The repeated and ciceronic phrase “the face is the mirror of the soul” can be responded to with countless objections. Vileness can come from a symmetrical face, a greenish look or rosy cheeks, just as the most endearing gestures of kindness can come from a broken nose, a pitted complexion or a jagged smile. Even so, there is no doubt that in the conjunction of all those facial characteristics lies our most basic identity, the deepest root of our being. There are those who would say that we are our actions, but also, and above all, we are fundamentally our face.
Cover of the Spanish edition of ‘The Reconstructor of Faces’. Illustration: Fernando de Vicente
And what would happen if, suddenly, our face jumped into the air?annihilating our identity but still, for some bad joke, keeping us alive? During the First World War, thousands of boys languished with their faces and identities destroyed in no man’s land, that bloody mud that separated the trenches of the opposing armies. In the field hospital, they looked with envy at their companions with mutilated legs and arms, but intact faces: they—they thought—would continue, at least, being who they were.
Lindsay Fitzharris (United States, 1982) is, in addition to being a television presenter and writer, a medical historian. In his last essay, The face reconstructor, which will be published in Spain on November 4 with the publishing house Captain Swing, takes a look at those four years of devastation, focusing on the health care received by those men with facial injuries.
To do this, Fitzharris focuses his sights on Harold Gilliesa New Zealand surgeon who before the conflict made a living in a private clinic in London. As many did, once the war broke out, he moved to French territory to offer his services in what was the first mechanized war in history.
mechanized warfare
Almost like a fordian production chainthat war was responsible for receiving enormous quantities of young people as raw material that was soon transformed into tattered creatures with astonishing speed and efficiency. Every time an officer’s whistle blew, tens of thousands of boys came out of their trenches and were subjected to the effects of destructive machinery never seen before. Very soon, military hospitals were overwhelmed by burned men, with their viscera in plain sight, without arms, without legs, or even without faces.
The ways that the military industry had to crush a man were, furthermore, very varied and fatally imaginative. A soldier could be burned by cordite – an explosive used to propel howitzers -, suffer from lung abrasion from chlorine thrown into the trenches, have his chin shattered by an explosive bullet, or be disemboweled by a bayonet blow. . All of this translated into the need for surgeons to seek urgent solutions to each of the types of wound, which required specific and personalized assistance.
During his year in France, Gillies encountered a harrowing repertoire of cases with diagnoses like he had never seen before. War engineering advanced by leaps and bounds, at a pace that medical sciences were incapable of keeping up with.
Their only hope was to resort to their imagination to find solutions to remedy the devastation that war caused in men’s bodies as if it were a meat grinder. Soon the surgeon became interested in victims of catastrophic facial injuries. Give them back the face they had lost It was, to a large extent, restoring something that had gone out inside the soldiers.
It was in his first year of war in France that Gillies encountered a series of health professionals who were beginning to develop revolutionary techniques to restore the facial structure of their patients. Not only surgeons, also dentists They proved to have an important role in reconstructing the faces of the soldiers. The problem, however, is that each of them acted in isolation, without the assistance of other experts in related health fields who could provide them with essential assistance.
Harold Gillies (second from left) in the operating room. Photo: Captain Swing
Realizing the progress of these men, but also the shortcomings of their method and the improvements he could add, he returned to England. There, he soon pulled a series of strings that allowed him to create the Cambridge Military Hospital from Aldershot, a town 60 kilometers from London. In that place, Gillies would take the first steps—giant steps, on the other hand—in the development of modern plastic surgery.
The modernization of plastic surgery
The first innovation that Gillies introduced and that he considered essential was in the composition of his team. Just as the professionals he had known carried out their work in an individualistic manner, he approached patient treatment from a multidisciplinary perspective. Otorhinolaryngologists, surgeons, dentists, sculptors and draftsmen They worked side by side in that hospital to try to give their devastated patients a second face that would make them forget, at least for a moment, that they once lost their first.
Another fundamental change was that of the very philosophy of his work. Until now, maxillofacial surgeons had had as their main objective to recover a minimally normal appearance so that the soldier could function in society without provoking the repudiation of a people that owed him a lot. Gillies, however, focused primarily on the functionality of the organs of the face.
“When planning a restoration,” wrote Gillies, The first thing to take into account is the functionand it is fortunate that the best aesthetic results are only obtained, as a general rule, when that has been restored.” In this way, the surgeon combined functionality and aesthetics.
But there is one more change that was decisive for the subsequent development of modern plastic surgery. As a prelude to his reconstructive work, Gillies used to approach the stretcher where his new patient was with a catalog under his arm. Then, he began to turn the pages before the surprised soldier, who saw before him a display of photographs of noses, eyes, lips and faces of all kinds. “What would you like to look like?”the surgeon asked him.
With this question, Gillies focused on the healing effect on mood and self-esteem that a change in appearance entails according to the patient’s will. Those men were destroyed at essential levels, not only in body but also in soul. Suddenly, their surgeon and savior approached them and gave them back the reins of their lives. For the first time, and after having been subjected to the cruelty of a war that was not their concern, they could decide what was going to happen to their bodies.
