The Wilder Side of Skin Grafting

Animals have always been essential to medicine. From cross-species viruses that bring modern pandemics to animal models in research laboratories, the fate of humans appears historically to have been closely bound up with that of other living creatures, often to the detriment of the latter. This was especially so in burns medicine, a field in which animals have historically been sacrificed for the benefit of injured humans. In recent years, they have continued to be burned in great numbers in order to devise and improve therapies designed to reduce scarring. Throughout past centuries, animals have been burned, flayed and consumed in great numbers in efforts to improve practitioners’ knowledge of burns and their abilities to treat them successfully. A conference held in York this spring, entitled ‘Consuming Animals’, appeared the ideal setting in which to present some preliminary findings in this area and enable the ‘Forged by Fire’ team to join a wider discussion on animal-human relations in the past.

The incorporation of animal products into the early modern materia medica of burns is evident in the work of Wilhelm Fabry, otherwise known by his Latin name, Hildanus. Recognised by some as the ‘father’ of German surgery, Fabry was a prolific writer and innovative surgeon. Among his twenty published volumes is De Combustionibus (1607), one of the first books devoted entirely to burns, and one in which he proposed the classification of burns in three degrees. In Chapter 14 of the work, Fabry also described a number of his ‘proven’ scar-softening treatments. Many of these recipes contained animal products, including hen’s grease, goose fat, and bear seame (or fat).

M0018240 Pharmacy: Bear's grease for hair

Bear grease was also used for hair, as these labels from pharmacy jars illustrate. Picture courtesy of Wellcome Images – this and the two other pictures from Wellcome Images used in this blog post are Creative Commons Attribution only licence CC BY 4.0.

Other recipes called for egg yolk, earthworms and even human fat, demonstrating the early modern practitioner’s continued reliance on the hangman for several of their more ‘vital’ ingredients. Some of these items survived in prescriptions into the nineteenth century, including mercury and, perhaps surprisingly, frogs.

Developments in anaesthesia and antisepsis in the middle of the nineteenth century are long recognised to have opened a new era in surgery, let alone burns therapy. The control of pain and infection also led to a period of experimentation and interest in transplantation, often employing animal tissue, and far less known than the physiological experiments that gave rise to the anti-vivisection movement. For example, animal skin was the most common of tissues to be transplanted in the second half of the nineteenth century, primarily in the hopes of finding a substitute for human dermis destroyed by accidents, such as burns and scalds. Among the leaders in this research field was the French-trained Swiss practitioner Jacques-Louis Reverdin (see picture below), who reputedly transplanted the first ‘fresh skin’ allograft. Soon after achieving this goal with human skin, he began to transplant animal skin, variously known as hetero-, xeno-, or zoografting, some of his experiments having been undertaken in the laboratory of famed French physiologist Claude Bernard.

M0010236 Portrait of Jacques Louis Reverdin

Among the most persistent of heterografters, Reverdin employed the skin of rabbits, cats and sheep, and even attempted reciprocal grafts, transplanting human dermis onto animals. His most famous case involved a 21-year-old woman who was scalped as the result of a machine accident and approached Reverdin for help six months later, in 1876, when her wound failed to heal (see image below). Reluctant to donate her own skin, the woman submitted to 50 operations in which Reverdin repeatedly attempted to graft the granulated surface of her scalp with rabbit and dog skin. Although regarded a failure, the experiment inspired others to refine his techniques for the remainder of the century, filling the pages of medical journals and newspapers with experiments which might easily have inspired H.G. Wells to write his novel, The Island of Dr Moreau (1896).

Reverdin1876

Image from Jaques-Louis Reverdin, ‘Ein Fall von Abreissung der Kopfhaut, durch Transplantationen geheilt’, Deutsche Zeitung für Chirurgie, 6 (1876).

Reverdin’s technique is said to have been imported into England by William Bowles in 1872, but within a decade many other practitioners across the country and farther afield were reporting what they, in contrast to Reverdin, described as ‘successful’ attempts to graft human and animal skin. For example, country doctor William Allen, of Leadgate, County Durham, wrote to the Lancet in 1884, describing the use of frog skin to replace the burned dermis of a child brought to him by parents who were hesitant to donate their own skin. As a result of their reluctance, Allen had dispatched the father to collect some frogs, which were available in great numbers, and, more importantly, provided skin that was uniform in thickness and free of fur or feathers. Allen’s correspondence describes the course of the procedure, including the way in which the patterned frog’s skin gradually lost its colour in the days following the transplant and eventually blended with the boy’s own dermis. Interestingly, rather than recognise that the foreign tissue had been destroyed by the boy’s immune system (as would become clearer in the 1940s), Allen speculated that the two types of skin cell had reproduced to form a new ‘breed’ of skin. One can only image how this might have been interpreted by contemporaries and altered the boy’s identity later in life.

Over the next two decades or more, many others repeated such experiments, flaying an array of animals, live and dead, from pigeons to puppies in their efforts to heal human patients. An English army doctor joined this lively debate in the periodical press claiming to have been the first to employ frog skin, describing a procedure he undertook, first on his own foot, then repeated between 300-400 times while in India in the 1880s. Like many who experimented in this area, few ever followed up their cases, or even performed histological studies, eager not to damage skin which had healed only with great difficulty. By the 1910s, however, others began to survey the field in efforts to describe what now seemed more like an embarrassing and cruel past. By this time, the New Zealand-born, Sidcup-based surgeon Harold Gillies was relying on the ‘tube pedicle’ to replace the skin of wounded soldiers and reconstruct their faces. Perhaps few people involved in these operations, however, realised that they, too, were still reliant on animal products, in this case horsehair, catgut and silkworm thread, which were used to suture mouths, noses and eyelids into place. With their reliance on animal products less noticeable than in an earlier age of plastic surgery, discussions now focused on the changing course of reconstructive surgery, and no longer the shifting boundary between humans and their animal cousins.

By Professor Jonathan Reinarz (University of Birmingham)

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