Sullivan on Fitzharris, 'The Facemaker: A Visionary Surgeon's Battle to Mend the Disfigured Soldiers of World War I'

Author: 
Lindsey Fitzharris
Reviewer: 
Evan Sullivan

Lindsey Fitzharris. The Facemaker: A Visionary Surgeon's Battle to Mend the Disfigured Soldiers of World War I. New York: Farrar, Straus and Giroux, 2022. 336 pp. $23.99 (cloth), ISBN 978-0-374-28230-1

Reviewed by Evan Sullivan (SUNY Adirondack) Published on H-War (October, 2022) Commissioned by Margaret Sankey (Air University)

Printable Version: https://www.h-net.org/reviews/showpdf.php?id=58030

Two stories stood out while reading the final sections of Lindsey Fitzharris’s new book, The Facemaker: A Visionary Surgeon’s Battle to Mend the Disfigured Soldiers of World War I. The first was about a young Australian violinist named Daisy Kennedy. Kennedy was at a lunch in Mayfair and was speaking to a soldier beside whom she was seated. The soldier “seemed to have escaped the war completely unscathed.” Little did Daisy know that he was one of Harold Gillies’s patients, one of the many mutilated soldiers whose faces had been reconstructed by the New Zealand World War I plastic surgeon at Cambridge Military hospital in Aldershot, England, and Queen’s Hospital in Sidcup. “I was so moved that I couldn’t speak,” wrote Kennedy. “His face bore no sign of ever having been under a surgeon’s hand” (p. 223).

The second story originated from the day that international delegates congregated at the Palace of Versailles in France in June 1919 to sign the Treaty of Versailles officially ending World War I. The French prime minister Georges Clemenceau had invited the Délégation des Mutilés, a cadre of disfigured French soldiers, into the Hall of Mirrors to stand as testimony of the violence of the war. The dignitaries, including the leaders of Germany, passed by the Délégation des Mutilés to sign the treaty. The wounded soldiers had spent their surgical recovery without access to mirrors in order to shield them from the depression that medical professionals assumed soldiers would feel if they saw their mutilated faces before surgical reconstruction had been completed. But there, in the Hall of Mirrors, they were surrounded by hundreds of mirrors, making their mutilation supremely visible (p. 224).

The two stories are apt reflections of the rest of The Facemaker because of the continuous tensions that existed among the traumatic visibility of facial wounds, the medical promises to erase such mutilation despite the fact that medicine was continuously evolving, and the mixed successes of facially wounded veterans’ homecomings after they left the hospital wards. As Fitzharris shows in her book, wounding and healing rarely happened with such clear-cut binaries. Often messy, sometimes revelatory, facial reconstruction surgery grew as a surgical specialty during World War I, and much of that growth was a result of New Zealand surgeon Harold Gillies and the team that surrounded him that included surgeons, artists, dentists, and anesthesiologists. The Facemaker brings that story to light in an accessible, illuminating way.

The Facemaker consists of thirteen chapters bookended by a prologue and an epilogue. The first chapter introduces Harold Gillies not as a war surgeon but as a substitute surgeon who treated civilian performers at the Royal Opera House before the outbreak of World War I, and the chapter’s premise contextualizes the cosmopolitan city of London in the months before the outbreak of war as well as the contingent nature of Gillies’s position as a prominent war surgeon based on his civilian practice merely filling in for a contemporary. The chapter ends with the outbreak of war, discusses early recruitment and optimism in British society, and highlights Gillies’s ultimate decision to join the Red Cross. Chapters 2 and 3 explore the wartime experiences of Franco-American dentist Auguste Charles Valadier and Armenian dental surgeon Varaztad Kazanjian through early 1916. The two figures instilled in Gillies the centrality of dentistry to effective facial reconstruction just as Gillies was set to open Cambridge Military Hospital at Aldershot.

Building on those two chapters, chapter 4 recounts the challenges Gillies encountered when he first opened the hospital ward for facial surgery, including his efforts to have facially wounded soldiers sent to him in the first place, the conditions of war that precipitated traumatic facial wounds, and his initial encounters with facially wounded soldiers in Aldershot. From there, the narrative recounts Harold Gillies’s baptism of fire at Aldershot by treating an influx of military personnel who were wounded at the momentous battles of Jutland and the Somme—the former produced casualties who were primarily burn victims as a result of the cordite from naval shell fire. Other chapters explore the medico-military histories of face transplants, the interconnectedness of Sidcup hospital with the surrounding town, the dangers of transporting the wounded by hospital ships, the development of anesthesia and blood transfusions, and the significant roles that artists played in prolonged and painful facial reconstruction surgeries.

