The First World War left an indelible mark on the psyche of mankind. However, for those who were mutilated by the front, facing home was a trial upon itself.
Being a soldier has never been an undivided joy, but WWI changed a lot in how you were doing your job. First of all, of course, there were all the new methods invented to kill you. Trench warfare, artillery, tanks, machine guns, poisonous gas and later even fighter planes. Dying now happened on a massive scale, but more and more men were also surviving ‘going over the top’. Granted, they had half their faces ripped off, but at least they were alive. At the beginning of the war, nothing could be done to help these guys. If they managed to breathe without a nose or eat without a neck, they hid inside, and if they had to show themselves in public it was with a mask or wrapped in bits of cloth. Not only were they ashamed of their appearance, but they were also told that confronting the community with their wounds would be bad for morale and therefore unacceptable.
When the war started in 1914, Harold Gillies was in England. He had been born in Dunedin, New Zealand, but finished his medical training in Cambridge a few years before. He had worked in hospitals for a bit, but was still looking for his niche when the Great War broke out. Trying to evade conscription, he volunteered for the Red Cross and went to France, to work in a field clinic. There he met a French-American dentist, Auguste Valadier, who had just established a face and jaw unit in a converted sugar store. Here he was trying to do something about the injuries that bullet wounds had inflicted on faces and jaws. Gillies was fascinated. Plastic surgery didn’t exist yet and he had never seen anything like it.
For a few months, he helped Valadier out, learning what he could, and experimenting with skin grafts himself. Then he went to Paris, to meet Valadier’s mentor, Hippolyte Morestin. Morestin was by this time working to sew back mouths of soldiers, by trying to cut and roll skin from his patients’ jaws onto the wound to get the skin to regrow. Gillies, by this time one of the main medicos at the British General Hospital in Rouen, was very impressed. Back in Britain, he started doing plastic surgery at the military hospital at Aldershot. In 1915 and 1916 he and his colleagues operated on thousands and thousands of men. In the first ten days of the Battle of the Somme alone, 2000 severely wounded were brought to their 500-bed clinic.
Overwhelmed, Gillies pressed the military powers-that-be for a specialized plastic surgery hospital, and this opened in Sidcup in 1917. The place was Frognal House, the birthplace of Thomas Townshend, the man we know as Lord Sydney. Here Gillies quickly started to set up the best facility he could think of. Because nobody had done anything like this before, he made it up as he went along. First of all, with Morestin’s experiments in mind, he invented a whole new way of treating people. Most of his patients had horrific wounds in their face and antibiotics had not been invented yet. Trying to graft skin in the ‘normal’ way would be, Gillies thought, a recipe for infection and death. So he implanted rib cartilage in people’s foreheads and then took skin from elsewhere, that he sewed close to the place where it was needed. His innovation was to leave the flap in place in two places until it had healed and grown at its destination. It was called a ‘forehead flap’ and sometimes men had to walk around for six months like this. Then the next stage of the surgery could take place, rolling the flap to construct the new nose, mouth, jaw, or whatever else had been blown off. Often, the whole process would take two, three years.
Plaster casts of a patient’s face were taken, from which a facial reconstruction was made. A mask was then made, fitted to the injured man and painted a skin colour.
In the meantime, Gillies did everything he could to protect his patients from the outside world. He held special meetings in Sidcup, teaching the villagers how to deal in a kind way with the men. There were distinct blue benches in town, where the soldiers could sit in peace and quiet. Gillies also hired specially trained nurses and orderlies and made certain there were no mirrors in the hospital and a lot of pleasant things to do. And he developed one of the first examples of a peer support network and invented the multidisciplinary team, working with dental surgeons, and encouraging anaesthetists to come up with a better way of putting the patients under. It turned out to be a method that is still being used today. The most special of Gillies’ innovations was that he employed a whole group of the best artists around. Painters like Henry Tonks, who made drawings of the soldiers before, during and after their treatment. Those drawings were used by the surgeons, to see what the problems were and to come up with a plan to fix them. They were also shown to the new men, as proof that healing was, in fact, possible. There were sculptors too, who made casts of people’s faces and mock-ups of the new nose or ears that were necessary. One of those sculptors was Kathleen Scott, the widow of the Antarctic explorer. A friend of Auguste Rodin, George Bernard Shaw and Isadora Duncan, she worked for Gillies for years.
During the time he ran Sidcup, Gillies treated more than 6,000 men, doing more than 11,000 operations. In 1920 he published a book that became the Bible of the then-new specialism of plastic surgery, Plastic surgery of the face. During the 1920s and 30s, Gillies worked at St Bartholomew’s Hospital in London, fixing cleft pales, harelips and increasingly the results of industrial accidents and that new-fangled invention, the automobile. When another war broke out, he travelled Europe to organize plastic surgery units, training doctors and fixing pilots who had been severely burnt. He also started rebuilding the genitals of injured soldiers, the first time this had ever been done.
Then, in 1945, a woman called Laura Dillon came to see him, asking if he could build her a penis and change her gender. Gillies’ colleagues and the public at large were furious. Who was he ‘daring to alter nature’? Alarmed lawmakers quickly acted to make the procedure illegal, which Gillies ignored by going to Dublin, Ireland, instead. Dillon became the first person to get a sex change operation turning a woman into a man.
In 1951, Gillies also performed the first reassignment surgery from male to female, on Robert(a) Cowell. Harold Gillies kept operating until he was very old. In 1960 he was trying to fix the leg of a young girl when he had a brain bleed. He died a few weeks later, 78 years old. Without him, millions of people would have had to put up with horrific injuries and deformities. And gender would be set in stone.
A life well lived indeed.