It is said that war stimulates progress in many fields, and technology is often cited as the prime example. In order to kill more efficiently, new weapons are developed at a speed undreamt of in peace time. Tanks, of course, were the novel machines of the First World War, but machine guns and various gases, though not invented between 1914 and 1918, became the iconic weapons of the trenches. Aeroplanes hardly existed before the war; by the end, strategists were drawing up plans for mass bombing of other continents.
All this inevitably meant soldiers, sailors, and airmen were dying in previously unimaginable numbers, and being injured in similar quantities, placing a responsibility on the armed forces for which they were totally unprepared. In fairness, no one was prepared. No one dreamt of the sheer numbers of casualties, and unknown thousands died for the want of some fairly simple care.
As the war progressed, the provision of medical care did improve, though it was always playing catchup. This book follows one strand of that care. That available for men with facial injuries. At the beginning, there was little anyone could do for them. They were generally hidden away, prevented from mixing with the population at home for fear of the effect on morale.
But a number of doctors and surgeons were working, with very limited means, to help these men. This book concentrates on one of them. Harold Gillies. A New Zealander, he arrived at the front, and was horrified by his experiences and by the general lack of adequate facilities and knowledge. He was eventually drawn to those with terrible facial injuries, now far more common because of the effects of new weaponry.
Returning to England, he slowly built up the first hospital dedicated to facial surgery and brought around him a dedicated group of doctors and nurses. Together, they developed new techniques of plastic surgery, and turned the lives of many men around.
This is not a biography of Gillies, nor a complete history of the First World War, nor a history of plastic surgery. But it is a gripping account of the lives of many shattered men, and how Gillies and his team tried to help them get their identities and lives back from the horror inflicted on them by war.
Their efforts were not always successful. Many men died during the process. This was an age before antibiotics, and many lives were lost that would have been saved less then twenty years later. Gillies and his team had no text books to refer to. There were a few pioneers before the war who he was able to refer to, but most of his and his colleagues work was a step into the unknown. Sometimes it failed, but more often it was at least partially successful, and they slowly moved forward.
A remarkable feature of his work was that he actively included artists and photographers in his team. Firstly to show the men what progress they had made. Some would have many operations – up to thirty – before Gillies was happy, and they often looked worse before they got better. Secondly for medical progress and records, so other doctors and surgeons could learn from these new techniques.
Some of these pictures are in the book, and the author says she thought long and hard before including them. She was right to do so. They are hard to look at, and you wonder how any of the men lived through the injuries and wounds they suffered. But they are compelling at the same time, a testimony to Gillies desire to do something for these men who had no other hope.
His pioneering work really laid the foundations of future plastic surgery, although as the author does point out, there were surgeons working in other countries carrying out similar work on their own shattered troops.
The story of Gillies is smoothly intertwined with the pertinent events of the war, and the other doctors, dentists, and surgeons he worked with (or occasionally fell out with). He comes across as a driven, determined man, passionately trying to do his best. I got the feeling he may never have been fully satisfied with his own work.
Apart from one or two occasions where a surgical procedure had me floundering, and I had to re-read a passage two or three times, the book is beautifully written for the non-medical reader. It flows well, and as we follow each soldier whose shattered face is rebuilt, their story is told in a compassionate but candid way. Their pain and suffering can only be imagined, both from the original injury, and that of the surgery in days when anaesthesia was still very poorly understood.
This is a moving work, telling the story of men whose lives would never be the same, even if Gillies managed to work wonders, by the standards of the times. Most of the men he operated on were forever grateful to him for restoring their identity, for those with facial deformities are often shunned by society, even today.
This is a review of the Allen Lane 2022 hardback edition.
