The regular meeting of the Royal College of Surgeons starts at 8:00 in the morning and ends at 18:00 in the evening. There is a break from 11:30 to 1:30 in the middle, which lasts for 8 hours. The time seems to be very long, but in fact, for the various meeting contents,

Not a small amount of compression has been done.

Morning is a new trend in surgery.【1】

Although it is named "surgery", it actually covers a very broad scope. It mainly introduces new operations that are applied in surgical operations, and is not limited to the surgery itself. The technology has various shortcomings, and some have very narrow applicability.

But Kawei still has to marvel at their eclectic adaptability.

For example, Fermi, the first surgeon at St. Mary's Hospital, introduced a new anesthesia method to everyone:

"On January 16 this year, our hospital received a patient with maxillofacial trauma. At that time, it was discovered that his facial injury was severe and he was not suitable for the conventional preoperative anesthesia administration mode, so I tried to use an enema pump."

【2】

Ether is put into the enema pump, heated slightly or gently shaken, then ether gas can be poured into the rectum, and finally blocked with a cork to achieve anesthesia.

Of course, there is also a method of mixing ether liquid directly into the enema solution, but it is difficult to ensure that the operating bed is clean enough after the patient falls asleep.

"Enema anesthesia is not limited to maxillofacial injuries. It can also be used for some patients who are afraid of masks. They don't like the feeling of their mouth and nose being covered, and they will be irritable and feel suffocated. Enema can prevent this from happening."

Fermi is very confident in this method of drug delivery: "I believe it has broad room for development. The only thing that needs attention is the dosage issue."

Dosage is the ultimate question that troubles general anesthesia. How long the anesthesia lasts and how deep the anesthesia is needs to be studied. Unfortunately, ether is just a passer-by in the history of anesthesia. It will be gradually eliminated as new anesthetic drugs appear, and it is difficult to measure the dose.

The enema was just a flash in the pan.

However, Dr. Fermi did not leave the podium after finishing the anesthesia introduction, but instead started the demonstration session of the second technology.

Soon his assistant came to the podium with a simple combination of belts, cloth pads, and pressurizers: "For the same patient just now, after using enema for anesthesia, we used a brand new hemostatic kit.

, effectively curbed massive maxillofacial bleeding” [3]

Ignatz watched their operation demonstration and was very interested in this set of belts: "It's good for facial bleeding. It's quite suitable for plastic surgery. No wonder it was chosen."

Kawei looked at it and just nodded, not interested in it.

Although it is effective to stop bleeding by pressing on the epidermis, it is too limited and difficult to last for a long time, so it is generally used at trauma scenes and transportation. Once you actually enter the operating room, you still need to quickly find the bleeding location and perform precise blood vessel suturing to stop the bleeding.

It is not that easy to find broken blood vessels. In many cases, the incision needs to be extended. It is easy to put on but difficult to remove. At that time, these straps will become an obstacle to hemostasis.

However, in the 19th century, trauma rescue was poor, transport was basically zero, and the application conditions of the belt compression hemostasis method were too harsh. In comparison, the hemostasis method in the third game was more reliable, and it has been used even in the 21st century.

"For lower limb amputation, especially high amputation of the upper thigh, it is not easy to stop bleeding during surgery."

This time it was Dr. Lockard from Glaze Hospital, who put on a set of abdominal anatomy models: "Just like cutting off a river, if we avoid those branches and branches and choose to block the upper blood flow, we can completely

The purpose of stopping bleeding.”【4】

In fact, what he chose to amputate was the iliac artery that supplies blood to the lower limbs.【5】

When encountering a ruptured femoral artery due to leg trauma, if there is no way to find the severed end of the blood vessel at the first time, opening the abdomen to block the iliac artery is always a second-hand option. For emergency scenes with massive blood loss due to trauma to the lower limbs, air bag pressure can be used to resist shock.

The same principle applies to pants.

To be able to think of this step, and to do it in order to avoid abdominal infection, is a big improvement. It's a pity that Ignatz is still worried about Hills' departure:

"Amputation surgery itself is already quite dangerous, and suppuration of the incision is normal. I remember that their amputation mortality rate last year was 47%, which is too exaggerated! Just like this, one more incision has to be made. Have you not thought about ulceration? Look.

Look at the German guy in our Ward 3, how bad his legs are."

Kawei asked inappropriately at this time: "Teacher, what was our amputation mortality rate last year?"

"emmm38%."

"It doesn't sound like it's much lower."

Ignatz knew that this number was still on the high side, and quickly explained: "Maybe it's because of the physical condition of those patients. When I amputated several generals, I found that their chance of developing ulcers after surgery was not high, about 10%.

about."

"I don't think it has much to do with the physical constitution." Kawei hopes to lead Ignatz to the cause of the infection instead of focusing on the physical constitution. "The reason should be the hospital environment."

