Early Plastic Surgery Education in the United States through the Lens of Dr. Jerome P. Webster's Case Logs: 1943-1948.

Abstract

Jerome P. Webster, known as the "father of plastic surgery education" in the United States, established Columbia University's first plastic surgery professorship and residency program. His educational philosophy was shaped by formative training with William Halsted, Sir Harold Gillies, and Vilray Blair, combined with World War I service and international teaching experience. This study examines Webster's case logs from 1943-1948, digitized from the Columbia University Medical Center Archives, to understand his educational approach and surgical practice. We categorized 820 documented procedures by type, anatomical location, and reconstructive technique while analyzing accompanying illustrations and patient notes. Webster's practice focused primarily on head, face, and neck procedures (51.6%), with ear reconstruction (107 cases), nasal procedures (94 cases), and lip repairs (46 cases) predominating. Hand and upper extremity procedures constituted 15.3% of cases, while breast and torso procedures accounted for just 5.5%. Common surgical techniques included split-thickness grafting (57 cases), pedicle flaps (121 cases), and tube pedicles (28 cases). Major etiologies included burn reconstruction (13.7%), congenital anomaly correction (8.7%), and scar revision (16.3%). Webster's educational methodology emphasized detailed visual documentation through illustrations co-created with painter Ivan Webster, hands-on technical training, and systematic recording of clinical judgment through resident notes. His approach established foundational principles that continue to influence contemporary plastic surgery training, demonstrating that the field was grounded in achieving functional and aesthetically adequate reconstruction rather than being purely anatomically focused.