Defjrmities oe the Face 
AND 
Orthopedics. 
TRFATMENT OF SPINAL CURVATURES 
With New Aluminum Shell Jackets. 
ARTIFICIAL DEVICES FOR DEFORM- 
ITIES OF THE FACE 
New Appliance for Treatment of Flat-Foot 
Also Report of Operations on Children 
Under Three Years of Age for An- 
gular Deformities of the Legs. 
BY FRANK L. R. TETAMORE, M. D. 
new York. 
, Reprints from New England Med. Journals. DEFORMITIES 
X 
/ 
OF THE 
Pace and Orthopedics. 
Treatment of Spinal Curvatures with New 
Aluminum Shell Jackets, Artificial De- 
vices for Deformities of the Face. 
New Appliances for Treating Flat Foot. 
Also Report of Operations on Children under Three 
Years of Age for Angular Deformi- 
ties of the Legs. 
BY 
FRANK L. R. TETAMORE, M. D., 
NEW YORK. 
Reprints from Medical Journals. 
Illustrated by Photo-Engravings, 
Cor. Broadway and Madison St., 
BROOKLYN, N. Y, 
i8b4t 7'he Engravings in thi2 painpUet were made by 
THE GILL ENGRAVING CO. 
104 Cham be as Stkeei, 
NEW YORK. DEFORMITIES OF THE FACE. 
Report of Plastic Operations and also Mechanical 
Appliances for Covering Disfigurements. 
By Frank L. R. Tetamore, M. D. 
NEW YORK. 
There is no class of deformed persons more sus- 
ceptible to the gaze of the general public than those 
who have disfigured and deformed faces, and as a 
rule they are very sensitive. Surgeons have tried 
plastic operations, such as grafting tissues from dif- 
ferent parts of the face, from the arms, and also from 
lower animals. 
Parts of fingers have been grafted on to form a 
bridge for the nose. Many of these operations have 
been reported, but very few have been successful, 
often increasing the disfigurement. 
It is my purpose to present a few cases to show 
where operations will be of benefit and also to show 
that it is far better to provide artificial pieces to 
cover the disfigurement than to attempt any plastic 
operations when the results would be doubtful, as 
there are ten failures to one successful case. 
The first two cases reported, plastic operations 
were done and the results were satisfactory; so 
much improvement was made in the appearance of 
the patient that the operations were warranted. 
I have tried grafting of soft and hard tissues from 
the lower animals and in no case were any satis- 
factory results obtained. I have classed them as 
useless operations. The tissues from the lower 
animals will not unite with human tissues and never 
have done so, reports having been made to the con- 
trary. 
When only a part of the nose has been destroyed 
the work of the surgeon becomes of great benefit, 
but when the supports to the soft tissues are des- 
troyed, some artificial work must be provided. 
Case I, Fig. i. Miss L. M., age 22 years.—The 
bridge of the nose was destroyed by disease in early 
childhood, leaving the disfigurement as shown in the 
engraving. A sinus admitting of a small lead pen- cil led into the nasal cavity. The history was hered- 
itary. Two operations were performed. The 
bones remaining' of the bridge and portions of the 
adjoining bone on each side were partially separa- 
ted and elevated about of an inch and held in 
position by sutures and steel spring fastened from 
the back and extending over the top of the head; 
this was secured by bandages. A fine silver wire 
was secured to the raised bones then fastened to 
the spring so as to hold them in place. Enough soft 
tissue was brought from the sides and from above 
to cover the bones. About four weeks after the first 
operation a large flap was turned down from the 
forehead; the tissue previously drawn over the raised 
bone having united, healed and formed a good sur- 
face. New bone had also formed, uniting the ele- 
vated portions to the main bones. The flap was su- 
tured to the freshly denuded surface; the pedicle was 
cut two weeks later, the whole thing healing by first 
intention. The space on the forehead, where the flap 
was cut was drawn together, the tissues covering 
the forehead being very full and easily brought to- 
gether by sutures. Strict antiseptic precautions 
were taken. The slight disfigurement which re- 
mains being hardly noticeable. Fig 2. 
