Facial repairs on the battlefield go back to warfare in the 7th century BC. Even Alexander the Great went to war with his own physician and his life was saved on the battlefield during his conquest of India. Marcus Aurelius, the Roman emperor of the 2nd century AD, always went to war with his own Greek surgeon.
Haig called for dentists to attend the BEF in France in 1914. The BEF ranked vets and blacksmiths higher than dentists in their list of priorities, and when Haig developed toothache in the autumn of 1914, the BEF did not have a dentist on hand to treat him. His toothache had to be treated by a French surgeon, Charles Valadier. Charles Valadier, or Sir August Charles Valadier as he later became, was a dental surgeon from Paris to whom Haig was sent. By the end of the year, there were 11 dentists treating the BEF, an average of one for four divisions. It was not until 1917 that mobile dental treatment units were introduced.
Valadier could not have been a better choice - as the war progressed, he became interested in developing new techniques to treat maxillo-facial trauma suffered by troops during the Great War.
Facial injuries involving shrapnel or rifle bullets invariably required surgery as well as dentistry. The pace of medical expertise quickened so that surgeons were carrying out operations within 15 minutes (under local anaesthetic) which would have taken at least two and a half hours back in the UK.
In 1915, a New Zealand surgeon, Harold Gillies (he had studied medicine at Cambridge University, UK), was sent to France and he worked with Valadier at the hospital at Wimereux. It was here that the major treatment for jaws shot away by bullets or shrapnel was to replace the missing bone. To do so, other bone was surgically removed from elsewhere in the patient's body or, if this was not possible, carefully chosen pieces of metal were used. Gillies returned to the UK and opened a hospital near Aldershot to assess provision for treating men.
In July 1916, during the first ten days of the Battle of the Somme, 2,000 men were sent back from France for surgery on facial injuries but there were only 50 beds available.
Expansion came in the form of wooden huts in the grounds of Frognal House, Sidcup. Gillies set up his hospital which became known as the Queen's, as Queen Mary became a benefactor soon after it was instituted. Between 1917 and 1921, there were 1,000 beds and the hospital treated over 5,000 servicemen for maxillo-facial and plastic surgery.
To help Gillies an artist named Henry Tonks would produce paintings of the patients at various times during the series of operations which were necessary for the repairs. Sometimes a patient would have to undergo over 50 operations before Gillies was satisfied with the result. Other doctors and surgeons joined Gillies at the Queen's hospital, especially after serving on the Western Front.
William Kelsey Fry, while serving on the Western Front, became aware of the importance of the initial treatment which would avoid losing the patient. He introduced the practice that, when the wounded were brought in from battle for treatment, any one suffering from a facial injury had to lie or be laid down on the stretcher face down, no matter how severe the facial injury. Too many men died on the stretcher during transfer if this practice was not carried out. Kelsey Fry wrote about the emergency treatment of such injuries, advice which became essential as the war entered its final phase.
Anaesthetics had to be improved in order to carry out the lengthy operations which were necessary in order to repair these severe facial injuries. Queen's hospital at Sidcup slowly became a ‘must see' hospital for surgeons coming to the Western Front from Canada, New Zealand, Australia and the USA. As a result, plastic surgery became big business in the USA after the Great War, more so than in France and the rest of Europe.
Gillies was soon joined by very able young surgeons at the hospital after the Great War, using their talents to promote better ways of tackling hair lips and cleft palettes. Soon post cancer operations were using Gillies' techniques for cosmetic surgery.
Later, when fighter pilots suffered severe facial burns in the Battle of Britain, Gillies and his cousin, Archibald McIndoe, were at hand to use their skills in repairing the damage, this time at Rooksdown House at Basingstoke and Queen Victoria hospital at East Grinstead. The skills learnt during the Great War were still important twenty years later.
This article is based on a talk given by Rob Burkett to the Yorkshire branch of the WFA.
Contributed by: Peter J. Palmer
Images courtesy Wikimedia. Original image of Walter Yeo from the Gillies Archives, Queen Mary's Hospital, Sidcup UK.
Amended information (May 2010) on Walter Yeo kindly supplied by Dr Andrew Bamji, Curator of the Gillies Archives.
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Note to Australian Dental Hospital Photograph:
AWM Caption: France: Picardie, Somme, Bussy A dental officer of the 34th Australian Dental Unit, working at an advanced post at NC.4.9.2 (Sheet 62D). The sides of the tent was revetted, as the staff sleep within and the Germans dropped three bombs within 100 yards of this place one evening. This was the most advanced unit working in the Corbie Sector during June and July. It gave attention to men requiring immediate relief from the front line and support line. The unit worked here for about seven weeks.
Left to right:
- Driver A. E. Reid, 27th Army Service Corps
- Private (Pte) J. McTeay, 13th Field Ambulance
- Buglar Gordon
- Captain F. R. Forster, Officer Commanding, 34th Dental Unit
- Pte R. Turpin (patient)
- 10664 Staff Sergeant (SSgt) William Thomas Rickey, 34th Dental Unit (behind)
- 13323 Pte Ernest Edward Mildern, Orderly, 34th Dental Unit
- 8866 SSgt L. H. Allen, 34th Dental Unit