Modern hospitals are places where patients are treated and saved. The first impression they give people should be that they are neat and clean, but these inherent impressions are completely divorced from reality.

In fact, any place that is inhabited cannot be clean.

The reason why modern cities are clean is simply because of their complete garbage disposal and sewer systems. European cities in the 19th century were not modern, so they were not as beautiful as people thought. They were synonymous with chaos and filth.

As hospitals are highly populated places, this situation will only become more serious.

It is still the transition between winter and spring, and the fat mice have already swaggered out of their burrows and are looking for food in the corners of the beds in various houses. If we go back a month and wait for the weather to get warmer, those mice hiding in the cracks will

Xiaoqiang will also crawl out in groups to bask in the sun.(1)

The hospital is such a place.

Although the wards in the old days were noisy, dirty, and crowded, this familiar scene immediately reminded Kawei of his job as a doctor.

In the past, it would have been considered too modest for him to call himself this way. Even if he didn't use those titles, he would still have to add the prefix "director" to himself to be justified. But now Kawei is just an assistant, even

The assistant physicians back then were not as good as him.

After all, the latter still has a certain degree of professionalism and requires several years of professional study and professional examinations.

The identity contrast was so sharp that Kawei couldn't adapt to it for a while. When introducing himself, the word "doctor" just blurted out.

The 19th century was an era when all doctors wore formal attire when entering and exiting wards and operating rooms. The coat he wore looked so dirty that it was impossible for a normal person to equate him with a doctor.

"Sorry, I was a little excited just now."

Kavi re-introduced himself: "My name is Kavi, Kavi Hines. I was recommended here by Teacher Ignatz. I work as a surgical assistant."

The young nurse was wearing a pale gold dress with a white apron on top. She was probably in her 20s. Seeing Kawei's behavior, she didn't pay much attention to it. She just nodded and pointed to a hospital bed in the distance and said:

"Since you are an assistant, hurry up and follow me. They are doing rounds of wards."

Ward rounds...

The original meaning of the little nurse's words when translated was indeed ward rounds, but Kawei looked closely and didn't see a trace of what a ward round should look like.

The three young men are all wearing black formal suits, with tall and straight figures, and their manners are gentlemanly and elegant. If they were walking on the street, Kawei believed that their posture would definitely be good, and they would definitely attract the attention of all the girls.

But this is not a runway show, but a ward round!

They did not conduct a physical examination, nor did they have any verbal communication with the patient. They did not have a stethoscope, and they did not carry the patient's medical records. At most, they only asked a few questions to the family members beside them, and then hurriedly walked to the next bed.

"It's more casual than going through the motions at night..."

Kawei muttered something in a low voice, and suddenly reached out towards the little nurse just now: "Where are the medical records?"

"Oh, the medical records are on the doctor's examination table."

In fact, it wasn’t that the young nurse had memorized the rules wrongly. After all, it was what the head nurse had repeatedly emphasized. In fact, Kawei’s actions and tone of voice did not allow her to refuse, making her feel like she was being questioned by a superior doctor, so she did it naturally.

There was a reaction.

"Bring it to me and see."

"Okay, wait a moment."

After she handed everything into Kavi's hands and relaxed, she realized that the patient's medical history information should not be handed over to an assistant casually.

However, it was already too late. Just when the little nurse knew that she had made a mistake and wanted to actively seek ways to correct it, Kawei had already remembered all the conditions of the 13 patients in this ward: "Thank you, I see.

It’s over.”

"so fast?"

“The admission record is written on it, so there is nothing difficult to remember.” (2)

The little nurse only regarded it as a joke because of her pride. There were 13 beds of patients with different types of diseases and different priorities. It was so easy to remember. What's more, the writing of the medical records was all written by Ignatz.

It's full of all kinds of professional terms, and it's still written in complicated and difficult-to-understand Latin.

Even those young doctors have to look at it for a while to understand what it means. How can an assistant understand it?

The little nurse wanted to scold him because she had come to the hospital a week earlier, but she didn't expect that Kawei didn't give her the chance and ran to a bed not far away in the blink of an eye.

Lying on the bed was a 10-year-old boy, with his mother standing beside him, looking anxious.

It was probably the first time for the mother and son to meet these doctors who were born into celebrities. It could be seen from the way they acted during the "ward rounds" just now that their words were a bit reserved. Now that people have gone to the next few hospital beds, the mother has been hesitating whether to go again.

Talk to those people about it.

Kawei has worked in the hospital for more than 30 years. He could see at a glance that the ward rounds just now failed to solve their problems, so he walked over immediately and asked: "Is there anything I can help you with?"

The mother finally found someone who could speak and explained: "My son's leg was injured very seriously. They said it would be amputated..."

"Ok, I know."

The mother looked back at her son who was enduring severe pain on the bed, and felt very uncomfortable: "But my son doesn't want to have his leg amputated, and neither do I. He is only 10 years old. If it is amputated, he will definitely lose his job, and the family will not have much money anymore."

..."

