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The Maxillofacial Unit

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The Maxillofacial Unit Alnnals of the Royal College of Surgeonis of Englnd (I975) 1ol 57 The maxillofacial unit Sir Terence Ward CBE FDSRCS FRCS Queen Victoria I-Iospital, East Grinstead I am going to speak on the maxillofacial the result that he was lout oni a stretcher anid, unit with particular reference to East Grin- having got a fracture through both angles, he stead because this association of suffocated and died. dentistry 'I well remember wrapping him in a blanket and with plastic surgery is not altogether due to burying him that night, anci I made up my mind anatomical propinquity but evolved from a that if I had an opportunity of teaching that les- deep personal relationship between two pio- son to others, I would do so. That was the mile- neers in their own field, Harold Gillies and stone of my life.' Kelsey Fry. Kelsey was wounded in France again, dec- orated on the field, and throu,h the influence First World War of Arbuthnot Lane, the Consulting Surgeon In I962, at this podium, Kelsey Fry gave to the Armiy, he was posted to the Cambridge the opening address at the First International Hospital at Aldershot to treat facial injuries, Congress of Oral Surgery, which was held where he was joined by McGill, Rowbotham, in this College, and I quote from that and Henry Tonks. Henry Tonks FRCS was speech: the Slade Professor of Fine Art in the Uni- 'There was a young officer, a delightful boy, who versity of London-one of many members was asked to do a little exploration in no man's of the medical profession land. I told him that when he jumped over I who relinquished would be with him, but before he had gone very the scalpel for the brush or other instruments far he fell back in my arms with an injury. At of art. Later they were joined by a young that time I did not know what it was, but it ear, nose, and throat surgeon, Captain Harold was an injury somewhere to his face. You can Gillies, and the whole team was transferred picture the situation. I was a young man with to St no knowledge of fractured jaws, a wet cold night, Mary's Hospital, Sidcup, where, under mud up to my ankles. Nevertheless I walked him the leadership of Colonel Henry Newlands, down slowly through the trenches to my aid post the noted Adelaide surgeon, they spent the with his head well forward because blood was remaining period of the war treating pouring out of him. He was a brave lad and as facial I had to return to the trenches I left him in charge injuries. of another medical officer. From there he was to General anaesthesia had been given in an be conveyed by ambulance to the ambulance sta- upright position to avoid inhalation of foreign tion. I had not gone far back to the trenches when material, but McGill and Rowbotham intro- I was called back and told that my patient had duced endotracheal anaesthesia, and indeed died. the first endotracheal tubes were 'Now that was a terrible thing to me-that I fabricated had failed to give instructions to my other officers in Kelsey's dental workshop. With the ad- that this mani should not be put oni his back, vent of endotracheal anaesthesia and the ttse although mentally I knew what I was doinig, wvitll of suction apparatus the morbidity of stir- Mclndoc Lecture delivered on 5th December 1974 68 Sir Terence Ward gery in the mouth diminished so much that time we were beginning to form up into more elective surgery could be carried out teams, we would be reorganized'. I was to in safety on the facial bones and mouth. learn later in life that we tend to meet any In 1917 Kelsey wrote: 'Neither the dental new situation by reorganizing, and a wonder- aspect is neglected by Major Gillies, nor the ful method it can be for creating illusions surgical aspect by myself, and reconnaissance of progress while producing confusion, in- into the other man's territory has led to cfficiency, and demoralization. I fear in the the closest co-operation between us working tumults that are affecting British medicine as a team and we believe with satisfactory today Gaius Arbiter could be speaking of results'. When you consider that this was the our own legislators, and perhaps a better preantibiotic era their results were magni- preliminary to the practice of politics would ficent, and in World War II I was privileged be a degree in the classics rather than in to see many of their patients, men who had economics or the social sciences. rejoined the armed forces in the time of need. The second proviso in the report states: 'The special hospital should be easily acces- Between the wars sible to transport, to visiting consultants, After the war Gillies was appointed to St and should be situated preferably