CHAPTER XVIII. Case Recording Methods

CASE RECORDING METHODS

Every case, whether of little consequence or of important nature, should be properly and fully recorded in a thorough and systematic manner. Apart from the value of such a record, to the operating surgeon it often proves of the greatest importance in cases where operations of a purely cosmetic nature are undertaken.

Patients who beg us to make them more beautiful, or less unsightly in the eyes of the ever-critical observer, are the most difficult to please, and often complain, after a few days of constant mirror study, of the parts changed by methods that are the result of years of hard-earned experience, that the nose or the eyes or the ears have not been changed as much as they desired—in fact, so little that their closest friends have failed to evoke ecstatic remarks about the improvement.

This is not unusual with the most intelligent patients and is due to the fact that cosmetic operations performed on an ugly though otherwise normal organ have not yet become very frequent, and while friends are inclined to remark a change in lesser defects, they fail to credit this to the cause, owing to a lack of the knowledge of cosmetic surgery, or their ignorance of the art entirely.

=Photographs.=—Where a pathological defect, wound, or scar or traumatic deformity is to be corrected, the patient is usually kind enough to permit of photographs being made of the parts to be operated on, but where the defect is hereditary, or the result of age, objections are invariably raised by all concerned, for fear their pictures will be used in some outlandish way.

The objection to photographs is obvious, since it usually requires visits to a studio, and the necessary loss of time to the surgeon, whose presence is nearly always necessary to secure the proper negative.

This is especially true of the nose. Very few photographers will make a satisfactory sharp profile picture. It is less artistic, but most desired by the surgeon, and when the patient is presented for a second negative after the operation has been performed, the picture varies more or less in pose from the first taken.

It would be well for physicians to have a camera for use in the operating room, and those who can manipulate one will find that taking a 5 × 7 negative the most suitable.

=Stencil Record.=—For those who cannot provide themselves or bother with a photographic apparatus, the stencil record is recommended.

For this purpose a picture of a normal eye and its lids, a nose, lip or ear, is drawn upon a piece of oiled or stencil paper, or upon any thick, stiff book board.

The paper is laid down upon a plate of glass and the outlines of the picture are cut out, wide enough to allow the sharpened point of a pencil to pass. Where the lines are long it is advisable to allow connecting links to remain at various intervals as desired to keep the stencil stiff and to prevent cut margins from slipping or rolling up. (See Fig. 521.)

The stencil thus made is laid upon the record card and a tracing is made upon the latter by passing the lead-pencil point along the cut outline.

The stencil is now lifted and the defect sketched into the picture of the normal organ.

If this should be the anterior nasal line, a perfect sketch can be made of the defect by placing a card alongside of that organ and drawing the outline upon it as the pencil is made to glide over the nose, the point facing the card in such a way that a true profile outline is obtained. The card is then cut along the pencil line.

The nasal section of the card is now placed upon the stenciled nose and its outer border traced into or over it, as the case may be, by drawing the pencil point along the outer margin.

The same method may be followed post-operatio. This method can be employed for the other parts of the face as well, as, for instance, the mouth, ears, base of nose, etc.

Distances in measurements should be put into the record drawing to make it more exact.

=The Rubber Stamp.=—Another method is to make outline sketches of normal parts of the face with India ink upon drawing board and have those reproduced in rubber stamps, using the stamp in place of the stencil and marking in the defect in the manner before mentioned.

=The Plaster Cast.=—The best method by far, however, and the one found most accurate, is the plaster cast. It is not a difficult thing to make a cast of a nose, eyelid, lip, or ear, and the latter is much more preferable to any other method of record.

For this purpose some modeling clay is required, which is molded into a strip and laid around the part to be reproduced.

This forms a sort of raised ring or border and prevents the overflow of the semiliquid plaster, and avoids the annoyance of trickling the liquid upon other parts of the face about the site of the part worked on; at the same time it permits of neatness and uniformity in the size and shape of the casts to be filed away as records. (See Fig. 522.)

The skin surface, and hair, if any, within this ring area, before using this plaster of Paris, is now thoroughly coated with clean oil, or petrolatum, applied with a soft sable brush. The inner and upper part of the wax ring is also coated.

If there are openings in the parts of the face, such as the nostrils or the auricular orifice, they should be plugged lightly with dry absorbent cotton, care being taken, however, to avoid distending the alæ.

The plaster is now prepared in a small porcelain or soft rubber bowl by adding warm water to it until the powder, upon stirring, forms an even semiliquid paste.

This is poured first upon the area to be reproduced to fill all the finer crevices and to avoid air holes, and is then put on with a spatula, or wooden slab, until the space within the clay boundary is properly filled, covering the organ all over with a layer ¼ to ½ inch in thickness on all sides. Over the eyelids a thin coating of plaster should be used, whereas over other parts of the face a thickness of half an inch can be allowed without discomfort to the patient.

It is well at first to make the plaster thick, as the mold is liable to be broken upon removal or in drying. After a little experience splendid results are obtained with very thin walls of plaster.

The plaster is allowed to dry and harden, while the patient is instructed to remain still and silent. If a cast of the nose is made, the patient should refrain from talking and breathe gently through the mouth.

Tapping on the plaster now and then with a lead pencil will show when it has hardened sufficiently to be removed.

A firm, quick pull relieves the mold.

