A critical comparison of Davis Principles of Plastic Surgery with Gillies Plastic Surgery of the face *

Journal of Plastic, Reconstructive & Aesthetic Surgery (2011) 64, 17e26 A critical comparison of Davis Principles of Plastic Surgery with Gillies Plastic Surgery of the face * M. Felix Freshwater* University of Miami School of Medicine, Department of Surgery, 9100 S. Dadeland Blvd. Suite 502, Miami FL 33156-7815, USA Received 17 January 2010; accepted 4 March 2010 KEYWORDS History of Plastic Surgery; John Staige Davis; Harold Delf Gillies, Frederick Strange Kolle; Manchot; Tansini Summary Introduction: The second decade of the 20th century saw the publication of two landmark books - John Staige Davis Plastic Surgery its Principles and Practice published in Philadelphia in 1919 and Major Harold Gillies Plastic Surgery of the Face published in the United Kingdom early 1920. The aim of this paper is to compare the books critically as scholarly achievements in their time and note their present day relevance. Material and Methods: Copies of both books are available online having been scanned by Google and Microsoft. They were analyzed with Acrobat software for key words. A senior plastic surgeon with over 30 years of clinical experience reviewed both books for current relevance. Key results: Davis book was more comprehensive as it encompassed reconstructive plastic surgery from head to toe while Gillies book focused on the face. Davis book contained a bibliography over 2000 references, while Gillies book had one reference. Despite Davis s title containing the word Principles, Gillies book not only mentioned principles almost five times as often, but almost all of Gillies principles remain relevant 90 years later. Furthermore, the quality of Gillies post-operative results are far outshines to Davis. Conclusion: While Davis book demonstrates his honesty and scholarship, now it is as interesting as a historical curiosity. Gillies book remains valuable as it shows his originality and the continued relevance of his principles. ª 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. * Presented at the 2009 Winter Meeting of the British Association of Plastic Reconstructive and Aesthetic Surgeons, December 3, 2009. * Tel.: þ1 305 670 9988; fax: þ1 305 670 0770. E-mail address: mfelix.freshwater@gmail.com In June 2009 Johns Hopkins plastic surgery reunion speaker proudly declared that in 1919, John Staige Davis had written a unique textbook in a new field. I knew that Davis and Sir Harold Gillies were contemporaries and I wondered how their books, published within a year of each other, compared. Before comparing the content, it is worthwhile to discuss the authors motives for writing their books. Both 1748-6815/$ - see front matter ª2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjps.2010.03.009

18 M.F. Freshwater Davis and Gillies shared the same motive in writing their booksdfrustration. Each was frustrated by the state of plastic surgery as he experienced it. To better understand the source of their frustrations, it is important to learn something about these authors. Who was John Staige Davis? Davis was born in Virginia on January 15, 1872 and was named after his grandfather who was surgeon during Civil War. His father was a physician in our Public Health Service. Davis grew up in the Dakota Territory and headed back to the East Coast for high school and for his bachelor s degree that he received from Yale in 1895. Davis moved from New Haven to Baltimore where he joined the class of 1899 of a new medical school named after a Quaker merchant named Johns Hopkins. Davis performed well enough at Hopkins to be asked to stay at Johns Hopkins Hospital for one year as an intern. He completed 4-month rotations in medicine under Sir William Osler, Obstetrics under Howard Kelly and Surgery under William Halsted. Next, he completed three years of surgery training at what is now Union Memorial Hospital, whose chief of surgery, John Finney, had been Halsted s first associate at Hopkins. 1 Davis wrote that it was Finney who suggested that he specialize in plastic surgery. He said that every general surgeon was operating on these cases because they had to be taken care of, but that no one in this country was doing the work properly and that the field was undeveloped. 2 After completing his surgery training, Davis became the first American to limit his practice to plastic surgery, and, in addition, he did research at Hopkins, published a number of experimental papers and taught at the now defunct Women s Medical College in Baltimore. John Staige Davis was a prophet without honor in his own land. 3 Neither Halsted nor his successors at Hopkins-Dean Lewis and Alfred Blalock supported Davis. The most glaring example of their failure to support Davis was that they never granted him admitting privileges; in other words, he had neither beds nor operating time. He could only treat patients in the dispensary or outpatient department. Surgery residents could invite him to do cases with them and the ultimate irony was that he trained at least one Hopkins resident, Kenneth Pickrell, who without any further training beyond his time with Davis, reigned for over a quarter of a century as chief of plastic surgery at Duke. 4 Pickrell admitted that despite most of the resident cases being indigent, it was Davis who operated on all of his patients while he assisted. In addition, Davis trained a number of preceptees including Edward Hanrahan, who would become Webster s brother-in-law, and Edward Kitlowski, the latter of whom Blalock appointed chief of plastic surgery at Hopkins. Davis served as a captain in the US Army from 1917 to 1919 but never saw service overseas. He wrote Plastic Surgery Its Principles and Practice during this time and it was published in 1919 when he was 42 years old. Davis frustration was extrinsic. He was frustrated by how he was treated by Halsted and he was frustrated by the scope of plastic surgery. Davis wrote in his introduction: During the war (1914e1918) plastic surgery was arbitrarily limited, by regulation, to maxillo-facial reconstruction. This, it is true, is a very important part of the subject, but it must be remembered - and the fact should be emphasized - that plastic surgery of the trunk and extremities is equally important. The results may be less spectacular, but surely are just as vital to the patient. The field of plastic surgery extends from the top of the head to the sole of the foot, and no properly trained plastic surgeon would be willing to limit his work to the face alone. 5 Davis found frustration with the dearth of plastic teaching when he wrote: The teaching of this subject has been absolutely neglected everywhere, both for medical students and for post-graduates. There is yet no department for instruction of this kind in any American University, and no complete textbook has hitherto been written on the subject. It has been commonly said that any surgeon who can successfully do an intestinal suture can do plastic surgery. Careful investigation of this point warrants the statementewithout qualificationethat few general surgeons do plastic surgery as it should be done. The possibilities are little understood by the practising physician, and hardly more by the general surgeon. There should be a well-trained plastic surgeon on the staff of every large general hospital, in order that these patients may be cared for intelligently. 6 Davis declared the purpose of his book to be: To show the general practitioner the possibilities of plastic surgery, and start the student or beginner in this subject on the right track. The more experienced surgeon may also find methods with which he is unfamiliar, and which may be of use to him in dealing with cases. 6 In 1926 Davis warned Webster that: One could not earn a living from the practice of plastic surgery alone. 7, a We may suspect how Davis dealt with this obstacle based upon this article titled, Baltimore Society Events, that appeared in the January 5, 1902 issue of The New York Times: A fitting climax to the day s entertainments was the brilliant ball given in the late evening by Mr. and Mrs. W. Graham Bowdoin in honor of their debutante daughter Miss Kathleen Bowdoin. The elegant new residence on North Charles Street just completed by Mr. Bowdoin which is not only one of the handsomest in Baltimore, but in this section of the country. 8 Kathleen Bowdoin married Davis in 1907. b Despite having been a debutante, she drew a substantial portion of the a Pound incorrectly spelled the name Davies and wrote that Davis was a New York pioneer of the specialty. b Op. Cit. reference 1 p. 373.

A critical comparison of Davis, Principles of Plastic Surgery with Gillies Plastic Surgery of the face 19 Figure 1 Davis depiction of his modification of Tansini s musculocutaneous flap. In the legend he noted that he did not include muscles as had Tansini. In the text Davis wrote. plastic operations are not desirable in covering defects left by the radical operation for carcinoma of the breast (Davis JS. p. 625). Figure 2 Cartoon drawn by Gillies on the first free endpaper of the copy of his book that he gave to Jerome Webster in 1944 (Courtesy Webster Library, Columbia University).

20 M.F. Freshwater Figure 3 Illustration of Carpue s first patient s result drawn and engraved by Charles Turner (from Carpue, author s copy). artwork for her husband s book that he dedicated to her with the inscription: To K.B.D. whose good counsel and never failing encouragement has meant so much to me in the ups and downs of life. 9 Davis book was a scholarly achievement and an even more amazing accomplishment for a solo author who had been practising, teaching and performing laboratory research. Its 25 chapters covered the field from head to toe. Davis included 2005 references for: The reader who wishes to delve more deeply into that particular subject. 10 Two references are particularly notable. The first was the work by Tansini on the use of the latissimus dorsi musculocutaneous flap for covering post-mastectomy defects. Sadly, this work was ignored in America for over half a century. Curiously, Davis said that he specifically excluded any muscle when he used this flap. (Figure 1) 11 The other reference was the work of Manchot on the arterial supply of the skin. Although Davis included many illustrations from Manchot s work, he did not refer to them in the text. 12 GilliesdCoping with frustration Gillies too had to deal with frustration. Unlike Davis extrinsic frustration, Gillies frustration was intrinsic because unlike Davis who was spurned by Halsted, Gillies had virtually unlimited support and resources through the Royal Army Medical Corps (RAMC). His book Plastic Surgery of the Face, published in 1920 by Oxford University Press, delved into the frustrations that he faced when he had to treat over 2000 facial injuries beginning in 1916. Not only was Gillies better equipped by the RAMC, but also he was better equipped to deal with frustrations because he had grown-up overcoming social, physical and psychological handicaps. Harold Delf Gillies was born on June 17, 1882, the youngest among eight children whose father died when Harold was three years old. 13 As a child, Gillies fractured his elbow that resulted in his having permanent limitation of motion. c Nevertheless, Gillies compensated for his limited mobility, got his Blue on the 1904 championship Cambridge crew and through persistent practice served on Cambridge s golf team. It was through golf that Gillies became well-known to the sporting public winning the St. George s Challenge Cup for Amateurs in 1913. He had two handicapped and invented a raised tee that enabled him to drive a ball further than he might otherwise do particularly in light of his stiff elbow. It is logical to conclude that he invented his ergonomic needle holder to compensate for his limited ability to pronate and supinate because of his childhood fracture. Gillies discounted his personal appearance and dealt with it through humor (Figure 2): If I with a bald head and no chin were to wake up tomorrow with curly red hair and a strong chin, imagine how pleasant my disposition would become? 14 Plastic Surgery of the Face begins like a Spielberg action film that immediately engages the viewer as in Jaws or Jurassic Park, where the shark attacks or velociraptor attacks early in the film. Similarly, on the first page of chapter one, Gillies sucks you into the maelstrom of his World War I experience. On the first page of chapter one, he tells us that something was rotten in the state of plastic surgery. He noted: c There is some dispute about which elbow was fractured. Ralph Millard told me that it was the right elbow, Gillies biographer Pound claimed that it was the left. A film of Gillies doing a forehead flap nasal reconstruction shows him hyperflexing his right wrist which would be compatible with compensating for elbow stiffness.

A critical comparison of Davis, Principles of Plastic Surgery with Gillies Plastic Surgery of the face 21 There is hardly an operation hardly a single flap in use to-day that has not been suggested a hundred years ago. The earlier months, then, were spent in a very thorough trial of the then known methods. It has been illuminating to discover the impracticability of many of these, which would appear to have been put forward on the study of one case only, or even on purely theoretical grounds. 15 The problem that Gillies faced was that the vast body of plastic surgery literature that had developed in the 19th century was for the most part science fiction. Plastic surgery had begun in London with Joseph Carpue s anatomic experiments and subsequent clinical cases. 16 Carpue was a surgical scientist in the finest tradition of John Hunter and he demanded accurate representations of his post-operative results. To achieve this goal, Carpue had noted artist Charles Turner who creates illustrations. (Figure 3) However, Carpue was unique. All too many texts and papers contained that followed him had results that were imaginative at best and dangerous at worst. Here are some astounding results of mid-19th century American plastic surgery for the release of a burn contracture of the neck (Figure 4). 17 The nadir of plastic surgery as science fiction was reached in the United States shortly before World War I. Notwithstanding the statement at the Hopkins reunion, John Staige Davis did not write the first American textbook of plastic surgery. He wrote the first honest American textbook of plastic surgery. A strange character named Frederick Strange Kolle wrote the first 20th century textbook of plastic surgery Plastic and Cosmetic Surgery published in 1911 by Figure 4 Series of engravings demonstrating the release of burn contractures using Mutter s flap (from Pancoast, author s copy).