Case II Solution of Pepsin for Treating Lupus — 
The whole of the nose involved, but no other part 
of the face ; had suffered constant pain for several 
years. At the first operation the diseased tissues 
were removed with the knife, followed by several 
applications of acid and pepsin solution. Formul 1 
Acid Hydrochloric 16m water 3 oz. 
This was applied fr ely and followed fifteen min 
utes later by Pepsin solution 20 gr. water 3 oz The 
disease was arrested at once and cured in three 
weeks. The second operation: Large flaps were 
taken from each cheek to cover the parts. I hese 
flaps united by first intention. A third operation 
was necessary to give the nose the proper form 
I his also was successful. In this case the cartilage 
ami bones were not destroyed, thus leaving a frame 
work to build on. 
Case III. Merchant of New York, years. 
Nose destroyed by disease of specific character. He FIG. II. 
FIG. I. 
had been operated upon at least ten times; first for 
removing the diseased parts and then for restoring 
the shape of the organ At the last operation a plat- 
inum plate was inserted to form abridge; this was fas- 
tened to the bones on each side, but the tissues could 
not be made to cover it thus defeating the object 
sought by the surgeon. The operations increased 
the disfigurement. 1 advised removal of the metal, 
also advising the wearing of an artificial piece. This 
was done. An artificial nose was made of a light, 
plastic material, which he has worn with great com- 
fort. He says that strangers do not notice the arti- 
ficial nose, and in fact persons have stood talking 
to him and not noticed the mechanical work. He 
has one which he wears during the day and one for 
evenings. This is done because of the color, which 
shows light jr with artificial light, the evening piece 
being painted darker. The nose was secured in 
place by spectacles. 
Case IV, fig. 3.—Dr. H. A., prominent physi- 
cian, nose entirely destroyed by a disease of a 
cancerous nature. He was operated upon several 
times in Chicago and in New York. A large flap 
had been taken from the forehead (leaving an un- 
sightly scar) and brought over the opening, the ob- FIG. IV. 
FIG. III. 
FIG. VI. 
fig. v. 
ject being- to partly close it, each operation tend- 
ing to im rease the deformity. 
He came to the city and applied to me for help. 
I made an artificial nose, which he has worn with 
satisfaction, as it covered all the disfigured parts, 
except where the flap had been taken from the 
forehead. Fig. 4 
Case V. Airs. B.. Fig. 7 and 8. — Portion of 
nose destroyed, which was cured by treatment, 
she being under the care of her family physician. 
As she was unable to come to New York, I sent FIG. VIII. 
FIG. VII. 
directions for taking-a cast of the face in different 
positions. The casts were made and forwarded 
with photographs to me. I made an artificial nose 
and sent it to her. 
Case VI. Mrs E., New York City, aged 60 years.— 
Disease had destroyed all the nose and cheek. The 
diseased parts had been removed by operation at 
the New York Skin and Cancer Hospital. All the 
nose, part of the superior maxillary and the malar 
bone on the right side, together with the floor of the 
orbit, were removed. At a second operation a large 
flap was taken from the right temple, which restored 
the cheek and filled up the opening where the eye 
and floor of the orbit was removed. No attempt had been made to close the opening- caused by re- 
moving the nose. I made an artificial piece con- 
sisting of nose, cheek and eye, which she has worn 
with much satisfaction, as the unsightly disfigure- 
ment is covered up, the artificial work being hardly 
noticeable. 
FIG. X. 
FIG. IX. 
Case VII. Mr. B , Farmer, Figs. 9 and 10.— 
The nose had been completely destroyed by 
disease which had been entirely cured, the new 
tissue which formed completely closed the nasal 
opening. The appearance of his face, without a nose, made life a burden to him. I made an artifi- 
cial nose for him, as shown in the illustration, 
a mustache being- fastened to the nose piece. 
I did not advdse a plastic operation, knowing that it 
would be impossible to form a nose that would in 
any way improve his appearance. 
Case VIII, Figs. 11 and 12.—Nose sunken, as the 
bones and cartilages were all destroyed. I made an 
artificial nose with mustache attached. 
