Facing the facts.
The facts of modern warfare apparently came as a surprise to many who manned the trenches in 1914. One fact that seemed to be particularly hard for soldiers to accept was that human reflexes are no match for the speed of machine gun bullets and shrapnel.The February 2007 printed issue of Smithsonian Magazine documented the sad outcome of some of the unsuccessful contests between human heads and machine guns, bombs, grenades and shrapnel, in an article by Caroline Alexander (“Faces of War“). The online edition shares the story, along with a gallery of photos from the article and a brief period video (“About Face“), showing the work at a prosthetic mask shop that was run in France by the American artist Anna Coleman Ladd.
The French pioneered cleft lip and cleft palate repair, and German surgeons were also early in the field of facial reconstruction, but plastic surgery was still in its infancy when the First World War intervened to make the specialty grow up fast. Dr. Harold Gillies of New Zealand is credited with innovations that vastly improved the outcome for those who failed to dodge the bullet.
The war gave Gillies hundreds of patients to practice on, and he and his new interdisciplinary teams worked wonders for the facially maimed, although he is quite honest about the failures and other hard lessons he learned along the way. To look at the photos in his book, Plastic Surgery of the Face, as well as the full-color drawings of the patients by the artist-surgeon Henry Tonks, is to wonder how any of those unfortunate men survived at all, at a time when iodine and sulfur dust were the only antiseptics available to prevent infection in wounds that were inevitably heavily contaminated.
The cards were stacked against the wounded, what with blood loss, shock, and the delay in getting first aid. If they survived the trek from the trenches, they still had to look forward to hurried surgery to save their lives.
Later, they would have to endure the protracted process of undoing primitive wound closures, with additional surgery to prepare and harvest skin, bone and cartilage grafts from elsewhere on the patient’s body. Every effort was made to approximate the appearance of the man before he was wounded, but perhaps good information about pre-injury appearance may have been lacking, because some of the noses Gillies gave his patients seem, to me, to resemble his own.
There were the inevitable worst-case scenarios, in which just the ability to restore enough basic facial and dental structure to enable eating, drinking and breathing would have been a triumph. For those whose extent of wounding or scarring meant living with a less than desirable appearance, there was the last resort: a prosthetic mask, colloquially known as a “tin nose.” These metal contrivances could not have been comfortable to wear, and they would have needed continuous maintenance and frequent repair. Modern facial prostheses are more lifelike in appearance, but the robotics technology that is necessary to fully animate them is still in the future.
These days, surgeons have successfully transplanted complete faces, and Smithsonian Magazine also recently published a brief article about that development (“Saving Face,” October, 2014 printed issue). There was a time when it was thought that injuries to nerves were permanent, but that may have been an artifact of the limits of available surgical techniques. Modern microsurgery now enables more accurate splicing of tissues, and today’s facial reconstruction patients are beginning to recover sensations, reflexes and motor functions about which Harold Gillies and his patients could only have dreamed.