BOOKS INTERVIEW
INTERVIEW / LINDSEY FITZHARRIS
“This was a time when losing a limb made you a hero, but losing a face made you a monster” LINDSEY FITZHARRIS talks to Rhiannon Davies about her book on a pioneering
ON THE
plastic surgeon who rebuilt men’s shattered faces during the First World War
Rhiannon Davies: Your book focuses on Harold Gillies, a surgeon in the First World War who made huge strides in facial reconstruction surgery. But how far back in history can we trace plastic surgery?
Lindsey Fitzharris: It pre-dates the First World War, so I don’t want
anyone to think that Harold Gillies is the father of plastic surgery as a whole. The term “plastic surgery” was coined in 1798. At that time, plastic meant something that you could mould and shape – so in this instance, a patient’s skin or soft tissue. And attempts at early reconstruction of the face or to alter the appearance tended to focus on really small areas of the face. Rhinoplasty [reconstructing the nose] is one of the oldest surgical procedures on record, dating back to around 600 BC. It wasn’t until the American Civil War that there were attempts to reconstruct the entire face, and even then it was quite limited. How has facial disfigurement been viewed through history?
Disfigurement has been strongly associated with shame, because of its association with disease. Syphilis, which ravaged much of the world for centuries, caused “saddle nose”, where the nose would cave in. People associated syphilis – and the disfigurement it caused – with a moral failing. The other thing was that sometimes someone would be purposely disfigured as a form of punishment: people’s noses were injured purposefully for sexual transgressions such as prostitution or adultery. And this stigma really continues even to today. If you look at Hollywood movies a lot of villains are facially disfigured, like the Joker or the Phantom of the Opera, and that’s a really lazy trope to say that the person is evil or has some kind of moral failing. You write that there was a huge need for facial reconstruction during the First World War. Why was this?
The Facemaker by Lindsey Fitzharris (Allen Lane, 336 pages, £20)
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Trench warfare led to sky-high rates of facial injuries – many combatants were shot in the face simply because they had no idea what to expect. One surgeon wrote: “They seemed to think they could pop their heads up over a trench and move quickly enough to dodge the hail of machine-gun bullets.” Men were maimed, they were gassed, they were kicked in the face by horses. During the war, around 280,000 men from France, Britain and Germany alone suffered facial trauma.
This was a time when losing a limb made you a hero, but losing a face made you a monster to a society that was largely intolerant to facial differences. Whereas a prosthetic limb doesn’t necessarily need to look like the arm or leg it’s replacing, a face is an entirely different matter. Any surgeon willing to undertake the monumental task of reconstructing a soldier’s face at this time not only had to consider the loss of function such as the inability to eat or to swallow, but they also had to consider the aesthetic, so that the face was deemed socially acceptable. As a result, plastic surgery flourished during the First World War, and was eventually ushered into the modern era by men like Harold Gillies. How did Gillies first become involved in facial reconstruction?
Gillies was an ENT (ear, nose and throat) surgeon, and he volunteered to go over with the British Red Cross when the war broke out. He was introduced to facial reconstruction on the western front by a really amazing character called Charles Valadier. He was a French-American dentist who retrofitted his Rolls Royce with a dental chair and drove it to the front under a hail of bullets; I mean, he was an absolute legend. So Gillies went back to Britain and petitioned to open his own specialty facial reconstruction unit at the Cambridge Military Hospital in Aldershot, and that’s how it all began. Eventually he was so overwhelmed by the number of men needing his help that in 1917 he opened the Queen’s Hospital, which later became Queen Mary’s Hospital, in Sidcup – a hospital dedicated to facial reconstruction. What was unique about his approach to facial reconstruction?
Gillies wasn’t the only surgeon operating on faces in this period. There were people in other countries that were doing this – like Jacques Joseph, a Jewish-German surgeon working for the Germans – but they tended to work alone. They didn’t bring on, for instance, dental technicians, who were actually really key in facial reconstruction. Gillies was the opposite and recognised their importance from the start. He brought a dental surgeon called William Kelsey Fry into the Queen’s Hospital, and really worked in tandem with him. While they were reconstructing a patient’s jaw, for instance, Kelsey Fry would be working on aligning the teeth and the jaw and getting all of the prosthetics in place, and Gillies was working on the missing chunks from the face, and the soft tissues that were damaged. So it was really a team effort. What other professions did Gillies collaborate with?
He also brought in artists, photographers, radiographers and mask makers, building a wonderful creative team who all worked towards
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