Case IX, Figs. 5 and 6.—Mrs , from western 
part of New York State. Nose completely destroyed 
by disease. No operation. Artificial nose.* 
* Tnese artificial noses are made of a very light plastic material, which 
is non-irritating. The color of the material is very near to the natural, 
thus requiring very littie coloring. They are secured on the face by bow 
spectacles made especially for the purpose. 
FIG. XII. 
FIG. XI. EXTENSIVE NECROSIS OF BONE. 
Amputation and Excision. 
Recovery. 
[Report of case about twenty months after the operation.] 
Miss , Aged 28 years, of Brooklyn, N. Y.— 
The history is as follows : Father has been 
dead several years and had suffered from dis- 
eases of a specific nature. The mother (living), 
has also had specific disease contracted from 
husband. This daughter showed symptoms 
ot disease about ten years ago. She then com- 
plained of slight pains in right knee, with some 
swelling. The family physician diagnosed rheum- 
atism and treated accordingly. The swelling of the 
knee increased and extended down to the foot, in- 
volving the whole leg and foot. About three years 
ago the left knee began to swell, but the swelling 
did not extend to the foot. At the same time the 
soft parts of the right leg were involved, ulcers 
breaking out in different places. Eighteen months 
ago the patient was put under my care for treatment, 
all the tissues of the right foot and leg were dis- 
eased, the soft parts broken down and suppurating, 
the odor very offensive; the knee joint enlarged to 
twice its normal size, hard and ankylosed. as shown 
in the engraving, Fig. 13. The left knee enlarged, 
Fig. 14, and partly ankylosed. The right shoulder 
ankylosed, with several discharging sinuses. There 
were also several ulcers on the front of neck The 
pain in all the diseased parts was very intense, the 
patient very weak and emaciated. She had been 
under the care of several physicians. 1 he first im- 
pression was that the case was hopeless. 
The right limb was amputated at the junction of 
the upper and middle third of the thigh. Chloro- 
form was used as an anaesthetic. She rallied, the 
stump wound healed very rapidly and there was no 
apparent shock. Four weeks following this opera- 
tion, the bones of the knee, two inches of the femur, 
the patella, and two inches of the tibia and head of 
the fibula were removed by excision. The inner part of 'the 'tibia, which was diseased its full length, Was 
removed with a long handled euret, leaving only 
a shell. 
The ends of the bone could not be secured to- 
gether. The leg was put up in a Bavarian plaster 
splint and suspended in a cradle hung from the ceil- 
FIGS. XIII., XIV., XV. 
ing. Carbolic acid solutions were used during the 
operation for instruments and washing, and the fol- 
lowing antiseptic powder used for dressing: 
Bismuth S. C., Iodoform 4 dr., acid salicytic, 
2 dr., M. Fig. XVI. 
Fig. XVI shows the bones as they were taken from the amputated limb. She made a good recovery, the wound healing 
entirely in eight weeks. The shoulder was thorough- 
iy'cleansed with carbolic solution and dressed with 
antiseptic powder The following was given after 
the first operation and continued about four months. 
Rad. Sarsaparilla 6 oz., Rad. Sassafras 3 oz., Senna 
1 oz. Pulv. Cinnamon Aniseed, Coriander seed, each 
Yz oz ; bruise and mix and add water, y2 gallon. '1 he 
following powder to be put in a linen bag after being 
thoroughly trituated together : Calomel J4 oz. Sugar 
4 oz., Pulv. Alum 6 oz Let stand and macerate 
twenty-four hours, boil fifteen minutes, strain when 
cold and add V\ hiskey 6 oz. Dose, wineglassful 
before meals. 
After the wound was entirely healed a cast was 
taken of the leg. A sole leather boot lined and nicely 
covered with soft leather was made over the cast. 
This was made to lace in front. The leather was 
strengthened on each side and underneath with steel 
braces. She has worn this support ever since. She 
now weighs seventy pounds more than she did be- 
fore the first operation, and her recovery from the 
disease seems to be complete. Fig. XV. 
The mercurial mixture has since been given to 
several patients suffering from the results of speci- 
fic diseases, with the best and most satisfactory re- 
sults. The Treatment of Spinal Curvature with 
Aluminum Shell Back Corsets. 
