Medicine and War — Sir Harold Gillies: the father of plastic surgery

There is no doubt that war brings death and destruction, but it can also be a catalyst for medical advances. This is clearly demonstrated by the Great War and the developments made in plastic surgery. This blog is focused particularly on the work of Harold Gillies, a New Zealander who worked in Britain during the early twentieth century, and who headed pioneering research and practice in the field of plastic surgery.

The use of Maxim’s machine gun and the shrapnel from exploding shells in the Great War led to horrendous injuries and deformities of the soldiers who faced them. Such injuries often left soldiers disfigured and challenged their ability to function, especially when involving the loss of limbs.

 

Harold Delf Gilles. Credit: Science Museum, London.

 

Harold Gillies trained as a doctor at Cambridge University and went on to become a surgeon. He served in the Great War and experienced first-hand the terrible injuries suffered by the soldiers that he fought alongside. He understood not only how life-threatening these injuries could be but also the great psychological impact suffered by soldiers who could sometimes no longer recognise themselves in the mirror. Gillies became particularly interested in the surgery performed to repair injuries of the jaw and face, in order to try and reconstruct as much as possible the soldiers’ previous appearance. He paid particular attention not only to functionality, but also to aesthetics.

Gillies set up a hospital in Aldershot in 1915 which later moved to Sidcup in Kent. He treated many soldiers who had fought in the Battle of the Somme – one of the bloodiest battles of the Great War. Gillies is often referred to as the ‘father of plastic surgery’ and he pioneered novel techniques such as the ‘pedicle tube’ which enabled the grafting of healthy skin to areas of the body destroyed by the trauma of battle. Some of Gillies’ work can be seen in a book that he published in 1920 entitled ‘Plastic Surgery of the Face’, shown below:

 

Wellcome Images CC BY Credit: Science Museum, London

 

Harold Gillies laid the foundations for modern plastic surgery. His work helped thousands of soldiers who survived the War in living as normal a life as possible. After Gillies’ death, the American Society of Plastic and Reconstructive Surgery wrote the following which accurately describes his legacy:

 

The ideas engendered by his fertile brain have spread and are being spread afar, and generations of plastic surgeons will be affected by what he gave forth to the world. His memory may perish but his influence is immortal.

 

 

Further Reading

National Army Museum, ‘The Birth of Plastic Surgery.’ Accessed 7 June 2019. https://www.nam.ac.uk/explore/birth-plastic-surgery.

Oxford Dictionary of National Biography, ‘Gillies, Sir Harold Delf (1882-1960).’ Accessed 7 June 2019. https://www.oxforddnb.com/

 

Lucy Havard

 

 

 

 

The Worshipful Society of Apothecaries

This blog is all about the Worshipful Society of Apothecaries and their recent 3-day history of medicine course which ran from 1st-3rdMay. This fascinating course comprised a series of interesting lectures, spanning the history of medicine over two thousand years in Europe and beyond.

 

Image 1: Worshipful Society of Apothecaries Coat of Arms

 

The Worshipful Society of Apothecaries is quite simply an historical gem nestled in central London, a stone’s throw from St Paul’s Cathedral. Like many of the other London livery companies, the Society of Apothecaries looks rather unassuming from the street. But, walk into the courtyard, and then through the main entrance up a beautiful seventeenth-century staircase into the court room or parlour, and prepare to be met by gorgeous wood paneling, impressive life-size portraits of various Society benefactors and lots of rhinos – the Society’s emblem for over 400 years! The origins of the Grocers and Apothecaries of London can be traced back to 1180. In 1617, the Apothecaries separated from the Grocers to form the Worshipful Society of Apothecaries of London.

 

Image 2: The Court Room

The delegates that were attending the course were of varying backgrounds – medical students, practising doctors, pharmacists, historians, nurses, museum curators and those with a general interest in the history of medicine. Such an eclectic group of people made for probing questions and stimulating discussion at the end of each lecture.

The talks during the course covered a broad range of themes and topics – there really was something for everyone! Day one featured art and surgery, the history of the coroner, the founding of voluntary hospitals and disease and medicine in ancient Egypt. Day two brought talks focused on medicine in Scotland and Japan as well as women in medicine and a broad overview of Britain and world medicine. On the final day, we were treated to the history of pharmacy, the history of X-rays and a talk on the archaeological findings from Salisbury Plain as well as a general overview of the history of clinical medicine. All in all, a satisfying and fulfilling course that provided a comprehensive overview of the history of medicine.

