Chapter 123: Officially a Doctor [2]
“Oh, I have a leg to amputate today.”
“I need to check on the baby too.”
“Yes, yes.”
Robert Liston and Blundell returned to their seats. These, too, were matters that needed attention at some point. The ruler of the scalpel…
Wait, wasn’t it an orthopedic surgeon who amputated us?
Even in modern medicine, Amputation had not disappeared. There were still situations where it could not be avoided. Diabetic foot, for example, or severe trauma from traffic accidents. When all the bones were crushed, there was often no alternative. My friend once said that in cases like that, there was really nothing you could do.
But… huh? This did not feel like the right way to cut.
Anyway, since Robert Liston also seems to think surgery needs improvement, I’ll give him a hand.
Originally, I had not planned on intervening. Liston was a genius, so I figured he would naturally improve things on his own. But when I thought about what it really took to create a new surgical method… it was like inventing a new martial art. That was not common. If it were, wouldn’t the whole field just split into factions? When I realized it was not even possible for me, or for my teacher, it no longer felt right to just sit back.
“You just need to find something… Can I speak casually?”
At any rate, the first thing to do was look into the professor’s research materials, which were originally stored in this room.
“Huh? What are you doing? You only call others ‘professor.’”
“Oh… right… Taepyeong…”
It might be my job to review the materials, but digging through them was still a chore. And when it came to chores… there were a lot of them.
In twenty-first-century Korea, there would be outrage if students were forced to do unpaid labor. But here? Students practically got their teeth pulled if a professor told them to.
“Can I look for something like this?”
“Sure, something like that.”
“Alright.”
So even asking nicely for help did not really mean much. On the contrary, they almost looked pleased. Were your friends professors? Wouldn’t that make them jealous? If someone had a bad personality, that jealousy could really burn.
But Joseph had always respected me, and Alfred had literally saved my life.
“Can I take this too?”
“Uh, yes. But really, feel free to talk more casually.”
“You’re a professor. How could I… I’ve been learning from you this whole time.”
“Well… if that’s more comfortable for you, sure.”
“Okay.”
Colin, who used to be the strictest with me, had long since turned into a loyal assistant. Thanks to that, I got the materials quickly.
First, I looked at Hemorrhoids, which were in my specialty. Technically, it was not just the colon and anus, and it was not even called “colo-anal” back then, but hadn’t I been obsessed with this since residency?
“This will be your bread and butter after graduation.”
It was a bit weird hearing that while pointing to a patient’s anus, especially an undeveloped one, but it was true. If you looked at private clinics, ninety percent of patients were hemorrhoid-related.
Let’s see…
Resting my hand on my forehead, I went through Professor Noh’s materials. The illustrations were incredibly detailed, so detailed that they made me squirm. But that was not a bad thing. It showed sincerity, a desire to help patients.
The issue, though, was that sincere doctors from this era did not always get the best results.
Didn’t Napoleon also suffer from hemorrhoids…?
Sure, it was the era of nobles, but would things really have changed in just twenty or thirty years? If even someone that powerful suffered, that said a lot.
Wait, what is this?
Among the professor’s drawings, one image stood out. It was not sketched, but printed. There were no brushstrokes. It was probably a print. The patient’s posture was shocking: standing, arms resting on the wall, lower body completely exposed.
You would think this provided a clear view of the anus, but in reality, it did not. If it did, everyone would have used this position.
And… are they really burning hemorrhoids with fire?
The posture alone did not explain everything. The surgeon, no, the butcher, was holding a soldering iron. What he was aiming at was not exactly clear, but it had to be the Hemorrhoids. It had to be. That was too terrifying to misidentify.
If it’s overheated, the blood will just burst out… Wait, is that a bellows next to him?
The assistant held a bellows, pumping it to heat the iron. In short, the patient was in a position where you could not even clearly see the hemorrhoids, and someone was poking around blindly with red-hot metal.
And… was this professor also doing that…? Oh, there was a note.
“In many cases, the flesh burns, the anus becomes blocked, and the patient dies. We must refer to Sir Felix’s technique used on Louis XIV.”
