Facial prostheses of the First World War

The metrics of the First World War are horrible. In all, there were 37 million civilian and military casualties: 16 million dead and 21 million injured.

Never before has a conflict caused such devastation in terms of death and injury.

In response, during the four years of war, military surgeons have developed new techniques on the battlefield and in supporting hospitals that, in the last two years of war, have caused more survivors of wounded who would have proved deadly in the first two.

On the western front, 1.6 million British soldiers were successfully treated and returned to the trenches.

At the end of the war, 735,487 British soldiers had been dumped as a result of serious injuries. Most of the injuries were caused by shells of shells and grenades.

Many of the injured (16%) had facial injuries, over a third of which were classified as "serious".

Historically, this was an area in which very little was attempted, and survivors with severe facial injuries were left with greater deformities that made it difficult to see, breathe easily, or eat and drink – in addition to looking horrible.

A young New Zealand otolaryngologist surgeon, Harold Gillies, who worked on the western front, tried to repair the ravages of facial injuries and realized that there was a need for specialized work.


The horrible scale of facial injuries in World War I led physicians and sculptors to develop methods to help the sick move without feeling mutilated. A New Zealand surgeon has developed a skin grafting technique, producing a "mask" of skin on the person's face and eyes. They also suited those who needed them with glass eyes and modeled a pair of fake glasses to keep them all together as innocently as possible. In the picture: an archive image of a patient before (left) and after (right)

The history of the prosthetics was touched in the successful show Boardwalk Empire with a character played by Jack Hutson who had glasses and face-to-face masks

The timing was right, because the military medical director was recognizing the benefit of setting up specialized centers to deal with specific wounds and injuries, such as neurosurgical and orthopedic wounds or gassing victims.

Gillies was given the go-ahead, and in January 1916 he was setting up Britain's first plastic surgery unit at the Cambridge Military Hospital in Aldershot.

Nobody won the last war but the medical services. Increased knowledge was the only determinable gain for humanity in a devastating catastrophe

Gillies visited basic hospitals in France to look for suitable patients to send to his unit.

He returned pending about 200 patients – but the opening of the unit coincided with the opening of the Somme offensive in 1916, and more than 2000 patients with facial injuries were sent to Aldershot.

The treatment was also necessary for sailors and aviators who suffered from facial burns.

Gillies described the development of plastic surgery as a "strange new art".

Many techniques have been developed by trial and error, although some mirror work that had been done centuries before in India.

This is a close-up of an eye and eyelid prosthesis attached to the glasses to keep them fixed

A selection of noses, eyes and eyelids just modeled in France in 1918 for wounded soldiers

The prosthetic creators would make a mold of the person's face using papier-mâché to get the right shape of their faces. Once done, they painted on their features and their skin

Making colored glass puppets: the master craftsmen use cut glass and glazes to make glass eyes for soldiers who lost their eyes during the First World War. A glass bulb is blown and applied in color (top left); the eyes are cooked and the colors set (top right); the eyeball is cut to fit (bottom left); The finished article is carefully polished (bottom right)

One of the main techniques developed by Gillies was skin transplantation with stalk.

A flap of skin was separated but not detached from a healthy part of the soldier's body, sewn into a tube, and then sutured to the injured area.

A period of time was needed to allow the formation of a new blood supply to the implantation site.

It was then detached, the tube opened and the flat skin covered the area that needed coverage.

One of the first patients to be treated was Walter Yeo, an artillery guarantee officer on HMS Warspite.

Yeo sustained facial injuries during the Battle of Jutland in 1916, including the loss of his upper and lower eyelids.

The valuncular peduncle has produced a "mask" of transplanted skin on the face and eyes, producing new eyelids.

The results, even if all but perfect, have meant that he had a face once again. Gillies continued to repeat the same kind of procedure on thousands of others.

Four photographs documenting the facial reconstruction of a soldier whose cheek was heavily wounded during the Battle of the Somme in July 1916

The artisans painted the mask while on the soldier, so that it matched perfectly the tone of the soldier's real skin. In the picture at the top left there is a seriously disfigured soldier and immediately is depicted with the mask created

There was a need for larger structures for surgical and postoperative treatment and also for the rehabilitation of patients, together with the different specialties involved in their care.

Gillies has played an important role in designing a specialized unit at the Queen Mary's Hospital in Sidcup, in south-east London.

It opened with 320 beds – and by the end of the war there were more than 600 beds and 11,752 operations had been carried out.

But reconstructive surgery continued long after the hostilities ceased and, when the unit finally closed in 1929, about 8,000 soldiers were treated between 1920 and 1925.

The details of the wounds, the operations to correct them and the final result were all recorded in detail, both from early clinical photography and from detailed drawings and paintings created by Henry Tonks, who despite being a doctor, had abandoned the medicine for painting.

Tonks became a war artist on the western front, but then joined the Gillies to help not only in recording the new plastic procedures, but also in their planning.

The complex surgery of the face and head required new ways of administering anesthetics.

Two wounded soldiers playing cards after wearing a full denture in April 1919

Anesthesia was generally advanced as a specialty during the war years – both in the way it was administered and in the way the doctors were trained (previously, anesthetics were often administered by a junior member of the & rsquo; surgical team).

Survival from operations that required anesthesia improved, although the techniques were still based on chloroform and ether.

The team of Queen Mary's anesthetists has developed a method for passing a rubber tube from the nose to the trachea, as well as working on the endotracheal tube (trachea mouth) that was made with commercial rubber tubes.

Many of their techniques remain in use today. As an Austrian doctor wrote in 1935: "No one has won the last war but the medical services.The increase in knowledge was the only determinable gain for humanity in a devastating catastrophe."

  • This article was originally published by The Conversation
  • The author wishes to acknowledge the assistance of Norman G Kirby, major general (retired), director of military surgery 1978-82

The American socialite and sculptor who followed her doctor in Europe at the start of the First World War changed the lives of nearly 200 soldiers disfigured in battle by creating "portrait masks" that could be worn to hide the wounds on the face

by Regina F Graham, is the DailyMail.com reporter

  • Anna Coleman Ladd has helped nearly 200 soldiers with facial deformations of the First World War creating "portrait masks"
  • Born into an important family just outside Philadelphia in 1878, she studied sculpture in Europe before marrying her husband in 1905 and moving to Boston
  • The couple moved to France in 1917, where they founded the American Red Cross Studio of Portrait Masks and hired four assistants to help her
  • The noble services of Ladd earned her the Légion d & # 39; Honneur Croix de Chevalier and the Serbian Order of Saint Sava

More than 16 million soldiers and civilians died during the First World War, becoming the deadliest war in history. Many of those who survived the battlefields did so with serious facial injuries, and it was difficult to return home with a dramatic change in appearance.

They worried about how both family and friends would react and also how they would be treated because they lacked a nose, an eye or pieces of their jaws after suffering disfigurements caused by splinters, bullets and flamethrowers.

In an attempt to restore normality in their lives, the American sculptor Anna Coleman Ladd, who had moved to Paris with her husband at the start of the war, created portrait masks modeled on photographs of men before the wound.

"A man who came to us had been injured two and a half years earlier and had never been home," according to a 1919 report by Ladd's study which was published by the Smithsonian Museum as part of its archives.

"He did not want his mother to see how bad he was." Of all his face there was only one eye left and after 50 operations. . . 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 socialite and sculptor who followed her doctor in Europe at the start of the First World War, found her art in the prosthesis. It has transformed the lives of over 200 soldiers. Here he works on a prosthetic mask worn by a French soldier to hide his disfigurement in July 1918

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