Surgical Specialties Emerging from World War II (Part Two of Two)

Last week I posted the first half – on the development of neurosurgery – of a paper on the surgical specialties that emerged from the Great War I was to give at a symposium at Cal State Channel Islands in late October. The symposium was cancelled as the Woolsey Fire approached. Fortunately, no damage was done to the campus or its wider environs, but the paper “hung fire”, so to speak. So, I post it for a wider audience.

Herewith, the second half. It looks like the footnotes transferred this time (they didn’t last week when I used my iPad), but if you want a copy of the complete paper with footnotes, let me know and I’ll send you a copy.

Trench warfare also saw a huge increase in facial wounds, compared with previous wars. The lore of plastic surgery has Hindu surgeons performing nose reconstructions for men who’ve had their noses cut off as punishment. But the reality is that “[w]hen we entered World War I, there was a total ignorance of plastic surgery in the army, but it must be said, that even in civil hospitals and medical schools of that time, 1917, the appreciation of this branch of surgery as a special subject was also lacking.”[1] Interestingly, the first major influx of facial wounds on the British side came from the Royal Navy after the Battle of Jutland. Up to this point, any reconstructive surgery of the face was in the bailiwick of the otolaryngologists (ear, nose, throat specialists) and dental surgeons, and both Germany and France had put together teams of dentists and surgeons to deal with these problems. As fate would have it, another “great man” of his surgical art, Harold Gillies, a New Zealander trained in ear, nose and throat surgery, serendipitously fell in with August Valadier, a French-American dentist in France in 1915. Valadier had set up a unit to care for soldiers with jaw injuries, and Gillies, intrigued by the challenges of facial reconstructive surgery, went back to England to lobby for a hospital dedicated to these cases.[2] Once granted, Gillies and a team of surgeons, dentists, anesthetists, and technicians he gathered around him, set out – initially “by trial and error”[3] – to work out techniques of reconstruction that gave grievously wounded men – men with noses and jaws blown off – functional and cosmetically satisfactory results. Like Cushing, Gillies acknowledged that when he set out to repair the horribly wounded faces he saw, “…the principles laid down by the fathers of surgery [were] found to be of general application… But our work [was] original in that all of it had to be built up again de novo. …The earlier months, then, were spent in a very thorough trial of the then known methods. It has been illuminating to discover the impracticability of many of these, which would appear to have been put forward on the study of only one case, or even on purely theoretical grounds.”[4] Major accomplishments by Gillies and his team included the successful use of “tube grafts”, by which skin can, in stages, be transferred from, say, the chest to fill large facial defects; and the transplant of cartilage from the ribs into the face to rebuild noses, and more. By the time America came into the war, Gillies and his team had such an extensive experience that our medical officers who spent time with them were prepared to provide knowledgeable care to American doughboys wounded in combat. The U.S. Army set up several centers in France specifically for the care of men with facial wounds. The Army also established Plastic Surgery Centers in 9 hospitals stateside where these men received definitive care, being retained in the Army until they had received “maximal benefit” from the surgeons’ hands.[5] After the war, interest in plastic surgery varied. In England, just four men continued with development and practice of the specialty and these same four were the only experienced plastic surgeons available to British military forces at the outset of World War II. [6] In the U.S. on the other hand, interest was greater, promoted at least in part by increasing numbers of automobile accident victims needing skin grafting and other specialized care. One result was that the U.S. could provide 60 well experienced specialists to the army and the navy prior to our entry into the war. [7] As in the Great War, the Army established a series of short training courses to bring other surgeons up to speed in assessment and technique, and so well did the program work in providing needed talent, that the “short course” system was discontinued before war’s end.[8]

When peace finally came, the value of plastic and reconstructive surgery had been nearly universally appreciated, and training programs found their way into almost all medical schools in the west. Plastic surgery in the Soviet Union languished and was generally performed by general surgeons. Specialty practice existed only in Moscow and Leningrad, and access there limited largely to the political elite, movie stars and the security services.[9] Plastic surgery as a distinct specialty was recognized in Russia only in 2008, and specialty training centers established the same year.[10] China, on the other hand, established training programs in plastic / reconstructive surgery after World War II, and the profession has flourished, especially in the 21st century as the nation has become more wealthy, and demand for aesthetic surgery has grown. The International Society of Aesthetic Plastic Surgery estimates that more than 23,000,000 cosmetic procedures were performed world-wide in 2016.[11] Nearly 6,000,000 reconstructive surgical operations were performed in the United States in 2017.[12]

