Under the Double-Edged Knife: The Reality of Surgical Progress in the First World War
Second Lieutenant Norman Eric Wallace was serving as an RFC artillery observer when his plane was shot down and caught alight on 19 September 1917. He suffered severe burns to his face, leaving many of his original features distorted. Incredibly, however, after undergoing 21 complex skin graft operations under the expert care of Harold Gillies, his face was able to be largely restored.
Norman Eric Wallace pre-burns; pre-surgery; and post surgery (IWM Lives of the First World War; Gillies, Plastic Surgery of the Face, 1920; RCS)
The reconstructive surgery carried out on those like Wallace during the First World War was undoubtedly groundbreaking. It pushed the limits of what was previously known about plastic surgery, and the knowledge and techniques discovered and first used at this juncture continue to provide the foundations of plastic surgery today. What is often seen as the most remarkable thing about this, however, is that Gillies and the rest of the team at Sidcup were performing these operations with few textbooks and little guidance. Although early forms of plastic surgery date back to antiquity, understandings nevertheless remained limited and little literature existed to guide surgeons through the complex cases of the First World War.
Yet while the progress made during this time, therefore, is undeniably remarkable, we often forget the poignant and more troubling reasons which enabled this innovation to take place.
Indeed, as much as the Queen’s Hospital was a place of innovation and developing knowledge, it was just this – developing. The lack of textbooks and guidance meant Gillies was largely working by trial and error. Operations did not always go to plan and attempts at new techniques did not always work. In 1917, Second Lieutenant Henry Ralph Lumley sustained significant burns across his entire face following a severe aircraft crash. The team at Sidcup attempted to perform an unprecedented facial graft to replace the whole skin of the face using a large skin flap from a volunteer’s chest. Lumley, however, was too fragile to handle such an advanced surgery. The graft failed to take and his surgical wounds quickly turned gangrenous. On 11 March 1918, Lumley died.
Lumley’s case, however, was instrumental to the development of plastic surgery. Gillies realised he had attempted too much too quickly and, from then on, carried out staged grafts on the thousands of other servicemen who sustained facial burns. Indeed, Wallace’s successful series of staged grafts were a direct consequence of the lessons learned from Lumley. Innovation, then, was largely only possible because of earlier loss and sacrifice. Gillies and his colleagues developed their knowledge by performing on real people, and progress owed to the influx of injuries generated during the First World War which provided a seemingly endless supply of material to practise on.
Henry Ralph Lumley pre-injury (IWM Lives of the First World War)
Gillies's notes and drawings of Lumley (Gillies Archive)
Yet perhaps most troubling of all, we should not forget why the Queen’s even existed in the first place. As a military hospital, it was, by its nature, ultimately healing men so they could return to war. While this is often conveniently forgotten today in favour of tales of medical advancement, it was at the fore of the minds of all of those at Sidcup at the time. Recovering from surgery after being shot through the jaw at the Battle of Cambrai in 1917, patient Percy Clare confessed his fears of being sent back to the front in a letter home to his mother:
"Shall I whisper a secret to you? I’m afraid of getting well. The sooner I recover the sooner ‘out there’ I go again, and frankly I don’t want to go."
Private Percy Clare, letter to his mother, 1917
Clare’s fear was a very real possibility. One officer underwent a series of painful and complicated procedures at Sidcup to treat a deep wound which ran from his temple to his chin, only to be sent back ‘out there’ once recovered. He was subsequently shot in the leg and died of his injuries in the same casualty clearing station which had first received him for his face wound. The staff at Sidcup evidently also felt the strain of this. During an address to the Medical Society of London in 1917, Gillies outlined the dilemma he faced between his obligation to ‘send back to duty as many soldiers as possible in the shortest time’ and his obligation ‘to the patient and to do the best for him’ (Chatterton, p.37.). These duties, he said, frequently clashed. Gillies and his staff were well aware that, by mending these men’s faces, they were also helping to send them back one step closer to death.
When we think of Harold Gillies and plastic surgery during the First World War, we often immediately focus on the incredible reconstructive surgery he performed and the innovative techniques he invented to do so. Yet it’s important to also remember why this was able to happen. The First World War did bring significant progress in our ability to heal face wounds and injuries, but only because of the immense devastation and destruction it inflicted on so many.
_edited.jpg)
Wounded British troops at Dernancourt, Sep 1916 (IWM Q1318)
Explore Further
​
Level 1: BBC Bitesize, ‘The Impact of War on Medical Developments’.
Level 2: Imperial War Museum, ‘Henry Ralph Lumley’s Medical Treatment’.
Level 2: Imperial War Museum, ‘Medicine in the First World War’.
Level 3: Claire Chatterton, ‘Working in a ‘World of Hurt’. Nursing and Medical Care Following Facial Injury During World War One’, European Journal for Nursing History and Ethics, 3 (2021), 24-43.