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Sir Harold Delf Gillies (17 June 1882 – 10 September 1960) was a New Zealand-born, and later London-based, otolaryngologist who is widely considered the father of plastic surgery. The horrific new injuries that came with the First World War led to the pioneering work in plastic surgery by Harold Gillies, a special kind of war hero.

Sir Harold Delf Gillies (17 June 1882 –- 10 September 1960) was a New Zealand-born, and later London-based, otolaryngologist who is widely considered the father of plastic surgery. The horrific new injuries that came with the First World War led to the pioneering work in plastic surgery by Harold Gillies, a special kind of war hero.

How do you Fix a Face That’s Been Blown Off by Shrapnel?

While the emotional repercussions of war aren’t easy to measure, photos of soldiers who went home injured after WWI tell a pretty unsettling story

Warning Some Images Maybe Disturbing.

Over a million soldiers died in World War One, and double that amount went home injured. For many of those lucky enough to return, the wounds they had suffered in Europe would leave them permanently disfigured.

The trenches protected the bodies of soldiers, but in doing so it left their heads vulnerable to enemy fire. Soldiers would frequently stick their heads up above the trenches, exposing them to all manner of weapons.

At the start of the war, little consideration was given to the trauma of facial injuries. It came as something of a surprise that so many victims survived to the point of treatment. Escaping the war with your life was seen as reward enough. The advent of plastic surgery would radically change that perception.

The biggest killer on the battlefield and the cause of many facial injuries was shrapnel. Unlike the straight-line wounds inflicted by bullets, the twisted metal shards produced from a shrapnel blast could rip a face off.

Not only that, but the shrapnel’s shape would often drag clothing and dirt into the wound. Improved medical care meant that more injured soldiers could be kept alive, but urgently dealing with such devastating injuries was a new challenge.

Harold Gillies was the man the British Army tasked with fixing these grisly wounds. Born in New Zealand, he studied medicine at Cambridge before joining the British Army Medical Corps at the outset of World War One.

Gillies was shocked by the injuries he saw in the field, and requested that the army set up their own plastic surgery unit.

Warning Some Images Maybe Disturbing.

Soon after, a specifically-designed hospital was opened in Sidcup. It treated 2,000 patients after the Battle of the Somme alone. Here Gillies would do some of his finest work.

Previously viewed with suspicion, facial reconstruction became an integral part of the post-war healing process. However, in a world before antibiotics, going under the knife for an experimental form of surgery posed as many risks as the trenches themselves.

The war led surgeons to attempt ground-breaking procedures, which paved the way for modern plastic surgery.

When you are trying to devise techniques for things that have never been done before, you have to experiment, and you experiment in different ways.

You try different techniques, but by pulling everyone together into the same place, everyone has the opportunity to learn.”

Dr Harold Gillies set up a multi-disciplinary team of surgeons, nurses and artists at what was then the Queen’s Hospital in Sidcup, south-east London. The team worked together to try to repair the devastating injuries of war, using grafted flaps of skin and transplanted rib bones.

Sir Harold Gillies (far left) developed new medical techniques to reconstruct the faces of WWI soldiers.

Sir Harold Gillies (far left) developed new medical techniques to reconstruct the faces of WWI soldiers.

Harold Delf Gillies was born at Dunedin, New Zealand, on 17 June 1882, the son of Robert Gillies, a surveyor, and his wife, Emily Street, a niece of Edward Lear, the nonsense writer and landscape painter. Robert Gillies was a member of the House of Representatives in 1884 and 1885. He died in 1886, two days before Harold’s fourth birthday. Harold Gillies attended Wanganui Collegiate School between 1895 and 1900. He was a school prefect and played cricket for the First XI. On leaving school he studied medicine at Gonville and Caius College, Cambridge University, and won university blues for rowing and golf. He later played golf for England. After clinical training at St Bartholomew’s Hospital, London, Gillies qualified in 1908. He became an FRCS in 1910 and specialised in ear, nose and throat surgery.

On 9 November 1911 Gillies married Kathleen Margaret Jackson, at London. During the First World War he served with the Royal Army Medical Corps, and in France was influenced by Hippolyte Morestin, a brilliant French surgeon treating injuries of the face and jaw. Gillies successfully urged upon the army authorities the need for special care in this field and a unit was set up in England under his command. By the end of the war some 11,000 patients had passed through his hands. He was made a CBE in 1920.

