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11 Weird Old-School Plastic Surgery Techniques

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Despite its common usage as a term to mean "artificial" or "cosmetic," plastic surgery derives from the Greek πλαστικός (plastikos), which means "to mold or give form." Modern plastic surgery encompasses both cosmetic and reconstructive surgery, and has a history that goes much further back than our modern movie stars and beauty obsessions.

1. Egypt, 1200 B.C.E.: Post-Mortem Modifications

Catalogue General Antiquites Egyptiennes du Musee du Caire; The Royal Mummies. G. Elliot Smith, 1912. 

The first plastic surgery wasn't done on living beings, but was considered crucial to the Egyptians who were mummified. In the afterlife, the only physical feature believed to be completely retained was the facial structure, but mummification dried the body such that the face was often unrecognizable. Ramses II was known for his elongated nose, so to ensure he would be recognized as a king in the afterlife, bone and seeds were surgically inserted under the skin of his nose after the desiccation of mummification, to restore and exaggerate its original shape.

2. India, 600 B.C.E.: Nose Reconstruction


Science Direct

In an era where cutting off the nose of an adulterer or crook was a common punishment, one doctor sought to encourage forgiveness and decrease public shaming of criminals. Sushruta wrote of many corrective surgeries, including the ear surgery pictured above, in Sushruta Samhita (Sushruta's compendium), but focused on nasal reconstruction. His method involved cutting a flap of skin from the cheek to cover the mutilated area. He then inserted two reeds or tubes, to ensure the nostrils didn't heal closed, rubbed the new nose with an abrasive powder, and dressed it in clean cloth, which irritated it and caused it to start healing. Later Indian surgeons used an attached skin flap from the forehead, which they then rotated down, to cover the mutilated nose.

3. Rome, 1st century B.C.E. -  5th century C.E.: Body Modification

Romans were notorious for their idolization of the perfect body, and viewed congenital and injury-based deformities with suspicion and mockery. Aulus Cornelius Celsus, in De re Medicina (14-37 C.E.), described surgeries that hid scars on the back, reduced gynecomastia (increased breast tissue in males), repaired genital deformities, and used skin flaps to fix nasal and ear-lobe injuries. Celsus' work remained the primary reference guide for plastic surgery for the next 1700 years.

4. Rome, 129-216 C.E.: Eyelid Adjustment and Early Nose Jobs

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Increased obsession with the body during the time of Galen led to even more advances in plastic surgery. Blepharoplasty (adjustment of the eyelids) was used to fix persistently drooping or squinting eyes. There is also evidence that Galen performed aesthetic rhinoplasties on the wealthy, which is the first time purely cosmetic plastic surgery was described. Unfortunately, only 20 of Galen's 600 texts survive, so the procedures he used are not known, and his plastic surgery is only briefly mentioned. 

Between 7th-14th century C.E., the spread of Christianity throughout Europe during the Middle Ages led to surgery being deemed "sinful" and "pagan." The power a surgeon had to spill blood and modify the body was almost akin to magic. This belief was established near the fall of the Roman empire, but was formally declared by Pope Innocent III in the 12th century. Modifying the human body was a punishable offense.

5. Sicily, 1415: The Indian Method to the Italian Method


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Against the law of the church, surgeon Branca de'Branca used the "Indian method" to restore the nose of a man who lost his in a duel. His son Antonio Branca improved upon the method, using a flap of skin from the upper arm to restore the nose. Though it left less scarring, the method required holding the arm behind the head for 20 days, which was incredibly uncomfortable. Antonio's method became known as the "Italian method."

6. Turkey, 1465: Treating Facial Fractures

MuslimHeritage.com

Şerefeddin Sabuncuoğlu published Cerrahiyyet’ül Haniyye (Imperial Medicine) at the age of 80. In addition to being the first illustrated text on pediatric surgery, many of Celsus and Galen's plastic surgery methods were included. Many of the old Greek and Roman texts made their way to the Islamic world, and were preserved despite the attempts to destroy them in Europe. Sabuncuoğlu also illustrated treatment of facial fractures to avoid deformity as they healed.

7. 1597: The Italian Method, Continued


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Gaspare Tagliacozzi wrote Die Curtorum Chiurgia, detailing and illustrating the "Italian method" of nasal reconstruction developed by Antonio Branca. By this point in history, syphilis (and its "cures") had erupted as a major cause of deformity in Europe, and Tagliacozzi made a name for himself reconstructing noses and lips that were destroyed by disease or injury. However, the noses he formed from the skin of the arm did not always "take" well, and would occasionally come off if blown or struck too hard.

8. Europe, 17th-18th centuries: Early Rhinoplasty

Science Museum

Shortly after Tagliacozzi's death, the counterreformation came down harshly on surgery, and it was once again a punishable offense to the Catholic church. Surgery continued in the East, however, and in 1794, two British surgeons residing in India witnessed the "Indian rhinoplasty" being performed on a former prisoner who'd had his nose cut off in punishment. Shortly after continental surgeons began performing this procedure back in Europe, Karl Ferdinand von Graefe published Rhinoplastik. This was the first use of "plastic" in reference to reconstructive surgery, and the first known use of the term "rhinoplasty." Von Graefe used the Indian method for many patients, and developed a method to create a nose on the patient's arm, before transplanting it onto the face. Like Tagliacozzi's method for nasal reconstruction, this nose could come off if blown too hard.


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10. Virginia, USA, 1820s-40s: Reconstructive Surgery

Wiki.UIowa.Edu

John Peter Mettauer and his sons established a thriving practice in Prince Edward County, VA, first specializing in repairing genital anomalies, and later working in all fields of reconstructive surgery. In 1827, John Mettauer performed the first successful hard cleft palate repair in the Americas. The use of "bone flaps" (previously only skin and muscle had been transplanted) was a significant step forward in major reconstructive surgery. The innovative techniques and tools that Dr. Mettauer devised, and a life dedicated to his craft, have led to him being considered "America's first plastic surgeon."

11. London, 1910s-1950s: Reconstructing Facial Features and Sex Change Operations

Harold Gillies and his team at The Queen's Hospital at Sidcup used skin flaps from unaffected parts of the body to reconstruct facial features on soldiers from both World Wars. Harold Gillies also performed one of the first female-to-male sex change operations in 1946, and the first modern male-to-female sex change operation in 1951, using what he learned about pedicles and flaps by reconstructing the faces of soldiers. The "flap" procedure used in the male-to-female operation was the standard for over 40 years.

Sources: National Geographic News; "History of plastic surgery in India." J Postgrad Med 2002;48:76; Aspects of the history of plastic surgery since the 16th century. J Royal Soc Med 1983;76:152 [PDF]; Berke, Andreas; Vogel, Wolfgang. Brief History of Vision and Ocular Medicine;The History of Plastic Surgery; Beautiful Body: A History of Plastic Surgery; BBC; A Sketch of Dr. John Peter Mettauer.

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Food
The Gooey History of the Fluffernutter Sandwich

Open any pantry in New England and chances are you’ll find at least one jar of Marshmallow Fluff. Not just any old marshmallow crème, but Fluff; the one manufactured by Durkee-Mower of Lynn, Massachusetts since 1920, and the preferred brand of the northeast. With its familiar red lid and classic blue label, it's long been a favorite guilty pleasure and a kitchen staple beloved throughout the region.

This gooey, spreadable, marshmallow-infused confection is used in countless recipes and found in a variety of baked goods—from whoopie pies and Rice Krispies Treats to chocolate fudge and beyond. And in the beyond lies perhaps the most treasured concoction of all: the Fluffernutter sandwich—a classic New England treat made with white bread, peanut butter, and, you guessed it, Fluff. No jelly required. Or wanted.

There are several claims to the origin of the sandwich. The first begins with Revolutionary War hero Paul Revere—or, not Paul exactly, but his great-great-great-grandchildren Emma and Amory Curtis of Melrose, Massachusetts. Both siblings were highly intelligent and forward-thinkers, and Amory was even accepted into MIT. But when the family couldn’t afford to send him, he founded a Boston-based company in the 1890s that specialized in soda fountain equipment.

He sold the business in 1901 and used the proceeds to buy the entire east side of Crystal Street in Melrose. Soon after he built a house and, in his basement, he created a marshmallow spread known as Snowflake Marshmallow Crème (later called SMAC), which actually predated Fluff. By the early 1910s, the Curtis Marshmallow Factory was established and Snowflake became the first commercially successful shelf-stable marshmallow crème.