Conclusion

Two surgical specialties, for which there had been virtually no antecedent experience, emerged from the unique injuries soldiers in the Great War experienced in high numbers due to their exposure in trench warfare. The experience gained from treating these patients permitted surgeons to lay down principles of practice that inform the practice of neurosurgery and plastic / reconstructive surgery even today. Acceptance of these as separate surgical specialties was not universal until experience in World War II confirmed their value. Every major nation except the Soviet Union saw their advancement in the later 20th century. This progress and acceptance has only expanded in the 21st century.

Copyright 2018 Thomas L Snyder

[1] John Staige Davis, “Plastic Surgery in World War I and in World War II,” Annals of Surgery 123, no. 4 (April 1946): 610-621.

[2] Andrew Bamji, “Sir Harold Gillies: Surgical Pioneer,” Trauma 2006 8, http://www.gilliesarchives.org.uk/traumahdg.pdf (accessed 18October2018).

[3] John Staige Davis, op. cit.

[4] Harold Delf Gillies, Plastic Surgery of the Face Based on Selected Cases of War Injuries of the Face Including Burns, with Original Illustrations (London: Oxford University Press, 1920), reprint by Andesite Press / Creative Media Partners 2015

[5] Davis, op.cit.

[6] Richard Battle, “Plastic Surgery in the Two World Wars and in the Years Between,” Journal of the Royal Medical Society 71 (November 1978), http://journals.sagepub.com/doi/pdf/10.1177/014107687807101115 (accessed 21 October 2018).

[7] Lihani du Plessis, The Influence of World War I on the Development of Reconstructive Plastic Surgery. 2016. Honors Baccalaureate of Science thesis, Oregon State University.

[8] Davis, op. cit.

[9] “Soviet Plastic Surgery: When the USSR Went Under the Scalpel,” The Calvert Journal (22 March 2017), https://www.calvertjournal.com/articles/show/7971/soviet-plastic-surgery-ussr-under-scalpel (accessed 22 October 2018).

[10] Alexander V Melerzanov, “Plastic Surgery in Russia,” Prime – International Journal of Aesthetic and Anti-Aging Medicine (17 January 2014), https://www.prime-journal.com/plastic-surgery-in-russia/ (accessed 22 October 2018).

[11] International Society of Aesthetic Plastic Surgery, “International Study of Aesthetic / Cosmetic Procedures Performed in 2016 (Summary),”

https://www.isaps.org/wp-content/uploads/2017/10/GlobalStatistics.WorldWide.Summary2016s-1.pdf (accessed 22 October 2018).

[12] American Society of Plastic Surgeons, “2017 Plastic Surgery Statistics Report ‘ 2017 Reconstructive Surgery Statistics,” https://www.plasticsurgery.org/documents/News/Statistics/2017/reconstructive-procedure-trends-2017.pdf (accessed 22 October 2018).

Advertisements
Post a comment or leave a trackback: Trackback URL.

Comments

  • Richard VandenBrul  On 08 Jul 2019 at 11:04

    I would love to attend your up coming lecture on July 13th as I am on the Board of WWIHA and have know Sal for many years. I live in Michigan but grew up in Rochester N.Y. My father and his twin served in the Navy on the hospital ship U.S.S. Solace. They were both on the ship when the attack on Pearl Harbor occurred. My father had many stories about picking up wounded after various battles and transporting them to Brisbane or Auckland. He was transferred to San Francisco in June 1944 just before the attack on Saipan. He was trained to operate the laundry at the Waldorf Astoria while Solace was at the Brooklyn Navy Yard before gong to Pearl. I have a book, The U.S.S Solace Was There written by H.C. ‘Pat’ Daly M.S.C. U.S.N. Retired. Edited by Lt. Colonel Dorothy B. Howard C.S.M.R.- M.S.C. Retired Many accounts are written by Doctors some of whom lived in San Francisco.

    • thomaslsnyder  On 08 Jul 2019 at 11:36

      I’m sorry not to be able to meet you this Saturday. I’d be most interested in learning more about your father’s and uncle’s experience in USS Solace. I will also do a search for that book! Thanks for writing.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: