SEW FACES FOR OLD.

REMEDIES FOR WAR WOUNDS. PLASTIC SURGERY. (from out OWN CORRESrO.NDE.VT.) LONDON, November 10. The man in tho street will insist on laughing and scoffing at a funny face. ]t matters very little whether a man gained the V.C. when hi 5 face was fcmashed and pulped beyond recognition. That will not help him much when he gets back into '"civvies," and has to take his disfigured countenance with him into the highways -and byways. Moreover, the disfigurement will be always present with him and, unless he is a very strong-willed man, it will tend to prey upon his mind and make him despondent. That is one side of the problem of facial wounds —tho merely aesthetic or sentimental side. There is, of course, another aspect. Many of the men who come back by tlio Via Dolorosa from the trenchcs to the English countrybide, have their faces so damaged that they will not heal, but will gangrene and* cause death. Others .are wounded in a healthy enough way, and the wounds might heal, but tue loss of a complete jaw, or even more, will prevent the patient from masticating or swallowing food, and so cause deatu. This is the life-and-dcath side of tho problem."which musfc bo tackled from the purely practical standpoint.. •.-Before the great war men with shattered faces died of wounds or broken hearts. Now they go to a special hospital where marvels of surgery arc perJormcd, and stop out into the world again, whole and confident. 1 found the hospital for facial cases at .Sidcup, Kent, in tile grounds of Frognal—a teat of the Sydney family, and the home, in peace-time, of the Hon. Mis Robert Marsliam-Townshend. It is chieflv a hutment hospital in the beautiful 'park. The Commandant, I was flattered to discover, is a New Zealander, Major D. H. Gillies, R.A.M.C., who before the war had a .Harley street practice, and was well-known in the golfing world. Frognal accommodates about 350 mpatents, but there are another 150 biJlcteH in. the neighbourhood, and coming in for their surgical treatment. It has been going as a special hospital for more than a year, aud to-day it is the Mecca of the face and head specialists, as Roehampton is of the limb., specialists. The raison d'etre of Frognal is, in a word, to renovate damaged faces. The order of reference extends not merely I to skin aud superficial injuries, but to actually making new faces where the old ones have been damaged beyond repair. To begin with something simple. A seaman in the battleship Malaya at the battle of Jutland had the whole of the skin burnt off the front of'his face, in a cordite explosion. It was healthy enough, but it was raw. flesh, and' would. not mend. Tho process adopted was this: The. skin of the chest was cut away to a depth of about a Quarter of an inch, and rolled back ownwards, making a scroll sufficient to cover the face. It was then laid over the face and kept firmlv in posi- ' tion, the lower end being still attached to tho chest to keep the blood circulating. In a fortnight the. flap had ' taken root on the raw flesh of the face. It was then cut off. round the chin, and what was not required was replaced on the chest, being drawn over tightly to j close, the gap left by the place that was j transplanted. The apertures for the j nose and throat were then cut, and the man wont out of hospital with *aperfectly healthy fact., A remarkable case was that "of a ' young officer of the R.F.C., whose face was practically burned off by his machine taking fire in the air. Tho whole face had gone. The eyes were destroyed, and scarcely visible in the empty sockets. Tho nose was burnod completely off, the two apertures opening direct into the skull. The photograph looked like that of a skull, apparently well advanced in decomposition. It only remaina to be said that the officer has now a face not badly' disfigured, and that though he has lost his sight his other faculties are unimnaired. MAKING NEW NOSES. The making of new noses is an everyday matter at Frognal. Bombs and snipers have a habit of leaving men with broken noses, and some with. the nose quite destroyed. This is an injury which has a particularly grotesque C+fect on the appearance and Major Gillies' staff has been ablo to correct it j in a host of cases. A flap of skin is raised from the cheeks and turned back on the forehead. Upon this the new nose is built and started growing. Working from pre-war photographs of the patients, a cast of the nose is made from which to build. The pieces of cartilage are taken from below tho eighth rib, where there is_a good wide expanse, and if any bono is required it is taken from that rib. Tho cartilage thrives vigorously after transplantation, but the bone is not 6uch a ready grower, and has to be watched carefully. When the whole structure is well rooted, the flap with the new nose is swung round to the proper place, and left to grow there. Very few noses fail: when they do it is.generally due to absorption of the tissues causing them to collapse. Jaws and teeth are also made habitually. It is not uncommon for a man • .to. have the whole lower jaw blown . away, so that although quite healthy, ho jg unable to 'take food or to SDeak.

The staff at Sidcup enter upon such a job with professional joy. The man is put oil tbe table for a double operation. One surgeon opens the side and removes from the rib the required pieces of bone for the new jaw-, while another, working on the head, grafts the pieces into their new position. Every stage must be allowed to work itself out before another is entered upon, so as to be sure that the transplanted bone, has taken healthy root and is growing. Flaps of skin and flesh from other parts of the face and body arc then drawn over to make the fleshy" part, and, finally, in the mechanical dentistry department, a new "lower set"' will he evolved and fitted into the new lower jaw. The case is finished off by the nocessary massage to restore the damaged muscles and shape the tissues as before.

AUTISTIC FINISH. Nor are the surgeons anything less than artists at their profession. They are most particular what skin to uso foi- what jobs.- The new nose is usually clothed in a piece stolen from the forehead. There is a case on record — from the early days, in which it was cut slightly too far up—into the hair —with the melanchoiy result that a soldier who is glad enough to have a presentable faco at all has now to shave ouo side of his nose regularly. A chin incapable of growing a beard would not satisfy the surgeons. As a rule they-take a strip from the scalp, turn it down and lay it over the chin for a week or two until it grows, then cut off what is not required and return it to the head. There is practically no injury to the face which cannot be. very' largely remedied by plastic surgery,., and," unquestionably, army medical services in tho future will regard it as part of their legitimate duty to return their maimed soldiers to civil life, as nearly as possible restored to their old seives, not only in health but t also in appcarance. New Zealand, I' am glad to say, is taking an oar in Sidcup for the benefit of her unfortunate soldiers, as she does at Rochampton. One of the New Zealand patients (Rifleman Kilworth, of Canterbury) I met playing billiards in the rccreation room. General Richardson paid a visit to Sidcup a few weeks ago, and the D.D.M.S. (Colonel Parkes), has now attached Major ' H. P. Pickerill, N.Z.M.C. (Duncdin), for duty there. It may be remarked en passant that Sidcup, like Roehampton, has a fully equipped re-education side, where men in search of technical training or a new trade, can go on with it while their surgical treatment is running through its "necessary prolonged course. .'The-Queen paid a visit to Frognal yesterday and was much interested in the marvels of Major Gillies' command.