In molds of the ear an anterior and posterior impression should be made, if a cast of the entire organ is desired. This can be done by first applying a layer of plaster to the posterior surface up to the outer rim, allowing this to harden and painting the anterior ear and the exposed plaster border with petrolatum before putting the plaster over it. Upon traction, when set, the plaster will separate readily at the point of the separation.

The removed piece of set plaster is called the mold.

It is allowed to dry thoroughly and then preferably coated inside with a thin coat of liquid petrolatum, which is found to be much better than oil.

A thinly prepared paste of plaster is poured into it at the outer brim and allowed to harden. The best results are obtained by setting the mold into a small pasteboard box in which it is held in proper position and prevents the thin plaster from running over the depressed edges.

By gently tapping the mold when the cast has set, it is made to separate from the latter sufficient to permit of separating or cutting away of the mold inside of it.

The cast, when removed and dry, is coated with white shellac varnish. Upon its reverse side a note is scratched into it, giving the case number, or such information as the surgeon may desire.

The author advises the addition of a small quantity of Armenian bole to the plaster used for the cast, as it gives a less ghastly tint and aids much by its color in the cutting away of the white mold from the cast. Several of these casts, taken before and after operation by the author, have been shown in the preceding chapters.

After operation and healing of the parts a second cast is made.

Hooks can be inserted into the casts, when still soft, to hang them up by, or loops of string or wire are stuck into them, while setting for the same purpose.

Such a collection is not only of great value to the operator, but is a means of constant and absolute record, even to the extent of reproduction by photography.

The necessary data in respect to the method employed in operating, dressing, etc., is to be added to the record as generally done with medical or other surgical causes.

=Preparation of Photographs.=—There are some cases of which no other permanent record can be made, except by photograph. If these can be obtained, the negatives are to be printed without retouching, the prints being made on silver printing paper of the glossy type to permit of reproduction in half-tone when desired at some future time.

In printing such pictures, the eyes, or other part of the face not operated on, may be obliterated by laying strips of paper next to the negative, the part thus covered coming out white in the positive.

The photographs made of parts to be operated on should be made as near as the normal size, for obvious reasons of accuracy and measurement.

This can be done by comparing the size of the part to the picture found on the ground glass.

Cameras that do not permit of ground-glass focusing are useless as well as uncertain. Time exposures are necessary for the best results.

Dark backgrounds should be used to get the sharp outlines by contrast. Too much light on the parts, such as direct sunshine, is undesirable, as it makes the parts appear flat and lifeless; therefore a muslin screen is of great value to graduate the intensity of the light, and if this is not at hand, a sheet of paper will answer the same purpose.

In printing make note of the depth of color of the parts most desired to be shown, varying with the different parts of the face. Look to contrast, and in pathological cases have the diseased area printed so that it will stand out forcibly as compared to the fellow organ in health or the normal tissue beyond its border.

To protect photographic records, they should be properly bound in book fashion to avoid scratching, rubbing, or breaking. This not only implies neatness and thoroughness on the part of the surgeon, but also permits of ready reference at all times.

An index to the contents of such a book is a desirable adjunct.

INDEX TO AUTHORS

ADAMKIERWICZ, osteoplasty, 101.

D’ALGUIE, rhinoplasty, 360.

ALLIOT, history of reparative surgery, 5.

ALLIS, inhaler, 65.

VON ALTMANN, bioblasts, 100.

ALTER, partial stenosis of nares after paraffin injection, 229.

AMMON, blepharoplasty, 108.

VON AMMON, rhinoplasty, 358.

ANGERER, antiseptics, 38.

VON ARTHA, blepharoplasty, 112.

AUVERT, rhinoplasty, 359.

BARATOUX, paraffin injections, 210. skin grafting method, 99.

BARDELEBEN, antiseptics, 40. sutureless blepharoplasty, 119.

BARDENHEUER, meloplasty, 203. rhinoplasty, 416.

BARTLEY, antiseptics, 37.

BAUMAN, antiseptics, 37.

BAYER, meloplasty, 201.

BAYER-PAYR, rhinoplasty, 424.

BECK, peroxoles, 41.

BEINL, harelip clamp, 145.

BENNETT, cocain, 70.

BERGER, cheiloplasty, 183. classification of lip deformities, 162. nasal retention apparatus, 385. rhinoplasty, 384, 424.

VON BERGMAN, antiseptics, 38. history of plastic surgery, 7. operating gown, 19.

BILLROTH, antiseptics, 38, 40. carcinoma of lips, 168. combined anesthesia, 67.

BLANDIN, history of reparative surgery, 5. rhinoplasty, 435, 444.

BLASIUS, cheiloplasty, 177. rhinoplasty, 363, 367.

BOECKMAN, preparation of catgut, 32.

BOJANIS, history of rhinoplasty, 3.

BONNET, rhinoplasty, 434.

BOUILLON, antiseptics, 40.

BRANCA, history of rhinoplasty, 3, 349.

BRANCA, Antonius, history of rhinoplasty, 3.

BRETZ, sutureless coaptation, 48.

BRINDEL, facial phlebitis after paraffin injection, 226. paraffin injection, 210.

BRŒCKÆRT, antiseptic with paraffin, 218. facial phlebitis after paraffin injection, 226. paraffin injection, 210.

BRUNS, cheiloplasty, 163, 171, 175.