Gillies applied the lessons learned in war to civilian casualties and extended the techniques of plastic and reconstructive surgery. His first book, Plastic surgery of the face, was published in 1920. In hospital and Harley Street practice, and as consultant to the armed forces, he created almost single-handedly the specialty of plastic surgery. He combined technical skill with an imaginative and ingenious mind, unhindered by preconceived ideas. One of his innovations was the multidisciplinary team; for example, when operating on a face he ensured that a dental surgeon was on hand. And, because surgery on damaged faces was impossible when a mask was used to anaesthetise the patient, he encouraged anesthetists to develop alternative techniques, such as using a tube in the trachea.

Plastic surgery theatre, Queen Mary Hospital, 1917. Gillies is seated on the right. Permission: Andrew Bamji, The Gillies Archives of Plastic Surgery.

Plastic surgery theatre, Queen Mary Hospital, 1917. Gillies is seated on the right. Permission: Andrew Bamji, The Gillies Archives of Plastic Surgery.

Surgeon Harold Gillies was 32 when war broke out. Posted to France in 1914, he knew little of plastic surgery. As a junior Red Cross officer, he was horrified by ghostly images of disfigured men limping back from the front. He was also shocked to discover that French surgeons were way ahead of the British. He immediately saw the opportunity to make himself the greatest plastic surgeon in the world. By 1915, Gillies had his own plastics unit and two years later his own purpose-built hospital – the Queens in Sidcup. It had 1,000 beds and was the first of its kind in the world. The young Gillies was more magpie than innovator. Obsessively poring through textbooks and research papers, he taught himself everything there was to know about reconstructive surgery. Remarkably he got his patients by sending address labels marked “Sidcup Hospital” to the battlefields of the Western Front.

Lieutenant William Spreckley. Facial reconstruction was still a primitive form of surgery. Experimentation was part of the process and Gillies tried a number of different methods he had learned from books. Images: Royal College of Surgeons (1-4); Findmypast.co.uk (5)

Lieutenant William Spreckley. Facial reconstruction was still a primitive form of surgery. Experimentation was part of the process and Gillies tried a number of different methods he had learned from books. Images: Royal College of Surgeons.

Lieutenant William Spreckley, was one of Harold Gillies’ biggest successes. To fashion him a new nose, Gillies hit the books and came across an old Indian idea known as the ‘forehead flap’. He took a section of rib cartilage and implanted it in Spreckley’s forehead. It stayed there for six months before it could be swung down and used to construct the nose. From start to finish, the process took over three years. Spreckley was admitted to hospital in January 1917 at the age of 33 and discharged in October 1920.

A pioneer in his field, Gillies was keen to push the boundaries of plastic surgery further.

Many of the men sent to Sidcup had wounds far graver than any doctor had seen before. While they were surviving these injuries in greater numbers, the procedures used to treat them lagged behind.

Gillies was determined not just to restore function to the facial features of his patients, but to try to achieve an aesthetic result as well. This desire pushed Gillies towards further experimentation. But in a time before antibiotics, he was taking a big risk. What followed would teach Gillies a valuable lesson about the limits of the surgeon’s knife.

A pilot named Henry Lumley was admitted to Sidcup with horrific facial burns. To repair them, Gillies attempted to take a massive face shaped flap from his chest. The massive graft soon became infected, and unable to bear the trauma of surgery, Lumley died of heart failure.

Twenty-three-year-old Henry Lumley had joined the fledgling Royal Flying Corps in December 1915. It took him six months to qualify as a pilot. And then tragically, on the day of his graduation, he crashed. Lumley suffered horrific injuries, injuries which were impossible to repair using skin from anywhere on his face. Gillies’ reaction was nothing if not ambitious. He decided to harvest a section of skin from Lumley’s chest and use it to make him a new face. It was a meticulously planned operation. A large face-shaped flap of skin was lifted from his chest, still connected to his shoulders by pedicles that allowed blood to flow to the graft. Things began well, but within days the graft became infected. Unable to bear the trauma of surgery Henry Lumley died of heart failure. Gillies knew he had gone too far. “My desire to obtain a perfect result somewhat overrode my surgical judgement. “Never do today what can honourably be put off till tomorrow.”

