It is a horrifying but undeniable fact that many medical advances are made or greatly improved on the bloody battlefields of war. Medical staff are forced to improvise and learn under terrible conditions, often facing wounds and trauma they’d never seen before. This was never more true than during World War I when the technology of killing far surpassed medical knowledge.

Despite the chaos and bloodshed, doctors and nurses did what they could to ease suffering. The Facemaker by Lindsey Fitzharris looks at the stories of some of the wounded and at one doctor in particular that worked tirelessly to help them. This book is equal measures heartbreaking and inspiring while also showing the cost of war in human suffering.

Harold Gillies already had an interest in plastic surgery before the war. (The word “plastic” doesn’t refer to the material, but to the meaning of the word as a noun – “easily shaped or molded”.) This field of surgery was still in it’s infancy and not readily accepted as legitimate by the medical establishment. However, World War I was especially brutal when it came to facial injuries as troops faced war machines, poison, fire and explosives never seen before. The nature of trench warfare (where soldiers would peek their head over the edge of the trench making them an easy target) and the lack of any effective protective armor as well as scarcity of medicine and delays in reaching aid (many men lay on the battlefield for three or more days before being rescued) led to a staggering number of dead and wounded.

Gillies volunteered as soon as the war broke out. What he saw in France convinced him of the importance of facial reconstruction and he set about creating a medical unit in Britain dedicated to treating these men. He assembled doctors from various disciplines including dentists and surgeons and encouraged innovations such as using skin grafts. By reconstructing destroyed faces he not only improved the soldier’s quality of life, but saved their mental health. “At a time when losing a limb made a soldier a hero, but losing a face made him a monster to a society largely intolerant of disfigurement, Gillies restored not just the faces of the wounded but also their spirits.”

Reading the stories of the soldiers and what they suffered is sobering and shows the incredible cruelty and randomness of war. That so many of them kept a positive attitude and readily endured multiple, painful surgeries can be attributed to Gillies and the atmosphere of the hospital he created. There was entertainment, good food and outdoor excursions for the men and Gillies himself was an inspiration. Gillies never flinched from horrific wounds that would shake even experienced doctors and he never failed to see the person beyond the ruined face. Beloved by patients, he treated not just the physical but understood how saving the appearance helped soldier’s mental state.

The Facemaker is fascinating to read. The writing never drags and, while Fitzharris does not spare medical details, it is not sensationalist. In many ways it is hopeful, that surgery can restore so much that was brutally taken. Highly recommended.

If you would like to learn more about the book and hear from the author and how she strived to write with compassion about the soldiers, I recommend listening to the Noble Blood podcast episode that first aired on July 19, 2022 “Surgery of the First World War with Lindsey Fitzharris”