Evening star. [volume] (Washington, D.C.) 1854-1972, 1880-01-24
"A STRIKING SURGICAL FEAT.
Rebuilding a Patients Nose.
IN. Y. Times.

1ttleFue hospital Inc patent, young man II
years OF age. had previously been treated for a
degeneration OF the tissues OF the nose, which Is
described upon the hospital records under the
somewhat anomalous term of lupoid ulcer
He was also AFFLICTED with the congenital NAL
formation, familiarly styled the cleft palate,
and had deformity OF the lip, which caused
considerable aversion, and prevented him from
holding cigar or cigarette between MS npS.
As he was very fond OF smoking. this state or
facts was one that he lanented exceedingly.
TO these troubles. which impaired the function
Of articulation and materially interfered with
the probability OF his obtaining remunerative
employment he added settled eonjunctivitis,
which impaired his vision, prevented him from
reading more than few minutes at a time, and
in consequence he was obliged to sleep with his
eyes bandaged In order TO avoid the annoyance
given by flies to liberated or tnfiaMed and semi
purulent surfaces.
The immediate cause of the so-called lupoid
liberation OF the nose was a blow with a club,
received some years ago across the nose little
below the bridge. Inflammation and resolution
were followed by malignant and progressive
ulcer, which gradually consumed the mucous,
muscular. and cartilagimous tissues OF the nose,
and finally attacked the oSSeous structures,
which, when he was first admitted to the hos
pital, were extensively necroSed. No history Of
scrofula or other malignant disease could be OBJ
tained, and the liberation ultimately yielded to
treatment, leaving an unSightly opening which
led directly to the poSteriOr cavities. The pa
TENTS physical constitution was not only good
but rather unusually strong, and previous to
the nasal injury for which he was treated he
had been noted among his acquantances for
robust health and extraordinary endurance.
Some six weeks ago. moved by the entreatieS
operation which would remedy the unsightlf-
ness OF his physical appearance and sufficiently
restore his articulation to enable him to get
employment, distinguished surgeon in this
city, whose name is suppressed by particular
request, consented to perform the unparalleled
operation which has been attracting so many
medical visitors to the hospital during the past
few days. This was nothing less than the con-
struction Of new nose to take the place Of the
lost organ, by transplanting the second and
third phalangeS OF the middle finger Of the left
hand. There exists in surgical history, experts
say, Only uiiiS precedent for this operation, and
that an English one, performed by surgeon In
Birmingham. The patient was young woman,
who had lost the tip of the nose by malignant
liberation, and the restoration consisted In
TRANSFORMING the third phalanx of the left hand
to supply the place OF the lost section Of the
nasal tissues, and amputating the finger at the
third joint when union had been established
In this case the artery OF the transplanted finger
was ligated on the seventy Second day after the
primary operation, and the amputation soon
followed, while In the Bell evue case legation was
performed after about thirty days. But as it
amounted to little more than transportation
OF the ball OF the finger, and was far less extern
sive as well as far less complicated than the
American operation in every respect, the Eng
lSh case can scarcely be quoted as precedent,
and certainly not as a parallel, The diSttn-
guished surgeon by whom the American opera
ton was performed, very frankly admits that it
was suggested by the Birmingham case, while
his surgical admirers aver that the latter was in
no manner extraordinary, and claim complete
originality for American skill and science in
every essential detail.
