That the growth is not limited by the size of the mass injected is the author’s belief; in other words, the replacement of the new tissue is not proportionate to the injection, but that other forces, such as adjacent tissue pressure and presence and outer influences, as, for instance, the daily massage of the parts with the hands, have much to do with the final amount of tissue caused to be developed by the initial stimulus of the injection. Nothing further or definite, however, has been written on this supposition.
16. The Difficulty of Procuring Paraffin with the Proper Melting Point.—This should not prove an objection to the method, since operators can procure pure and sterilized paraffins of the various melting points from any reliable chemical house.
What the operator should determine first of all is the kind of paraffin he intends to use for subcutaneous injection.
The selection of paraffin of a certain melting point should be influenced by what he has read on the subject, as given by authorities of wide experience.
A few cases do not suffice from which to draw conclusions; it is only from a great number of similar operations that a definite form or preparation of paraffin can be decided on.
From the following authorities is shown a variance in the melting points of the preparations used, but by a glance it may be noted that the first division of men, from numbers 1 to 10 inclusive, use paraffins of melting points very near to each other; the latter group, from 11 to 13 inclusive, employ those of the higher melting points.
The former group may, therefore, be said to utilize the paraffins of lower melting points.
| Group I | |||||
| 1. | Gersuny | 36-40° | C. | 97-104° | F. |
| 2. | Moskowicz | 36-40° | C. | 97-104° | F. |
| 3. | Parker | 102° | F. | ||
| 4. | Freeman | 40° | C. | 104° | F. |
| 5. | A. E. Comstock | 107° | F. | ||
| 6. | Walker Downie | 104-108° | F. | ||
| 7. | A. W. Morton | 109° | F. | ||
| 8. | Harmon Smith | 110° | F. | ||
| 9. | Stephen Paget | 108-115° | F. | ||
| 10. | Pfannenstiel | 115° | F. | ||
| Group II | |||||
| 11. | Brœckært | 56° | C. | 133° | F. |
| 12. | Eckstein | 56-58° | C. | 133-136° | F. |
| 13. | Karewski | 57-60° | C. | 134-140° | F. |
From a glance of the first group the variance of the temperature of melting points is not a great one, practically lying between 102° and 115° approximately. When we consider the actual difference in the employing practicability and the effect upon the tissue there is practically little, if any, difference. The only difference between these authorities is that some employ their preparation in liquefied form, through the application of heat, while the others employ it in the cold or semisolid form. The choice of such method, from what has already been said, should unreservedly be the employment of a paraffin in the cold or semisolid form at a mean temperature of about 110° F.