on the out- Bartholomew's Hospital and Kelsey Fry to skirts of a town and where possible it should Guy's, but they continued to co-operate and have adequate grounds'. treat together a large volume of cases dur- As a result of this report, prior to World ing the ensuing years. War II, Alvin Mahoney, the Principal Den- In I932 the Army Council appointed a tal Officer of the Ministry of Health, asked committee to report to them on maxillofacial Kelsey Fry (who was the civilian consultant injuries. The Chairman was Colonel J P in dental surgery to the Ministry) and Harold Helliwell, the Director of Army Dental Ser- Gillies to select four hospitals around London vices, and the members were Kelsey Fry, to accommodate the facial injuries that could Harold Gillies, and Warwick James. The be expected if and when hostilities started. secretary was Major Sammy Woods. They The reason for the selection of the Queen met for 3 years and in 1935 produced a Victoria Hospital, East Grinstead, was ex- report that was to have a profound influence plained to me by both Fry and Gillies. Kelsey on the organization of treatment centres for Fry's son Ian, now a distinguished radio- maxillofacial injuries in World War II. logist, was at school in East Grinstead and Their first recommendation states 'A spe- Kelsey, forseeing the rationing of petrol, cial hospital reserved solely for the treatment needed a reason to visit that area. Harold of maxillofacial injuries is preferable to spe- Gillies on his part was more than content cial departments in general hospitals'. This to have a hospital half-way between his fa- considered opinion of 40 years ago is equally vourite golf course at Rye and London. The true today, when we are faced with reorgan- hospital had large grounds and a modern 50- ization and streamlining which so often is bedded cottage hospital, but these criteria directed more to the welfare of administra- played a small part in its selection. Hutted tion than to the welfare of the patient. I accommodation was built in the hospital would quote Gaius Petronius Arbiter, the grounds and when war started Mclndoe, who Roman general during Nero's reign, who said: was Gillies' partner, and Kelsey Fry 'We trained hard, but it seemed that every moved in. The maxillofacial unit 69 Second World War men from the Dental Branch of the RAF The plastic surgery team comprised Mclndoe were attached to East Grinstead for longer and Nils Eckhoff as principals and a young periods to train in order that they could surgeon, Percy Jayes, who later contributed open maxillofacial units in RAF hospitals, so much to the high reputation of East Grin- and it is interesting when one travels the stead in the field of plastic surgery. The world today to find many senior men who resident dental team was under the director- obtained their first training and a taste for ship of an Australian dental surgeon, Alan specialized work at East Grinstead. During McLeod, a superb dental surgeon and bril- these courses teaching, research, and clinical liant organizer, with Rae Shepherd and work put a tremendous strain on the resident Gilbert Parfitt each contributing special ex- dental team. pertise to the team. The anaesthetists were Materials for dental prostheses and splints under the direction of that virtuoso of an- were in short supply, but Bobby Bell was the aesthesia, John Hunter, one of the great char- Senior Dental Officer for hospitals in England acters and raconteurs of medicine, who was and Wales and he procured all the equip- joined by a young Westminster man, Russell ment that was wanted or desired. Davies, who later became director of the Kelsey Fry was amply rewarded for his Anaesthetic Department at the hospital and dedication to training when the Normandy added greatly to the high reputation of British invasion commenced. To be at the RAF hos- anaesthesia. The third member of the anaes- pital at Wroughton, where convoys of am- thetic team was a part-time general prac- bulance planes were flying in with the titioner anaesthetist who, with a very unstable wounded, and to see the facial injuries arriv- monocle, a laryngoscope, an endotracheal ing having had the most expert primary tube, but only two hands, had to produce treatment in the field gave him tremendous feats of juggling rather than anaesthetic satisfaction. The alleviation of pain and ability to intubate the patient. The ophthal- suffering and the reduction in mortality by mic field was in the very capable hands of having properly trained dental officers in Ridley. advanced first aid stations and hospitals was McLeod, Shepherd, and Parfitt were joined thus visibly shown when mass casualties were for varying periods of time by many dis- returned to this country.
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