Quick Guide: Faces of Battle

Hidden horror


As Armistice Day approaches an exhibition reveals a hidden side to the horror of World War I.

It contains previously unseen images of British servicemen who suffered terrible facial injuries in the conflict.

The exhibition also tells the story of one surgeon - Harold Gillies – who through his efforts to help them became known as the father of modern plastic surgery.

WARNING: Some of the following images are of a very graphic nature.



The wounded


The Faces of Battle exhibition makes extremely unsettling viewing, but its organisers feel it is something the public need to see.

And at a time when the care of British soldiers wounded in Iraq and Afghanistan is in the headlines, it makes it clear that the issue is not new.

"We remember the dead, but we don't remember the wounded, the people who had to go on living," exhibition co-curator Samantha Doty says.



Trench warfare


World War I was unlike any conflict before or since.

It was the first fully mechanised war, and the advent of heavy artillery, shells and machine guns meant more devastating injuries than ever before could be inflicted.

At the same time, the fighting was mostly in trenches which provided protection for men’s bodies, but left their heads exposed.

New Zealander Gillies saw the results of this lethal combination first hand when he was posted to the Western Front in 1915.



World first


When he returned to Britain in 1916, Gillies set up a facial ward at The Cambridge Military Hospital in Aldershot. After the Battle of the Somme, the team there expected 200 casualties – but they got 2,000.

It was clear a dedicated hospital was needed – the world's first.

A year later, thanks to Gillies, the Queen Mary in Sidcup was opened.

In all, 5,000 soldiers were treated there by a team of surgeons and other specialists drawn from all over the Commonwealth.



Rebuilding faces


Traditionally, the edges of facial wounds were simply stitched together, but when scar tissue contracted faces were left twisted and disfigured.

Gillies did something different. He rebuilt faces using tissue from elsewhere in the body.

Today we think of breast implants and nose jobs, but plastic surgery had its birth in the wounded faces of veterans.

Dr Andrew Bamji, the Gillies archive curator, says: "He was prepared to try anything. He wouldn't give up."



Tubed pedicle


Antibiotics had not yet been invented, meaning it was very hard to graft tissue from one part of the body to another because infection often developed.

But while treating Able Seaman Willie Vicarage, Gillies invented the “tubed pedicle”. This used a flap of skin from the chest or forehead and “swung” it into place over the face.

The flap remained attached but was stitched into a tube. This kept the original blood supply intact and dramatically reduced the infection rate.



New nose


One of Gillies' biggest successes was William M Spreckley (pictured) who lost his entire nose in the Battle of Ypres.

The surgeon implanted a section of cartilage from one of Spreckley's ribs under his forehead. Then he "swung" the cartilage and a flap of skin into the nasal cavity to create a new nose. Over time the new tissue fused with the old and filled the hole.

"Gillies' unique idea was to marry cosmetic appearance and function," Dr Bamji says.



Psychological scars


Years later, Spreckley's physical scars were barely visible.

His daughter Elizabeth Gregory said: "What Gillies did for him was absolutely astonishing."

Spreckley was hugely grateful to Gillies and even named his son Michael Gillies in his honour.

Nevertheless, he was psychologically scarred, and his grand-daughter Alexandra Kingman says: "He must have felt like a freak when it happened. All his life he still thought he looked hideous."



Staged grafts


Gillies couldn't help everyone, but he learned from every case.

One of those was Henry Ralph Lumley whose face was horrifically burned. The Sidcup team tried a very advanced facial graft using a large flap of skin from Lumley's chest to try to repair it.

Sadly he didn't survive. Gillies realised he had tried too much, too quickly, and from then on carried out staged grafts.

This gradual rebuilding process forms the basis of the technique still followed today.



Guinea Pigs


Gillies (pictured) was knighted in 1930 and even went on to perform the first female to male gender reassignment in 1946.

He also helped train his distant cousin and fellow surgeon Archibald McIndoe who became a plastic surgery pioneer in his own right.

During World War II, McIndoe famously performed reconstructive surgery on British airmen who had been badly burned.

His incredible and often experimental work earned them the nickname the Guinea Pig Club.



Personal stories


The National Army Museum exhibition showcases Gillies' work, but also reinterprets it through a series of sculptures.

Artist Paddy Hartley, funded by The Wellcome Trust, has used military uniforms to tell the surgical and personal stories of some of Gillies' patients. For Project Facade, Hartley has stitched their photographs and case notes onto the fabric and added testimony from their relatives.

"I feel a responsibility to tell people what these men went through," Hartley says.



Appearance-obsessed


Faces of Battle opens to the public on 10 November.

"We know it's a difficult exhibition to come to, but people should be able to see what these injuries looked like," Ms Doty says.

"And we want people to reflect on their own appearance - what would it mean if that changed?

"We live in an appearance-obsessed society and if you say 'plastic surgery', people think Nip/Tuck. But when they see this they'll hopefully realise what it's really about."