Surgery at that time did not have the concept of perioperative period[1]. Doctors were only responsible for the operation, without preoperative preparation. Postoperative recovery was also the patient's own business.

Ignatz is much busier than other surgeons. On weekdays, he only cares about surgery. His schedule basically alternates between the anatomy room and the theater. From time to time, he also has to see those noble gentlemen, and occasionally returns to the hospital.

Go to the office and take a break.

The daily care of the patients in the ward is taken care of by nurses, and the medical records are compiled by Kawei. Ignatz needs to enter the ward very rarely, and he only comes to do rounds and observe their postoperative recovery.

Ignatz has been busier and busier these days, and has been forced to skip several ward rounds.

However, even if he was exempted from ward rounds, he had to keep up with the postoperative observations as much as possible, so every time he was in a hurry and left after just two glances.

Of course, this is not a normal phenomenon. The ward is not on duty. Early and night ward rounds are the key to understanding the patient's physical condition and should not be skipped. So this morning Ignatz hoped to complete the ward rounds as soon as possible before going to the theater, but he did not expect Alphonse

His butt held him back.

I originally planned to come back and make up for the ward rounds first, then go to the anatomy room to remove the white cloth from the couple in Room 102, and then carefully cut their lips with Kawei.

But as soon as he entered the ward, Ignatz suddenly stopped.

He was in a hurry to do an examination in the morning and was pressed for time. He didn't think there was anything wrong here, but now he found that there seemed to be some changes in the ward.

The first thing that eluded him was the windows...

"Why are the windows open?" Ignatz asked the nurse on duty as soon as he walked in. "It's only March, the weather is still a bit cold, and the air is full of turbid and toxic miasma..."

Before he finished speaking, the nurse pointed at Kawei behind him and said, "Your dear assistant gave this order."

"Yes, it's me." Kawei let the nurse pass and explained on his behalf, "I decided to let them do this after reading the battlefield nursing notes of British nurse Nightingale."

Ignatz had heard Nightingale's name for a long time, and his reaction was similar to that of the British gentlemen, a kind of disdain carefully packaged in politeness: "It's just a daily record of helping bring tea and water to wash clothes. It only counts women."

Excellent essays written in one’s spare time.”

"If it were just for excellent essays, I don't think she would be admitted to the Royal Statistical Society as an exception. That place never accepts women."

Ignatz didn't know about this: "Oh? Those people in the UK have changed their behavior?"

"I think it should be because of her outstanding contribution during the Crimean War."

Carvey reminded: "She reduced the mortality rate of wounded soldiers in the British army from 42% to 2%, and then used the new Rose Chart [2] to make those tough military figures and even the Queen herself agree with her medical treatment

Reform plan.”

Ignatz took off his hat, his face full of doubt: "Can it really drop that much?"

"The New England Journal of Medicine has published several articles about her." Kawei took out the book from the cabinet on the side. "This should be an old book I bought in the middle of last year. I found it when I was sorting out the bookcase. It was originally

Published some of her new nursing concepts."

"Oh, it's this book... Those arrogant British guys, the whole book is written in English. I regretted buying it." [3]

Ignatz likes to go under the knife and is very receptive to new surgeries, but it is difficult for him to accept too advanced nursing concepts, so he translated a few pages and threw them aside: "There are many traditional practices in it.

I don’t agree with anything that goes against it.”

"But these were all experiments on the lives of British soldiers. I think it's worth a try."

Ignatz thought for a while and found that it made sense. He couldn't help but nodded and asked: "Besides opening the window, what else is there?"

"For traumatic wounds, you can use strong alcohol to clean the wound and surrounding skin, and then use ointment [4] and cotton cloth to cover the surface to isolate the miasma in the air." Kawei took out the rest of the miasma in the air from the side.

Brandy, "I specially got this bottle of brandy that has been distilled twice."

English can indeed let "alcohol" slip under Ignatz's nose, because he is simply too lazy to translate.

But at the same time, Ignatz is unwilling to change his temper: "I still think it is a bit unconsidered to directly change the environment and nursing methods of the ward. This is the ward with the lowest mortality rate in Austria."

This is a strong statement, but when implementing new methods, you are bound to encounter resistance.

And Kawei is not just talking. Since the data and the New England magazine report are not enough to impress him, he can only prove it with facts: "Teacher, do you remember the little boy last time? The one who had his leg crushed."

.”

"Bed 11, remember."

"The surface of the wound has basically healed."

"Oh...there's nothing surprising about this." Ignatz didn't take it seriously.

"But he is just a malnourished child from a poor family, not one of those strong nobles and celebrities, and his recovery speed is completely incomparable." Kawei suddenly asked, "Count Morasso's groin did not recover so smoothly."

Ignatz sighed: "Indeed, there are ulcers on the surface of the wound."