Anyone interested in attending the History of Medicine course or applying for the Diploma in the History of Medicine (DHMSA) at the Worshipful Society of Apothecaries should consult the following website for the most up-to-date information:

 

https://www.apothecaries.org/diploma-in-the-history-of-medicine/

 

Image 3: Dürer’s Rhinoceros – emblem of the Worshipful Society of Apothecaries

 

Lucy Havard.

Now Walks Like Others

How were poor crippled children treated in England during the late 19th and early 20th centuries before the advent of free healthcare through the NHS and the Welfare State?

A group of  Northampton children – all very keen on medical history – believe that if medical history is to be truly relevant it must live. So one day, while happening to sit in an outpatient clinic they decided to answer the above question using the extensive historical archive held at Northampton General Hospital. They give their answers with a short film (20 mins, link at end of post).

 

        

Image 1: CC BY Credit: Science Museum, London

The Northampton Crippled Children’s Fund (NCCF, 1893-1925) provided medical care for ‘poor crippled children in straightened circumstances under 17 years of age’ initially in Northampton and eventually county-wide. It also gave long term dietary supplementation and summer seaside holidays. It had wide community support. In its final year before the opening of the Manfield Orthopaedic Hospital it treated 3000 children. Crippled Children’s Funds were widespread in the UK before the establishment of the National Health Service (NHS) but there are few surviving records and research has been limited in this area.

My day job is as a consultant community paediatrician. This film is a way of introducing medical history to my patients, keeping my day job interesting and giving something back to the community where I work.

The children involved in the film are my patients, their siblings and members of Theze Guyz Theatre Company, Northampton. Together, working with healthcare professionals and historians they relate, recreate and assess the work of the Northampton Crippled Children’s Fund within its historical context. The film includes full medical and dietetic reconstructions, and some cartoons. You can view it using the following link:

https://www.youtube.com/watch?v=vvU8suIPTiU

The film credits acknowledge the funders who made this film happen.

The film was written and directed by Professor Andrew N Williams PhD FRHistS consultant community paediatrician and curator of Archive, Northampton General Hospital.

 

Andrew Williams

Joseph Bazalgette (28/3/1819 – 15/3/1891)

Thames Water, the authority responsible forLondon’s water and sewage system, is currently building a massive new ‘Super Sewer’ known as “Tideway”. Approximately 25km in length and due for completion in 2024, this project is being undertaken to prevent the release of thousands of tons of untreated sewage into the River Thames on a daily basis. This contemporary, complex and sometimes controversial civil engineering project is a reminder of the birth of London’s sewage system, designed by Joseph Bazalgette, born two centuries ago last month.

 

Portrait of Sir Joseph Bazalgette. Credit: Wellcome Collection. CC BY.

 

161 years ago Victorian MPs were busy arguing and prevaricating over the cost and necessity (or not) of building and funding a proper purpose-built sewer system, designed by Bazalgette. They rapidly ceased all opposition to the project during the long hot summer of 1858 when low tides meant that huge quantities of untreated sewage that normally ran into the Thames were deposited on the river’s foreshores. The resulting appalling smell became known as “The Great Stink”. Believing, as most did at that time, that bad smells spread disease, MPs had to hang sheets soaked in carbolic against the windows in the Palace of Westminster to stop the suffocating stench. Before finally leaving The House ‘en masse’ the MPs quickly voted in the necessary funding for Joseph Bazalgette’s brilliantly conceived sewer system. It consisted of “intercepting sewers”, pumping stations and treatment works that are still being used today thanks to the high quality brick-lined tunnels and the use of durable Portland cement.

 

Civil engineering: construction drawings for the Thames Embankment. Coloured drawing, 1865, after Sir J. Bazalgette. Credit: Wellcome Collection. CC BY.

 

Bazalgette was a brilliant engineer, who started his career working on various railway projects. He was responsible not only for the London Sewer System but also for the Thames Embankment, and numerous major roads in London such as Shaftesbury Avenue and Northumberland Avenue. He strengthened or rebuilt 12 bridges over the Thames and freed them from tolls. He also engineered the Blackwall Tunnel and the Woolwich Ferry, and important parks such as Clissold Park, Finsbury Park and Victoria Park “the green lung of East London”.

