Pipe-stems, wires, shot, and other foreign bodies, are from time to time recorded as remaining in the brain for some time. Wharton has compiled elaborate statistics on this subject, commenting on 316 cases in which foreign bodies were lodged in the brain, and furnishing all the necessary information to persons interested in this subject.
Injuries of the nose, with marked deformity, are in a measure combated by devices invented for restoring the missing portions of the injured member. Taliacotius, the distinguished Italian surgeon of the sixteenth century, devised an operation which now bears his name, and consists in fashioning a nose from the fleshy tissues of the arm. The arm is approximated to the head and held in this position by an apparatus or system of bandages for about ten days, at which time it is supposed that it can be severed, and further trimming and paring of the nose is then practiced. Acolumn is subsequently made from the upper lip. In the olden days there was a timorous legend representing Taliacotius making noses for his patients from the gluteal regions of other persons, which statement, needless to say, is not founded on fact. Various modifications and improvements on the a Talicotian method have been made; but in recent years the Indian method, introduced by Carpue into England in 1816, is generally preferred. Syme of Edinburgh, Wood, and Ollier have devised methods of restoring the nose, which bear their names.
Ohmann-Dumesnil reports a case of rhinophyma in a man of seventy-two, an alcoholic, who was originally affected with acne rosacea, on whom he performed a most successful operation for restoration. The accompanying illustration shows the original deformity--a growth weighing two pounds--and also pictures the appearance shortly after the operation. This case is illustrative of the possibilities of plastic surgery in the hands of a skilful and ingenious operator.
About 1892 Dr. J. P. Parker then of Kansas City, Mo., restored the missing bridge of a patient's nose by laying the sunken part open in two long flaps, denuding the distal extremity of the little finger of the patient's right hand of nail, flesh, tendons, etc., and binding it into the wound of the nose until firm union had taken place. The finger was then amputated at the second joint and the plastic operation completed, with a result pleasing both to patient and operator.
There is a case quoted of a young man who, when first seen by his medical attendant, had all the soft parts of the nose gone, except one-third of the left ala and a thin flap of the septum which was lying on the upper lip. The missing member was ferreted out and cleansed, and after an hour's separation sutured on. The nostrils were daily syringed with a corrosive sublimate solution, and on the tenth day the dressing was removed; the nose was found active and well, with the single exception of a triangular notch on the right side, which was too greatly bruised by the violence of the blow to recover. When we consider the varicosity of this organ we can readily believe the possibility of the foregoing facts, and there is little doubt that more precaution in suturing severed portions of the nose would render the operation of nose making a very rare one.
Maxwell mentions a curious case of attempted suicide in which the ball, passing through the palatine process of the superior maxillary bone, crushing the vomer to the extent of its own diameter, fell back through the right nostril into the pharynx, was swallowed, and discharged from the anus.
Deformities of the nose causing enormous development, or the condition called "double-nose" by Bartholinus, Borellus, Bidault, and others, are ordinarily results of a pathologic development of the sebaceous glands. In some cases tumors develop from the root of the nose, forming what appears to be a second nose. In other cases monstrous vegetations divide the nose into many tumors. In the early portion of this century much was heard about a man who was a daily habitue of the Palais-Royal Gardens. His nose was divided into unequally sized tumors, covering nearly his entire face. Similar instances have been observed in recent years. Hey mentions a case in which the tumor extended to the lower part of the under lip, which compressed the patient's mouth and nostrils to such an extent that while sleeping, in order to insure sufficient respiration, he had to insert a tin-tube into one of his nostrils. Imbert de Lannes is quoted as operating on a former Mayor of Angouleme. This gentleman's nose was divided into five lobes by sarcomatous tumors weighing two pounds, occupying the external surface of the face, adherent to the buccinator muscles to which they extended, and covering the chin. In the upright position the tumors sealed the nostrils and mouth, and the man had to bend his head before and after respiration. In eating, this unfortunate: person had to lift his tumors away from his mouth, and during sleep the monstrous growths were supported in a sling attached to his night cap. He presented such a hideous aspect that he was virtually ostracized from society The growth had been in progress for twelve years, but during twenty-two months' confinement in Revolutionary prisons the enlargement had been very rapid. Fournier says that the most beautiful result followed the operation which was considered quite hazardous.