This taught Gillies that plastic surgery had to be carried out in small stages rather than one big operation. It’s a lesson that still informs the field today.

Four views of facial reconstruction after a war wound, July 1916.

Four views of facial reconstruction after a war wound, July 1916.

Gillies knew that when taking skin from one part of the body to another, it had to remain attached to survive. He also knew that doing so without antibiotics would be incredibly dangerous. How he did it would prove to be his greatest innovation.

Like his predecessors, Gillies knew that excised strips of flesh needed to remain connected by means of a pedicle before they grew into their new home. But as Lumley’s case had proved, exposed flesh was dangerously prone to infection – infection which could kill. By chance, Gillies then stumbled on an obscure Russian idea. Simply wrap up all the skin and tissue into a tube. It was called the tube pedicle. It may look like a suitcase handle, but the tube pedicle was a stroke of surgical genius. What’s really clever about forming a tube is you get round the problem of infection, because what you’re doing is all the living tissue and blood supply is enclosed within the outer dead layer of skin, which is waterproof and infection resistant, so you could keep it in place for weeks at a time without a serious risk of it going horribly wrong. The tube pedicle became Gillies’ signature operation. And though the original idea may have been borrowed from the Russians, Gillies was to make it his own with a brilliant piece of surgical improvisation. He called this the waltzing tube pedicle. If, for example, your chest was really burnt so you couldn’t get the skin and tissue from there, he might collect it from your abdomen or even your leg. He would then swing up this great, big mass of tube flesh and attach it to, say, the arm and then onto the face from there. Fantastic.

This method allowed Gillies to move tissue from A to B without worrying about infection. Living tissue was encased by the outer layer of skin which was waterproof and infection resistant. Gillies was able to leave these tubes in place for weeks at a time, with little risk. This greatly reduced the chances of something going wrong. Once a blood supply had grown into it from the new end, the original connection could be cut. From there the flesh could be swung into place.

Facial Prosthetics World War 1.

Facial Prosthetics World War 1.

Many of Gillies’ patients would never overcome the psychological impact of their injuries.

Despite surgical advances, disfigurements remained profound, and patients often couldn’t face going out in public. Some continued to cover their faces despite surgical success.

Inside the hospital, mirrors were removed to stop them seeing their reflection and fainting. Given the time it took to carry out complex facial reconstruction, some patients would go years without properly seeing themselves in the mirror.

Nearby park benches were painted blue to designate them for men with facial injuries. However it was also done to warn local residents that the appearance of men using them may be distressing.

Some men could re-enter the workforce, but they were often too embarrassed to be in public and so would be hidden away in back-rooms.

Others became completely withdrawn, unable to face their wives, families and friends.

Paris, France. Anna Coleman Ladd face masks.

Plaster casts taken from soldiers’ mutilated faces (top row), new sculpted faces (bottom row), and final masks (on the table) sit in the studio of Anna Coleman Ladd in 1918. American Red Cross/Anna Coleman Ladd papers/Archives of American Art/Smithsonian Institution

Ladd

Photos of a World War I veteran with and without his mask, circa 1920. American Red Cross/Anna Coleman Ladd papers/Archives of American Art/Smithsonian Institution.

Sometimes art can change how people see the world. But Anna Coleman Ladd made art that changed how the world saw people.

After World War I and soldiers were coming home from the battlefield with devastating injuries. Those who survived were often left with disfigured faces.

“The part of the soldier’s body that was most vulnerable was his face, because if he looked up over a trench, that was the part that was going to be hit,”

As director of the Red Cross mask-making studio in Paris, Ladd worked with mutilés de la face, men who had taken shrapnel, bullets and flamethrowers to the face. Ladd studied dozens of those disfigured faces, then sculpted masks made to resemble the soldiers’ former selves.

She wanted to make the Studio for Portrait Masks, as it was called, a really warm and inviting place, where men could come in and feel happy and relaxed.

It started in 1917, when Ladd, who was then a sculptor and socialite living in Boston, read about the work of a sculptor who ran what was called the “Tin Noses Shop,” a mask-making studio for disfigured British soldiers. Inspired, Ladd set up her own studio in Paris and set to work sculpting new faces for those who had lost a piece of theirs in trench warfare. For many, the studio was a safe haven.

