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History of Plastic Surgery : Early Struggle for Recognition

© Michael McLaughlin

The emergence of plastic surgery would not have been possible without the advances in general surgery at the turn of the century. Nineteenth-century American surgeons with financial means essentially trained themselves by traveling to Europe and observing great surgeons of their day. Dr. William Stewart Halsted followed the same route after graduating from Columbia University’s College of Physicians and Surgeons in 1877. After observing surgeons such as Billroth, Thiersch, and Volkmann, he returned to Johns Hopkins in 1889 and created the first general surgery training program in the United States. In 1904 he published The Training of a Surgeon, which was monumental in describing what would later become the prototype of modern training programs. With the spread of Halsted’s principles throughout the country, the United States finally developed a level of surgical sophistication rivaling that of Europe. As the scope of surgery broadened, the United States quickly surpassed the world in further specialization within the field.

Plastic surgery was slow to emerge as a recognized subspecialty. Plastic surgery was occasionally equated with the works of the relatively few cosmetic surgeons of the time, some of whom were referred to as charlatans and quacks. The life of Dr. Charles Miller, considered as one of the originators of cosmetic surgery, reflects such controversy. In 1907, Miller’s The Correction of Featural Imperfections, the first text on cosmetic surgery, was ahead of its time in many respects but was considered “quackery” by many general surgeons. The book, however, was the least of the controversies surrounding Dr. Miller. In 1914, the Chicago Tribune revealed that Miller headed a syndicate that owned three “quack drugstores” involved in dispensing false pharmaceuticals and morphine. Although charges were later dropped, their effect would remain with Miller and his tarnished reputation for years to come.

Several famous individuals continued the struggle to gain recognition for the entire field of plastic and reconstructive surgery. Vilray P. Blair performed the first closed ramisection of the mandible in 1909 and published Surgery and Diseases of the Mouth and Jaw in 1912. In New York City, William Luckett described a correction for protruding ears in 1910, and Frederick Strange Kolle published his text, Plastic and Cosmetic Surgery, one year later. Despite these advances, however, there were still no plastic surgery services, organizations, or journals.

John Staige Davis of Johns Hopkins was considered by most to be the first American to dedicate his practice solely to plastic surgery. He also devoted much of his life to the formation of separate divisions of plastic surgery. Ironically, Davis struggled many years for the advancement of plastic surgery while working at the institution that had pioneered the American surgical training program. Davis’ paper in the Journal of the American Medical Association in 1916, which described the role of plastic surgery and again stressed the need for specialization, reflects the persistent struggle of the field as the United States entered World War I.

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