WOUNDS OF WAR.

Taranaki Daily News, 21 January 1918, Page 6

WOUNDS OF WAR.

MAIMED FACES AND THE MARVELS OF PLASTIC fiURGERI". (By Arthur Mason, Special Correspond>uit of the Empire Press Union). London, Nov. 1017. At Sidcup, in the county ot K- ; .ai, there is a war hospital which is assured of distinctive fame, even though the war hospital of to-day is universal and itl relief of suffering 1 very miracle of beneficent achievement. To say nothing of the preventive effort of medical science, by means of which tens of thousands of lives have been saved to the British Army, the surgery of war-time is accomplishing a work whose value cannot yet be measured, and perhaps is immeasurable. And it is the surgery *n war-time, in one of its branches, that fa so successfully active at this hospital of Sidcup—specialised surgery, concerned solely with met who have suffered facial wounds (Facial wounds are necessarily amorg the most distressing of all the varied' hurts of war They arc rarely less than disfiguring, and very often they Te disfiguring io the point of shocking un sightliness More than that, tlmy are usuaUr wo.inds which, directly or indirectly, have injurious effect upon the function? g? vital organs. The surgery inteadeu to relieve them employe itself, therefore, not only with the repair of facial deformity, but also with such restoration of the injured parts a: will assure to the body as a whole its normal health and vigor An institution which should specialise in the surgery of wounds of this class was not always regarded as 1 iif!«3?ar7. But the gradual increase in 1 their number and their severity, the sur- [ giea! problems "ihey set up, and the inevitably protracted treatment they demand now mftko it clear that the facial woirada pt soldiers and sailors too numerous, too tomplex, and too specifically a sttdy in 'heir own right for general surgery, can be adequately hsn/lten only hy msn of specialised training asd experience Ma jor H. U. Gillies, R A.M.C, who '« in sharge at Sidcup, anl the staff assisting lumj are of that quality. They have ill their earc some 500 patients, otf whom 150, more or less, are not in residence but await on furlough—though under supervision—the operations that arc

the next stage in their relief. The administration of the hospital and its auxiliaries is in the care of Lt.-Col. Colvin, commandant, and it is increasingly an interest of the medical profession and tlig Army authorities. To the mere layman, even a glimpse of its work such as one was recently allowed reveals un-Ithought-of and almost incredible wonk.erj of surgical science.

RATHEk GRUESOME. The patients are very fortunate in respect of surroundings. The hospital wards and accessory offices are built up in a series of airy and admirably lighted huts spread about the grounds of a large country h'ouse, while the walks abroad available to the convalescents are of typically Kentish charm. The visitor may, us he prefers, see the patients them- j selves and their injuries, or photographs of patients at progressive stages of their treatment, or masks and models of the injured faces as they were first presented for that treatment. There is, for oxample, in one corner of the hospital i little museum. Hung about its walls are plaster easts, and water-color drawings drawn from life, of wounded faces, and in its cabinets are faces modelled in wax with all their injuries plain to sec. It is not a pretty display. On the contrary. it is rather gruesome—and for that matter the whole array of wlial ic to ba "seen at this Sidcup hospital will distress the visitor until he is able to set against the pitiful ugliness of this aspeet of the ministering agency of the surgeon'? work upon it. In the light of that, he will besin to bear the shock, to look without, shrinking upon those pathetic distortions of tfca human ieatures, and to think less of the wounds which are their cause than of the skit! which so amazingly heals and hides them The nose, the mouth, the jaws, and the eiieek surfaces suffer grievous hurt in the battles of to-day. Here is a typical case—that, of a nose-wound, the bullet indicting which has torn most of the feature from the face and has left, in its .stead a rather dreadful wreckage. The staff at Sidcup, however, see tjie injury as oie eminently suited to ffhn magic they call plastic surgerv. Bv virtue of nlastic surgery they will make a. rose for that now almost noseless face. The marvel to be wrought will need timeperhaps a. year, perhaps eighteen months. Tt will be a matfer also of delicate operations, the number and scope of which "inly the progress of the ease will reveal. But. the problem set—the provision of a new nose—will he solved without any manner of doubt. And this is the way of it:

MAKING A NOSE. As a first stop, measurements are taken and models aro made which determine the shape and size of the restoration called for, and the surgeon begins to work upon the damaged tissues, preparing them by operation for efficient contact with the surface covering of the nose to come. That repair of the tissues is more or less familiar surgery, but at Sidcup it is a matter of inflnite variety and exhaustive and (JTten novel methods. And a 9 for the actual provision of a nose, that is a wholly new marvel of the healing art. It is quickly in being, nevertheless. From the man's rib is removed a spread of cartilage equal to the measurements already taken—removed from his rib and grafted upon his forehead, and shaped and fashioned there with due regard to the model already made. And from each cheek a flap of skin is lifted and attached by one end to the transferred cartilage," its other end remaining affixed to the face. The cartilage, built into due shape, is now a nose merely out of position. It jis left to grow upon the forehead until the tissues awaiting it are healed, and then, when all is ready, it is lifted again, drawn down by the 'flaps of skin and lifted carefully into the place where is should be. Other magic is wrought upon it by way of finishing touches, and the scar? npon the forehead and tho face are excised by grafting and by massage. The sr-ar upon the body already has vanished, but in any case was of no great moment. The surgeon's triumph—and the patient's is in the fact that a nose has hcen provided, the contour of the face has been restored, and the wounded man is saved a distressful unsightliness.

MOUTH-BUILDING. Sometimes, of course, the injury is less revere. Sometimes the nose needs only partial restoration. Most often, it, seems, tlie Tiridge is shot, through, and the wizardry called for is that which will fit new bone and new tissue into almost invisible junction with the old. Sometimes, on the other hand, they get at Sidcup a case such as that of a man the entire front of whose face had been 'blown in br an explosion of cordite, A

dreadful Injury which, however, was healed with manellous result by (he transplanting vf the ."kin of his chest. But whatever the injury may be, these Sidcup surgeons ~eeiii prepared for it, and iu case '.\fter case of nose-wound they are restoring terribly disfigured men to the normal, men who will bear upon their faces only negligible scars to suggest the affliction they have escaped. There are many cases, ioo, of mouth-wounds, in ivhich the lips and t' eir surrounding have been shot away, wholly or in part; and are restored again by similar won-der-working. In each such case an operation or two —plastic surgery-flaps and attachments —transplantings of skin and mucous membrane from one place to another—great skill and an infinite patience -and the thing attempted is done. The mouth emerges almost as it was before its injury. Threatened disfigurement is replaced, by scarcely perceptible lines upon the new surface. The man is whole again. JAW RESTORATION. Jaw injuries are more serious and often aro very complicated, almost always, indeed, needing the closest care of the dental specialists whose task it is to build anew upon the ravage of bone and tissue confronting them. The dental department ia necessarily one of the most important centres of the work at Sidcup, and every possibility of jaw injury is known there and assured of highly expect attention. A typical jaw patient is a man whose wounds are a matter of disastrously cut and torn flesh and lost or fractured or splintered bones. Apparently, the mouth is ruined. Tlie line of the face is destroyed seemingly without hope of repair. But the surgeons arc soon at. work, the X-ray disclosures are »ead. the operations begin, and the shattered framework of the jaw is restored by graftings of bone and tissue and by mechanical supports—palate plates, vulcanite splints, biting flanges, et--. Thea, with the foundation firmly laid and the functions of jaw and teeth once more efficient, the exterior miracle i« wrought, the miracle of plastic surgery with its grafts and flaps and all the accessory magic of its healing and concealing. Thus, surely though slowly, reienvo and skill and patience prevail, deformity and ugliness glvo place to presentee contours, and one more sufferer is transformed and restored All this, however, is merely to hint at tho marvels in daily achievement at Sidcup hy virtue of plastic surgery and the wealth of specialised skill within the meaning of that word. It is comparatively recent work, but already it is established as a brilliant contribution to the unparalleled surgery of this wartime. Furthermore, it is increasingly of interest to the Dominions, for, while wounded Dominion soldiers are already treated there, it has now been decided, thanks to the efforts of Sir Arbuthnot Lane, Bart., C.8., Consulting Surgeon, to attach to the stfl#F at Sidcup surgeons and dentists from the Dominions, .who thus Will have unique opportunity of extending their knowledgo of one of/ the most interesting developments of modern surgerv.