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James Barrett Brown (1899-1971), Head and Neck Surgeon of a Half Century Ago
Donald P. Shedd, MD;
Loring W. Pratt, MD
Arch Otolaryngol Head Neck Surg. 2002;128:233-235.
ABSTRACT
This article summarizes the life and work of James Barrett Brown, MD
(1899-1971), a plastic surgeon from St Louis, Mo, whose many contributions
to the knowledge of surgery include his pioneering use of large split-thickness
skin grafts to resurface defects. Along with a coauthor, he published an excellent
book on radical neck dissection in 1954 (Neck Dissections, published by Charles C. Thomas, Springfield, Ill). Brown was a leading
figure in the organization of high-quality plastic surgical care to injured
soldiers in World War II. His training program in plastic surgery at Barnes
Hospital in St Louis provided education to many leaders in the field. He received
a number of honors for his many accomplishments.
INTRODUCTION
It is important to remember the individuals on whose shoulders we stand
as we engage in the care of our patients. James Barrett Brown, MD, was a person
to whom we owe a debt every time we carry out the routine procedure of taking
a split-thickness skin graft. A brief review of his career gives a picture
of a significant contributor to medical knowledge and surgical technique.
BACKGROUND
Dr Brown (Figure 1) was born
the son of a pharmacist in Hannibal, Mo, in 1899.2
His early education was in that city, following which he did his undergraduate
work at Washington University in St Louis prior to matriculating in the school
of medicine of that same university. He ranked high in his class, graduating
in 1923, after which he was accepted for surgical training at Barnes Hospital,
St Louis, where he worked under important figures in the history of American
surgery, including Evarts Graham and Vilray Blair (Figure 2). Dr Blair was one of the first American surgeons of the
20th century to concentrate on head and neck cancer, an interest shared by
Brown who joined Blair in practice in 1925—an association that lasted
until Blair's death in 1955. Other noteworthy surgeons joined that group at
Barnes Hospital, including Louis Byars, Frank McDowell, and Minot Fryer. They
published many articles on head and neck oncology over the years. It is reported
that Joseph Ogura profited from his exposure to their teachings.
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Figure 1. Portrait of James Barrett Brown,
MD. Reprinted with permission from Lippincott, Williams & Wilkins, Baltimore,
Md.1
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Figure 2. Vilray Papin Blair, MD, partner
of Dr Brown.
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CONTRIBUTIONS
Prior to Brown's work, skin grafts had customarily been cut freehand,
a technique that required considerable skill. They were small and very thin,
making them difficult to handle, especially when resurfacing large areas.
Dr Brown's research showed that when cut thicker and larger, skin grafts still
promised good healing at the donor site.3 He
coined the term split-thickness skin graft, borrowing
the terminology from the leather industry. His work in the early 1930s revolutionized
the established concepts of skin grafting, a change that had wide ramifications
throughout the entire field of surgery. The largest impact was in of the care
of thermal burn injury.4-5 After
the introduction first of the mechanical and later the electric dermatomes,
the cutting of grafts became more precise and required less skill and practice
on the part of the operator.
The level of Brown's dedication is manifested by his authorship of more
than 300 articles and 60 book chapters. He was author or coauthor of books
in the following areas:
- Surgery of the face, mouth, and jaws
- Plastic surgery of the nose, including reconstruction of war injuries
- Essentials of oral surgery
- Skin grafting
- Care of thermal burns
- Neck dissection
Albeit small (163 pages), Dr Brown's book on neck dissection cowritten
with Frank McDowell provides a very full account of the subject.6
It includes high-quality color drawings of the stages of the operation, good
coverage of complications of the operation, and a section on combined neck
dissection with jaw resection. All in all, the book provides an excellent
account of the state of the art in a major part of head and neck oncology
as of 1954.
MILITARY ROLE
Dr Brown played a major to role in organizing facilities for the reconstructive
surgical care of war casualties in England in the 1940s.1
He was instrumental in the establishment of a number of plastic surgery centers
in that country. Brown then played a leading role in the establishment of
plastic surgery centers in the United States for care of the returned casualties,
and he directed the one at Valley Forge, Pa. His service at that installation
had as many as 2500 inpatients. Working with him were many individuals who
became leaders in plastic surgery in subsequent years, including Milton Edgerton,
a man who has left a significant imprint on the care of patients with head
and neck cancer. Another coworker of that era was Joseph Murray, who later
received a Nobel prize for his work on renal transplantation.
HONORS
James Barrett Brown was a member of the Society of Head and Neck Surgeons,
and he was among the founders of the American Board of Plastic Surgery, which
he later chaired. Other honors included the following: Vice presidency of
the American College of Surgeons; Presidency of the American Association of
Plastic Surgeons; Presidency of the Western Surgical Association; and Honorary
Award Medal of the American Association of Plastic Surgeons.7
CONCLUSION
The life of James Barrett Brown, MD, is an impressive record of what
a gifted person can achieve if he has a high enough level of dedication. His
accomplishments were not limited to clinical contributions but emcompassed
organizational and educational areas as well. He was a pioneer in the use
of large, split-thickness skin grafts in the care of the burn patient. His
extensive experience in the reconstructive surgery of war wounds singularly
equipped him to plan and carry out reconstructive procedures for cancer patients
left with significant defects as a result of the ablation of their tumors.
He organized the best possible plastic surgical care of war casualties. And
he trained many individuals who subsequently became leaders in the field.
The prestige of plastic and reconstructive surgery as a discipline increased
markedly during and immediately after World War II, and Dr James Barrett Brown
was a major factor in that rise.
AUTHOR INFORMATION
Accepted for publication October 2, 2001.
This biographical sketch was presented at the annual meeting of the
American Head and Neck Society, Palm Desert, Calif, May 15, 2001.
Corresponding author and reprints: Donald P. Shedd, MD, Department
of Head and Neck Surgery, Roswell Park Cancer Institute, Elm and Carlton streets,
Buffalo, NY 14263 (e mail: donshedd{at}prodigy.net).
From the Department of Head and Neck Surgery, Roswell Park Cancer Institute,
Buffalo, NY (Dr Shedd); and Maine General Hospital, Waterville (Dr Pratt).
REFERENCES
1. Kiehn CL. Nomination of Dr. James Barrett Brown for Honorary Fellow in the American
Association of Plastic Surgeons. Plast Reconstr Surg. 1966;38:284-286.
PUBMED
2. McDowell F. James Barrett Brown, M.D., 1988-1971. Plast Reconstr Surg. 1971;48:101-104.
PUBMED
3. Blair VP, Brown JB. The use and uses of large split-thickness skin grafts of intermediate
thickness. Surg Gynecol Obstet. 1928;98:82-97.
4. Cannon B. As I remember James Barrett Brown. Ann Plast Surg. 1981;7:79-83.
PUBMED
5. Blair VB, Brown JB, Hamm WG. Early care of burns. JAMA. 1932;98:1355-1359.
6. Brown JB, McDowell F. Neck Dissections. Springfield, Ill: Charles C. Thomas; 1954.
7. Cannon B. Announcement of award to Dr. J. B. Brown. Plast Reconstr Surg. 1967;40:308-311.
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