Dan Snow's History Hit - The Man Who Rebuilt the Faces of WW1

Episode Date: September 4, 2022

The mechanised warfare of the First World War brought unprecedented new levels of firepower and destruction to the battlefield and with it horrific new injuries. Advances in medicine also meant that soldiers were surviving injuries that previously would have been fatal. Many of these men were left with horrific, disfiguring facial injuries which carried with them not just a physical trauma but a social stigma as well. One man made it his mission to help them and in the process developed many of the techniques that formed the basis of plastic surgery as we know it today. Dr Lindsey Fitzharris joined Dan on stage at the Chalke Valley History Festival to talk about the extraordinary career of the pioneering plastic surgeon Harold Gillies. They discuss the realities of combat injuries, how Gillies established the first hospitals dedicated entirely to facial reconstruction and the profound impact he had on the lives of his patients.Warning: This episode contains discussions of surgery and battlefield injury.This episode was produced by Mariana Des Forges, the audio editor was Dougal Patmore.If you'd like to learn more, we have hundreds of history documentaries, ad-free podcasts and audiobooks at History Hit - subscribe to History Hit today!To download the History Hit app please go to the Android or Apple store.

Hi, buddy. Welcome to Dan Snow's History. A great episode for his day. Dr. Lindsay Fitzharris, you've heard her before on the podcast. She talked beautifully about the history of medicine, fascinatingly about the history of surgery, and how until so recently, if we put our lives in the hands of surgeons, we are frankly rolling the dice. They were fantastically incompetent. Well, that's changed, thank goodness. Science is a beautiful thing. And Dr. Fitzharris' work really helps us understand how medicine and science has evolved over the past 150 years. It's quite extraordinary. In this conversation with Lindsay, recorded at the Chalk Valley History Festival, so you may hear some festival goers, you may hear some wind, you may hear some flags flapping, you may hear the Victorian merry-go-round

popping away in the distance. But I want to bring you this conversation anyway because it's completely fascinating. We talked about the facemaker. We talked about the man who basically invented cosmetic surgery. And this was not, friends, for Instagram influencers who'll be surprised to know, this was for heroic men who were horrifically injured in the battles of the First World War. Medicine could now save them where previously they would have died a horrible lingering death. But their faces, in many many cases were grotesquely disfigured. This is the story of the man who helped put those faces back together and really

helped thousands of people to live out normal, happy, prosperous, fulfilled lives. When in previous conflicts they'd have been shunned by their families, by society, and they would not have been able to do so. This is a great story. Apologies if the audio is a bit ropey in parts, but we were in a tent. It's worth it though. Enjoy. So everybody, we're here to talk about a very remarkable surgeon. But first of all, Lindsay, surgeon. But first of all, Lindsay, tell me, on the outbreak of war in 1914, when someone had a horrific, disfiguring facial injury, on the outbreak of war, what kind of treatment might they expect and what kind of recovery could they look forward to? So yeah, that's a really good question. You might say that Harold Gillies is the grandfather of plastic surgery, but plastic

surgery certainly predated the First World War. In fact, the term plastic surgery was coined in 1798 by a French surgeon named Joseph Dussault. At the time, plastic meant something that you could shape or you could mold. So in this case, a patient's skin or soft tissue. But attempts at reconstructing an entire face really didn't happen until sort of the mid-19th century with the American Civil War. But there were some crucial differences in the Civil War and what ultimately happened in the First World War. The first was that in the Civil War, surgeons didn't really care what it looked like. They just were concerned with restoring function, making sure a patient can eat and can

speak. But they didn't go beyond that because they didn't understand germ theory yet, so infection rates could be quite high. For that story, You can see my first book, The Butchering Art, which is about germ theory and Victorian surgery. So they didn't care what it looked like. And also it just wasn't being done on a huge scale. By the end of the American Civil War, there were fewer than 40 plastic operations on record. Now, when you compare that to what happens in the First World War, where there's hundreds of thousands of men who need facial reconstruction, you can understand why it enters this modern era where new methods can be tried and tested and become standard into practice. And what kind of injuries, and I guess, are we seeing worse injuries because they're things that are survivable now due to other advances in

medicine? Right. Yeah, that's a good question, too. I mean, there were so many advances in artillery and weaponry during the First World War that a company of just 300 men in 1914 could deploy equivalent firepower as a 60,000-strong army during the Napoleonic War. So you see things like flamethrowers invented that belch forth fire that destroy everything in its place. You see the invention of tanks, which leave its crews susceptible to new kinds of injuries at this time. And of course, you have the invention of chemical weapons. Men were maimed. They were burned. They were gassed. Before the war was over, 280,000 men from France, Britain, and Germany alone suffered some form of facial trauma at this time.

So there was this enormous need for facial reconstruction. And that's where Harold Gilley steps into the scene. Tell me about him. He was a frontline medic, effectively. Yeah, he had volunteered with the Red Cross and he was New Zealand born, Cambridge educated. But what happens is he goes to France and he runs into this character named Charles Valladier. He is a French-American dentist. He's sort of bigger than life. He has a Rolls Royce that he retrofits with a dental chair, and he literally drives it to the front under a hail of bullets. This guy is a legend. He works for free the entire war, and it's really Valladier who shows a young Harold Gillies

this desperate need for facial reconstruction near the front. He also teaches Gillies this importance around dentistry when rebuilding a face. A lot of surgeons at this time wouldn't work with dentists, and so this becomes a very important aspect of what Gillies this importance around dentistry when rebuilding a face. A lot of surgeons at this time wouldn't work with dentists. And so this becomes a very important aspect of what Gillies is ultimately able to accomplish. These men were hidden from public. And I really think it's important that we look at their faces today and that we reckon with what war does to the human body, especially as we're seeing the return of old school warfare in Ukraine. And what are the techniques that are being pioneered at this time to help to reconstruct? We're not going to set up a tent. We do like a reenactment.

Gillies had no textbooks at this time, so he was really making a lot of this up. But there were some procedures that pre-existed. So there was a procedure where you take a flap and move it from the forehead to reconstruct a nose. So if you take a piece of string from the tip of your nose to the top of your forehead, you will find that your nose, the length of your nose is roughly the length of your forehead. So if you take a piece of tissue and you move it down over the nose, you will find that's a very effective way of reconstructing the nose. And what you do is you take the skin that's remaining and you stretch it over that area

to kind of cover it up. So some of these procedures existed. Rhinoplasty is a very old procedure. But of course, the extent of damage that these men were facing from World War I was extensive. And the technique that I find extraordinary is where you do that, but all the way up your arm or you can borrow bits of uninjured skin and tissue and kind of move it a long way up the body, can't you? That's right. So I'm going to show you a picture of William Vicarage. He was injured during the Battle of the Jutland. He was terribly burned and he becomes the first patient to receive what Gillies called a tubed pedicle. So if you think of plastic surgery, there's two things. There's grafts and there's flaps. Grafts are like the pastrami of plastic surgery. It's

like a thin piece of meat. And the flaps are like the stakes, okay? So it's a bigger piece of flesh and tissue. And you're mostly going to need flaps when you're missing noses and pieces of your face. So what would happen is when you move the flap, it would remain open on the back side. And so it could get infected. So what Gillies did was he would take that flap and he would roll it into a cylinder and he'd stitch it so all of the tissue inside was encased in skin. So it looked like an elephant's trunk. So if you take a flap from my thigh and you move it up here,

it will remain attached to its blood supply until it becomes attached to my abdomen. Then you're gonna sever it here. You're gonna flip that side up and up to my face and so forth and so on. So you could waltz these trunks of flesh and tissue up to the face in order to reconstruct it. And it was a miracle. This is before antibiotics and Gillies had to do all of this without any textbooks to guide him. So I always keep saying that because even spending five years researching, writing this book, it's still a miracle to me that he was able to do this. It is a miracle.

And how quickly was he recognized by the military medical authorities? And was he given resource and space and support to this? Because initially he must have been kind of developing it whilst being a normal emergency surgeon. Yeah, there was an element of that. So when he met Vladimir, the French guy who was with Rolls-Royce, he recognized that there was a need for a specialty unit back in Britain. So he went back to the war office and he petitioned for them to open this specialty unit. They weren't really convinced there was a need, but these were a lot of pencil pushers who weren't seeing the injuries that were happening and coming out of the trenches.

