01-25-2004, 01:37 PM
The Washington Post
December 13, 1994, Tuesday, Final Edition
SECTION: HEALTH; PAGE Z11
LENGTH: 1025 words
HEADLINE: Altered Images;
<b>Plastic Surgery's Earliest Cases Date to Ancient Egypt, India </b>
SERIES: Occasional
BYLINE: Thomas V. DiBacco, Special to The Washington Post
BODY:
Plastic surgery, the reshaping of body tissues for reconstructive or cosmetic
purposes, dates back to antiquity. Derived from the Greek plastikos and the
Latin plasticere, both meaning to mold, the surgery was employed in instances of
battle wounds or animal attacks.
Egyptians performed plastic surgery as early as 3400 B.C., <b>but it was in
India, sometime between the sixth century B.C. and the sixth century A.D. when
the Hindu medical chronicle Susruta Samhita was written, that the skill evolved</b>.
Indian surgeons devised what came to be known as the attached-flap method of
plastic surgery as a solution for the punishment for adultery -- the cutting off
of the nose. In the procedure, skin transplanted to the nose area was kept ali
by remaining attached to healthy tissue. As the Susruta Samhita explained:
"When a man's nose has been cut off or destroyed, the physician takes the
leaf of a plant which is the size of the destroyed parts. He places it on the
patient's cheek and cuts out of this cheek a piece of skin of the same size (but
in such a manner that the skin at one end remains attached to the cheek). Then
he freshens with his scalpel the edges of the stump of the nose and wraps the
piece of skin from the cheek carefully all around it, and sews it at the edges.
"Then he places two thin pipes in the nose where the nostrils should go, to
facilitate breathing and to prevent the sewn skin from collapsing. There after
he strews powder of sapan wood, licorice-root and barberry on it and covers with
cotton. As soon as the skin has grown together with the nose, he cuts through
the connection with the cheek."
The Greek physician Galen (130-201 A.D.) performed reconstruction of the
nose, ears and mouth, but plastic surgery fell into disuse in Europe for the
next thousand years. During the Middle (or Dark) Ages. it became the target of
the Catholic Church because surgery ran the risk of inflicting death upon
patients. What's more, the spilling of blood by a surgeon and the power that he
held over a patient's body were suggestive of sorcery.
The procedure would not be revived in Europe until around the time
Christopher Columbus set sail in 1492, when Italian surgeons used skin from both
the cheek and arm to replace noses. In 1597, Gasparo Tagliacozzi, professor of
surgery at Bologna, employed upper-arm skin grafts on individuals whose noses
had been destroyed by syphilis. The graft at one end remained attached to the
arm, to be nourished by the body's blood.
<b>Not until the 18th century, when British surgeons in India saw the
attached-flap surgery performed, did the procedure make headway in northern
Europe. A century later, free-tissue grafts were initiated in which tissue was
completely cut away from original sites.</b>
Plastic surgery came to America in the 19th century. It was the hallmark of
itinerant, untrained surgeons who promised far more than they could deliver in
correcting various deformities. Their patients often were left with
complications and ugly scars, giving the practice a bad name.
Approximately a third of plastic surgery today deals with beautification,
although the line between its two main branches, reconstructive and cosmetic,
has been blurred.
Equally offensive were hack inventors who took advantage of the public's
gullibility for miracle cures, as for example a "nose-improver" that was hawked
on the streets of the nation's capital in the 1880s. Consisting of a two-part
metal shell connected by a hinge, the device was to be affixed over the nose
only at night, with the manufacturer claiming results in a mere eight weeks.
"The inventor boasts," read one contemporary account, "that it will keep its
shape until the owner grows tired of it, when he may buy an improver with a
different mold, and appear with another equally beautiful nose."
Physicians in the early 20th century such as Jacques Joseph (1865-1934) in
Berlin and Sir Harold Gillies (1882-1960) in England began to publish scholarly
articles and textbooks on plastic surgery that described advances they had made.
These publications came as the ravages of World War I made reconstructive
surgery a necessity. Still, this specialized field of medicine was slow to
develop in America. Not until 1937 was the American Board of Plastic and
Reconstructive Surgery founded to establish standards for practitioners. The
high casualty rates of World War II spurred improvements in plastic surgery
procedures for wounds and burns.
In recent decades, plastic surgeons have used a variety of skin flaps as well
as cartilage, bone and nerve grafts.
Use of artificial limbs (prostheses) and fixation plates and wires to hold
tissue, and the repositioning and suturing of displaced tissue fragments, are
sophisticated techniques used to treat trauma patients and those with congenital
defects.
And microsurgery has permitted the rejoining of microscopic nerves and blood
vessels, extending the application of plastic surgery.
By the 1990s, silicone breast implants aroused controversy because the
device sometimes ruptured into surrounding tissue. In response, the Food and
Drug Administration in 1992 restricted such implants to women needing
reconstructive surgery after breast cancer treatment.
Approximately a third of plastic surgery today involves beautification,
although the line between reconstructive and cosmetic surgery has been blurred
by the argument that improved form enhances a person's ability to function.
The distinction is made by insurance companies in denying benefits for
"cosmetic surgery or other services primarily intended to change or improve
appearance."
Thomas V. DiBacco is a historian at American University.
CAPTION
anels from Tagliacozzi's 16th century text show four stages in the
rebuilding of a nose. 1. Skin flap is partly cut from arm of noseless patient,
upper left. 2. Other end is grafted onto face while patient wears a rigid
harness for 14 days so blood from arm can nourish skin for the new nose, upper
right. 3. Flap is severed from arm, lower left. 4. Skin graft is bandaged, lower
right, for two more weeks before it can be molded into a new nose.
