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WOUNDED TOMMIES facetiously called it "The Tin Noses Shop." Located within the 3rd London General Hospital, its proper name was the "Masks for Facial Disfigurement Department"; either way, it represented one of the many acts of desperate improvisation borne of the Great War, which had overwhelmed all conventional strategies for dealing with trauma to body, mind and soul. On every front--political, economic, technological, social, spiritual--World War I was changing Europe forever, while claiming the lives of 8 million of her fighting men and wounding 21 million more.
The large-caliber guns of artillery warfare with their power to atomize bodies into unrecoverable fragments and the mangling, deadly fallout of shrapnel had made clear, at the war's outset, that mankind's military technology wildly outpaced its medical: "Every fracture in this war is a huge open wound," one American doctor reported, "with a not merely broken but shattered bone at the bottom of it." The very nature of trench warfare, moreover, proved diabolically conducive to facial injuries: "[T]he ... soldiers failed to understand the menace of the machine gun," recalled Dr. Fred Albee, an American surgeon working in France. "They seemed to think they could pop their heads up over a trench and move quickly enough to dodge the hail of bullets."
Writing in the 1950s, Sir Harold Gillies, a pioneer in the art of facial reconstruction and modern plastic surgery, recalled his war service: "Unlike the student of today, who is weaned on small scar excisions and graduates to harelips, we were suddenly asked to produce half a face." A New Zealander by birth, Gillies was 32 and working as a surgeon in London when the war began, but he left shortly afterward to serve in field ambulances in Belgium and France. In Paris, the opportunity to observe a celebrated facial surgeon at work, together with the field experience that had revealed the shocking physical toll of this new war, led to his determination to specialize in facial reconstruction. Plastic surgery, which aims to restore both function and form to deformities, was, at the war's outset, crudely practiced, with little real attention given to aesthetics. Gillies, working with artists who created likenesses and sculptures of what the men had looked like before their injuries, strove to restore, as much as possible, a mutilated man's original face. Kathleen Scott, a noted sculptress and the widow of Capt. Robert Falcon Scott of Antarctica fame, volunteered to help Gillies, declaring with characteristic aplomb that the "men without noses are very beautiful, like antique marbles."
While pioneering work in skin grafting had been done in Germany and the Soviet Union, it was Gillies who refined and then mass-produced critical techniques, many of which are still important to modern plastic surgery: on a single day in early July 1916, following the first engagement of the Battle of the Somme--a day for which the London Times casualty list covered not columns, but pages--Gillies and his colleagues were sent some 2,000 patients. The clinically honest before-and-after photographs published by Gillies shortly after the war in his landmark Plastic Surgery of the Face reveal how remarkably--at times almost unimaginably--successful he and his team could be; but the gallery of seamed and shattered faces, with their brave patchwork of missing parts, also …