'The Facemaker' profiles the British surgeon who treated WWI's disfigured soldiers

TERRY GROSS, HOST:

This is FRESH AIR. "The Facemaker" is one book title that's meant to be taken literally. In it, medical historian Lindsey Fitzharris describes the work of a pioneering plastic surgeon who reconstructed the faces of soldiers who'd suffered severe facial trauma during World War I. Our book critic, Maureen Corrigan, has a review.

MAUREEN CORRIGAN, BYLINE: There were no textbooks. That's the one detail amidst all the other revelations that Lindsay Fitzharris offers in "The Facemaker" that continues to take me aback. There were no textbooks for the British surgeon Harold Gillies to consult when he and his team were called upon to reconstruct the faces of some of the estimated 280,000 men who suffered facial trauma during World War I. Those soldiers' faces were shattered and burned by the new technologies that that war ushered in - machine guns, chemical weapons, flamethrowers, shells and hot chunks of shrapnel from explosives. As one battlefield nurse said, the science of healing stood baffled before the science of destroying. In "The Facemaker," Fitzharris, a historian of science and medicine, has written a riveting, old-fashioned, man-meets-the-moment account of Gillies' work in the field of plastic surgery before plastic surgery as a field officially existed. As Fitzharris acknowledges, procedures such as the correction of cleft palate and ear pinning had been performed well before World War I. And some rudimentary plastic operations involving skin grafts and rubber prostheses were conducted on soldiers whose faces were damaged in the American Civil War. But the wreckage the military technology of World War I inflicted on human bodies was different in kind and degree. As Fitzharris says, physical injuries were only part of the grievous wounds these men endured.

Unlike amputees, men whose facial features were disfigured were not necessarily celebrated as heroes. Whereas a missing leg might elicit sympathy and respect, a damaged face often caused feelings of revulsion and disgust. In France, they were called the broken faces. While in Germany, they were commonly described as twisted faces. In Britain, they were known simply as the loneliest of Tommies - the most tragic of all war victims, strangers to themselves. Gillies, who was in his early 30s at the beginning of the war, initially volunteered as a battlefield surgeon. What he witnessed in France and Belgium, including the work of dental surgeons who were ministering to men with missing jaws and obliterated noses, prompted him to set up first a hospital ward and, eventually, an entire military hospital in England dedicated exclusively to facial reconstruction. Upon the opening of that first site, Cambridge Military Hospital, casualties began pouring in, some with labels indicating name, type of wound and whether they had received an anti-tetanus injection. Many, however, bore labels that simply read GOK - God only knows. Gillies was a pioneer not only in plastic surgery, but in assembling a multi-disciplinary team of surgeons, dentists, artists, anesthesiologists, sculptors and photographers. This team was these broken soldier's last best hope.

There's an inherent danger of sensationalism in the subject of gruesome facial injuries. But Fitzharris is a pretty straightforward writer, relying on letters, reports and newspaper accounts to give vivid immediacy to the patients' ordeals. Gillies, who seems to have been universally hailed as a kind, even fun-loving doctor, would greet newly admitted patients with what became his trademark words of reassurance. Don't worry, sonny, you'll be all right and have as good a face as most of us before we're finished with you. Fitzharris describes how before each major operation, Gillies would sequester himself in his office, obsessively reviewing his plan for a patient's face and smoking nonstop. Once in the operating room, Gillies and his team might have to excise thick scar tissue and maybe take skin flaps from a patient's cheek and chin to construct a new top lip. Sometimes, an entire face would be drawn on a patient's chest and transplanted whole. As Gillies was perfecting his techniques through trial and error, inevitably, procedures failed. Noses collapsed. Skin grafts didn't take. When the soldiers' wounds were too severe for surgery, the artists stepped in, surveying pre-war photographs to craft lifelike masks out of painted metal. The horrible irony was that many of Gillies' recovered patients would be sent back to the front, fodder for the war machine. In "The Facemaker," Fitzharris includes a few before-and-after photographs of Gillies' patients. It's impossible to look at these side-by-side photos of their faces without feeling first ashamed and then awed by what we humans are capable of doing to and for each other.

GROSS: Maureen Corrigan is a professor of literature at Georgetown University. She reviewed "The Facemaker" by Lindsey Fitzharris. Tomorrow on FRESH AIR, we'll talk about some of the latest developments in the January 6 investigations by the Justice Department and the House select committee, and look ahead to the committee's first public hearing. Our guest will be Luke Broadwater, who covers Congress for The New York Times and has been reporting on the latest revelations. I hope you'll join us.

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GROSS: FRESH AIR's executive producer is Danny Miller. Our senior producer today is Roberta Shorrock. Our technical director and engineer is Audrey Bentham. Our interviews and reviews are produced and edited by Amy Salit, Phyllis Myers, Sam Briger, Lauren Krenzel, Heidi Saman, Therese Madden, Ann Marie Baldonado, Seth Kelley and Joel Wolfram. Our digital media producer is Molly Seavy-Nesper. Thea Chaloner directed today's show. I'm Terry Gross.

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