Recently, the variety show "Heartbeat Offer" medical student season official announcement, hot search out, many viewers said that they look forward to seeing the real doctor's daily life.
But there are also many medical students who have spoken out that the daily life of doctors is definitely not a variety show that can be presented.
It just so happens that Ah Xin recently read a new book, "The Birth of Surgery", and deeply realized that there is a bumpy road behind the treatment of modern medicine that we can enjoy.
David Schneider translated by Zhang Ning
September 2021 CITIC Publishing Group, Synopsys Culture
Many of the things that we take for granted today: doctors have to sterilize their hands before surgery, anesthetize patients, artificial stents can be installed on the heart, worn knee joints can be replaced with artificial parts...
These medical knowledge or technologies, not so far away, were regarded as "outliers" and "innovations" for making money and killing people.
In the past 300 generations, only the last 5 generations have enjoyed the benefits of modern medicine, while the "care" of doctors before them was almost unhelpful and possibly even fatal.
Ashin today is like talking about how the real surgeons in history have walked through this bumpy road.
Young people obsessed with corpses
Today, when sick people walk into the hospital, 80% of what they think is "saved", while hundreds of years ago, sick people went to see doctors, and what they meditated on in their hearts was "no salvation".
Some doctors are hand-to-hand, and some doctors are "hand-to-hand". In the Middle Ages, regardless of the disease, the main treatments were these four: bloodletting, vomiting, urine tests and enemas.
An important reason why these doctors are unreliable in saving people is that they do not know what the structure of the human body looks like.
In the 2nd century AD, a doctor named Galen proposed to understand the anatomy of the human body through "dissection". However, because dissecting the human body is illegal, he can only dissect the animal to learn, and while obtaining some important discoveries, he has also caused many mistakes.
Galen, Source: Chongqing Digital Science and Technology Museum
And these mistakes have been taken as a guideline by generations of doctors, until the emergence of some "outliers".
Born in Brussels in 1514, Andreas Vesari was born into a family of medicine and naturally chose to study medicine.
Because of entrenched anatomical bans, prominent physicians often stood on high platforms, reading Galen's theories, with disdain for personally taking charge of the scalpel.
Vesalius received this kind of teaching, he did not need to do it himself, but watched from a distance from low-status surgeons and hairdressers do some superficial and casual organ display.
Vesalius, Credit: Wellcome Collection
However, Vesalius was a maverick, and with a strong curiosity, he visited the Holy Child Cemetery in Paris many times, selecting decaying corpses and crawling maggot skeletons, and spent a long time in the cemetery.
After returning to Brussels, Vesalius began searching the area for corpses, observing the bones hanging from the gallows.
"I deliberately kept myself locked out of town so I could find a way to remove my chest... I was so eager to have these bones that I was alone with those bones in the middle of the night. ”
Vesalius, who graduated with honors, soon became director of surgery and anatomy.
This eccentric young man, in his first practical anatomy class, stepped down from a high throne and stood next to the corpse with a scalpel in hand, demonstrating and explaining medical knowledge to the students.
At the age of 25, Vesalius began writing The Anatomy of the Human Body, in which he criticized the galen gods, who had always been regarded as authoritative. Once published, the book became a masterpiece and had a profound impact in the 200 years since.
Anatomy, Source: Wellcome Collection
Later history has proven time and again that surgery was created by craftsmen, eccentrics, lonely geniuses, enlightening mentors and maverick young men, and doctors like Vesalius were one of them.
Saw legs, open abdomen, surgery with 300% mortality...
When surgeons gradually realized how absurd medieval bloodletting therapy was, they still could not cope with the wide variety of trauma and disease.
As a result, in the 17th and 18th centuries, amputation was treated as a panacea, regardless of major injuries or minor injuries.
Because the doctor cannot deal with the gas gangrene of the wound, he can only follow the treatment principle of "as long as you saw enough, you can cure it".
