It’s something we take for granted today, reconstructive surgery.
People rebuild, augment, or reduce parts of their bodies by the millions.
100 years ago, though, it was in its infancy, and indeed it was the First World War that
saw the rapid development of modern plastic surgery.
I’m Indy Neidell; welcome to a Great War special episode about plastic surgery and
the First World War.
During the war, weaponry and military technology were leaps and bounds ahead of surgical technology.
This was particularly the case with regard to the faces of soldiers and sailors that
had been damaged by bullets or shrapnel.
If you think about it, trenches protected bodies better than they did heads.
A soldier who peered out over no man’s land could well get a facial injury from an enemy
sniper, though exploding shells and shrapnel were the chief causes of facial damage.
A surgeon from New Zealand named Dr. Harold Gillies, eventually Sir Harold Gillies, studied
medicine at Cambridge and was shocked by the facial injuries he saw in the British Army
Medical Corps.
He took the initiative in plastic surgery and eventually set up a specialist hospital
in London.
Although there were plastic surgery techniques that date back 2,000 years, modern plastic
surgery developed and advanced quite rapidly during the war as Gillies and his team of
surgeons performed some 100,000 operations on around 5,000 men.
Multiple surgeries were required back then in the days before antibiotics when skin grafts
and open wounds had a high rate of infection.
Gillies overcame the infection problem by actually moving living tissue from one part
of the body to another, and this process could take years and many surgeries.
One method involved embedding rib cartilage on the forehead, and when that surgery had
healed the cartilage was swung down to form the nose.
The real trick was to keep the tissue connected to the body’s bloodstream and immune system,
and allow skin to grow its natural waterproof protection.
This sounds pretty radical, doesn’t it?
But perhaps the most revolutionary procedure was the development of the tube pedicle.
This involved forming human tissue into tubes in someplace like the shoulder, and then walking
the tube to the face.
It’s anchored at both ends and then you sever one and reconnect it closer and closer
to the face.
This process was invented by Gillies.
It actually looked like the handle on a piece of luggage and the process of moving it was
called “waltzing” the tube pedicle.
Gillies and his team set up their plastic surgery hospital in Sidcup, south east of
London, and Gillies got a war permit to travel around France to study things there like cosmetic
rhinoplasty.
In the public areas near the Sidcup hospital, blue benches were set up where the wounded
men could sit without the public having to look at them, which protected the patients
from the horrified stares.
And mirrors were not provided for patients because many of them would collapse in shock
at the sight of their own faces.
European surgeons from before the war had a strong influence on Gillies and plastic
surgery, as he acknowledged, though he was the first to practice reconstructive techniques
in Britain.
There were plastic facilities on the continent during war, of course, in places like the
center for Maxillofacial surgery in Lyon, Jacques Joseph’s Section for facial plastic
surgery at Charité Hospital in Berlin, and the Dusseldorf Hospital for the Facially injured,
and August Lindemann was writing publications hoping to improve the facially injured soldiers’
initial frontline care.
Dr. Gillies and his team took loads of before and after photos, and you can find many such
photos searching on the Internet.
What they document is that a soldier, literally with his face blown off, could years later
have a normal looking face.
Again, plastic surgery was still in its infancy so many soldiers did not get a normal looking
face in the end, nor survive the many surgeries.
One success story was Lieutenant William Spreckley, whose face was damaged at Ypres.
He spent over three years at the hospital, and you can see the process of repairing his
face to a normal looking face over the course of multiple surgeries.
Eventually, people could not even tell his face had been reconstructed, and the older
he got the more natural his face looked.
If, for some reason, a disfigured soldier did not get a good result, he was provided
with a mask.
These were usually made with copper or tin and were held on with straps or attached to
eyeglasses.
Sculptors and artists achieved notable success forming and painting the masks to approximate
the color of facial skin.
At Third London General Hospital in Wandsworth, Francis Derwent Wood made metal masks in what
became known as “the Tin Noses Shop”.
Wood made custom designed masks and prosthetic attachments using prewar portraits of his
patients.
American sculptor Anna Coleman Ladd, did pretty much the same thing for French and American
soldiers at her Studio for Portrait Masks in Paris.
Of course, facial expressions were either partly or wholly obscured, though grateful
letters were sent to the makers of the masks because they allowed some soldiers to re-enter
normal life.
And that was a big problem with disfiguring facial wounds, and many of those men had sad
fates.
They referred to themselves as “broken gargoyles”.
Veterans who came home with a mask would quite likely send their own children running in
fear and revulsion and apparently hospitals for amputees were cheerful in comparison to
the facial reconstruction hospital.
Patients leaving the hospital could face serious difficulty in life.
Many sought employment that allowed them to work out of sight of others.
Marriages could break up.
Single men with disfiguring injuries could be unable to find a mate, and social isolation
and shame for these men often resulted.
It is not without some truth to say that for those with these wounds, perhaps the most
horrible wounds of the war, it was a fate worse than death.
A soldier lost his identity, his pride, perhaps his wife, attractiveness in general, the willingness
to work, play, and socialize with other people.
The face is the home to your feelings, personality, emotions, romantic attachment, age, ethnicity,
identity, communications, and more.
And when war takes away someone’s identity, though they survived its battle horrors, you
can really see its true cost.
Alcoholism, isolation, depression, and suicide were the fates of many of these men.
Today, plastic surgeons can quickly work miracles, and there is no question that those miracles
began during the First World War, and many began with Dr. Harold Gillies.
He is very much an unsung hero of the war, and at least there is the consolation that
something good, something very important in our modern world, came out of this war with
all of its slaughter and misery.