Hospitals in Vienna are generally divided into two main categories.

The first category is missionary hospitals. At first, they were simple churches with some modifications, with medical supplements and missionary work as the main focus. Later, they gradually developed under the impact of modern medicine. The most typical one is St. Mary's Hospital, the center of the entire hospital.

Not the inpatient department or the administrative department, but the Catholic Church.【1】

When patients enter the hospital, they go to the outpatient clinic. If the condition is serious, they can be hospitalized. Then they go to church to pray with the doctors who cannot cure them.

The Municipal General Hospital is also considered a church hospital, and it also has a church, but it is located in a remote location and has a small area. It can be regarded as a spiritual comfort for patients. In its operation, it has been mixed with a lot of secular things, and the hospital's sponsors are no longer limited to churches, but churches.

Raise large amounts of donations and investments from nobles and capitalists through charitable organizations.

The purpose of this money cannot be simply to preach, but something else, such as fame or more say within the hospital.

If you look at the whole of Europe, the image of municipal general hospitals is actually more in line with charitable voluntary hospitals. Because the hospital itself does not earn fees, patients can receive free medical outpatient services and low hospitalization fees as long as they meet the poverty relief standards, so the number of disease sources

Very big.

In fact, the number of sources of disease in the Municipal General Hospital has become so large that it has to attract the attention of the government, and even the results of its medical services have directly affected the labor risk control ability of the western part of Vienna.

Therefore, in recent years, the government's capital investment in hospitals has gradually increased, which also reflects from the side the reason why the Municipal General Hospital has such a scale and strength.

The second category is secular hospitals.

Many of their predecessors were church hospitals, but for some reasons they broke away from the control of the church and became self-sufficient medical institutions. Hartman and Glaze are typical examples. Secular hospitals are completely open to capital, but medical expenses are also high.

Not cheap, basically rejecting the poor people at the bottom.

For them, money is not an issue, talent is.

Surgery is not like internal medicine. It is not enough to have medical theory, but also to have practical skills. Without enough sources of diseases, it is impossible to train first-class surgeons, and secular hospitals basically follow the upper-level route, so it is difficult to train strong surgeons on their own.

of surgery.

Poaching has become their main method.

In the eyes of Kawei and Ignatz, Hills' operation foundation is not solid enough and his temperament is not calm enough. He is adequate as an assistant, but he is still not good enough as the chief surgeon of major surgery.

But in the eyes of Graze Hospital, Hills's resume is already quite gorgeous. In order to tie him up this time, the hospital also spent a lot of money, not only giving him the position of chief surgeon, but also giving him the opportunity to give a speech on stage.

Already.

Personnel changes are common, and decisions that may seem rebellious to others are actually a remedial measure after he can see himself and the situation clearly.

Kawei has met many people like him.

Think about it for a moment, if you were yourself, you might choose to leave in such an environment.

After all, one Ignatz is a teacher who can support him, and the second Ignatz will become a roadblock blocking his upward path. Moreover, the second "Ignatz" who appeared out of nowhere is still a 17-year-old child.

No one can help but think more about their future.

He is young, has a high starting point, and is promoted quickly. He can hold his own no matter what he does.

After grabbing an assistant, he then grabbed the position of the surgeon. In fact, on that day when Ignatz disappeared, Kawei did snatch the position of the surgeon for cesarean section.

After repeated struggles, Hills recognized the fact that he could only be ranked third, and also saw his future in the Municipal General Hospital. He refused to be second to others, and did not surpass Kawei's self-confidence.

There's only one last option left: leave.

In fact, Hills did not expect Kawei to come. Originally, he wanted to explain to the teacher the reason why he ran away, hoping to get understanding.

But after seeing Kawei, he instantly lost motivation and put everything in the surgery report.

Hills is reporting on a complex eyelid surgery.

The surgery was not done by him, but by Dr. Corrigor who wanted to talk about cleft palate surgery in the morning. Although he was a bit conceited, and the new suture method of the cleft palate surgery did not have many highlights, this eyelid surgery was even more impressive than Waterman.

A masterpiece that keeps nodding your head.

Upper eyelid ptosis combined with severe lower eyelid ectropion.【2】

In fact, starting from Ignatz’s lithotripsy, the difficulty of reporting surgeries has gone up a level, from simple diseases to complex surgeries involving multiple diseases.

"The patient is a businessman and has had problems with the upper eyelid of his right eye since he was a child." Hills began to introduce the patient's basic situation. "Not long after he was born, his right eyelid began to droop. The amplitude was not large. The only trouble was.

It's because of the habitual squinting after the visual field is blocked.

The ptosis of the upper eyelids did not have a serious impact on his life, so he never sought medical treatment.

Until the middle of last year, a mass appeared around the lower eyelid on the same side. The presence of the mass broke the balance of the upper and lower eyelids, not only causing the lower eyelid to ectropion, but also causing the ptosis of the upper eyelid to obscure the visual field even more due to the traction effect.

serious."

The upper eyelids are drooping, and the lower eyelids can actually be regarded as drooping, but the former can be ignored, while the latter is much more troublesome.

“The tumor grew very quickly and caused much more severe symptoms than those on the upper eyelid,” Hills explained. “The patient developed symptoms of chronic conjunctivitis, increased secretions, and this year also experienced abnormal thickening and congestion of the conjunctiva.

