The Anderson intelligencer. [volume] (Anderson Court House, S.C.) 1860-1914, 1880-02-05
Ne,u York Times.

a very ioAidoAoAuoAy otSAe'A, sAae
one that has only one precedent, and no
complete parallel in surgical history,
is now in progress at Bellevue Hospital.
The patient, young man 81 years Of
age, had previously been treated for q
degeneration Of the tissues of the nose,
which is described upon the hospital re-
cords under the somewhat anomalous
term of q lupied ulcer. He was also
afflicted with the congenital malforma-
ton, familiarly styled the cleft palate,
and had deformity of the lip
which caused considerable eyersion, and
prevented him from holding cigar or
cigarette between his lips. As he was
very fond of smoking this state of facts
was one that he lamented exceeding. 10
these troubles, which impaired the func-
ton of articulation and materially inter
ferred with the probability of his OBJ
tanning remuneratiye employment, he
added a settled conjunctivitis, which I'M
pared his vision, prevented him from
reading more than few minutes at q
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 infamed semi-purulent sur
faces.
The immediate cause of the so.called
lupoid liberation of the nose was a blow
with q club, received some years ago,
across the nose little below the bridge.
Inflammation and liberation werefollow-
ed by malignant and progressive ulcer,
which gradually consumed the mucous,
muscular, aud cartilagimous tissues of
the nose, and finally attacked the osseous
structures, which, when he was first ad-
mitted to the hospital, were extensively
necrosed. No history of scrofula or
or other malignant disease could be OBJ
tanned, and the liberation ultimately
Welded to treatment, leaving an insight
" opening, which led directly to the
posterior cauities. The patients physi-
cal constitution was not only good, but
rather unusually strong and, previous to
the nasal injury for which ne was treated,
he had been noted among his acqualn-
tances for robust health and e1traordi-
ry endurance.
Some six weeks ago, moved by the en-
treaties of the patient, who offered TO SUD-
NIT to any operation, which would rem
edy the unsightliness of his physical ap-
pearance and sufficiently restore his ar
ticulation to enable him to get employ
ment, a distinguished surgeon in thiscity,
whose name is suppressed by particular
request, consented to perform the unpar-
slleled operation, which has been at
tracting 80 many medical visitors during
the last few days. This was nothing less
than the construction of new nose, to
take the place of the lost organ, oy
transplanting the second and third pha,
langes Of the middle finger OF the lett
hand. There exists in surgical history,
experts cav, only one precedent for this
operation and that an English one, per-
formed by surgeon in Birmingham.
The patient was q young woman, who
had lost the tip of the nose by a ma
lignsnt liberation, and the restoration
consisted in transplanting the third
phalanx of the left hand to supply the
place of the lost section of the nasal tis-
sues, and amputating the finger at the
third joint when union had been estao-
lished. In this case the artery OF the
transplanted was ligated on the seventy
second day after the primary operation,
and the amputatior soon followed, while
ia the Bellevue case legation was per-
formed after about thirty days. But as
it amounted to little more than a trans
plantation of the ball of the finger, and
was far less extensive as well as lar less
complicated than the American opera
ton in every respect, the English case
can scarcely be quoted as precedent,
and certainly not as parallel. The dis
tinguished surgeon by whom the Ameri-
can operation was performed very frankly
admits that it was suggested by the
Birmingham case, while his surgical ad-
mirers aver that the latter was IN no
manner extraordinary, and claim com,
plete originality for American skill and
science in every essential detail 9
Having decided to operate, the mode
of procedure was very simple. The nail
wasdissected from the finger to be trans
planted, as preliminary 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 cartilages. The
next step. was by means of the usual in
cisons to form pocket at the upper ex.
tremity of the nose, into which the end o.,
the transplanted finger was to be inserted,
and where it was to be secured in place
by Woods compressor. These and a
few other preparatory movements, tri-
fling in themselves, essential to the con-
ception of the operation, were completed.
The next and most important step was
to lay open the inner aspect OF the finger
from the second joint to the tip with
single clean and perfect incision, whose
walls, composed of minute vessels,
should suffer 80 little confusion and
bruising that union with another simi-
larly free surface would take 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 enyeloped in a plaster of
paris Jacket, with the left arm in the
proper position to prevent involuntary
displacement. 1t is needless to say that
the work was carried on in an atmos-
phere permeated and pervaded with an
tisepetic spray, and that no precaution,
however slight, essential to insure per;
feet union of the surfaces, was spared
by the operating surgeon. The secret
was very carefully kept for some weeks,
also, for had the operation failed, as
there was a possibility that it might,
whole ceiums of scientific explanation
could not have saved the operator from
becoming as ridiculous in the medical
world as he is now likely to be ceieora-
ted. The venture was a serious one IN
many ways, though undertaken at the
solicitation of a patient, who declared
II AL xASa