Robert C. van de Graaf

Sir Charles Alfred Ballance (1856-1936) and the introduction of facial nerve crossover anastomosis in 1895

Sir Charles Ballance (1856-1936) was the first surgeon in history to perform a facial nerve crossover anastomosis in 1895. Although, recently, several papers on the history of facial nerve surgery have been published, little is known about this historically important operation, the theoretical reasoning behind the operation or the surgical perspective in which Ballance developed this method. An original document on the operation, dated in 1895, is not known. The earliest report of the operation is a paper by Ballance, published in 1903. Study of this 1903 paper reveals that Ballance stopped performing the operation after his first attempt in 1895 until he resumed in December 1901. What was the reason for this interruption? Why did Ballance start doing it again in 1901? Between 1895 and Ballances 1903 paper, several other surgeons had published the results of their facial nerve crossovers. Were they inspired by Ballances operation from 1895 to do the same or did they invent the method independently? To enhance our knowledge about the early history of facial nerve surgery, the original manuscripts by Ballance and his contemporaries have been studied. Ballances first facial nerve crossover from 1895 is described in the surgical perspective of the end of the 19th century. The theoretical reasoning for the operation is discussed. It was discovered that Ballances operation was first recorded in St. Thomass Hospital Report of 1895, which was published in 1897. However, this report was probably hardly known by Ballances contemporaries and consequently could not have stimulated them to perform the operation themselves. Jean Louis Faure (1863-1944), from France, appears to have been the first to have performed the operation until Ballances 1903 paper was published. In 1903, after Ballances paper had been published, many other accounts of this method were reported in the literature. At that moment facial nerve crossover seems to have been widely regarded as a potential successful technique, a technique which, a century later, is still part of our repertoire.

On the surgical treatment of facial paralysis in the early nineteenth century

Summary: The treatment of facial paralysis is generally considered to have been nonsurgical until the end of the nineteenth century. However, the authors discovered recently that already in the 1840s the celebrated German facial reconstructive surgeons Dieffenbach and von Langenbeck applied the technique of subcutaneous myotomy to healthy facial muscles to reestablish balance in the chronically paralyzed faces of their patients. They performed their operations at a time when anesthesia, asepsis, antisepsis, and antibiotics had not yet been introduced into surgery. It is concluded that Dieffenbach and von Langenbeck were the first, in recorded history, to develop a surgical way to treat irreversible facial paralysis. As their principles are still being used in surgical practice, they cannot be regarded as antiquated, which illustrates the difficulties that reconstructive surgeons still experience in the treatment of irreversible facial paralysis.

An Early Observation on the Anatomy of the Inguinal Canal and the Etiology of Inguinal Hernias by Petrus Camper in the 18th Century

The famous Dutch medical doctor Petrus Camper (1722–1789) was appointed professor of anatomy and surgery at the University of Franeker, Amsterdam, and Groningen. As Praelector Anatomiae of the Amsterdam Guild of Surgeons, he gave public anatomy lessons in the Anatomy theatre in Amsterdam. During the mid 18th century he performed dissections on corpses of children and adults to investigate the anatomy and etiology of inguinal hernias. The concept that a hernia was caused by “a rupture of the peritoneum” was common at that time. Camper concluded that this was incorrect and provided a clear description of the etiology of hernias in children and adults. For the treatment of inguinal hernias, he designed a truss based on the geometrical proportions of the pelvis. This “truss of Camper” was much used and internationally renowned. His anatomical studies and perfect, self-drawn illustrations contributed to a better understanding of the anatomy of the inguinal canal, on the national as well as international level. Camper’s “Icones Herniarum” is his most widely known work on inguinal hernias and included a series of outstanding anatomical illustrations. Petrus Camper should be considered one of the pioneers in the field of inguinal hernias.

The Anatomy Lesson of Dr. Nicolaes Tulp' : from a group portrait to a true lesson in functional anatomy

1. Kumar P. Causative agents producing burn injury. Burns 2002; 28: 400. 2. Rice P. Sulphur mustard injuries of the skin: pathophysiology and management. Toxicological. Reviews 2003; 22: 111–8. 3. Emergency Management of Severe Burns® UK Course Manual, 8th edn. London: British Burns Association UK, 2004. 4. Ahmad Z. A picture paints a thousand words – the use of 3G camera mobile telephones in managing soft-tissue injuries. Eur. J. Plastic Surg. 2008; 31: 4.