Because the puncta cannot adhere closely to the eyeball, the patient still has epiphora and dry eyes, which is extremely painful." [3]

His vision was already affected by upper eyelid ptosis, but now his lower eyelids were also affected. Unable to bear it, the patient went to the Municipal General Hospital.

"Coincidentally, I was the one who received the patient at that time." Hills said with a smile, "But considering that the operation at the Municipal General Hospital requires that the patient without a knighthood need to enter the theater for public display, he flatly refused the operation.

A week later, he was transferred to Glaze Hospital.

Dr. Corigo gave him a detailed examination and then formulated a plan that suited him: eyelid tumor stripping and removal + upper eyelid lifting + lower eyelid shortening surgery.”

For a 19th-century plastic surgeon, the surgery was indeed complex enough, and it was pretty good that Corrigo could complete it.

Kawei is not a plastic surgeon, but he often sees patients with ectropion of eyelids in emergency surgery. They often have scar contracture caused by burns or chemical injuries. The surgical method is usually to control the burn and then perform skin grafting to remove the contracture.

Part of the skin is stretched open.

It was his first time to see upper eyelid ptosis and lower eyelid ectropion, and he was very concerned about the surgical treatment method.

It's a pity that Corigo's surgery is limited by the thinking of the 19th century. All it can do is simple addition and subtraction. Lifting is done for ptosis, and shortening is done for valgus. From a layman's point of view, it is already very good, but it is different from the experience.

After decades of training in modern surgery, there is still a big gap between the methods Kawei can think of.

"The first thing Professor Corigo did was to remove the lesion."

Hills took out the drawings from the operation: "The mass in the lower eyelid has the greatest impact on the patient. After incising the eyelid skin, the soft tissue was separated. The professor quickly performed the dissection, ligated the blood vessels, and then removed the mass. After pathological analysis, it was found that

It’s a fibroid.”【4】

It is not difficult to remove tumors in the eyelids, and it is more delicate than subcutaneous tumor removal. What is difficult is the treatment after the removal.

Without the traction of the tumor, the lower eyelid seems to be able to temporarily return to normal, but that is just an appearance, just like when Ignatz completed the cleft lip repair surgery.

Corigo has rich experience in eye plastic surgery and knows very well that long-term lower eyelid swelling has caused the patient's lower eyelids to relax. After the incision heals, this scar will continue to pull downwards. Relaxation+

If stretched, the patient's lower eyelid ectropion will definitely "recur".

“In order to prevent eyelid sagging, the professor performed eyelid shortening surgery on the patient after the tumor was removed.” [5]

Hills knew that this was a critical point, and someone who liked to find faults would definitely not miss this flaw, so he took the lead in pointing it out: "There are two wounds on the lower eyelid, so the postoperative edema is more serious. But the sutures during the operation are not

When something went wrong, the edema began to slowly subside on the fifth day after the operation, and the wound recovered very well."

In comparison, upper eyelid lift surgery is simpler.

It is said to be a lift, but it actually means removing a small piece of skin and then suturing it.【6】

This is a method that ignores the cause and directly solves the symptoms fundamentally, which is called treating the symptoms but not the root cause. But even in modern times, only similar corrective surgeries can be performed for congenital ptosis.

Of course, "standard" and "original" are not completely binary opposites.

Compared with the 19th century, modern times have a better understanding of congenital ptosis. It is generally believed that congenital ptosis is due to abnormal development of the levator palpebrae superioris muscle, resulting in muscle fibrosis and fatty infiltration. [7]

Modern medicine still cannot cure the root cause in the true sense, but it can get closer to the "root cause" on the basis of treating the symptoms.

Professor Corigo's simple skin incision and suture did not affect the abnormally developed levator palpebrae superioris muscle, and there is a possibility of recurrence or upper eyelid ectropion after surgery. This is not the case with modern levator palpebrae superioris muscle shortening surgery.

With the help of new silk threads, a radical cure can be achieved.

One eye alone required three incisions. The operation itself was not difficult, but it was not easy to achieve the desired results.

"The patient's wound did not grow well after the operation, and the expected results were not achieved."

Hills admits this, but in the view of him and his colleagues, it is difficult to avoid. It would be unkind to deny the advantages of an operation for this reason alone: ​​"This complex eye surgery is not

Pioneering plastic surgery in Austria."

After saying that, he packed up the report contents in his hand and looked at the host: "My report is finished."

"Okay, it is indeed an excellent eye surgery. In my impression, no one has ever treated two deformities on the same stage. I must praise you for being bold and careful." The host also affirmed the advantages of the surgery.

, "The next step is the question and answer session."

Starting from Ignatz’s lithotripsy, the number of questions increased significantly, and Hills’ surgery also received many good questions.

Some asked about the suturing method, some asked about the angle and length of shortening the lower eyelid, some asked about the length of the incision, and some asked about the specific area of ​​the upper eyelid skin to be cut. Hills answered all the questions as best he could, but some of the questions were too detailed.

, Corigo didn’t write down the data, so he had no choice but to give up.

"I've said everything I can say."

Hills shook off the report paper in his hand and said with a smile, "I have told you everything the professor wrote. Most of it is based on his experience during the operation and only represents his personal opinion."

"We understand. We are just asking for reference."

Hills nodded.

If he just packs up his things and leaves the stage, his first surgical report at the College of Surgery will be considered a successful conclusion.
To be continued...