There is no class of cases presented to the geh-* 
eral practitioner which requires more careful atten- 
tion and knowledge of mechanical treatment than 
that of spinal disease and curvtaures. They are 
cases which a physician should not undertake to treat 
unless he understands the application of mechanical 
appliances and, in fact, knows how to make them. 
The successful orthopedic surgeons have their in- 
struments and appliances made under their direct 
supervision. Practical experience has demonstrated 
tnat there are several important facts in regard to 
mechanical treatment. ist. That all appliances 
must be as light as possible and must tit accuiately, 
having equal pressure on all the parts when applied. 
2d. 1 hat in curvatures of the spine no direct force 
must be used, but the pressure must be gradual. 3d. 
I hat the suspension apparatus now used for getting 
extension is the most cruel instrument that can be 
used and I doubt if there was ever any benefit de- 
rived from its use. 4th. That the plaster jacket 
now in use should become a thing of the past. It 
is heavy, uncomfortable to the patient and in many 
cases painful to wear. Appliances of any kind 
should be light. They should fit accurately, 
with even pressure. How many physicians 
have had patients come to them who have 
worn the heavy steel braces, suffering from 
the effects of uneven pressure ; sores, hard, 
tender or callous spots. We see children playing in 
the streets with these instruments of torture on, 
often loose and ill-fitting. Force should not be used 
to straighten a curved spine because it cannot be 
maintained all the time on account of the pain pro- 
duced. It causes irritation of the spinal cord and, 
in fact, causes harm in all cases. The same can be 
said of the suspension apparatus ; it is both cruel 
and harmful. How often have we seen patients 
faint and become completely exhausted while being 
suspended for the appliance of a plaster jacket. The FIGS. XXI., XXII., XXIII. 
plaster jacket is heavy ; it does not accomplish the 
purpose for which it is applied; it is uncomfortable to 
wear and causes a great deal of pain. The patient 
is suspended, the jacket applied and when the pa- 
tient is lowered the parts all go back to where they 
were, leaving a pressure on the ribs which interferes 
with respiration 
'1 he history of a case or two [I might refer to 
hundreds] will illustrate these points. 
Mr.W., a compositor, suffering from Pott's disease, 
with posterior curvature of the spine—Had been 
treated by several physicians on the plan of “Hang 
him up and put on plaster; give him phosphates and 
cod liver oil. ” The result was constant pain, ina- bility to wear the plaster jacket, inability to work 
and anxious to die to obtain relief. He came under 
my treatment. 
A cast of the back was taken; shell jacket made 
and put on. '1 he relief was almost instantaneous 
after the jacket was laced up. In three months he 
was able to go to his work and has done so over 
one year. 
A child nine months old came under my care in 
general practice. The mother informed me that it 
had cried almost incessantly since it was born. The 
physician had prescribed opiates and other remedies, 
but no relief. The spine was examined at once and 
indications of disease were found in the dorsal 
region. The parents had done the usual jouncing 
to keep the baby quiet, but the more they resorted 
to this barbarous way of quieting the child, the more 
it cried. Chloroform was administered, cast of the 
back taken and a shell back corset made and put 
on. The result was relief at once. This jacket 
was worn two years. The boy is now ten years 
old, and perfectly well. Another child one year 
old had been cross nearly all the time since birth ; 
at times it would be on its back kicking its legs and 
keeping up a constant moaning. A slight tender 
prominence was discovered on the spine at lower 
dorsal vertebrae. Chloroform was administered; 
a shell jacket made and put on. The child had re- 
lief in two or three days. The mother says she 
has no more trouble with a cross baby. 
This is evidence enough to show that a proper 
fitting and comfortable appliance will give relief at 
once and be the means of effecting a cure. 
In the treatment of all cases of antero postero 
curvatures, where there is much prominence, the 
pressure must be very light over the tender part. 
The treatment of lateral curvature is on the same 
general principle. The main object in the treat- 
ment of all spinal diseases is to put the patient in 
as natural and comfortable a position as possible 
and try and keep him so, but no force must be 
used that will aggravate the disease. 
