Dr Jerome Pierce Webster (1888–1974): Surgeon,historian,campaigner,and ‘the father of plastic surgery education’

Early years and training

Jerome Pierce Webster was born on 2 August 1888 in Ashland, New Hampshire, USA. The youngest of three children, he attended Holderness Boys School, where his father, Rev. Lorin Webster, was headmaster (Figure 1).^1,2 Jerome’s sporting, musical, and academic record at school earned him a place at his father’s alma mater, Trinity Hartford, Connecticut, where he obtained a Bachelor of Arts degree, before securing a place at the prestigious Johns Hopkins Medical School in 1910. ³ OPEN IN VIEWER

It was here that Webster excelled in his studies; he graduated MD in 1914, and then obtained a surgical internship under John Miller Turpin Finney, a Professor of Surgery at Hopkins and a major figure during the early era of abdominal surgery. In addition to his clinical achievements, Finney was elected the first President of the American College of Surgeons, a role that arguably influenced Webster’s heavy involvement in professional societies. ⁴

Webster gained much of his experience in plastic surgery through federal service during the Great War, as most elite surgeons of this period had done. ³ His work at Hopkins was interrupted in July 1916 when he went to work for the American Embassy in Berlin, prior to the U.S. becoming officially involved in the war. His role was Special Assistant to the U.S. Ambassador to Germany, with the primary responsibility of inspecting prisoner-of-war camps. When America entered the war in April 1917, he was attached to the 30th Engineers, 1st Gas Regiment, and saw action on three fronts in France, eventually winning the Croix de Guerre with Gold Star.

When his time in Europe came to an end in 1918, Webster returned to Hopkins to resume his surgical training. It was not long, however, before Webster’s training direction changed once again. As a result of the 19th-century Anglo-Chinese Opium War, the China Medical Board was established as a philanthropic initiative with assistance from the Rockefeller Foundation. Peking Union Medical College was opened in 1921 as a part of this initiative, becoming the first ‘western medicine institution’ in China.^5,6 The college was headed by surgeon Adrian Taylor, appointed given his previous and extensive missionary work in China, as well as his superb academic record at Hopkins and Harvard. Taylor knew Webster through their surgical training at Hopkins and had subsequently invited Webster to become his first surgical resident at Peking, but by the time Webster left in 1926, his rank had progressed to Associate Professor of Surgery. ⁷ It was while at Peking that Webster’s lifelong affiliation and love for China was cultivated, leading to his election as President of the American Bureau of Medical Aid to China in 1956.

Webster used his time away from Hopkins to continue his learning, touring plastic surgery clinics across the Far East and Europe. One particularly influential encounter was with Harold Delf Gillies in London, where Webster spent a considerable amount of time in 1926. Here, Webster learnt about Gillies’ pioneering ‘tubed pedicle’ flap technique for facial reconstruction, developed during the Great War. Gillies and Webster would remain friends after this meeting and often corresponded with one another, even co-authoring The Principles and Art of Plastic Surgery in 1957. Webster’s later research was clearly influenced by Gillies’ work involving skin grafts. He paid tribute to Gillies upon his death in 1960, describing him as a ‘World renowned authority, author and teacher of Plastic Surgery’. ⁸

Following his time in London with Gillies, Webster returned to the United States in 1927 to work in St Louis, Missouri under the direction of Vilray Blair. Blair was another pioneer of plastic surgery and published Surgery and Diseases of the Mouth and Jaw in 1912, considered the ‘bible’ in surgical management during the First World War. ⁹ After Blair died, Webster remarked to Blair’s son that his father’s work had done more to raise the standard of plastic surgery in the USA than any other factor. Webster practiced under Blair for eight months, before accepting a post in New York, a role that would define much of his later career.

Columbia Presbyterian Hospital, New York, opened in 1927 and its surgical department was headed by Allen O .Whipple, famed for his innovative ‘Whipple procedure’ for pancreatic cancer. Webster was invited to join the institute by Whipple as Harkness Fellow in Surgery with the intention of establishing a plastic surgery department. At the beginning of his time there, Webster treated a variety of surgical patients in order to develop both his operative skills and reputation. Gradually, Webster was able to incorporate private work into his practice, the fees of which were diverted into a developing plastic surgery clinic at Columbia, which Webster ran from 1931 until he retired in 1954. ⁹ Over this 23 year period, the service evolved into one of the finest of its kind worldwide, saw over 60,000 patients and contributed pivotal research. ¹⁰

