‘A Mirror to the Face of Modern Culture’: Lindsey Fitzharris’ The Facemaker
“A force that flung men around the battlefield like rag dolls.”
"From the moment that the first machine gun rang out over the Western Front," writes Lindsey Fitzharris in The Facemaker, “one thing was clear: Europe's military technology had wildly surpassed its medical capabilities.”
Newly developed modes of warfare brought unprecedented levels of savagery and devastation to the battlefields of the First World War. “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 forms of hot chunks of shrapnel, often covered in bacteria-laden mud, wrought terrible injuries on its victims—bodies were battered, gouged and hacked.”
Fitzharris' harrowing account of trench warfare reveals an unfathomable level of torturous hardship and torment. From 'trench mouth', where “monotonous diet and lack of oral hygiene led to the painful conditions of acute ulcerative gingivitis,” to badly wounded soldiers in agonising pain waiting days for help, often bleeding to death before any relief has arrived. We hear of dogs trained to locate casualties, driven mad by shellfire, stretcher-bearers petrified at the thought of going anywhere near the deadly trench to rescue the injured, and of men choking to death on their own blood blocking their airways. It took time, explains Fitzharris, before the recommendation was made that “soldiers with facial injuries be carried facedown, with their head hanging over the end of the stretcher, to avoid accidental suffocation.”
“Fiancés broke off engagements, children fled at the sight of their fathers.”
The cruel nature of trench warfare led to high rates of facial injuries. It was massive carnage: “Noses were blown off, jaws were shattered, tongues were torn out and eyeballs were dislodged, in some cases entire faces were obliterated.”
The savage facial disfigurement sustained by so many men was unlike anything seen before. So horrific were their injuries that medical staff stood helpless in shock, dumbfounded by the surreal-looking figure before them as blood gushed out from where a human face once shone.
“The ghastliness of this type of injury could elicit terror in even the most battle-hardened warrior," explains Fitzharris. The recollections of soldier Louis Barthas spoke of one such dehumanising injury. “The man had almost no face left. A bullet had hit his mouth and exploded, blasting through his cheeks, shattering his jaws, ripping out his tongue, a bit of which was hanging down and the blood gushed abundantly from these horrible wounds.” The soldier was still alive, noted the shocked soldier, but no one in his squad recognised him without his face. “Would even his own mother have recognised him in a state like this?” Barthas wondered.
So helpless and impotent felt rescuers and fellow soldiers, Fitzharris notes, that often all that was left was to watch him painfully perish and talk to the chap about his family back home. Throughout the book, the author shares personal tales that demonstrate the magnitude of the devastation of the war, as well as the soldiers’ heroism. One such tale is that of Private Percy Clare. When a bullet ripped through his face, he was convinced the wound was fatal. Wobbling on his feet before sinking to his knees, his mind drifted to memories of his wife and child. Then an officer named Rawson came to his aid. “Shaken by the sight of Clare's ravaged face,” the officer panicked. “Unable to determine the source of the bleeding,” he stuffed an entire packet of emergency field dressings into Clare’s mouth before rushing to the line to join his men. The attempt to “dam the outlet” nearly choked Clare. But with the little strength he had left, he crawled across the battlefield towards a road in the distance. He collapsed as thoughts of his grave flooded his mind.
“Pulling a small bible from his pocket and clutching it to his chest [in the hope] that whoever found his body would post it back home to his mother,” a friend recognised Clare and insisted on finding stretcher bearers who would help carry him to safety. Two rescue teams had already failed to do so, counting the Tommy to be “beyond help.” Against all odds Clare survived, only to “receive a shock” when he first looked in the mirror. He was now “an unlovely object.”
Loneliest Tommies
Clare was one of many disfigured young men who miraculously survived, and through treacherous terrain, found their way back to Britain. This was where the unbearably cruel reality struck. Unlike a missing limb, which often prompted waves of sympathy, facial injuries triggered gasps of horror and disgust. Not only did victims not get the heroes' welcome they deserved, but they were also doomed to be recluses to their dying day.
“Disfigured soldiers often suffered self-imposed isolation from society following their return from war,” writes Fitzharris. “The abrupt transformation from typical to disfigured was not only a shock to the patient but also to his friends and family—fiancés broke off engagements and children fled at the sight of their fathers.” “One man,” writes Fitzharris, “recalled the time a doctor refused to look at him due to the severity of his wounds,” probably because he thought it was only a matter of hours before his disfigured body “would pass out of existence” anyway.