22 M.F. Freshwater Table 1 Gillies Principles circa 1920 Pre-Operative 1. Mistakes in diagnosis due to inadequate examination are perhaps the commonest cause of indifferent treatment. 2. In planning the restoration, function is the first consideration, and it is indeed fortunate that the best cosmetic results are, as a rule, only to be obtained where function has been restored. 3. The restoration is designed from within outwards. The lining membrane must be considered first, then the supporting structures, and finally the skin covering. 4. There is no royal road to the fashioning of the facial scaffold by artificial means: the surgeon must tread the hard and narrow way of pure surgery. 5. It may be laid down as a guiding maxim that the replacement should be as nearly as possible in terms of the tissues lost, i.e. bone for bone, cartilage for cartilage, fat for fat, etc. Operative 1. All normal tissue should be replaced as early as possible, and maintained in its normal position. 2. Speaking generally, the use of any foreign body is to be condemned whenever it is possible to substitute a graft from the patient himself. Any form of a foreign body is a tissue irritant, and tends to give trouble early or late, in the attempt on the part of the tissues to remove it; whereas grafts, if successful in the early stages, continue satisfactory. 3. The gain of skin below the mouth has to be written off against the loss which occurs when the bed from which it was raised is closed. 4. Apart from those containing a definite artery such as the superficial temporal (the base for which may be cut quite narrow), the base should be at least as wide as any other part of the flap. 5. The pedicle is returned not earlier than ten days in most cases, and it is of advantage largely to increase this interval where the blood-supply of the receiving bed is dubious. Post-Operative 1. Disappointment is in store for him who would confine his repair to the surface tissues, heedless of Nature s lessons in architecture. 2. Satisfactory early results are obtained by very cautious and repeated injections of paraffin wax in small quantities, but the late results are rarely good and are often appalling. 3. For larger hollows, free fat and muscle grafts are used; these are naturally more uncertain of result. It is not yet established how they will be affected in conditions of wasting, or in old age. The fat-graft, however, owing to fat necrosis, often undergoes a partial absorption. 4. The production of an invisible scar is a question constantly exercising the mind of the plastic surgeon. 5. The factors necessary for the production of the optimum scar are: Asepsis, avoidance of tension on the apposing sutures, perfect apposition of the skin edges, an often unknown personal factor in the patient, early removal of sutures. 6. The most frequent cause of failure of a Wolfe graft is lack of pressure firm enough to ensure complete apposition. 7. Time is the plastic surgeon s greatest ally, and at the same time his most trenchant critic. Appleton & Co. in New York and London. Kolle s topics range from antiseptics, anesthetics, blepharoplasty, otoplasty, cheiloplasty, meloplasty, rhinoplasty and electrolysis. The longest chapter containing 130 out of 511 pages was about Subcutaneous Hydrocarbon Prostheses d paraffin injections. The book is replete with line drawings that demonstrate amazing post-operative results. d Faced with thousands of patients with injured faces, no reliable anesthesia, no blood transfusions, no antibiotics, the prospect that failure could result in suicide and hardly any valid techniques to draw upon, Gillies created his own principles that he enumerated in the first chapter. We can divide the principles into pre-operative, operative and post-operative groups. (Table 1) d Kolle claimed various qualifications including Fellow of New York Academy of Medicine, member of the Deutsche Medizinische Gesellschaft and the Kings County Hospital Alumni Society. He had a curious way of citing authorities. He quoted names and had an index of the names, but, unlike Davis, gave no references. His book contained just four clinical cases; a cosmetic otoplasty, a reconstructive otoplasty, a lower lid ectropion, and a nasal rim reconstruction. Kolle s book had little positive influence on the development of 20th century plastic surgery and as Gillies said when describing various French and German cheek flaps should have been relegated to the lumber-room where it would remain undisturbed for decades. Comparing Davis and Gillies books In contrast to Davis who exhaustively reviewed the literature upto 1918, Gillies had just one reference. In describing the permanence of cartilage grafts, Gillies cited an experimental paper on grafts in dogs from the 1917 volume of Annals of Surgery by none other than John Staige Davis! 18 One might imagine that a 21st century fillerologist would write:

A critical comparison of Davis, Principles of Plastic Surgery with Gillies Plastic Surgery of the face 23 The technique for the injection. is simple and the injection can be given, after a little practice, by anyone who is able to purchase the equipment. However, that was Davis writing about paraffin injections and he listed 22 complications of paraffin injections. 19 Occasionally each author let the reader peek behind the curtain and see what his feelings were. Perhaps with Kolle in mind, here is Davis discussing paraffin injections: The injection of paraffin is the sheet anchor of the quack facial specialist. 20 Quack facial specialist is a biting phrase. A sheet anchor is an emergency anchor; hence, Davis s sentence makes more sense as a scatological pun when sheet is pronounced with a Virginian accent. Gillies puckish sense of humor also is evident in his book. For example, in thanking his photographer he wrote: Their excellence speaks for itself.[he was] devoted to ensuring that [the photos] shall be an honest and true record. He has had to suborn his art to this end, sternly suppressing the temptation to manipulate the lighting or retouch the negatives. 21 In discussing nasal reconstruction he wrote: No man has ever, previously, had sufficient material to elevate this branch of surgery from its unfavourable status, which has been so aptly summed up by the French in their saying before he was horrible: now he is ridiculous. 22 By using search technology, one can compare both books for key words and references. (Table 2) It assists us in seeing how painfully honest each surgeon was. Writing about surgical correction, Davis states that the cosmetic results for ear reconstruction were fair or poor. Gillies used the word cosmetic almost twice as often. When Gillies used the word cosmetic the word function frequently appears nearby. Often Gillies qualified his results: The result of this implantation was satisfactory from a cosmetic point of view but, surgically speaking, it was not gratifying on account of a small leak into the nose, causing later infection of the graft. In one such case its adoption has resulted in a marked cosmetic improvement, and also a small improvement in function. Improvement has been achieved to a greater or lesser extent, and in three, the cosmetic result has been distinctly indifferent. Remembering that both surgeons were operating before the development of antibiotics and blood transfusions, each reported patients dying. Davis reported one patient dying from pneumonia and one cleft palate child almost succumbing from undiagnosed hemophilia. Gillies described how two of his burn reconstruction patients died from postoperative infection. Despite Davis s title containing the word Principles, Gillies book without Principles in its title, mentions Table 2 Keyword and reference comparison of Davis and Gillies Davis Gillies Principle(s) 28 102 Cosmetic 12 23 Cure 10 16 Death (patient) 2 2 Mistake 2 9 Safe 3 4 Simple (method) 24 22 References 2005 1 principles 102 times compared to Davis 28 times. While most of Davis 28 times are adjectives or adverbs Gillies principles were the solid foundation of his work. Although Davis wrote: If this book should prove of use in bringing relief to any one of our wounded soldiers who require the aid of the plastic surgeon, I shall feel fully repaid for the time spent in its preparation. 23 He had no military cases. In contrast, the overwhelming majority of Gillies book was a record of military plastic surgery. Just one chapter with four pages of text called Plastic Surgery of Civil Cases had civilian work. Interestingly, that chapter describes the theoretical use of a tubed pedicle flap for post-mastectomy breast reconstruction. 24 (Figure 5) What were the career consequences of these books? Despite being under-appreciated by Halsted, the shortterm consequences for Davis were most interesting. In 1925, Yale awarded him an honorary M.A. degree. The citation read: He has been a pioneer in plastic surgery. His voluminous treatise on the subject published in 1919 is an acknowledged authority. In this field he stands at the head of his profession, his combined original research with practical services to humanity, stimulating the minds of his pupils, colleagues, and healing the bodies of sufferers. e There were no short-term career consequences for Gillies because of his book, he was appointed O.B.E. in 1919, was promoted C.B.E. in 1920, and was knighted in 1930 for his military service and not for his writing. 25 From a surgical perspective, Davis and Gillies works best can be compared as shown in (Table 3). Davis longest lasting technical advance was the small deep skin graft. It was an ideal advance for the general surgeon who faced a difficult wound coverage problem, as it was easy to perform requiring no complex equipment and hardly any skill. The results, though aesthetically poor, were long lasting. (Figure 6) Gillies longest lasting e Op. cit. reference 1 p. 375.

24 M.F. Freshwater Figure 5 These three line drawings are the final stages of Gillies theoretical breast reconstruction. He believed that The gap left by removal of the female breast should be remediable in terms of tubed flaps designed to carry large masses of fat, e.g. from the buttock. (from Gillies, author s personal copy).

