facial surgery

On this Remembrance Day, Andrew Bamji, writer of ‘Faces from the Front’, has given us a glimpse into a lesser-known aspect of World War 1 casualties – the men who received facial wounds. 

Article by Dr Andrew Bamji

As a rheumatology trainee, specialising in the treatment of arthritis, I hardly expected to write a book about plastic surgery in the First World War and confront a forgotten area of medical history.  

But my consultant appointment was at Queen Mary’s Hospital, Sidcup which, as I soon discovered, was very proud of its place as the seat of facial reconstruction. 

facial reconstruction
From an English edition of the book Nie Wieder Krieg (‘Never Again War’), the ironic caption referring to a failed facial reconstruction. (Picture: Andrew Bamji)

My book was stimulated by the serendipitous discovery of the bulk of the case files, complete with operation details, photographs and paintings – a unique survival of wartime medical material.  

This primary source was backed up by my acquisition for the hospital of an extensive library of period books, ranging from soldiers’ and nurses’ diaries to textbooks.

men with broken faces
The top and bottom left images show a Nigerian soldier with dental appliances and the others illustrate skin flaps used to move tissue from a donor to a trauma site. (Pictures: RCS, AWA, the BAPRAS Archive)

The book began as a resumé of the remarkable technical advances pioneered at Sidcup, and it was apparent that these resulted from the centralisation of facial surgery on one site.  

The lead surgeon, Harold Gillies, was ahead of his time in ignoring professional boundaries; rather than pursuing an autocratic approach, usual at the time, he encouraged the collaboration of surgeons, dentists, technicians and illustrators in what is probably the first multidisciplinary medical service.  

This approach included the patient as part of the team, again unique for the period.     

facial injury world war 1
Private William Thomas of 1 Cheshires on the day of admittance in 1918. (Picture: RCS)
Men with broken faces
Thomas’ face during an intermediate stage in 1920, the last picture showing a skin flap being used to reconstruct the trauma site. (Picture: RCS)
men with broken faces first world war
Thomas’ appearance after reconstruction was completed in 1924 (image: RCS)

Sidcup became the focus for major facial trauma, and over 5,000 patients were treated there. It was an international service, with staff from Great Britain, Canada, Australia and New Zealand working in parallel.  

While some patients had injuries that were irretrievable - and indeed some died - the final results on many of the patients were little short of remarkable, given that nearly all the wounds were infected, and there were no antibiotics.  

Men with broken faces first world war
Lieutenant William Spreckley whose nose was later reconstructed. (Picture: RCS)
Men with broken faces first world war
Private Harold Page of the Norfolk Regiment before (left) and after (right) his completed reconstruction, shown in July 1917. (Picture: RCS)

Furthermore, the surgeons started from a knowledge base of zero; while a few surgeons had for centuries attempted facial repair, their outcomes were almost universally bad, and there was no attempt to plan, and record surgery in a systematic way until Sidcup.  

There was also a major emphasis on rehabilitation. 

The scope and success of the work will surprise those who believe that plastic surgery began in the Second World War at East Grinstead under Archibald McIndoe. Indeed Sidcup’s burns patients are proto “Guinea Pigs”.

Facial injury tongue RFC burn victim first world war
Lieutenant FG Adams of the Hampshire Regiment (left) is shown with his tongue stuck to the raw tissue on the injury site, and Ralph Lumley of the RFC (right) shown with burn injuries. (Picture: RCS)

Having developed an archive website, and lectured widely on the surgical successes and problems, I began to receive information from relatives of Sidcup patients. 

This challenged my belief that facial disfigurement led to a life of seclusion and unhappiness. This was, in fact, rare.  

Most men lived happy and fulfilled lives and it became apparent that those who did have psychological problems developed these as much from their experience of war as from their injury.  

One example is a tank officer, Stanley Cohen, who was badly burned in August 1918.  

While his personal life was damaged by his disfigurement, his writings indicate that he was badly affected by the experience of running over a German machine gun position in his tank and ordering the shooting of surrendering enemy soldiers.   

Facial injury plaster cast
A plaster cast of one soldier with facial wounds. (Picture: Andrew Bamji, from a copy of the cast provided by the Royal Australian College of Surgeons)
First World War facial reconstruction model
A wax model that was used to demo reconstruction methods, created by Tom Kelsey for Henry Pickerill, head of the New Zealand section at Sidcup. (Picture: RCS)

It also became clear that there was a major difference between patients treated in Britain and those managed in France and Germany, where surgeons worked independently and geographically separated, with a corresponding failure to develop satisfactory techniques.  This left men both badly treated and isolated.  

Thus, Sidcup’s legacy was not only an advance in surgery and development of a new specialty (and alongside that, a major advance in anesthesia) but also a vindication of the benefits of resource concentration – not only in surgical terms but also for the psychological well-being of the patients.

To learn more about the pioneering facial reconstruction attempts made at Sidcup during the First World War, read Andrew Bamji’s book ‘Faces from the Front’. It can be purchased here. Use the code POPPY17 to get a £5.99 discount, valid until November 30, 2017.

Dr Bamji qualified in medicine from the Middlesex Hospital, London in 1973.  He was President of the British Society for Rheumatology in 2006-8. Having retired from clinical practice and moved to Rye, East Sussex, he continues to assist students and researchers and has lectured in the UK, France, New Zealand and America. 

Television appearances include contributions to Jeremy Paxman’s mini-series on the First World War, “Timewatch” with Michael Palin and with Pat Barker on the “South Bank Show”.  

He is Gillies Archivist to the British Association of Plastic, Reconstructive and Aesthetic Surgeons. The archives website is www.gilliesarchives.org.uk

Faces from the front first world war men with borken faces

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