BRYANT, antiseptics, 39.

BUCHANAN, cheiloplasty, 176.

BUCHHOLZ, antiseptics, 38.

BUCK, cheiloplasty, 165, 172.

BULL, epicanthus, 113.

BÜNGER, history of rhinoplasty, 5, 350.

BURCHARDT, compressing forceps, 145.

BURNETT’S fluid, 41.

BURNS, charpie cotton, 67. flap method, 86.

BÜROW, antiseptics, 35. cheiloplasty, 178. rhinoplasty, 65. sliding flap method, 85.

BUSCH, rhinoplasty, 430, 433.

CARPUE, history of rhinoplasty, 4.

DE CAZENEUVE, facial phlebitis after paraffin injection, 226. hot-water jacket for syringe, 233.

CELSUS, Aulus Cornelius, cheiloplasty, 169. “Father of Plastic Surgery,” frontispiece. history of plastic surgery, 1. skin incisions, 80, 485, 487.

CHARRIÈRE, nasal prothesis, 348.

CHELIUS, replantation of nose, 349.

CHEYNE, injection of paraffin, 210.

CLARK, J. G., Kumol apparatus, 32.

COMSTOCK, disposition of injected paraffin, 235, 236. effect of paraffin on animals, 225. melting point of paraffin, 241.

CONDY, fluid of, 40.

CONNELL, injection of paraffin, 210, 230.

COPELAND, history of plastic surgery, 7.

CORNING, injection of oils, 209.

COSTA, temperature of cocain solution, 72.

CZERNY, history of plastic surgery, 6. sterilization of silk, 30.

DAWBARN, preservation of needles, 16.

DAVIDSOHN, care of instruments, 15.

DAVY, Sir H., nitrous oxid, 67.

DEBOUT, nasal prothesis, 348.

DELAIN, vaselin injections in animals, 217.

DELANGRE, nasal prothesis, 209. thermoform sleeve for syringe, 233.

DELPECH, cheiloplasty, 181. history of rhinoplasty, 5. rhinoplasty, 353.

DENONVILLIER, rhinoplasty, 428, 430, 438.

DIEFFENBACH, blepharoplasty, 104, 105, 109. cheiloplasty, 157, 164, 173, 187. history of reparative surgery, 5. microstoma, 195. rhinoplasty, 357, 372, 431, 446, 466.

DIEFFENBACH-VON LANGENBECK, stomatoplasty, 193.

DOBOUSQUET, skin grafting method, 99.

DOWNIE, celloidin in protheses, use of, 228. electrothermic syringe heater, 233. paraffin injection on carcinoma, effect of, 235.

DREESMANN, history of plastic surgery, 7.

DUBERWITSKY, rhinoplasty, 356.

DUNBAR, vaselin injection in animals, 217.

DUPUYTREN, rhinoplasty, 431, 445.

ECKSTEIN, absorption of paraffin, 220. encapsulation of injected paraffin, 234. Hart-paraffin, 210. rubber insulator for syringe, 231, 263.

EICHHOFF, aristol, 41.

ENGLE, median cleft harelip, 148.

ERICHSEN, JOHN ERIC, history of plastic surgery, 6.

ESCHWEILER, new tissue formation after paraffin injection, 237. oft-repeated injection, 215.

VON ESMARCH, antiseptics, 40. cheiloplasty, 158. dropping bottle, 60. inhaler, 60. number of rhinoplastic operations required, 347.

ESTLANDER, cheiloplasty, 171.

ESTLANDER-ABBÉ, cheiloplasty, 166.

EWALD, thermoform sleeve for syringe, 233.

EDWARD-ALBERT, meloplasty, 199.

FABRICIUS, history of rhinoplasty, 3.

FABRIZI, rhinoplasty, 375.

FAHRENBACH, bilateral cleft, 158.

FEHLEISEN, erysipelo-coccus, 56.

FEINBERG, amyl nitrate inhalation, 71.

FÉRÉOL, iodoform, 42.

FILLEBROWN, cheiloplasty, 152.

FISHER, osteoplasty, 102.

FORQUE, rhinoplasty, 359.

FOURNEAU, stovain, 75.

FOWLER, inhaler, 66.

FREEMAN, blunt needle for paraffin injection, 227. early encystment of paraffin, 235.

FRICKE, blepharoplasty, 108.

VON FRISCH, subcutaneous prothesis, 209.

FRITZ-REICH, rhinoplasty, 431.

GÄDEKE, cocain, 70.

GARRE, skin grafting method, 93.

GÄRTNER, care of instruments, 15.

GAUTHIER, cocain solution, 72.

GELEY, antithermics, 57.

GENSOUL, rhinoplasty, 465.

GERSUNY, correction of labial defect, 185. duration of paraffin protheses, 238. encapsulation of vaselin, 234. history of rhinoplasty, 8. meloplasty, 201. mucosa grafting, 101.

GEUZMER, cheiloplasty, 157.

GLÜCK, antisepsis, secondary, 57. history of plastic surgery, 6, 7. ivory bone plates, 101.

GORIS, rhinoplasty, 387.

GRAEFE, history of plastic surgery, 5. rhinoplasty, 352, 374.

GRÄFE, cheiloplasty, 154.

GREENE, correction of coloboma, 125.

GUERSANT, bilateral facial cleft, 149.

GUINARD, antithermics, 57. cheiloplasty, 183.

