The First War World magnified the horror and scale of warfare to levels never experienced by humans before. To put it into perspective, developments in the art of war allowed a company of just 300 men in 1914 to deploy the equivalent firepower as a 60,000-strong army in the Napoleonic Wars 100 years before. Flamethrowers, tanks, and mustard gas were suddenly able to rip through the battlefields of Europe and those who were forced to tread them.
While military technology had come along leaps and bounds, medicine was still hobbling out of the Victorian Age. Antibiotics were not yet invented and aesthetics was still a very sketchy business.
Amid the chaos of the war, one visionary surgeon boldly ventured through the dark field of early modern medicine – and in doing so, he restored humanity to the victims of this dreadful war and became the "father of modern plastic surgery".
In her new book – The Facemaker: One Surgeon's Battle to Mend the Disfigured Soldiers of World War I – Dr Lindsey Fitzharris recounts the true story of Harold Gillies, the New Zealand-born British surgeon who rebuilt the disfigured faces of the First World War’s soldiers and helped to pioneer techniques that underpin modern plastic surgery.
Facial reconstructions had been toyed with before the 20th century. Ancient Indian medicine experimented with basic "nose jobs," for instance, while a few dozen soldiers received rudimental ear and nose reconstructions following the American Civil War. However, the intensity of the First War World turbo-charged the need and demand for such a risky surgery.
“When you compare this to the First World War, when you have 280,000 men from France, Britain, and Germany alone who requires some kind of facial reconstruction, you can understand why plastic surgery flourishes and enters this new modern era,” Fitzharris told IFLScience.
Unlike most veterans returning from WW1, soldiers with damaged faces were not met with respect and admiration. Instead, they were ostracized, isolated, and discriminated against – an attitude that Fitzharris believes still lingers deeply in our culture today.
“You only really have to look to Hollywood to know this is true,” she explains. “How many villains are there in movies with facial disfigurements? There’s the Joker, Blofeld. Harvey Dent becomes evil after his disfigurement. There’s Voldemort. The list goes on and on. It still goes on today, this facial bias against disfigurement.”
Fitzharris, a best-selling author who often frequents the most grueling corners of medicine and sciences’ past, wrote about Victorian medicine in her previous book, The Butchering Art. This told the story of how medicine in the late-19th century “cleaned up its act” by appreciating the importance of germs, handwashing, and sterilizing.
For The Facemaker, Fitzharris takes a story-like approach to explore the new world of 20th-century medicine where colossal challenges still remain. Steps of progress had been made since the 19th century, but we are still talking about the pre-penicillin era, which makes Gillies's surgeries all the more incredible and dangerous.
Each surgery was tailored to the patient, depending on their separate needs, with some patients requiring multiple operations drawn out over years if not decades.
For one soldier, Gillies may have crafted a nose out of their rib, and nurtured the tissue on their shoulder to build new cartilage, before grafting it onto their face. One other common technique was cutting deeper into the skin to create a large flap of tissue near a wound. Still connected to the much-need blood vessels, the flap would then be twisted and swung over to the face. The new wound could be stitched up and, somewhere along the line, cartilage from elsewhere in the body would be used to form the nose bridge. The flap of skin, all being well, would eventually heal onto the face.
Carrying out such a feat in the WW1 era is even riskier than it first sounds.
“Anaesthesia hadn’t really progressed since 1846 when ether had been discovered, so we’re talking about a rag of chloroform over the face or a very rudimentary mask that delivers ether. This was a problem with facial reconstruction because the mask will cover the area that requires surgical attention,” explained Fitzharris.
“There is one scene in The Facemaker where Gillies is leaning over a patient breathing ether, and Gillies is actually getting sleepy – not a good situation for your facial reconstructive surgeon!"
While rooted in history and medicine, The Facemaker is driven by the personal stories of both Gillies and the many men he saved. Far from the cold image of an ambitious surgeon, Gillies was a personable prankster who developed deep longstanding relationships with his many patients, some of whom went on to work with him in the years after their surgeries.
“He had this alternative persona called ‘Dr Skroggy’ where he would smuggle in champagne and oysters at night and gamble with the boys. He really lifted their spirits,” added Fitzharris.
“He was a jokester. He could still see the lighter side of events, even when those were terrifying in the moment. His gallows humor served him well in the First World War,” she said.
Gillies's work did not stop after WW1 and he continued to apply his skills to the victims of the Second World War. During this period, he started to venture into the genital reconstruction of injured pilots, which led him to yet another remarkable chapter of his life.
In the late 1940s, Gillies performed the world’s first phalloplasty, a surgical procedure where a penis is created, on a trans man called Michael Dillon. Dillon was eventually outed by the British press in a cruel act of prejudice, forcing him to flee the country, but Gillies stood by him and continued to send letters of support for the rest of their lives.
While this might not be the prime feature of his legacy, it's a story that sums up all the features that made Gillies so great: skill, dedication, boldness, and – perhaps above all – being human.
“He really believed that people control their identities. In 1949, there might not have been many people who would have been willing to view Dillon as a man, but Gillies was one of them,” Fitzharris noted.
“He was extremely forward-thinking.”