For many men fighting in the First World War, the fear of being permanently disabled was more terrifying than death. Even worse than the prospect of a life-altering disability was the horror of facial disfigurement. While men who lost a limb were treated as heroes, those who suffered facial injuries were often shunned or reviled. The mothers pressed their children inside to avoid seeing these disfigured men; the women broke off their engagement with their mutilated fiancés.
Harold Gillies, a New Zealand surgeon trained in Britain, has helped thousands of men face the world again. His work in the unit he created at Queen’s Hospital, Sidcup, was overshadowed by the more familiar story of his cousin, Archibald McIndoe, who reconstructed the burned faces of pilots in his “Guinea Pig Club” during the second World War. Yet it was Gillies, an extraordinarily compassionate man as well as a skilled surgeon, who truly transformed the specialty of plastic surgery.
In her gripping book, Lindsey Fitzharris not only tells the story of Gillies’ accomplishments, but she immerses us in the world of the men he helped, following them from the carnage of the trenches to the halls where they made long and painful recoveries. .
Gillies was 32 when the war broke out. He joined the Red Cross and was sent to France in 1915, where he first encountered men with appalling facial wounds from shells, shrapnel and sniper bullets. Plastic surgery was in its infancy. A few enterprising physicians had attempted reconstructive operations, but mainly on the nose and ears and with varying results. Some operations allowed patients to eat and talk but left gaping holes. Gillies realized that a specialized facial surgery center was needed where patients would receive expert treatment and surgeons could hone their skills.
He was first posted to duty at Cambridge Military Hospital in Aldershot, where he recruited a multidisciplinary team including dentists, nurses and an anesthesiologist as well as an artist to document their work. Soon after, he was given his own dedicated center at Sidcup, in a Georgian mansion surrounded by wooden cabins, which opened as Queen’s Hospital in 1917.
Men arrived with jaws, noses and cheeks destroyed, tongues pulled out and eyeballs dislodged. Pilots in plane fires, sailors in explosions at sea and soldiers in tanks that caught fire were brought in with their faces terribly burned. Some had already had operations that distorted their features, so Gillies had to reopen the wounds before starting the reconstruction.
Without manuals to follow, Gillies had to invent his own solutions, often sketching out ideas on a shell and then performing multiple operations involving skin, cartilage and bone grafts. “He was getting to work on a man who had half of his face literally shredded with the skin that was left in shreds,” said a nurse who worked alongside him. Gillies took scraps of skin from patients’ chests and elsewhere, leaving them tied in tight bands to maintain blood supply, then rotated them to cover facial wounds. In a landmark operation, he sewed the bands into tubes – or “pedicles” – which reduced the risk of infection. Using these techniques, Gillies recreated noses, jaws, lips and eyelids. A man underwent 40 operations to reconstruct his nose.
To maintain morale, the hospital organized sports days and staged amateur plays. Patients were encouraged to walk through local streets where some benches were painted blue so passers-by were warned in advance that a disfigured man might be sitting there. After the war, Gillies set up a private practice where he carried out more pioneering operations, including, in 1949, the first gender reassignment from female to male.
This is not a book for the faint of heart. Meticulously clear and detailed accounts of gruesome injuries and grueling operations are complemented by superb portraits by war artist Henry Tonks, who depicted patients before and after their reconstructions. Despite its harrowing subject matter, however, Fitzharris presents an extremely moving and immensely enjoyable story about a remarkable medical pioneer and the men he remade.