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In the First World War, large numbers of soldiers perished because machine guns and artillery bombardments had rendered the old techniques of combat and weapons hopelessly outdated. In addition to the many deaths, many soldiers were also seriously injured. At the outbreak of the First World War, ENT surgeon Harold D. Gillies signed up with the Royal Army Medical Corps. He used his knowledge of reconstructive surgery in a creative and innovative manner to treat the severely mutilating facial injuries. He thus improved the established techniques of nose reconstruction, skin grafts and facial reconstruction. At the end of the First World War, he had operated on about 11,000 casualties. Surgeons from every part of the world adopted his new principles and Gillies thus created the specialism of plastic and reconstructive surgery. Some of the techniques developed by Gillies are even still in use today.