So they did grant him permission, but he knew that they weren't going to really push for this. So what he did was he went on onto the Strand in London. He got his own labels. He addressed them to himself. He sent them to the front. And very soon within weeks, all of these men were showing up at his specialty unit with little labels saying two Harold Gillies at the Cambridge Military Hospital in Aldershot. So he starts with a specialty unit. He gets overwhelmed by the number of men needing his help. And he eventually opens the specialty unit. He gets overwhelmed by the number of men needing his help. And he eventually opens the first ever hospital dedicated to facial reconstruction, which was the Queen's Hospital in Sidcup. Presumably these, you're not just healing the body, but you are

enabling people to go and have, be less judged by the extent of their very obvious injuries. I mean, there's a huge element to that going on. Yeah. I think, you know, there's a lot of facial bias at this time. I often say that this is 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 of these facial differences. I also want to say that I call these men disfigured, and it's even in the subtitle,

but I worked with a disability activist who has a facial disfigurement, and we talked about the language, because you might not say someone's disfigured today. You might say they have a facial difference, but it was important to me, and she also agreed, that these men were called disfigured because they were disfigured to the society they lived in. These men, when they left the hospital grounds, were forced to sit on blue benches so that the public knew not to look at them. This was an incredibly isolating experience. Some people probably have seen Boardwalk Empire,

and there's a fictional character named Richard Harrow who wears one of these tin masks. These mask makers offered non-surgical solutions to these men. But again, you have to remember that they were wearing the mask for you, not for them, because they were very uncomfortable. They didn't age. They were fragile. And for a were very uncomfortable, they didn't age, they were fragile, and for a lot of reasons, they didn't offer that long-term solution. They are amazing, they look so realistic,

and they were realistic to an extent, but if you were sitting across from someone wearing one of these masks, it doesn't operate like a face, so it could be very unsettling, and a lot of times, these men would wear these masks and their children would flee from them. It was so awful and so isolating. And that really can't be overstated here about what Gillies was able to ultimately do for these men in the end. We can also say arguably that Harold Gillies is also a product of those facial biases because he was going far beyond what needed

to be done to restore function, to make the face socially acceptable as well. I guess I want to just briefly return to the point we made. In the Napoleonic Wars, these people probably would have survived facial injuries like this. Yes. But many of the advances that you've traced in your previous book, which is brilliant, by the way, means that a little bit like in the war on terror, we'd have more triple amputees

because our trauma response is so good now. Yes. But that means we have this issue of how to... How to rehabilitate. It's a new field partly because of the advances in other fields as well, I guess. Yeah, absolutely. I mean, during the Napoleonic Wars, there were men who survived facial injuries, but a lot of times they were killed by their own comrades

because it was believed that they were sparing them from a fate worse than death. We now know that this is like a misplaced belief. Of course, this is ableism in action. But so strong was this nose. So it was related to morality. It was related to criminality. A lot of times, certain kinds of crimes, you would get your nose cut off, for instance, or there would be purposeful disfigurement. And that is still alive today. Think about how many Hollywood villains are disfigured today, right? Voldemort, you have Blofeld, you have Harvey Dent in Batman Becomes Evil after he is disfigured, the Joker. I mean, the list goes on and on. And so I still think that these facial biases are well

and alive today. And I would love to see these men as heroes in their own story because they were heroes in their own stories back then. Well, let's hear a little bit more about the men because what's so interesting in your book is you chart the journeys these men from the battlefield from the moment of being wounded right the way back, and just their sense of safety and happiness at being in a place that was set up for them in particular. It's amazing, but tell me about a couple of the journeys of the individuals you followed. The one story that I really like is Private Walter Ashworth. So Private Walter Ashworth was injured on the first day of the Battle of the Somme. If you don't know anything about World War I, you probably recognize the Battle of the Somme. It was a bloodbath. Of the hundred thousand

British soldiers who took place on the advance that day, 60,000 were killed or injured. Never before or since has a single army suffered such losses on a single day in a single battle. Now Private Ashworth was hit in the face at that time. He did survive and what happened was he fell forwards onto the battlefield. And he laid there for three days without a jaw, unable to scream for help. Three days. Now, you might ask yourself, how could you lay on a battlefield for three whole days? But when these stretcher bearers stepped onto the battlefield, they became targets themselves.

And they had to make life and death decisions about who was going to be taken off that field a face wound is very ghastly it looks like you can't survive it so a lot of times these men were left in the battlefield i should say the image is really really really troubling he has lost most of the bottom portion of his face and then you show the progression to his yes post-surgery and And it's completely extraordinary. It's the kind of thing you would expect today, let alone over 100 years ago. I mean, to go from the bullet went right through the side of the face and took off part of his jaw, lots of the tissue. His nose stays intact.

But it was horrible. Now, crucial to his survival that day was falling forward. A lot of times these men fell backwards or they were placed under their backs by well-meaning doctors and in doing so they ended up choking on their own blood or their tongue slipped back into their throat because they were missing certain anatomy and they suffocated. So he was very lucky. When he got to Harold Gilley's hospital, his fiance broke off their engagement. Unfortunately, this was not an uncommon experience for a lot of these men. engagement. Unfortunately, this was not an uncommon experience for a lot of these men. But his story has a bit of a good ending because the fiance's friend got wind of this and she thought this was terrible. And so she began writing Ashworth at the hospital and soon they fell in

love and soon they were married. But when Ashworth was discharged from the army, he went back to work as a tailor's assistant and his boss made him work at the back of the shop because he didn't want him to frighten the customers. So one of the themes of The Facemaker is that not all wounds are inflicted on the battlefield in the First World War. You listen to Dan Snow's History, we're talking about The Facemaker, more coming up. Hello everyone, James Rogers here, the host of the Warfare podcast by History Hit. I'm a war historian who works with the UN, NATO and governments around the world. Twice a week, every week, we bring you the defining wars of history

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Who were rarely the best of friends. Murder. Rebellions. And crusades Find out who we really were By subscribing to Gone Medieval from History Hit Wherever you get your podcasts Would there be bone reconstruction as well?

There would have been bone grafting. A lot of times, so they were taking bone and tissue always from the patient. So they weren't necessarily taking bone from animals or from other patients at this point. There was a little bit of that going on, but not that much. So everything to reconstruct Ashworth's face would have come from him. So they would have taken cartilage from the ribs. Sometimes they would take a chest flap and move it up over the face. My husband, Adrian Teal, is a cartoonist. He's actually one of the head cartoonists for Spinning Image. And thank goodness for him because he would read the case notes and he would draw it

out for me. It was really hard to visualize, you know, some of these case notes, but artists are very important to this story because actually Gillies brings artists into the hospital. They go into the operating theater with him. They draw out everything. And there's an artist named Henry Tonks who's very famous in his own right. And he actually paints portraits of these men. And they're so much more human than the photographs are. Did Gillies, he created an environment, he created a safe place

for these men. Was he thinking about the psychological wounds as much as the physical? He was always trying to lift their spirits. He would say, don't worry, Sonny, you'll have as good a face as any of us before I'm done with you. And he really bonded with these men. You have to remember that the trauma surgeons near the front, of course, they didn't often know the names of the soldiers. They were just trying to save lives, stop the hemorrhaging, and move on to the next soldier. Whereas Gillies was working with these men for years, sometimes even over a decade, and he really bonds with them. In fact, he had this alternative persona he called Dr. Scroggie, and he would dress up in this alternative persona at night, and he'd bring in champagne and oysters, and he would gamble with in this alternative persona at night and he'd bring in champagne and

oysters and he would gamble with the men. All the things that had been technically banned at the hospital he would allow them to do. So he was always trying to lift their spirits. The other psychological advantage of the Queens Hospital at SITCUP was everybody was disfigured. So if you were disfigured and you were sent to a general hospital, you might feel a little bit shy about participating in some of the sports events or other events that the hospital had. Whereas at the Queens Hospital, nobody had to feel shy or self-conscious because everybody had a facial wound. So they had sports days, as I said. They had art clubs. They taught the men how to barber, how to farm. They taught them languages. It was really a community. It was really a town that he built.

And I think in that sense, even if he wasn't thinking specifically about the psychological rehabilitation, he still was attending to that aspect of it. Did demand outstrips apply, though? Did he inspire similar setups, or was it just a huge waiting list to get in to see him? Well, yeah, I mean, it was good luck if you fell into his hands. Because as you say, 280,000 men from France, Britain and Germany. So there were other surgeons working on facial reconstruction. I talk about them in The Facemaker. There's a man named Jacques Joseph in Germany who's doing it. There's a French surgeon. But they tend to work solo, not with dental surgeons. So Gillies really works collaboratively.

He brings in x-ray technicians, artists, mask makers, dental surgeons, all kinds of people. And I think for that reason, he's able to achieve what he achieves because it is a collaborative effort working to rebuild these men's faces, whereas some of these other surgeons were just working alone and they weren't necessarily approaching the problem of rebuilding a face from many different angles, including creatively as well as scientifically. But there were many, many people who just had to go with the mask option. There were. I mean, Gillies hated the mask because they reminded him of the limitations of plastic surgery at that time. He still employed mask makers because if you think

about rebuilding a face, if it takes many years, the in-between while you're convalescing, you might still need the mask. So there's one man who would wear the mask when he'd go out into London on days out. And when he would come back to the hospital, he would hold up one, two, three, or four fingers to let Gillies know how many people had fainted or reacted negatively to his face when he took it off, if it got too hot. So remember, these masks are made out of metal. We've all just come out of a pandemic here. We've all know how even the mask that we wear can be very uncomfortable. So imagine wearing a metal mask over an injured face. It must have been really uncomfortable. You're reminding us all that the wounds sustained on the battlefield, 14 to 18, it's only the beginning of the gigantic trauma

that would have assaulted societies across the world. Yeah, absolutely. Deep into the 20s and 30s, beyond those scars and jewels. A lot of people ask me, is this book about the guinea pig club? Because a lot of people, especially in this country, are familiar with the guinea pigs. The guinea pig club was, they were operated on a surgeon named Archibald McIndoe. He was actually Harold Gillies' cousin. And it was Gillies who introduced him to the strange new art of plastic surgery. Archibald McAdoo operates on the burn pilots of World War II, and he becomes really famous.

And actually, he sort of eclipses Gilly's legacy in a way, because there's a lot more media during World War II, and there's the romance of the World War II pilots. But it really began on the battlefields of World War I. And so I tell people this is sort of the prequel to the guinea pig club. And we should say why were they called the guinea pig club? Because they were literally the guinea pigs they were being experimented on and in fact there's a letter a man wrote to Gillies and he said that it really got him upset that they were called the guinea pigs because the real guinea pigs he said were found on the battlefields of the first world war so a lot of that got I wouldn't say covered up, but it got forgotten during the Second World War. But it really does start during the First World War, that important work. Now that we've got the world's leading medical historian on this stage, can we talk

about the First World War and other medical advances? Because it is a time of extraordinary transformation in military equipment, tactics, everything, which we will part for the moment, but in medicine and emergency response. What else are we looking at? So you have the birth of plastic surgery and facial reconstruction. You also have advances in anesthesia at this time. So anesthesia hadn't really progressed since 1846 when ether had been discovered. So you're talking about chloroform with a rag over the face or a rudimentary mask with ether. Now, this is problematic for Gillies. In fact, there is a scene in The Facemaker where Gillies is bent over a patient and the patient is breathing ether back into Gillies' face and he's getting sleepy from it.

So this is a real problem. Also, putting a mask over a damaged face could be painful and difficult for other reasons. So what you have is parallel advances in anesthesia at this time. In fact, it is Gilley's anesthetist, Ivan McGill, who develops intertracheal anesthesia at the very end of the war, which is really important to the subspecialty of anesthesia. Okay. Intertracheal is? Yeah, through the trachea. It's right through the mid part of the throat. So again, you're not having to put the mask over the face necessarily. Remember again, too, when you put the mask over the face, it's obscuring the area that needs surgical attention. So you have basically the surgeon and anesthetist fighting over

this very small area that they need to work on. Which is also terribly damaged, yeah. Yeah, which is terribly damaged. I mean, it's crazy. Your book, your art book, and this book, but your book, your art book, because it's a civilian application, just made me so powerfully aware of two things. one is how unbelievably lucky we are to be alive today like yeah and the other is how recent like yeah the leaps and bounds that we've made we're talking

