NEW FACES FOR OLD.

Otago Witness, Issue 3333, 30 January 1918, Page 54

NEW FACES FOR OLD.

SURGERY'S CROWNIKG WAR WORK. HOW NOSES ARE GROWN. I have had a remarkable insight (writes the London correspondent of the Argus) into the achievements of war surgery. Wounded men are to-day transported from the front line, where death is, right back to peaceful England, where ill is peace and comfort, in a few hours. The walking cases have the best chance of a speedy crossing. The men on stretchers take lenger. But even these usually reach an English hospital in four days. It was these seriously wounded men that I have been visiting. On the outskirts of Sideup, a little village in Kent, stands a country house, with spacious, well-timbered, open grounds. It was once Lord Sydenham's property, but the present owner has handed it over to the great healing cause. After the style of the hundreds of military hospitals which have been hurried to completion in all parts of the country, this building consists" of clustered wards, constructed of wood in a uniform 'pattern, and all linked up by covered-in walks. Thus the original house becomes the headquarters, while the new, well-ventilated, hygienic huts fill the grounds. Nothing about the place suggests that it has any features differing from the other hospitals. Even its name does not betray its work. But the'visitor oh-his approach is quick to observe that all the blue-suited soldiers met in the green country lanes are bandaged about the head, and more particularly about the face. Some faces are almost entirely obscured in swathes of linen, for the hospital is concerned wholly in repairing, and even in replacing, faces that have suffered in battle.

Disfigurement of the face is always specially distressing, and although some of the refinements of feeling in the case of many of our soldiers may have become b'lunted by arduous campaigning, they are at that time of life when it is natural to retain an excusable pride in the matter of personal good looks. It is therefore explainable that some men who come here with a piece of the face actually missing may not always be in the mood to get well. . Most of our surgeons in these days are students of psychology, and the nurses are their ardent supporters, so that the firs't part of the treatment in such cases is to fill the man with encouragement, and tell him that lie will be made whole again. In the majority of cases it is no vain hope, because the war surgeon provides new noses, new cheeks, new lips, new chins. The' laughter, muffled sometimes, it is true, that one heard round the -wards was the best evidence of the success of this spirit of optimism. I saw a man whose case is not the most- remarkable in the hospital's crowded 18 months' record, but it gives point to the importance of the psychological stimulus in the early stages. On the journey to the hospital he attempted to commit suicide. He had not been dangerously hit; but the wound robbed him, as he thought permanently, of all his personal attractiveness. A machine-gun bullet had entered the back of the neck, and in coming out just below the nose had torn open the upper lip. A fracture of the upper jaw is serious enough, but combined with it were the loss of teeth and a big jagged wound like a hare-lip spreadin" in several directions. In such a case it was not difficult to_ understand the man's suicidal tendencies. To many a soldier who would face death with equanimity it is a horrible prospect to live a lingering, cramped life, his face a revolting spectacle, or minus some of his limbs, 3 or otherwise so maimed that he will be constantly an object of pity. The Surgeon Plants a Moustache.— , ' The first operation in the case referred to was to reunite the jaw. The next, to bring together the severed parts of the upper lip, and then followed the fitting of the teeth, and the crowning operation of providing hair-growing skir for the upper lip. This was so deftly done that no sear remained, and the moustache grew as thickly on the new part as on the old. This operation of grafting skin from one part of the bodv to another is of almost dailv occurrence! The new moustache is provided in an extremely simple manner. A flap of skin from the neck just below the cheekbone is lifted, and, while one end is still attached, it is swung up into position on the upper lip. After some davs, when it is observed that the graft has been successful, the end still attached to the neck is severed, leaving the grafted piece growing independently on the upper lip. There thus remains a hairless patch on the neck; but in these clean-shaven, days that does not 'matter, and the scar, neatly covered with a patch of skin from some other part of the body, is not noticed. The man who had appeared before the doctor, depressed and disfigured, was tieated in the way I have described,

and left the hospital to rejoin his regiment completely restored, and showing no sign of his terrible injury. One of tho most common operations is the fitting of new noses—real noses, with no plaster and no paint about them. The method is distinctly novel. In the first place, the surgeon gets the material for tho new nose. It has been found that a piece of cartilage from the man's own rib makes him a good nose—a nose tliat ho can blow. The preliminary operation takes out tho cartilege of the eighth rib. It is cut to the right shape and sizo, and, •wonder of wonders, it is then planted under tho skin of the man's forehead to grow! The cartilage .itself does not, of course, grow, but it is served with blood from the blood vessels in the forehead, and soon becomes adhered to the skin of tho forehead. It -was queer to see men with their faces bandaged walking about with these lumps showing out prominently above one eye. When the new nose is ready the next operation is to swing it down into place. This is a complex "job, because the same operation has to prepare the place for it, remove it from its temporary lodgment in the forehead, and set it quickly and neatly in the centre of the patient's face. The job is made perfect by raising pieces of the skin of the face on either side as flaps to put over the nose so that the joinings may be rendered invisible. Shapely Noses to Order. —

