Saving Face with Harold Gillies

This BBC podcast is supported by ads outside the UK.

Hey there, it's Ryan Seacrest for Safeway.

Spooky season is quickly approaching, so time to stock up on all your favorite treats.

Now, through October 7th, you can get early savings on your Halloween candy favorites when you shop in-store and online.

Save on items like Hershey's, Reese's, Pumpkins, Snickers, miniatures, Tootsie Rolls, raw sugar, milk, chocolate, caramel, jack-o'-lanterns, Brock's candy corn, charms, mini pops, and more.

Off friends, October 7th.

Restrictions apply, offers may vary.

Visit Safeway.com for more details.

Suffs, the new musical has made Tony award-winning history on Broadway.

We demand to be home.

Winner, best score.

We demand to be seen.

Winner, best book.

We demand to be quality.

It's a theatrical masterpiece that's thrilling, inspiring, dazzlingly entertaining, and unquestionably the most emotionally stirring musical this season.

Suffs, playing the Orpheum Theater, October 22nd through November 9th.

Tickets at BroadwaySF.com.

BBC Sounds, Music, Radio, Podcasts.

You're about to listen to a brand new series of History's Heroes.

New episodes will be released weekly wherever you get your podcasts.

But if you're in the UK, you can listen to the latest episodes a week early first on BBC Sounds.

In January 1915, a young surgeon called Harold Gillies was sent to the Western Front in France.

Gillies volunteered to serve with the Red Cross as soon as the First World War began.

The conflict was already taking a devastating toll on the soldiers who fought it.

From the first moment that the machine gun rings out over the Western Front, one thing is abundantly clear.

Mankind's military technology wildly surpasses its medical capabilities.

In the early 20th century, warfare had become increasingly mechanized with more advanced artillery than ever before.

There were so many advances, in fact, that a company of just 300 men in 1914 could deploy equivalent firepower as a 60,000 strong army during the Napoleonic Wars.

New technology inflicted new types of injury.

Men were maimed, they were burned, they were gassed.

You know, they used to say that you could smell the front before you could see it.

And a lot of that had to do with the dead bodies that were littering the battlefield.

You have descriptions of men climbing over these dead bodies that are partly skeletalized.

The death toll was shocking, but many of those at the front also suffered major injuries.

Hands, feet, legs and arms were lost.

And the hail of munitions also destroyed some men's faces.

This was a time when losing a limb made you a hero, but losing a face made you a monster to a society that was largely intolerant of facial differences.

During the First World War, more than 280,000 servicemen suffered facial disfigurement.

Even if they survived, these men became some of the most tragic casualties of the war.

Many fell into depression.

Some took their own lives.

Most doctors could do little for these men.

But when Harold Gillies looked on their destroyed faces, he believed he could could rebuild them.

For BBC Radio 4, this is history's heroes.

People with purpose, brave ideas, and the courage to stand alone.

I'm Alex von Tunselmann.

I'm a historian and I want to tell you about Harold Gillies.

He was a surgeon, but not just any surgeon.

Where others saw injuries they couldn't bear to look at, he saw his patient's humanity and gave them hope.

Gillies was 5'9, but it was said that he seemed shorter because he had a bit of a stoop.

Dr.

Lindsay Fitzharris is a medical historian and author of The Facemaker, a biography of Harold Gillies.

He was a bit of a funny-looking guy and he made fun of his looks later in life.

He said, you know, how different would his fate be if, you know, he had a slightly stronger jaw or a slightly different nose.

Harold Gillies was born in New Zealand in 1882.

After his schooling, he moved to England to study medicine at Cambridge University.

He made friends easily.

He had a nickname Giles.

And, you know, one of the things that he was popular for was just sort of his rebellion.

He took his scholarship and he bought a motorcycle with it.

And he liked and enjoyed debating with his professors as well.

He was always sort of challenging the status quo.

And he was kind of one of these people who was just very good at anything he set his mind to.

Gillies was a talented golfer, artist, and musician.

As his medical training progressed, his obsessive attention to detail made him a perfect candidate for a career in surgery.

By 1914, Gillies was practicing as an ear, nose and throat surgeon on Wimpole Street in London.

His wife, Kathleen, a former nurse, was expecting their second child.

It looked like everything was set for a successful, contented middle-class life.

And then suddenly the First World War breaks out and he is faced with this enormous challenge.

Though he had a young child and his wife was pregnant, Gillies volunteered straight away.

Harold Gillies was one of the first to volunteer with the Red Cross when the war broke out.

And I think a lot of people in Britain especially didn't think that the conflict was going to last that long and everybody was a bit excited to volunteer.

When Gillies finally arrived at the Jaw unit at Vimero near Boulogne at the beginning of 1915, the injuries he saw coming back from the front were shocking.

The artillery, the damage that was being done to bodies had never been seen on this scale.

And so even surgeons who were qualified were probably pretty rattled by the sights they saw at first.

Face and neck injuries were common in trench warfare because the soldiers' bodies remained mostly underground while they raised their heads for a lookout.

And owing to the dirty conditions, infection was rife.

One of the things that battlefield surgeons near the front did was they would hastily stitch up the faces because they were trying to stop the hemorrhaging.

The face is vascular, it bleeds and it bleeds.

So in trying to stop the bleeding, they would just stitch these wounds up very fast.

Sometimes they would stitch in the bacteria from the battlefield and literally seal these men's fate.

Uncleaned, hastily closed wounds could quickly become infected.

If an injured man survived the blood loss, he might still die of infection.

Gillies and his fellow medics were fighting a losing battle.

Even for experienced surgeons, the visceral horror of wounded and infected faces was hard to bear.

A lot of doctors at this time admitted that they really struggled to look at men with these injuries to their face.

It was just very shocking.

And again, nobody had seen this kind of damage to the face on this scale.

The jaw unit had been set up by a French-American dentist called Charles Valladier, who was quite a character.

He's independently wealthy.

He had a Rolls-Royce when he retrofitted it with a dental chair and he literally drove it to the front under a hail of bullets.

Valladier tried to tend to these injuries, but as a dentist, he wasn't allowed to operate unless there was a qualified surgeon overseeing his work.

That was the job Gillies was there to do, but it quickly became clear that existing expertise fell well short of the need.

The term plastic surgery was coined in 1788 by a French surgeon named Joseph Dousseau.

At the time, plastic meant something that you can shape or you can mold, so in this case, a patient's skin or soft tissue.

But attempts at repairing or altering a person's appearance tended to focus on very small areas of the face, such as the nose, rhinoplasty being one of the oldest medical procedures documented in history.

After the American Civil War in the 1860s, there'd been progress in the field of large-scale facial reconstruction, but these innovations were modest.

American surgeons in the 1860s don't really care about aesthetics.

They don't care if it looks good.

There's good reason for this.

Germ theory was still not widely accepted during the 1860s, so any surgery was extremely dangerous.

So they really just wanted to get in, get out.

They wanted to restore functions such as the inability to eat or to speak, but they really didn't want to go much further than this.

This meant that during the American Civil War, the total number of plastic surgery operations on faces that was documented was only around 40.

But the numbers of men who needed facial reconstruction in the First World War was 7,000 times higher than that.

Even though Gillies was supposed to oversee Charles Valladier's work, it was the dentist who taught him about new techniques of facial reconstruction.

The ideas Gillies learnt from Valladier were crucial.

The dentist was was thoroughly irrigating his patients' faces to flush away dirt from the trenches before closing their wounds.

He was also performing pioneering bone grafts.

Gillies was sent on to the Belgian field hospital at Hochstader, where he tended to some of the thousands wounded at Ypres and then on to another hospital in France, but he was increasingly thinking about how he could develop plastic surgery.

By late 1915, the British capital was filled with soldiers who had been sent home in pieces.

There were streams of walking wounded coming into London.

Facial injuries, of course, were the worst of the worst.

And although you would see men with those injuries, they tended to be sort of hidden from the public view.

Men with facial injuries either became recluses, living indoors, or wore masks to cover the damage.

Several mask makers, these artists like Anna Coleman Ladd, who was an American who set up a studio in Paris, and they created these very realistic prosthetics to wear over the face.

A distinguished British-American sculptor, Francis Derwent Wood, set up a unit at the 3rd London General Hospital making prosthetics for injured men's faces.

He began with a plastercast of the patient's face.

Then, using pre-war photographs as a guide, he sculpted a restored face over the plastercast with clay.

The new face was then cast in tin and electroplated with copper.

It was then meticulously hand-painted and soldered with individual tinted metallic threads to simulate eyelashes and brows.

These masks were beautiful works of art, but wearing them was fraught with problems.

They were hot, they were uncomfortable, and a lot of these men sort of grew to hate them themselves.

They would say, these blankety blank faces, you know, give us something that we can shave.

Harold Gillies sought to give these men faces that were more alive.

The first job, though, was to get them back from the front.

He meets a man named Sir William Arbruthnut Lane, and he petitions to open a specialty unit for facial reconstruction at the Cambridge Military Hospital in Aldershot.

Gillies knew that the ambitious work he wanted to carry out on these men's faces was much more complex than anything which could be done in a field hospital.

He approached the War Office to make arrangements.

These pencil pushers weren't very convinced, you know, they weren't seeing the horror that was going on on the front lines, so they didn't really think that this was necessary.

And Gillies got that sense of it.

He thought that they were sort of laughing at him or certainly not taking him seriously.

Gillies was determined to prove his work was essential.

He left the British War Office and went to a stationery shop on the Strand.

And he spent £10 and he bought himself some labels.

And he addressed those labels to himself at Aldershot.

He went back to the British War Office, he gave them the labels, he asked them to send them to the front.

They weren't very convinced that this was needed, but they did it.

And before long, all of these men began arriving at the Cambridge Military Hospital in these tattered, bloodied uniforms with these handwritten labels pinned to their chests.

Soon, the hospital was overrun with men with facial injuries desperate for help.

Gillies had shown the need.

Now he took the revolutionary step, inspired by Charles Valladier, of recruiting dentists as a core part of the medical team.

He always said that the dentists were the ones who dealt with the hard structure and he, as the plastic surgeon, was dealing with the soft structure, so the tissue and the skin and the muscle.

These doctors and dentists were effectively making up a new medical discipline as they went, and one with unique challenges.

Whereas a prosthetic arm or leg doesn't necessarily need to look like the limits we're placing, a face is an entirely different matter.

Any surgeon willing to undertake the monumental task of rebuilding a soldier's face at this time not only had to consider the loss of function, such as the inability to eat or to speak, but that surgeon also had to consider the aesthetics so that the face was deemed socially acceptable by the standards of its day.

All the while Gillies was developing this delicate, complicated, and time-consuming surgery, new cases continued to come in.

It was impossible to keep up with the demand.

And then came the Battle of Jutland.

On the 31st of May, 1916, the dark waves of the North Sea were set ablaze.

The Battle of Jutland was fought between the British and the German navies.

It was the largest naval battle of the First World War, involving 279 ships and over 100,000 men.

The outcome was inconclusive and continues to be disputed today.

Either way, the human cost was high and the injuries sustained were horrific.

Men were getting these cordite burns driven by the propellant, the explosive propellant, and it was almost like a flash.

And any skin that was exposed at the time would end up being burned.

These burns didn't behave as surgeons expected.

A lot of times these sailors looked like they were only sort of mildly burned, almost like a just sort of bad sunburn at first, and then it would start to slowly develop into something a lot more severe over time.

Some of these surgeons were using an antiseptic dressing and placing it over these burns.

It was drying the skin out.

Peeling these bandages off would get very painful because they would get meshed into the skin.

Suddenly, Harold Gillies had huge numbers of men arriving at his unit with catastrophic facial burns.

This was the first time that Gillies really came into contact with severe burns of that nature.

But Gillies was never really rattled by that.

You know, he would look at these men and he would say, don't worry, sonny, you'll have as good a face as any of us when I'm done with you.

Hey there, it's Ryan Seacrest for Safeway.

Cough and cold season is coming, so make sure you're prepared and stock up on your family's favorite personal wellness products.

Now, through October 7th, shop in-store and online for savings on products like Mucinex, Kickstart Combo, Zertec, allergy relief tablets, or liquid gels, Haul's cough drops, and Mucinex fast day and night.

So you and your family are armed and ready for the season ahead.

All friends, October 7th, restrictions apply, offers may vary.

Visit safeway.com for more details.

Sucks.

The new musical has made Tony award-winning history on Broadway.

We demand to be home.

Winner, best score.

We demand to be seen.

Winner, best book.

We demand to be quality.

It's a theatrical masterpiece that's thrilling, inspiring, dazzlingly entertaining, and unquestionably the most emotionally stirring musical this season.

Suffs, playing the Orpheum Theater, October 22nd through November 9th.

Tickets at BroadwaySF.com.

Gillies worked away, but before long, there was another overwhelming influx of injured men, this time from the Battle of the Somme.

Of the 100,000 British soldiers who took place in the advance that day, 60,000 were killed or injured, many of them gravely.

Never before or never since has a single army suffered such losses on a single day in a single battle.

And a lot of these men received injuries to the face.

And so they begin streaming onto Gillies' board.

Gillies was given 200 more beds to accommodate the casualties, but his complex surgeries took time to complete, and he couldn't keep up with the demand.

He wrote, My days and nights were filled with the problems of the wounded.

Among the patients he saw was Private R.W.D.

Seymour, known to his friends as Big Bob.

As Big Bob advanced on the Germans, Germans, a shell exploded, filling his face with shrapnel and taking off half his nose.

As he spun round from the explosion, he was shot five times in the back by a machine gunner.

He was rescued from the battlefield and first had to be treated for his gunshot wounds.

Then he was sent to Cambridge and to Gillies.

Gillies grafted a piece of cartilage onto Big Bob's face in a flap of tissue folded down from the forehead.

Over months, he was slowly able to transform this into a new nose.

Big Bob was so delighted with the results that he became Gillies' private secretary and worked with him for the next 35 years.

Gillies went back to Sir William Arbuthnot Lane to ask for a whole new hospital, and he got it.

The Queen's Hospital in Sidcup was revolutionary.

The operating room is full of light.

It is spacious and uncrowded.

The smell of drugs is not oppressive.

On the 6th of December 1917, an unusual article appeared in the Yorkshire Evening Post.

A little group of people are gathered in the centre.

I notice two nurses standing perfectly still.

Just beyond these women are three or four men masked and gloved.

I'm introduced to Major Gillies, who bows to me and then turns to his patient.

A journalist, Harold Begbie, had had been invited into the Queen's Hospital to witness something he described as a miracle.

The patient is sitting up on the operating table.

He's naked to the waist and the whole of his flesh is painted a reddish yellow with iodine.

It is only by an effort that I can bring myself to look at his face.

What I see, I dare not describe.

Begby was clearly overawed.

Major Gillies points with his knife to the man's chest.

There, faintly marked on the reddish-yellow flesh, as it were with thin pencil strokes, is the shape of a face.

The surgeons told Begbie that the face drawn on the chest was to be cut out, lifted off, and placed over the man's disfigured face.

The nose was rebuilt with cartilage from his ribs and lined with living skin.

There is silence.

Now the knife gets to to work.

I begin to feel how hot it is.

My mouth is dry.

Yes, it is wonderful.

Most wonderful.

The science of surgery.

A miracle.

A revolution has come.

A new face is grafted on and grows there and becomes a real face, not a mask that hides horror.

Harold Gillies achieved his miracle through constant innovation at the Queen's Hospital.

The hospital is extraordinary.

It's a hub for plastic surgery, and it's set around four autonomous units.

Surgeons watched what each other did.

Although they're working autonomously, they're all looking at each other's work, and as a result, standards kind of rise across the board.

Building on the success of working with dentists, Gillies brought in experts from other disciplines as well.

It's also x-ray technicians, it's mask makers, it's artists.

He has an artist named Henry Tonks, an extraordinary portrait artist, who creates this beautiful medical record of what he's doing in color.

And it's very important to document what he's doing, what Gilly's doing, so that it could be replicated later.

At the same time, Gilly's pioneered the development of new techniques in skin transfer.

The old system served surgeons well to a point.

In order to rebuild a face, you can use grafts or you can use flaps.

So grafts are kind of like the salami of plastic surgery.

It's this thin piece of tissue and it's free form.

So you would remove it, like a skin graph from a different area, and then you would place it over the area that you were trying to reconstruct and it would create its own blood supply.

Whereas a flap is more like the burgers of plastic surgery.

It's this meatier piece of tissue.

And a flap remains attached at its original blood site on one end.

Both techniques were flawed.

Grafts often failed because of the lack of blood supply and weren't substantial enough to replace lost tissue.

Meanwhile, flaps were often too small because they had to be pulled from near the face.

So Gillies tried something new.

Gillies is operating on a sailor at one point, and he just decides to take that flap and to roll it.

So he creates almost essentially what's like an elephant trunk of tissue and it's encased in skin.

So it's protected now from infection.

Creating trunks of flesh hanging from the body allowed Gillies to move tissue from all parts of the body to the face.

So, for instance, you might start at the thigh.

You might create what he called a tubed pedicle, that elephant trunk of tissue.

It would remain attached on one side to the original blood source on the thigh, and he would take the other part of the trunk and he would attach it to the lower abdomen.

Once it created a blood supply in the lower abdomen, he would sever it at its original source on the thigh.

He would take that side, flip it over its end and move it up to the chest and so forth and so on.

So he could waltz these tubed pedicles to the face.

The development of tubed pedicles allowed Gillies to move the large quantities of tissue needed to rebuild a face from areas that were less visible, such as the chest or thighs.

This offered new hope for men who had been disfigured.

But Gillies was under such huge pressure that it was inevitable he would also make mistakes.

I found myself operating too soon and too often, he wrote.

