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Facial Reconstruction in the First World War

The outbreak of war in 1914 saw both staff and Council members of The Royal College of Surgeons of England (RCS) join the war effort, in the capacity of providing military and medical service at home and abroad. As well as investing £100,000 in the War Loan, it lent the expertise of its staff and associates to the cause. Council members played key roles in the coordination of military surgery and the College itself was called on to advise the Government on how to deal with the medical demands of the conflict.1

Patient Records

The RCS archives include collections relating to the First World War which cover the medical and social history of the War. One of its most significant collections is the Gillies Patient Record files of British and New Zealand servicemen.2 Gillies Patient Record files detail the injuries of the patients, which ranged from gunshot wounds and shell or shrapnel wounds to burns, mainly of the face. The files are arranged alphabetically by patient's surname and each patient has been assigned a unique ID or case number; they list rank, regimental number, regiment, age, and date of wounding so that the battle in which they were wounded can often be identified. There are clinical operation and progress notes, and some of these records are accompanied by photographs or diagrams relating to their injuries and operations. Some of the diagrams were hand-drawn by Henry Tonks (Fellow RCS 1888), an artist and surgeon, and annotated by the surgeons. In some cases, there are prints of x-rays.

There are also watercolour portraits to accompany some of the files for patients from New Zealand, which show their injuries on admission to the centre. Many of the watercolours are unsigned, but identified artists include Daryl Lindsay and Herbert R. Cole, a book illustrator and portraitist. 

Sir Harold Gillies (1882-1960)

Having worked in otolaryngology, it was not until the First World War that Sir Harold Gillies (Fellow RCS 1901) began to develop maxillo-facial surgery and has since been considered by some to be the father of plastic surgery.

Gillies developed and devised independently the potential and varied applications of a new medical technique, the tubed pedicle and the twin tubed pedicle. This used grafted flaps of skin and also tissue from other parts of the body. He was distinguished for his thorough pre-operative planning clinics, which contributed to his precisely planned procedures.

Following the outbreak of the War, Gillies joined the Royal Army Medical Corps (RAMC). He witnessed first-hand the horrific effects of war and the disfigurement of men caused by battle. He also worked alongside renowned dentist Charles Auguste Valadier. Gillies was inspired by Valadier’s efforts to repair jaw wounds using new skin graft techniques. He also went on to observe renowned surgeon Hippolyte Morestin, a pioneer in maxillo-facial surgery, to learn more about skin grafting. Their advances underpinned much of the work that he later did and led him to recognise the need and importance of starting special treatment in this field. He managed to persuade the War Office to allow him to set up a dedicated unit at Aldershot, Hampshire. Following the Battle of the Somme, Aldershot proved to be inadequately equipped to cope with the demand of the massive influx of casualties. Gillies pressed for a larger, purpose-built facility, devoted exclusively to plastic surgery, to replace the unit. With the help of Sir William Arbuthnot Lane, Chief Army Surgeon of the RAMC, a hospital was built at Sidcup, Kent. The Queen's Hospital opened in June 1917. It became the largest centre of its kind in the world and was developed as the War's major centre for pioneering maxillo-facial and plastic surgery. Between 1917-1921, the hospital and its associated convalescent units admitted over 5000 servicemen and completed more than 11,000 operations.

Gillies often called on the talents of artists to help him. The sculptor F. Derwent Wood collaborated with Gillies in cases when the manipulation of living tissues needed to be supplemented with modelling in an artificial substance, such as wax. In 1915 the ex-surgeon turned artist Henry Tonks, volunteered to paint portraits of men with facial injuries and helped to design their repair.

The Team

The War led surgeons to attempt ground-breaking procedures, through trial, practice and experiment. In Gillies’ case, he had the foresight to use a multidisciplinary approach, working closely with a range of medical staff such as dental surgeons and other surgeons, who formed his team of experts (also consisting of physicians, anaesthetists, nurses, and artists) and this enabled him to carry out such pioneering work. The meticulous detail of the injuries recorded in the drawings and paintings helped record his procedures. These also act as a record of the extent of the horrific injuries sustained by the soldiers during the war. Gillies’ notes highlight the importance of record-keeping, and the way in which it served to influence future generations.

Gillies and his team made a significant contribution to the First World War through his innovative treatment and the advancement of reconstructive surgery.

After the War


Gillies saw that his new specialty was still necessary in peacetime. He set up in private practice, was elected to the staff at St Bartholomew’s and was appointed consultant in plastic surgery to the Royal Navy, The Royal Air Force, the Queen Alexandra Military Hospital and, St Andrew’s Hospital, Dollis Hill, St James’s Hospital (Balham), the North Staffordshire Royal Infirmary, the London County Council Hospital, and the Ministries of Health and of Pensions.

Following the outbreak of the Second World War in 1939, he organised plastic surgical units in different parts of the country and personally supervised the largest unit at Park Prewett Hospital, Basingstoke. Shortly after the war Gillies formed the British Association of Plastic Surgeons of which he was the first president. He was also honorary president of the International Society of Plastic Surgeons. He continued to train and teach people from all over the world, as well as, operating and advising. In 1920 his book ‘Plastic Surgery of the Face’ was published, setting down the principles of modern plastic surgery and becoming the leading textbook in its field.

After his death, the British Association of Plastic Surgeons created a fund in his memory to promote education and research in plastic surgery.

RCS Archive

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Corporal W McRae (artist unknown)
Watercolour portrait of Corporal W McRae, the follwoing images are from his case file.
Gillies British Patient File of Corporal W McRae

Gillies British Patient File of Corporal W McRae

by Karyn French | 03 Nov, 2016

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    Other Features




    Credits/footnotes:
    Archive reference: RCS-COM/5/1
    Archive reference: MS0513.This collection consists of 52 boxes and contains patient records for over 2,000 servicemen who underwent plastic surgery at the unit set up by Sir Harold Gillies at Queen's Hospital, Sidcup. The files serve as a record of how treatment was facilitated, and also help to document the development of plastic surgery at the beginning of the Twentieth Century.

    Images:
    (except watercolour) Gillies British Patient File of Corporal W McRae, Archive reference: MS0513/1/1/ID 1363, The Archives of the Royal College of Surgeons of England.

    Watercolour portrait of Corporal W McRae (artist unknown), Archive reference: MS0513/2/2/ ID 164, The Archives of the Royal College of Surgeons of England.