SCIENCE science.org 10 JUNE 2022 • VOL 376 ISSUE 6598 1167PHOTO: SCIENCE & SOCIETY PICTURE LIBRARY/GETTY IMAGES
By Cathy NewmanA
soldier who sustained serious
trauma to the face during World
War I bore a soul-crushing liability.
Those missing a leg or arm were apt
to evoke sympathy. But those un-
lucky enough to “lose face”—in this
instance, the term is literal as well as figu-
rative—more often provoked disgust. Chil-
dren, medical historian Lindsey Fitzharris
writes in The Facemaker, would flee from
the sight of their fathers. One wounded
corporal, upon catching sight of his face in
a mirror, wrote his fiancée to break their
engagement. In Germany, they were
called Menschen ohne Gesicht (men
without faces); in France, les gueules
cassées (broken faces).
Military weaponry in World War I
far outstripped the ameliorations of
military medicine. The deadly, disfigur-
ing arsenal included ammunition with
magnesium fuses, shrapnel, mortar
bombs, caustic gases such as chlorine
and phosgene, and flame throwers.
Wood and canvas airplanes, mean-
while, were essentially stacks of tinder
that fed fires started by exploding gas
tanks. Most airmen carried a pistol to
end their own lives in the event that the
plane they were piloting caught fire,
notes Fitzharris.
It is poignant and revealing that sur-
geon Harold Gillies banned mirrors in
his wards. The New Zealand–born, Uni-
versity of Cambridge–educated pioneer
in the emergent field of plastic surgery
at the heart of Fitzharris’s story under-
stood the searing trauma of facial in-
jury and disfigurement.
Before enlisting in the Royal Army
Medical Corps in 1915, Gillies had
worked in the posh private practice of a
laryngologist on call to London’s Royal
Opera House, where his most memorable
experience was ministering to a ballerina
who had accidentally sat on a pair of scis-
sors. “The brutal hothouse of frontline sur-
gery” that was the Great War was different
altogether. There was no textbook, no in-
struction manual in the radical reconstruc-tion that many soldiers’ injuries required,
nor even the knowledge of how to admin-
ister anesthesia to a patient with a gaping
hole in the middle of his face.
Skin grafting had been done in the 15th
century to replace a nose tip sliced off by
a dueling sword, but Gillies was working
on a much larger canvas and understood
that success depended on establishing and
maintaining blood supply and warding off
infection. He refined the procedure by lift-
ing, but not severing, the graft from the do-
nor site, stitching it into a tube, and moving
the free end to the area of injury: his tubed
pedicle became a reconstructive mainstay.But technical expertise is only part of
Gillies’s legacy. His creation of the Queen’s
Hospital at Sidcup in 1917—the first hospital
dedicated to facial reconstruction—was dis-
tinguished by its multispecialty staff, which
created a fertile climate for innovation and
collaboration. He employed artists and pho-
tographers who could document operative
technique and the before-and-after rendi-
tions of surgery, dentists conversant in jaw
anatomy and physiology, caring nurses and
orderlies, and even a barber trained to shave
faces marked by scars and missing flesh.To counter the book’s unsparing im-
mersion in the atrocities of war, Fitzharris
presents vivid depictions of humanity that
act as a profound salve. A nurse prepares
a glass of warm milk for a hospitalized
patient. A woman looks past a soldier’s
disfigurement and falls in love. Gillies
meticulously plans each move in the
operating room, committed to the res-
toration of face and soul, agonizing
when things go wrong.
Interwoven through Fitzharris’s story
is the irony of Gillies’s efforts, as encap-
sulated in an exchange between a bacte-
riologist and a surgeon in a London hotel
lobby overheard by journalist Harold
Begbie. “Here we are, you and I, whose
business it is to save life, in the midst
of men whose business it is to destroy
life,” the bacteriologist is said to have
remarked. There was one bright spot,
however, as surgeon Fred Albee ob-
served: “That in the long run, human-
ity would benefit from the knowledge
surgeons had gained in time of war.”
Indeed, this would prove to be the
case. In addition to pioneering work
in reconstructive plastic surgery, bat-
tlefield medicine also led to improve-
ments in orthopedic surgery, blood
transfusions, and trauma surgery.
After the war, Gillies became the
first surgeon to construct a penis for a
trans man, thereby pioneering gender
affirmation surgery. “The world,” his
patient wrote after the successful phallo-
plasty, “began to seem worth living in.” De-
spite negative feedback from some of his
peers, Gillies understood that the patient’s
needs came first.
“The practice of medicine is an art,
not a trade; a calling ...in which your heart will
be exercised equally with your head,” William
Osler, the father of American medicine, once
said. As Fitzharris so elegantly reveals, Har-
old Gillies embodied this sentiment. j10.1126/science.abo7797HISTORY OF MEDICINEThe surgeon and the soldiers
The Facemaker: A Visionary
Surgeon’s Battle to
Mend the Disfi gured
Soldiers of World War I
Lindsey Fitzharris
Farrar, Straus and Giroux,- 336 pp.
INSIGHTSThe reviewer is a freelance writer and former editor at large
at National Geographic based in Washington, DC, USA.
Email: [email protected]A soldier wounded in 1916 smiles after
facial reconstruction surgery.Plastic surgery pioneer Harold Gillies transformed facial reconstruction during World War I