This choice would fall upon any one of the paraffins used by the authorities given in Group I.
The objections to the “Hart paraffins” of melting points given in Group II have been sufficiently shown in preceding paragraphs, although a few pointed objections from the various surgeons may not be out of place here to offset the claims and advocacies of those employing the preparation in liquid form at higher temperatures than 110° F.
Paget says: “I am absolutely sure now that Eckstein’s paraffin is without any real advantage. It is very difficult to handle; it sets very rapidly; it causes a great deal of swelling and some inflammation, and may even produce some discoloration of the skin, and it yields no better results than does Pfannenstiel’s paraffin, which melts at 110° F.”
Again he says: “The best paraffin is that which has a melting point somewhere between 108° and 115° F. When the paraffin has to stand heavy and immediate pressure, the higher melting point is preferable.”
He had up to the date of the latter extract operated upon forty-three cases of deformed noses and “in no case was there embolism, sloughing of the skin, or wandering of paraffin.”
Paget, however, employs the paraffin in liquefied form, and allows cold water to trickle over the nose while the injection is molded into form. Of this later.
Comstock says, “Paraffin must be used where it will be at all time above the body temperature,” and further that, “in selecting the melting temperature for surgical uses, it should be that from 106° to 107° F., the best for use in subcutaneous injections, for the reason that it gives a substance firm enough to hold very well its form, especially when confined by the surrounding tissue, and at the same time with a melting point out of the reach of the system at all times.”
From this we are given to understand that he uses his preparation in cold form entirely when injecting, but of the melting point mentioned.
The author can see no advantage in using any paraffins of low temperature melting points in liquid form. Here is the very factor of causing embolism reintroduced. Surely a liquid of any kind injected into a blood vessel will give cause for trouble, even if the temperature of the setting of such a paraffin be high or low. The employment of the paraffins of a melting point above 120° F. in cold form is difficult, if not impossible, even with the latest pattern of screw syringe which is quite true, but there is no need of using such paraffin nor any liquefied paraffin, since any such preparation of about the melting point of 110° F. will serve every purpose overcoming all the objections of the advocates of those using any other.
If a vessel be injected and filled with any paraffin preparation there is danger of phlebitis and thrombosis; the only possible way to overcome it is not to puncture the vessel.