For about twelve months he remained without a nose, when he had a new one put on by a man of the brickmaker caste, near Poonah. This operation is not uncommon in India, and has been practiced from time immemorial. Two of the medical gentlemen, Mr. Thomas Cruso, and Mr. James Trindlay, of the Bombay Presidency, have seen it performed as follows: A thin plate of wax is fitted to the stump of the nose, so as to make a nose of a good appearance. It is then flattened and laid on the forehead. A line is drawn around the wax, and the operator then dissects off as much skin as it covered, leaving undivided a small slip between the eyes. This slip preserves the circulation till an union has taken place between the new and old parts. The cicatrix of the stump of the nose is next pared off, and immediately behind this raw part an incision is made along the upper lip. The skin is now brought down from the forehead, and being twisted half around, its edge is inserted into this incision, so that a nose is formed with a double hold above, and with its alæ and septum below fixed in the incision. A little terra japonica is softened with water, and being spread on slips of cloth, five or six of these are placed over each other to secure the joining. No other dressing but this cement is used for four days. It is then removed, and cloths dipped in ghee (a kind of butter) are applied. The connecting slips of skin are divided about the twenty-fifth day, when a little more dissection is necessary to improve the appearance of the new nose. For five or six days after the operation the patient is made to lie on his back; and on the tenth day bits of soft cloth are put into the nostrils to keep them sufficiently open. This operation is very generally successful. The artificial nose is secure, and looks nearly as well as the natural one; nor is the scar on the forehead very observable after a length of time."
J. C. Carpue of London was the first surgeon to make use of this information and, in 1814 and again in 1815, he successfully performed rhinoplasty by the Indian method. Since that time the operation has been performed many times and numerous modifications of the original method have been tried.
Bünger in Marburg in 1823 was successful in making a new nose with a free flap of skin from the patient's thigh, thus being the first European surgeon to carry out successfully the old Indian method. Graefe did not succeed with his attempts at rhinoplasty with free flaps, and Walther, Dieffenbach and Wertzer were scarcely more successful. In spite of discouraging results, these and other surgeons continued to experiment in rhinoplastic and other plastic operations, with varying success.
Rhinoplasty by gliding lateral facial flaps over the defect is called the French method, although for the fundamental principle we are indebted to Celsus. The utilization of it in all sorts of plastic work is invaluable. It was developed by Larrey, Dieffenbach, Bouisson, Baudens, Burow, Mütter, Szymanowski, and others.
Dieffenbach, in his work and by his writings, gave a tremendous
