Varela, the surgical columnist for daily newspaper Vienna, today experienced for the first time what it was like to be kicked out of the Theater an der Wien.

The direct reason was that he taunted Hills after he failed to enlarge the incision, and was kicked out by Carvey on the grounds that it would affect the operation. Facing the sticks in the hands of the two theater guards, his usual smoothness was completely gone.

Wherever you are, you can only leave the scene obediently.

Varela looked back at the sign, took out the cigarette case and matches in his arms, and lit a cigarette for himself.

He knew that something was too much today, and he would never have done it before. He had followed and reported on surgical performances for more than ten years, and he must know that keeping as quiet as possible during the operation is the most basic respect for doctors and patients.

But Varela still couldn't hold it back.

He didn't know why Ignatz was not present today. The operation was so difficult and he was still an unknown. Now that there was no surgeon, the result was self-evident.

Maybe it was because Ignatz didn't play that he felt a little absent-minded, or maybe it was because Hills fell short when he was about to succeed and made him impatient. Anyway, it was a terrible day for Varela.

The basin of cold water that Kawei poured on him calmed him down a lot, but one step at a time meant that failure of the operation was inevitable.

"The time is approaching the 20-minute mark, and the child hasn't come out yet, and there is so much blood. Hills is like a fool, and he doesn't know how Ignatz teaches people..."

Varela blew smoke rings into the sky and complained about the operation and the people, "Twenty minutes is a long way to go. It's over, it's definitely over. The operation failed again."

He has traveled to many countries and seen other people's surgeries.

Britain and France are major countries in medicine. They are ahead of Austria in both surgery and internal medicine. Germany in the west and Tsarist Russia in the east are also showing signs of overtaking. The cigarette case in his hand was received when he visited Tsarist Russian medical officials.

Gift.【1】

Healthcare reform is underway across Europe.

The United Kingdom has already opened the University of London that accepts civilian admissions, as well as several well-known European medical journals; France and Germany have successively increased medical industry standards, and the Russian Department of Surgery is also actively seeking exchanges with other countries.

Among the big countries, only Austria is still planning the big event in Hungary, and has not put medical care on its agenda at all.

Although belittling Ignatz is a new attempt by the newspaper to increase sales, Varela does not deny that he also hates iron for not being able to make steel. Such as "not actively innovating" and "holding on to old theories and resting on one's laurels" and so on

His remarks are all labels given to Austria by the health systems of other countries, and they are used by him to borrow flowers and offer them to Buddha.

He was not like Ignatz, who guarded one-third of an acre of his vienna and enclosed it for his own sake.

As a columnist who travels all over Europe, I have to exchange some surgical techniques with other countries every time I travel. Now, not to mention Britain, France, Germany and Russia, even surgeons in the Netherlands, Sweden, and Belgium are shaking their heads at the Austrian surgery, that is,

A guy like Ignatz can still put himself on the stage and say a few words.

He badly needs a victory to prove his country's surgical skills.

"never mind."

Varela stubbed out the cigarette butt, feeling a little frustrated, pulled up the lapel of his coat, and stopped a carriage: "Go to the Vienna Daily newspaper office."

"Isn't this Mr. Varela? Why do you go to work so late?"

"I have to write in a hurry. Tomorrow's headlines will be on the front page..."

...

The placenta is a highway for the fetus to obtain nutrients from the mother's body and send away waste products. The large amount of blood flowing through it is the carrier of these nutrients and waste products.

In the 20th century, formal modern obstetrics gradually entered the market. Before performing a cesarean section, B-ultrasound examination must be completed to clarify the location of the placenta. In addition, the selected lower uterine segment incision can naturally avoid non-placenta previa, unless the patient has never had an examination.

The operation must be urgent, otherwise the placenta will hardly be damaged by the operation.

Of course, there are no absolutes in the world. It is normal for poor people not to have prenatal check-ups. Clinically, intraoperative placental damage will still be encountered. Once the placenta is injured, it is equivalent to cutting off the entire highway. The amount of bleeding is extremely exaggerated. If you want to stop the bleeding and

Not easy.

There was definitely no B-ultrasound in the 19th century, there was just luck. Obviously, luck is not on their side today.

No one knew that Nora’s placenta would appear in this position, not even Kavi. Therefore, when performing a cesarean section, you cannot rush to incise the uterus to remove the fetus, but you need to observe the location of the placenta first. [2]

It's not that Hills has never seen blood. On the contrary, he has seen blood every day to the point of numbness. The blood splattering everywhere is not a good sign. His rich experience in amputation told him that if he messed up the operation, Nora would die.

undoubtedly.

It only takes a moment of discouragement for death to take away a doctor's will and courage.

"Teacher Hills! Teacher Hills!!!"

"The amount of bleeding is too much..." Hills looked at Herman who was still trying to pump blood. Although he tried his best to press the bleeding hole with the gauze in his hand, he had no fighting spirit in his heart. "What's her condition now?"

Sample?"

The nurse quickly answered his question: "Heart rate 110 beats/minute."

"It's a bit fast..."

