There were no textbooks.
That's the one detail, amidst all the other revelations that Lindsey Fitzharris offers in The Facemaker, that continues to take me aback. There were no textbooks for the British surgeon Harold Gillies 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 World War I.
Those soldiers' faces were shattered and burned by the new technologies that that war ushered in: machine guns, chemical weapons, flamethrowers, shells, and hot chunks of shrapnel from explosives. As one battlefield nurse said, "the science of healing stood baffled before the science of destroying."
In The Facemaker, Fitzharris, a historian of science and medicine, has written a riveting, old-fashioned, man-meets-the-moment account of Gillies' work in the field of plastic surgery, before "plastic surgery" as a field officially existed. As Fitzharris acknowledges, procedures such as the correction of cleft palate and ear pinning had been performed well before World War I, and some rudimentary "plastic operations" involving skin grafts and rubber prostheses were conducted on soldiers whose faces were damaged in the American Civil War.
But the wreckage the military technology of World War I inflicted on human bodies was different in kind and degree. As Fitzharris says, physical injuries were only part of the grievous wounds these men endured:
"Unlike amputees, men whose facial features were disfigured were not necessarily celebrated as heroes. Whereas a missing leg might elicit sympathy and respect, a damaged face often caused feelings of revulsion and disgust. ...
In France, they were called les gueules cassées (the broken faces), while in Germany they were commonly described as das Gesichts entstellten (twisted faces) or Menschen ohne Gesicht (men without faces). In Britain, they were known simply as the "Lonliest of Tommies" — the most tragic of all war victims — strangers to themselves.
Gillies, who was in his early 30s at the beginning of the war, initially volunteered as a battlefield surgeon; what he witnessed in France and Belgium-- including the work of dental surgeons who were ministering to men with missing jaws and obliterated noses — prompted him to set up, first, a hospital ward and, eventually, an entire military hospital in England dedicated exclusively to facial reconstruction.
Upon the opening of that first site, Cambridge Military Hospital, casualties began pouring in, some with labels indicating name, type of wound and whether they had received an anti-tetanus injection; "many [however] bore labels that simply read "GOK" (God only knows)." Gillies was a pioneer, not only in plastic surgery, but in assembling a multidisciplinary team of surgeons, dentists, artists, anesthesiologists, sculptors and photographers. This team was these soldiers' last best hope.
There's an inherent danger of sensationalism in this subject of gruesome facial injuries, but Fitzharris is a pretty straightforward writer, relying on letters, reports and newspaper accounts to give vivid immediacy to the patients' ordeals. Some of these soldiers had to endure close to 40 or more incremental procedures to restore a semblance of their pre-war faces. Gillies, who seems to have been universally hailed as a kind, even fun-loving doctor, would greet newly-admitted patients with what became his trademark words of reassurance: "'Don't worry, sonny ... you'll be all right and have as good a face as most of us before we're finished with you.'"
Fitzharris describes how before each major operation, Gillies would sequester himself in his office, obsessively reviewing 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 maybe take skin flaps from a patient's cheek and chin to construct a new top lip. Sometimes, an entire face would be drawn on a patient's chest and transplanted whole.
As Gillies was perfecting his techniques through trial and error, inevitably, procedures failed: noses collapsed, skin grafts didn't take. When a soldier's wounds were too severe for surgery, the artists stepped in, surveying pre-war photographs to craft life-like masks out of painted metal. The horrible irony was that many of Gillies' recovered patients would be sent back to the front, fodder for the war machine.
In The Facemaker, Fitzharris includes a few 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, then, awed by what we humans are capable of doing to and for each other.