Show vr vv aira i ira y g HOME STUDY COURSE S y i self education through the medium gf J i by prominent instructors e interesting 6 features 0 t of medicine by george thoma M D III plastic surgery surgery which deals PLASTIC with the repair of injuries or congenital defects in which there Is actual absence of abo normal tissues presents one of the most interesting studies of all of medicine the wonder and very apparent results make it far moro interesting and fascinating than the lees shown branches of practice and its development in the past few years makes a review of the subject alive with almost sensational conditions the subject was well developed years ago in india where the common punishment of offenders against the law by removing the ear or nose brought the surgeons skill frequently into play in the manufacture of new organs while as far back as 1597 an italian had successfully made a new nose from the tissues of the arm in modern times the germans of whom langenbeck koenig and Thier schare able examples have advanced the work remarkably plastic argery probably had its origin in the observation of the tendencies of the either partially or entirely removed from the body to heal back in place if held in apposition to the original seat such causes have often been witnessed as in the tearing off of the entire scalp leaving it attached only by email shreds which healed about a a it was originally frequently the finger tips or tips of the joae that have been accidentally put off have healed back in place while manul tells of a soldier who carried bia car in hs pocket for several hours and then had it sewed on with good rc aults upon these two classe injuries we have based the two general methods of plastic work the first la the repair of parts by tissue with flips left attached to the original site drawing their blod supply until firmly attached to the new region as the supply of tissues for a new nose from a flap from the forehead the flap Is not entirely separated from the forehead until firmly attached as a nose the second class Is the filling up of a defect with fragments of tissue absolutely separated either from the person himself or a second person or animal or by the use of foreign matter in this class we may cite the filling of gapa la bone with samuel hahnemann father ot homeopathy cartilage from calves the covering over of denuded surfaces with thin layers of skin or the patching of acoves with strands of catgut tho impression would be given that in opera tlona of class the tissues must be taken from parts amme adjacent but on the contrary the grafts or flaps may be made from any part of the body which can bo placed in apposition to the diseased area the arm may be repaired tor instance with flaps from the side or chest and the nose from tissues of the arm to Is due the credit of introducing loose fragments of aklu on i to ulcerated surfaces and be found that by scattering such fragments tho new skin grew in every direction from these islands but method of taking alie entire skin was moro painful to the patient and never so satisfactory as that of Th lersch who implants layers ot the as thin n tucy lc shaved the sharpest baor tho utility of alil method of grafting liaa inn ply demons rated in tho last few year cue of alie root remarkable of its ue was a case in which the cn lire scalp had been removed by a wo mans loup hair being entangled ait kome machinery such cases usually ended in doth d oth from the various corn which ault modern skin grafting nn injury baa been millred la two aba urn for tho method in largo denuded and ulcerated surfaces especially those following burns are w numerous an hardly to ba the usually adopted 19 td take the grafts from the healthy parta of the patient or gome or un hired tor hint purpose though it lias recently been demonstrated tb jbf skin tram a dead body wiloh baa pui artor pr tram a aw ly amputated member eniy bo itis it is known that the antt naty tie taken faoro n uw on a white man or alie reverse fop ali skin lilay z 1 turns white very promptly or the white skin placed on a turns brown this Is dye according to karg to the fact that the color pigments lie ii the deeper parts of the skin than ere removed in the method aside from the grafting of human the skin of lower animals may be used iu one case in which the skin of a frog had been transplanted to man the green pigment disappeared in ten days and the new area could not be told from the human culls akin to skin grafting Is the art of transplanting the mucous membranes for which we are indebted to wolfer by this procedure the linings of the mouth and eyelid have been repaired when injured the conjunctive of a rabbit has been used in closing a gap of the human eyelid in practically all oatho tissue s of the body repaid by plastic methods has been attained nerves have been split and stretched out to make up deficiencies while new pieces of nerve have often been inserted gluck has succeeded in filling out a separated human nerve with the nerve of a rabbit bone defects can be remedied by covering the lum the membrane investing bones and containing the bonfe forming cells with chips of bone or tone fragments which have been softened and deprived of their lime salts by the use of acids while mace win has been repaired with pieces of