is 29 years old, has his own unique understanding and persistence in technology, and is on the road of rapid strengthening of surgical capabilities.

Even without Carvey, the two would follow their own surgical path to their rightful place in medical history.Now with Carvey, just a little help can take them further than they could have been.

This kind of progress does not require too 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 been spent most of your life.

Shotguns were not uncommon on the battlefields of the 19th century. They were the last line of defense for artillery, the weapon most often encountered by infantry and cavalry when charging artillery positions, and the direct cause of many soldier deaths.

This type of firearm injury is not difficult for modern surgery.

Debridement, aseptic technique, antibacterial therapy, hemostasis and blood volume supplementation required for treatment have long been agreed upon, and there are quite a few mature methods.

At this time, the production of shotguns was simple, and the power of the explosives was much smaller, which could not compare with the fragmentation injuries caused by the plethora of cluster bombs on the modern battlefield.But for Bill Roth and Bottini, who had never experienced the battlefield, bullet wounds were their uncharted territory.

For this reason, they approached Carvey, and even went to the Royal Library to read the book left by Joseph Zamora, a famous artillery general of the Empire - "Austrian Royal Artillery Officer's Handbook" [1], which described the characteristics of shotgun in detail.

The outermost layer of the shotgun is a thin cylindrical tin can, the bottom of which is an iron sheet, and the can contains hundreds of bullets with a diameter between 1 and 5 cm.

The moment the projectile leaves the barrel, the tin shell will burst open, and the bullets will be ejected from it, forming a circular pie-shaped barrage that spreads out in space.

The texture and size of these bullets determine the strength and lethality of the barrage. Since the second half of the 18th century, iron bullets have been used to replace lead bullets.The iron bullet is fast and can form a ricochet after hitting the ground or an obstacle, which effectively increases the killing efficiency.

In Zamora's book, he compared the shotguns of Austria, Britain, France and other countries and found that the dispersion diameter of the shotgun was basically about one-tenth of its flight distance, and finally formed a quadrilateral-like killing area.

If a team like the Kravov Infantry Battalion encounters artillery attacks 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." Billrot had already entered the abdominal cavity along the wound, and could clearly see the trajectory of the bullet entering the human body. "If the angle has not changed, the bullet should be near the liver." .”

In fact, because of the angle of entry, the ballistic trajectory of the projectile is deflected after passing through the skin and muscles, passing the edge of the liver and continuing to travel upwards obliquely.

Because of poor penetration, the projectile ended up making a small hole in the diaphragm and narrowly missed entering the chest cavity.

But Billroth's investigation is not so extensive, and he doesn't care about the state of the diaphragm above the liver.What he has to do is to ensure that there is no problem with the injured abdominal cavity. In simple terms, stop the bleeding if there is bleeding, and sew up the rupture if there is a rupture.

if nothing
"This bullet is interesting, where did it go?"

Bill Roth leaned on the chandelier with more than a dozen candles on the top, but still couldn't find the bullet that entered the wounded soldier's body.Even with the hands wearing rubber gloves, the intestines, stomach, liver, and spleen have been passed through the stomach back and forth, but there is still no success.

At this time, I recalled the scene when the wounded soldier first entered the hospital. Although the clothes on his body were stained with blood, it was more caused by the rupture of peritoneal blood vessels, and there was no active bleeding.

Before, Bill Roth was afraid that the bullet would cause the internal organs in the abdominal cavity to rupture, causing unstoppable internal bleeding, but after entering the abdominal cavity, he found that there was no semi-coagulated blood inside, and after washing it twice with normal saline, he did not find any newly overflowing blood. blood.

So after searching for half an hour to no avail, he decided to close his abdomen: "Suck up the water in the stomach, put the intestines back in place, and then suture."

Bodini on the side was still nervously suturing a large blood vessel on his thigh. Seeing that Billrot was about to withdraw, he asked, "Did you find the projectile?"

"This guy is lucky, I searched around but couldn't find it." Billrot glanced at the wounded soldier's face, hoping to gain some good luck from him, "I guess he flew to some other unimportant place. .”

"Is there no bleeding?"

"No."

"Well, as long as people are alive, keep the bullets."

Both of them strictly followed the principles of firearm injury treatment advocated by Carvey [2], and kept the operation as simple as possible to reduce the damage to surrounding normal tissues.For taking bombs, in principle, the injury should not be aggravated. If there is no obvious impact on the human body, there is no need to take it.

"If you can still see his posture and angle of attack when he is attacked at the scene, maybe he can directly judge the position of the projectile without cutting his stomach."

Billrot asked again about the vital signs of the wounded soldier, and after confirming that the numbers were stable, he resolutely gave up on continuing the operation: "Do you need help here?"

"No need, just sew up the blood vessel." Bodini touched the dorsalis pedis artery again, "The pulse is not bad, and the leg should be able to keep it."

Billroth leaned forward and took a look. After he felt that there was no problem, he gave up the operating table to three assistants, and ran to the entrance of the operating room by himself to see if there was another operation.But in fact, just 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 shotgun wounds, five and no. 60 people have been sent, and a few of them are almost dying."

"I gonna go see."

Billrot took off his disposable rubber gloves and apron, and was about to walk towards the door, but was stopped by Sears: "No, let's take a look at the one next to me first, he is also seriously injured. "

"what's the situation?"

"When the right thigh was shot, the left thigh was directly blown off, and even the left hand was cut open by the shrapnel." Hills moved away from the angle, allowing Bill Roth to "appreciate" the left hand attached to the wrist by a layer of skin , and the exposed bone at the stump of his left leg, "but the heaviest thing right now is his neck."