Anesthesia was not invented at the time, and when the procedure was performed, the patient could even feel the vibration of the serrations on the bones.
Tens of thousands of legs were sawn off in this way during the war, and Dominique Jean-Larry, a surgeon in the French army, held a record: more than 700 amputations were performed in 4 days.
Even bolder than amputation is open surgery.
In 1809, the first successful open surgery in history was performed at the home of The American surgeon McDowell.
Patient Jenny has a high abdomen bulge due to "enlarged ovaries", and according to experience, such patients will basically die within 1 year. In the face of death, the patient decided to take the risk of trying the only way to do it – to remove the huge ovarian tumor.
No one had ever had this surgery before.
The operation was performed in Dr. McDowell's home, the table was used as an operating table, and without anesthesia, the patient had to endure the severe pain of cutting open stomachs.
Dr. McDowell cut a 9-inch-long incision in the patient's stomach, exposing the tumor and spilling the patient's intestines onto the table.
In later surgical records, Dr. McDowell recorded the scene as follows: "The intestines cannot be stuffed back. But during the operation, he had to force a composure, remove the tumor, put the intestine back into the patient's abdominal cavity, and suture the wound.
It was the first successful open surgery in history, and the patient eventually lived to the age of 78.
In fact, when the operation was performed, there was a commotion around McDowell's house, and people thought that the operation was a deliberate murder! People hung a rope from a tree in front of McDowell's house, claiming that as soon as Jenny died, they would hang Dr. McDowell as well.
The operation took only 25 minutes to complete, and this "fast" may have saved Jenny's life. But when "fast" is enshrined as the norm, there are also some surprises.
In the early 19th century, Robert Liston, then known as the "fastest knife in London", performed an operation with a 300% mortality rate.
Once, when he was operating on a patient, Liston cut off two of his assistant's fingers too quickly, causing him to die of excessive blood loss. At the same time, one of the observers was frightened by this bloody scene and died of a sudden heart attack, and the patient who was the "protagonist" died of infection.
In the end, three people were killed in this operation.
In these surgeries that now seem "outrageous," surgeons are not daredevils who turn a blind eye to human life. On the contrary, it was precisely with reverence for life and sympathy for the sick that they took up the scalpel, hoping that this time it would be a miracle of good luck.
Surgeons are usually immune to disgusting things and can even sacrifice themselves. The ability to endure self-inflicted nausea and the abhorrence of disease, the strange balance of the two forces, many breakthroughs in the field of medicine have originated.
Anesthesia, disinfection
Innovative "outliers" and advances in medicine
In the chaotic 17th and 18th centuries, patients and doctors performed surgeries to cure diseases, but the mortality rate of surgery has always been high, which has frustrated and guilty many doctors.
In 1536, a French military physician, Ambres Parré, discovered that, following an ancient medical method, burned wounds of wounded people with boiling oil to stop bleeding.
After a battle, due to too many wounded and the boiling oil in the operation, Pare had to give up on stopping the bleeding for some of the wounded. He wrote in his diary: "I tossed and turned, thinking that the wounded who did not get boiling oil would be poisoned to death. ”
The next day he went to the ward to find that the wounded, who had not been burned by boiling oil and had only taken some medicines, had recovered better.
So he gave up this cruel treatment that had lasted for hundreds of years, and he thought of a better way to stop the bleeding, suturing the wound with needles and threads, and this method of suturing with needles and threads is still used today.
But the pain of the operation was not completely eliminated until 1842, when a dentist named William Morton, after hearing that a chemical called ether might have anesthetic effects, immediately put into the experiment, and his experiment was by example.
Morton once inhaled ether with a handkerchief and passed out, fortunately the handkerchief fell automatically, he did not have a life to whimper, after waking up Morton understood the key to the problem: must effectively control the inhalation of ether, you can achieve the effect of anesthesia.
In October 1846, Morton presented the results of his experiments to the world, the first truly painless operation in human history.