GUTCH, care of instruments, 15.

GUTHRIE, chloroform anesthesia, 60. history of plastic surgery, 7.

HAAGEDORN, catgut sterilization, 31. cheiloplasty, 156, 159. needle holder, 78. needles, 77.

VON HACKER, rhinoplasty, 391, 436, 438.

HAHN, history of plastic surgery, 7.

HAINSLEY, cheek compressor, 161.

HALBAN, subcutaneous prothesis, 209.

HAMILTON, injection of paraffin, 210.

HÄNEL, quantity of cocain injection, 72.

HARE, respiratory forgetfulness, 64.

HARTMAN, skin grafting method, 97.

HASSELMANN, unilateral facial cleft, 149.

HAWLEY, ethyl chlorid, 68.

HEATH, adhesive plaster dressing, 161. injection paraffin, 210.

HELFERICH, history of plastic surgery, 6. rhinoplasty, 382, 397.

VON HELMONT, total rhinoplasty, 350.

HERTEL, chronic irritation of tissue after paraffin injection, 236.

HEUTER, artificial mouth, 196. rhinoplasty, 365. stomatoplasty, 196.

HEYDENREICH, history of plastic surgery, 7.

HILL, injection of paraffin, 210. secondary diffusion of paraffin, 253.

VON HIPPEL, history of plastic surgery, 7.

HIRSCHBERG, skin-grafting method, 107.

HOFFACKER, replanting of nose, 349.

HOLDEN, blindness following paraffin injection, 225.

HÜBSCHER, skin-grafting method, 94.

HURD, blindness following paraffin injection, 225.

ISRAEL, meloplasty, 202. rhinoplasty, 402.

JACKSON, ether anesthesia, 63.

JAKIMOWITSCH, history of plastic surgery, 7.

JÄSCHE, cheiloplasty, 174.

JENNESCO, stovain anesthesia, 75.

JOBERI, history of reparative surgery, 5.

JUILLARD, mask, 66.

JUKUFF, disposition of injected paraffin, 235. safety of vaselin injection, 218.

KALLE, iodol, 41.

KARG, cause of skin pigmentation, 100.

KAPSAMMER, paraffin injection, pulmonary embolism after, 224. subcutaneous prothesis, 209.

KAREWSKI, hot-water jacket for syringe, 233. subcutaneous prothesis, 210.

KEEGAN, rhinoplasty, 356, 380.

KERSTEN-MATHIEU, needle forceps, 77.

KOCH, antiseptics, 35, 38.

KOCHER, catgut sterilization, 31.

KOFMAN, death following paraffin injection, 224, 260.

KOLLE, blepharoplasty, 113. care of hands, 18. cheiloplasty, 185, 187, 188. classification of facial deformities, 276. classification of nasal deformities, 212. danger of injecting liquid paraffin, 241. drop syringe, 265, 266. electric tattooing needle, 487. electrothermic paraffin heater, 244. hyperplasia and fibromatosis after paraffin injection, 256. malposition of ears, correction of, 139. nasal chisel and mallet, 453. otoplasty, 124, 135, 137. paraffin mixture for injection, 243. rhinoplasty, 437, 440, 452, 454, 456, 458, 465. stomatoplasty, 195.

KOLLE-PRAVAZ, syringe, 72.

KOLLER, cocain, 70.

KÖNIG, cheiloplasty, 156. rhinoplasty, 390, 439.

KOOMAS, history of rhinoplasty, 4, 352.

KOSSMAN, preparation of catgut, 32.

KRASKE, antisepsis, 35. meloplasty, 201.

KRAUSE, history of skin grafting, 6.

KRAUSE, F., rhinoplasty, 398. skin-grafting method, 91.

KRONIG, preparation of catgut, 32.

KRYMOFF, cocain solution, sterilized, 70.

KUHNT, otoplasty, 123.

KÜMMEL, care of instruments, 15.

KÜSTER, iodoform collodium, 45. rhinoplasty, 423.

KÜSTER-ISRAEL, rhinoplasty, 384.

LABAT, rhinoplasty, 255, 363.

LABORDERIE, skin grafting, 99.

VON LAIR, history of plastic surgery, 7.

LAKE, paraffin injection, 210.

LANDREAU, rhinoplasty, 360.

VON LANGENBECK, blepharoplasty, 108. cheiloplasty, 179. history of plastic surgery, 5. rhinoplasty, 359, 362, 388, 419, 430, 433.

VON LANGENBECK-WOLFF-SEDILLOT, cheiloplasty, 153.

LANGENBUCH, antiseptics, 39.

LANGER, polyotia, 138.

LARGER, cheiloplasty, 182.

LARREY, history of rhinoplasty, 5.

LEISER, collapse after paraffin injection, 224.

LENTENNER, flap method, 86.

LILIENTHAL, Z. O., aseptic plaster, 47.

LINHART, rhinoplasty, 363, 466.

LISFRANC, history of rhinoplasty, 5. rhinoplasty, 253.

LITTLEWOOD, fixation of elbows in cheiloplasty, 153.

LISTER, J., antiseptics, 34, 35. catgut preparation, 31. history of antisepsis, 5. protective silk plaster, 47.

LOVE, antiseptics, 39.

LUSK, Z., skin-grafting method, 96.

LYNCH, subcutaneous prothesis, 210.

