E D I T O R I A L

" P L A S T I C " S U R G E R Y

THERE is an all too common misbelief that the word " plastic " was originally applied to a surgical specialty during the first world war ; occasionally there is even mild resentment at the " unfortunate choice " o f label, so easily confused with the products of a great modern industry. It would seem that the ancient lineage of the term " plastic surgery " and its traditional use in all the maior European languages for more than a century are too little known even amongst its present-day practitioners.

The word comes from the Greek adiective ~k,o-7,~co~ which in turn is derived from the verb ~rkdo-¢e,v, meaning to mould or form. It is found in the Latin of the first century A.D. as plastic-us, and by the time o f the Renaissance it was in common use in French (plastique) and English ; thus Ben Jonson (" Magnefick Lady ," I632 ) wrote : " Not . . . as we were to mould every scene anew ; that were a mere plastic or potter 's ambition."

The root plastic has been in continual use almost from the beginning of the present era of plastic surgery, which dates from the publication in I816 of Carpue's book " An Account of Two Successful Operations for Restoring a Lost Nose." Although Carpue nowhere mentions the word, a similar work two years later (I818) by Graefe was entitled " Rhinoplastik " in the German edition and " De Rhinoplas t ice" in the Latin. In the following year (I819) Baronio's treatise on animal grafts, " Degli Innesti Animali," was translated into German with the title " Ueber animalische Plastik."

During the next decade or so a host of new words were coined by tacking the ending--plasty (French, plastie; German, plastik) on to the Greek names for various anatomical sites. Many of these like " otoplasty " and " blepharoplasty " survive to -day ; others such as " ophrioplasty " (repair of the eyebrow) have been forgotten. At this time, too, the possibility of using tissues other than the patient's was envisaged and the words " autoplasty, . . . . anaplasty, . . . . homoplasty," and " h e t e r o p l a s t y " came into use.

The first at tempt to survey the whole field of the rapidly expanding specialty was made by Blandin in i836 with his book " Autoplastie : ou restauration des parties du corps qui ont ~t6 d&ruites fi la faveur d 'un emprunt fait fi d'autres parties plus ou moins 61oign6es." It was customary in France to submit a thesis when applying for a university chair and Blandin wrote no less than five Thkses de Concours before he was appointed Professor of Surgery in Paris in I84I. "Autoplas t ie " was his third and contains little original work ; it consists largely of material borrowed from the works of Dieffenbach, Delpech, Roux, Lisfranc, and others, uncritically reviewed and unsystematically assembled.

Two years later a work of a much higher standard appeared, which finally established the use of the term " plastic surgery." Eduard Zeis's " Handbuch der plastischen Chirurgie " (I838) is a careful scholarly work in which the author collected and systematised all the previously published material. He took great pains to define the scope of the new specialty and his list of chapter headings

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250 BRITISH JOURNAL OF PLASTIC SURGERY

might serve as a model for a similar book to-day, apart from the section on perineal and vaginal repair, an undoubted branch of plastic surgery long since lost to the gynmcologists. Curiously enough, he omitted the treatment of cleft lips and palates, his reason being that these were closed by simple union of the edges and not by the interpositioning of new tissue. They were, however, included in his later book.

Zeis maintained his interest over the years and collected and arranged with the thoroughness typical of his race every reference to plastic surgery which he could find in the world's literature. In 1863 he published one of the finest of medical bibliographies, "D ie Literatur und Geschichte der plastischen Chirurgie." Although this was written some years before the introduction of free skin grafting (Reverdin, 1869) it contains no less than 2,oo8 annotated references.

In the interval between the publication of the " Handbuch" and that of " Die Literatur und Geschichte" a surprising number of treatises on Plastic Surgery, "Chirurgie Plastique, . . . . Plastische Chirurgie," and "Chirurgia Plastica," appeared. Clearly the term was universally used a century ago to describe a special branch of surgery.

To-day it refers to almost exactly the same field. Free skin grafting has been introduced and absorbed ; gymecology has splintered off. Otherwise there is little change. It is still, as Dieffenbach wrote in his foreword to Zeis's " Handbuch, . . . . die hochste Blfithe der ganzen Chirurgie."

The following are some of the more important works published under the title of plastic surgery over a hundred years ago : - -

" Plastic Surgery." (Anonymous author.) Brit. and For. med. Rev. , London, 7, 386. 1839; 9, 396. 1845.

" Plastic Operations." Pancoast, J. Amer. J . med. Sci., N.S. 4, 337. 1842. " Practical Essays on Plastic Surgery." Wells, T. S. Med. Times, N.S. 9 (O.S. 30),

9, 32, 55, Io9, 21o, 661. 1854. " Trait6 de Chirurgie Plastique." Jobert (de Lamballe). 2 vols. Paris: J . B .

Bailli6re. 1849. " Ad Chirurgiam Plasticam Symbolae." Lange, G.O. Bonnae. ~856. " Handbuch der plastischen Chirurgie, nebst einer Vorrede von J. F. Dieffenbach."

Zeis, E. Berlin : G. Reimer. 1838. " Die plastische Chirurgie nach ihren bisherigen Leistungen kritisch dargestelh."

Von Ammon, F. A., and Baumgarten, M. Berlin : G. Reimer. 1842. " Die plastische Chirurgie in ihren weitesten Umfange dargestellt und durch

Abbildungen erl~utert." Fritze, H. D., and Reich, O. F. G. Berlin: A. Hirschward. 1845.

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