Anesthetics
Poppies were used for anesthesia, and records still exist of opium preparations being used in those three civilizations. Alcohol and various herbal decoctions were also used. A big problem with anesthesia was coming up with the right strength. If it was too weak it was not helpful; if it was too strong, it was lethal.

Morphine, a purified form of opium, was developed in 1804 in Germany. At first it was used as a cure for opium and alcohol addiction, until people found it was even more addictive than those two substances. After hypodermic needles were developed in 1853 it became used for anesthesia, and standardization of anesthetic dosage became possible. This was the beginning of our modern pharmaceutical industry.

In the nineteenth century effective and controllable anesthetics were investigated by dentists as well as physicians, resulting in nitrous oxide, ether, chloroform, cocaine, and lidocaine.

Infection control
Until the nineteenth century, surgeons did not realize that hand-washing or changes of clothing were desirable. The existence of bacteria was unknown, and only gradually with much controversy was it eventually established. Sterile technique was introduced over great opposition from the medical establishment. Eventually, penicillin was discovered and brought into medical use. During WW II, it was very helpful in controlling infection and reducing the deaths and amputations that would otherwise have resulted from infection.

In fact, both WW I and WW II gave many opportunities for doctors to learn about plastic surgery. Explosive weapons caused drastic facial and head injuries and physicians all over Europe were pushed into more innovation and experiment that lead to far more knowledge and expertise.

The term plastic
Plastic, as in plastic surgery comes from the Greek word plastikos, meaning to mold, or to give form to something. It does not mean "fake" or "artificial". That is a connotation that has grown up in recent years, resulting from plastic flowers, plastic jewelry, etc.

If plastic surgery (or its sub-specialty, cosmetic surgery) results is a "fake" look, then it has been overdone, or done poorly.

Board certification
The American Society of Plastic Surgeons (ASPS) was founded in 1931, to allow physicians to communicate more easily, and learn from each other. Soon after, the American Board of Surgery established the American Board of Plastic Surgery (ABPS). This is the board which now certifies doctors as being qualified Plastic Surgeons.

Since the 1930s, plastic surgery has continued to innovate and improve, and to communicate more with the general public. Plastic surgery can be done for two reasons:
·To repair an injured or genetically defective feature, such as a deformed hand
·To enhance a feature for greater attractiveness, such as breast implants to create a better-proportioned body shape