A Visionary Surgeon’s Battle to Mend the Disfigured Soldiers of World War I
By Lindsey Fitzharris
315 pages. Farrar, Straus & Giroux. $30.
The more disembodied our digital existences become, the more startling it can be to read about medical practices from a century ago — something I was reminded of again and again while reading Lindsey Fitzharris’s grisly yet inspiring new book, “The Facemaker.”
Fitzharris recounts the life and work of the pioneering reconstructive surgeon Harold Gillies, a specialist in mending those who survived the mechanized slaughter of World War I with an eye gouged out, or a nose blown off, or a jaw obliterated. Such injuries were common enough that countries had special terms for the men who bore them: les gueules cassées (“the broken faces”) in France or das Gesichts entstellten (“the twisted faces”) in Germany. In Britain, where the New Zealand-born Gillies worked, these men were called the “Loneliest of Tommies.”
Unlike amputees, Fitzharris says, disfigured soldiers weren’t celebrated as heroes so much as they were met with revulsion. The damage to their faces was a graphic reminder of wartime carnage. Outside the hospital where Gillies worked, blue benches were reserved for his patients; if those blue benches were occupied, squeamish passers-by would know to avert their gaze.
Gillies, however, would look closely at such faces day after day, often over the course of multiple operations, improvising and inventing surgical techniques — or, as he put it, “fumbling towards new methods.” Penicillin wouldn’t be discovered for another decade, so infection was an ever-present danger, especially for soldiers who had been lying with their gaping wounds — sometimes for days — in muddy battlefields that teemed with rats and germs.
Fitzharris’s previous book, “The Butchering Art,” told the story of Victorian medicine in the late 19th century, when doctors finally began to accept the importance of hygiene in the operating theater (it took a while). In “The Facemaker,” she describes how Gillies learned about wound irrigation from a French American dentist named Auguste Charles Valadier, who had invented a mobile apparatus nicknamed the “fire engine.” Only once a wound had been effectively flushed with clean water could Gillies really get to work.
And work it most definitely was, though Gillies, at least as he is presented here, was innovative, buoyant and relentlessly hopeful. He had to be — how else would he even think to fashion a nose by taking a patient’s rib bones and attaching them to the patient’s shoulder to build new cartilage, for grafting onto the face? Another miracle: Gillies would cut a flap of skin from a patient’s chest, leaving it attached on one side for the sake of the blood vessels, and then stretch that flap up across the lower half of the patient’s face, which had been terribly burned. (The flap could eventually be severed once the free end had properly attached itself to the new site.)
Just as impressive as Gillies’s technical skill was his encouraging bedside manner. Fitzharris describes how men who were in constant pain, with injuries — a hole in the jaw, scarred eyelids — that made it unimaginably difficult to eat or to sleep, felt rescued from object despair by the affable Gillies. “Don’t worry, sonny,” he would tell them. “You’ll be all right and have as good a face as most of us before we’re finished with you.”
Aside from recalling some moments of professional competitiveness — Gillies vied with another doctor to be identified as the inventor of a reconstructive technique known as the “tubed pedicle” — Fitzharris depicts her hero as irrepressibly dedicated and unfailingly likable. The suspense of her narrative her comes not from any interpersonal drama but from the formidable challenges posed by the physical world.
One scene has Gillies almost falling asleep at the operating table because he inhaled the etherized breath of his patient; another has him taking a scalpel to scar tissue around a patient’s mouth and noticing that the man’s nose had moved and suddenly turned blue.
Men make war, and war makes new realities. The horrific injuries introduced by the military technologies in World War I meant that medicine was playing catch-up. As one battlefield nurse observed, “The science of healing stood baffled before the science of destroying.”
Sometimes the science of destroying would even co-opt the science of healing, as men were stitched up and sent back to the front to fight again. “Ironically,” Fitzharris writes, “medical advances that owed their existence to remediating the horrors of the war also served to prolong it.”
Conflicting imperatives put Gillies in a bind. His patients his often benefited from long-term, incremental care. But his duty his to the Army, he once admitted, meant that he was obliged to return to service “as many soldiers as possible in the shortest time.” Gillies recalled how one of his patients his arrived with a deep gash that ran from his temple to his chin. After enduring multiple painful operations, this soldier was then sent back to the front, where he was injured a second time; he died from his new wound.
The facial destruction wreaked by war was so culturally potent that France sent a “Délégation des Mutilés” to Versailles. In the palace’s extravagantly mirrored halls, nobody — including “the mutilated” themselves, who had spent much of their recovery avoiding reflective surfaces — could fail to notice their disfigured faces. “Here is your reward,” the French prime minister Georges Clemenceau told the men, when the Treaty of Versailles was signed.
“Its harsh terms would lay the foundations for a second and even more devastating global conflict,” Fitzharris writes of the treaty, which would ruin Germany and allow the grievance politics of Adolf Hitler to take root. “The Facemaker” is mostly a story of medical progress and extraordinary achievement, but as Gillies himself well knew — grappling daily with the unbearable suffering that people willingly inflicted on one another — failure was never far behind.