Chapter 81 78. “Satan” moves

Appendiceal surgery comes and goes quickly. Once the appendix is ​​caught, in the hands of a skilled surgeon, it usually takes no more than 10 minutes to remove and close the abdomen.【1】

Appendiceal surgery in the 19th century was very bad, but one thing is still worthy of recognition, and that is the preparation before surgery.

Because there is no need for Kavi to remind him, and there is no need to worry about the doctors' impromptu whims. Most people, including Morasso, Alphonse and the priest, will have their intestines ready at any time to ensure that the surgeon can see them after cutting them off.

What is there is a fresh and tender tube cavity with some green medicinal residue, rather than feces pouring out like a mudslide.

At that time, enema was indeed a very magical and common thing, and Father Schmidt was one of the representatives. His preoperative preparations went beyond the scope of ordinary seriousness.

The priest believed that abdominal pain was a treacherous and dirty trick of Satan. From the beginning of the onset of the disease, he increased the number of enemas he used to purify his body and mind from two to four times a day to ensure that he could drive away this demon.

For Schmidt, this is a holy war of his own.

Unfortunately, the concoction used for the enema was not powerful enough, so Ignatz and Kavi had no choice but to force their way in to help.

The severed appendix is ​​indeed spectacular, and the actual length may be longer than Kawei predicted, probably 27-28cm. This has never been seen before he traveled through time, and it is indeed a record.

"Herman, go on"

Kawei picked up the suture left on the stump and the crow's beak forceps on the other side, and threw the entire appendix into the prepared container: "Don't throw it away in a hurry, keep it for use."

"It's for pathology."

"right."

Postoperative pathology is an important link.

Observing organ changes with the naked eye will become too subjective and lack specificity. Only by starting from the highly specific cellular level can we clarify what is wrong with these diseased organs.

It would be fine if it was just an ordinary inflamed and ulcerated appendix. Kawei did not insist on it, but this time the appendicitis bulged into a meat bag and needed to be cut into slices and carefully looked at under the microscope. This was also the reason Kawei came into contact with the Ignatz microscope.

good opportunity.

Find the appendix, cut it out, and then sew the stump. For Ignatz, this is a job that is better than worse. He definitely can't do purse-string sutures in the modern sense, but he can still use sutures.

Easily sew up the gaps.【2】

While suturing, he had some insights: "The appendix has been removed, and now we need to suture the gap. General surgeons may think it's nothing here, just do a simple suture, but I have been doing double ligation."

Because catgut sutures are often not tied firmly, resulting in intestinal fistulas and patient death after surgery."

This is true, and purse string suture is no longer necessary in evidence-based medicine in the 21st century.【3】

Surgery is a team game, and its completion requires the efforts of everyone.

Even if the technical content required for the secondary anesthesia was low, Kawei could not hold the appendix with one hand and suture it while using his feet to anesthetize the priest. Moreover, anesthesia itself is dangerous. In addition to controlling the dose, you also need to pay attention to it anytime and anywhere.

Father's heart rate, breathing, and prevention of aspiration after vomiting.

Hermann's contribution was obvious to all, but after the operation, the audience's applause still went to Ignatz as the chief surgeon.

This is a period of silence and accumulation that every surgeon must go through. There is always only one surgeon, and it is always inevitable to do some odd jobs behind the scenes.

Therefore, compared to Hills, who wanted to stand in the chief surgeon's position, Herman, who could stabilize his mentality and practice silently to gain experience, satisfied Carvey more.

Kawei himself doesn't care about the applause. Yesterday's cesarean section has already made him shine, so it's not a bad idea to give up some honors. And this kind of humility is not in vain. He can definitely get it from Ignatz.

Get some benefits out of it.

After all, Ignatz himself knew that the reason why he got all the applause was because of Kawei's initial judgment on the position of the appendix.

These are all secondary. What really needs attention now is the postoperative treatment.

Ignatz handed the priest with his open belly to Kavi's hands, meaning that he would do the final suturing of the abdomen. But in Kavi's mind, the operation was not over at all, and there was one last step before the abdomen was closed.

:Clean the abdominal cavity.

The reason why surgery collapsed in the 19th century was largely due to the lack of disinfection of wounds, coupled with the lack of masks and gloves, which completely exposed surgical incisions to bacteria.

In this kind of surgical environment where protection is close to zero, and with such an exaggerated 17cm large incision, even with the support of modern antibiotics and strict disinfection, there is still a risk of infection, so the cleaning of the postoperative wound and abdominal cavity has become

Especially important.

Cleaning the abdominal cavity is a routine operation in abdominal surgery.

Pus is hidden in the abdominal cavity, which can infect the appendix incision at any time and cause peritoneal irritation. If the abdominal cavity is not cleaned, the operation will be the same as not having been done at all.

Even putting these aside, the blood and exudate caused by the incision are a petri dish for bacteria, and new infection foci may form at any time.

