Denial of the truth did not suit every temperament. Nor was it always conducive to romance. Gillies sympathised. ‘One can appreciate a sweetheart’s repugnance at being expected to kiss shapely but unresponsive lips composed of enamelled phosphor-bronze,’ he remarked.
Covering up the damage did not always bring lasting satisfaction. Gillies believed he could find another solution by acknowledging the problem rather than denying it. He was convinced that there was a different way in which to bring new life and hope to these shattered men as well as to those who loved them.
4
Acknowledgement
Winter 1918
A week after the Armistice the well-known Australian violinist, Miss Daisy Kennedy, had sat next to an exceptionally good-looking young man at a lunch party in London. Chatting about heroes she had mentioned her pride at being a nearby country kinswoman of the brilliant surgeon Harold Gillies. Looking straight at her the young man said, ‘You couldn’t pay me a greater compliment.’
Daisy Kennedy was puzzled. Might she indeed be speaking to the great man himself, she enquired? But she was mistaken. ‘I am one of his patients,’ the young man told her. And looking still closer, Daisy was amazed to see that there was not a mark on his beautiful face. He was perfect.
The young New Zealand surgeon Harold Gillies had seen for himself the extent of the severity of face wounds while out working at the 83rd Stationary Hospital in the town of Wimereux, just outside Boulogne. He became determined to help men whose lives had been ruined in the second it took for the shell or bullet or piece of death-dealing shrapnel to do its frightful damage. He persuaded the head of army surgery, Sir William Arbuthnot Lane, to give him a ward at the Cambridge Military Hospital in Aldershot so that he could develop a small specialist unit. To ensure facial patients came directly to Aldershot, he arranged for casualty labels, printed at his own expense and bearing the hospital address, to be tied to the arm of the worst cases and sent directly to him from the field hospitals. Back in England Gillies began experimenting with all the resources and imagination he could muster to mend the faces of these shattered men.
Word soon got about of this remarkable surgeon and his expert team who offered hope where there had once been only despair. Gillies’s meticulous use of new surgical procedures succeeded in filling in vacant sockets that had once contained an eye, and replacing missing ears, noses and jaws. For some it was as if the Creator himself had returned to restore an old job. Before long Gillies had found the bed capacity at Aldershot wholly inadequate for the extensive demand and contacted the Chief of the Army Medical Staff, Sir Alfred Keogh. Both he and Sir William Arbuthnot Lane were initially distrustful of’this new-fangled plastic surgery’, but Gillies convincingly argued that by correcting physical disability, time-consuming claims against the Government for compensation would decrease. The proposition was an attractive one to a government that made no financial allowance for facial injury on the premise that such injury did not prevent manual productivity in the same way that a lost limb did. It seemed the psychological effects of damaged faces were impossible to quantify in cash terms.
Gillies hoped that he could eventually help enlighten the Government in their insensitive approach to such distress and his charm and exceptional surgical skills were hard to resist. The massively built Arbuthnot Lane, his disconcertingly ‘shrill little voice’ at variance with his bulk, was won over. He persuaded the Government to join the Red Cross in raising funds to build a special hospital in the grounds of a small estate near Sidcup in Kent.
The Queen’s Hospital opened in August 1917 with one thousand beds, especially designated for treatment of the face. As the patients often stayed at the hospital for the many months that it took Gillies to complete each individual’s series of operations, proper convalescent facilities were provided. These included a chapel, a cinema and a substantial canteen. A number of private houses and a large children’s home were requisitioned to fill the growing need for beds. Queen Mary, who had contributed generously to the cost of establishing the hospital, had visited Gillies’s new premises when they opened and saw for herself’the marvellous results of the treatment’.
Gillies was the clinical director of the hospital, heading a team of some thirty surgeons from America, Australia, Canada and New Zealand who all brought their international experience to Kent to help with the huge number of face cases. But Gillies himself handled as many operations as a hard-working day would allow, not permitting his managerial responsibilities to get in the way of what mattered to him most.
Despite their lengthy, painful and often humiliating ordeal, the patients trusted this delightful man who called everyone, man or woman, either ‘my dear’ or ‘honey’. He was an original, his scientific gift enhanced by an enquiring mind and a talent for painting. Before an operation Gillies would sometimes take a pencil and draw the potential reconstruction on a photograph of a damaged face. Art became an integral part of the surgical procedure, and in time Gillies persuaded several artists to join him at Sidcup as part of his unusual team of professionals.
Gillies was acutely conscious of the importance of the aesthetic as well as the practical success of his work. Private Horace Sewell, known to his friends as Paddy, was apprehensive about the nature of post-war life without his own nose. The day before his operation, