‘Facemaker’ portrays WWI plastic surgeon Harold Gillies: Photos

Four American soldiers carry a wounded soldier on a stretcher in Vaux, France on July 22, 1918. As many as 280,000 World War I combatants suffered facial injuries.

Sergeant Adrian C. Duff/Getty Images

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Sergeant Adrian C. Duff/Getty Images

Four American soldiers carry a wounded soldier on a stretcher in Vaux, France on July 22, 1918. As many as 280,000 World War I combatants suffered facial injuries.

Sergeant Adrian C. Duff/Getty Images

The First World War, which lasted from 1914 to 1918, ushered in a new kind of mechanized warfare. Bodies were mutilated, burned and gassed, and up to 280,000 fighters suffered horrific facial wounds. Medical historian Lindsey Fitzharris claims that soldiers who suffered facial injuries were often shunned in civilian life.

“The reactions could be very extreme,” she says. “It was a time when losing a limb made you a hero, but losing a face made you a monster.”

In Britain, soldiers with facial injuries were called the “loneliest Tommies”. When they left the hospital grounds, they were forced to sit on bright blue painted benches so the public knew not to stare at them. The field of plastic surgery was still in its infancy, but a surgeon in England – Dr. Harold Gillies – endeavored to treat the injured. Fitzharris tells the story of Gillies in the new book, The Facemaker: A visionary surgeon’s battle to repair the disfigured soldiers of World War I.

It was pioneering work. Any surgeon wishing to reconstruct a soldier’s face had to consider loss of function – such as the soldier’s inability to eat or speak – as well as the aesthetics of what would make the face socially acceptable by the standards of the industry. ‘era. And there were no manuals to guide the way, nor antibiotics available.

“Gillies really works without a net. … He doesn’t have anyone teaching him how to do that. He really has to make that up,” Fitzharris says. “You really have to come up with creative solutions, which he absolutely does.”

Gillies lobbied the British War Office to set up a hospital to treat facial injuries, and he banned mirrors on some wards so that newly wounded would not be traumatized by their own unrecognizable faces. He spent the war replacing lost skin and restoring jaws, noses and teeth to give thousands of veterans a chance to return to civilian life.

“What Harold Gillies is able to do for these men is not just to mend their broken faces, but to mend their broken minds,” Fitzharris said. “This is what is at the heart of The Facemaker: It’s about identity and what happens to you when you lose it and how do you get it back? And that’s ultimately what Gillies was able to do for these men to help them find their identity.”

Interview Highlights

The Facemaker, by Lindsey Fitzharris
The Facemaker, by Lindsey Fitzharris

On his use of the word “disfigured” in the book

In fact, I worked with a disability activist named Ariel Henley, who is the author of a book called A face for Picasso, and we discussed language and how I would end up describing some of these wounds in the experiences of these men, and I use the word “disfigured” in this book, which we might not use today. We could use a word like “facial difference”. But I felt it was important not to diminish this experience for the reader, because these men were truly disfigured by the society in which they lived.

On the challenge of evacuating wounded soldiers from the battlefield

A facial wound is very bloody. It’s very awful. Anyone who’s had even a minor cut on their face will know it bleeds and bleeds and bleeds. And so often these stretcher-bearers didn’t think it was possible to survive those injuries. They had never seen anything like it before. And of course, they’re also in the midst of the terror of battle, which doesn’t help. So they would leave these men behind.

There are stories, for example, of Private Walter Ashworth who lies on the battlefield after the first day of the Somme for three days without a jaw, unable to cry out for help. And it’s mind-boggling to us that anyone could stay there that long. But again, these stretcher bearers, they just didn’t think it was survivable injuries. The other challenge was that often when they abducted these men, they would, with good intentions, place these men on their backs, on the stretchers, and inadvertently kill [them] because they would end up drowning in their own blood, or they would choke on their tongue because they didn’t have the anatomy to hold their tongue [in] a regular post. The medical challenges were therefore immense. Just leaving the battlefield was a real challenge for these men.

