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PLASTIC surgery has been likened to a phoenix arising anew from the ashes of war. Indeed, the late Dr. Jerome P. Web­ ster said that the story of plastic surgery was the story of military surgery. Everyone is familiar with the Army Instructional Courses in Plastic Surgery taught by Dr. Webster during World War II, which inspired many of our current leaders in plastic surgery. Most people in the audience realize that great advances in plastic surgery were made by such giants as Vilray Blair, Robert Ivy, Harold Gillies, and Varstad Kazanjian as a result of World War I. Some people might recognize the name Gurdon Buck and, as a result of Dr. Richard Stark's research, we know what plastic surgical feats Buck achieved during and after the American Civil War. However, few people realize that it was Joseph Con­ stantine Carpue (Fig. 1 ), the first military plastic surgeon, who was responsible for the renaissance of plastic surgery 160 years ago. Joseph Constantine Carpue was born into a Catholic family in London on May 4, 1764. His early career goals were uncertain, for at various times he wanted to be a priest, a bookseller, and a lawyer. He seemed to fulfill the require­ ments for a medical career described by a former president of Yale University; namely, that a person went into medi­ cine because he was too stupid for law, too lazy for business, and too immoral for the ministry. At the age of 32, Carpue enrolled at St. George's Hospital on August 5, 1796 as a pupil of surgeon Everard Home, John Hunter's son-in-law.3 Apparently, Carpue did well as Mr. Home's pupil because, at the end of a year, Home offered Carpue 500 pounds a year to remain as his assistant and clinical clerk.2 However, Carpue probably realized that, as a Catholic, his chances of being appointed Surgeon to St. George's Hospital someday were nil and, instead of accepting Mr. Home's offer, he joined the Army and was immediately appointed Staff Surgeon to the Duke of York's Hospital in Chelsea, a posi­ tion he would hold for a dozen years. The Lancet tells us, "His career as a lecturer on anatomy commenced in the year 1800 in the following manner. While at the York Hospital, he omitted no opportunity of perfecting his acquaintance with anatomy, and a gentleman, who was then studying medicine, one day said to him, 'I wish I knew anatomy as well as you, Carpue,' to which Carpue replied, 'If you desire it I will teach you.' They then set to work diligently, and the result was so satisfactory to the pupil, Mr. Norman, that he insisted on the acceptance of 20 guineas by his teacher. This circumstance suggested to Mr. Carpue the first idea of

Conceptualization of the problem in reduction of the large breast is defined. A technique for reduction mammaplasty is presented based on: (1) the Wise-type pattern, (2) wide undermining of skin flaps with definitive sculpting of the breast parenchyma, and (3) utilization of hypotensive anesthesia. A series of 63 patients is presented in which this technique was utilized.

The reconstructive surgeon experienced in the use of rotated or free muscle and myocutaneous flaps, skilled in microvascular surgery, and interested in lower extremity trauma, may favorably alter the course of management of these historically difficult problems. It can be of great advantage to the patient if this surgeon is involved in the primary evaluation, so that all initial therapy can be performed with the future reconstructive goals in mind.