DR JOHN DAVIES (1796 -1872) A Pioneer of Plastic Surgery

 

John Davies Edwards, the son of a ”respectable farmer” was born, on November 9th 1796 at Llanbadarnfawr, a village on the banks of the beautiful River Rheidol, a few miles outside Aberystwyth. Given the time and place of his birth he would, almost certainly, have been Welsh speaking. Known as just John Davies at school he continued with this abbreviated name for the rest of his life. There need not be anything particularly sinister in this – the most probable explanation is that there was already another pupil with the same name.

After leaving school, Davies was apprenticed to Mr W. Evans, a surgeon in Aberystwyth. He then went to London to continue his studies at St. Bartholomew’s Hospital and after qualifying, in 1819, he became an assistant to Dr. William Lloyd Thomas who practised in Hatfield. After a few years Dr. Davies decided the time had come to set up on his own and he moved back to London, to Somers Town, St. Pancras, and during his time there he married Elizabeth, Dr. Wil­ liam Lloyd Thomas’ sister. Davies’ next move was to enter into a partnership with Francis Ray L’Estrange at 189 Tottenham Court Road. This, to quote from his obituaries, “proved unfavourable” and one is left wondering what went wrong. However it was while he was with L’Estrange that Davies performed a pioneering operation whereby a man who was “a most hideous object” was returned to normality.

The rebuilding of noses (rhinoplasty) has been known in India since time immemorial and had been observed and noted by men serving with the East India Company. However an operation of this kind was not carried out in Europe until the early 19th century when Joseph Carpue (1764 – 1846) successfully performed the operation on two army officers. His report on the operations was published in 1816 and was widely reported upon in medical journals with the result his name passed into posterity. The name of Dr John Davies would have become more widely known had he sought more public acclaim. He personally published a small, flimsy 16 page booklet called ”Where an operation for restoring a LOST NOSE was successfully performed” which was available from selected medical booksellers. It was published with a minimum of publicity. Only two copies of the pamphlet are known to exist. One is in America, in the National Library of Medicine, Bethesda and the other was acquired, in 1999, by the Wellcome Library of Medical History, London.

Let us go back to Dr John Davies at work in his surgery at 189 Tottenham Court Road. Early in 1822 he was visited by a Mr Capon who had brought with him his brother Shepherd. Shepherd Capon’s face made him “a most hideous object”. It had been grotesquely disfigured by mercury treatment he had taken to cure syphilis, for that at least the mercury treatment had been successful. To hide the disfigurement Capon wore across his face a large handkerchief immediately below the eyes. This impaired his vision making it difficult for him to work. Also severe damage to his jaw made his speech intelligible to only those who knew him well, with the result he found it very difficult to make a living and support his wife and six children. Obviously the unfortunate man had gone to London desperately seeking medical expertise not available nearer to home.

Dr Davies’ publication describes how the “nasal bones were nearly all gone” and “the upper jawbone entirely destroyed between the two canine teeth”. The front teeth and soft palate were missing and the hard palate was split. Without the necessary support, the remains of Capon’s lips sagged inwards. Davies discussed the problems of the case with his colleagues and was advised not to get involved – advice he chose to ignore. Davies decided to tackle the problem making sure that Capon fully understood what would have to be endured and the risks. On the positive side the would-be patient was strong, healthy and living in a clean, country environment. Shepherd Capon was then told to go home and think very carefully about the whole procedure.

He returned some months later prepared to suffer the ordeal and the operation was set for September 18 at the St. Pancras Infirmary. Once more Dr. Davies and his colleagues discussed the case before deciding how the operation should proceed. The following day, after an examination by the Infirmary’s physician, the operation began. Davies was assisted by Dr. Alexander Barrack, the only one of his colleagues free to help, and with four pupils present. After making the patient sit with his face towards a window (and remember this was before anaesthetics were available), Davies started by working on the lip. To quote from his own words:-