It was no longer a question of whether the injury was serious or not. It was a miracle that this wounded soldier could be sent here, and even now he was still conscious.

"I know full well that I've been knocked down!"

The wounded soldier held the thick gauze covering the wound on the left side of his neck with his only good right hand, and said in a very fast voice: "The hateful Prussian shell exploded directly at my feet. I was lying on the ground. I was covered in dark red liquid from my mouth. I felt like I had been run over my head by a wagon wheel, but I didn't know how badly I was hurt until I wanted to wipe the blood off my face with my left hand Only when it was discovered”【3】

"Okay, we all know, don't talk about Major Kravov, your neck is starting to bleed again!" Hills asked the anesthesiologist to cover his face with an ether mask, "Hurry up and let Mr. Major calm down .”

"Listen to me, you must have never experienced what it feels like to lose a leg." Kravov didn't mean to stop at all, and continued, "That's a cannon shell, and I knew it when I saw it explode. It's over. By God, it must be God, I'm still alive!"

Hills couldn't stand it anymore, and helped him cover his face with an ether mask: "Major, please be quiet, the imperial surgical team is blessing you now!"

Kravov finally became quieter, with a trace of sadness after being too calm on his face: "Are you going to amputate my left hand?"

"Yes, it is impossible to keep the left hand. The bandaging of the stump of the left leg is too dirty and messy. It needs to continue to cut off part of it." Hills briefly introduced the operation process. After all, the opponent is a major. "If you are lucky enough, You should be able to see the moon tonight."

"It's okay, come on!"

Kravov once again showed the calmness that a commander should have, and even turned his head to look at the nurse holding the ether, "It is the responsibility of every officer to dedicate his body to the empire. Hurry up and complete your operation, and wait for me to wake up." I have to count the number of casualties and make a report."

Ether rushed through his lungs, finally shutting down his brain half a minute later.

Hills didn't know much about neck anatomy, or at least had little experience.Kravov's neck was bleeding profusely, and it was so difficult to stop that one couldn't help but think that there was something wrong with the arteries.

But as long as the wound is enlarged and the anatomical structure is carefully found, it can be found that the cut wound on his neck was caused by a fragment shot from the side directly cutting the skin and cutting his anterior jugular vein.

There are abundant blood vessels around this superficial vein, and it is almost impossible to stop bleeding in a short period of time with gauze bandages.

However, if hemostats and suture needles are introduced, regardless of the integrity of the blood vessels, the suture of the bleeding point will be done directly, and the difficulty of the operation will be reduced exponentially.Even in the end, there was no need for Sears to stay on stage.

It has to be said that the lack of "quality" in the first two injured players that Bill Roth took over cost him 40 minutes of time.

The other wounded waiting for surgical treatment at the door of the operating room were heavy, and a large part of them did not need to be dispatched to the second shift.Because their injuries were in the limbs, either their hands or their feet, with the current surgical methods, there is no need to keep them.

The Fortress Hospital has a considerable reserve of surgeons. The 1400-bed hospital is equipped with nearly 30 surgeons and more than 200 assistants, which are fully capable of handling amputations.

The only factor limiting them to complete treatment is the small number of operating rooms.

But after hearing that the battle was still ahead, Hills had vacated several temporary operating rooms, and the entire fortress hospital was running at full capacity to digest the wounded who were being sent in continuously.

After stabilizing the treatment capacity of the fortress hospital, Bill Roth had the opportunity to select the wounded who suited his team.

It is an important part of the sorting system to let each medical staff appear where he should appear, and to avoid the waste of medical resources, which is also the original intention of Karvey to establish 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 very good." Bill Roth inspected the wounded at the door and made his own judgment simply, "Hills, here is a To investigate, there may be internal bleeding, come on.”

"Okay, send it to the operating room now."

"The next step is a severe open fracture of the right leg and amputation; a shot in the chest. It seems that the sternum is broken?" Billroth finally became interested after a simple examination, "Bottini, here is a shot in the chest."

Bottini has also got off the operating table, and is now checking the other side of the aisle: "I'm afraid that one will have to be released."

"what happened?"

"I have a heavier one here." Bodini walked up to a wounded soldier, gently unwrapped the bloody cloth blanket wrapped around him, and then shouted: "The left shoulder is rotten!" There it is! The left arm is hanging there, and I can even see the pecs and ribs!"

Bill Roth couldn't believe it, and even asked, "Alive?"

"Alive, but the situation is not very good." Bodini briefly monitored the heart rate. "The heartbeat is very fast, and the breathing is not very good."

"Send it to the operating room quickly." Bill Roth refused to give up. "Cut off the damaged muscle and stop the bleeding. There should be a chance!"

At this moment, another group of carriages rushed into the gate of the hospital, and soon the stretcher soldiers rushed into the hospital carrying the wounded soldiers.Among them, the most interesting thing is a stretcher "team" consisting of five people rushing to the front: "Come on, give way, give way! This is Major General Maciej! He was shot!!! "

"Shot? Where was the shot?" asked a doctor's assistant at the door who was in charge of confirming the trauma site.

"Left calf!" said the soldier carrying the stretcher. "He needs surgery now! Hurry up!"

Since the start of the battle, 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?"

"Where else was shot?"

He was holding a receipt in his hand, and wanted to write after drawing the location of the shot in his left leg, but the other party shook his head again and again: "Only the left calf was injured, but there was a lot of blood, and the major general was in excruciating pain. Immediate surgery is required!"