Thank God. At least this professor was not doing that.
Relieved, I kept flipping through the pages. Then I saw another drawing, much rougher this time. Judging by the handwriting, it was definitely the professor’s. Sadly, the patient was still in the same posture.
Well… I guess this means proper patient positioning was starting to catch on. And presumably, this was after anesthesia.
In modern medicine, positioning the patient for the surgeon’s convenience was crucial. Some might think I was overthinking it, but wouldn’t the results improve if the surgeon was comfortable?
As surgeries grew more precise, they also took longer. But for long procedures to be possible, patients needed to be unconscious and their muscles relaxed. So really, this only became feasible once Anesthesia advanced.
Anyway… oh, tying the hemorrhoids with thread? Does that mean cutting off the blood supply? That has to be it.
There was probably no deeper symbolism here. I hoped not. I kept reading, and sure enough, it said the thread was tied and left for over an hour while they waited for the blood flow to stop. Then it was cut with scissors.
Hmm… well, not terrible, but…
It was not clear whether they had checked the Hemorrhoids properly. There were two types, external and internal, but the professor did not distinguish them. There was not even any mention of the four stages of hemorrhoids. Maybe he just did not know. If he had known, he would have done better.
That must have been unbearably painful. And this was done without anesthesia, right?
Hemorrhoids were excruciating. The anus was one of the most sensitive areas in the body. Doing that procedure without Anesthesia…
“Heh…”
A sigh escaped my mouth. I closed my eyes and offered a moment of silence.
Sure, it was better than cauterizing the anus with a soldering iron, but… I doubted anyone was truly happy in those times.
Even basic surgical protocol was missing, such as disinfecting the area.
Common sense says you’d at least clean the place before operating, right?
I would not dream of touching that area with bare hands, but… what? No, of course. This was a time without proper toilet paper. So… just wipe with water? After trying it, I understood why people in India washed with water. Honestly, I suspected the rate of Hemorrhoids was lower there. Anal hygiene mattered.
Anyway, let’s go back to the basics. Back then, whether surgery happened or not depended purely on the mood. That was the system.
The more I read, the more problems I found. They were fundamental issues, but… in an era where fundamentals had not been established yet, what else could you expect?
Even now, in the twenty-first century, people were reluctant to talk about hemorrhoid surgery. So it was not surprising.
Anyway… which patient should I operate on? I haven’t even figured that out yet.
This was what was called a “surgical indication.” And it was arguably the most important thing for a surgeon.
My teacher, who was not a kind man but was a great doctor, used to say this:
“How to do it comes later. First, decide when to operate, and what for.”
That was exactly right. There were plenty of non-surgical treatments for Hemorrhoids. In fact, performing surgery on stage 1 or 2 cases was often overkill. Especially now, with so many limitations, surgery should be avoided whenever possible.
It might sound strange coming from a surgeon, but that was what was best for the patient.
Start with sitz baths. Teach that first. Okay. Then tweak the surgical technique a little… The director said patients who hesitate can be postponed for now. Good.
That was how I settled my approach to Hemorrhoids.
Meanwhile, my assistants, or rather, my students and friends, were doing their best to dig up the reference materials I had mentioned.
Since Hemorrhoids were already handled, I started looking for information on benign prostatic hyperplasia. Honestly, I was surprised. How had they figured out that an enlarged prostate caused urinary discomfort in older men?
Well… maybe they figured it out intuitively during dissections?
Prostates did enlarge with age. If they saw that during dissection, they could have made the connection.
What I was really curious about was how they treated it.
Modern treatment had advanced a lot, with medication and surgery, but what about back then?
My heart pounded a little as I looked at the instrument Joseph had found and laid out on the desk.
“Oh… is this an endoscope? Wait… no, it isn’t, right?”
It looked like one, but there was no lens. Just a hollow instrument with a blade-like tip. That was ominous.
“With this… you just… drill through? Is that it?”
“I think so?”
“Because the urine is blocked and won’t come out.”
“…Ah.”
Good God… even imagining it was terrifying.
No, it hurt. Just thinking about it hurt.