A critical comparison of Davis, Principles of Plastic Surgery with Gillies Plastic Surgery of the face 25 Table 3 Subjective Comparison Davis Gillies Results Journeyman Master Goal for target audience Cookbook Theoretical/ aspirational Major technical Small deep Tubed pedicle flap advance skin graft Utility of the technical advance Little skill, less judgment More skill, more judgment, artistry anyone. Davis book has been digitized by Google. 26 Gillies book is part of the Internet Archive. 27 Competing interests I did my plastic surgery fellowship at Johns Hopkins that now proudly claims John Staige Davis as its first plastic surgeon. I did my plastic surgery residency under Ralph Millard, who was Gillies co-author and disciple. Financial disclosure None. References Figure 6 50-year post-poperative result of a patient who had small deep pinch grafts by John Staige Davis after a street car accident. Note the hypopigmented donor sites and cobblestone appearance of the grafts on the foot (photographed by author July 4, 1976). technical advance was the tubed pedicle flap. It was a demanding and requiring planning, operative skill and judgment and complex post-operative care. Davis deep graft was designed to be permanent, but Gillies tubed pedicle flap was designed to be only a temporary delivery system for tissue d a means to an end. If Davis had connected the dots about the arterial supply of the skin from his references to Tansini and Manchot, then Gillies tubed pedicle flap may have reached obsolescence after World War I rather than have lasted as a viable technique for delivering tissue for over 60 years. One objective means of comparing the value of the books is to compare their economic appreciation. Although, both books has a similar list price when first published, the asking price for an original copy of Gillies has now increased by almost 3½ times as much as the value of Davis (Table 4). Despite the dear current costs of hard copies of both books, each can be enjoyed and studied for free as they are both accessible on the internet and can be downloaded by Table 4 Objective Economic Comparison Davis Gillies Publisher s list price $10 3.15 Amazon price $963 1338 Increase in price 9530% 42376% 1. Davis WB. The life of John Staige Davis. Plast Reconstr Surg 1978;62:368e78. 2. Davis JS. Plastic Surgery Its Principles and Practice. Philadelphia: P. Blackiston s Sons; 1919. vii. 3. Webster JP. In memoriam-john Staige Davis. Plast Reconstr Surg 1947;2:171e3. 4. Pickrell KL. Recollections of John Staige Davis. Ann Plast Surg 1979;2:346e9. 5. Davis JS. Plastic Surgery Its Principles and Practice.Philadelphia: P. Blackiston s Sons; 1919. viieviii. 6. Davis JS. Plastic Surgery Its Principles and Practice.Philadelphia: P. Blackiston s Sons; 1919. vii. 7. Pound R. Gillies Surgeon Extraordinary. London: Michael Joseph; 1964. 78. 8. Baltimore Society Events NY Times. Available from: http:// query.nytimes.com/mem/archive-free/pdf?resz9e03e6da103 DEE32A25756C0A9679C946397D6CF; January 5, 1902 [accessed 15.11.09]. 9. Davis JS. Plastic Surgery Its Principles and Practice.Philadelphia: P. Blackiston s Sons; 1919. v. 10. Davis JS. Plastic Surgery Its Principles and Practice.Philadelphia: P. Blackiston s Sons; 1919. viii. 11. Davis JS. Plastic Surgery Its Principles and Practice. Philadelphia: P. Blackiston s Sons; 1919. 627. 12. Davis JS. Plastic Surgery Its Principles and Practice. Philadelphia: P. Blackiston s Sons; 1919. 114e115, 607e609, 689e 692. 13. Available from: http://www.dnzb.govt.nz/dnzb/default.asp? Find_Quick.asp?PersonEssayZ3G9 [accessed 15.11.09]. 14. Pound R. Gillies Surgeon Extraordinary. London: Michael Joseph; 1964. 72. 15. Gillies HD. Plastic Surgery of the Face. London: Henry Frowde; 1920. 3e4. 16. Freshwater MF. Priorities in Plastic Surgery. Plast Reconstr Surg 1984;73:987e90. 17. Pancoast J. A Treatise on Operative Surgery. Philadelphia: Cary and Hart for G.N. Lewis; 1846. 366 plate 76. 18. Davis JS. A comparison of the permanence of free transplants of bone and cartilage. Ann Surg 1917;65: 170e4. 19. Davis JS. Plastic Surgery Its Principles and Practice. Philadelphia: P. Blackiston s Sons; 1919. 45e46. 20. Davis JS. Plastic Surgery Its Principles and Practice. Philadelphia: P. Blackiston s Sons; 1919. 47. 21. Gillies HD. Plastic Surgery of the Face. London: Henry Frowde; 1920. 3e4. 22. Gillies HD. Plastic Surgery of the Face. London: Henry Frowde; 1920. 211.

26 M.F. Freshwater 23. Davis JS. Plastic Surgery Its Principles and Practice. Philadelphia: P. Blackiston s Sons; 1919. ix. 24. Gillies HD. Plastic Surgery of the Face. London: Henry Frowde; 1920. 393e395. 25. Obituary: Sir Harold Gillies. Br Med J Sep 1960;2:866e7. doi: 10.1136/bmj.2.5202.866-c [accessed 11.11.09]. 26. Available from: http://books.google.com/books?idzc2aoaaaa YAAJ&printsecZfrontcover&dqZeditions:0Uguck6yTBPURd#vZ onepage&qz&fzfalse [accessed 11.11.09]. 27. Available from: http://www.archive.org/details/plasticsurgeryof00gilluoft [accessed 11.11.09].