In all these operations the grafted skin is not merely the thin outer layer, but includes also the tiny blood systems\mderneath, which ensure that the skin shall live in its new position. It is for this reason that the new nose is still left with an attachment to the forehead for some time after it has been swung down into its final position. The cartilage, before being planted in the forehead, is slit up, so that when brought down it takes a position similar to an inverted V, and the nasal apertures are provided for. When the severance with the forehead is carried out later the vacant patch on the forehead is covered with a little, graft of skin from some- unnoticed part of the body, and the man goes forth with a nose which is probably more shapely than the one he had originally and quite as useful, because it usually happens that some of the cells that convey the sense of smell have survived the original wound. Shell wounds aro principally responsible for the extensive facial injury which causes the surgeon so mucL anxiety and stimulates him to his greatest efforts. Some soldiers come in with their faces literally "pushed in." Thanks to. the organisation methods which single out such cases as soon as they arrive in England, and send them to this hospital, these severe cases are put under prompt treatment. Delay in dealing with this sort of injury has led to some specially difficult work. Where a profile no longer stands out in natural lines, it is the surgeon's plan to Eut in supports, just as one replaces the roken pole of a collapsed tent. Upper and lower jaws which have been fractured and splintered are made firm and strong and whole again by means of the graf tingin of cartilaginous supports. The Xray department shows the exact locality and nature, of the injury, and, as treatment goes on, these photographs disclose the progress made in the healing of the shattered parts. • Dental Enterprise.— Naturally, there is much dental work to be done in connection with this campaign against the wounds that threaten to rob men of their features. And the dentists rise to such a level of skill as has never before been attempted in private practice. One of the prettiest "splints" for holding the lower jaw rigid in the event of its being fractured consists of an artificial set of teeth, upper and lower, clamped together and so fixed to the existing teeth as to keep the jaw motionless. A smiling sergeant showed a whole front of gold teeth when he explained how easy it was to eat apricots and rice through the gap left round -at the side of this impassable golden gate. The medical superintendent is a New Zealander, Major Gillies, born in Dunedin, but more recently a surgeon practising in Wimpole street. He has a staff of a dozen surgeons, and a scheme of his has juet been approved by which Australian, New Zealand, and Canadian surgical, specialists shall becomo attached to the hospital. The Canadians, I understand, will be in the field- first, with a section of the hospital under the care of their own surgeons. Major Gillies expressed to me his hope that the hospital might remain—not necessarily on the present elaborate scale —after the war, because, the work of curing is slow, and many of the soldiers now in hospital will require further treatment later. The average length of stay in the hospital is nearly 12 months, and there are cases which are discharged during the developmental periods between operations. Some patients have as' many as a dozen separate operations before thev are quite restored. The work, therefore, is thorough, and no man goes away until he has received the best that can be dono for him, and no man goes without first having his teeth completely overhauled. It is a notable fact that the medical faculty has at last impressed utdoii the military chiefs the importance of having men with sound teeth for the fighting-line. Bad mean inadequate mastication; this causes indigestion, which results in military inefficiency. Plaster casts of injuries and "before-and-after " photographs are being prepared of every case that passes through the hospital, and already they constitute a remarkable record of surgical success. There have been a number of Australian and Now Zealand soldiers. A well-known medical artist has already built up an extensive series of striking coloured portrait studies, in which the injury is accurately ehown on an artistic likeness of the patient himself. This, I fancy, is something almost hew in the profession, and for museum purposes this collection of pictures is particularly convincing and valuable.

A naval seaman was badly burnt about the face and body bv a flash of cordite in the battlo of Jutland. This prompted the resourceful surgeon-in-chief to deal with the desperate hurt by a bold yet practical remedy. He took the skin of the man's chest to replace the missing skin of tho face. A strip was taken, running almost from shoulder to shoulder, and, while still attached at both ends, this flap was brought up to cover tho face. Apertures were made in it for the nose and mouth, and the new skin was sewn closely down all round. And, as in the other cases, when' the new face was in time being fed by blood from the vessels directly beneath the surface, the ends were severed and the portions remaining replaced on the chest. A British pilot, who crashed with his machine during an air duel, and was severely burned by flaming petrol, lies in hospital for a similar operation. His mother bravely visits him, but the doctors, very wisely, are not yet allowing other relatives to see him. When his new face has restored his personal appearance —that will be ample time for him to see and be seen bv his friends. There is no limit to the successes that are being achieved by these patient and tireless surgeons. I saw a man running his fingers through a beard which had come from the top of his own head! He had suffered from a shattered jaw, and when all the other troubles had been righted the surgeons swung down a strip of the skin from his head to make good the deficiency of the chin. The only lasting trouble was that a bald spot was left on the crown of his head, which is not an uncommon spectacle. Coming away from this wonderful place one had Visions of the day when possibly the uglv ones among us mav disappear for a month or two and reappear to capture beauty prize 3! This branch of surgery, although it has already gone far since the war, is onlv in its'infancy.