Webster as an educationalist

Although his reputation as a surgeon was exceptional, Webster is more often remembered as a teacher and has been called ‘the founding father of plastic surgery education in the United States’. ¹ While at Hopkins, Webster studied under William Stewart Halsted, who is today considered one of the most influential and innovative surgeons the United States has ever produced and whose emphasis on strict aseptic techniques during surgical procedures and his meticulous planning and note keeping influenced Webster’s approach to surgery throughout his life. ¹¹ Halstead restructured the methodologies of surgical teaching at Johns Hopkins Hospital as he believed training needed to commence early on with graded responsibilities and it was this concept that was incorporated into Webster’s Plastic Surgery Residency at Columbia-Presbyterian. ¹² The course consisted of weekly teaching sessions, case discussions, anatomy lectures and research projects as its chief modes of delivery. Under Webster’s guidance, the programme trained over 40 surgeons, many of whom became acclaimed in their own right, illustrating the legacy that Webster had left. ¹³

One former resident was George Crikelair, who succeeded Webster in directing the plastic surgery service at Columbia from 1959–1971. Crikelair authored over 90 publications in plastic surgery and held several influential positions, including chair of the American Board of Plastic Surgery (ABPS) (1970–1971), but is best remembered for his work on paediatric burns, and campaigning that led to the 1972 Flammable Fabrics Act. ¹⁴

Webster’s role as an educator was not restricted to students at Columbia-Presbyterian.

With his encyclopaedic knowledge and advocacy of good teaching, he authored multiple papers and books, such as General Principles of Plastic Surgery (1942), as well as directing four 12-week courses in Plastic and Maxillo-Facial Surgery for the army during the Second World War. But Webster was not only academically devoted to plastic surgery. An avid historian and bibliophile, he amassed his own collection of rare history of medicine books, which is now perhaps the most comprehensive collection on the history of plastic surgery in the World, including as it does 5000 books, 40,000 reprints, as well as an extensive collection of cases and photographs.^14,15 The library was initially started to aid his research into the 16th-century Italian surgeon, Gaspare Tagliacozzi (1545–1599), who fascinated Webster and whom he regarded as the Renaissance ‘father of plastic surgery’. Webster’s work culminated in the 1950 publication of The Life and Times of Gaspare Tagliacozzi, Surgeon of Bologna, which he co-wrote with historian Martha Teach Gnudi. ¹⁰

Developing his plastic surgery library became Webster’s main occupation after he retired, and when he passed away the entire collection was donated to Columbia University, which honoured him with its ‘citations for distinguishable services to the University’. ¹² Webster’s love of history and significant figures in plastic surgery is reflected in some of his publications, writing several biographies, including those of Harold Gillies and Vilray Blair, as well as chairing the ‘History and Cultural Medicine’ section for the cultural magazine Bulletin for 20 years.

Webster and the professionalisation of plastic surgery

Webster represents one of the major proponents of the professionalisation of plastic surgery in an era when it was still regarded as a ‘specialist interest’ of general surgeons. ³ William Stewart Halsted was one of the traditional general surgeons, who disagreed that Plastic Surgery merited to be its own speciality and who opposed the formation of the ABPS. ¹ As a founding member of the ABPS, Webster along with 10 colleagues established what was to become the first professional organisation regulating plastic surgery, and played an instrumental role in its official recognition as a specialism in 1941 (Figure 2). OPEN IN VIEWER

Established in 1937, the ABPS’s primary objectives were to outline a minimal standard for training through education, licensing, and self-policing.^16,17 As part of this overhaul, the ABPS reviewed training programmes across the US, with Webster’s residency being the first to achieve board certification in 1938, making it the longest running Plastic Surgery programme in the world to date.^9,18

In addition to these astonishing and pivotal achievements, Webster held numerous other influential roles, including Presidency of the American Association of Plastic Surgeons in 1941, Chairman of the ABPS from 1945 to 1947, Vice Presidency of the American Society for Surgeons of the Hand 1956, and further leadership roles in over 20 plastic surgery societies. ² It is within this context that Webster's relentless commitment to furthering the specialism is best seen.

In 1959, Sir Harold Gillies wrote an article in the British Medical Journal in which he outlined the necessity for plastic surgeons to utilise the media, in order to ‘educate the public in the truths of our lovely profession’. ¹⁹ It was this cautious and informative approach to reporting on plastic surgery that Webster applied to his own practice.

Originally established to house Webster’s collection of rare history books, the Jerome Webster Library of Plastic Surgery remains, and now contains the clinical papers mapping his career within plastic surgery. ¹⁰ The collection includes Webster’s patient notes, personal letters as well as newspaper clippings that he had collected over his professional career. It was his belief that the media portrayal of the speciality lay central to professionalization which led him to collect both positive and negative press relating to plastic surgery, often circling names of those associated with malpractice. Webster’s contribution towards the professionalization through the ABPS, the Columbia programme, and his conservative approach illustrate his foresight and determination for the progression of plastic surgery. ²⁰

Webster as a scientist and surgeon

Webster’s philosophy with regard to operating had one central focus; conservatism. Analysis of Webster’s patient notes reveals that the majority of his work was dedicated to the reconstructive, rather than the cosmetic, pole of the plastic surgery spectrum, which is also reflected in his scientific research and publications. For potential cosmetic clientele, the equally new speciality of psychiatry provided medical grounding on which to justify cosmetic surgery as an ethical, reputable intervention, and was used extensively by Webster as a guideline for practice. It was his belief that only those who suffered from an inferiority complex because of their appearance should receive cosmetic surgical interventions as a means of improving their psychological health. ¹⁷ Although not his primary academic focus, Webster’s reputation as a cosmetic surgeon was still internationally renowned, receiving several requests by members of European royalty and movie stars. It was specifically. Webster’s reputation as a perfectionist that preceded him; his operative techniques were detailed and precise, but often impractical, as for example he was known to have removed hundreds of stitches ‘all because of a slight aesthetic flaw’. ²¹ His meticulous eye for detail is also reflected in his patient notes, often sketching the patient in addition to polaroids, a thorough patient history and a detailed surgical plan.

Although Webster was often reluctant to perform cosmetic procedures, the final decision as to whether or not he operated was often given to the patient. It was this understanding of the psychological benefits plastic surgery could offer its recipients that drove his work, particularly his reconstructive procedures. One of Webster’s research focuses, and perhaps a nod to his earlier shadowing of Gillies, was improving the aesthetics of skin in reconstructive surgery. Publications such as his 1944 article ‘Refrigerated skin grafts’ ²² and ‘Crescentic peri-alar cheek excision for upper lip flap’ ²³ published in 1950 are examples of this work. Webster also wrote on the revision of congenital deformities, including ‘The surgical treatment of the bifid nose’ (1950) ²⁴ and ‘Congenital dermoid cysts of the nose’ published in 1952. ²⁵ It is not surprising that Webster published on birth defects, as a large proportion of his case load in New York consisted of reconstructing cleft lip and palate deformities. The breadth of Webster’s publications is in itself worthy of commendation, and, in an era when plastic surgery was still to some degree experimental, Webster contributed significantly to developing the speciality as a science.

Webster the man

Webster’s professional career was laden with accolades. Both the Chinese and Greek governments decorated him for his work overseas. Webster’s influence in developing the emerging speciality of plastic surgery saw his commendation via an honorary citation in 1958 from the American Society of Plastic and Reconstructive Surgeons and an honorary award in 1973 from the American Society of Plastic Surgeons for his exceptional contributions to the field. Webster’s publication with Martha Gnudi was immediately hailed as a classic of scientific biography, winning them the 1954 William H. Welch Medal of the American Association for the History of Medicine.

But aside from his exceptional academic achievements, lay a warm, friendly, family man. His first wife, Geraldine Rockefeller McAplin died in 1934 during childbirth. Webster had three children with Geraldine, twin boys Jerome and G. Hartley, and an older son Robert J Dellenback. Webster remarried in 1951 to Emily Burne Randall, whom Webster also out-lived; she died in 1965.

Radford Tanzer became Webster’s first senior fellow in plastic surgery at Columbia Presbyterian, and wrote an obituary for the June 1975 edition of the Journal Plastic and Reconstructive Surgery, in which he affectionately described his mentor as ‘a warm and friendly person, an engaging conversationalist and a charming host. Some of his happiest times were spent with his devoted family at their lovely home, “Meadowlawn,” where he delighted in entertaining friends and rollicking with adoring grandchildren’. ² Aside from spending time with his family, Webster’s other loves were watching Trinity Varsity Basketball, whom he followed avidly, and playing golf with friends.