There were no textbooks.
This is the only detail, among all the other revelations that Lindsey Fitzharris offers in The Facemaker, it continues to amaze me. British surgeon Harold Gillies had no manuals to consult when he and his team were called upon to reconstruct the faces of some of the estimated 280,000 men who suffered facial trauma during the First World War.
The faces of these soldiers were shattered and burned by the new technologies introduced by this war: machine guns, chemical weapons, flamethrowers, shells and hot pieces of explosive shrapnel. As one battlefield nurse put it, “the science of healing was bewildered by the science of destruction.”
In The Facemaker, Fitzharris, historian of science and medicine, has written a gripping, old-fashioned, in-the-moment account of Gillies’ work in the field of plastic surgery, before “plastic surgery” as a field n officially exists. As Fitzharris acknowledges, procedures such as cleft palate correction and ear pinning had been practiced long before World War I, and some rudimentary “plastic operations” involving skin grafts and rubber prostheses were performed. conducted on soldiers whose faces had been damaged during the American Civil War. .
But the wreckage that World War I military technology inflicted on human bodies was different in kind and degree. As Fitzharris says, physical injuries were only part of the serious injuries these men suffered:
“Unlike amputees, men with disfigured facial features were not necessarily celebrated as heroes. While a missing leg could elicit sympathy and respect, a damaged face often evoked feelings of revulsion and disgust. ..
In France, they were called the broken mouths, whereas IIn Germany, they were commonly described as das Gesichts entstellten (twisted faces) or Menschen ohne Gesicht (faceless men). In Britain they were simply known as the “Lonliest of Tommies” – the most tragic of all war casualties – strangers to themselves.
Gillies, who was in his early thirties when the war began, first volunteered as a battlefield surgeon; what he witnessed in France and Belgium – including the work of dental surgeons who cared for men with missing jaws and obliterated noses – prompted him to set up, first, a room hospital and eventually an entire military hospital in England dedicated exclusively to facial reconstruction.
As soon as that first site, the Cambridge Military Hospital, opened, the wounded began to pour in, some with tags indicating their name, type of injury and whether they had received a tetanus shot; “many [however] wore labels that simply said “GOK” (God only knows).” Gillies was a pioneer, not only in plastic surgery, but also in building a multidisciplinary team of surgeons, dentists, artists, anesthetists, sculptors and photographers. This team was made up of those soldiers. ‘ last best hope.
There is an inherent danger of sensationalism in this subject of gruesome facial injuries, but Fitzharris is a fairly straightforward writer, relying on letters, reports, and newspaper accounts to lend vivid immediacy to the patient’s ordeals. Some of these soldiers had to endure almost 40 or more progressive procedures to restore some semblance of their pre-war faces. Gillies, who seems to have been universally hailed as a kind, even amusing doctor, greeted newly admitted patients with what has become his trademark reassurance: “‘Don’t worry, son…you’ll be straight and straight. have as good a face as most of us before we’re done with you.””
Fitzharris describes how, before every major operation, Gillies would sequester himself in his office, obsessively revising his plan for a patient’s face and smoking nonstop. Once in the operating room, Gillies and his team might have to excise thick scar tissue and possibly remove skin flaps from a patient’s cheek and chin to construct a new upper lip. Sometimes an entire face was drawn on a patient’s chest and transplanted whole.
As Gillies perfected his techniques through trial and error, inevitably the procedures failed: noses sag, skin grafts fail. When a soldier’s injuries were too severe to operate on, artists stepped in, examining pre-war photographs to craft realistic painted metal masks. The horrible irony was that many patients recovered from Gillies would be sent back to the front lines, fodder for the war machine.
In The Facemaker, Fitzharris includes some before and after photographs of Gillies patients. It’s impossible to look at these side-by-side photos of their faces without feeling, first, ashamed and, second, intimidated by what we humans are capable of doing to each other.