My experience with the injection has been limited to six cases of facial deformity, and it is in the technique of this use of the substance to which I wish to direct attention.

In the correction of the nasal deformity known as saddle-nose, in which there is quite a sinking in of the bridge, paraffine prosthesis seems especially adapted. Even a slight distortion of the nose, due either to disease or trauma, mars one's appearance very much, and if one can correct this deformity by so slight an operation as the injection of a few cubic centimeters of paraffine, quite an advance has been made in this branch of surgery.

The technique of the operation is not so simple as it at first seems, and considerable attention must be given to minor details in order to secure satisfactory results.

The selection of a paraffine with the proper melting point is essential. As ordinarily found in the shops the melting point is considerably above that required for prosthesis. Naturally, the melting point must be higher than the bodily temperature, else it would not solidify within the body. Gersuny recommended a melting point of 38°C. to 40°C. (100.4° to 104° F.). The higher the melting point the more difficulty will be experienced in the injection, as the substance quickly solidifies in the syringe and needle. Gersuny used an ordinary glass barrel antitoxine syringe, and with this instrument a higher melting point cannot be used. By means of a specially devised syringe which I now use I find a paraffine with a melting point of 43° to 45° C. (109.4° to 113° F.) the most satisfactory.

TECHNIQUE.

A quantity of paraffine is first sterilized by boiling for a few moments. The bulb of a thermometer is quickly dipped in the mass and a thin coating of the paraffine adheres to the bulb. The thermometer is now placed in a water bath and heat gently applied till the paraffine separates from the bulb and rises to the surface of the water. The thermometer will indicate the exact melting point of the mass. If the melting point is too high, as it will be in most cases, liquid paraffine or ordinary vaseline may be added till the proper melting point is obtained. In using the ordinary glass barrel antitoxine syringe I found difficulty in using a paraffine with

a melting point above 38° C. (100° F.), as it solidified so quickly in the needle. By means of this syringe, which I have had made by Max Wocher & Son, a paraffine of a much higher melting point can be easily used.

The syringe is a solid metal one, and capable of thorough sterilization. It works with a screw action, and is so constructed that the plunger does not turn in the barrel, thus reducing the friction to a minimum. It will not get out of order, is very powerful, and forces the paraffine through

the needle in the form of a fine thread. The melted paraffine is drawn up into the syringe and allowed to cool. Before using it is placed in a pan of warm water, not hot, for a few moments till the contained paraffine has the consistency of soft wax (Fig. 1).

The site of the operation is first sterilized as for any other operation. The loose skin over the depressed area is caught up between the thumb and finger the same as for an ordinary hypodermic injection. The needle is passed under the skin and carried a little beyond the depression. As the needle is withdrawn, the paraffine is slowly forced out in the form of a fine thread. An assistant makes pressure upon the sides of the nose to prevent the paraffine from passing into the surrounding tissues, and at the same time with the other hand moulds the paraffine into the required shape. shape. The whole proceeding occupies but a few moments. The site of puncture is sealed with collodion and cloths wrung out of ice-water applied to cause the paraffine to quickly set and retain the form given to it. Care must be taken not to inject too large a quantity at one time, as it cannot be easily recovered. If too little is injected a second or third injection can be resorted to. An anesthetic is not absolutely essential, but is desirable, as considerable pain accompanies the injection,

paraffine had passed into the loose areolar tissue at this point. The eye was swollen and edematous for a week, but it passed off under the use of ice applications and no unfavorable results followed. At the tip of the nose, where the connective tissue and skin are closely united to the underlying cartilage, the injection is more difficult. Fortunately, this region is not often the seat of deformity.

In the six case reports in which I have used this method the results have been quite satisfactory, both to myself and the

affine can be felt as a firm, bony-like mass beneath the skin, which in time becomes encapsulated, and if there is any shrinking it is very slow, and from the experiments of Prof. Meyer seems to be by oxidation rather than by absorption.

CASE REPORTS.

Case I.-Maud F., aged twenty-two, has a very prominent deformity. In addition to a sinking-in of the bridge of the nose, the left cheek and left alæ cartilage have been partially destroyed by some dis

and swollen. At the inner canthus of the left eye a portion of the paraffine could be felt. The eye was much swollen and edematous, and it looked like the tear-duct was going to be involved. Cold applications were made, and in a few days all unfavorable symptoms disappeared. Two weeks later, under Schleich solution, a second injection of 1 c.c. was made beneath a deep scar extending across the lower portion of the nose. There was little or no reaction following this injection. The following day the paraffine

(104° F.) was injected beneath the loose skin covering the depression. Very little reaction followed this case, and you could not tell by looking at the case that any nasal deformity had existed.

Case III.-Mary T., aged twentythree, has had a sinking of the bridge of the nose since childhood. The space between the eyes is unusually wide. There is no disease of the inner portion of the nose to account for the depression. Under Schleich solution anesthesia, 5 c.c. of paraffine with a melting point of 43° C. (109.4° F.) was

pearance. To the patient the result is very satisfactory.

Case IV.-Mary O., aged fifty-one, is almost totally blind from an old trachoma, in which the cartilage of the upper lids has been almost entirely destroyed. From the loss of the tarsal cartilages both lids roll in and the constant scratching of the inverted cilia has produced a pannus of both cornea. She has been operated upon several times for a blepharophimosis, or narrowing of the palpebral opening. A canthoplasty was done by dividing the

The pannus has entirely disappeared, and the woman is able to attend to her household duties. Before the operation she had to be led about and spent most of her time in a dark room. She now goes about the street alone, and is anxious for a similar operation upon the other eye. Of course, the canthoplasty has something to do with the favorable result in this case, yet I think the small amount of paraffine injected in the margin of the lid is helping to support the lid and helping to keep it from curling inwards.

He states that five years ago he had nasal catarrh, and at that time several pieces of bone came away from the inner portion of his nose. Soon after the last large piece of bone came out he noticed that there was a gradual sinking in of the bridge about half an inch back of the tip of the nose. This sinking in continued for about a year, and finally left the nose in a very deformed condition, so much so as to attract marked attention when in public.

An examination showed that the whole