cartilage from young animals even defects of the eye have been repaired with eye tissues from animals and only in the reproduction of muscle fibers have we been entirely thwarted while it is true that muscles can be reunited when severed or can be repaired by muscles from the dog when there Is loss of tissue we know that the muscle fibers do not amalgamate but that connective or scar tissues take their places in bone work a great deal has been done As an experiment the phalanx finger bone was grafted into the skull with absolute success gluck filled in a bone cavity with pegs of ivory about which the new bone tissues grew en and firmly Im bedding the foreign matter and making it a part of the skull then senn introduced de calcified bone plates which gave very satisfactory results it was noted however that unless the greatest care waa in antisepsis these fragments did not grow in their place but separated as foreign or extraneous matter in a case where there was a marked detect on oneff the two bones of the lower leg icahn grafted the defected bone into one thereby making a single forked bone instead of the kwoi aba results acro gratifying although tile rotary power of the leg was impeded where plastic surgery haa done its greatest work however Is in the rectification fi of defects of tho face of these harelip cleft palate sunken or defective large or defective ears averted lips or eyelids or the tissues removed with facial humors may be rectified the unsightly deformity of harelip together with the defects of apeci common to it gives way readily to tl burgeons knife when one realizes that this cleft often extends not only through the lip but up through the eye to tho forehead involving tho bone as well as the softer tissues the importance of the operation Is increased defects of the eyelid are filled in with flaps from the cheek or side of the pose while the great gaps left in the lips after removing cancers of those organs are supplied by the tissues of the cheek and chin tho results of severe atoma titis inflammation of the mouth which may cause the destruction of most of the tissues 0 abo tace in infants bo rectified by flaps of healthy tissue the most interesting work however is on the nose has made up for the absence of the noso by transplanting an index finger together with the bone thus giving the artificial organ new support while used gold platea for this support ml kulacz uses alro covered with india rubber and was successful with amber after this foundation is placed the soft is supplied by u flap from tho forehead small tubes being placed to keep alie nostrils open As an improvement on the rather flat noso that this produces under grafts to the tip the soft parts of the little toe it is remarkable what satisfactory results are obtained by this method the on the car has not beau as gratifying as lad been expected for cars made from new als bucs have not been inucci more alinn masses of flesh and have not contributed very materially either to the appearance or in aiding the hoar ing however largo cars have been improved by the removal of V shaped pieces and stiff protruding ears lave been mado much less unsightly by tho removal of part of the cartilage theao cases in which there la no opening of the canal yield readily to treatment the operation of making n new tympanic membrane or eardrum has recently been brought into by an operation of the kind upon miss in many uch is a brief survey of the work that Is now belne done in th flold of plastic surgery the review Is not full for the number 0 operations possible is lealoa and each operation is subject to ninny variations to suit various conditions the operator lo 10 plastic surgery must always be guided ly the nature of the injury and the materials for repair at ha command it Is thai as abo arost exception of iho baalu ann r boea transplanted from to giuin ath functional aba tins mar eliav a wonderful future ath ns vet by oven ita niest followers fol Sowers IKC by lewla D t B interesting features i y J af medicine t 0 by george thoma palmer M D 0 i I 1 o s i c IV the germs of diseases the past decade the DURING ideas regarding the causes or the etiology of diseases have been entirely revolutionized formerly diseases were charged by our predecessors to innumerable vague sources to wind storm heat cold dryness moisture to inflammation to humors to skin affections driven in and to causes so intangible and so remote as to make the logical hesitate before accepting the teachings today along most lines and in most we have a fairly alvo idea of etiology and in many cases we are able absolutely to point out and demonstrate an actual specific cause in the characteristic disease germ the seed front which the disease process springs we know that consumption is the fruit of the tubercle bacillus and that pneumonia arises from the nov how do thase wo know that consumption Is the fruit cholera germs magnified eight hundred times of the tubercle bacillus because in every case of consumption tubercle ba callus la found because tubercle bacilli are only found in such conditions because the disease cab be caused by the artificial introduction of these germs into animals if we find the same germ in every case of a disease and it we can cause the disease by the artificial introduction of the germ we