The Dawn of Plastic Surgery
The modern definition of plastic surgery is rooted in ancient medicine. The Sanskrit text Sushruta Samhita, written around 600 BC by the ancient Indian medical practitioner Sushruta, describes the quintessential plastic surgery procedure of a nasal reconstruction utilizing tissue harvested from the cheek. During the 16th century, Italian surgeon Gaspare Tagliacozzi and French surgeon Ambrose Paré adopted these early procedures and started to use local and distant tissue to reconstruct complex wounds. Further advances in similar procedures were made by prominent European plastic surgeons in the 18th and 19th centuries. For example, in the 19th century, German surgeon Karl Ferdinand von Gräfe first used the term plastic when describing creative reconstructions of the nose. The term plastic surgery stems from the Greek word plastikos, meaning “to mold” or “to form.”
Today, plastic surgery can be broadly defined as the functional, structural, and aesthetic restoration of all manner of defects and deformities of the human body. Modern plastic surgery has evolved into the two broad categories of reconstructive and aesthetic surgery. Reconstructive plastic surgery aims to restore the normal condition, and aesthetic surgery strives to improve the normal condition. Prior to the early 20th century, almost all plastic surgery was reconstructive in nature. Following World War I, advancements were made in both facial reconstruction and facial aesthetic surgery, which allowed the specialty to evolve and progress given technological and educational developments. Aesthetic, or cosmetic, surgery became more accepted, and, as advancements were made, surgery also became safer and less invasive. Additionally, cosmetic surgery began to be performed on the breasts and body.
Compendiosa Totius Anatomie Delineatio [A complete delineation of the entire anatomy].
Thomas Geminus. London: John Herford, 1545.
Thomas Geminus (Thomas Lambert or Lambrit), an engraver, mathematician, and surgical instrument maker, published this book as an abridged and pirated copy of Vesalius’s Fabrica, originally published in 1543. It is illustrated with figures from both Vesalius’s Fabrica and Epitome and re-engraved in copperplate. The book was dedicated to Henry VIII who, five years earlier, had given assent to an act uniting the barbers’ and surgeons’ guilds. Later that same year, another act supplied cadavers to the newly formed Company of Barbers and Surgeons for dissection. This work would help provide greatly needed anatomical information to members of that guild.
De Medicina [On medicine].
Aulus Cornelius Celsus. Basel: Johannes Oporinus, 1552.
Aulus (or Aurelius) Cornelius Celsus, an encyclopedist and possibly a practicing physician, wrote this encyclopedic book drawing upon the ancient Greeks. The work was first published in the first century and was the earliest complete text to follow the tripartite division of medicine as established by Hippocrates and Asclepiades: diet, pharmacology, and surgery. His work espouses advanced medical practices urging cleanliness and antisepsis, using vinegar and thyme oil. He also discusses reconstructive plastic surgery of the face utilizing tissue and skin from other parts of the body. Using such tissue flaps is still practiced today.
De Curtorum Chirurgia per Insitionem [On the surgery of mutilation by grafting].
Gaspare Tagliacozzi. Venice: Gaspare Bindoni the younger, 1597.
Gaspare Tagliacozzi, both a philosopher and a physician, was well known throughout Europe outside his native Bologna. This work built upon those of distant predecessors such as Celsus and the more recent Gustavo Branca of Sicily. The De Curtorum is the first book exclusively devoted to plastic surgery. Tagliacozzi discusses the “Italian Method” of nasal reconstruction involving a delayed flap from the forehead skin, thoroughly considering every aspect of the flap from design to postoperative care. A quotation from his book has become a standard of care in plastic surgery to this day: “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.”
Les œuvres [The works].
Ambrose Paré. London: John Clarke, 1665.
Ambrose Paré, a French barber surgeon, is considered to be a father of both surgery and forensic pathology. This comprehensive work discusses many facets of surgery of that era. Particularly known for his work on battlefield medicine and the treatment of war wounds, Paré also reintroduced Galen’s method of artery ligation instead of heat cauterization, the latter often failing as a means to cease bleeding during amputations. Paré also made numerous contributions to rehabilitation with his work on limb prostheses following amputation, as well as ocular prostheses fashioned from gold, silver, porcelain, and glass. Unlike others in reconstructive nasal surgery, he favored a nasal prosthesis over autogenous tissue reconstruction.
The Cure of Old Age and Preservation of Youth.
Roger Bacon. Translated from the Latin by Richard Browne. London: Thomas Flesher, 1683.
Roger Bacon (also known as Frater Rogerus or Doctor Mirabilis) was a philosopher and Franciscan friar known for his study of nature through empiricism. In this book, Bacon teaches ways to cure illness and keep off the accidents of old age while preserving the youth, beauty, and strength of the body. He recognized the connection between a sound mind and a sound body. Although surgical rejuvenation of the body was not possible then, Bacon espoused many other ways to preserve youth. It would take over two centuries until surgeons started to develop surgical means for rejuvenation.
Surgeons and Barbers of London Act, 1741.
George II. London: Thomas Baskett, 1745.
The Black Plague wiped out the majority of physicians in the 14th and 15th centuries. This created a great demand for barbers and their surgical procedures. Coupling with that was the fact that universities during the Renaissance did not provide formal education in surgery because it was considered a trade due to its manual nature. Therefore, it was difficult to accept that surgeons were equal to medical doctors. Physicians trained together in medical school to earn their medical degree, while barber-surgeons trained as apprentices and sat for an exam to obtain their diploma. Today’s surgical residency programs still follow this method. In the 1540s, barbers and surgeons joined together to form the United Company of Barbers and Surgeons in order to gain credibility. Their combined guild lasted for over two hundred years. In 1745 the surgeons broke away from the barbers to form the Company of Surgeons, which became the Royal College of Surgeons in 1800. This proclamation separating the combined guild into two separate guilds was printed by Thomas Baskett, the son of John Baskett, the official printer to the King.
