The Facemaker, by Lindsey Fitzharris

During the pandemic, in the months when the faculty and staff were working from home, I worked my way through all of the episodes of ER and Botched (among other shows). I was fascinated by the way medical knowledge advanced during the run of ER (1994-2009) and what the two surgeons on Botched were able to do for their patients to rebuild faces and bodies. Lindsey Fitzharris’s illuminating (and occasionally harrowing) account of the work of Sir Harold Gillies during World War I, The Facemaker, takes us back just over 100 years, to explore the dawn of plastic surgery. It turns out that some of the things the doctors on Botched do were pioneered by Gillies and his collaborative team of surgeons and dentists whereas others (like the use of ether and chloroform as anesthesia) are now seen as primitive. It’s even more remarkable when you know that this incredible, ground-breaking work was done as thousands of patients were pouring into Gillies’s hospital over four years of unceasing warfare on the Western Front.

Although Gillies practiced surgery before and after the war (Gillies died just a month after performing his last surgery), Fitzharris focuses her account on the war years, when Gillies and his team were constantly pushed to innovate. She opens by explaining that soldiers in World War I faced weapons that were much more dangerous, on a much bigger scale, than in previous wars. Poison gasses could kill, blind, and maim lungs in seconds. Machine guns were in every trench, ready for anyone to stick their heads over the top. Artillery produced massive craters in and out of the trenches that would obliterate anything in their path. And yet, at the beginning of the war, some armies sent their infantry into battle with flimsy helmets or no hard protection for their heads at all. The iconic Tommy helmets came a bit later. Conditions on the ground meant that, if a soldier was wounded, they were very likely to pick up infections before they could be rescued and sent to a hospital. Given the nature of the weapons they faced, it was little wonder that so many soldiers suffered catastrophic injuries that also required their doctors to learn, almost on the fly, radical techniques to treat their patients.

Fitzharris is incredibly good at condensing a lot of medical history in the chapters of The Facemaker. She can dip into medical history reaching as far back as Sushruta or briefly explain the history of blood transfusions and blood-typing to catch readers up on what they need to know to understand what Gillies et al. are doing with their surgical techniques. Plastic surgery (plastic in this case meaning shapeable or malleable) had been performed before World War I, but it was rare. Pre-anesthesia, pre-antisepsis, and pre- a lot of things we see as necessary for safe surgery, plastic surgery was very experimental before Gillies came to maxillofacial surgery. Fitzharris’ descriptions of Gillies’s techniques are clear. For readers who want more, there are archives of before, in-progress, and after photos of soldiers who had their faces rebuilt at Gillies’s hospital. Rebuilt is the right word. Some of the patients Gillies and his fellow surgeons saw were missing teeth, jaws, noses, eyes, and a lot of skin. Gillies and his team were able to rebuild faces from ruin.

It takes a remarkable kind of person to walk into unprecedented medical cases and think about what was possible, rather than focus on what they’d been taught was impossible. Gillies and many of the people he worked with during the war had the right mix of talents, thoughts, and personalities to work with patients who had been through physical and psychological hell. I’m glad Fitzharris retells Gillies’s story and the stories of several of his patients and colleagues; these stories should never be forgotten.

I received a free copy of this book from the publisher via NetGalley, for review consideration.

Gassed, by John Singer Sargent c. March 1919 (Image via Wikicommons)

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