John Reissberg Wolfe (1823–1904): a plastic surgeon in Garibaldi's Army

A new era

The Italian Risorgimento (‘re-awakening’) was an era marked by a search for national identity. This sentiment gained wide support in Scotland and many sympathetic Scots joined Garibaldi's army in the struggle for unification, in which Garibaldi personally led an army of untrained local rebels to victory in Palermo, Sicily, and Naples. Although his forces suffered from lack of equipment, food and money, Garibaldi commanded several Scottish men and women who travelled to Italy to help the popular hero. Curiosity, national self-perception and perhaps even a feeling of identification with Italy prompted the young Scottish surgeon John Wolfe to join the Italian adventure. Wolfe was later credited with having introduced the ‘whole’ or full-thickness skin graft into clinical practice, as described in Wolfe's biography written more than a half-century ago. ¹

A romantic life

Wolfe's colourful life seems to have been taken from a novel. Born in Breslau in 1823, a Hungarian born of good family and brought up in the Protestant faith, he was educated and prepared for the Church. Around 1845 religious troubles arose in his home country and a deputation of the United Secession Church of Scotland was sent to Breslau to investigate the dispute. Influenced by the deputation, Wolfe decided to travel to Scotland. He became Hebrew tutor for Free Church students in the Arts Faculty at the University of Glasgow and graduated MD from Glasgow University in 1856. His name appeared for the first time in the Glasgow Directory for 1853 as JR Wolfe, 4 Cambridge Street. In connection with his work for the Free Church, he travelled with a Presbyterial Certificate to Salonica, Greece, then part of the Ottoman Empire, where he practised for 30 months. Soon Wolfe went to Paris to study ophthalmology and he undertook a surgical practice in the Cliniques of Auguste Nélaton (1807–73), Armand Trousseau (1801–67) and Louis Auguste Desmarres (1810–82). From Paris he contributed a scientific paper, ‘Iridectomy in Glaucoma’, to The Lancet, published on 6 December 1859. In January 1860 he filled the position of Paris correspondent to The Lancet.

A Scottish surgeon in Garibaldi's army

On 15 July 1860 Thomas Wakley (1795–1862), Editor of The Lancet, introduced him to General Giuseppe Garibaldi, writing ‘Dr Wolfe is a highly educated surgeon and he wishes with a generous and noble spirit to offer his services to your Hospitals’. ¹ On 18 July 1860 the treasurer of the Garibaldi Fund, William Henry Ashurst (1819–79), gave him an additional introduction to Garibaldi: ‘My dear General, I have the honour to introduce to you Dr Wolfe, a surgeon eminent in this country, who is desirous of devoting his services to the national cause. He has had considerable experience in Military Hospitals and is the bearer of a large quantity (about 6 Tonnes weight) of the choicest and most useful kinds of Drugs, Surgical Instruments and appliances, for an Army in the Field … ’ It was later announced:

Dr Wolfe is also appointed as Correspondent of the Ladies Committee here for the Relief of the Sick and Wounded, of widows and orphans of your noble army! ²

A Neapolitan outrage

In November 1860 The Lancet reported what it termed ‘A Neapolitan outrage’ namely that John Wolfe ‘had excited the indignation of persons in authority at the hospitals of Garibaldi by frankly describing in this journal the faults of administration, the surgical deficiencies and the general defects of the hospitals he visited in Sicily and Naples’. ¹ Wolfe was placed under arrest and sent to Caserta gaol. Before a council of war he faced charges that he was an adventurer and an unqualified practitioner, and that he had embezzled stores entrusted to him. However, Wolfe had accurately described the faults of the hospitals in the Bourbon area and the charges against him were proven to be false. As a result he was allowed to return to Scotland.

On 28 December1860, before leaving the harbour of Genoa for Britain, Wolfe wrote a letter in Italian to a mutual friend to ask General Garibaldi for few lines of appreciation for his commitment to the struggle for Italian freedom as well as a formal apology for the suffering he had experienced ³ (Figure 1; see the addendum for the authors' translation). In February 1861 Wolfe wrote from Glasgow to the editor of The Lancet a translation of the letter of appreciation he claimed to have received from Garibaldi. It concluded: ‘Now I offer you my hand, and beg to excuse the wrong which you have suffered, and to be assured of my gratitude for all that you have done for the Italian cause.’ ¹ Unfortunately, historical evidence of this letter has not been found apart from Wolfe's purported published translation. However, there does exist and it is published here for the first time, a letter in which Wolfe asks for money from Garibaldi. Wolfe never published in The Lancet his request to General Garibaldi ‘for the payment of salary for 6 months service in your army’ that he wrote on 24 August 1861 from Glasgow to Garibaldi's private home on Caprera. ⁴ Indeed, it was unusual to offer free services for a noble cause and then to ask for payment for it.