Ignatz looked at his assistant in disbelief, remembering the hospital environment he had discussed with him, and immediately became alert: "I remembered that you valued that British woman's research report before. Her research

Although the report is somewhat convincing, he is actually a lunatic at heart!"

madman?

Kawei didn't understand what he meant: "What crazy person?"

"Her new idea is to tear down all the city hospitals and let us move to the countryside to open small clinics! This suggestion is simply ridiculous. I thought a surgeon should not agree to it. But"

Ignatz stood completely opposite to Nightingale and tentatively asked Carvey: "Do you also want to demolish the Municipal General Hospital?" [6]

"How is that possible?" Kawei explained. "The hospital is innocent. It is just a pile of stones and bricks. What really needs to be improved is our concept. Doctors need to wash their hands and clean the incision site before and after surgery. At least

The wounds of the patients I participated in all recovered pretty well."

"Where's Mr. Li Ben?"

"Li Ben was just an accident." Kawei's face was solemn, regretting his mistake. "The situation was urgent at first, and the carriage would not arrive for another hour. I thought he was about to die and had to be sutured."

"I think his legs can still be saved, just like the earl did."

"I hope he can get through it. If he still doesn't get better tomorrow, I can only debridement him."

Having known Kawei for more than half a month, Ignatz has seen everything with his eyes and has gradually come to accept hand washing and cleaning before and after surgery.

He is not one of those stubborn obstetricians and is very sensitive to the patient's mortality rate. Even a 5% difference is already considered a huge gap, but the reality is that the chance of wound ulceration in patients who have been prepared for surgery by Kawei's hands is about 20%.

None of the patients died.

Although the sample size is not large, Ignatz has a hunch that Kawei’s postoperative myth will continue.

The compression and hemostasis method of the common pelvic iliac artery received some applause, but as a name appeared, the applause gradually became more enthusiastic: "Next is the famous British surgeon who fought against Nightingale's medical pioneer, Dr. Lister.

At the right time, our Vice President Edinson will read out his latest research report to us."

Because of some comments related to surgery, Nightingale has become the target of surgery.

She has indeed received a lot of recognition in the UK, but she is "notorious" abroad, especially the Austrian Department of Surgery, which has always been conservative.

Originally, Ignatz only classified her into the ranks of ordinary women, with at most some small achievements, and his basic attitude was disdain. Now because of the increasingly outrageous "hospital demolition theory", Ignatz has no choice but to oppose Nanding.

Geer, because no one wants to move to the countryside and be surrounded by mountains, rivers and farmland every day.

There are no corpses, no medical school teaching sites, and not enough sources of disease. Leisure will be the chronic poison of every surgeon striving for the top.

Therefore, the voices of opposition are rampant. Unfortunately, in Vienna, Austria, they can only live with their words. It is the British surgeons who really have high hopes for the entire surgical community.

And Liszt is the most famous one.

"What I bring this time is the judgment made by Mr. Lister after reading the public research of a French chemist."

Edinson looked at the two report papers in his hand with a particularly complicated mood. Narrating the next paragraph may be more difficult than reading the Austrian defeat report: "Everyone, Mr. Lister, he still admitted that the surgical trauma in the big hospital was caused.

The chance of ulceration is extremely high.”

"What?"

"What a joke!!!"

"Even he backed down? Doesn't this just allow that crazy woman to succeed?"

"Oh, it turns out that the British are unreliable."

"Is he still a man? Where is a man's ambition???"

Kawi, who was born in modern times, has difficulty understanding their way of thinking.

It was just an admission of a fact that had already been proven, but the situation got out of control. It felt like the boxer they had supported for a long time suddenly gave up on the eve of the decisive battle with his fateful opponent, which was hard to accept.

"Everyone, please be quiet! Please be quiet!!!" Vice President Edinson tried his best to maintain order in the venue. "We still have to face this reality objectively. In fact, there is still room for change, and it has not become worse."

"Oh forget it, Edinson, the truth is already bad, I feel like the hospital in Vienna will be demolished soon to make way for those factories."

"Are we, the most prestigious surgical professors, allowed to open barber shops in rural areas?"

"I don't want to go to the country"

Facing the doubts of his colleagues, Edinson had to raise his voice: "Although Mr. Lister temporarily acknowledged Nightingale's point of view, he put forward another possibility. As I just said, he was

I said this after reading a research report by a French chemist."

"Who? What's your name?"

"Um" Edinson glanced at the name scrawled on the report paper, "named, Louis Pasteur."

"do not know."

"Chemist? Is there any connection between chemists and surgery?"

"We are neither pharmacists nor physicians. How can chemists control our scalpels?"

These were just objections based on existing theories. Soon these voices became less harmonious: "After reading a French research report, an Englishman actually admitted a woman's crazy talk.

, you taste it carefully!!!"

"It's over. The right to speak in the Department of Surgery has actually fallen into the hands of these people."

"sorrow!"

"I feel like surgery is going to be over."
To be continued...