These men couldn’t be seen on the street, They’d gone through multiple operations, and they were seen as so hideous people would sometimes pass out from seeing them.

Ladd started by getting to know the men: their quirks, daily habits, what their siblings looked like, the limited facial expressions they were still capable of. Then, she would choose an expression. For some, that expression would be the only one they could wear.

She’d make a plaster mold of her subject’s face, fill in the missing parts, and then galvanize the result in copper. After repeated fittings and adjustments, which might take several weeks, Ladd would position the mask on his face and take out a paintbrush.

She would try to paint a pigment that would be like the colour of that man’s skin. She would always take a tone that was halfway between what it would appear to be on a cloudy day and what it would appear to be on a sunny day.

In about a year and a half, Ladd and her colleagues sculpted almost 100 masks, each one a labour-intensive feat.

She was very proud of the fact that men who had thought they were going to have to live lives as recluses were able to go back into society.

When the war ended, the Red Cross couldn’t fund the studio anymore, so the studios closed. Ladd returned to Boston, where she resumed sculpting portrait busts and art for fountains.

I would imagine, that the art that she made before and after the war nowhere comes near the sort of importance and gravity of what she did during the war.

WW1 sailor Walter Yeo who was the first person in the world to receivedmodern plastic surgery. Walter sustained terrible facial injuries includingthe loss of upper and lower eyelids in 1916 but received groundbreakingtreatment from Sir Harold Gillies to rebuild his face. This photograph of Walter, the first of a sequence of eight shows his original injuries untreated.Re SWNS story SWPLASTIC: These are the shocking images released in a bid totrack down the family of the first person to undergo plastic surgery - a soldier who was horrifically wounded during the First World War. The photographs show before, during and after pictures of the ground breakingmedical procedure carried out on sailor Walter Yeo. Walter sustainedterrible facial injuries including the loss of upper and lower eyelids whilemanning the guns aboard HMS Warspite (corr) in 1916. In 1917 he was treatedby Sir Harold Gillies - the first man to use skin grafts from undamagedareas on the body - and know as 'the father of plastic surgery'.

WW1 sailor Walter Yeo who was the first person in the world to received modern plastic surgery. The photos of Walter, the first of a sequence shows his original injuries untreated. These photographs are shown out of sequence, before, after and during pictures of the ground breaking medical procedure carried out on Yeo. Walter sustained terrible facial injuries including the loss of upper and lower eyelids while manning the guns aboard HMS Warspite (corr) in 1916. In 1917 he was treated by Sir Harold Gillies.

Walter Ernest O’Neil Yeo – One of the first people to undergo Plastic Surgery

Walter sustained terrible facial injuries including the loss of upper and lower eyelids while manning the guns aboard HMS Warspite in 1916 during the Battle of Jutland. The young sailor, of Plymouth, Devon, was given new eyelids with a ‘mask’ of skin grafted across his face and eyes.

Walter was born in 1890 and after marrying wife Ada was severely injured during the battle of Jutland while manning guns. Records show he was admitted to Sir Harry Gillies’ care on August 8, 1917 – just two months after he opened his specialist hospital. Documents show after the procedure Walter, a gunnery warrant officer, was ‘improved, but still had severe disfigurement’.

The First World War, was a war dominated by high explosives and heavy artillery. Casualties treated by Sir Harold Gillies included an unprecedented number with horrific facial injuries. “Often unable to see, hear, speak, eat or drink, they struggled to re-assimilate back into civilian life. Gillies is credited with developing new, untried techniques to treat the injuries created by this new kind of war, taking grafts from undamaged areas of flesh.

The Queen’s Hospital, opened in June 1917, provided over 1,000 beds. There Gillies and his colleagues developed many techniques of plastic surgery and carried more than 11,000 operations on over 5,000 men.

Records show that Walter Ernest O’Neil Yeo was born on October 20, 1890, youngest of three children born to Petty Officer First Class Francis Yeo and his wife Rhoda. Within three weeks his father was dead, lost when the Devonport torpedo cruiser HMS Serpent, en route to Sierra Leone, hit rocks in Punta Bay on Spain’s Galician coast. Only three of the 150 men aboard survived.