Hills pressed the incision that was full of blood. Although he was still trying to stop the bleeding, there was no fighting spirit in his eyes.

Carvey knew very well that Hills was no longer useful, but he couldn't kick him away just yet.

I have just kicked out the annoying Varela. If I drive him out again, I will look very arrogant. And more importantly, the ensuing mess will not be easy to deal with. It will be difficult for myself and Herman to complete it alone.

.

However, before deciding whether Hills should stay or go, the audience must first be appeased, or at least let them know the progress of the operation.

"We cut the placenta and the bleeding was a bit heavy, but there is still a chance. We have to get the baby out first."

After clarifying the direction of the next operation, Kawei turned to the midwife on the side: "Two of you, come and help. The taller one will help Herman pump blood, and the shorter one will come over and get the baby out first. Herman will go and get it."

Two pairs of umbilical cord clamps and the bottle of medicine I brought, hurry!!!"

Under the command of Kawei, this makeshift surgical "team" began to look like a first-aid operation.

The tall midwife worked hard to pump blood, and the shorter one with smaller hands easily reached into the enlarged uterine cavity and pulled out the child covered in blood immediately. Herman followed up and clamped both ends of the umbilical cord, and quickly

After cutting the umbilical cord, all of Kavey's attention was focused on the operating table.

"The fetus has been delivered. The next thing to do is to peel off the damaged placenta as soon as possible..."

As soon as the words were spoken, Kawei's hand had already reached into the uterine cavity, and at the same time he said to Hills beside him: "Teacher Hills, there are two bleeding holes here, use gauze strips to suppress them."

"..."

"Teacher, I need gauze strips to stop the bleeding!!!"

"Um?"

Hills was just like the panicked Bergert. He held the uterine incision in his hand, but what he was thinking about was how to face all this after the operation. He had already lost his mind: "Stop the bleeding?"

Kawei no longer cared about status, snatched the gauze and crow's beak forceps from his hand, leaned forward and said in a low voice: "If you still want her to live, just do everything I say.

Do it. If you can’t do it, get out of here! Nora doesn’t need a piece of wood to do her surgery!!!”

Hills was a little confused after being scolded.

The "colleagues" around the operating table also heard something about it and were very confused.

Even some spectators in the stands smelled something and saw some hints of infighting within the team.

Kawei was just an assistant. He was from a civilian background and had not received any systematic medical training. It was taboo to do anything wrong during the operation. But Hills' failure and numbness were obvious to all. Kawei's reaction at least saved Nora's life.

Allow the operation to continue.

Moreover, the right to speak has been in Kawei's hands from the beginning, and outsiders cannot tell that the command has been handed over.

Hills seemed to wake up from the scolding, and looked at Nora who looked slightly pale again, and nodded: "I will do it."

"There are not enough manpower and crow's beak forceps, so just cover both sides of the incision with gauze and leave it alone." Kawei made a judgment and then said something shocking, "All you have to do is stand on the operating table and reach into her abdominal cavity.

, pinch the uterine body tightly with your palms.”【3】

Hills had never heard of this method of stopping bleeding: "Pinch the uterus?"

"Do it!"

Kawei stopped talking to him. After assigning the task, he needed to completely remove the placenta as soon as possible. As long as the placenta remained in the uterus, the uterus would not be able to contract well. If the uterus contracted poorly, the blood vessels inside would be like unscrewing.

The faucet keeps bleeding out.

The placenta is deeply embedded in the uterus. You need to find its edges, separate it with your fingers, and then tear it off in one piece.

"Don't have an implant... don't have an implant... don't have an implant..." [4]

A minute later, Kawei pulled out a large black-red mass of tissue from the uterus, and left Nora's body along with the umbilical cord and umbilical cord clamp he had just taken out: "Everyone, we are pretty lucky, Nora.

The placenta did not adhere or implant, and was peeled off very smoothly. All we have to do is wait for the uterus to contract further to stop the bleeding.”

He breathed a sigh of relief. Delivering the placenta was the first step in stopping the bleeding.

But the surgical theater, which had been quiet just now, suddenly became noisy. Only then did Kawei realize that he had said the wrong thing.

The explanation just now would be understandable even to medical students in the 21st century, because it is written in textbooks. But in the 19th century, when cesarean section is blank, it would seem unreasonable and confusing.

In addition to the upper-class nobles, there were also many medical students and working surgeons in the audience. It was difficult for their brains to accept so much irrelevant knowledge at once. After asking each other to no avail, they could only ask questions on the spot.

"Mr. Carvey, what does placenta accreta mean?"

"Implantation should mean that it is difficult to remove."

"But what does stripping or not stripping have to do with hemostasis? As long as the umbilical cord is clamped, massive placental bleeding can be prevented. Wouldn't it be more appropriate to control the break just now?"

"Yes, why didn't you just stop the bleeding and take out the baby first? Can't you stop the bleeding first and then take out the baby?"

"The child can understand it. After all, leaving it in the uterine cavity will cause damage and affect the hemostasis operation. But it is difficult to understand if the placenta is removed first. I have read a lot of obstetrics medical books and cesarean section surgery records, and there is no mention of it.
To be continued...