While The Facemaker is primarily a book about Harold Gillies and those who surrounded him, major figures whom Gillies worked with often provide windows or starting points for discussions that help one understand the histories of plastic surgery more generally. For example, chapter 2, “The Silver Ghost,” focuses on Auguste Charles Valadier’s influence on Gillies. Valadier operated a mobile operating room behind the lines of the western front, but through his story, Fitzharris describes the context of dentistry before 1914, which helps the reader understand why dentistry was so marginal compared to mainstream medicine and was therefore not included in the foundations of British military medicine in 1914. The British military’s lack of attention to dentistry had real consequences for soldiers who had numerous dental problems. Though as Fitzharris shows, it was only when Douglas Haig came down with a toothache during the Battle of Aisne in October 1914 and needed treatment that he could not get because of the absence of dentists that the army then sought to include dentists in military medicine, which suggests the significance of one’s social class in determining real health outcomes. Valadier entered the scene early in the war, when he and Gillies met at a special jaw unit in Wimereux. From there, as Fitzharris demonstrates, Gillies recognized the value of dentistry in his own work, including the importance of thoroughly cleaning jaw wounds.

Lindsey Fitzharris handles her subject matter in a skillful and responsible way. Popular journalistic narratives of facial wound reconstruction can fall victim to understanding Harold Gillies’s surgical career and Anna Coleman-Ladd’s mask creations as nothing less than medical and artistic triumphs. Fitzharris does not do that. Accurate academic studies—by Marjorie Gehrhardt, Julie Anderson, Fiona Reid, and Joe Kember, to name a few—have similarly noted that though the masks made by Coleman-Ladd and others made up for what the surgeries could not “fix,” the facial coverings were not without flaws. Veterans were incredibly uncomfortable wearing the masks on hot summer days, the emotionless masks sometimes frightened family members, and the masks did not age with the veterans (p. 130). Similarly, Fitzharris also highlights the more problematic examples of surgical trauma that accompanied surgical successes. Gillies, for example, had to undo some of the surgeries that Private James Bell had undergone before he could even begin to reconstruct his face, and another soldier had been operated on already but the results were so unsatisfactory that Gillies had to correct the damage through a succession of twenty-one operations over five years (p. 113). Fitzharris, therefore, is careful not to rely on triumphalist medical narratives that would have discounted the real trauma soldiers experienced. Fitzharris concludes that the most effective surgeon—presumably Gillies himself—paled in comparison to the devastating injuries of World War I. “Though there were triumphs,” she concludes, “did those triumphs make up for the shattering sorrow?” (p. 118).

Fitzharris also subtly demonstrates that she has taken into consideration perspectives from disability studies scholars. In disability studies, scholars and activists have decentered medical narratives, highlighted individual disabled peoples’ perspectives, and emphasized the social model of disability that argues that social, cultural, and physical barriers have more often marginalized disabled people than their own biological realities. Fitzharris writes in “A Note to the Reader” that she “consulted various experts, including a disability activist with a facial disfigurement” when considering whether or not to include medical photographs in the book itself (p. xi). She considers a disability studies perspective likewise later in the book when, instead of relying solely on primary source newspaper articles to understand how the public described facial wounds—sources that might have perpetuated early-twentieth-century ableist stigma of facial disfigurement without considering the perspective of the person with the facial wound—she follows the source analysis with, “one cannot help but wonder what the patients themselves may have thought when they encountered such dehumanizing descriptions of their injuries in the news” (p. 86). However, a more disability-studies-centered approach may have done still more to seek out “what the patients themselves” thought.

While Lindsey Fitzharris’s attention to disability studies and care with which she uses medical sources are obvious strengths, more still could have been done to demonstrate the global nature of World War I. Did Gillies treat nonwhite soldiers? The British Empire mobilized nonwhite soldiers from its global domains to fight in Europe and other theaters of war. The author mentions Canada and New Zealand, and discusses the battle of Gallipoli, but gives less attention to critical discussions of race and medical reconstruction. In chapter 5, for example, Gillies boasted of the diversity at Sidcup, the second location he opened, that was an “impressive array” that included Canadian, Irish, New Zealanders, Australians, and Americans. Gillies concluded, “The whole hospital was an excellent example of the harmonious interlocking of the forces of the British Empire and U.S.A.” (p. 146). While this was certainly true from Gillies’s perspective, the British Empire included far more territories involved in the war. Hundreds of thousands of commonwealth soldiers from Africa, India, and the Caribbean served in the war both in Europe and around the world. Did any of them come under Gillies’s care? Were there facial reconstructive needs in places such as Africa or the Middle East? If Gillies only considered white soldiers as part of the “excellent example” of the British Empire, what does this tell us about how Gillies viewed the role of the British Empire in the war, and the ways nonwhite people contributed to the war effort? These questions are left largely unaddressed.