“A piece of integument, large enough to cover the opening, was then dissected out of the side of the face…. leaving a small peduncle for the vessels to enter into it. This piece was twisted down, to cover the deficiency in the lip, and a stitch put into it, in order to retain it in its situation…. an incision was next made on each side of the original nose, and the skin dissected forward, nearly to the edges of the chasm on each side, and then turned inside out and brought together in the middle. A stitch was put in its edges, to retain them together, that they might support the integuments, of which the new nose was to be made……The next step, was to bring down sufficient skin from the forehead, to form the nose. The model of this was already cut out in sticking plaster. This piece of plaster was stuck on the forehead, and the portion of skin covered by it was dissected down, as low as the root of the old nose, between the eyes. A small peduncle was left here to the flap, in which a twist was formed, in order to bring the skin outward. The flap was then brought down over the support which was already made for it, by the integuments turned forward from the sides of the old nose…….three stitches were put on each side….The nostrils were next plugged up with lint, and a compress of old cloth, rolled up, was applied longitudinally on each side of the nose……The wound on the forehead was dressed with adhesive plaster, and a roller was applied moderately tightly all over the face.

The patient bore the operation without a groan, although, as must be supposed, a painful one. His suffering must have been greater, owing to the complicated nature of the operation of his case rendering the operation more tedious, than if the nose alone had been destroyed. Immediately after the operation, he felt very cold. He was put to bed, and a little wine and water given to him”.

That evening Shepherd Capon was taken to his lodgings and three days later the dressings were removed. A number of Davies’ colleagues were present to view the outcome of this ambitious operation. He writes, among other details, that the “nose was as straight as it could be, and presented a well formed bridge” although, quite naturally it was swollen. It was also noted that the patient’s speech had already improved. After six days the stitches were removed and three days later the patient was allowed to return to Suffolk. The nose was now firm and the wound on the forehead had shrunk considerably. Capon was given instructions on how to change the dressings and how to keep the nostrils open with lint, to make sure they did not close as his nose healed and reduced in size. “This man was a most hideous object before he was operated upon; but when he left to return home, very few would have known him to have been the same individual”.

Before returning to Suffolk, Capon was seen by a number of eminent surgeons. Also present was the editor of the ‘London Medical Repository’ which published an article on the operation which Davies had written and to which the editor added praiseworthy comment.

Before long, however, Shepherd Capon was back in London seeking further help. In spite of the enormous improvement to his appearance people still ridiculed him. The scar on his forehead was barely visible and a moustache now concealed the hare-lip but one nostril had closed as he had failed to keep it open with lint plugs as directed. Dr. Davies pondered whether a charitable institution or benefactor could be found to finance the next stage of Capon’s facial improvement for it would have been, as he put it, “a pity to allow the imperfections about the lip and mouth to remain: the cleft in the lip was still of that form which the hare-lip operation could not remedy. “

Dental work was outside John Davies’ field and Capon had very limited resources. However luck was on their side when John Snell, a dentist who had heard of the case, offered his services. By inserting four human teeth into a piece of hippopotamus tooth, Snell was able to recreate the missing section of Capon’s jaw. The new piece was attached to Capon’s own teeth with gold clips. He also made replacement section for the missing part of the lip which he had fashioned out of ivory and coloured to match the original. The two were fitted together with gold pivots. The addition of a false moustache completed the process and it was agreed by all those who saw him that Shepherd Capon now looked normal – the only difference being a very slight change in colouring between the original and the replacement sections. Shepherd Capon remained in London for several months before returning to Suffolk. When he left there was nothing to indicate anything would go wrong in the future and, as far as is known, nothing did.

Meanwhile Davies was having problems with his health and his working relationship with L’Estrange. He and Elizabeth decided to leave London for the country and in about 1827 moved to Hertford. They would have known the town from their Hatfield days and Hertford had the advantage of being near Elizabeth’s brother, who was still practising at Old Place,. North Road, Hatfield, a mere 8 miles or so away. Hertford offered both a lucrative living and a pleasant, bustling place in which to live. The town was surrounded by many large country estates, occupied by noble families, landed gentry and wealthy London bankers and merchants. Hertford itself was home to many affluent professional people and moneyed traders. Also the markets and corn exchange were a focal point for farmers and traders from the more rural areas.