LYNN, history of rhinoplasty, 4.

MAAS, antiseptics, 35, 40. cheiloplasty, 156, 159.

MACEWEN, history of reparative surgery, 7. osteoplasty, 101.

MAISONNEUVE, rhinoplasty, 368.

MALGAIGNE, cheiloplasty, 154. history of plastic surgery, 2.

MALPIGHIAN, skin layer of, 89.

VON MANGOLD, cartilaginous support in rhinoplasty, 405.

MARTIN, nasal prothesis, 348, 388.

MATHIEU, nasal prothesis, 248.

MAYO, saline injection in protheses, 275.

MENDEL, injection of fibrolysin, 197, 488.

MERLING, beta eucain, 74.

MEYER, WILLY, sterilizer, 24. vaselin injection in animals, 217.

MICHEL, time required to replace injected mass, 238.

MIKULICZ, use of iodoform, 42.

MINTZ, blindness following paraffin injection, 226.

MIRAULT-BRUNS, cheiloplasty, 155.

MONGITORE, history of rhinoplasty, 3.

LE MONIER, history of reparative surgery, 5.

MONK, correction of malposed ears, 139. rhinoplasty, 450.

MORGAN, antiseptics, 40. cheiloplasty, 180.

MORRIS, prothesis for cheek, 207.

MORTON, ether anesthesia, 63. time required to replace injected paraffin, 238.

MOSETIG-MOORHOF, history of plastic surgery, 8.

MOSZKOWICZ, injection of vaselin harmless, 210. pulmonary embolism after paraffin injection, 224. thermoform sleeve for syringe, 233.

MULE, history of plastic surgery, 8.

MUTTER, history of plastic surgery, 5. rhinoplasty, 429, 433.

NÉLATON, cheiloplasty, 152. rhinoplasty, 364, 400, 406, 433.

NÉLATON, CH., rhinoplasty, 420, 425.

NEUMANN, rhinoplasty, 413.

NICOLADONI, history of plastic surgery, 7.

NIEMAN, cocain, 70.

NOYES, clamp in otoplasty, 127.

VON NUSSBAUM, hair transplanting, 102. history of plastic surgery, 7.

OBERST, meloplasty, 198.

OLLIER, ether, safety of, 64. history of plastic surgery, 7. osteoplasty, 101. rhinoplasty, 417.

PAGET, heating paraffin syringe needle, 232. melting point of paraffin, 241.

PANCOAST, history of reparative surgery, 5.

PAQUEL, antiseptics, 40.

PARE, Ambroise, history of reparative surgery, 4.

PARKER, paraffin injection, 210.

PARKHILL, otoplasty in macrotia, 135.

PAVONI, B., history of rhinoplasty, 3.

PETRALI, rhinoplasty, 359.

PFANNENSTIEL, embolism from paraffin injection, 209. pulmonary embolism from paraffin injection, 224.

PFLUGH, hot-water jacket for syringe, 233.

VON PFOHLSPUNDT, history of rhinoplasty, 3.

PHILLIPPEAUX, history of plastic surgery, 6.

PLESSING, blepharoplasty, 106.

PONCET, history of plastic surgery, 7. osteoplasty, 101.

PORTER, Poplar sawdust dressing, 48.

POZZI, rhinoplasty, 456.

POZZI-HAAGEDORN, needle holder, 78.

PRAVAZ, syringe, 72.

PREIDESBERGER, rhinoplasty, 398.

QUINLAN, injection of paraffin, 210. paraffin heater, 232.

RANCKE, antiseptics, 40.

REDARD, care of instruments, 15.

REGNIER, skin grafting in cheiloplasty, 180.

REVERDIN, catgut, preparation of, 32. history of skin grafting, 6. skin-grafting method, 89, 107.

RICARD, history of reparative surgery, 5.

RICHERAND, cheiloplasty, 168.

RICHTER, nasal prothesis, 348.

RIEDINGER, history of plastic surgery, 7.

ROE, classification of nasal deformities, 212. rhinoplasty, 457, 469.

ROSE, cheiloplasty, 151. classification of harelips, 147. stomatoplasty, 196.

ROSER, otoplasty, 120.

ROTTER, rhinoplasty, 393.

ROUX, history of reparative surgery, 5.

SCHAFFER, catgut sterilization, 31.

SCHEDE, antiseptics, 38.

SCHIMMELBUSCH, dropping bottle, 60. folding mask, 61. rhinoplasty, 394.

SCHLEICH, cocain solution, 71, 275.

SCHULTZ, W., antisepsis, 37.

SCHWARTZE, fracture of ear cartilage, 120. otoplasty for microtia, 134.

SCHWEININGER, hair transplanting, 102.

SEBILEAU, diffuse fibromatosis after paraffin injection, 256.

SEDILLOT, cheiloplasty, 164. rhinoplasty, 383, 432.

SENN, history of rhinoplasty, 7. osteoplasty, 101.

SERRE, history of reparative surgery, 5. meloplasty, 199. rhinoplasty, 366, 445.

SIMON, cheiloplasty, 160.

SMITH, skin-grafting scissors, 89.

SMITH, HARMON, drop syringe, 267. heating needle of syringe, 232. nontoxic effect of paraffin, 235. paraffin heater, 246. paraffin injection, 210. redness of skin after paraffin injection, 248. safety of vaselin injection, 218. tissue replacement of paraffin, 235.