 

However, it is Bazalgette’s sewer system for which he is probably most famous. He designed it anticipating a population increase in London from 2 million to 4 million – extremely far-sighted for the time. Given that the current population of London is approximately 8.5 million, no wonder a ‘Super Sewer’ is needed to provide for the increased strain on the system. More important than saving Londoners from a further ‘Great Stink’, Bazalgette’s work played a critical role in saving the lives of many thousands from deadly water-borne infections such as cholera. For this, he deserves to be remembered.

 

 

Further Reading

  • Stephen Halliday,The Great Stink of London: Sir Joseph Bazalgette and the Cleansing of the Victorian Metropolis(Sutton Publishing: Gloucestershire, 1999).
  • ‘Tideway – Reconnecting London with the River Thames,’ accessed 30/3/19, available at: https://www.tideway.london.
  • ‘Thames Water,’ accessed 30/3/19, available at: https://www.thameswater.co.uk/

 

 

Hermione Pool

 

A Breath of Life in the Archives

Laboratory (? at Sudbury), Credit: Wellcome Collection

 

A young man, an assistant in the laboratory, poses for the camera. The surroundings and his attire flag a bygone era. What stories might he tell us of that time?

The photograph is undated, and the location not precisely specified [1]. The time and place can, however, be established with some certainty. The lab is part of the Serum Department of the Lister Institute of Preventive Medicine at Elstree, Hertfordshire. The year is 1903, or as near as matters, when this new establishment was unveiled to the press [2]. Another version of this image, artistically faded at the corners, appeared in a promotional pamphlet soon after [3].

In the archives of the Lister Institute, tucked away under ‘historical items’, sits a remarkable memoir [4]. Albert Riggs was 17 years old, and had been out of work for 4 weeks, when a neighbour working as a builder on the Elstree site suggested he apply for a vacancy. Riggs passed the interview and started as a lab assistant on 3 September 1903 on a weekly wage of 12 shillings. He was appointed Head Assistant at the beginning of World War I and remained an employee of the Institute for 48 years. He put down his memories in a 100-page annotated typescript illustrated with hand-drawn diagrams. Riggs’ first impressions of the Elstree Laboratories were drawn upon by the best-known history of the Lister Institute:

 

At six o’clock on a lovely August morning in 1903, I first saw the Lister Institute, or as it was then known locally “Queensberry Lodge”, and now whenever it comes to my mind, I see it as I saw it then, the lovely tree lined drive, the green fields, the trim hedges, the old house with its rustic porch in front, the stables with their eighteen horses and whistling stablemen, and the calm peace which reigned over everything. [5]

 

In considerable detail, Riggs describes the labs, animal houses and stables. He covers the routines involved in making a variety of serum products and the role of lab assistants immediately prior to 1914, and he offers a first-hand insight to the work of the Institute during the war when it supplied tetanus antitoxin and other antisera to the Army [6]. Most engagingly, Albert touches on aspects of his life, candidly recalls many of his colleagues, and describes – warts and all – some of the ‘characters’ under whom he worked.

With its authentic voice – a rare counterweight to the large volume of ‘official’ documents typical of institutional archives – this lab assistant’s memoir breathes life into history.

 

 

References

[1] Image of laboratory at Sudbury (?), Lister Institute, Wellcome Library Archives, SA/LIS/R.163.

[2] British Medical Journal1 [2217], 1513-15 (1903); The Lancet, 2 [4167], 120-1 (1903).

[3] A Laboratory at Queensberry Lodge, The Lister Institute of Preventive Medicine – with notes on serum therapeutics by members of the staff of the Institute, 1904, SA/LIS/P.13, facing p. 10.

[4] Albert Riggs’ Memoirs of the Lister Institute of Preventive Medicine, Elstree, Hertfordshire, c. 1951, SA/LIS/M.6.

[5] Chick, H, Hume, M. & Macfarlane, M. (1971) War on Disease: A History of the Lister Institute, London: Andre Deutsch, p. 80.

[6] Wawrzynczak, E.J. (2018) Making serum, saving soldiers: the Lister Institute during World War I, VesaliusJournal of the International Society for the History of Medicine,Vol. XXIV, No. 2, 40-48.

 

 

Edward Wawrzynczak