Remarks on the early history of Bell’s palsy

Sir, In his review article entitled ‘Management of peripheral facial nerve palsy’ [1], Dr. Finsterer makes the incorrect statement that Bell’s palsy was Wrst described by Friedreich in 1797. The clinical entity, which we currently call Bell’s palsy, was already clearly observed more than a century earlier, in 1683, by the Dutch physician Cornelis Stalpart van der Wiel (1620–1702) (Fig. 1a) [2, 3]. Nevertheless, in 1797, Nicolaus Anton Friedreich (1761–1836) (Fig. 1b) was the Wrst in history to write a thesis about Bell’s palsy, which he called ‘rheumatic paralysis of the facial muscles’, because he believed it was caused by exposure to cold air [4]. He wrote: ‘A man of forty-six years, subject to frequent catarrhs and rheumatisms, was conWned some weeks to bed, on account of a surgical operation. The Wrst time that he left his room, he exposed his left side to a stream of cold air from a window. [...] On visiting the patient on the morning of the Wfth day, I found the muscles of the left side of the face paralysed, and the mouth and nose drawn towards the right side. My fears were, however, soon dissipated, as, on considering the preceding occasional causes, the previous swelling and pain in the region of the mastoid process, and the integrity of all the senses, and of all the other muscles of the body, I could not view the evil as apoplectic, but as being local, and proceeding from the rheumatism aVecting the place’ [4]. Also, Sir Charles Bell (1774–1842) (Fig. 1c), the discoverer of the true function of the facial nerve, and whose name is attached to the clinical entity, considered Bell’s palsy to be caused by exposure to cold air. He stated: ‘A physician paid me a visit who had come up from the country in the mail, and had fallen asleep in the night-time, with his cheek exposed at the open window to the east wind. On the morning of his arrival, when preparing to go abroad, he found, upon looking into his glass, that his face was all twisted. His alarm gave more expression to one side of his face, and produced more horrible distortion. Both laughing and crying, you know, depend on the function of the portio dura, but when he came to me he considered it no laughing matter: I never saw distortion more complete. It was diYcult to comfort him; but I am happy to add, that the paralysis gradually left him, as I told him it would.’ [5]. The oldest hypothesis on the etiology of Bell’s palsy considers ‘rheumatism’ or exposure to cold to be the cause of the aVection. Ever since, a multitude of other etiological explanations (e.g. vascular ischemia, autoimmune disease and viral infection) has been proposed. But despite all this scientiWc eVort, the true cause of Bell’s palsy has still not been found. It is fascinating to read that even today the old ‘cold-hypothesis’ still seems to be alive, as Dr. Finsterer remarks: ‘some patients report exposure to an air-condition outlet, or an open window before the attack’ [1]. Is this an expression of the diYculties we still experience with understanding the pathomechanism of Bell’s palsy? Or should we really consider exposure to cold as a possible etiological factor in some patients aVected by Bell’s palsy? What exactly happens with the facial nerve of these patients after it has been exposed to cold air? R. C. van de Graaf (&) C.F. von Graefe Institute for the History of Plastic Surgery, Zijlsterried 32, 9746 PB Groningen, The Netherlands e-mail: robertcvandegraaf@histplastsurg.com

The Polish Surgeon Tomasz Drobnik (1858 to 1901): Pioneer in Facial Nerve Crossover Anastomosis and Tendon Transfer

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A plea for a more critical and scientific attitude regarding the use of historical information

dressing or other type pressure dressing. Final graft take was close to 100%. Foong et al had used VAC in one of their cases but found that it produced only small amounts of granulation tissue. Certainly, in our experience, VAC used over wider areas of bare calvarium will not produce significant granulation tissue in a short time period, unless the cortical bone surface is first modified eg by fenestrations. We feel that the combination of a granulation tissue layer and thicker split skin graft allows a more stable and hardy skin suited for permanent coverage though we do not have any objective measures of this.