Rhinoplasty is one of the oldest surgical operations, known to have been practised by the Indian surgeon Sushruta in the 1st millennium BC, and with great sophistication in the 17th century by the Italian physician Gaspare Tagliacozzi, who created new noses from the muscles of the upper arm.
This case reported in the 1830s in The New England Journal of Medicine was, therefore, nothing new – but it was nevertheless a resourceful and successful example of aesthetic surgery conducted in the pre-anaesthetic era.
A young lady, now about twenty-seven years of age, belonging to the State of Maine, thirteen months ago, was urged by an uncle to consult a medical pretender by the name of Mason, of Waterbury, since dead, in consequence of the existence of a small wart, as she denominates it, near the tip of the nose. It was considered a cancerous pimple, which should be dispersed, and the doctor, therefore, advised the application of caustic. This produced a high degree of inflammation, which was so extensive and severe that poultices were used for reducing it. These were continued, it seems, a considerable time—for on the fourteenth day after using the caustic, in the act of taking off a poultice, the entire fleshy part of the nose dropped off‘, close to the bones, producing a shocking and wholly unlooked for calamity. For a young lady, whose features were regular and handsome, in the prime of life, health, hope and enjoyment, nothing could have been so disastrous or painfully distressing as a facial deformity of this character. On seeking further advice from the same source, she was told, by way of encouragement, that the organ would grow again, and eventually be perfectly restored.
Dr Mason was evidently as competent in the art of prognosis as he was in matters of therapeutics. Happily the young woman turned to a more capable practitioner for her next stage of treatment.
Having waited thirteen months, without discovering any indications of a reproduction of the nose, and having read in the newspapers an account, which was extracted from this Journal, of a successful taliacotian operation in Boston, she came to this city for surgical advice. This was in August last; but for some reason, she returned home, and again arrived in Boston early in November.
‘Taliacotian’ is a reference to Tagliacozzi, whose operation was still being used three hundred years after he invented it.
Everything being in readiness, on the 17th of November, Dr. J. M. Warren commenced the operation by taking a large triangular piece of skin from the middle of the forehead, which was detached, except a small strip between the eyes. The broad flap, on being reversed, was necessarily twisted in the narrow part. The edges about the locality of the original nose were pared, and the edges of the transported material for the new one, nicely adjusted in all directions, and secured by ligatures instead of pins. Keenly as the unfortunate patient must have suffered —for it was not the work of a moment, but a slow process, to fit one part to another—she never manifested the slightest indications of uneasiness. Such is the fortitude of females. Finally, the best part of the narration may be expressed in a few lines. Everything worked kindly—the new nose knit by the first intention, and the nostrils and wings are well turned, and promise to go on improving in appearance. We called upon the heroic patient the other day, and found her sitting in a comfortable great chair at the breakfast table, free from pain, the inflammation having subsided, and in a fair way of soon being in a condition to return to her friends.
This is truly another triumph of science and art, in the restoration of that essential feature of the face, on which expression and articulation necessarily depend. The patient came here an object of disgust to herself, and exciting the deep sympathy and commiseration of all who chanced to see her; but she leaves Boston, a living monument of the boundless resources of human ingenuity, with a deep feeling of gratitude towards God and the surgeon, not to be expressed, and only to be felt, in full force, in the secret recesses of a woman’s heart.