Although other companies were manufacturing similar products, it was Emma who set the Curtis brand apart from the rest. She had a knack for marketing and thought up many different ways to popularize their marshmallow crème, including the creation of one-of-a-kind recipes, like sandwiches that featured nuts and marshmallow crème. She shared her culinary gems in a weekly newspaper column and radio show. By 1915, Snowflake was selling nationwide.

During World War I, when Americans were urged to sacrifice meat one day a week, Emma published a recipe for a peanut butter and marshmallow crème sandwich. She named her creation the "Liberty Sandwich," as a person could still obtain his or her daily nutrients while simultaneously supporting the wartime cause. Some have pointed to Emma’s 1918 published recipe as the earliest known example of a Fluffernutter, but the earliest recipe mental_floss can find comes from three years prior. In 1915, the confectioners trade journal Candy and Ice Cream published a list of lunch offerings that candy shops could advertise beyond hot soup. One of them was the "Mallonut Sandwich," which involved peanut butter and "marshmallow whip or mallo topping," spread on lightly toasted whole wheat bread.

Another origin story comes from Somerville, Massachusetts, home to entrepreneur Archibald Query. Query began making his own version of marshmallow crème and selling it door-to-door in 1917. Due to sugar shortages during World War I, his business began to fail. Query quickly sold the rights to his recipe to candy makers H. Allen Durkee and Fred Mower in 1920. The cost? A modest $500 for what would go on to become the Marshmallow Fluff empire.

Although the business partners promoted the sandwich treat early in the company’s history, the delicious snack wasn’t officially called the Fluffernutter until the 1960s, when Durkee-Mower hired a PR firm to help them market the sandwich, which resulted in a particularly catchy jingle explaining the recipe.

So who owns the bragging rights? While some anonymous candy shop owner was likely the first to actually put the two together, Emma Curtis created the early precursors and brought the concept to a national audience, and Durkee-Mower added the now-ubiquitous crème and catchy name. And the Fluffernutter has never lost its popularity.

In 2006, the Massachusetts state legislature spent a full week deliberating over whether or not the Fluffernutter should be named the official state sandwich. On one side, some argued that marshmallow crème and peanut butter added to the epidemic of childhood obesity. The history-bound fanatics that stood against them contended that the Fluffernutter was a proud culinary legacy. One state representative even proclaimed, "I’m going to fight to the death for Fluff." True dedication, but the bill has been stalled for more than a decade despite several revivals and subsequent petitions from loyal fans.

But Fluff lovers needn’t despair. There’s a National Fluffernutter Day (October 8) for hardcore fans, and the town of Somerville, Massachusetts still celebrates its Fluff pride with an annual What the Fluff? festival.

"Everyone feels like Fluff is part of their childhood," said self-proclaimed Fluff expert and the festival's executive director, Mimi Graney, in an interview with Boston Magazine. "Whether born in the 1940s or '50s, or '60s, or later—everyone feels nostalgic for Fluff. I think New Englanders in general have a particular fondness for it."

Today, the Fluffernutter sandwich is as much of a part of New England cuisine as baked beans or blueberry pie. While some people live and die by the traditional combination, the sandwich now comes in all shapes and sizes, with the addition of salty and savory toppings as a favorite twist. Wheat bread is as popular as white, and many like to grill their sandwiches for a touch of bistro flair. But don't ask a New Englander to swap out their favorite brand of marshmallow crème. That’s just asking too Fluffing much.

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The Hospital in the Rock
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History
Budapest’s Former Top-Secret Hospital Inside a Cave
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The Hospital in the Rock

At the top of a hill in Budapest, overlooking the Danube River, sits Buda Castle, a gorgeous UNESCO World Heritage site visited by thousands of tourists every year. Directly underneath the castle, however, lies a less-frequented tourist attraction: a series of ancient, naturally formed caves with a colorful and sometimes disturbing history.

The entire cave system is over six miles long, and most of that has been left unchanged since it was used as cold storage (and a rumored dungeon) in the Middle Ages. Between 1939 and 2008, however, a half-mile stretch of those caves was built up and repurposed many times over. Known as Sziklakorhaz or The Hospital in the Rock, its many uses are a testament to the area’s involvement in World War II and the Cold War.