On Gillies having to repair the work done by trauma surgeons in field hospitals

Often these men were removed from the battlefield. They were pulled from the trenches. They fell into the hands of trauma surgeons. Now you can imagine near the front lines in these hospitals, there was a lot of chaos around these surgeons. And really their goal is to save people’s lives. So often they would stitch up those wounds very quickly, trying to stop the bleeding, trying to save lives. And in doing so, they often sealed the fate of these men because they sutured the bacteria from the battlefield into the face and into the wound. So when these men came to Gillies, Gillies often had to undo much of what had been done near the front and start over. The process of reconstructing a soldier’s face at that time could take many months, sometimes years, and even more than a decade in some cases.

Why Gillies banned hospital mirrors

Medical historian Lindsey Fitzharris discusses Dr Harold Gillies in her new book, The Facemaker: A visionary surgeon’s battle to repair the disfigured soldiers of World War I.

Stuart Simpson/Penguin Random House

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Stuart Simpson/Penguin Random House

Gillies banned mirrors because he was really trying in his mind to protect them so they wouldn’t be shocked by their faces for the first time. Also, during facial reconstruction, your face might look worse before it gets better. And he didn’t want them to get depressed or frustrated by this process. So we can understand that. But also, he inadvertently instilled in these men the belief that they had faces that weren’t worth looking at.

On the state of wartime plastic surgery history

Plastic surgery predates World War I. In fact, the term “plastic surgery” was coined in 1798. Back then, “plastic” meant something you could shape or mold – in this case, a patient’s skin or soft tissue. But attempts to reconstruct or alter a person’s face tended to focus on very small areas, such as the ears or the nose. You won’t really get attempts at complete facial restructuring until the mid-19th century during the American Civil War. And even then, there are a lot of differences between what happens in the Civil War and what ultimately happens in World War I. And one of them is the fact that Civil War surgeons just didn’t care about cosmetics because infection rates could be quite high back then. This was before the mass adoption of germ theory. So they only go so far as to restore function, making sure the patient can eat and talk.

On the collaborative methodology of Gillies

[Gillies] worked very collaboratively. He brought in radiology technicians, mask makers, artists, dental surgeons too, which was really important… They were the ones who kind of built this scaffolding for Gillies. … But the challenges were immense and … an important principle of Gillies was that you replace the same to replace bone with bone, skin with skin. So the [were] no artificial implants that went in the face at that time.

On where Gillies would get bone to rebuild a jawbone

Often they grafted the patient’s own bone. They took the cartilage from the ribs. They were taking the thigh bone. Wherever they could really get it and they would place it in the face to rebuild that tough structure. This is absolutely mind-boggling when you consider this was before antibiotics. What Gillies and his team [were] able to accomplish was truly miraculous on so many levels.

On the masks that some patients wore

Many people are familiar with World War I masks from the fictional character Richard Harrow and Boardwalk Empire. There were these wonderful artists who offered these non-surgical solutions to disfigured soldiers at that time. People like Anna Coleman Ladd, who had a studio in Paris. And every time I upload these still images of these masks on Twitter, on Instagram, they tend to go semi-viral because they’re amazingly realistic. But you have to remember that when you’re looking at a still photo, it’s very different than sitting in front of someone who might be wearing that mask, because the mask doesn’t function as a face. It does not age, it is fragile. It’s hard to wear on an injury. It’s uncomfortable to wear. And for all of these reasons, the mask didn’t really offer that long-term solution that many of these men were looking for.

On Gillies’ career after World War I

I think Gillies is crucial to what ultimately becomes of plastic surgery. After the war, he continues to work on the disfigured soldiers, of course, because the war is not over for them. But he knows that if he wants to make plastic surgery a full-fledged sub-specialty, he will have to expand the practice. He is therefore also embarking on the field of cosmetic surgery. If people think plastic surgery is a title and under that you have cosmetic and reconstructive – those are two important parts of plastic surgery and they both continue to this day. And so Gillies did both.

Lauren Krenzel and Thea Chaloner produced and edited the audio for this interview. Bridget Bentz, Molly Seavy-Nesper and Laurel Dalrymple adapted it for the web.

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