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Figure 1

Wolfe's letter (in Italian) to Garibaldi asking for his excuse and gratitude (Museo Centrale del Risorgimento, Roma)

Return to the Civil Service

In 1862 Wolfe obtained a practice in Montrose and in March 1863 he was appointed Ophthalmic Surgeon at the Aberdeen Royal Infirmary. ⁵ In 1868 he applied to fill vacancies as Lecturer in Ophthalmology in the University of Glasgow and as Surgeon at the Glasgow Eye Infirmary. After failing to secure either appointment he established, in his former private residence at 65 Bath Street, the Glasgow Ophthalmic Institution with six beds. This ‘Institution for Diseases and Injuries of the Eyes’ that Wolfe advertised in The Glasgow Herald offered daily consultations free of charge from 14h00 to 16h00. The project aroused considerable local opposition and Wolfe once more found himself in the midst of professional controversy. He obtained local support from the Earl of Stair, from the Lord Provost and from Free Church leaders, and was awarded the post of Lecturer in Anderson College. ⁶ Wolfe directed the operation of the College for the next 25 years during which time he acquired an international reputation. Eventually the original building was enlarged before moving to a new location at numbers 126–146.

Surgeons who practised eyelid surgery wondered whether skin grafts could be used in the treatment of eyelid pathology. In 1875 Wolfe presented a novel technique of full-thickness skin graft. ⁷ He argued that the pedicle of the skin flaps made no contribution at all to the vitality of the flap and this was against the theory of Gaspare Tagliacozzi (1545–99). Indeed healing was complete once he removed all the subcutaneous tissue of the graft. The question arises as to why Wolfe submitted his paper to the British Medical Journal and not to The Lancet since Wolfe had been The Lancet correspondent from Paris and Italy only a few years earlier. In fact, on 15 October 1870 George Lawson (1831–1903), a British surgeon with the Royal London Ophthalmic Hospital, operated on a patient with a complete ectropion of the upper eyelid, applying an autologous full-thickness skin graft. In two weeks the wound was healed and Lawson concluded that full-thickness grafts were able to heal provided they were applied carefully.

In 1870 Lawson published two papers related to this topic ^8,9 and hence Wolfe's assertion to be the first to transplant successfully a full-thickness graft was simply not true, even though he is still credited for cutting the first ‘whole’ skin graft that was popularized later by Fedor Krause (1857–1937). ¹⁰

In 1882 an anonymous reporter wrote that a patient with ectropion was operated with full-thickness skin grafts. It was noted in the paper that the operation was performed by the method that Lawson had described in 1870 and in the following years. ^11–13 Wolfe immediately wrote a letter to the editor of The Lancet ¹⁴ stating that he had introduced this operation and that his operation differed from Lawson's ‘in principle and practice’. The editors replied that they had been unable to discover any difference ‘in principle and practice’ between Lawson's method and Wolfe's. Lawson ignored Wolfe's letter completely. The historical evolution of free skin grafts is reviewed elsewhere. ¹⁵

Conclusion

John Wolfe was a professional migrant, probably an adventurer and surely a hero of the type portrayed by Robert Louis Stevenson (1850–94). His professional profile deserves appreciation not only for the skin-graft technique he popularized, but also for the Ophthalmologic Institution he organized and ran for many years. It is a pity that the Sighthill Cemetery in Glasgow where he is buried is in a bad state of repair with hundreds of gravestones fallen down. However we must pay tribute to the heir of Tagliacozzi's reconstructive technique and to an ante litteram genius of professional surgical marketing saying, as medical historians and as plastic surgeons, that even if a narcissistic physician could be as dangerous as a dysmorphobic patient it is still a valuable quest to promote the progressive homogenization of an international scientific community.