Having decided to operate, the mode of pro-
cedure was very simple. The nail was diS5ected
from the finger to be tranSplanted, as prelimi-
nary to the work which was to follow. BY
means OF two deep inciSionS, one at the base of
each aspect of the nose, two considerable flaps
were brought down in such manner as to form
triangular mass over and about the opening
left by the destruction of the nasal bones and
carttlageS. The next step was by means or the
usual 1ncislonS to form pocket at the upper
extremity of the nose, into which the end of the
tranSplanted finger was to be inserted, and
where 1t was to be secured In place by Woods
movements, trifiing in themselves, but essential
10 the conception OF the operation, were CON-
pleted. The next and most important step was
70 lay open e inner aspect Of the finger from
and perfect 1nctSion, whose walls, composed of
minute vessels, should suffer so little
confusion and orulsing that union with
place with least possible Inflammation
and risk of sloughing. 1t was five weeks
ago ON Saturday that this major part of
the operation was performed, and the finger
placed in position and secured by silver Sutures
and Woods compressor, the head and trunk of
the patient having been previously enveloped
In plaster OF paris jacket with the left arm in
the proper position to prevent involuntary dis
placement. Ii is needless to say that the work
was carried on in an atmosphere permeated and
pcENdutu VIII dulES6pllC spray, ana UndU no
precaution, however slight, essential to insure
perfect union of the surfaces, was spared by the
operating surgeon. The secret was very care
FULLY Kept for some weeks, also, for had the
operation failed as there was possibility that
II might, whole columns OF scientific eXpla Ia
ton could not have saved the operator from be-
coming as ridiculous in the medical world as he
Is now likely TO be celebrated. The venture was
serious one in many ways, though uad ertaNen
at the solicitation of a patient, who declared
that he would rather lose all the fingers of his
10 In rDElgsn tod tsi.,1aAn
contemplate his future in the con iitton in
which he then was, In the first inst inca, the
nature of the liberation b. Which the nasal It's
sues were destroyed was By no means as .er-
tanned, and its possible malgnancy, when re-
awakened by the in1lammatory action OF
fncfSed surfaces placed in opposition, was
factor to be dreaded; in the second some posi-
bic faint of disease in the blood. dormant so
long as II was not provoked, might spring into
sudden and terrible activity under the strain of
the operation. The trial has shown the futility
OF these fears, for the appoSited surfaces have
united kindly, and there has been no failure
anywhere except In the loss, by necrosis OF the
artificial pocket prepared to receive the tip of
the transferred finger. 1t was scarcely expect
ed that this would stand, as 1t was impractical
Bile to secure 1t by SutureS, and the force OF the
compressor was insufficient for the purpose To
compllcate matters still further, at critical
stage In the operation the patieatS respiration
became so embarrassed that the Jacket had to
be split and silver breathing tube inserted in
an incision OF the windpipe. He has been kept
under the influence OF morpha constant
ly during the progress OF the expected
union, which had made such progress on
Wednesday last that it was decided 10 ligate
one OF the arteries OF the ddherent finger. This
was done by means OF a silver lgature. The
remaining large vessel VIII be tied in day or
two. and then the preparations viii be nearly
complete for the amputatiOn OF the finger at the
second joint. 1t was at first intended TO ampu-
tate about the middle OF the first phalanX but
this purpose has been abandoned as unaece5Sa-
ry. or course, the bones or the two tran Splauted
phalaDgeS serve admirably TO supply the place
OF the lost nasal bones and cartridges but their
ultimate metamorphoSiS in their new position is
one that VIII be observed with keen scientific
interest.
After amputatioA, it will remain to bring down
triangular flap from the surface or the fore
head in such manner as TO furnish a uniform
surface for the nose thus strangely created and
IL is probable that at least six weeks must elapse
before the patient leaves the hospital and re-
turns to the outer world the hero OF one OF the
most extraordinary operations OF modern sur
gerry. since the operation the cOnjunctivitiS has
materially aDated. But 1t must be rather IN
comfortable to lie imbedded in a plaster Jacket
for weeks while ones nose IS rebuilt at the ey
pense OF ones fingers.
THE WEDDING CUSTOMS OF THE TowKAs.-In
Central America Is a country called Towka and
without doubt the TOwkanS. whatever else they
may be, are the JollieSt people In the world at
wedding. They appear 10 be such an ignorant
race as 10 be unable to Keep record OF the age of
their children, except in a manner somewhat
similar to that adopted by Robinson Crusoe with
his notched post for an almanac. The ToWkans