Illness and Disease
The main tenets of medicine include both accurate diagnosis and treatment. As surgeons, the practitioners of plastic surgery used what was available to them to restore the parts of the human body that were lost or ravished by illness, disease, trauma, or birth defect. The guiding principles of restoration of form and function were as important hundreds of years ago as they are today. Medical anatomy was also beginning to be formally described, which helped these early surgeons advance in their practice of surgery and perform plastic surgery on all parts of the body and on all age groups. This advance included skin grafting, which entailed transplanting pieces of skin from one part of the body to another without a blood supply. Tissue flaps were also being performed, which transferred adjacent segments of skin and muscle with an attached blood supply to restore and fill those aforementioned lost defects. Plastic surgeons adapted well, not only utilizing what was available to them at the time but constantly forging forward in their thinking, planning, and ultimate execution. What made these advancements possible, of course, was concurrent medical progress in anesthesia, antisepsis, and instrumentation. Today an entire face with its attached skin, muscle, nerves, bone, and blood supply can be transplanted.
Le chirurgien dentiste [The surgeon dentist].
Pierre Fauchard. Paris: Chez Pierre-Jean Mariette, 1746.
Although trained as a physician, Pierre Fauchard is widely regarded as the father of modern dentistry. In Le chirurgien dentiste, Fauchard describes basic oral anatomy and function. He also discusses oral medicine and pathology as well as procedures for both the removal and restoration of teeth. He starts most of the book devoted to the care and treatment of the face and jaws in the specialty known today as oral and maxillofacial surgery—one of the precursors of modern-day plastic surgery. Fauchard is also credited for inventing and improving surgical instruments. He borrowed ideas for these fine instruments from the watchmakers and jewelers at the time. He even was inspired by the instruments and tools of the barbers. He was also known for the fabrication of dental prostheses for the replacement of teeth that were lost to extraction or disease.
Degli innesti animali [On grafting in animals].
Giuseppe Baronio. Milan: Dalla stamperia e fonderia del Genio, 1804.
Giuseppe Baronio was both a physician and a physiologist. In this book he recounts his experiments with skin transplantation on a sheep. This marked the beginning of skin grafting in plastic surgery. These skin grafts were carried out by the detachment of skin from one part of the body and transplanted to other parts, where they successfully healed. A successful take, or survival, of the graft was noted by the presence of hair growth. The research was conducted very scientifically and in a controlled manner. It took another thirteen years for the first successful skin grafting to be performed on humans.
Comments of Corpulency.
William Wadd. London: John Ebers & Co., 1829.
William Wadd was not only a medical author but also a noted British surgeon. In his Comments of Corpulency, Wadd discusses through anecdote and experience not only the diseases of obesity but leanness and diet as well. He was one of the earlier advocates of a sensible approach to food. He concluded that obesity was simply a result of “an overindulgence at the table.” His work was highly influential, and dieting consequently became more popular during the Victorian era. Wadd was also a skilled artist and draftsman and is credited with the drawing of all the etchings in the book. Today, the Wadd Society is dedicated to the exploration of the history of obesity.
“Gelungene Lippen- und Nasenbildung” [Successful lips and nose formation].
Maximilian Joseph Chelius. In Heidelberg Clinical Annals. Vol. 6. Heidelberg: J. C. B. Mohr, 1830.
Maximilian Joseph Chelius was both a German surgeon and an ophthalmologist, who worked as a military surgeon in Munich. In this early treatise on plastic surgery, Chelius describes a reconstruction of the upper lip and nose utilizing a forehead flap. Known for his surgery on the head, neck, and eye, his most famous patient did not suffer from a head-and-neck ailment, but rather one who was treated for an infection of the finger. This patient was Frédéric Chopin. Chopin repaid Chelius by the performance of a private concert. Chelius was a catalyst in the development of the medical faculty at Heidelberg University and was considered the founder of the surgical tradition at that institution.
Nouveaux éléments de médecine opératoire [New elements of operative medicine].
Alfred Velpeau. 2 vols. Brussels: H. Dumont, 1832.
Alfred Velpeau was a French hospital surgeon. He was not only the most skilled surgeon in France during the first half of the 19th century but was also a master of anatomy. He authored hundreds of texts not only about surgery and anatomy but also in the fields of embryology and obstetrics. Médecine opératoire was the most detailed surgical work on France in the middle of the 19th century. In it, Velapeau describes and classifies numerous plastic surgical procedures. These include detailed procedures of face and breast reconstructions. An atlas with exquisite illustrations was also printed as a supplement.
Hunterian Reminiscences.
John Hunter. London: Sherwood, Gilbert, and Piper, 1833.
John Hunter was a Scottish surgeon and one of the more distinguished and respected surgeons of his day. He was an early believer in the scientific method of medicine, which mandated careful observation. He gained an appreciation for anatomy by assisting his elder brother, William, at his anatomy school in London. He quickly became an expert in anatomy and spent years as a surgeon in the army. He amassed a collection of animals whose skeletons and other organs he prepared as anatomical specimens. He eventually amassed nearly 14,000 preparations demonstrating the anatomy of humans and other vertebrates, including over 3,000 animals. In his Reminiscences, Hunter discusses his lectures and principles in the practice of surgery. The Hunterian Society in London is named for him, as is the Hunterian Museum at the Royal College of Surgeons, which curates his collection of anatomical specimens.