Illustration Fig. 23 shows the position of the pa- 
tient while the cast is being taken, and this, in fact, is the most important. The diseased tissues are 
generally the bodies of the vertebrae, or cartilage, 
between the bodies. The tendency is always for 
the patient to stoop. By placing the patient face 
downward on a flat table with arms slightly ex- 
tended and chest and chin resting on a small pillow, 
the pressure on the bodies is relieved and the spinal 
column is in a more natural position. 
For lateral curvature the line of the body must be 
so as to straighten to a certain extent the spinal 
column. With children it is always best to give 
chloroform. The patient being placed in the proper 
position, back bare, a thin piece of muslin wet with 
warm water is evenly laid over. The mould should 
extend well up on the neck and down on the hips. 
Wrater at about a temperature of 90 degrees fahr. 
of sufficient quantity (i quart for a child, 3 quarts 
for adults) is put into a large bowl; fine plaster of 
Paris is stirred in until it is of the consistency of 
thick cream. (If it is necessary to have it set 
quickly add about 1 drahm sulphate of potash to 
quart.) The mixture is spread on the back evenly 
until it is covered about one inch in thickness. 
Wrhen hard the mould can be easily lifted off. 
This mould is then painted over with a solution 
of soap after removing the cloth. Plaster is 
mixed in same way as before but in larger quanti- 
ties, the mould filled up and allowed to dry hard 
before they are separated. The mould can be 
broken if it does not separate easily. The cast is 
now thoroughly dried by being put in a warm place. 
The object now is to make the shell, which should 
be very light. I have used papier-mache, sole lea- 
ther stiffened with steel, and also aluminum. Of 
the three the last is the best, but requires more 
work. To make the shell of paper, first draw heavy 
Canton flannel or duck over the cast, making it fit 
smoothly. A glue mixture is made by dissolving 
white glue in sufficient water to make it liquid, or 
use Page’s liquid glue thinned down. Stir in about 
one quarter the weight of white oxide of zinc. 
Cut manilla paper in strips about one inch wide, 
cover on one side with the glue and apply on the 
back, covering each layer until it is about eight ply, being careful to lay the paper smooth. Cover with 
thin muslin, let dry three or four days, remove and 
tit to the back, the patient taking the same position 
as when the cast was made. A corset is made to 
tit accurately, keeping the shell in position, and 
straps are brought over the shoulders, to keep them 
back against the shell. 
The leather shell is made by taking sole leather, 
skiving it off and cutting it to the size required. 
Soak well in water for two or three hours, then 
mould to the cast and retain in place with bandages; 
let dry for two or three days, then fit the same as 
papier mache. The most useful, the lightest, the 
most durable and comfortable is the aluminum shell. 
This is made by cutting sheets of the metal into 
strips about % of an inch wide, being previously 
softened by annealing. These strips are woven to- 
gether over the cast, leaving meshes or openings 
about % inch square. After this is formed to the 
cast the metal is riveted together and then fitted to 
the back After being trimmed off it is bound with 
thin metal or leather. It can be stiffened if neces- 
sary, with steel. The corset is made in the same 
way as that previously described. 
In lateral curvatures, the cast is shaved down from 
54 to of an inch, where the prominence is, so that 
the shell will cause a pressure, or pads may be fast- 
ened in the shell. 
This shell is light, being about one quarter the 
weight of brass. It is more comfortable to wear in 
hot weather. The best material to make the corset 
of is duck. 
The advantages of these jackets are: ist.— They 
fit the back in its natural position ; the head being 
thrown back, pressure is taken off the bodies of the 
vertebra. 2nd.—They are light, easy to adjust and 
can be padded to take away the appearance of de- 
formity when such exists. 3rd.—They give relief at 
once in every case. The suspension apparatus ex- 
tends the spinal column, relieving the pressure on 
the bodies temporarily ; drawing back the shoulders 
naturally relieves the pressure from the diseased 
part ; the shell with the straps holds the shoulders 
back, thus giving relief from pain, Figs. 20 and 21, Report of Four Operations on Children under 
Four Years of Age for Angular 
Deformities. 