The Analysis of Beauty.
William Hogarth. London: John Reeves, 1753.
William Hogarth was an English satirist and editorial cartoonist, as well as a painter and printmaker. In The Analysis of Beauty, Hogarth discusses the six principles that he felt affect and influence beauty. He admits that these principles have an effect, but he does not commit to each of their influences. The principles are fitness, variety, regularity, simplicity, intricacy, and quantity. His principles served to formulate an objective basis to beauty that still holds true today. This work serves as a useful adjunct to Roger Bacon’s work on the cure for old age.
“Of the Harmony between Moral Beauty and Physical Beauty.”
Johann Kaspar Lavater. In Essays on Physiognomy. Vol. 1. London: John Murray, 1789.
Johann Kaspar Lavater was a Protestant pastor and Swiss writer. The word physiognomy is derived from the Greek physis, meaning “nature,” and gnomon, meaning “judge” or “interpreter.” Physiognomy involves the art of assessing one’s character or personality from his or her outer appearance and expression, especially the face. The term also refers to the general appearance of a person or object. Physiognomy dates back to ancient times with the poets of Greece and the Siddhars of India. Ancient Chinese practiced mianxiang, or “face reading.” Aristotle and Zopyrus were also known to practice ancient physiognomy. Lavater is credited for promoting modern physiognomy. His Essays on Physiognomy, originally published in German, were later translated into French and English.
Illustrations of the Great Operations of Surgery.
Charles Bell. London: Longman, Hurst, Rees, Orme and Brown, 1821.
Charles Bell was a noted Scottish surgeon and anatomist of the early 19th century. Most noted for describing Bell’s palsy, he also discovered the differences between sensory and motor nerves in the spinal cord. His Great Operations meticulously details the sentinel operations in surgery, including hernia repair, amputation, and aneurism repair. The book includes twenty etched plates by Thomas Landseer after drawings by Bell. Bell is also credited for writing the first works on the notions of the anatomy and physiology of facial expression for illustrators and painters in 1806.
Phillippe-Frédéric Blandin. Paris: d’Urtubie et Worms, 1836.
Phillippe-Frédéric Blandin was a French Surgeon of the mid-19th century who worked as an anatomical assistant to the faculty of medicine in Paris, where he later became a prosector (one who prepares a body for dissection for demonstration purposes). Although well known in the field of plastic surgery for his work on rhinoplasty, he is best known for his work on autoplasty, which is the surgical procedure of taking tissue from one body part and transferring it to another for reconstructive purposes. This procedure, which is still employed today, served as the basis for many other future reconstructive plastic surgical procedures.
Die plastiche Chirurgie [Plastic surgery].
Friedrich August von Ammon. Berlin: Verlag von G. Reimer, 1842.
Friedrich August von Ammon was a German surgeon specializing in ophthalmology. He settled in Dresden, Germany, and was known for his works in ophthalmology and plastic surgery; he was also responsible for helping to develop each one into a separate specialty. He developed procedures in oculoplastic surgery and penned a prize-winning book on eyelid surgery. His work on plastic surgery was the first to survey the entire history of plastic surgery.
A Treatise on Operative Surgery.
Joseph Pancoast. Philadelphia: Carey and Hart, 1844.
Joseph Pancoast was an America surgeon responsible for many of the sentinel advances in surgery. He not only described these procedures but published graphic depictions of them as well. His treatise is his greatest work, containing over four hundred eighty illustrations with over eighty plates. His contributions to plastic surgery within the book include the formation of a nose by means of plough and groove, an eyebrow reconstruction with a transposed scalp flap, and turndown flaps of abdominal skin for bladder exstrophy treatment. His abdominal tourniquet, which compressed the aorta, saved many lives during procedures invlolving increased blood loss such as lower extremity amputation.
Buch der Béndth-Ertznei [Book of the Béndth-Ertznei].
Heinrich von Pfolspreundt. Berlin: Druck and Verlag von G. Reimer, 1868.
Heinrich von Pfolspreundt (or Pfolsprundt) was a German army surgeon. He advanced medical and surgical practice during the late medieval and early Renaissance periods. This work, originally written in 1460 but not published until 1868, served to advance the practice of medicine and surgery. The book discusses military surgery and alludes to the removal of bullets and treatment of war injuries. It includes one of the earlier accounts of Western rhinoplasty after Celsus and, more recently, the Brancas from Sicily. He also proposed suturing techniques for the repair of a cleft lip, a technique more anatomic and functional than others performed during his time.
Plastics and Orthopedics.
David Prince. Philadelphia: Lindsay and Blakiston, 1871.
David Prince was an American surgeon who served as brigade surgeon to the Army of the Potomac under General McClellan. When McClellan was forced to retreat, the patients within the hospital were captured. At first, Prince refused to be exchanged for another prisoner, but he later acquiesced and went back to Jacksonville, IL. He then built a hospital and took care of the wounded, where he perfected many procedures in both plastic surgery and orthopedic surgery. His Prince Infirmary treated over three thousand patients a year. Many of these treatments were in the field of plastic surgery, including burn procedures and cancer reconstructions. He was also a great proponent of antisepsis.