The Facemaker

The guns fell silent on the Western Front at 11 a.m., November 11, 1918, hours after German representatives signed a peace treaty.

Days later Australian violinist Daisy Kennedy was celebrating in Mayfair, an affluent area in London’s West End, and became absorbed in a conversation with the handsome young officer sitting next to her - a veteran of fighting on the Western Front, and, during the conversation, Daisy mentioned New Zealander Harold Gillies, a fellow Antipodean – person from Australia or New Zealand, whose work was renowned the world over.

“You couldn’t pay me a greater compliment,” replied the soldier, who seemed to have escaped the war unscathed and unscared.

Confused and startled at the idea that she might be speaking with one of the world’s most famous surgeons, Kennedy responded, “But you are not Major Gillies?”

The young man with the flawless face responded, “No, I was one of his patients.”

Ms. Kennedy’s response: “I was so moved that I couldn’t speak. His face bore no sign of ever having been under a surgeon’s hand.”

_____

As important as it is, author Lindsey Fitzharris’s The Facemaker: A Visionary Surgeon’s Battle to Mend the Disfigured Soldiers of World War I is not for the fainthearted. With a 2009 Ph.D. from the University of Oxford in the History of Science, Medicine & Technology, she makes trench warfare, cluster bombs, suffocating mud and the 141 days long Battle of Somme almost too real to keep reading. 

July 1, 1916, the first day of the deadliest battle in the history of the Empire, saw 57,470 British casualties, including 19,240 deaths; the French Sixth Army had 1,590 casualties, and the German 2nd Army suffered 10,000 – 12,000 loses. More than three-million fought in the Battle of Somme, and one million were killed or wounded in what has been ranked as one of the deadliest battles in history. 

From the moment that the first machine gun rang out over the Western Front, one thing was clear: Europe’s military technology had wildly surpassed its medical capabilities. Bullets tore through the air at terrifying speeds. Shells and mortar bombs exploded with a force that flung men around the battlefield like rag dolls. Ammunition containing magnesium fuses ignited when lodged in flesh. And a new threat, in the form of hot chunks of shrapnel, often covered in bacteria-laden mud, wrought terrible injuries on its victims. Bodies were battered, gouged, and hacked, but wounds to the face could be especially traumatic. Noses were blown off, jaws were shattered, tongues were torn out, and eyeballs were dislodged. In some cases, entire faces were obliterated. In the words of one battlefield nurse, over ‘T]he science of healing stood baffled before the science of destroying.’

“The nature of trench warfare led to high rates of facial injuries. Many combatants were shot in the face simply because they’d had no idea what to expect. “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,” wrote one surgeon. Others, like Clare, sustained their injuries as they advanced across the battlefield. Men were maimed, burned, and gassed. Some were even kicked in the face by horses. Before the war was over, 280,000 men from France, Germany, and Britain alone would suffer some form of facial trauma. In addition to causing death and dismemberment, the war was also an efficient machine for producing millions of walking wounded.

After brief periods observing the French-American dentist Auguste Charles Valadier, who was developing primitive ways of repairing jaws, and Hippolyte Morestin, the Frendh surgeon known as “The Father of  Mouths” for his work in oral and mamaxillofacial surgery, Gillies convinced British army officials to establish a facial injury ward at the Cambridge Military Hospital and developed a tagging fsystem by which injured soldier on the battlefield  could be identified and transferred to the Cambridge Military Hospital, Aldershot, and, eventually Queen Mary’s Hospital, Sidcup, which grew to 1,000 beds and special wards for pre- and post-op patients and facilities in which wounded soldier could convalesce over long periods between multiple surgeries. 

In over 11,000 operations on more than 5,000 men – mostly soldiers with profound facial injuries, Gillies and his skilled, multi-discipline team 

Working with artists, sculptures, dentists and an ever-expanding team of medical specialists, Gillies developed successful techniques of skin-grafting and nose, eye socket, cheek and neck reconstruction and, ultimately, essentially almost-full facial replacement, while battling the infections that resulted from mud and trench warfare. 

Knighted in 1930 by King George V, Dr. Gillies, continued  yo serve facially wounded British military through World War II and is considered a “Facemaker” and the father of modern plastic surgery.

“Men [who] save life never get the same appreciation and reward as those whose business it is to destroy it.” Quipped St. William Arbuthnot Lane, who had been instrumental in helping establish the Quen’s  Hospital.

Harold Gillies saved and changed men’s lives!

Consider Lindsey Fitzharriss’s insights into the effects of wartime facial injuries:

Between eight and ten million soldiers died during the war, and over twice as many were wounded, often seriously. Many survived, only to be sent back into battle. Others were sent home with lasting disabilities. Those who sustained facial injuries…presented some of the greatest challenges to frontline medicine.

