The Facemaker: One Surgeon’s Battle to Mend the Disfigured Soldiers of World War I

The Facemaker: One Surgeon's Battle to Mend the Disfigured Soldiers of World War I by Lindsey Fitzharris

The Facemaker: One Surgeon’s Battle to Mend the Disfigured Soldiers of World War I is an extraordinary book by medical historian Dr. Lindsey Fitzharris (Ph.D. in the history of science and medicine).

Ostensibly, the book is about New Zealand otolaryngologist, and pioneering plastic surgeon, Sir Harold Gillies (1882-1960). However, its wider reach covers the long-term affects of WWI and the stigma behind facial disfigurements.

Although it’s a bestseller we’re covering here, do note there are excerpts ahead detailing descriptions of severe injuries.

The Facemaker by Dr. Lindsey Fitzharris

As we covered in our recent review of Peter Jackson’s They Shall Not Grow Old (2018), WWI was a different type of war to anything ever seen.

With advanced weapons designed to cause unprecedented levels of destruction, it’s no surprise the war created widespread forms of new horrors.

One was the psychological impact of shell shock (PTSD).

The other was in the form of horrific facial mutilations. We’d read of these previously in Erich Maria Remarque’s incredible book All Quiet on the Western Front (1929), but people nowadays are likely unaware just how extensive this awful type of injury was during WWI.

The war began 24 years after the death of Joseph Merrick (the Elephant Man). His was a tragic and tumultuous life, but one of the more successful in the Victorian era for someone with severe disfigurements.

However, it’s fair to say most people in late 19th century society didn’t take kindly to his appearance.

Move forward to circa 1915 and, suddenly, tens of thousands of soldiers with horrific facial injuries were flooding back into England.

But it was exactly the type of injury that didn’t elicit much public sympathy:

“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 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.'”

To combat the crisis, Gillies set up his landmark medical unit at Cambridge Military Hospital in Aldershot, Hampshire. He did so after persuading the army’s chief surgeon, Sir William Arbuthnot-Lane (1856-1943), it was an essential duty.

The army took some persuasion, but Gillies was steeped with an incredible sense of determination and resolve. All of which was born out of genuine human kindness—Gillies saw at the front the damage being done. And he wanted to make a difference.

As the wounded began attending his hospital, Gillies invented constant new procedures to try and cope with some of the horrendous injuries.

His creativity was essential as WWI also invented endlessly appalling new ways for soldiers to suddenly find half their faces missing. Particularly from some of the war’s most awful battles.

There was The Battle of Jutland (31st May-1st June 1916), Battle of the Somme (July-November 1916), and Passchendaele (July-November 1917). All just goddamn horrendous from start to finish.

The damage wrought on human bodies was matched by the psychological damage medical professionals had to contend with:

“The sight of a soldier with injuries to his head and neck could send shock waves through the ranks of even the most battle-hardened nurses. A Swiss nurse, Henriette Rémi, working in a German hospital during the war recalled disfigured men with ‘mutilated debris in lieu of faces.’ Mary Borden—a nurse who later suffered a mental breakdown—described a time when she lifted the bandage from a soldier’s head and half his brain slipped out. Such carnage brought home to the nursing staff on the wards the severity of the distant conflict raging on the front. ‘You could not go through the horrors we went through, see the things we saw and remain the same,’ Catherine Black [a nurse at Gillies’ clinic] later reflected. ‘You went into it young and light-hearted; you came out older than any span of years could make you.”

Throughout all of this Gillies, commended for his humane approach, was notable for trying to lift the spirits of those injured. He was acutely aware the psychological damage was immense and actively promoted a good time in his hospital.

He used his ready wit and sense of humour to cheer up patients. He also encouraged on-ward drinking and turned a blind eye to gambling (banned from most other hospitals).

But he did ban mirrors from his hospital. Even so, many soldiers were left in ruin:

“The psychological toll on the wounded could be overwhelming. [Catherine Black wrote] ‘Hardest of all was the task of trying to rekindle the desire to live in men condemned to life week after week smothered in dressings and bandages, unable to talk, unable to taste, unable even to sleep without opiates because of the agony of lacerated nerves, and all the while knowing themselves to be appallingly disfigured.'”

