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

You will sure learn some new ways humans are capable of inflicting injury on each other. It's very matter-of-fact and detailed when it comes to war injuries, while at the same time it isn't all cold medical facts. Great care was taken in presenting the stories of those disfigured by war, both the medical side and the human side. Highly recommended for those who want to learn more about this aspect of history.
The book begins with a short history of WWI itself, medical care in the army, as well as the histories of Harold Gilles and the other doctors developing plastic surgery techniques. I was disgusted and yet not surprised about the fact that the army stopped employing dentists once munitions had evolved so that soldiers no longer show more needed to rip open cartridges with their teeth. I liked that some time was spent covering women who, while not plastic surgeons, contributed to helping disfigured soldiers by creating life-like full-face masks. So interesting! 
There are some amazing tales of hope and ingenuity in this book. Some of these injuries I couldn't begin to think how they might repair, and yet they managed success in both cosmetic and quality of life repairs. It's hard to think that some of these soldiers were unable to eat, had difficulty keeping their airway clear, and in some cases couldn't even close their eyes. While thinking of the reality is harrowing, and not all cases end well, it makes me appreciate the team who was working hard through the war to solve these issues.  
I also appreciated the epilogue, about the continuing work of Harold Gillies in the field of plastic surgery. I was surprised to learn he was the first surgeon to perform a phalloplasty for a trans man in 1949! 
The audiobook narration was engaging, with just the right mix of factual reporting and emotional acknowledgement.  show less

A well-written account of this corner of medical history, blending the medical innovations (explained well in layman's terms) with the stories of the wounded and how war, and medicine, changed their lives. I didn't find it gruesome but am not very squeamish; it has many descriptions (never sensationalist, but dreadful in their plainness) of terrible injuries and the surgeries required to help. Fitzharris reveals something of the surgeons who pioneered this work, and the nurses and doctors tirelessly supporting them, and gives us a glimpse of how hard it must have been for them all. Moreover, rather than limiting herself to the biology, she takes care to highlight - as Gilles the surgeon and his companions did - the impact of injury and show more deformity on each person's psyche. Appearance is part of self-image, and also greatly affects how others treat us, and we see both aspects in both good and tragic lights throughout this book. Hopeless men have their spirits renewed by caring treatment, but we hear about the widespread shunning of those with facial injuries and how this treatment further damaged them. From here, the transition to an account of Gilles' other pioneering work, the first phalloplasty, and the care with which he approached his patient's need and provided appropriate treatment, is natural.

The book does not discuss politics at all, even war, beyond a very brief account of how the war started and a few mentions of domestic matters that directly relate to the establishment and running of the medical services. Nevertheless, simply as a witness to the utter pointlessness of all this human suffering - with acts of heroic life-saving and incredibly medical breakthroughs as a foil - it really drives home what a monumental folly the war was, and every war continues to be. show less

Excellent addition to WWI literature. The French called them gueules cassees - "broken faces." The industrialized weaponry of this war caused appalling injuries of all kinds, all the more dangerous for the filth of the trenches, wounds embedded with shredded uniforms, the absence of antibiotics or expertise in anesthesia or pain management, and the sheer numbers of afflicted men, delaying their care. While the loss of a limb might elicit sympathy, the terrible facial damage suffered by many caused visceral reactions of horror in the people who saw them and psychological traumas for the men who had lost the most visible manifestation of who they were: their faces. Eyes, noses, cheeks, lips, jaws were simply gone, torn away by bullets and show more shrapnel. Field hospital patch-up jobs left faces twisted, distorted, infected, scarred, unable to heal.

The Facemaker was Harold Gillies, a jovial, driven surgeon with a side line in amateur golf tournaments, who dedicated those years to caring for these men. In an age where "plastic surgery" wasn't even a widely-used phrase, he quickly understood just how complicated facial surgery was - delicate, highly vascular tissues in intricate layers of epithelium, dermis, and mucous membranes, with bony and cartilaginous structures underneath, that simply could not be stitched up like a lacerated leg. These men needed to be able to eat, to swallow, to breathe. There were few surgeons who even tried this type of work - several of them who did were dentists, who at least understood the architecture of the lower face. Gillies plunged in, experimenting, inventing, nursing along his patients, greeting new ones with a cheery: "Don't worry, sonny, you'll be all right and have as good as face as most of us before we're finished with you." He convinced military authorities to establish hospitals specifically for facial injuries, where patients could get the most rigorous specialized care - and where they were not outliers of deformity among less dramatically injured men. He hand-wrote labels to be sent to the front, instructing field staff to tag soldiers with facial injuries to be sent directly to him. He pioneered techniques of skin grafts, flaps and tubed pedicles that are standard procedures to this day. A fascinating aside is the work of a number of artists who worked alongside - notably, Henry Tonks, who created detailed drawings of these ravaged faces, to document their presentation, intermediate progress, and final results. There were women sculptors who created delicate masks of thin metal, replicating the men's original faces, to be worn over injuries that were impossible to repair - one of them was Kathleen Scott, widow of explorer Robert Falcon Scott.

Briskly written, impressively researched, Fitzharris's book also profiles a number of the patients themselves through their diaries, letters, memoirs, and family interviews. Their courage, tenacity and sometimes tragedy is deeply moving. Readers should note that the illustrations include a number of carefully chosen photographs of these men that are very difficult to look at, but in this context feel necessary to fully tell their stories.