SOBIERANSKI, vaselin injections in animals, 217.

SOCIN, tinfoil dressing in skin grafting, 90.

SPICER, diffusion of paraffin, 254. injection of paraffin, 210.

SPRAGUE, sterilizer, 26.

STAFFEL, meloplasty, 206.

STEIN, safety of vaselin injections, 218. subcutaneous protheses, 209. tissue replacement by paraffin, 235. vein puncture, avoidance of, in paraffin injection, 227.

STEINHAUSEN, rhinoplasty, 412.

STEINTHAL, rhinoplasty, 377, 406.

STRAUME, vaselin injection in animals, 217.

STUBENRATH, vaselin injections in animals, 217.

SUSRATA, history of rhinoplasty, 2.

SYLVESTER, resuscitation method, 63.

SYME, cheiloplasty, 177. rhinoplasty, 367.

SZYMANOWSKI, history of reparative surgery, 5. restoration of auricle, 129. rhinoplasty, 363, 366, 375, 386, 447.

TADDIE, vaselin injection in animals, 217.

TAGLIACOZZI, KASPAR, history of rhinoplasty, 3. harness, 87. rhinoplasty, 371.

TEALE, cheiloplasty, 185.

TERRIER, ethyl bromid, 67.

THIERSCH, history of skin grafting, 6. gauze compress dressings, 90. skin-grafting razor, 93. skin grafting in cheiloplasty, 180. rhinoplasty, 381.

THOMPSON, rhinoplasty, 435.

THORNDIKE, mandibular cleft, inferior, 157.

TRENDELENBURG, cheiloplasty, 174. median cleft with rhinophyma, 147.

TRIFFE, rubber apron, 19.

TRIPIER, blepharoplasty, 111. stomatoplasty, 194.

TUFFIER, secondary elimination paraffin, 262.

UNNA, zinc oxid plaster mull, 489.

VASSERMAN, gangrene following vaselin injection in nose, 222.

VELPEAU, nasal amputation, 349.

VERNEUIL, rhinoplasty, 380.

VIANEO, VINCENT, history of plastic surgery, 3.

VINCI, Beta eucain, 74.

VIOLLET, electrothermically heated syringe, 233.

VOLKMAN, rhinoplasty, 379.

VULPIAN, history of plastic surgery, 6.

WALCHER, dressing forceps, 55.

WALLACE, sterilizer, 25.

WARREN, history of reparative surgery, 5.

WEBER, O., flap-twisting method, 85. history of reparative surgery, 2. needle holder, 78. rhinoplasty, 434.

VON WECKER, skin-grafting method, 107.

WEIRICK, skin-grafting method, 97.

WENDEL, encystment of paraffin, 236.

WENZEL, encapsulation of paraffin, 236.

WHITE, A. C., liquid air anesthesia, 74.

WILDE, polyotia, 138.

WITZEL, malformation of lip, 148.

WOLFE, blepharoplasty, 106. history of skin grafting, 6. skin-grafting method, 91, 107.

WOLFE, J., history of plastic surgery, 7.

WOLFENDEN, iodol, 42.

WOLFF, use of Hart paraffin, 219.

WÖLFLER, mandibular cleft, lower lip and tongue, 150. mucosa-grafting, 101, 110, 165.

ZAHN, osteoplasty, 102.

ZEIS, cheiloplasty, 181. history of reparative surgery, 5.

INDEX TO SUBJECTS

Abscess, due to paraffin pressure, 261.

Alæ, reduction of thickened, 466. restoration of, 427.

Alar deficiency, 312.

Alcohol, use of, 35.

Alcohol-chloroform anesthesia, 67.

Aluminium acetate, use of, 35.

Anesthesia, combined, 66. alcohol-chloroform in, 67. chloroform-ether in, 67. chloroform-ether-alcohol in, 67. ethyl bromid, 67. ethyl chlorid, 68, 69. general, 58. chloroform in, 60. dropping bottles in, 60. ether in, 63. masks in, 61. preparation for, 59. local, 69. cocain in, 70. ethyl chlorid in, 69. eucain, beta, in, 74. liquid air in, 74. stovain in, 75. nitrous oxid, 67.

Angular nose, correction of, 449.

Ankyloblepharon, operation for, 116.

Antiseptic powders, 41.

Antiseptic solutions, 34.

Antithermics, indication for, 57.

Aristol, use of, 41.

Artificial mouth, 196.

Auricle, deficiency about, 334. malformation of, 128. malposition of, 138. restoration of, 121.

Auricle, traumatism of, 120.

Auricular appendages, 137.

Auricular lobule, malformation of, 127.

Auricular protheses, 125.

Autodermic skin-grafting, 88.

Bandages, removal of, 49.

Battery, dry cells, 477. portable, 476. wet cell, 470.

Benzoic acid, 35.

Blepharoplasty, classification of, 103.

Bone, grafting of, 101. Senn’s chips of, 101.

Boric acid, use of, 35.

Boric acid oil, use of, 55.

Broadened base of nose, correction of, 465.

Broadened lobule, correction of, 455.

Bulbous lobule, correction of, 455.

Buccal fissure, 150.

Canthoplasty, 114.

Carbolic acid, danger of, 36. use of, 35. in face peeling, 489.

Cartilaginous support of flaps, use of, 404.

