Few soldiers returned uninjured from battle.

The trenches protected the bodies of soldiers, but in doing so it left their heads vulnerable to enemy fire. Soldiers would frequently stick their heads up above the trenches, exposing them to all manner of weapons.

Wounds were inflicted by gunshots or shrapnel. Where bullets normally produce straight-line injuries, twisted-metal shards, from shrapnel blasts, could rip-off a face, or damage it so badly that it made a person unrecognizable.

We know each other by our facial features. When our facial features become unrecognizable, extreme psychological damage can become part of the damage equation.

Often facial injuries were so horrific that living with the disfigurements sometimes kept people from returning to their families.

Pioneering plastic surgery helped to reconstruct the faces of badly injured soldiers who needed extensive bone, muscle and skin grafting to restore their appearance. Nevertheless, the home front had great difficulties in getting used to the reconstructed faces.

Die Kunst des Messers / The art of the knife

an article from the Berliner Volks-Zeitung newspaper, September 12, 1915

Original: ''Die Kunst des Messers. Die furchtbaren Waffen des modernen Krieges haben die Verwundungen vervielfacht in denen operative Eingriffe notwendig sind, um das Leben des Verletzten oder wichtige Glieder zu erhalten. In demselben Verhältnis ist die Bedeutung der Chirurgen gestiegen, und die Chirurgie hat sich allmählich zu einer wirklichen „Kunst des Messers" entwickelt. (...)

Der echte Chirurg operiert mit dem Kopf, nicht mit der Hand. Daß Messers bedeutet für ihn nur das Instrument, daß feine Gedanken überträgt, so wie es für den Maler der Pinsel und für den Bildhauer der Stichel ist. Und wie man einen berühmten Maler an seiner Strichführung, einen Bildhauer an den Konturen seiner Werke erkennt, so muß auch die Operationsart eines Chirurgen eine individuelle, persönliche Note haben.''

English translation: ''The art of the knife. The terrifying weapons of modern warfare have multiplied the injuries that require surgical operation to save important body parts or even the life of the wounded. In accordance to this the significance of the surgeon has risen and surgery has gradually developed into a true “Art of the Knife”. (...)

A real surgeon operates with his head, not with his hand. The knife is just the instrument that transmits the detailed thoughts, like the brush for the painter or the graver for the sculptor. And just as we recognize a famous painter for his characteristic strokes or a sculptor for the contours of his works, so should the way of operating of a surgeon have an individual and personal touch.''

Soldiers with mutilated faces were not easily accepted by society and sometimes even rejected by their own family. Plastic surgery as we nowadays know it was uncommon. Mikaël Schweitzer was a dental surgeon helped severely mutilated soldiers by giving them an acceptable physical appearance.

The Belgian soldier Edouard Van Landschoot got injured during the defence of the Liège fortresses on August 5, 1914. On 6 August, his leg was amputated just below his knee. A second amputation, above the knee, followed on November 2, 1914.

Short handwritten account of what had happened to Edouard Van Landschoot.

Original (dutch):
Gedachtenis van den oorlog
1914-1915

Belgische soldaat Edouard Van Landschoot gekwetst aan het linker been door een shrapnel den 5 Augustus 1914 te Sart-Tilman bij Luik, den 6 Augustus 1914 overgebracht naar clinique Béthesohr dadelijk het been af gezet onder de knie. Een tweede afzetting den 2 November 1914 boven de knie in de ambulance camion.

Aan mijn broeder

*English translation: *

Memory of the war
1914-1915

Belgian soldier Edouard Van Landschoot wounded on his left leg by shrapnel on 5 August 1914 at Sart-Tilman near Liège, 6 August 1914 brought to “Béthesohr” clinic, leg immediately amputated right under the knee. Second amputation on 2 November 1914 right above the knee in the ambulance truck.

To my brother.

A French soldier is seriously wounded and lies on an operating table. His arm and leg will be amputated by the doctor's team.

Mikaël Schweitzer, originally a dental surgeon, helped to have soldiers an acceptable physical appearance again. He became the "French specialist in facial dental surgery" for many "Gueules cassées".

Because of the abundant experiences from World war I plastic surgery quickly developed and made siginificant progress. Like many others the Dutch surgeon Johannes Esser was a pioneer in this field. Rejected by the Allied forces who did not recognise his qualifications, Esser started working in Germany and wrote extensively about his findings.