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Lindsey Fitzharris on the Loneliest Tommies
Telling the fascinating story of trailblazing plastic surgeon Harold Gillies and his revolutionary work restoring the faces - and rekindling the identities - of soldiers disfigured during the First World War, Lindsey Fitzharris' compelling The Facemaker is a breathtaking mix of military history and medical science. In this exclusive piece, Lindsey discusses the background to her acclaimed new book.
The Loneliest Tommies: Disfigurement in World War I
From the moment that the first machine gun rang out over the Western Front, one thing was clear: Europe’s military technology had wildly surpassed its medical capabilities. Bullets tore through the air at terrifying speeds. Shells and mortar bombs exploded with a force that flung men around the battlefield like rag dolls. Ammunition containing magnesium fuses ignited when lodged in flesh. And a new threat, in the form of hot chunks of shrapnel, often covered in bacteria-laden mud, wrought terrible injuries on its victims. Bodies were battered, gouged, and hacked, but wounds to the face could be especially traumatic. Noses were blown off, jaws were shattered, tongues were torn out, and eyeballs were dislodged. In some cases, entire faces were obliterated. In the words of one battlefield nurse, ‘[T]he science of healing stood baffled before the science of destroying’.
The nature of trench warfare led to high rates of facial injuries. Many combatants were shot in the face simply because they’d had no idea what to expect. ‘They seemed to think they could pop their heads up over a trench and move quickly enough to dodge the hail of machine-gun bullets’, wrote one surgeon. Others sustained their injuries as they advanced across the battlefield. Before the war was over, 280,000 men from France, Germany, and Britain alone would suffer some form of facial trauma. In addition to causing death and dismemberment, the war was also an efficient machine for producing millions of walking wounded.
Unlike amputees, men with facial injuries 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 newspapers of the time, maxillofacial wounds—injuries to the face and jaw—were portrayed as the worst of the worst, reflecting long-held prejudices against those with facial differences. The Manchester Evening Chronicle wrote that the disfigured soldier ‘knows that he can turn on to grieving relatives or to wondering, inquisitive strangers only a more or less repulsive mask where there was once a handsome or welcome face’. Indeed, the historian Joanna Bourke has shown that ‘very severe facial disfigurement’ was among the few injuries that the British War Office believed warranted a full pension, along with loss of multiple limbs, total paralysis, and ‘lunacy’—or shell shock, the mental disorder suffered by battle-traumatized soldiers.
It’s not surprising that disfigured soldiers were viewed differently from their comrades who sustained other types of injuries. For centuries, a marked face was interpreted as an outward sign of moral or intellectual degeneracy. People often associated facial irregularities with the devastating effects of disease, such as leprosy or syphilis, or with corporal punishment, wickedness, and sin. In fact, disfigurement carried with it such a stigma that French combatants who sustained such wounds during the Napoleonic Wars were sometimes killed by their comrades, who justified their actions with the rationalization that they were sparing these injured men from further misery. The misguided belief that disfigurement was ‘a fate worse than death’ was still alive and well on the eve of the First World War.
Disfigured soldiers often suffered self-imposed isolation from society following their return from war. The abrupt transformation from ‘typical’ to ‘disfigured’ was not only a shock to the patient, but also to his friends and family. Fiancées broke off engagements. Children fled at the sight of their fathers. One man recalled the time a doctor refused to look at him due to the severity of his wounds. He later remarked, ‘I supposed he [the doctor] thought it was only a matter of a few hours then I would pass out of existence’. These reactions by outsiders could be painful. The surgeon Fred Albee noted that the ‘psychological effect on a man who must go through life, an object of horror to himself as well as to others, is beyond description’. He observed that a disfigured soldier often felt like a ‘stranger to his world’, adding that it must be ‘unmitigated hell’.
Doctors and nurses at wartime hospitals experienced enormous challenges, but none was greater than the one posed by men with facial injuries. For them, survival alone wasn’t enough. Further medical interventions would be needed to allow these men to return to some semblance of their former lives. Whereas a prosthetic limb did not necessarily have to resemble the arm or leg it was replacing, a face was a different matter. Any surgeon willing to take on the monumental task of reconstructing a soldier’s face had to address not only the loss of function, such as the ability to eat, but also consider aesthetics in order to reflect what society deemed acceptable.
Fortunately for many of these soldiers, a visionary surgeon named Harold Gillies had established the Queen’s Hospital in Sidcup, England—one of the first in the world dedicated solely to facial reconstruction. From the outset, Gillies demonstrated an extraordinary ability to see past a soldier’s disfigurement. Those who knew him saw ‘a man of steel nerve and a great heart’ who viewed his patients as more than just numbered combatants. D. M. Caldecott Smith, whose brother was under Gillies’s care, remembered the doctor as being ‘full of human kindness’. Similarly, Sergeant Reginald Evans expressed astonishment that ‘ordinary soldiers received as much care as officers’. He wrote that Gillies ‘even dressed my wounds himself and visited me at night to see if I was comfortable, though he was up to his eyes in work’. Evans attributed the relative normality of his later life to Gillies’s successful reconstructive work: ‘I owe much of my happiness to him’.
For his patients, Gillies’s very presence had its own curative power. He would often comfort the wounded with his trademark 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’. His easy manner and sense of humor rarely failed to lift moods on the wards. ‘I thanked Heaven for an inherited ability to twist fun out of the ordinary things of life’, he remarked.
Over the course of the war, Gillies adapted and improved existing, rudimentary techniques of plastic surgery and develop entirely new ones. His unwavering dedication to this work was all in the cause of mending faces and spirits broken by the hell of the trenches. To help him with this daunting challenge, he assembled a unique group of practitioners whose task was to restore what had been torn apart, to re-create what had been destroyed. This multidisciplinary team included surgeons, physicians, dentists, radiologists, artists, sculptors, mask-makers, and photographers—all of whom assisted in the reconstruction process from beginning to end. Under Gillies’s leadership, the field of plastic surgery evolved, and pioneering methods became standardized as an obscure branch of medicine gained legitimacy and entered the modern era. It has flourished ever since, challenging the ways in which we understand ourselves and our identities through the reconstructive and aesthetic innovations of plastic surgeons the world over.
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