“These soldiers’ lives were often left as shattered as their faces,” notes Fitzharris. “Robbed of their very identities, such men came to symbolise the worst of a new, mechanised form of war.” In France they were known as Les Gueules Cassées (the broken faces); in Germany Das Gesichts Entstellten (twisted faces) or Menschen Ohne Gesicht (men without faces). In Britain, they were known simply as the “loneliest of Tommies.” They were the “most tragic of all war victims—strangers even to themselves.”
The Saviour—From Evil Came Innovation
Fortunately for Clare and other disfigured soldiers, a “visionary surgeon named Harold Gillies had recently established the Queen's Hospital in Sidcup, one of the first in the world dedicated solely to facial reconstruction.” Throughout the war, the Cambridge-educated New Zealander would “adapt and improve existing rudimentary techniques of plastic surgery, and develop entirely new ones.”
Now widely recognised as the ‘Father of Plastic Surgery’, pioneering surgeon Gillies treated facial destruction of unprecedented scale and nature. It necessitated the complete recreation of the face, rebuilding bone structures, reconstructing soft tissues, and restoring basic functions. With unwavering dedication, Gillies and his team searched for ways to grant their patients “a human appearance,” and to restore their ability to eat, drink, and speak.
Harold Gillies was 32 years old and with a newborn baby and pregnant wife when he became a medical volunteer in France. This is where he watched in awe the wealthy French dentist Auguste Valadier. Valadier had famously converted his Rolls Royce into a mobile operating room, and volunteered his personal fortune to rebuild soldiers’ faces. His bone grafting mastery inspired Gillies and taught him the value of dentistry in the practice of facial reconstruction. It demonstrated the transformative power of plastic surgery, and made clear the urgent need to set up an independent medical unit that treated soldiers’ bones, teeth, and skin.
An experimental, rarely executed exercise with hardly any proven skill or knowledge to go by, it was the flood of disfigured young men arriving from the trenches that created an urgent need for plastic surgery to speedily progress from its infancy stage. Fitzharris describes how at his special unit, Gillies made history and laid the foundations for plastic surgery. It was tough, as staff found the gruesome disfigurement too much to bear, and there were even reports of nurses who suffered nervous breakdowns. But it was through the tragedy of war that the opportunity was granted for such extensive surgical innovations to take place.
Gillies persevered, often undoing the hastily joined wounds of the war hospital. He faced soldiers who could not eat, drink, or breathe unaided, often arriving at the hospital malnourished and dehydrated. One such case, unable to breathe properly, sat up through the entire ten-day journey back to Britain, arriving not just malnourished and dehydrated but with his face “bathed in pus, foul smelling and gangrenous.” Still, throughout the hospital Gillies spread calming assurances. “Don’t worry Sonny," he would tell the traumatised wounded. “You’ll soon be all right and have as good a face as most of us.”
Nurse Black, who assisted Gillies, later wrote that “he would set to work on some man who had half his face literally blown to pieces, with the skin that was left hanging in shreds, and the jaw bone crushed to pulp, that felt like sand under your fingers.” It was “a strange new art,” reflected the pioneering surgeon himself years after the war had ended. “We were fumbling towards new methods and new results without the boon of sulfa drugs, plasma or penicillin.”
But there were victories and losses along Gillies's wartime journey. Of the many harrowing accounts, one William Henry Young, recipient of the Victoria cross, stands out.
At the age of 38, Young in 1914 was shot in the leg by a sniper but returned to duty. Back on the battlefield, he fell victim in the spring of 1915 to a chlorine gas attack which left him with impaired vision. Still, after a period of recovery, he was sent back to fight. Here, on the morning of December 22, 1915, he made his way through barbed wire amid heavy fire to save a wounded mate. He had been pulling the man back to safety when a bullet smashed his jaw and chest. Remarkably, despite the severity of his injuries, Young walked half a mile to receive treatment. He was then sent to Britain for recovery where he was awarded the Victoria Cross for his bravery, and he was soon on his way to Gillies’ specialist unit for jaw reconstruction.
“Gillies was confident in his ability to repair Young's jaw but the operation was not without risk,” writes Fitzharris. “One of the greatest challenges his team faced was the administration of anaesthesia. Facial injuries often resulted in the obstruction of the airway, either from swelling of the tongue and throat, or from the loss of muscles controlling the larynx.”
