N IS FOR NOSE JOBS

     There was no shortage of fashionistas in the 16th century,

but cosmetic surgery was unheard of  - with one exception.  Physicians performed rhinoplasties - otherwise known as nose jobs - although I'm using that term in a misleading way.  We're talking about full nasal reconstruction procedures, not small tweaks.  Men of that era tended to have a nasty habit of lopping each others' noses off during duels and swordfights.  In fact, that's what happened to Tycho Brahe (1546-1601), the renowned Danish astronomer, who lost most of his nose in a duel and for the rest of his life wore a metal (some say silver) prosthesis over it.  And diseases like cancerous tumors and syphilis did their fair share of nasal damage too.
     But the history of cutting off someone's nose to punish or humiliate them goes back much farther than the medieval era.  An article by plastic surgeon Larry Nichter, M.D., provides the following information:

     Examples abound in Asian and European literature. In the ninth
     century the Danes slit the noses of Irishmen who could not pay
     the annual levied tax of one ounce of gold. Sixtus Quintus of
     Rome (1521–1590) ordered nasal amputation of thieves and
     other rogues. In 1769–1770 Pritivi Narayan, the Ghoorka King
     of India, ordered the amputation of nose and lips of all 865 male
     inhabitants in the recently captured city of Kirtipoor, Nepal. Only
     musi­cians who played wind instruments were ex­cluded. Adding
     insult to injury, he changed the city’s name to Naskatapoor, which
     means “city without noses.”¹⁵ In recent times, too, the Da­coits of
     Northern India plundered a village and punished resistance by
     amputating the noses of their enemies.

Nichter also says that in India, mutilation of the nose was practiced "on women suspected of infidelity, on sexual offenders, and as a prime means of 'mortal revenge.'"  Because nasal mutilation was not uncommon in that country, it's thought that the practice of nasal reconstruction originated in India.  The first detailed description of nasal replacement is found in a classical Indian text written in about 600 B.C.  The method employed was removal of a flap of skin from the patient's cheek, attaching it to the bridge of the nose to maintain a blood supply, sewing it in place over the nose area, and binding it all together with bandages until healing was complete.  At some later point, the "Indian method" of nasal reconstruction came to involve the use of a flap of skin from the middle of the patient's forehead, rather than from his cheek.

     Gradually, Indian medical knowledge spread to the West.  In 15th-century Italy, the Branca family of Sicily - whose members were NOT physicians - developed a new and innovative technique for nasal reconstruction using a flap of tissue taken from the upper arm.  This knowledge was apparently transmitted to an Italian surgeon, Gaspare Tagliacozzi (1545-1599), a professor at the University of Bologna, who went on to popularize the procedure as the "Italian method," and to discuss it in detail in his 1597 treatise, De Curlorum Chirurgia per Insitionem, the first text in any language to discuss plastic surgery exclusively.
     What made the Italian method unique was that it involved only partially removing the skin flap from the arm.  One end would remain attached so as to continue the blood flow, and the free end would be shaped into a nose and grafted onto the patient's face.  How?  Like this:

     The arm would be held immobilized in that position for weeks while the graft firmly attached itself, after which the flap would be cut from the arm and the new nose would be molded into shape.  The bottom line, I would say, was that nobody in his or her right mind would undergo this kind of torturous procedure just to remove a bump or two.  The intent was to give noses to the noseless.  In Tagliacozzi's words:

          We restore, rebuild, and make whole those parts which nature hath given, but
          which fortune has taken away. Not so much that it may delight the eye, but that
          it might buoy up the spirit, and help the mind of the afflicted.
    
     Healing the wounded body and the wounded spirit at the same time.  It sounds like good medicine to me.