Thursday, May 25, 2017

A SHORT HISTORY OF NOSE SURGERY FROM EGYPT TO THE OLD WEST





THE DOCTOR'S BAG

the blog about the medicine and surgery of yesteryear

Keith Souter aka Clay More







You may think that Plastic Surgery only started in the twentieth century. Well, it is true that it advanced dramatically, but its origins go back to antiquity and surgeons over the centuries gradually pushed back its frontiers.

Ancient Egypt
The Ebers papyrus, which was reputedly written by a physician called Hesy-Ra in about 1550 BC, contains 110 pages about diseases and treatments known to the Egyptians.

 The Ebers papyrus

It contains methods for removing wrinkles and correcting squints.

Ancient India
In 600BC the Indian surgeon Sushruta wrote his book the Samhita, which describes the operation of nasal reconstruction, using the 'forehead method.'

Sushruta - father of plastic surgery

Cutting off the nose  was the official punishment for adultery and other transgressions and crimes. It was because of this that Indian surgeons developed the technique.


The forehead method of nasal reconstruction

In Susruta's operation a flap of skin from the forehead was made and brought down to cover the deficit. Nostril tubes were left in place until the skin flap healed.

He also described a method of repairing torn ears by rotating a cheek flap of skin.

The first actual rhinoplasty
In Italy in the early 15th century Antonio Branca developed the first real nasal reconstruction rhinoplasty). The method was described in a book by Heinrich von Pfolspeundt, 'Buch der Bundth-Ertznei,' published in 1460.

He used several stages:

1) A model of the nose was constructed from parchment of leather.

2) This model is laid on the forearm and a line drawn around it.

3) The marked area is then cut and separated from the underlying tissues in such a way that the bottom of the nose flap remains attached to the arm.

4) The arm is raised to the head with the nose flap positioned on the face and is then stitched in place.

5) The arm is bound to the head .

6) After 8-10 days when the skin has healed to the defect, the lower part of the skin flap is cut, freeing the arm and allowing for the reconstruction of the nostrils.

Although Antonio Branca had developed it, in the 15th century, it was not until Gasparo Tagliacozzi published his book De Curatorum Chirurgia in 1583 that the method was picked up and used by surgeons throughout Europe.  The reason for the operations were mainly injury, but also the ravages of diseases like syphilis or cancers.

The Old West
We come now to Tombstone and my surgical hero,  Dr George Goodyear, thee renowned 'physician to the gunfighters.' One of his best friends was George Whitwell Parsons, a licensed attorney who kept a diary from 1869 until 1929. It gives a detailed picture of life during the Earp era.

George Whitwell Parsons

On June 22, 1885 a fire erupted at the Arcade Saloon, which spread until half of Tombstone's business district was on fire. Fortunately no-one lost their life in the blaze, but George Parsons was badly injured. While trying to fight the fire he was on a balcony that collapsed when the beams fell. He sustained injury to his head, nose and jaw.

Over a period of several months Dr George Goodfellow performed a series of innovative operations to rebuilt his smashed nose.

He describes it himself in his diary:

"I was knocked senseless by a dislodged beam and a large splinter had entered just under the skin glancing upward and just missing the eye, face quite flattened and nose all over it. Dr Goodfellow made a plaster cast, cut away the deformity in the cast and then cut my nose loose from the bone and tacked it up in place so that the case, with the aide of a wire run through my nose, held it in place. I eventually recovered emerging with a fine Roman nose, free from disfigurement."

Dr George Emory Goodfellow

Dr George Goodfellow was a truly pioneering surgeon. Throughout his career he established a reputation as the foremost expert on gunshot wounds, as well as being the first surgeon to perform a perineal prostatectomy (he actually performed 78  prostatectomies and compiled statistics about them), along with other 'first' operations. His work on George Parson's nose fits in there.

He wrote and published many medical papers in the journals of the day. His work on the impenetrability of silk would lead to the actual bulletproof vests of the future.

It probably took a special sort of man to be a physician-surgeon in the Old West. Goodfellow seems to have been a very complex man. Apart from being a doctor, he was a scientist, geologist, rancher and gambler. He was pugnacious, short- tempered, but also exceedingly kind. He also had a wry western sense of humour, as evidenced by his autopsy report on a gambler who was shot during a card game. He reported that he had 'done the necessary assessment and found the body so full of lead, but too badly punctured to hold whiskey.'

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THE DOCTOR'S BAG - MEDICINE AND SURGERY OF YESTERYEAR has been published by Sundown Press, available in ebook or paperback.


Clay More's novel about Dr George Goodfellow is published in the West of the Big River series by Western Fictioneers. 



8 comments:

  1. What's really incredible about that is the lack or not-so-effective anesthetic!

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  2. Indeed, Jacquie. A testament to the efficacy of wine and opium. But apart from the aesthetics of covering a hole in the face, having a nose of any shape would reduce respiratory infections of all sorts.

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  3. Fascinating story as always Keith!

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  4. Thanks, JES! Doc Goidfellow was one of those larger than life characters. There are so many wonderful tales about him.

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  5. Keith, I've been so amazed by the innovative, unique, and complex solutions medical practitioners came up as far back an ancient times. The approaches they used, I believe, revealed such a deep commitment to healing no matter what the challenge. Fascinating backgrounder. Thanks.

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  6. As usual you have given some wonderful and to me, exciting information. Thank you. Doris

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  7. Thanks, Tom. The physician treats, but nature cures. The body always tries to deal with disease - and treatment!

    You are right, though. Practitioners have been ingenious over the centuries.

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  8. Thanks, Doris. I am pleased that you find these little posts of some use.

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