97. I let you disrupt the situation, but I didn’t let you disrupt me too.

The entire regular meeting seemed casual, but there was Waterman's little deliberateness everywhere.

First, Lister and Nightingale introduced new concepts of surgical disinfection and care, and then arranged several new surgical trends that seemed good, but they were not allowed to be selected for the afternoon surgical report because the patient died of postoperative infection.

Postoperative infection, that is, incision ulceration, is very common, and no one cares about it during this process.

So in the end, Waterman deliberately started with Ignatz's inguinal hernia, and then added his own purulent osteomyelitis of the mandible. Both patients had severe inflammation in their bodies, and generally speaking, conventional surgical incisions would inevitably

Festering is just more or less rotten.

But both operations were successful. Morasso had some twists and turns, but the situation was reversed in the end. Both patients' incisions have healed, and both patients survived.

The facts are already in front of us. Something must have blocked the miasma in the air and prevented the incision from festering.

Seeing that the surgeons who only wanted to improve their surgical skills had no response to the ulceration of the incisions, Waterman had no choice but to rely on Carvey to advance his intentions.

He knew that Kawei wanted to promote preoperative disinfection and various postoperative care work, which happened to coincide with his own ideas. He was also a "master" in abdominal surgery. Asking him to be the first to inquire about disinfection and care, he could also

Help share some of the conservative firepower.

Of course, the questioning method also requires some skills. According to Waterman's idea, the best questioning content should be like this:

[Why do so many patients die from incision ulcers, but a syphilis patient who has always been weak can still avoid ulcers in her large incision after undergoing such a severe and complicated operation?]

With just a simple question and answer, Waterman was able to point out that he tried to follow Lister's approach and used cotton wool cloth soaked in carbolic acid to protect the wound.【1】

Once the answer comes out, combined with the debridement of Count Morasso's groin, it will not only promote this kind of care, but also pave the way for Carvey's upcoming appearance on the stage.

Make a foreshadowing

bedding

How to lay the groundwork now?

What a foreshadowing!!!

You are here to disturb the situation, but you are not allowed to disturb me as well. Such a sentence comes out of nowhere, how do you want me to answer it?

Saying that you are right saves your face, but what I did was wrong. Saying that you are wrong means losing face completely, so what can I use as an excuse?

Waterman heard questions that were completely different from what he expected. His mind, which was full of disinfection methods, went blank when asked, and he almost restarted.

What kind of ivory mandible is made of? Is it also made of silver?

Although he was surprised and didn't follow the idea at first, Kawei's modern idea of ​​using other materials to replace bones had never been mentioned before and was very new. This curiosity secretly activated his surgical thinking.

He thought about the feasibility of this approach as if he was not under his own control.

Cut off the mandible and then make a new mandible?

This is not rhinoplasty, just use some skin from the side and piece it together. Bone replacement is unheard of, is it really possible to use other materials for filling?

What to do?

Waterman was stunned in front of the podium. There were various discussions caused by this topic in the audience. Because the dean never responded to express his position, the quarrel was endless. "The price is expensive", "The wound inflammation will be more serious after filling", "The joints will be more inflamed"

"What to do" and "How to fix it" are the focus of the discussion.

But Waterman's mind was unusually quiet, as if the quarrel between these people had nothing to do with him.

If you really want to make a replacement, do you have to measure the length, width and height of the patient's mandible first?

No, each patient has a different infection site, and the surgical removal site is different. This machine happens to perform complete mandibular removal surgery, but there are many patients whose infection is limited to one side, or only to the distance of 2-3 teeth.

This is the time to perform precise resection.

Does precision resection mean on-the-spot sculpting?

Then do I have to find a famous sculptor to wait in the surgical theater? Wait for the mandible to be removed during the operation, and then compare the size.

It would be even more outrageous if it were to be replaced with a silver one. You would have to make an inversion mold first, and then

Years of surgical work have made him accustomed to using various angles to deal with problems. Once he reaches a dead end, he will think of other ways.

No, wait!

Why does this kind of thing have to be done on the spot?

Waterman's idea went back to the beginning. He measured the length, width and height of the patient's mandible in advance, and then temporarily made an entire mandible according to this size. Then after the operation started, he made a temporary cut according to the location and size of the removal.

.

Yes, intercepted on the spot!

In this case, the only material is ivory.【2】

If ivory can fill the mandible, then the maxilla can certainly do the same. Perhaps patients with bone and joint fractures can also use ivory joints to make new joints?

Mandible.Ivory

The mandible is quite large, and the ivory is long and strip-shaped. Are the tusks that thick?

If you don't want to do it separately, make it half on the left and half on the left.

