The Facemaker

Lindsey Fitzharris

author of facemaker

Harold Gillies

1 of the surgeons who had pushed the limit of plastic surgery during his time

Born June 17, 1882

Died September 10, 1960

1914 to 1918

time period of wwi

Flammenwerfer

First produced by the Germans, most notably against the British at Hooge in 1915

Portable device, belched a stream of burning oil which destroyed everything within range

Left victims with severe burns over their entire bodies

Chemical Weapons

(more psychologically devastating innovation)

First large scale lethal gas attack came on April 22, 1915

chlorine gas

Members of a special unit of the German army released 160 tons of ____ over the battlefield at Ypres, Belgium, within minutes over 100,000 French & Algerian soldiers were killed, further 4,000 wounded

british

Tanks also became a new addition to the battlefield → first developed by the ____

20 minute club

Early airman sometimes referred to themselves collectively as the____ -- the average time it took to shoot down a new pilot

butchers blade

German sawback bayonet

it was so loathed that the French and British armies warned the Germans that any many caught with one would be tortured and executed. By 1917, it had been widely outlawed in battle.

jam tins

Discarded_____ were made deadly early in the war as soldiers began improvising bombs by filling them w/ explosives and scrap iron and fitting them w/ fuses

8-10 million

____ soldiers died during the war, over twice as many were wounded: often seriously

Maxillofacial wound

injuries to the face and jaw

lunacy

shell shock, mental disorder suffered by war-traumatized soldiers

despondency

a state of low spirits caused by loss of hope or courage

Melancholia

severe depression characterized especially by profound sadness and despair

les gueules cassées

french for the broken faces

Gesichts entstellten

german for twisted faces

Menschen ohne Gesicht

german for men without faces

Loneliest of Tommies

in britain known as the most tragic of war victims, strangers even to themselves

Private Percy Clare

bullet tore through his face-initially thought it would be fatal-knew it would take really long time for stretcher-bearers to get to him because of risk of being shot themselves

referred to himself as “an unlovely object” when returned to britain and saw his face

suffocation

being laid on back with facial injuries can cause…

aldershot

first main hospital for gillies

sidcup

second main hospital for gillies

laryngologist

voicebox/larynx

Otorhinolaryngology

surgical speciality dealing with head and neck/ENT

ENT

ears, nose, throat

ergonomic needle

gillie’s disability caused him to invent ____ to make up for limited mobility

Kathleen Margaret Jackson

Gillie’s wife

Gavrilo Princip

shot Austrian Archduke Franz Ferdinand and wife Sophie at Sarajevo.

Austrian Archduke Franz Ferdinand

Gavrilo Princip (part of terrorist group Black Hand) shot _______ and wife Sophie at Sarajevo

executed

deserters in britain were…

Auguste charles Valadier

Franco-American dentist

trench mouth

bacteria build up in mouth, ulcers, bleeding, bad breath

acute necrotizing ulcerative gingivitis

Monotonous diet+lack of dental hygiene

cocaine

dental anesthetic at the time

larger

general base hospital

more specialized

stationary base hospital

28%

____ died of wound infection

plastic surgery

coined in 1798 by French Surgeon Pierre-Joseph Desault

american civil war

Face reconstruction attempts began in _____ due to conical bullet

Anesthesia and antisepsis

bone grafts became more common with

Rosa Vect

Nurse at Belgian Field Hospital, shrapnel in leg so bad that she needed to get it amputated at the hip at Veurne, lost too much blood during operation - only Dutch nurse to die in WWI

Petite curies

vehicle with hospital bed, x-ray machine, generator

Battle of Ypres

killed thousands, including 14yo, and chlorine gas first used by germans

chlorine gas

Diatomic gas(about 2 ½ times denser than air) that reacts with water in the lungs to form hydrochloric acid, causing permanent tissue damage and death

more deadly phosgene, bromine, and bis(2-chloroethyl) sulfide aka mustard gas

chlorine gas replaced by…

catherine black

Irish Nurse at Cambridge Military Hospital

GOK

god only knows

necrosis

cellular destruction, can spread to nearby healthy tissue if left untreated

flap

section of healthy tissue that is partially detached from its original site and moved to cover a wound, flap has its own bkood supply in form of single large artery or multiple smaller blood vessel

local flap

skin can be transferred from a site adjacent to the wound by cutting a flap from an intact piece of tissue and rotating it about its pedicle -the part where the flap remains attached to the body- to cover the injury →incisions by surgeon stitched closed, or flap can be advanced in direct line when intact skin is pulled taut to cover a wound before being stitched into place

distant flap

transfer of tissue from remote area on body, similar to local one side of flap must still remain connected to original site in order to maintain blood supply, could entail leaving long “tether” of skin exposed which leaves area susceptible to infection/life threatening

Private William Henry Young

sniped in thigh →chlorine left impaired vision → shot in jaw/chest, deemed hero and sent to Aldershot for jaw surgery

died of sudden heart failure under anesthesia

chloroform

common anesthetic at the time, found to be able to cause ventricular fibrillation which is a fatal cardiac arrythmia

