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Über die operative Verkleinerung einer Nase (Rhinomiosis) (pp.882-885, 5 Abb.).
. BKW, 35/40. - Berlin, August Hirschwald, 1898, 4°, pp.877-896, Brosch.. Erstdruck! - "1898 fürhte Jacques Joseph (1865-1934) in eigener Praxis die erste Nasenverkleinerung über einen äußeren Zugang aus" - - "Joseph's rhinoplasty, developed independently of Roe and Weir." - "It is a fascinating experience to read the report of the first rhinoplasty operation by a man who eventually became one of the world's foremost plastic surgeons and who developed the classic rhinoplasty methods. The fascination of this paper is even greater for me because of my personal contact with Joseph and because, after practicing plastic surgery for almost half a century, I still find Joseph's classic methods unsurpassed. - Joseph began originally as an orthopedic surgeon, but soon he became involved with the reduction of large, protruding ears. Apparently the rumor of this successful operation spread around, and one day a male patient appeared in his office, asking to have his unshapely large nose reduced. - Joseph describes the psychologic effect of the conspicuous nose and makes the fundamental observation that the rhinoplasty was performed to make the patient inconspicuous. After the operation he noted that the patient "is happy to move around unnoticed." Even today, 70 years later, one often hears the erroneous remark that rhinoplasty is an operation for vanity's sake. That is not true. Vanity is the desire to excel. The average rhinoplasty patient wishes to be relieved of a real or imagined conspicuousness of his nose. - Joseph used the name "Rhinomiosis" for the operation. He liked to coin technical terms, usually Greek and Latin (e.g. "Rhinoneoplastik" for nasal reconstruction, "Melomioplastik" for a face lift, or "Metopo-mioplastik" for wrinkles and frowns of the forehead). - The day before the operation, Joseph tried it on a cadaver. He was extremely thorough, and his analytical approach manifested itself in the exact nose measurements, made before and after operation. I always admired this exactness when he fashioned a skin flap. He would measure the defect and flap from every angle, and carefully study the effect of turning the pedicle. The flap fitted perfectly; it never had to be stretched to make up for shortage. His sense of form was that of an artist. I have never seen a better total nasal reconstruction, whether from the forehead or arm, than Joseph's. - Joseph had an ingenious and constructive mind and devised many instruments, some of them obsolete today. It was bewildering for a young surgeon to see that he had a special instrument for practically every step of a rhinoplasty. It almost seemed that one only had to have all those instruments and the operation was easy. He also devised, for "aseptic" suturing, a horseshoe-shaped double-pronged forceps. It was to thread the suture material without touching either the needle or the thread. He gave this method the fancy name "Apodactyle suture" (fingerless suture). This was to prevent stitch infections. Joseph did not use gloves, only three rubber fingers on each hand. He considered the sense of touch important in endonasal plastic work. - He did not wear cap or mask. Nevertheless, he observed accurate aseptic technique and had few complications. This was due to his extreme care and gentleness in handling tissues; he called it "biologic sense." - Joseph amassed a vast experience which he crystallized into definite methods. No operative step was ever haphazard, nor without careful consideration. One could sense his concentration during an operation, saying many times "it can be done this way or that way." He often uttered the word "so," when he accomplished a step. - Joseph has been accused of being secretive about his methods. To a certain extent this was true. On the other hand, one must realize that there was sharp rivalry at that time among some of his colleagues in Germany who jealously observed Joseph's meteoric rise in this new specialty. They were eager both to learn and to appropriate his methods under their own names. Some of the general surgeons thought that rhinoplasty was a very simple operation, and that was the reason Joseph was reluctant to show it. It was said that Prof. Axhausen, one of Germany's leading plastic surgeons, asked and received permission to observe Joseph's operation. He admitted afterward that while rhinoplasty was surgically simple it took Joseph's special talent to perform it successfully. - Joseph gave some courses to foreigners (mostly Americans) after World War I-for which he charged a considerable fee. These consisted of observing (without questions in the operating room) his operations. He also gave a few courses in the Anatomical Institute on well-dissected specimens. In the beginning I had to pay him also, but only a nominal fee (coming from a poor European country). After a couple of months he relinquished my tuition, which was a great favor. At that time it was customary to pay for knowledge and experience. - Joseph did not lose much time in reporting his first rhinoplasty. Within about three months after doing it he presented this, his only case, before the Medical Society of Berlin. Priority was (and apparently always will be) an important ambition of surgeons. It must have been a shock and disappointment when Joseph learned that his rhinoplasty was not the first one. Nevertheless, without doubt, it was his original operation. It is touching, and characteristic of his reasoning, that he insisted that in certain respects his operation was the first one, just the same. With exacting mind he took apart Weir's operation, step by step, and compared it with his own. Finally he came to the conclusion that the only similarities between the two operations were that they both were done to relieve the psychologic effect of a large, conspicuous nose-and that both noses were radically reduced in size (rhinomiosis totalis). Otherwise his surgical method was entirely different, he claimed, and he achieved a better result with a single operation than Weir did with four. Therefore, Joseph felt that his priority claim was valid. - Peculiarly, both patients were men. - I am sure that if Joseph read this paper 20 to 25 years later, he must have smiled. Compared with later refinements, this first operation (which he so jealously defended) was primitive and crude. Nevertheless, from an historical point of view, it clearly sjnows the characteristics and the germs of the genius-who became the world's unchallenged father of modern rhinoplastic surgery." Gustave Aufricht, Frank MacDowell, Source book of plastic surgery², p.102-104 - - Garrison & Morton No.5755.3; Natvig 4
      [Bookseller: Antiquariat für Medizin - Fritz-Dieter S]
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