Cleaning is nothing more than pouring in a large amount of saline and pumping it back and forth a few times.

But for the 19th century, washing the stomach was a very strange practice, and there was no real sterile saline.

There was no saline solution, so Kawi had to prepare it himself. Fortunately, the people entering and leaving the theater were all upper-class celebrities, and the water flowing out of the water pipes was melted snow water from the Holy Alps, which was at least cleaner than pus.

Taking advantage of Ignatz's opportunity to accept the applause and do the finishing work himself, Kawei found Herman: "Herman, go and get a basin of water." [4]

Herman was a little surprised, but he was just surprised. Working behind Ignatz all year round made his body move faster than his brain. When he realized that Kawei's request was unusual, he had already turned around and walked away

to the preparation room.

Those who enter and leave the theater are all aristocrats and celebrities, and the water flowing in the tap water pipes is melted snow water from the Alps. If added with table salt from the audience lounge, it can be converted into a substitute that is comparable to normal saline.

Of course, in theory, warmed saline is better, but conditions are limited, so you can only make do with it.【5】

At this time, Ignatz was wiping his bloody hands and enjoying the applause of the audience.

After answering several medical-related questions, Greg, the new reporter who replaced Varela, squeezed in front of the crowd and grabbed the right to ask questions:

"Dr. Ignatz, congratulations on successfully completing another abdominal surgery. I am the surgical columnist of the daily newspaper and I would like to interview you with a few questions."

"Greg?" Ignatz was a little surprised hearing this unfamiliar name, "Where's Varela?"

"I'm not feeling well, so I'm resting at home."

"Oh, feel free to ask."

"Is there not much research on appendicitis in the European surgical community today?" Greg asked a very strange question, "I have checked many literatures and there are very few case reports in this area."

"That means you are looking in the wrong direction." Ignatz explained, "Most surgeons in Britain, France and Germany classified appendicitis into the category of 'pericecalitis'."[6]

"this"

"Do you think there will be more cases all of a sudden?"

"Indeed, this is a very common medical term that is often seen."

Ignatz sighed and said with a smile: "You can ask the medical students and doctors around you. In today's surgical medical community, the majority of people support pericecumitis. This term has been written openly in

It has been included in textbooks and spread to the ears of countless medical students every year.

But in fact, its authenticity has yet to be verified. After all, the phenomenon of 'pericecalitis' found in autopsy is often only the edema around the cecum, and the real area with serious disease is the appendix. And I have always been of the 'appendicitis' school, and I am absolutely

of the minority.”

Greg nodded repeatedly: "I didn't expect these interesting stories, but today's surgery can help Dr. Ignaz regain some of his disadvantages."

"It's hard to say." Ignatz didn't think that deeply.

Greg is still young and does not have as deep a foundation of surgical knowledge as Varela, so he can only start with interpersonal relationships. And his method of starting is far gentler than that of his two colleagues from the Times and the Free Press:

"Dr. Kawei completed a cesarean section last night. Objectively speaking, it was a wonderful operation as good as today. It is rare for two people to share the same stage. As his teacher, can you evaluate Dr. Kawei's operation for us?

ability."

Ignatz knew that this kind of question would come up sooner or later, so he had already thought of a response plan from the beginning:

"Kavi is one of the most talented children among the many children I have seen. He has learned a lot of surgical experience from his father, and his surgical skills are unquestionable. And in obstetrics, he already has overwhelming strength.

.”

In just three sentences, Kawei was promoted to a high position, causing many people to talk.

"Overwhelming strength?" Greg said, "There are sporadic examples of successful cesarean sections around the world. A single success should not be enough to prove this statement."

"There's no rush. All mothers who need cesarean sections from Graze Hospital, St. Mary's Hospital, and Hartmann Hospital have been sent here. You will see many cesarean sections in the future." Ignatz seemed to be worried about Ka.

Wei is quite confident, "As for whether it has overwhelming strength, it just depends on the final success rate of the operation."

"I see."

At this time, most of the eyes in the surgical theater were focused on Ignatz, and some audience members who did not need to ask questions chose to leave early. The operation was over, the fun was gone, and there was no point in staying here anymore.

Although everyone in the discussion group was talking about Kawei, only a handful of people really paid attention to Kawei.

Varela, who has been watching the operation in the preparation area, is one of them.

"What are you doing?"

"Wash your stomach." Kawei lifted up a small basin and poured the light salt water into the priest's open stomach. "It can wash away the remaining blood, tissue fluid and pus, and it can also help the incision heal quickly." [7

】

This sounds reasonable, but no one has ever asked: "Who said this?"

"Who?" Kawei thought for a moment, pointed at himself and said, "I, I said it."

"Is there any basis for this?"

"Yes, I have."

Kawei casually made up a basis and said: "The lithotripsy surgery was just completed yesterday afternoon. The patient's name is Fernand, and he is a butcher selling pork. He said that when cutting meat from a whole pig, he wanted to ensure that
To be continued...