The question has often arisen with surgeons on 
the advisability of operations on the long bones in 
cases of angular deformity in young children. Many 
disapprove in the strongest terms of these opera- 
tions, when the bones are cut or broken. They pre- 
fer the cruel, ill-fitting steel braces, and administer 
years of tedious and unnecessarily painful treatment, 
which finally results very unsatisfactorily. 
From my experience in operating on a number of 
cases, all with the most satisfactory results, it is 
proof that operative treatment is perfectly safe with 
young children. The desired results are obtained 
in a short time, all to the advantage of the patients 
FIG. XX. 
FIG. XIX. FIG. XVIII. 
FIG. XVII. 
and their friends. I do not propose to go into any 
lengthy arguments, but will present a history of four 
of the youngest and most difficult cases. 
MasterS., age3. Fig. 19.—Angular deformity both 
legs about middle third from birth. The boy had 
considerable difficulty in walking. Operation on 
both legs at same time, chloroform being used as 
anaesthetic. A seperate incision was made down 
to each bone With a tenatome and mallet the 
bones were partly cut through on an angle and sep- 
arated by fracturing. The case was then treated as 
a compound fracture, and the patient discharged 
perfectly well, with straight legs, in six weeks, 
f ig. 20. No attempt was made to cut out a V, as is 
recommended, the object being to get a clear frac- 
ture on an angle. 
Little Miss W., Fig. 17, 2 years, 6 months old.— 
Angular deformity of both legs from birth. Each leg operated on at different times. First operation 
right leg, chloroform used as anaesthetic. An- 
tiseptic precautions were not strictly used, only hot 
water. One incision was made, through which both 
bones were cut, fractured and treated as compound 
fracture. There was some suppuration and wound 
did not entirely heal until about seven weeks after 
operation. Second operation, left leg strictly anisep- 
tic. All solutions carbolized, wound thoroughly 
washed out and filled with the following antiseptic 
powder : Acid Salicyl., gr. xxx, Bismuth S. C. 2 dr., 
Morph. Sulph. 1 gr., M 
The wound healed very rapidly, being entirely 
well in two weeks. The results were satisfactory. 
Fig. 18. 
-\ngular deformity of both knees from birth. 
Child two years six months old. Operation 
on each leg at different times. An incision 
down to the bone above the condyles and partly 
through the bone with a tenatome, finishing by frac- 
uring, the limb straightened and put up with Ba- 
varian splint. The second operation was done two 
weeks later. The results in both cases were satis- 
factory. 
Little girl, two years old, angular deformity 
of one knee from birth. Same operation per- 
formed as in the preceding case: perfect results. 
In all these cases a leather support was made which 
was worn about three months after the wound 
healed Treatment of Flat Foot and Weak Ankles. 
I have made a number of experiments with devices 
for the support of weak an kies,and treatment and sup- 
port of ankles in flat-foot A boot or anklet made in the 
following manner meets the want and is very easily 
constructed. In flat-foot there is, plainly speaking, 
a giving way in the anklejoint or a displacement 
of the bones 
'I he treatment has been generally to place a steel 
support in the shoe to support the arch. Very little 
benefit has been derived from any appliance or 
FIG. XXVI. treatment that has been used. 1 he objeet desired 
is to support the ankles on each side and at the 
same time make an even pressure around the foot 
in the centre of the arch. '1 he same appliance or 
boot is used for weak ankles. l ake a piece of 
heavy paper, cut to tit the ankle and to extend half 
way up the leg and down to the sole of the foot. 
Lay this pattern on a piece of compact sole leather 
after the leather is cut to lit the pattern, soak in 
water, trim down edges, and mould on foot, and re- 
tain it there with bandages several hours, until the 
leather is perfectly dry; trim it up; put hooks on 
each side of the front for lacing and rivet a strap on 
each side to go under the sole. • his may be worn 
over the shoe. The straps must be drawn tight and 
secured with a buckle. I'igs. 24, 25, 26. THE DRAWINGS IN THIS PAMPHLET 
were made from 
ORIGINAL PHOTOGRAPHS 
BY 
THE ABOVE DESIGN WAS DRAWN 
BY 
W. E. DENNIS, Engrosser, 
No. 414 Bedford Avenue, 
Bet, Broadway and S. 8th Street, 
BROOKLYN, N. Y,