FURTHER DESCRIPTION OF TISSUES DESTROYED.

347

soft tissues of the posterior nares. The muscles of the upper lip and face that are partially destroyed are the orbicularis oris levator, labii superioris alaque nasi, and on the left side a part of the zygomatic and levator anguli oris. It should be remembered that the sketch given reverses the side of the face.

"On looking inward and downward, the parts presented

a deep, large cavity; the motions of the uvula could be seen by looking into the nose, and the tongue closed the opening through the palatine bones. Of course, speech and deglutition would have been impossible, had not the patient continually kept a large piece of raw cotton in this opening. The lower lip had also begun to suffer the ravages of the fearful disease, but it was arrested at this period, and this lip presented an enlarged appearance, from the healing of a large granulated surface.

348 MANNER OF MAKING AND ATTACHING THE NOSE.

"The first step in the process of making a mechanical contrivance to hide this hideous deformity was, to make a cast in plaster of the anterior portion of the face, and another of the mouth. A gold plate was then made, fitting the roof of the mouth; and upon this were inserted all the teeth that were deficient, and this plate was clasped to the remaining molar teeth. A model of an artificial nose and upper lip was then made, as near the natural form as possible. A cast of this model was filled with hard rubber, which was then vulcanized. A gold bar was attached to the inside of the artificial nose, which was made more firm by a cross-bar. The opening through the palatine bones gave an opportunity to secure the nose to the plate; this was done by attaching a short tube to the plate and passing the bar through it. The plate was then placed in the mouth, the nose was attached to the face, and the bar was passed through the tube, which held it firmly in position. The stiff, unnatural appearance of the upper lip was hidden by a heavy artificial mustache. The connection between the artificial and natural nose was concealed by the bow of a pair of spectacles. The artificial nose was then given a lifelike color, and the illusion was complete.

"This appliance so fully answered the purpose that the wearer had, at subsequent times since its introduction, assured him that it was perfectly priceless, and that he felt, if possible, like a new man."

ARTIFICIAL NOSE, LIP, AND DENTURE.-Dr. William M. Herriott made an appliance for a wounded soldier, which he describes in "The Dental Cosmos" as follows:

"Corporal Andros Guille, Company K, 97th Regiment Ohio Volunteer Infantry, aged thirty-two years, was wounded November 25, 1863, at the battle of Mission Ridge, by a fragment of shell, which carried away the entire nose to the turbinated bones, and the upper lip, with anterior portion of the alveolar process of the superior maxilla, from the right

DR. HERRIOTT'S CASE OF A WOUNDED SOLDIER.

349

to the last two molar teeth on left. He received also other injury at the same time.

"On or about the following dates, February 11th, February 27th, and April 1st, all in 1864, three surgical operations were performed by or under the direction of William Otterson, M. D., then a brigade surgeon having in charge the hospitals at Nashville, the object being to restore the parts lost;

but the first was a failure because erysipelas set in, the others on account of sloughing and muscular tension. It was then acknowledged that surgery could not be used to better the condition of the patient, and he was left as seen in Fig. 233.

"In September, 1864, I constructed the artificial appliance which is shown in Fig. 234, in the following manner: I first took an impression of the upper part of the mouth, extending it up as far as possible in front, and from this I

350

APPEARANCE WITH ARTIFICIAL NOSE AND LIP.

secured a model upon which I formed a structure to take the place of the destroyed hard parts and to act as a base for the teeth. This accomplished, I laid the patient on his back, and, having closed the nasal orifices with cotton, I tookusing very soft plaster-an accurate impression of all the parts which the nose and lip were to rest upon; and, procuring a model from this, I built upon it plaster, from which I

carved the form of a nose and lip. This I used to vulcanize a nose and lip upon, which are in one piece, covering the lip with an artificial mustache, which extends so as to hide the joint of the artificial lip with the adjacent parts, and securing the piece up and back at the top with a pair of spectacles, and back at the lower part of the nose to the artificial denture, with a gum ligature. The appliance was complete, and has been worn continually since."

DR. WILDMAN'S CASE OF NOSE AND OBTURATOR.

351

ARTIFICIAL NOSE AND OBTURATOR.-The following description of an appliance made by Professor Wildman is taken from Garretson's "Treatise on Oral Surgery":

Fig. 235 will convey an idea of the external appearance of the patient, but not fully, as the whole upper lip was cicatrized, and the left cheek depressed near the border of the cavity.

FIG. 235.

"In May, 1863, a young man," says Dr. Wildman, "aged twenty-six years, presented himself for the purpose of having an appliance made to repair a loss sustained by disease. Upon removing the black patch which he wore upon his face, and the cotton with which the cavity was filled (without the latter he could not articulate a word), I found that the entire external nose was gone; that the nasal bones, the nasal processes of the superior maxillary, also a large portion of their palatine processes, the approximal parts of the