Since this lecture was given, [ have done four more cases, making twenty-six in a'l. One of these four cases was the hardest I have yet hau; and I have failed, even witlh two operations, to do much good. The nose had been absolutely flat for half a century, and the skin was almost hopelessly rigid: and a preliminary use of the tenotomy knife caused some bleeding. Happily, I have done no harm, and some good; and shall be able to do more, a few weeks hence; but it is a disappointing case. Such intense tightness and unyielding rigidity of the skin are altogether exceptional. To sum up-I have had twenty-six cases without death or disaster; and the general results are very good. In nine cases out of ten, the surgeon can be sure of making a very great improvement: but he may not be able to do it all at once. He cannot make perfect noses; but he can make the patients good looking enough to be happy instead of miserable, and able to get work, to get married, and to go about without being ridiculed, pitied, or suspected of syphilis. Only. let nobody think that the method is so easy as it sounds. It is full of little difficulties; it wants experience; and it involves very grave responsibility.
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David Bruce (1903) studied this question.