The level of destruction does make for some terribly sad stories.

Corporal X (he goes unnamed) is one of the worst. A young lawyer with a thriving new business, he went to the war with a sense of duty. Suffering a terrible facial injury, he was one of Gillies’ patients.

The doctor did his best, but eventually had to reveal to Corporal X’s mother the final stage of his recovery—she turned deathly pale upon seeing him. Corporal X later managed to find a mirror, insisted curtains be drawn around his bed, and wrote a letter to his fiancé explaining to her he’d found another woman in Paris and wouldn’t return to her. Aware she’d reject him if she ever saw him again.

He lived the rest of his life as a recluse.

Whilst this may all make for harrowing reading, Dr. Lindsey Fitzharris weaves the story in compassionate and tremendous fashion. She makes it clear what Gillies and his team were doing here—he provided an incredible lifeline to thousands of men.

Corporal X’s story wasn’t a success, but hundreds of others were. Many integrated back into society successfully and led happy lives.

Private Percy Clare was one of them. Another, Private Walter Ashworth, found his fiancé left him due to his disfigurement. But he struck up a penpal relationship with his fiancé’s friend and the pair ended up happily married.

Such moments aside, there’s no denying this is a brutal read.

Fitzharris maintains a matter-of-fact tone throughout The Facemaker, as there’s no other way to tell this story. This is how it was. At times, it’s difficult to get through. Just because of how awful the many, many descriptions of personal tragedies are. But we think it’s a very important work.

It’s this flip side of the very worst, and the very best, of humanity all in one book. The heroic spirit of Sir Harold Gillies, and others, offered a lifeline. And Fitzharris tells it all in excellent fashion—we think it’s a crucial story to tell. Until recently, it was under threat of disappearing into the annals of history.

Instead, it’s brought back to life. That may be uncomfortable reading for some, but from our perspective we view it as an essential testament to the fighting spirit of the good people of the world.

Prosthetics and Artistic Integrity

Anna Coleman Ladd with a French soldier

Whilst Sir Harold Gillies is considered the founding father of modern day plastic surgery, many others were also involved. In Germany, to deal with the country’s injured, the German-Jewish doctor Jacques Joseph (1865-1934) was in charge of facial reconstructions in Berlin.

He was prominent in rhinoplasty and earned the nickname Nose Joseph.

However, a unique approach to disfigurement came from the world of art. And this dates back as early as 1566 when the astronomer Tycho Brahe repaired his nose (following a duel injury) with a prosthetic piece of brass.

For WWI, artist Derwent Wood (1871-1926) helped popularise the concept of using a lifelike mask to cover terrible facial injuries.

In March 1916, he established The Masks for Facial Disfigurement Department in London.

Anna Coleman Ladd was another, an American prosthetic designer and sculptor who grew up in Paris. She put her artistic skills to good use after WWI to help design masks for disfigured soldiers—all from her studio in Paris.

This is how effective her work could be for the disfigured French soldiers, dubbed les gueules cassées (the broken faces).

Ladd would create a moulded resemblance of the soldier’s face with copper, which was then silvered and coated with enamel.

After that, she’d paint over the mask. This medical process is now called anaplastology. For her efforts, in 1932 the French government awarded her a Knight (Chevalier) of the Legion of Honour.

Unfortunately, all her masks are now believed lost.

The downside was the masks had a fixed expression, which some people found disturbing (most notably some of the children of soldiers). Plus, paint would fleck away over time. And as the soldiers aged, the mask would become unsuitable for use.

Some later began rejecting the masks. But there’s no denying they offered considerable psychological respite for soldiers in the immediate aftermath of the war.

It’s just Gillies, who also used masks for extreme cases, was aware they weren’t a long-term solution for anyone. And his focus remained steadfastly on the exceptional pioneering work he completed in the chaotic period of World War I.

Dispense with some gibberish!

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