Catgut, preparation of, 31.

Cell, electric, 470.

Cell selector, 473. arrangement of, 474.

Cells, series connection of, 472.

Cheek, prothesis for, 206.

Cheek compressor, Hainsley, 161.

Cheeks, deficiency of, 321. surgery of, 198.

Cheiloplasty, 145.

Chin, receding, 329.

Chloroform anesthesia, 60.

Chloroform-ether anesthesia, 67.

Chloroform-ether-alcohol anesthesia, 67.

Chromic anhydrid, 37.

Classification for indication for protheses, 276.

Classification of blepharoplasty, 103. of deformities of lower lip, 167. of upper lip, 162. of harelip, 147. of nasal deformities, 212, 341. of skin-grafting, 88.

Coaptation, sutureless, 45.

Cocain, in local anesthesia, 70. Schleich’s solution of, 71.

Collodium dressing, 44.

Coloboma, correction of, 125.

Compression forceps, 145.

Corneal graft, 7.

Cosmetic rhinoplasty, 448.

Creolin, use of, 37.

Decortication method, 488.

Deficiency, about alæ, 312. about cheeks, 321. about chin, 329. about ears, 334. about lips, 314. about nose, 286. about subseptum, 313. labial, 184. of nasal lobule, 464. of vermilion border, 190.

Deformities, about the mouth, 314. of the nose, 286. classification of, 212.

Dermatol, use of, 41.

Deviation, nasal, correction of, 467.

Diffusion of injected paraffin, 228, 252.

Disinfection of operating room, 10.

Dissection, subcutaneous, 2.

Dressing forceps, 55.

Dressing of wounds, 43.

Dressings, changing of, 48. sterilization of, 24.

Dropping bottles, for anesthesia, 60.

Ear, surgery of, 120.

Ectropion, blepharal, 103. correction of, 104. labial, 186.

Electric battery, 470.

Electric tattooing needle, 487.

Electric wall plate, 475.

Electrodes, 477. arm, 478. multiple needle, 484. sponge, 477.

Electrolysis in dermatology, 470.

Electrolytic needle holder, 479.

Electrothermic paraffin heater, 244.

Elevated lobule, correction of, 454.

Embolism, after paraffin injection, 223.

Entropion, labial, 189.

Epicanthus, operation for, 113.

Epilating forceps, 481.

Ether anesthesia, 63.

Ether inhalers, 65.

Ethyl-bromid anesthesia, 67.

Ethyl-chlorid, use of, in protheses, 273.

Ethyl-chlorid anesthesia, 68.

Eucain, beta, use of, 74, 272.

Eucalyptol, use of, 37.

Exfoliation of facial skin, 488.

Face peeling, 489.

Facial cleft, bilateral, 149. unilateral, 149.

Facial pits, removal of, 488.

Fibrolysin, use of, 488.

Fibromatosis, after paraffin injection, 256. microphotographs of, 257.

Flap method, combined, in rhinoplasty, 378.

Flaps, implantation of, 87. nasal, cutting of, 345.

Flaps, nasal, organic support of, 387, 389, 390. pedunculated, care of, 50. transplantation of, 88.

Forceps, Burchardt’s compression, 145. dressing, 55. epilating, 481.

Forehead, receding, 280.

Foreign bodies, 51.

Formaldehyd disinfection, 10.

French method in rhinoplasty, 363.

Furrow, about canthi, 326. interciliary, 279. nasolabial, 317. oral-angular, 320.

Gangrene, symptoms of, 54. treatment of, 55.

Glycerin, use of, 37.

Granulation of wounds, 47.

Hair, transplantation of, 102.

Hairs, electrolytic removal of, 480.

Hands, preparation of, 16.

Harelip, cause of, 146. classification of, 147. correction of, 150. post-operative treatment of, 161.

Harelip clamp, 145.

Harness, Tagliacozza, 87.

Hemorrhage, control of, 49.

Heterodermic skin-grafting, 88-96.

Hindoo method, in rhinoplasty, 351.

Hydrogen peroxid, 39.

Hyperinjection of paraffin, 221.

Infection, erysipelatous, cause of, 56. treatment of, 57.

Iodin, use of, 39.

Iodoform gauze, use of, 57.

Iodol, use of, 41.

Instruments, care of, 14.

Interlobular deficiency, 310.

Irrigation, method of, 15.

Italian method, in rhinoplasty, 369.

Ivory bone protheses, 101.

Keloid, 120.

Koomas rhinoplasty, 352.

Labial deficiency, 184, 314.

Labial ectropion, 186.

Labial entropion, 189.

Lids, surgery of, 103.

Ligatures, 30.

Lips, surgery of, 145.

Liquid air anesthesia, 74.

Lobule, bulbous, correction of, 455. correction of, 455. deficiency of, 464. elevated, correction of, 454. nasal, restoration of, 423, 441.

Lysol, use of, 39.

Macrostoma, 150. correction of, 192.

Macrotia, 132.

Malformation, of auricle, 128. of auricular lobule, 127.

Malposition of auricles, 137.

Maxillary process, prominent, correction of, 468.

Masks, anesthetic, 61, 65, 66.

Meloplasty, 198.

Melting points of paraffin, 239.

Mercurial toxæmia, 38.

Mercury bichlorid, use of, 38.

Microstoma, correction of, 195.