The 1901 census records the Yeo family as living at 25 Arundel Crescent in Plymouth. Walter had two elder sisters, Adelaide and Elsie; his mother was then an alemaker at the Royal William Yard. Walter enlisted into the Royal Navy aged 12, serving as a Bugler until 1911.

He was promoted to Leading Seaman in 1912, becoming a Petty Officer in 1915 and a Warrant Officer in June 1917.At this time Walter was married to Ada and the family home was listed as 24 Staddon Terrace, North End, Plymouth.He was wounded on May 31, 1916, during the Battle of Jutland, while manning the guns aboard the battleship HMS Warspite.

There is some uncertainty as to where he was first admitted to hospital due to the poor quality of the documents. However, he is known to have been admitted to Plymouth Hospital while waiting for a place at Queen Mary’s Hospital in Sidcup, Kent, which was granted on August 8, 1917.

By July 1919, he was found to be fit for active service again and was recorded as having completed courses in September 1919. He underwent a further operation in August 1921, after which his disfigurement was recorded as ‘improved, but still severe’, and he was recommended for medical discharge, which took place on December 15, 1921. Walter later received further treatment for a corneal ulcer at the Royal Naval Hospital in Plymouth in 1938, but little else is known about him.

On a single day in early July 1916, following the first engagement of the Battle of the Somme—a day for which the London Times casualty list covered not columns, but pages—Gillies and his colleagues were sent some 2,000 patients. The clinically honest before-and-after photographs published by Gillies shortly after the war in his landmark Plastic Surgery of the Face reveal how remarkably—at times almost unimaginably—successful he and his team could be; but the gallery of seamed and shattered faces, with their brave patchwork of missing parts, also demonstrates the surgeons’ limitations. It was for those soldiers—too disfigured to qualify for before-and-after documentation—that the Masks for Facial Disfigurement Department had been established.

Harold Gillies’ seminal textbook “Plastic Surgery of the Face” (1920) has been digitised and is now available at the Internet Archive

After the war, Gillies continued to perform reconstructive surgery and also pioneered transgender and cosmetic surgery. He was awarded a knighthood in 1930, before returning to medical service during the Second World War. In 1946 he was elected the first president of the British Association of Plastic Surgeons.

In 1956, at the age of 73, he returned to New Zealand for a two-month holiday after 51 years abroad. He said he wanted ‘to smell the New Zealand bush on a wet day … I want to hear the tui, catch a brown trout, do a little painting, and perhaps play three or four holes of golf. And I want to see the pohutukawas in full bloom.’

He was never good at saving, which is why he was unable to retire after the Second World War, and he kept working until shortly before his death on 10 September 1960. He was 78 years old.

Aldershot’s Sir Harold Gillies and his pioneering plastic surgery …

Gillies, Harold Delf – Biography – Te Ara Encyclopedia of New Zealand

NZEDGE Legends — Harold Gillies, Plastic Surgeon — Scientists

Pioneering plastic surgery records from First World War published …

Pickerill and Gillies Great War Story | NZHistory, New Zealand history …

Plastic pioneers: How war has driven surgery – BBC News – BBC.com

 


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  • rantykiwi

    Let’s also remember his cousin Sir Archibald McIndoe CBE FRCS who joined him in these endeavours.

  • Huia

    I remember years ago reading about these great men. What inspiration and what dedication to help these brave young men so they could have a better quality of life.

  • Wasapilot

    I read a book years ago, I think the title was “The Gunei Pig Club” or similar. It was a great read and told the tale not only of the surgeons, but the patients also. Fantastic individuals.

  • Paul Marsden

    Extraordinary skill and courage, and the tenacious spirit of some people.

  • XCIA

    I recall during an induction course being showed a series of before and after slides of a poor wretch who had been shot, the round entering his neck and exiting his face, taking out his jaw and other fearures. The work undertaken by the skilled surgeons at the Royal Victoria Hospital, Belfast was such that they had improved on his appearance.

  • Brian Anderson

    It’s a pity that, in many (most?) people’s minds, plastic surgery is associated with things like ‘boob jobs’, face-lifts and cosmetic surgery rather than the incredible work done after things like burns and reconstruction following cancer removal, congenital malformations and so on. All praise to the ones who do this sort of thing.

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