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 newspapers of the time, maxillofacial wounds—injuries to the face and jaw—were portrayed as the worst of the worst, reflecting long-held prejudices against those with facial differences. The Manchester Evening Chronicle wrote that the disfigured soldier “knows that he can turn on to grieving relatives or to wondering, inquisitive strangers only a more or less repulsive mask where there was once a handsome or welcome face.” Indeed, the historian Joanna Bourke has shown that “very severe facial disfigurement” was among the few injuries that the British War Office believed warranted a full pension, along with loss of multiple limbs, total paralysis, and “lunacy”—or shell shock, the mental disorder suffered by war-traumatized soldiers.

It’s not surprising that disfigured soldiers were viewed differently from their comrades who sustained other types of injuries. For centuries, a marked face was interpreted as an outward sign of moral or intellectual degeneracy. People often associated facial irregularities with the devastating effects of disease, such as leprosy or syphilis, or with corporal punishment, wickedness, and sin. In fact, disfigurement carried with it such a stigma that French combatants who sustained such wounds during the Napoleonic Wars were sometimes killed by their comrades, who justified their actions with the rationalization that they were sparing these injured men from further misery.

Disfigured soldiers often suffered self-imposed isolation from society following their return from war. The abrupt transformation from “typical” to “disfigured” was not only a shock to the patient, but also to his friends and family….

One man recalled the time a doctor refused to look at him due to the severity of his wounds. He later remarked, “I supposed he [the doctor] thought it was only a matter of a few hours then I would pass out of existence.” These reactions by outsiders could be painful. Robert Tait McKenzie, an inspector of convalescent hospitals for the Royal Army Medical Corps during the war, wrote that disfigured soldiers often became “victims of despondency, of melancholia, leading, in some cases, even to suicide.

Sir William Arbuthnot Lane, who had been instrumental in helping Gillies establish the Queen’s Hospital. “[T]o my amazement, such monetary and titular awards were allotted only to … the fighting generals,” Lane complained. “Men [who] save life never get the same appreciation and reward as those whose business it is to destroy it.”

But why do we write about Dr. Harold Gillies almost sixty-two years after his death?

Because of Michael Dillion and Roberta Cowell.

Born Laura Maud Dillon in 1915 and with female genitalia, Michael (as he would later be known) approached Gillies as the war was ending and recounted that when he was seven-years-old a family friend joked that she would take him to the blacksmith to be made into a boy. “I had taken her seriously in my delight and excitement only to be reduce to tears when I found that such a thing could not be after all,” he wrote.

More comfortable in men’s clothes, Dillon graduated from the women’s St. Anne’s College, Oxford and was president of the Oxford Women’s Boat (rowing) Club. In 1939, Dillion secured a prescription for testosterone but was “outed” by a psychiatrist whom he was required to consult to receive the prescription and fled to Bristol, where he passed as a male garage worker. After a double mastectomy, he was able to legally change his name – to Lawrence Michael – and his birth certificate. Between 1946 and 1949 and using an exaggerated diagnosis, Dr. Gillies performed at least thirteen surgeries on Dillon, who completed medical school and was qualified as a physician in 1951 and spent six years at sea as a naval physician. In 1956, questions about his aristocratic heritage and title to a baronetcy caused him to leave England and pursue studies in Buddhism in India, where he died in 1962, aged 47.

Roberta Cowell was born Robert Marshall Cowell in 1918 and was commissioned in the Royal Army Service Corps as a second lieutenant in 1940, completed RAF flight training and was shot down over Germany in October 1944 and spent the closing months of the war in a prisoner of war camp, where she described killing the camps cats and eating them raw because of hunger.

In 1948, working with a Freudian psychiatrist, Cowell began to deal with the “feminine side of my nature, which all my life I had known of and severely repressed, [and] was very much more fundamental and deep rooted than I had supposed.” In 1950, Cowell met Dr. Michael Dillion, the first transsexual man to have a phalloplasty. In May 1951, Dr. Gillies performed vaginoplasty surgery – then an entirely new procedure - and she changed the name on her birth certificate. Cowell died on October 11, 2011; her obituary was published in The New York Times on June 5, 2020 – almost nine years later.

It's History.

The very first male-to-female and female-to-male surgeries were performed more than seventy years ago by one of History’s most important surgeons. 

In the run-up to the 2022 and 2024 elections, issues of sexual orientation and identity, “grooming,” team sports and which bathrooms kids can use will become hot button items with politicians who will claim that transsexuality is “simply a fad.”

A double mastectomy and at least thirteen surgeries is not a fade!

The stories – now more than seventy years old - of Dr. Michael Dillion, racecar driver, fighter pilot and prisoner of war Roberta Cowell and Dr. Harold Gillies put the lie to such claims.

If you hear a politician use the word “fad,” think LIAR – it almost sounds like LOSER!