GRAPHIC: ILLUSTRATION
December 13, 1994, Tuesday, Final Edition
SECTION: HEALTH; PAGE Z11
LENGTH: 1025 words
HEADLINE: Altered Images;
<b>Plastic Surgery's Earliest Cases Date to Ancient Egypt, India </b>
SERIES: Occasional
BYLINE: Thomas V. DiBacco, Special to The Washington Post
BODY:
Plastic surgery, the reshaping of body tissues for reconstructive or cosmetic
purposes, dates back to antiquity. Derived from the Greek plastikos and the
Latin plasticere, both meaning to mold, the surgery was employed in instances of
battle wounds or animal attacks.
Egyptians performed plastic surgery as early as 3400 B.C., <b>but it was in
India, sometime between the sixth century B.C. and the sixth century A.D. when
the Hindu medical chronicle Susruta Samhita was written, that the skill evolved</b>.
Indian surgeons devised what came to be known as the attached-flap method of
plastic surgery as a solution for the punishment for adultery -- the cutting off
of the nose. In the procedure, skin transplanted to the nose area was kept ali
by remaining attached to healthy tissue. As the Susruta Samhita explained:
"When a man's nose has been cut off or destroyed, the physician takes the
leaf of a plant which is the size of the destroyed parts. He places it on the
patient's cheek and cuts out of this cheek a piece of skin of the same size (but
in such a manner that the skin at one end remains attached to the cheek). Then
he freshens with his scalpel the edges of the stump of the nose and wraps the
piece of skin from the cheek carefully all around it, and sews it at the edges.
"Then he places two thin pipes in the nose where the nostrils should go, to
facilitate breathing and to prevent the sewn skin from collapsing. There after
he strews powder of sapan wood, licorice-root and barberry on it and covers with
cotton. As soon as the skin has grown together with the nose, he cuts through
the connection with the cheek."
The Greek physician Galen (130-201 A.D.) performed reconstruction of the
nose, ears and mouth, but plastic surgery fell into disuse in Europe for the
next thousand years. During the Middle (or Dark) Ages. it became the target of
the Catholic Church because surgery ran the risk of inflicting death upon
patients. What's more, the spilling of blood by a surgeon and the power that he
held over a patient's body were suggestive of sorcery.
The procedure would not be revived in Europe until around the time
Christopher Columbus set sail in 1492, when Italian surgeons used skin from both
the cheek and arm to replace noses. In 1597, Gasparo Tagliacozzi, professor of
surgery at Bologna, employed upper-arm skin grafts on individuals whose noses
had been destroyed by syphilis. The graft at one end remained attached to the
arm, to be nourished by the body's blood.
<b>Not until the 18th century, when British surgeons in India saw the
attached-flap surgery performed, did the procedure make headway in northern
Europe. A century later, free-tissue grafts were initiated in which tissue was
completely cut away from original sites.</b>
Plastic surgery came to America in the 19th century. It was the hallmark of
itinerant, untrained surgeons who promised far more than they could deliver in
correcting various deformities. Their patients often were left with
complications and ugly scars, giving the practice a bad name.
Approximately a third of plastic surgery today deals with beautification,
although the line between its two main branches, reconstructive and cosmetic,
has been blurred.
Equally offensive were hack inventors who took advantage of the public's
gullibility for miracle cures, as for example a "nose-improver" that was hawked
on the streets of the nation's capital in the 1880s. Consisting of a two-part
metal shell connected by a hinge, the device was to be affixed over the nose
only at night, with the manufacturer claiming results in a mere eight weeks.
"The inventor boasts," read one contemporary account, "that it will keep its
shape until the owner grows tired of it, when he may buy an improver with a
different mold, and appear with another equally beautiful nose."
Physicians in the early 20th century such as Jacques Joseph (1865-1934) in
Berlin and Sir Harold Gillies (1882-1960) in England began to publish scholarly
articles and textbooks on plastic surgery that described advances they had made.
These publications came as the ravages of World War I made reconstructive
surgery a necessity. Still, this specialized field of medicine was slow to
develop in America. Not until 1937 was the American Board of Plastic and
Reconstructive Surgery founded to establish standards for practitioners. The
high casualty rates of World War II spurred improvements in plastic surgery
procedures for wounds and burns.
In recent decades, plastic surgeons have used a variety of skin flaps as well
as cartilage, bone and nerve grafts.
Use of artificial limbs (prostheses) and fixation plates and wires to hold
tissue, and the repositioning and suturing of displaced tissue fragments, are
sophisticated techniques used to treat trauma patients and those with congenital
defects.
And microsurgery has permitted the rejoining of microscopic nerves and blood
vessels, extending the application of plastic surgery.
By the 1990s, silicone breast implants aroused controversy because the
device sometimes ruptured into surrounding tissue. In response, the Food and
Drug Administration in 1992 restricted such implants to women needing
reconstructive surgery after breast cancer treatment.
Approximately a third of plastic surgery today involves beautification,
although the line between reconstructive and cosmetic surgery has been blurred
by the argument that improved form enhances a person's ability to function.
The distinction is made by insurance companies in denying benefits for
"cosmetic surgery or other services primarily intended to change or improve
appearance."
Thomas V. DiBacco is a historian at American University.
CAPTION
anels from Tagliacozzi's 16th century text show four stages in therebuilding of a nose. 1. Skin flap is partly cut from arm of noseless patient,
upper left. 2. Other end is grafted onto face while patient wears a rigid
harness for 14 days so blood from arm can nourish skin for the new nose, upper
right. 3. Flap is severed from arm, lower left. 4. Skin graft is bandaged, lower
right, for two more weeks before it can be molded into a new nose.
GRAPHIC: ILLUSTRATION