Some years back, on a trip to London, I was able to visit the library of the Royal College of Surgeons. Serendipitously, they had a wondrous exhibit of Tonks's original drawings. This book is a terrific addition to the tragic and significant history of the Great War, its soldiers, its surgeons, and the history of medicine. show less

This is a fantastic book, describing the work of the New Zealand doctor, Harold Gillies, who pioneered plastic surgery on the faces of soldiers in Britain during the Great War. The author does a very good job detailing the people around Harold Gillies as well as Gillies himself, and the strides he made to give these massively wounded soldiers back their faces and their sense of self. It is an aspect of the Great War that I had not considered and I am very glad I took a chance on this book.

One thing I will mention here is that this book is not for the squeamish. There are pictures of some of the men Dr. Gillies treated; I am not sure if the descriptions of the men's wounded faces are more disturbing than the actual pictures.

Fitzharris show more describes the lethal combination of high-explosive shells and the bacteria-rich farmlands where many of the first battles were fought, such as the Second Battle of Ypres. Anesthesia was in its infancy, germ theory was often discounted, and the battlefield surgeons would often stitch together a face torn apart by a shell in an effort to stem the immediate blood loss.

When the soldiers finally came to Queen's Hospital, Sidcup, their battlefield wounds had nearly healed, forcing the surgical team to re-open the wound before beginning the multiple procedures of re-building a face. Dr. Gillies one of the pioneers of a technique called a pedicule to re-construct cartilage that would become part of a nose. He was among the plastic surgeons who used dentists to help re-create jaws, and even had the artist Henry Tonks on staff create sketches of the soldiers' faces to both help plan the surgeries and to document the progress of re-building their faces.

There soldiers with the most detailed steps of their plastic surgery are the ones who have pictures in this book. Private R.W.D. Seymour, injured on the first day of the Battle of the Somme, eventually became Gillies' private chauffeur. And pages from the diary of Percy Clare give a personal look at fighting in the trenches, to his rescue off of the battlefield, to the field hospitals, and finally to life at Queen's Hospital as a patient. show less

THE FACEMAKER is an impressive, intense, and fact-packed book, not only about the development of plastic surgery, but also an insight into World War One and its devastating effects. I admit my understanding of the war was negligible prior to reading this, but now I have learned enough to have my interest piqued and I want to learn more. I have just requested a review copy of MEN OF 18 IN 1918 by Frederick James Hodges, a book that I would have certainly passed over if I had not read THE FACEMAKER.

Dr Harold Gillies is the titular surgeon who is constantly creating new ways to help disfigured soldiers (warning! Link leads to extremely graphic photos that may be disturbing) live normal lives. It is noted that those who had lost limbs were show more celebrated as heroes fighting for their country, while those who sustained facial injuries were shunned and considered freaks. The reasoning behind this is: faces and their ability to create expressions are what makes us “human”, and any deviation of what is considered “normal” creates discomfort. A face without a nose, or with a shattered jaw is difficult to look at, and so those poor soldiers were hidden away from the general public. The wards where those men were kept contained no mirrors, lest they catch a glimpse of themselves and lose the will to live.

Gillies is not the only doctor mentioned in this book; many other courageous surgeons contributed to the effort to repair these poor soldiers. The book is interspersed with descriptions of action on the Western Front, excerpts from diary entries from the soldiers that were lucky enough to have their journals survive (even if they didn’t), and accounts of how collaboration among the doctors furthered their knowledge and experience.

What fascinated me the most was hearing about the soldier’s activity on the battlefield, how he came to be injured, then his ordeal with Dr Gillies, enduring multiple operations while new techniques were tried time and time again. The book does contain a lot of graphic detail, so if you are squeamish, be aware.

I learned about artwork bringing attention to the soldier’s plight – one of the more poignant ones is the painting by John Singer Sargent entitled Gassed. The human cost of war is depicted in this 21-foot-long epic work. Other paintings and drawings are noted throughout the book, explaining how these methods helped the physicians rebuild faces. Sculpture was also used; multiple casts were made as the recreation and correction of each visage progressed.

The epilogue of THE FACEMAKER notes how plastic surgery evolved from a necessity to a luxury; rhinoplasty, facelifts, and the like were performed by Gillies long after the war was over. He continued to help others feel better about themselves until he died in 1960. He was a true visionary whose work ethic and kindness made the world a better place for many, many others. show less

The story of the pioneering work done to rebuild the shattered faces of wounded soldiers could have been played for the gore aspects and shock value. Thankfully this is the opposite, taking a factual, sympathetic, and respectful tone that doesn’t shy away from the suffering, while always having a thread of hope.

While the discussions on surgical techniques and medical advances are fascinating, the heart of the narrative is the human ones from both the medical teams to the patients themselves.

A wonderfully balanced, fascinating, and engaging read.

What a fascinating history! I'm rather glad that I do not have a vivid, detailed imagination when reading, or some (many) of the descriptions of the injuries would have been too much to bear. Fitzharris is compassionate towards her subjects and sticks to minimal description, but facts of the patients Gillies worked with are what they are. Severe cordite burns or the traumatic injury from shrapnel to the face are simply horrifying.

The story of Gillies and his plastic surgery innovations (and, occasionally, failures) are interspersed with related details about the war, other people who attempted similar efforts for the soldiers or who worked with Gillies (dentists, artists, etc), and about life for the residents of the hospitals at show more Aldershot and Sidcup.

Overall, a really great, engaging history that gives me more appreciation for the field of plastic surgery (reconstructive and cosmetic!). show less