Dr John Davies’ stay in Hertford was a long and active one. His first surgery was in Bull Plain but by the late 1830s he had moved to the more prestigious address of Fore Street where he became a neighbour of Dr Colbeck and then of Dr R. Evans. Evans was also a Welshman – he was born in Pembrokeshire. Like many successful men John Davies promoted his standing in the community by becoming involved with local affairs. Shortly after arriving in Hertford he was appointed Surgeon to the Hertfordshire Militia (the phonetic spelling was always used). This could hardly have been arduous for the militia virtually went into abeyance after the Napoleonic Wars and was not revitalised until 1851. This was when an edict was issued requiring the Lord Lieutenants, who were by ancient tradition responsible for their county’s militia regiments, to recruit members. The Marquess of Salisbury advertised for 800 recruits and new headquarters were built at Hatfield. Davies resigned from this post in 1855. He was also appointed Inspector for Army Recruits – presumably for the regular army.

Dr Davies’ interest in local politics likewise began soon after his arrival in Hertford. He would have served as a councillor for at least a few years before becoming Mayor in 1835, the year the Municipal Act came into being, and he was elected again in 1841 and eight years later he became an Alderman. Politically Davies was a Tory.

Sadly his wife, Elizabeth, died in April 1848 after a “long, suffering illness”. She was 54. No mention is made anywhere of the couple having children. and Davies continued to live at the Fore Street address, together with a resident housekeeper and scullery maid. This, no doubt, explains his increased activity in public affairs when he was appointed medical consultant to various institutions. In 1849 he be­came Physician Extraordinary to the Hertford Infirmary (now the Hertford County Hospital) which was established in 1834. In the same year the Crown appointed him a Borough Magistrate and he also became a Commissioner for Paving. In 1851 he was appointed Surgeon to the County Gaol and House of Correction with an annual salary of £100. Both were incorporated into one site situated in the Ware Road. His obituary in the Hertfordshire Mercury records that he was never taken in by prisoners allegations of ill health to avoid hard labour on the tread mill and was amused by the many excuses that were given. The site is now covered by the Baker Street car park, the WVS headquarters and those of the Red Cross together with the recently closed Salvation Army Citadel. Another post involving the medical care of miscreants was the role of Surgeon to the Hertfordshire Reformatory at Chapmore End near Hertford which was established in 1857. He was also Medical Visitor to the Hadham Lunatic Asylum.

The railway reached Hertford in 1843 and this necessitated the building of an approach road to the planned terminus. The original station for the Hertford East line was opposite the present Great Eastern Tavern, on the site now occupied by Holden Close. The land on either side of the new road was sold for building and Davies bought the plot on which Davies Street is built, hence the name.

Dr John Davies died as a result of a rapid series of epileptic fits. He was taken ill and died the following day, on October 26, 1872. This final paragraph is from his obituary which appeared in the Medical News:-

“He passed a very industrious and useful life. His charities and assistance to the poor by giving the aid of his valuable advice and services were boundless and he worked to the last…….He was most esteemed amongst his patients for his ability and skill, by his friends for his straightforward, sterling honesty and simplicity of character and by his professional associates for the sturdiness with which he maintained his principles. His death will be deeply deplored and his memory long cherished”.

References

I am extremely grateful to Mr John Symons, Curator, Early Printed Books, The Wellcome Library for the History and Understanding of Medicine, London for his permission to use his article ”A Most Hideous Object” : John Davies (1796-18 72 ) and Plastic Surgery, as the basis for this article. His paper appeared in Medical History, 2001, 45: 395-402. ·

Also to Mrs Margaret Harris, of Hertford Museum, for bringing it to my attention and also to Ms Bonny West of HALS for her help. Added information came from the obituaries,.to Dr John Davies that appeared in The Hertfordshire Mercury The Hertfordshire Almanac and the Medical Times and Gazette (kindly supplied by Mr John Symons).