"I think we can learn from bed 11 and do some cleaning work on Count Morasso's groin to remove the rotten skin and flesh to make it easier to grow and recover." Kawei knew that he was overstepping a bit, so he quickly said with a smile,

"Of course, this is just my personal suggestion, and it is entirely up to the teacher to decide whether to adopt it or not."

Ignatz is a self-centered person, and of course he will not accept other people's suggestions easily. What's more, Kavi is just an assistant and has not reached the level of being equal to him.

But Morasso is his good friend, and he is not willing to watch the count die like this. If there is a chance, Ignatz is still willing to listen to some suggestions.

"Take me to see bed 11."

Eston is no longer in the depressed mood he felt when he was first admitted to the hospital, and is happy about his recovery every day. When he sees Ignatz and Kavey, his excitement is all written on his face: "Doctor, Mr. Kavey~

"

"How do your legs feel?"

"Very good, doctor."

"I need to see the wound."

Ignatz took two more steps forward, reaching out to untie the knot on the cloth. Eston was a little surprised and scared, but after seeing Kawei nodding, he still retained part of his smile and did not hide.

open.

Kawei usually takes care of Eston's legs, but this is the first time Ignatz has seen the stitched wound.

After opening the oily cloth, the scent of linseed oil mixed with brandy hit your nose.

There were several blood stasis all over the entire calf, and there was swelling under the skin. This was caused by the fracture and the suturing of large pieces of skin that had been torn off, but the swelling was much better than he expected. Compared with the other healthy calf, this one was

It's just a little thicker.

The sutures were done by Ignatz, and the suture lines and holes are faintly visible.

After so many days, the original incisions still fit very well, with no leakage or decay, and obvious healing can be seen.

This is what every surgeon most wants to see when a wound heals. It’s not that Ignatz has never seen it before, it’s just that he has seen it too little. What surprised him most was not only the healing, but also the damage on the skin of his legs.

A small incision.

"These cuts are..."

"Oh, I made a temporary cut to deal with the swelling in the leg." Kawei said, "When my father encountered such wounds in the past, especially wounds with large areas of skin detaching, he would choose to use this small incision to relieve the pain.

Pressure caused by swelling.”[5]

"Isn't this another injury?"

"No, the wound is not deep. It just releases pressure to prevent necrosis."

The 21st century orthopedic department's treatment of avulsion injuries and fractures deeply stimulated the brain of this 19th century surgeon. He couldn't understand why anyone could come up with such a method. There were so many small wounds, regardless of whether they were good or bad.

, aren’t you afraid of ulceration?

Yes, aren't you afraid?

So the question comes back to the original point, why didn’t Eston’s calf ulcerate?

At the beginning, he asked Bergt, Sarson and Mellen, and all three of them said that the wound would definitely fester and gangrene. Ignatz himself also felt that the possibility of gangrene was over 90% and almost inevitable.

But there are irrefutable facts before us.

This was a large-scale wound caused by being run over by a carriage wheel. It was originally intended to be amputated, and Ignatz needed a total of 24 stitches. It can be said that no matter which hospital in Vienna Eston was sent to, no matter what hospital he could

No matter how much money you spend, you are faced with amputation and no other options.

Ignatz handed the strip of cloth and the wound to Kavi again, and gave up his seat beside the bed: "You mean that with the help of alcohol and ointment, patients like this won't need amputation in the future?"

"That's not true. It's just that the child is lucky and the fracture is not dislocated. The chance is very small."

Kawei thought that maybe something like internal fixation could be developed in the future, but he said something else: "In terms of fractures, once they are dislocated or exposed to the air, amputation is safer, but

We now at least have another option, and it works for Count Morasso as well."

Ignatz still considers his patients at his core, and when Kawei blew him off in the theater just now, his already high mental level was raised a few centimeters.

Now it is impossible for him to deny Eston's legs, but the process of admitting them is more troublesome: "I just don't know if the earl can accept these things."

"I really want to promote this combination in the ward and do some experiments on Mr. Earl first." Kawei said grandly, "But now time waits for no one, and there is not much alcohol left. As a change of dressing every time

For the necessities, you also need to spend money to find someone to distill it.”

Ignatz did some mental struggle, and watched Kavi help Eston wrap the cloth again, and finally made up his mind: "I will go to the Earl's house for a follow-up consultation tonight. You are more familiar with the dosage of ointment and alcohol.

, so come with me. As for whether the count is willing to use it or not, that is his own business."

...

Alcohol disinfection has taken another step forward. During the discussion, the two of them regarded Morasso as an experiment before promotion, intentionally or unintentionally.

Eston's calf was not infected in the first place, so he was not rigorous enough in verifying the effects of oil and alcohol. And the Earl's groin had begun to rot. If even his wound could heal, the convincing would be stronger.
To be continued...