Surgery was in a state of rapid development overall in the 19th century, but if the years were carefully disassembled, it would be found that this development was not coherent.

In the first half of the 19th century, due to the lack of anesthesia, most of the surgery was short, so surgical diseases were basically equivalent to fracture trauma. At that time, the empirical surgery school was popular, and no diploma was needed, and only experience could become a surgeon.

War is a breeding ground for surgeons' growth, and anesthesia is an accelerator of surgical development. Therefore, Britain, France and the United States led the surgical development in the first half of the year.

Especially Britain, the Crimean War and the American War of Independence, as well as countless colonial wars, brought them a lot of surgical experience. At the same time, Britain was the first country after the United States to apply anesthesia to surgical clinical practice, which greatly stimulated the

Surgery development.

But in the second half of the 19th century, France began to go downhill due to some internal and external troubles, and Britain still insisted on the antibacterial method of Lister. However, the United States had already eaten almost the same amount of money because of anesthesia.

He is at a disadvantage in innovation, so he plays the role of a chaser.

During the period before the United States gradually became a world medical leader by relying on reference and social stability, the main achievements of surgery were more inclined to German-speaking countries.

Germany began to make efforts in the second half, with industrial production capacity, economy and scientific research flying together. With extremely advanced medical reform plans, such as the introduction of the national medical insurance system first [1], it won the leading position in medicine.

Austrian surgery has always been a warm water. Its ability to rise in the second half is entirely because the achievements of an independent individual are too dazzling. [2]

However, in 1866, when the second half of the year was just beginning, this development trend was still not obvious to many medical authorities.

"I don't understand, why are there so many drip on his arm?" When Fernan just entered people's vision, Mosier, a Frenchman who just complained about Kavi's ability, was a little unable to sit still, "I see the infusion.

I have never seen anyone lose so much. By the way, is that red dunk bottle blood?"

"It's blood." said a Viennese doctor next to him.

"Can you still live with blood transfusion?" Mosie claimed to be his experienced surgical experience, and at this moment he had to sigh, "This prisoner is really lucky."

"luck?"

Ignaz, who had almost fought with the other party just now, suddenly laughed: "The doctors in Vienna do not rely on luck, and my students do not rely on luck. This is a real and safe blood transfusion. He has received the blood of 7 people.

, there was no discomfort."

This is a miracle for the surgeon who is afraid of blood transfusion.

"7 people? How did it do it?" Botini, an Italian sitting next to Mosier, was also very curious. "My teacher once used blood transfusions, and the effect was indeed very good, but it was also very dangerous. The chance of success was less than

40%.

"Through a simple experiment."

Ignaz was unwilling to tell too much, not because he was unwilling to share, but because the British man Ferguson jumped out: "Look, he actually chose carbolic acid? Why did he use this kind of thing?

”

He was a conservative anti-disinfection doctor, and at least in 1866 this time. [3]

But in Botini's eyes, carbolic acid is a savior for saving high mortality rates in surgery and an important bargaining chip for surgical development.

However, his French is not good, so he can only fight back in extremely awkward German: "Even Austrian doctors who had always opposed anesthesia have started to use carbolic acid. The first British used ether now opposes the outstanding discoveries of their own surgeons. They actually show that they have shown that they have not yet used the best results.

It’s really a long time to live if you have to be so conservative.”

"What's the reason for living for a long time? You're only 30 years old!" Ferguson was a little unhappy.

"I am 29 years old."

Botini made up his bow tie, took out an Italian publication, and said proudly: "I firmly support Dr. Liszt's method of using carbolic acid, and has published "Surgery Application of Carbolic Acid in the Annual Journal of Medical University" in his country.

》. It focuses on the research results of the value of carbolic acid as a surgical field disinfectant. If you are interested, you can take a look."

"Hmph, a small Italian publication"

Ferguson's status is much higher than that of him, and he doesn't even care about Italian surgical guidance: "The Lancet in my country is the first-class surgical journal."

"It's okay, Dr. Lister's approach is more stable than me. His carbolic acid paper will be released at the end of this year or next year." Bottini said with a smile, "I heard it was published in Lancet."

"Let's talk about this when he publishes it!"

Perhaps it is due to the common thoughts of the peers, 55-year-old Mosier does not agree with carbolic acid, or is more willing to consider the issue from a neutral perspective: "The safety of carbolic acid needs to be considered, at least I know it is flammable.

, and has a certain degree of corrosion."

"Of course, the low concentration is chosen when using it."

“Is the effective performance guaranteed by low concentrations?”

"sure."

The three of them were all top surgeons, and the debate on disinfection did not further affect other aspects. Because before they could make a fuss, Kawei and the three assistants' next steps were blinded.

"What is this doing?"

"Why do you need to wear gloves in surgery?"

"It's not just gloves, they also covered their mouths and noses."

The emergence of gloves and masks even once made Carbonic acid advocate Botini ponder: "From his surgical disinfection method, he has done quite well. In a sense, he did it better than Dr. Lister and me.

It must be thorough. In my opinion, the surrounding area of ​​the surgery is already very clean. Is it really necessary to do this?"

"This is disinfecting and stoicism."

"I don't understand the purpose of doing this." Mosier is more rational than Ferguson. "Gloves will greatly reduce the accuracy of the operation, and it is very uncomfortable to cover the mouth and nose, which greatly limits the doctor's performance."

They had never watched Kawei's surgery, nor had they been exposed to his sterile theory, and they did not know the meaning of doing so, but they could still detect the weirdness through the keen surgical thinking of the three.

Everyone went on stage to perform surgery, and knew what kind of people were qualified to stand in an operating square of such a large scale. If Kawei had no ability, no ability to be recognized by the Vienna surgeons, he would not be able to go to the operating table.

I can't show my research results either.

So they naturally looked at the Viennese doctors beside them.

The one who has the most say in this should be Olgi, who was done by Kavi.

Although I did not use gloves and masks at that time, it can also explain the importance of sterility to surgical operations from the side: "Just a month ago, I was shot in the stomach. According to the considerations of past military doctors for abdominal surgery, even if it is from

Based on my own experience, there is not much possibility of success in the operation. It is usually conservative treatment, that is, waiting to die.

But Dr. Kavey did it magically, and the post-operative recovery was pretty good. The incision was just a little red and swollen, and there was almost no serious infection."

"This is the charm of carbolic acid." Botini was very excited to look at the incision in Orgi's belly.

"If these are true, the surgery can be said to be very beautiful." Mosie's head was still shook his head, "but this is not a reason to use a large number of props in the surgery. At least I think the mask will seriously interfere with my operation."

“Can a 0% mortality rate become an important reason?”

"Sorry, it's too noisy around. I didn't hear you clearly." Mosier heard the numbers, but couldn't believe his ears, "What did you say just now?"

"Since Dr. Kavi showed the first Caesarean section, he has completed more than 30 surgeries so far, and no patient died." Olgi looked back at Ignaz, wanting to confirm whether this number was

Right, “As his teacher, Dr. Ignaz should have a more say in this.”

"I can't remember it, it should be 33 units, or maybe 34 units."

Ignaz turned to look at Masimov again: "Did he go there before for a breast cancer removal?"

Masimov was staring at the operating table with a telescope, while gnawing on the vegetable rolls in his hand, not caring about the discussion around him. Now after Ignaz said that, he replied: "That breast cancer patient, hurry up

No, the tumor metastasized elsewhere and no resection was done.”

Ignaz nodded and replied, "That's 33."

"No, he just didn't have a breast cancer removal," Masimov explained. "What he did was ventricular drainage. Well, it wasn't right, it seemed to be called ventricular abdominal drainage."

“What???”

Before the 0% mortality rate was digested by those people, a more impactful word immediately penetrated into their minds. In fact, let alone the three of them, the other local doctors present had never heard of this word.

About half of the people even didn't know what the ventricle was. It was because the brain anatomy research was too shallow at that time.

"I just worked as the first assistant next to the operating table, and the operation was decided in a hurry, and I only knew some basic principles." Masimov didn't expect them to be so surprised, put down the telescope and said, "Let's go first."

Let’s see the operation, the scene is more exciting than my oral statement. I’ll talk about something else after watching it.”

At this time, Kawei's scalpel had cut open Fernan's abdomen, and advanced layer by layer, entering the abdominal cavity.

The incision of abdominal surgery will change with the different surgical locations. Some special operations will make special incisions to create a better surgical field of view. The incision on Fernan's belly seems more peculiar, and it is a person with a double rib margin.

The font cutout [4], the total length exceeds 30cm.

The main reason for choosing such an incision is that the surgical area is not limited to the liver, but also needs to be extended to the vicinity of the spleen to completely resolve esophageal and gastric varicocele.

In order to perform liver and spleen surgery under one incision, and considering that there is not much information in the abdominal cavity, Kawei can only choose such an incision to ensure the completion of the surgery.

"We separated the skin layer by layer, the shallow fascia, rectus abdominal muscle, oblique abdominal muscle, and now we are ready to enter the abdominal cavity." On the right side of Kavey is Nisuke Damiergaon, and on the left side is a loudspeaker supported by a metal stent.

, "We slowly incised the peritoneum"

Kawei and Herman used tweezers to lift the peritoneum, then cut a small hole with scissors, Damilgaon picked up the suction and penetrated it directly. Beggot could only do three aids in such a surgery, and he did nothing.

Cool work with technical content - hand-crank suction.

"The prisoner has a lot of fluid in his body, which is also a proof of his liver failure." [5]

The pale yellow and slightly turbid ascites left Fernan's body through the rubber pipe under the suction of Begter. The total amount was finally fixed at about 800ml. These ascites were not thrown away, but in Beg

Under special operation, he slowly added a rebate bottle and continued to enter Fernan's body through the infusion tube.

"The surgery consumes a lot and will also lose a lot of blood." Kawei examined the organs in the abdominal cavity and said, "Liquid reflux can greatly improve this condition and stabilize the patient's vital signs." [6]

Speaking of this, he paused and explained the meaning of these four words: "The vital signs I mentioned include heart rate, blood pressure and breathing rate, which can directly reflect the patient's physical condition. I know that everyone is very concerned about blood pressure.
To be continued...