four generations like if you look at i don't know shipbuilding or transport that way proceeds medicine and our modern understanding of surgery is super recent yeah i mean we hit the ground running in the mid-19th century once we solve pain issues with anesthesia so what happens in the butchering art is it opens with this scene um the first ever operation under ether in 1846 in london robert liston the fastest knife in the west end he's there he's a real showman and it works anesthesia Anesthesia, it's a miracle. We've solved the age of pain. But the problem is that now surgeons are more willing to go deeper into the body, and they don't understand germ theory yet. So these operations become nothing more than slow-moving executions. So in steps Joseph Lister,

who you might recognize through Listerine. He didn't invent it, but it was named for him. And he ultimately solves that next problem. And those two things in combination allow us to make leaps and bounds in medicine. Because once you can control the pain and you understand germ theory and can control post-operative infection, you're off and running. So you're absolutely right. I mean, when you think about Gillies, I mean, someone came up to me earlier and wanted me to sign a book for a woman named Elizabeth, and she actually worked with Gillies. She was a nurse working with Gillies in his burns unit.

So it's not that many generations removed. And I love when plastic surgeons especially come up to me at events, and they know all about Sir Harold Gillies, and they want to talk to me about his instruments. There's something called the Gillies forceps, which are still used today in operating theaters. So it's amazing. It's not that long ago. I found it completely terrifying and a bit affirming. It is. I mean, there's hope in redemption in this book. It's a hard read in a lot of ways, and it was hard to write too. I don't pull any punches. I lean into the violence of World War I because I don't feel that I would be doing these men justice unless I was explaining what that was like to be in those trenches.

What did it feel like? You know, they would say that you could smell the front before you could see it. You know, that really paints a vivid picture of what this was like. And these men, sometimes so young, only 15 or 16 years old, were being sent into a war that they didn't understand. There's a story about this one 16-year-old boy, essentially, who goes to sign up. They said, do you want to stay for the duration of the war or for a year? And he said, well, I don't want to stay in the army for a year. I'll stay till the end of the war, because everybody thought it would be over within

weeks or months at the most. So they were thrown into this terrible situation within weeks or months at the most. So they were thrown into this terrible situation. They didn't understand the technology. A lot of them thought that they could pop their head up over the trench and dodge the machine gun bullets. And the facial injuries were extraordinary. Also, I have to add, they were not sent into the trenches with helmets at first. The helmets come about a year later. So they had very little protection. And again, it's that old and new warfare. You have horses still.

People have seen the stage play War Horse, and you know how important horses were in the First World War. But the horses were also causing facial injuries as well. So it was really a challenging time for everybody, especially doctors and nurses. So we've got the first surgery you mentioned, and aesthetics. What else is going on?

The other thing I talk about in the book is blood transfusions. So you get enormous advances in blood transfusions at the time. The first blood banks appear in empty shell casings near the front, which is extraordinary. But I have to say... Empty shell casings? Empty shell casings. That's where the first blood banks were. But I have to say that as affirming as this all is, and as wonderful as these advances are and continue to serve us today,

we have to remember that in the moment, they actually served to prolong the war. Because as doctors and nurses got better at patching these men up, they were being sent back to the front, they were feeding the war machine, and it was this vicious cycle. And so I think we really need to acknowledge that part,

especially as we're seeing the return of old school warfare in Europe, that these advances, they are wonderful and they do serve us long after, but they can be a double edged sword in the immediacy. Gilly's after war, his work's recognized, he's allowed to continue. Yeah, he's knighted a little bit later than he probably should have been. I think he should have been recognized. Well, we all recognize that. We're all waiting on our knighthoods. It was quite a long time after the war, and there was a delay in that knighthood. When he was finally knighted, so one of the issues with this book was coming up with a title. Titles are really hard, right, Dan?

They're the bane of a writer's existence. And so I couldn't come up with a title, and I couldn't come up with a title. And finally, I came across a letter written to Harold Gillies congratulating him on his knighthood, and it said, Dear Facemaker. And I thought, well, that's the perfect title for this. But I have to say that although it is called The Facemaker and it is about Harold Gillies, it is as much about these disfigured soldiers and giving their voices back to the story. So it's about one man and it's about many men. It's such a harrowing but amazing story. Ladies and gentlemen, that was Lindsay Fitzharris. Thank you very much.

Thank you. work out.