Surgery

• German scientist Robert Koch discovered that steam sterilized surgical tools better than acid
• Antiseptic surgery

  Germs in the operating theater are killed before they can infect wounds
• Aseptic surgery


  Equipment and clothing are sterilized with steam, no germs should be present in the operating theater
• Source B shows a photograph of an aseptic operating theater in 1910
• Source C is a photograph of an operating theater in a temporary Hut at a close by clearing station around 1916
• Compromises in aseptic surgery during wartime: large windows may be a vector for germs, surgeons wearing rubber gloves, mixture of equipment, lack of face coverings, assistance from others
• Attempt to provide a safe, clean, and efficient operating theater during wartime
• Harold Gillies developed plastic surgery during World War I using skin grafts for facial reconstruction
• Shrapnel caused gruesome wounds but was not always fatal
• Harold Gillies used skin grafts to reconstruct faces of wounded soldiers
• Images of facial reconstruction surgery may be distressing
• Facial reconstruction process involved gradually rebuilding the face using skin grafts
• Face reconstruction using skin grafts

  Original condition of the patient to the grafts being started to move over the face, remolding the face, rebuilding the nose, eyebrows coming along, scars becoming less visible, appearance becoming more natural
• The treatment of the Soldier with plastic surgery techniques was quite extensive
• Tubed pedicles technique

  Flesh gradually moved from place to place with blood vessels still connected, molded to shape, left to heal, used to rebuild lower jaw destroyed by shrapnel, skin grafts moved into the jaw from the shoulder, tubes gathered up with blood vessels inside to prevent flesh from going bad, one side cut and moved further up the body, repeated on the other side, allowing the graft to walk end over end
• Case of William Vicarage

  • Tubed pedicles used to rebuild lower jaw destroyed by shrapnel, skin grafts moved from shoulder, incredible results in rebuilding the lower jaw
• Case of William Sprickley

  • Tubed pedicles used to rebuild nose destroyed by shrapnel, skin graft moved from forehead, successful procedure with scars barely visible in later years
• Plastic surgery developed significantly during the First World War
• Artists like Captain Wood were employed to make realistic face plates as an alternative to plastic surgery
• Surgery like that performed by Gillies was pioneering and experimental
• Advances in surgery during World War One would be useful in peacetime and further refined with the development of antibiotics
• Significant advances in brain surgery were made during World War One
• Reason for many head injuries in World War One

  Trenches were open to the air at the top, soldiers caught out could get head wounds from shrapnel, head injuries increased after steel helmets were introduced in 1916, more people survived head wounds due to the helmets
• Surgeons barely existed before World War One
• There was little knowledge of how the brain actually worked before World War One
• New techniques were developed during World War One
• Harvey Cushing


  One of the pioneers of early brain surgery
• A few World War One surgeons had experience of neurosurgery
• Dr. Harvey Cushing improved the effectiveness of brain surgery through his work, experimentation, and careful observation
• Patients operated on quickly were more likely to survive

  Specific casualty clearing stations became chosen as centers for brain surgery
• Battle of Passchendaele


  1917
• All head injuries during the Battle of Passchendaele in 1917 were sent to the CCS at Mendinghem
• Patients remained at the CCS for three weeks after surgery to allow the swelling of the brain to go down
• Seemingly minor wounds could hide more severe injuries
• General anesthetics caused harmful brain swelling, so Cushing used local anesthetic to keep the patient awake
• Infections affected head and brain injuries, so actions were taken to prevent and treat infections during and after surgery
• General survival rate for brain surgery in World War One was 50%, but for Cushing, it was 71%
• Harvey Cushing's improvements had a significant impact on surgery during World War One
• Harvey Cushing: 'Describing the conditions under which he worked during the Battle of Passchendaele on the 19th of August 1917'
• Facial reconstruction or plastic surgery was developed by Harold Gillies using tubed pedicles to move grafts of skin and flesh without infection