The metrics from World War I are terrible. In total, there were 37 million military and civilian casualties – 16 million dead and 21 million wounded.
Never before had conflict created such devastation in terms of death and injury.
In the four years of the war, military surgeons developed new techniques on the battlefield and in support of hospitals, which in the last two years of the war led to more survivors of injuries that would have proved deadly in the first two years.
On the Western Front, 1.6 million British soldiers were successfully treated and returned to the trenches.
By the end of the war, 735,487 British troops had been released after serious injuries. Most injuries were caused by shells and shrapnel.
Many of the injured (16%) had facial injuries, more than one-third of whom were classified as "severe".
In the past, this was an area where very little had been attempted, and survivors with severe facial injuries had serious malformations that made it difficult to see, breathe or eat and drink – and they were terrible.
The New Zealand ENT Surgeon (Harald Gillies, who worked on the Western Front) saw attempts to repair the ravages of facial injuries and realized that he needed special work.
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The terrible extent of the facial injuries in the First World War forced doctors and sculptors to develop methods to help those affected without being mutilated. A New Zealand surgeon developed a skin grafting method that creates a "mask" of the skin on the person's face and eyes. They also suited those who needed them with glassy eyes, and built false glasses to keep everything together as harmlessly as possible. Shown: an archive image of a patient before (left) and after (right)
The history of prosthetics was touched in the hit show Boardwalk Empire with a figure of Jack Hutson, who had the telltale glasses and the face mask
The timing was right as the military medical director recognized the benefit of setting up specialist centers to deal with specific injuries and wounds such as neurosurgical and orthopedic injuries or gassing victims.
Gillies got the go-ahead, and in January 1916, he set up Britain's first plastic surgery department at the Cambridge Military Hospital in Aldershot.
Nobody won the last war except medical services. The increase in knowledge was the only definable gain for humanity in a devastating catastrophe
Gillies toured base hospitals in France to seek suitable patients to be sent to his unit.
He expected about 200 patients – but the opening of the unit coincided in 1916 with the opening of the Somme offensive. More than 2,000 patients with facial injuries were sent to Aldershot.
A treatment was also required for sailors and airmen who suffer from facial burns.
Gillies described the development of plastic surgery as a "strange new art".
Many techniques have been developed through trial and error, although some mirrored works that were made centuries ago in India.
This is a close-up of an eye and eyelid prosthesis attached to glasses to fix it
A selection of newly formed noses, eyes and eyelids in France in 1918 for wounded soldiers
The makers of prosthetics would use paper mache to shape the person's face to get the right shape of their faces. Once it was done, they painted their facial features and skin
Making stained-glass eyeballs: Craftsmen use glass and enamel to make glass eyes for soldiers who lost their eyes during the First World War. A glass flask is blown and applied in color (top left); the eyes are baked and the colors are set (top right); the eyeball is cropped (lower left); the finished article is polished carefully (bottom right)
One of the main techniques that Gillies developed was the transplantation of tube pedicles.
A flap of skin was separated from a healthy body part of the soldier, but not detached, sewn into a tube and then sutured to the injured area.
It took some time for a new blood supply to form at the site of implantation.
It was then loosened, the tube was opened and the flat skin was sewn over the area that needed to be covered.
One of the first patients to be treated was Walter Yeo, officer of HMS Warspite.
During the Battle of Jutland in 1916, Yeo suffered facial injuries, including the loss of his upper and lower eyelids.
The tube stem created a "mask" of skin grafted over the face and eyes, creating new eyelids.
The results were far from perfect, but he had a face again. Gillies repeated the same procedure to thousands of others.
Four photographs documenting the face reconstruction of a soldier whose cheek was seriously injured during the Battle of the Somme in July 1916
Craftsmen painted the mask while she was on the soldier, so that it corresponded exactly to the actual skin tone of the soldier. At the top left is a heavily disfigured soldier and on the right he is pictured with the created mask
There was a need for larger facilities for the surgical and postoperative treatment as well as for the rehabilitation of patients together with the various specialties involved in their treatment.
Gillies was instrumental in designing a special unit at Queen Mary's Hospital in Sidcup, southeast London.
It opened with 320 beds – and at the end of the war there were more 600 beds, and 11,752 operations were carried out.
However, the reconstructive operation continued long after hostilities ceased. Until the unit's final closure in 1929, some 8,000 military personnel were treated between 1920 and 1925.
The details of the injuries, the operations to be corrected, and the final result were captured in detail, both through early clinical photography and through detailed drawings and paintings made by Henry Tonks, who, though trained as a doctor, had given up painting medicine ,
Tonks became a martial artist on the Western Front, but then he came to Gillies to help not only with recording the new plastic procedures but also with their planning.
The complex facial and head surgery required new possibilities of anesthesia.
Two wounded soldiers played cards after applying full-face prosthetics in April 1919
Anesthesia had generally developed as a specialty during the war years – both in the way it was performed and in terms of the training of doctors (previously, anesthetics had often been administered by a young member of the surgical team).
The survival of surgeries requiring anesthesia improved, although the techniques were still based on chloroform and ether.
The Queen Mary anesthesia team developed a procedure to deliver a rubber tube from the nose to the trachea (windpipe) and the endotracheal tube (mouth to trachea) made from standard rubber tubing.
Many of their techniques are still in use today. An Austrian physician wrote in 1935: "No one has won the last war except the medical services. The increase in knowledge was the only definable gain for humanity in a devastating catastrophe. "
- This article was originally published by The Conversation
- The author wishes to acknowledge the support of Norman G. Kirby, Major General (retired), Director of Army Surgery 1978-82
The American celebrity and sculptor, who followed her husband to Europe as a doctor at the beginning of World War I, changed the lives of nearly 200 combatants by creating "portrait masks" that they could wear to hide their facial injuries
by Regina F. Graham, DailyMail.com reporter
- Anna Coleman Ladd helped almost 200 soldiers in World War 1 face-offs to create "portrait masks."
- Born in 1878 in a prominent family outside Philadelphia, she studied sculpture in Europe before marrying her husband in 1905 and moving to Boston
- The couple moved to France in 1917, where she founded the American Red Cross studio for portrait masks and employed four assistants who helped her
- Ladd's noble services earned her the Légion d'Honneur Croix de Chevalier and the Serbian Order of Saint Sava
More than 16 million soldiers and civilians died in the First World War, making it the deadliest war in history. Many survivors of the battlefields did so with severe facial injuries, and it was difficult to return home with a drastic change in appearance.
They were worried about how both family and friends would react and how they would be treated because they lacked a nose, an eye, or parts of the chin after being brought through splinters, bullets, and flamethrowers.
The American sculptor Anna Coleman Ladd, who had moved to Paris with her husband at the beginning of the war, created portrait masks that were modeled from photographs of men born before their injury.
"A man who came to us was wounded two and a half years ago and had never been at home," says a 1919 report from Ladd's Studio, published by the Smithsonian Museum as part of their archive.
"He did not want his mother to see how bad he looked." There was only one eye left of his entire face and after 50 surgeries … he came to us
"People get used to seeing men with missing arms and legs, but they never get used to an abnormal face."
Anna Coleman Ladd, an American celebrity and sculptor who followed her husband to Europe at the beginning of World War I, found her craft in prosthetics. She has changed the lives of more than 200 soldiers. Here she works on a prosthetic mask worn by a French soldier to hide his disfigurement in July 1918