“never do today what can be put off till tomorrow”

Gillies’ motto

german immigrants

_____ living in Britain lost jobs, commited suicide, deported etc due to war hostility

Henry Tonks

volunteered to work in POW prison camp, art, doctor, made portraits/diagrams to document gillies work

Battle of Jutland

Ship explosions → many casualties →burn victims: very painful, morphine often did very little ; even first degree described burns could be fatal

flash burns

burned by superheated cordite - propellant explosive, detonation brief and affected just exposed flesh (face, hands) quick death

petric acid

used as antiseptic

left deep scars

eucalyptus and olive oil

used to keep dressings supple

function

Gillies’ prioritized _____ first

Sir Lane

surgeon, “no touch” used long tools as antiseptic to avoid directly touching wound

Seymour

injured in darkest battle of British history, gillies performed one of his first “nose jobs”

Rhinoplasty

an operation to alter the appearance of the nose; one of oldest recorded surgical procedures in India who devised method of Nasal reconstruction using flap from forehead/cheek

saddle nose

Syphillis patients often developed “______” which caused facial/nose disfigurement stigma

Tagliacozzie

published first book to deal exclusively with plastic surgery

Corporal X

loved molly; sank into despondency because surgery because of reflection

ended relationship bc of it

Wood

Artist, made masks for people in WWI (prewar photos, used clay to fill gaps, electroplated with copper, accessories and coat of silver)

Henry Brooks

made his own prosthetic nose, sucessful, made tin noses for others

cons of masks

Masks didnt allow for facial movement, fragile, “conceal”, not lasting = plastic surgery preferred

celluloid

(nitrated cellulose mixed with camphor) used for artificial noses but it was flammable so stopped being used , first plastic

flap

remains attached to one side to the original site to maintain own blood supply

graft

completely detatched from body before being transferred; survive as oxygen and nutrients diffuse into them from the underlying wound bed, but long term survival depends on new blood supply forming quickl

zeppelin

quiet, airship hydrogen balloon, attack British civilians by Germans “Baby killers”

Blepharoplast

eyelid plastic surgery

epithelium

vital tissue limiting internal and external surfaces of organs and glands

percy clare’s injury

bullet entered just in front of his right ear and travelled in downward trajectory, narrowly missing his right eye and fracturing his jaw in several places before smashing through his left cheek

Lumley

pilot crashed and was severely burned - chest flap to replace skin on pilots face - Gilles decided against waiting another year for second procedure

surgical wounds turned gangrenous(Death of body tissue) condition deteriorated, infection, towards the end metastatic absecesses(Swollen area containing pus) in various regions, heart gave out

huge demand for anesthesia

British alone used 413,198 pounds of ether, 249,341 pounds of chloroform and thousands of gallons of nitrous oxide

greatest challenge of anaesthesia

large amount of blood vessels in face; if blood pressure too high = bleed excessively could cause blood drowning/obscure area needing attention

sitting upright

Positive pressure necessary to prevent blood from entering the trachea, but surgeon got blast of ether-laden expirations

Endotracheal insufflation

improved methods of administering anesthesia by using motor pump to push vaporized ether through catheter placed in patients trachea

reduced chances of anesthetic shock by allowing doctor more control of quantity of drugs entering patient

antigens

Each blood type has different type of…

type O

blood type with no antigens

sodium citrate

acts as anticoagulant when mixed with blood, allowing it to be stored for later transfusion

banking

allowed blood to be collected in advance from preselected donors to supply the needs of frontline recipients, resuscitation teams

spanish flu

1918, reffered to as “3 day fever” bc of 3 day incubation, 3 day fever, 3 day convalescence nature of virus

took more lives than war itself, between 50-100 mil civilians and soldiers died a day, spread quickly among crowded soldiers,

Hippolyte Morestin

at the beginning didn’t let gillies observe him

died of spanish flue

November 11, 1918

Germany signed treaty that ended war on ….

ivan magill

Anesthetist, pioneered endotracheal anesthesia and angled “Magill Forceps” used to guide tracheal tube into larynx

percy clare ending

never made it back to the front, jaw locked due to premature reconstructive work, sent to other hospital not as good as Sidcup, honorably discharged due to severity of wounds, recieved British War Medal and Victory Medal for service

Jaques Joseph

developed intransal technique to alter tip of nose without creating external scar

X-ray hair removal

More than 35% of radiation-induced cancers in women could be traced to…

mrs brown

burn victim, lost all skin on face, decided to import skin from abdomen via tubed pedicle, used skin to create eyelids, cheeks, and nose, mouth biggest challenge, died untimely from epileptic seizure (not bc of Gillies)

Bombing of Royal College of Surgeons (London)

destoryed much of Gillies case notes, and other medical stuff, Henry Tonks portaits survived

vaginoplasty

creating a vagine

phalloplasty

creating a penis