Critiques notwithstanding, The Facemaker is an excellent book. It humanizes impersonal histories of military medicine through its illuminating stories of Harold Gillies and his contemporaries. It provides a tapestry of personalities, experiences, triumphs, and struggles that will appeal to general and specialist audiences alike. It is truly a wonderful addition to the ongoing literature of World War I, medicine, and wounded soldiers.

Citation: Evan Sullivan. Review of Fitzharris, Lindsey, The Facemaker: A Visionary Surgeon's Battle to Mend the Disfigured Soldiers of World War I. H-War, H-Net Reviews. October, 2022. URL: https://www.h-net.org/reviews/showrev.php?id=58030

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.

I was interested to read this review and wonder whether Evan Sullivan is aware of my own book "Faces from the Front: Harold Gillies, The Queen’s Hospital, Sidcup and the Origins of Modern Plastic Surgery" (Helion Press, 2017).  While Fitzharris' style is very readable, there are a number of errors of fact and interpretation; most of the personal accounts come from published work, including my own and the original biography of Gillies by Reginald Pound published in 1960. The only reason that the story could be advanced since 1960 is that I discovered the extant case files, and my book was some 25 years in the making.  I was not, regrettably, consulted on the final draft and so did not have the opportunity to correct the mistakes.

Just a few examples, referred to by Sullivan; the Jutland casualties were never treated at Aldershot, and Gillies first encountered Valadier in Boulogne.  Another error is the elevation of rank of an artilleryman from Bombardier to Brigadier, due to a misreading of the abbreviation.  The section about Gillies' pre-war work fails to understand the surgical hierarchy in England, and the idea that he was "a substitute surgeon who treated civilian performers at the Royal Opera House" is a misunderstanding.  Gillies was asked by his boss to visit Dame Nellie Melba, and forgot the third appointment.  The rest of his pre-war career is quite typical of an ear, nose and throat surgeon.

In my book I explore the difference in approach between the surgeons working in England and those on the continent.  By concentrating patients and staff in one place Gillies avoided the problems of communication and isolation which held back advances across the Channel, where surgeons worked in small units, often refused to discuss cases with colleagues and abandoned patients when they considered they had finished.  Two of Gillies' patients were substantially improved having been poorly treated in Fance and Germany. The concentration allowed both the development of sensible rehabilitation and patient intercommunication; later arrivals would see the improvements that might be possible surgically, not least because patients were given copies of their serial photographs.  This fact undermines the issue of mirrors; at the outset at Aldershot they were kept from patients, but the rules were later relaxed; after all, with hundreds of patients on the hospital site they could see each other anyway.  I do not accept the idea that the disfigured men at Versailles in the Hall of Mirrors was anything other than a crude attempt to shame the German delegation; the treaty signing was not designed around "Les Gueules Cassees".  And for Gillies masks represented surgical failure; very few of his Sidcup patients wore them.

I also dispute the concept of despair and hopelessness among the facially injured in the UK.  This is largely a myth, based on two accounts, both predating the establishment of the Queen's Hospital, Sidcup, and on early newspaper cuttings which were deliberately emotive to attract financial donations.  My own research shows that the majority of men treated at Sidcup lived long and happy lives; I have had the opportunity to study the postwar histories of over 100 Sidcup patients.  While a few men were clearly damaged by their experiences most were not.  For a short summary see https://hekint.org/2019/10/28/the-psychological-impact-of-facial-injury-in-the-first-world... A further analysis of this is currently in press.  So what the patients thought is already known.

The inclusion of photographs in my book was quite deliberate.  On the one hand it allows a better understanding of the development of techniques; on the other it is the only way to show what war can do - and also what surgeons can thereafter undo.

As for the question Sullivan asks about the Dominions and colonies: the surviving case files of the British Section number just over 2300, about half (the rest were destroyed in WW2); the New Zealand files 294, many of which latter are British soldiers with some overlap with the British Section and the Australian archives contain 345 files. The New Zealand Section files include several men of Maori heritage.  I have reconstructed the Canadian list from other sources, and there are 485 patients identifiable.  Within the British Section are one African, one Indian and one Chinese solder (and one Serb, one Russian, one Japanese - an airman - and a couple of civilians).  There was no specific discrimination and the makeup reflects the distribution of such men (there were relatively few on the Western Front in positions of risk) and the overwhelming preponderance of casualties from that theatre, from the navy and the air force.  One must remember that at that time social attitudes to race were very different and one must beware of judging yesterday by the standards of today.

 

Dr Andrew Bamji FRCP

Gillies Archivist, British Association of Plastic, Reconstructive and Aesthetic Surgeons