When he lost patients, when patients died in his care, it hit him even harder because he really did have relationships with these men and that could be a struggle.

This intimate, long-term facial reconstruction work and the friendships that it often created with patients left Gillies feeling conflicted.

The other part he struggled with was his duty to the military as well as his duty to his patients.

As the war went on, the military wanted to get injured men back to the front.

And so there was a lot of pressure to just hurry up and finish.

You know, again, restore function, but don't go much further, get these men back into the trenches.

And I think that must have been very difficult for him to see these men who he worked on for months or years be sent right back to the trenches and there were stories of men whom he had worked on who then were sent back and killed.

So it was feeding the war machine and in essence prolonging the war.

Eventually, the war did come to an end on the 11th of November, 1918.

After the war, Gillies continues to operate on the soldiers because they are in his care for years, sometimes, you know, over a decade.

But of course, as time marched on, he had fewer and fewer patients because the war was over.

By 1925, the last eight facial patients at the Queen's Hospital in Sidcup were transferred out.

With tears in his eyes, Gillies told a colleague he feared all they had pioneered in the field of plastic surgery would be lost.

So he really faced a decision he had to make.

Would he go back to Wimple Street, you know, go back to the Cushy ENT specialty, or would he try to establish plastic surgery as a sub-specialty in its own right?

In 1930, Gillies was knighted as Sir Harold Gillies for his service.

He remained in the field of plastic surgery.

In peacetime, though, much of the demand for facial alteration came from what he called beauty surgery, which we now know as cosmetic surgery.

Gillies really grappled with the decision to move into cosmetic procedures.

He wondered if it was ethical, but ultimately he decided that if somebody was unhappy with their appearance, they had a right to change that.

And who was he to say no?

You know, this again comes back to identity and to people being able to control their identity.

During the Second World War, Gillies worked again on faces and in another field of injury that was very personal to his patients, genital reconstruction.

After the war drew to a close, yet again he broke radical new ground in the field of surgery.

In 1945, a trans man named Michael Dylan comes to Harold Gillies and he wants to undergo what we would call gender-affirming surgery today.

And Gillies agrees to do this.

He performs the first ever phalloplasty on a trans man

and it's successful.

It's extraordinary he's able to do this.

This technique is very similar, if not identical, to one that is used today.

This was a surgery most had deemed impossible before now.

Gillies was discreet about this highly controversial procedure and he and Dylan became friends.

In the late 1950s though Michael Dylan was discovered and outed by the British press.

He fled the country.

And Gillies really stands behind him.

He believes that Michael Dylan is a man and I think that speaks to his progressiveness not just as a surgeon but as a human being.

And it shows that Gillies was always trying to push the envelope, but also ultimately that he felt people should be in control of their identities.

Harold Gillies died in 1960 at the age of 78.

Since then, the field of plastic surgery, which he pioneered, has become a massive global phenomenon.

You know, arguably, if we could have accepted the disfigurement, there would have been no need for Gillies beyond, you know, repairing function.

So you want to be able to breathe or to eat or to speak, of course.

But he went above and beyond this to make it aesthetically acceptable.

And so all of plastic surgery is really born out of this desire to make it so that these men can blend back into society.

And I think, as a result, we've all become sort of hyper-aware of how we look because of what happened in the First World War and because of the birth of plastic surgery as this enormous industry now.

next time on History's Heroes, a Hollywood star takes on the double standards of the studio system.

Catherine Hepburn, Queen of the Screen.

Hello, I'm Manishka Matandadauti, the presenter of Diddy on Trial from BBC Sounds.

Sean Diddy Combs is facing a fight for his freedom as his hugely anticipated trial starts for sex trafficking, racketeering with conspiracy and transportation for prostitution.

He denies all the charges.

I'll be bringing you every twist and turn from the courtroom with the BBC's correspondents and our expert guests.

So make sure you listen, subscribe now on BBC Sounds and turn your push notifications on so you never miss a thing.

Suffs!

The new musical has made Tony award-winning history on Broadway.

We demand to be home.

Winner, best score.

We demand to be seen.

Winner best book.

We demand to be quality.

It's a theatrical masterpiece that's thrilling, inspiring, dazzlingly entertaining, and unquestionably the most emotionally stirring musical this season.

Suffs!

Playing the Orpheum Theater, October 22nd through November 9th.

Tickets at BroadwaySF.com.

A happy place comes in many colors.

Whatever your color, bring happiness home with CertaPro Painters.

Get started today at Certapro.com.

Each Certipro Painters business is independently owned and operated.

Contractor license and registration information is available at Certapro.com.