Microtia, 129.

Milliampèremeter, 475.

Moles, removal of, 482.

Mouth, artificial, 196. deformities of, 314. surgery of, 192.

Mucosa, grafting of, 101.

Mucosa wounds, care of, 50.

Multiple needle electrode, 484.

Nævi, removal of, 484.

Nasal chisels, 453.

Nasal deficiencies, 286.

Nasal deformities, 286. classification of, 341.

Nasal destruction, cause of, 341.

Nasal deviation, correction of, 467.

Nasal flaps, cutting of, 345.

Nasal mallet, 453.

Nasal protheses, external, 347.

Nasal replanting, 348.

Nasal retention apparatus, 385.

Nasal transplanting, 349.

Nasal width, correction of, 468.

Nasolabial furrow, 317.

Nausea, after local anesthesia, 73.

Needle holders, 77. electrolytic, 479.

Needles, Haagedorn, 77. tattoo, 487.

Nitrous oxid anesthesia, 67.

Nose, broad base of, correction of, 465. surgery of, 339.

Ocular stump, deficiency of, 327.

Ohm’s law, 471.

Operating room, requisites for, 9.

Operations, number of, about nose, 346.

Operative field, preparation of, 20.

Oral-angular furrow, 320.

Orbit, deficiency about, 324.

Organic support of nasal flaps, 387, 389, 390, 404.

Orthoform, use of, 42.

Osteoperiostitic support of flap, 390.

Otoplasty, 120.

Oxid, nitrous, anesthesia by, 67.

Paraffin, diffusion of, 228. secondary, 252. hyperinjection of, 221. melting point of, 239. subinjection of, 221.

Paraffin compound for injection, 244.

Paraffin embolism, 223.

Paraffin heater, 232, 244, 246.

Paraffin injection for epicanthus, 113.

Paraffin syringe, Eckstein, 232.

Pedunculated flaps, care of, 50. implantation of, 87.

Periostitic support of flap, 389.

Peroxoles, use of, 41.

Photographic printing, 497.

Photographs, in recording cases, 491-496.

Plaster, protective, 44. removal of, 44. Z. O., 47.

Plaster casts, making of, 493.

Plastic operations, methods in, 79. principles of, 76.

Polyotia, 137.

Post-auricular deficiency, 335.

Potassium permanganate, use of, 39.

Powders, antiseptic, 41.

Pressure abscess, 261.

Principles of plastic surgery, 76.

Pro-auricular deficiency, 334.

Protheses, auricular, 125, 130. classification for indication of, 276. external, 8. nasal, 347. of cheek, 206. practical technique of, 272. subcutaneous, indication for, 8, 209, 210. precautions in, 213. untoward results in, 216.

Ptosis, operation for, 115.

Pus, laudable, 51.

Razors, skin-grafting, 93.

Receding forehead, 280.

Redness of skin after paraffin injection, 248.

Replanting nose, 348.

Retention apparatus for nose, 385.

Rheostat, 471.

Rhinophyma, 147.

Rhinoplasty, 339. French method of, 363. Hindoo method of, 351. Italian method of, 369. Koomas method of, 352. partial, 412. technique of, 344.

Round cell infiltration after paraffin injection, 258.

Rubber stamp recording method, 493.

Salicylic acid, use of, 40.

Scars, removal of, 485. treatment of, 486.

Scissors, probe pointed, 114. curved eye, 117.

Septicemia, 52. treatment of, 53.

Series connection of cells, 472.

Shoulders, deficiency of, contour in, 336.

Shunt rheostat connection, 473.

Skin-grafting, 88. classification of, 88. dermal, 6. epidermal, 6. general remarks on, 100. in blepharoplasty, 107. method of, 89.

Skin-grafting razors, 93.

Skin-grafting scissors, 89.

Sodium chlorid, use of, 40.

Solutions, antiseptic, 34.

Spartein, use of, 57.

Sponge electrode, 477.

Sponges and sponging, 22.

Stencil recording methods, 492.

Stitch scars, 45.

Stomatoplasty, 192.

Stovain anesthesia, 75.

Subcutaneous dissection, 2.

Subseptal deficiency, 313.

Subseptum, restoration of, 443.

Superfluous hairs, removal of, 480.

Sutureless coaptation, 45.

Sutures, and their care, 30. placing of, 76.

Syringe, Eckstein, 232. Kolle, 72, 265-266. Pravaz, 72. Kolle “Simplex,” 72. “Sub Q,” 72. Smith, 267.

Tattoo-marks, removal of, 485.

Telangiectasis, treatment of, 483.

Thiosinamin solution, use of, 488.

Thymol, use of, 40.

Transplanting of nose, 349.

Traumatism of auricle, 120.

Unna plaster mull, use of, 489.

Untoward results in paraffin injection, 216.

Vacuoles, result of paraffin injection, 258.

Voltage of cells, 471.

Wall plate, electric, 475.

Wall plate connections, 475.

Wound dressings, 43.

Wounds, granulation of, 47. of mucosa, 50.

Wrinkled eyelids, operation for, 116.

Xanthelasma palpebrarum, operation for, 118.

Yellow appearance of skin after paraffin injection, 259.

Zinc chlorid, use of, 40.

Z. O. plaster strips, 47.

Zoöcorneal graft, 7.

Zoödermic skin-grafting, 88, 97.

THE END