Gaining Respect in World War I

Trench warfare in World War I blew away jaws, lips, noses, cheek bones, and eyes. Airplane crashes added more injuries. Historian Elizabeth Haiken (1994) points out that the horrifying facial wounds were immediately recognized not only as a surgical problem, but also as a social problem. The unprecedented nature of the injuries challenged the most highly trained medical and dental surgeons of the day to push past the previous boundaries of reconstructive surgery. As they sought to restore function, they also tried to create an appearance that would allow a veteran to return to his family and his work, thereby retaining his sense of independent manhood. Most of the injured were willing to undergo virtually any ordeal, no matter how painful, to attain this goal. Grafts and flaps of all types were used by the men who would become the founders of the new specialty of plastic surgery after the war.

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Harold Delf Gillies, a New Zealand otolaryngologist (a specialist in ear, nose, and throat problems), directed a reconstructive medical unit in England . He began to sew together the parallel sides of the skin bridges used to supply flaps with blood. These “tubed pedicles,” also developed about the same time by ophthalmologists (eye specialists) Filatov of Odessa and Granzer of Berlin (Rogers 1988), better protected the blood supply and enabled surgeons to transfer skin in stages from one location to another. Johannes Fredericus Samuel Esser, an ingenious Dutch surgeon, experimented with epithelial inlays to rebuild eyelids and vascular pedicles to transfer hair-bearing skin for eyebrow reconstructions. Varaztad Kazanjian, an American immigrant from Armenia , was a dentist with two years of medical school when he joined the Harvard unit of the British Army Medical Corps. He established the first maxillofacial treatment center in France where he wired fragments of jaws together, developed specialized facial and dental prosthetics, and invented internal rubber splints to prevent faces from contracting until more extensive bone grafting could be done. Other American surgeons also went overseas to help and to learn. Vilray Blair, an experienced surgeon with a long résumé of articles and a book on surgery of the mouth and jaw before the war, was named chief of the Armed Forces' plastic surgery section. He returned from Gillies's facility to organize teams of medical and dental surgeons to care for the wounded (Hait 1994). He directed one of the three U.S. military hospitals eventually designated for plastic surgery patients — Jefferson Barracks in Missouri . His assistant, Robert Ivy, headed the team assigned to Walter Reed Hospital . George Shaeffer headed the unit at Ft. McHenry in Baltimore where John Staige Davis trained many of the surgeons.

Despite the considerable progress in reconstructive techniques, there were limits to what surgeons could do for the most severely maimed. Some devised unique prosthetics for such patients to help restore function and a more normal appearance. In those relatively few patients for whom both surgery and prosthetics proved inadequate, artists fashioned elaborate facial masks to hide the worst of their deformities.

But what could be accomplished by a skillful surgeon trained in the emerging techniques of plastic surgery was acclaimed as a modern miracle by the media. By the end of the war, these surgeons had earned the respect of their colleagues and the public. No longer were questions raised about the morality of surgical reconstruction or, for that matter, about the social value of medical practice.