Kawei just saw the medical record, which clearly stated the diagnosis of "tibia compound fracture", in Ignatz's own handwriting. (3)

He didn't understand what a "compound" fracture meant, but he knew very well that when dealing with such trauma patients, without the help of an X-ray machine, a rigorous physical examination must be used to determine the fracture injury.

At Kawei's request, the mother lifted the quilt off her son, revealing the severely injured left leg.

The shape of the left leg is really not right. There is a deep depression in the middle bone area, and the surrounding skin is swollen to varying degrees. The most important thing is that the skin in the deep depression area is defective, and there is an obvious gap between the subcutaneous tissue and muscle fascia.

avulsion separation.

This is a crushing injury caused by the strong traction force generated by the rotation of the wheel. Modern doctors also call it "avulsion injury" or "degloving injury".

Kawei looked at a ring-shaped avulsion wound on his leg and made a simple measurement: "Is it a bruise from the carriage?" (4)

"Yes." My mother couldn't help but shed tears again, "Last night when I was returning home from work, I was accidentally knocked over by a carriage and my leg was crushed."

Kawei nodded, avoiding the wound and doing a simple check on his leg. The main focus was not on the fracture itself, but on the soft tissue, blood vessels and nerves around the bone.

The soft tissue test examines the tension of the calf soft tissue, calf skin temperature, color, etc. If the soft tissue is swollen, the skin temperature is elevated, the skin color is red and dark, and there is severe pain, it is likely to be compartment syndrome. (5)

With the current medical level, there is no reason to hesitate, the leg must be amputated.

The tibial blood supply test is the pulse of the dorsalis pedis artery, and the nerve test is to check whether the toe movement is restricted and painful, whether there is foot drop, etc. If the blood vessels and nerves are damaged, the function of the distal limbs will definitely be impaired, so keep this

There is no solution to letting the infection continue in the leg. It would be better to amputate it.

The child is lucky, there are no problems with soft tissue, blood vessels and nerves.

Kawei then began to focus on the fracture, and needed to carefully examine the shape, length and circumference of the left leg to determine the fracture displacement.

Because there are no steel plates and steel nails for internal fixation, the scope of application of simple manual reduction and fixation is very limited. If the displacement is severe, it will be difficult for the bone to heal even if it is reduced, and the final result will be amputation.

Now the shape of the left leg has changed. The displacement is there, but the amplitude is not large from the appearance, and the length has not changed. It just happens to be the surgical indication for amputation.

At this time, the doctor needs to make a judgment on whether to save or cut off the treatment.

If it is safe, reduction and fixation are required. These are no problem. Fracture treatment has been around since ancient times. Manual reduction is not difficult, and the technique of splinting is already quite proficient. But the key problem is the avulsion injury. In such a hospital environment

With such a large open wound, infection and ulceration are inevitable.

Amputation does not have this problem.

As long as the amputated stump is properly embedded, the chance of infection at the suture line will definitely be much smaller. Even if infection occurs, the rate of development will be much slower.

Although in Kawei's eyes, they are all similar, and they are all fighting for their lives, but in the hands of Ignatz, the mortality rate of conservative treatment is definitely higher, and there is no problem in choosing amputation: "Personally, I think Teacher Ignatz's choice

That's right, amputation is the safest option and can minimize the mortality rate."

This is not Kawei's cold-blooded approach, it is the optimal solution within the constraints of the era, and Ignatz has reduced the mortality rate during and after amputation to about 20%, so you can definitely give it a try.

However, medical treatment is never a unilateral treatment by doctors. It also needs to listen to the demands of patients and their families.

"I don't want to have my leg amputated."

This time the speaker was the child lying on the bed: "I'm afraid of pain, and I'm also afraid of losing my job. I still have two younger sisters to take care of at home. I can help my mother earn an extra 400 helles a month. Without this salary,

They will starve to death."

"Then you need to be prepared for wound necrosis." Kawei said, "If necrosis occurs..."

"I understand this. Aulat who lived next door died because of a rotten wound." The boy glanced at his mother, and then said calmly, "If I die, I will have one less mouth. It is better than lying on the bed with my limbs amputated.

Be strong."

Kawei nodded: "Okay, I will talk to Teacher Ignatz and then make an evaluation of this leg..."

...

Just as he was discussing the treatment plan with the patient, the ward rounds of the three young men had also ended.

The boy's leg was seriously injured and he was admitted to the hospital as soon as he arrived last night. Preventing the wound infection from worsening was more important than other surgeries, so Ignatz put his amputation at the top of the list today and set the time at

Ten o'clock in the morning.

After the failed cesarean section the day before yesterday, the three of them were much more cautious. Not only did they get up early for ward rounds, but after the ward rounds, all their attention was on him.

"He should be the first surgery today, and Mr. Ignatz will be the surgeon."

"His medical record... here it is, bed 11, a little boy named Eston, 10 years old."

"Compound fracture of the tibia...tibial knee amputation."

"Teacher Ignatz's amputation technique is well-known at home and abroad. The operation is stable and fast. I must learn more today."
To be continued...