are comparatively certain that wo have discovered the characteristic germ of the disease the bacteriologist studies these little animals if such we may call them under the field of his microscope and learna their physical characteristics and habits and thereby Is able to recognize them when he comes in contact them at other times the physical characteristics are shown in various forms in which bacteria are found there are the elongated rod shaped germs called bacilli to which the germs of typhoid fever and tuberculosis belong there are the round or spherical germs known as of which class the germs of erysipelas and ordinary pus infection are types there are the curved or B shaped germs like those of a re lapsing fever known as to abeso classes may be added the plasmodia which invade the blood cells and are the cause of malaria aside from these forma some of the bacteria are provided wath processes known as flagella which aid them in moving about like the tall of a fish and under the high power microscope may sometimes be seen a whitish spot on the center of the germ chichis chIs the spore or egg the habits of the different bacteria are as characteristic 63 their forms some go in chains many arrayed in perfect regular lines some in clusters like a bunch of grapes while others are in pairs so close together that their surfaces are flattened one against the other making them look like a breakfast roll still others are found isolated and alone some of these germs grow beat in tho presence of fresh air and these are called bacteria while others which cannot grow in the presence of oxygen are called some are cultivated best on the surface of a cut irish potato others grow best in beef bouillon made to the consistency of jelly others thrive best on afaf agar a bort of ge eca inosa while others anre known to in blood scrum the growth upon cheso culture media very materially according to tho germs which produce them one may appear thick nud white another i blue another lemon polor another rod another orange 1 the value of bacteriology may bo estimated when it Is known that the physician who bag seen the patient him carefully considered every detail of the casu and has every change under ht observation places dependence upon tho of alic bacteriologist who aos never seen the case never read the history and probably knows very about the dlag noels or the treatment 0 the disease iffla well to impress upon the casual reader however that while he ta the key to the condition tiie germ Is not the disease the germ ot diphtheria Is often found ln the mouth of a healthy child the disease consists of the germ attacking tissues which are so reduced that they are not able overcome alic germ life bacteria are either the lowest form of animal life or the highest form of vegetable life there Is some doubt as to their place in cither th e animal or vegetable kingdom in size they are remarkably email and conn has endeavored deavo red to make their size clear to us by saying that the germ compares to a man as a crali of sand does to mont blanc has carefully and conscientiously estimated hc a germ his conclusion Is that the average weight of a germ Is one ten thousand millionth part of a milligram it must not be supposed that all bacteria are harmful to life for it as only the so called pathogenic bacteria that are productive of disease of the nonpathogenic there are hundreds which we take with our food which we breathe in the air and with which we come in contact every hour of our lives in fot many of our foods de pend upon bacterial action to become fit for consumption vinegar Is the result of germ life as are the curdling of milk to make cheese the ripening of cheese the raising of bread and so on but in the consideration of germs of diseases these do not have a place the diseases which we are certain are duo to germ life are many and yet there are a great many which we cannot determine accurately until our technique Is improved and our knowl edge widened we know that bolls and abscesses are caused by the pus cocci one experimenter peri menter having secured some pu from a boil rubbed it vigorously upon his forearm with abo result of baua ing a lumir of email bolls to appear in that regain erysipelas la caused by practically the same germs which confine themselves to invading the deeper layers of the skin lockjaw or tetanus Is a germ disease the bacillus being found in certain garden earth and being most commonly introduced by maans of a rusty and dirty nail the tubercle bacillus discovered by foch no only causes consumption I 1 tuberculosis of the but Is the cause of scrofula tuberculosis of the glands of the neck and of tuberculosis j of the skin or lupus glanders Is a germ disease which Is occasionally acquired by man from the lower aut mals asiatic cholera and leprosy are both conditions in which the characteristic te bacteria have been discovered and carefully described walli in diphtheria the discovery of the germ has led to the production of a cure which Is the most satisfactory the world has ever known antitoxin it la to be remarked that diphtheria antitoxin la the product of the germs of diphtheria it Is well known that typhoid ever Is usually caused by drinking water containing the typhoid bacilli and an interesting case la cited in which in a certain |