William Morton
At this point, human beings have finally got rid of the severe pain of surgery, and anesthesia has become one of the cornerstones of modern medicine.
After solving the pain of surgery, the next urgent need to be solved is postoperative wound infection.
As early as 1760, John Hunt, who was then serving as a British military medic, noticed this.
Hunter noticed that his surgical colleagues had stuck dirt-stained fingers and instruments into the wound, which actually caused more pain and hastened death.
So Hunter chose the principle of "less is more", not to explore and expand the gunshot wound, but to quietly treat the wound. In the end, the wounded, who were simply treated, or untreated, recovered much better than those soldiers who were "unlucky" to be treated.
But at the time, Dr. Hunter didn't know why, but with sympathy for the pain of the injured, he chose his own way.
The one who really realized that germs on the doctor's hands were the cause of the infection was a Hungarian obstetrician-gynecologist, Semmelves.
In 1845, Semmelweis came to work in the obstetrics and gynecology department of the General Hospital in Vienna, Austria. Many postpartum women in hospitals are plagued by a disease called puerperal fever, and doctors are helpless.
Doctors can easily bring germs on their hands to patients, Source: "Two Hundred Years of Surgery"
It wasn't until Semmelweis discovered that the mortality rate in ward I, which was handled by doctors, was much higher than in ward II, where midwives were in charge.
He began to speculate that this might have something to do with the doctor's work habits.
Once his colleague died of a scalpel-cut finger while dissecting a corpse, and the doctor's symptoms before his death bore striking resemblance to those of a puerperal fever patient, Semmelweis realized that the culprit of puerperal fever may be the doctor's hands.
He immediately demanded that the doctor in his ward wash his hands repeatedly with bleach powder before delivering, but was opposed by all the doctors, and he ended up dying alone in an insane asylum.
In London, another doctor, Joseph Lister, was also aware of the presence of pathogenic bacteria.
On August 12, 1865, Lister performed an open tibia fracture on an 11-year-old boy, and he thoroughly scrubbed the little boy's leg with a diluted solvent of stone carbonate, and many days later, the little boy's wound did not become inflamed or suppurative.
After repeated bandaging, the little boy who was supposed to have his leg amputated was cured.
Since then, Lister has sterilized every operation. Over time, the world gradually adopted the "Lister disinfection method", which ushered in a major revolution in medicine.
The day after Lister's first sterilization surgery, the repulsive "madman" Semmelweis passed away.
However, in the history of surgery, these two doctors deserve respect.
During the Franco-Prussian War, the mortality rate for calf fractures was 50 per cent, and during the First World War, the mortality rate for open femur fractures was as high as 80 per cent.
Now, however, no one is worried that an athlete who accidentally fractured a bone on the field will die from surgery.
Such peace of mind is laid by the search of generations of doctors.
In The Birth of Surgery, author David Schneider, a well-known American expert in joint replacement surgery, goes back hundreds of years of surgical surgery and asks: What shaped a great surgeon?
He also gave his own answer, a good surgeon should be calm and confident, with keen insight, dexterous hands and somewhat surprisingly humble character.
Most importantly, contemporary surgeons have the ability to communicate deeply with patients and have empathy for their pain.
Generations of healers, like people with a good sense of direction, drive at night in unfamiliar parts of town, but still know the way home.
What guides them is the ideal of curing the disease and alleviating the pain, and the benevolence of all the tormented patients.
#今日份互动 #
What kind of doctors have you ever met that make you feel cared for?
Let's talk about the comments section! Ah Xin will randomly pick 2 friends to give away a good book of Zhongxin.
Surgery for 400 years
A "deep biography" of birth, perfection and breakthrough
Absurd medical treatment
Accidental major inventions
Collect the history of medicine in one book
A History of DK Medicine
-End-
Edit: Cellur | Review: Yoyo
2021.10.26
【Source: CITIC Publishing Group】
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