On Plastic Operations for the Restoration of the Lower Lip.
Thomas Teale. London: John Churchill, 1857.
Thomas Teale was a British surgeon in the mid-19th century. He came from a family of surgeons and was a founder of the Leeds School of Medicine. The loss of one eye during his youth did not deter him. In this rare publication, Teale describes restorations of the lower lip (cheiloplasty) and reconstructions of other deformities of the face and neck. There is discussion of eyelid reconstruction as well. The surgical descriptions are accompanied by very fine illustrations.
Injuries and Diseases of the Jaws.
Christopher Heath. London: John Churchill, 1868.
Christopher Heath was a British surgeon and anatomist. He was also proficient in dental surgery. The jaws are the solid foundation to the face, in which surgeons continued to have a keen interest. In this book, Heath discusses not only injuries and diseases of the jaws but of the antra and sinuses. The treatment of these maladies is discussed both surgically and medically. Heath also led a very didactic life, serving as an examiner in both surgery and dental surgery.
A Treatise on the Diseases and Surgery of the Mouth, Jaws and Associated Parts.
James Garretson. Philadelphia: J. B. Lippincott, 1869.
James Garretson was an American surgeon and dentist in the mid-19th century. He taught at the oral surgery clinic at the Dental College of Pennsylvania. He was personally responsible for establishing the dental specialty of oral and maxillofacial surgery. He is aptly named the father of oral surgery. He used the first dental engine, or drill, for bone surgery and grafting. He devised techniques for the treatment of jaw fractures. In this book he discusses the diagnosis, management, and treatment of diseases of the oral cavity including the mouth and jaws. The treatise was written for both practitioners and students.
“Greffes cutanées ou autoplastiques” [Cutaneous and autoplastic transplants].
Louis Ollier. Bulletin de l’Académie de médecine 1, ser. 2 (1872).
Louis Ollier was a 19th-century French surgeon. Although famous for his work in bone and joint surgery, his greatest contributions to plastic surgery were in furthering the development of techniques in skin grafting, for which he is best known. In this work, Ollier reports devising thicker skin grafts and asserts that the recipient site should also be prepared adequately so as to accept the graft. Previously, this was not being done, leading to the failure of many skin grafts. He showed that these grafts, covering areas of tissue loss, allow faster healing and with a better quality scar. The term “skin graft” was coined by Ollier. He also declared that a skin graft should be used whenever a skin flap is not possible.
“Über die feineren anatomischen Veränderungen bei Auf-heilung von Haut auf Granulationen” [On the finer anatomical changes in healing of skin on granulations].
Karl Thiersch. Verhandlungen der Deutschen Gesell-schaft für Chirurgie 3, no. 69 (1874).
Karl Thiersch was a 19th-century German surgeon who was also a noted anatomist. In this journal article, Thiersch builds upon Ollier’s work, cutting free grafts of skin up to one centimeter in diameter. These were not the Thiersch grafts that were utilized later on, however. He was also a proponent of the concept of “flagellation,” where the donor region (from where the skin is harvested) was traumatized in order to increase its survival when transplanted.
Contributions to Reparative Surgery.
Gurdon Buck. New York: D. Appleton & Co., 1876.
Gurdon Buck was a pioneering 19th-century American military plastic surgeon during the Civil War. He is known for being the first doctor to incorporate pre-operative and post-operative photographs into his publications, a standard in today’s plastic surgery environment. His first published, illustrated medical photograph was of a fused knee joint. This book on reparative surgery is considered the first American plastic surgery textbook essentially devoted to reconstructive surgery.
Medicine and Surgery: Illustrated.
George Fox and Frederic Strugis. New York: E. B. Treat, 1882.
George Fox and Fredric Strugis were American physicians of the late 19th century. In this profusely illustrated book and atlas, they discuss numerous illnesses of the human body, with an emphasis on the disease process and surgical treatments. The work also includes the plastic operation for the loss of the nose and eyelids; another chapter considers the restoration of the lip. In this atlas, they were the first authors to use the mechanical photographic printing process developed in 1878 known as the artotype.
The Surgical Treatment of Disfigurement and Deformities of the Face.
John Roberts. Philadelphia: Philadelphia Medical Publishing Co., 1901.
John Roberts was an American surgeon in the late 19th and early 20th centuries. In addition to his work in facial surgery, he was a pioneering surgeon in cranial surgery. In this book he espouses many surgical techniques still in use today. He was a strong proponent of antisepsis in the field of neurosurgery. In addition to publishing works on neurosurgery, he wrote and edited books in general surgery, orthopedic surgery, and plastic surgery. In this book he discusses surgical management and treatment of facial injuries, particularly those caused from war wounds.