If the entire mandible is cut off, then the left and right parts are spliced. If only half of the mandible is cut off, it can be used, and the remaining half can be left as a souvenir for the patient. If the patient does not want it, it can also be kept for those who do not have it.

Money does jaw-dropping for poor people to use.

For poor people, it is definitely better to have a new mandible than to have an empty chin. As for whether it really matches their face shape, it is no longer important.

In fact, as long as the number of materials is accumulated, the more choices will be available, which means it will be more difficult when you first try.

It seems like you can try it!!!

Under a question from Kawei, Waterman had a new idea about cotton plastic surgery and even bone and joint plastic surgery. He ignored the chaotic situation in the audience, and with an old face, he quickly sorted out all the materials and then put them together.

They were all stuffed into the bag.

Waterman didn't say a word, but simply said hello to the host on the side and hurried off the stage and left the venue. Ignatz, Kavey and all the surgeons in the venue were regarded as nothing.

"The dean was so angry that he left. You should be able to see how outrageous this statement is. It's ridiculous to think about stuffing an entire ivory into your mouth."

"What are you talking about? There are people who put ivory nozzles into the steel doors. Wouldn't it be even more ridiculous?"

"One is sewn into the chin and never taken out for the rest of his life, and the other is just an enema. How can this be the same?"

"I think it's cool!"

"Cool P, think about it for a second, how would you feel if your butt was shaved off, then stuffed with ivory, and then sewn shut with thread."

"It's such an exaggeration, can't it still be made of silver?"

"Silver? That weight is stuffed into your chin, you go and eat something and try it! Oh, by the way, there is also the butt that my dear friend said. If the butt is filled with silver, I'm afraid I won't be able to stand up for the rest of my life."

"What this brat comes up with is all weird stuff, and it's not practical at all!"

"Actually, if you stop saying a few words, the dean might not leave."

The only people in the audience who could really understand Waterman were probably the two vice-deans. Ignatz looked at his father as he left and said with a smile: "Maybe he really thinks that your approach is feasible."

Kawei also didn't expect that he just tentatively threw out a concept similar to "artificial joints" and it became what it is now.

He didn't know when the earliest artificial joints were applied and what materials were used. Anyway, in this era, there is no sterilization and postoperative anti-infection. There is still a long way to go before this type of surgery can be done well.

It's a pity that this determination did not last long.

When the host called him to the stage to explain his cesarean section, Carvey discovered two documents that Waterman had left on the podium.

The above records in detail the various applications of carbolic acid by the famous British surgeon Dr. Joseph Lister, which is not only limited to the application of carbolic acid at the incision, but also uses a pressure pump to spray carbolic acid spray on the entire surgical theater. [3]

This was far beyond Kawei's expectations, because even he did not expect that the bacteria content in the air could be reduced in this way, thereby reducing the infection rate of surgical incisions in disguise.

And this design is already moving closer to the operating room.

Kawei originally thought that the attitude towards surgical theaters would not change much in the 19th century, and it was almost impossible to set up a relatively sterile operating room. But who would have known that on the other side of the strait, some people had already begun to introduce air disinfection

concept.

Of course, if he is more rigorous, Kawei prefers to use "antiseptic" to describe the effect of carbolic acid rather than "disinfection".

However, carbolic acid is too toxic. If it is made into a spray, it will not only cause damage to the surgical patient, but also the surgeon and other spectators present. Chronic poisoning will definitely not be able to escape.

"Everyone, I didn't expect Dean Waterman to leave." Facing the accusations from the audience, Kawei said with a smile, "If I guessed correctly, he should have thought of several ways to make ivory mandibular joints.

I’m anxious to go back and try it.”

"Stop bragging about this. What you say casually is unconvincing."

"Yes, instead of arguing with us here, why not just talk about your cesarean section. We came all the way here not to watch you chatting, but to really learn some cesarean section techniques, otherwise who would

Are you willing to sit in the audience and watch you act so arrogant and be annoyed by you?"

"That makes sense, let's just talk about surgery."

Kawei also wanted to do the surgery, but Waterman left these two pieces of paper not just for decoration, but with an obvious intention: You have to continue causing trouble for me!

Thinking that the other party was holding his admission letter of recommendation in his hand, Kawei had to continue working hard: "Before reporting on my cesarean section surgery, I think I still have to put an end to Dean Waterman's surgery."

"Isn't the dean gone?"

"The host has called you, can you please stop wasting time?"

Faced with the doubt, Kawei ignored it and just replied: "The question I just asked is indeed a bit wild, but if you want to say it is completely meaningless, that is not the case. When facing mandibular resection, the patient's appearance will change.
To be continued...