Compiled by Harold Gillies, this training manual was published after the end of World War One for surgeons wishing to specialise in plastic surgery.
British plastic surgery
In the early 20th century, plastic surgery (the repair and reconstruction of missing, or damaged, tissue and skin) was still in its infancy and operations were generally performed by general surgeons. In World War One, head and facial injuries became more common. This was partly due to the type of cover that a trench provided, which meant that the soldier's face was often the most vulnerable part of their body. Bullets had also changed from their traditionally rounded shape, to a pointed shell which embedded itself into the flesh, as well as dragging in dirt and clothing. Due to medical advancements more soldiers were surviving these injuries, but with severe disfigurements to their faces.
In 1916, plastic surgery was recognised as a specialist field – for the first time in British history – when a new unit was established in Britain at the Cambridge Military Hospital in Aldershot.
Harold Delf Gillies
At the helm of this new unit was Harold Delf Gillies, an ears, nose and throat specialist from New Zealand, who campaigned for the specialised treatment of facial injuries after working at hospitals along the Western Front in 1915.
To ensure that the unit had patients, Gillies bought a large quantity of labels printed with ‘Faciomaxilliary injury – Cambridge Hospital, Aldershot’ and sent them to CCSs (Casualty Clearing Stations) in France to be pinned to the wounded. As a direct result, soldiers with facial injuries began to arrive at Aldershot within a few weeks. Soon, the facilities and capacity of Gillies’s unit proved to be insufficient to deal with the high volume of arrivals. For instance, after the first fortnight of the Battle of the Somme (July 1916), an overwhelming 2,000 patients were transported to the hospital for treatment of facial injuries. In response, larger purpose-built facilities were constructed at the Queen’s Hospital, Sidcup.
Plastic Surgery of the Face
Published in 1920, Plastic Surgery of the Face is Gillies’s record of his work throughout the war. His aim was to disseminate the key skills, lessons and techniques that he had honed during his treatment of over 5,000 patients. This is significant as here, with no orthodox training in plastic surgery, Gillies is establishing the principles and practice of the repair to deformities of the face.
Chapters are divided along the lines of facial features (cheek, lip, nose and eyes), each of which are illustrated by case studies. These studies follow a general pattern of addressing the cause of the wound, the healed condition, stages of treatment and a reflection on the final result.
The sheer volumes of case studies, and their varied results, demonstrate the experimental nature of Gillies’s work. The techniques he employed included skin grafts, body tubes and the use of prosthesis. The advent of antiseptic surgery and anaesthesia made these complex operations possible.
This book reveals that results were not immediate and varied in success. For instance, treatment could take anywhere from six months to three years, and some patients were deemed fit enough to return to service, while others were left with a permanent disability. These conclusions were largely dependent on the type of wound sustained in the first place.
- Full title:
- Plastic Surgery of the Face; based on selected cases of war injuries ... With original illustrations ... With chapter on The Prosthetic Problems of Plastic Surgery by Capt. W. Kelsey Fry ... and remarks on Anaesthesia by Capt. R. Wade
- 1920, London
- Hodder & Stoughton
- Book / Photograph / Image
- Harold Gillies
- © The Gillies Family
- Usage terms
Harold Delf Gillies: You may not use the material for commercial purposes. Please credit the copyright holder when reusing this work.
Sidney Walbridge [photographer]: Public Domain.
- Held by
- British Library
- Article by:
- Louise Bell
- Wounding and medicine
The scale of the fighting during World War One as well as the kinds of injuries sustained meant that doctors and scientists had to develop new ways of treating patients. Louise Bell looks at some of the key medical technologies that emerged during the war.