At the start of World War II, the location served as a single-room air raid center, but operating theaters, corridors, and wards were quickly added to create a much-needed hospital. By early 1944, the hospital had officially opened inside the cave, tending to wounded Hungarian and Nazi soldiers. After less than a year of operation, the facility found itself facing its largest challenge—the Siege of Budapest, which lasted seven weeks and was eventually won by Allied forces on their way to Berlin.

As one of the few area hospitals still operational, the Hospital in the Rock was well over capacity during the siege. Originally built to treat around 70 patients, close to 700 ended up crammed into the claustrophobic caves. The wounded lay three to a bed—if they were lucky enough to get a bed at all. Unsurprisingly, heat from all those bodies raised the ambient temperature to around 95°F, and smoking cigarettes was the number one way to pass the time. Add that to the putrid mix of death, decay, and infection and you’ve got an incredibly unpleasant wartime cocktail.

A recreation inside the museum. Image credit: The Hospital in the Rock 

After the siege, the Soviets took control of the caves (and Budapest itself) and gutted the hospital of most of its supplies. Between 1945 and 1948, the hospital produced a vaccination for typhus. As the icy grasp of the Cold War began to tighten, new wards were built, new equipment was installed, and the hospital was designated top-secret by the Soviets, referred to only by its official codename LOSK 0101/1.

Eleven years after facing the horrors of the Siege of Budapest, in 1956, the hospital hosted the casualties of another battle: The Hungarian Uprising. Thousands of Hungarians revolted against the Soviet policies of the Hungarian People’s Republic in a fierce, prolonged battle. Civilians and soldiers alike lay side-by-side in wards as surgeons attempted to save them. During the uprising, seven babies were also born in the hospital.

Surgeons lived on-site and rarely surfaced from the caves. The hospital’s chief surgeon at the time, Dr. András Máthé, famously had a strict "no amputation" rule, which seemed to fly in the face of conventional wisdom, but in the end reportedly saved many patients' lives. (Máthé also reportedly wore a bullet that he’d removed from a patient’s head on a chain around his neck.)

The Hospital in the Rock ceased normal operations in December 1956, after the Soviets squashed the uprising, as the Soviets had new plans for the caves. With the Cold War now in full swing, the still-secret site was converted into a bunker that could serve as a hospital in case of nuclear attack. Diesel engines and an air conditioning system were added in the early '60s, so that even during a blackout, the hospital could still function for a couple of days.

The Hospital in the Rock

The official plan for the bunker was as follows: In the event of a nuclear attack, a selection of doctors and nurses would retreat to the bunker, where they would remain for 72 hours. Afterward, they were to go out and search for survivors. Special quarantined rooms, showering facilities, and even a barbershop were on site for survivors brought back to the site. (The only haircut available to them, however, was a shaved head; radioactive material is notoriously difficult to remove from hair.)

Thankfully, none of these nuclear procedures were ever put into practice. But the hospital was never formally decommissioned, and it wasn’t relieved of its top-secret status until the mid-2000s. For a while, it was still being used as a storage facility by Hungary’s Civil Defense Force. The bunker was maintained by a nearby family, who were sworn to secrecy. In 2004, it was decided that responsibility for the site fell solely on St. John’s Hospital in Budapest, who were seen as the de facto owners in the wake of the collapse of the Soviet Union.

By 2008 the bunker was renovated, refurbished, and ready to be opened to the public. Today it operates as a museum, with exhibits detailing life in the hospital from various periods of its history, as well as the history of combat medicine as a whole. The sobering hour-long walk around the hospital concludes with a cautionary gaze into the atrocities of nuclear attacks, with the final walk to the exit featuring a gallery of art created by survivors of the Hiroshima and Nagasaki bombings.

Another part of the caves beneath Buda Castle. Image credit:Sahil Jatana via Flickr // CC BY-NC 2.0

The caves beneath Buda Castle have certainly had a bumpy history, and walking through them now is chilling (and not just because they keep the temperature at around 60°F). A tour through the narrow, oppressive hallways is a glimpse at our narrowly avoided nuclear future—definitely a sobering way to spend an afternoon.

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