History of Plastic Surgery
Reconstructive surgery techniques were being carried out in India by 800 BC.[3] Sushruta, the father of Indian surgery[4], made important contributions to the field of plastic and cataract surgery in 6th century BC.[4] The medical works of both Sushruta and Charak originally in Sanskrit were translated into Arabic language during the Abbasid Caliphate in 750 AD.[5] The Arabic translations made their way into Europe via intermediaries.[5] In Italy the Branca family[6] of Sicily and Gaspare Tagliacozzi (Bologna) became familiar with the techniques of Sushruta.[5]
British physicians traveled to India to see rhinoplasties being performed by native methods.[7] Reports on Indian rhinoplasty performed by a Kumhar vaidya were published in the Gentleman’s Magazine by 1794.[7] Joseph Constantine Carpue spent 20 years in India studying local plastic surgery methods.[7] Carpue was able to perform the first major surgery in the Western world by 1815.[8] Instruments described in the Sushruta Samhita were further modified in the Western world.[8]
Aulus Cornelius Celsus, who lived in the first century AD, described plastic surgery of the face, using skin from other parts of the body.
The ancient Egyptians and Romans also performed plastic cosmetic surgery. The Romans were able to perform simple techniques, such as repairing damaged ears from around the 1st century BC. For religious reasons, they did not dissect either human beings or animals, thus their knowledge was based in its entirety on the texts of their Greek predecessors. Notwithstanding, Aulus Cornelius Celsus left some surprisingly accurate anatomical descriptions,[9] some of which — for instance, his studies on the genitalia and the skeleton — are of special interest to plastic surgery.[10]
In 1465, Sabuncuoglu’s book, description, and classification of hypospadias was more informative and up to date. Localization of urethral meatus was described in detail. Sabuncuoglu also detailed the description and classification of ambiguous genitalia.[citation needed] In mid-15th century Europe, Heinrich von Pfolspeundt described a process “to make a new nose for one who lacks it entirely, and the dogs have devoured it” by removing skin from the back of the arm and suturing it in place. However, because of the dangers associated with surgery in any form, especially that involving the head or face, it was not until the 19th and 20th centuries that such surgery became common.
Up until the techniques of anesthesia became established, surgeries involving healthy tissues involved great pain. Infection from surgery was reduced by the introduction of sterile techniques and disinfectants. The invention and use of antibiotics, beginning with sulfa drugs and penicillin, was another step in making elective surgery possible.
In 1792, Chopart performed operative procedure on a lip using a flap from the neck. In 1814, Joseph Carpue successfully performed operative procedure on a British military officer who had lost his nose to the toxic effects of mercury treatments. In 1818, German surgeon Carl Ferdinand von Graefe published his major work entitled Rhinoplastik. Von Graefe modified the Italian method using a free skin graft from the arm instead of the original delayed pedicle flap.
The first American plastic surgeon was John Peter Mettauer, who, in 1827, performed the first cleft palate operation with instruments that he designed himself. In 1845, Johann Friedrich Dieffenbach wrote a comprehensive text on rhinoplasty, entitled Operative Chirurgie, and introduced the concept of reoperation to improve the cosmetic appearance of the reconstructed nose.
In 1891, American otorhinolaryngologist John Roe presented an example of his work, a young woman on whom he reduced a dorsal nasal hump for cosmetic indications. In 1892, Robert Weir experimented unsuccessfully with xenografts (duck sternum) in the reconstruction of sunken noses. In 1896, James Israel, a urological surgeon from Germany, and in 1889 George Monks of the United States each described the successful use of heterogeneous free-bone grafting to reconstruct saddle nose defects. In 1898, Jacques Joseph, the German orthopaedic-trained surgeon, published his first account of reduction rhinoplasty. In 1928, Jacques Joseph published Nasenplastik und Sonstige Gesichtsplastik.
[edit] 20th century
In World War I, a New Zealand otolaryngologist working in London, Harold Gillies, developed many of the techniques of modern plastic surgery in caring for soldiers suffering from disfiguring facial injuries. His work was expanded upon during World War II by his cousin and former student Archibald McIndoe, who pioneered treatments for RAF aircrew suffering from severe burns. McIndoe’s radical, experimental treatments, led to the formation of the Guinea Pig Club. In 1946, Gillies carried out the first female-to-male sex reassignment surgery.
Plastic surgery, as a specialty, evolved remarkably during the 20th century in the United States. One of the founders of the specialty, Vilray Blair, was the first chief of the Division of Plastic and Reconstructive Surgery at Washington University in St. Louis, Missouri. In one of his many areas of clinical expertise, Blair treated World War I soldiers with complex maxillofacial injuries, and his paper on “Reconstructive Surgery of the Face” set the standard for craniofacial reconstruction.
Too much stress is laid on the article in The Gentleman’s Magazine by Ayurvedic proponents to establish the authenticity of Sushruta’s rhinoplasty. But the fact of the matter is that there is no reference at all to Sushruta in the Gentleman’s Magazine. It is a clear evidence that Sushruta was not known in 1794 and this fictitious figure was created only several decades after 1794. The Gentleman’s magazine of October 1794 edition gives a bizarre account of a curious operation of making a nose from a forehead flap of one Cowsajee. It is quite weird to note that the so-called operation was performed not by an Ayurvedic physician but by an illiterate man belonging to ‘brick-maker’ caste. The condition of the patient mentioned in the Magazine causes further doubt. It is alleged that Cowsajee, the patient, was caught by Tipu sultan’s men and they cut off his nose and one hand. It is also stated that he lived “for about 12 months without a nose.” On the face of it everything appears uncanny, inscrutable and strange. How could Cowsajee escape infection when his one hand and nose were amputated? This account is sent in the form of a letter addressed to the Gentleman’s Magazine by a person who had not divulged his name and address, but only the initials “B.L.” To give credence to this story, he has also given the names of two surgeons, Thomas Cruso and James Trindlay, who were alleged to have witnessed the operation. The surgeons’ identity has not been proved and they have not given any statement. They have not also published such a feat in any medical journal. Even the details of the grafting procedure and the figure of the patient shown in the Magazine were all diagrams and painting, and were published at third hand in London in 1794. In those days scholars belonging to Asiatic Society invented stories to become famous. In the absence of printed texts, and with no manuscript library, it was easy for them to get spurious manuscripts and claim inventions. Edward Pococke had hundreds of such fabricated manuscripts and he attempted to prove that Pythagoras got his ideas from India. William Jones, for instance, gave several arguments to prove that a group of Egyptian priests had in some remote age settled down in India. Reuben Burrow tried to prove that the Binomial Theorem was known to ancient Indians. Francis Wilford was cheated by Brahmin pundits employed by him when they interpolated into the old Sanskrit texts material cleverly forged so that the Sanskrit texts specifically mentioned Adam, Abraham and other Biblical personages. The forgery was detected by Wilford himself, but only after he had contributed quite a lot of material on the subject in The Asiatic Researches — which he sorely regretted. (Kejariwal, O.P., The Asiatic Society of Bengal, p.43)It is against this backdrop that we have to view the letter sent to The Gentleman’s Magazine describing skin grafting by one ‘B.L.’ was fabricated in view of the fact that without sterile technique, anesthesia and antibiotics an illiterate ‘brick maker’ could not have performed plastic surgery.