Despite Young being given as little anaesthesia as possible for his operation, the war hero sadly slipped into a coma. Having survived multiple gunshot wounds and poison gas, attempts to revive him failed. Private William Henry Young VC was dead from sudden heart failure, leaving behind a wife and nine children.
The Compassionate Innovator
Young’s death left Gillies “devastated,” writes Fitzharris, and in a letter to the Private’s widow he spoke of being “utterly miserable.” But good would come out of Gillies’ misery and frustration yet again as he set out to solve the ongoing problem of “how to safely administer anaesthesia to patients with facial injuries.”
Through the rebuilding of soldiers' battered faces, Gillies has laid the foundations of plastic surgery. Fitzharris describes in great detail the challenges he faced and the techniques he went on to invent and vastly improve. He learnt from early-day mistakes such as reconstructed noses shrivelling up due to the lack of mucous membrane, skin grafts failing to take, and flaps becoming infected.
One of Gillies’ most successful skin grafting techniques, according to the National Army Museum, “was to release and lift a large flap of skin, called a pedicle, from near the wound.” Still connected to the donor site, the “free end of the skin flap would then be swung over to the site of the injury without completely severing the connection to the body. Maintaining the physical connection ensured that blood was supplied to the skin, increasing the chances of the graft being accepted by the body.”
The museum also notes that “Gillies puzzled over how to ensure that larger skin grafts could be accepted over the site of the injury.” This was until he operated on Willie Vicarage, a twenty-year-old who had been severely disfigured during the 1916 Battle of Jutland.
One of the worst injured victims he had ever seen, the determined surgeon “proposed to raise a 'Masonic Collar Flap' of skin from Willie’s chest to repair the lower part of his face. During the operation, Gillies noticed that the edges of the pedicle flaps curled in on themselves under tension. He decided to sew them into a tube and found that the risk of infection was reduced and the blood supply was much better,” and once the tubed pedicle had become firmly attached near the site of the injury, it could be cut away from the donor site to be opened and spread out to graft a much wider area.
They Were Bigger People
Lindsey Fitzharris’ The Facemaker paints a vivid picture of the break of war and the nation’s mood at the time, from Kitchener’s astonishingly successful recruitment campaign through to the carnage of trench warfare and the disfigured men’s hellish post-war existences.
This harrowing book holds a mirror to the face of Western society and culture. It evokes reflective notions around the soldiers’ immense suffering and torment. As we read of the sacrifice made by these disfigured men, and all who fought selflessly to rehumanise them, we cannot help but feel, perhaps wrongly, that these men were different—that they were products of a less self-obsessed era.
Indeed it is hard not to wonder what would happen should a world war hit the West now. Would young men enlist? Are they patriotic enough to fight for king and country? If so, would they be willing to make the kind of sacrifice these men made, and are they capable of it in the first place? How many men today would have the physical and mental strength of men like William Henry Young, or Willie Vicarage?
Such questions are hard to answer, but I did present them to Colonel Richard Kemp CBE who spoke openly in the past against political correctness within the army. “If a situation occurs which requires today's young men to serve their country, they will do so just as previous generations did,” asserts Kemp. “I have seen the mettle of those who volunteer to join the forces and fight, which is every bit as strong as in the past. The fighting spirit of the British army in Iraq and Afghanistan in recent years is testament to that.”
This view is different to one conveyed to me by Robin Aitken, author of The Noble Liar who recently spoke to a Canadian army veteran. Aitken believes that should a world war strike, young men today would not have the patriotism within them to make the sacrifices that former generations did. Speaking of those generations, it is Thomas Sowell’s view that the older generations are by far superior to today's: that “they were bigger people.”
Science Fiction into Science Fact
The Facemaker shows how the procedures carried out today are indebted to the dedication, ingenuity and compassion of Harold Gillies. As Fitzharris concludes, it was Gillies who “had made it possible for science fiction to become science fact.”
It is quite astounding to think that plastic surgery, now synonymous with Hollywood stars’ superficiality and the age of affluence, was born out of young men having their faces obliterated through shattering war injuries. I urge readers to sift through the pages of Gillies’ book on the topic, published in 1920, to see the unbelievable transformations of the savagely deformed men.
Hannah is a London based journalist covering culture and current affairs. She writes about photography, film and TV for outlets in the UK and US, and covers current affairs with particular interest in the Jewish world. She is also an award-winning filmmaker and photographer. Her films were screened in festivals worldwide and parts of her documentary about Holocaust survivor Leon Greenman were screened on the BBC. You can find more from Hannah here.
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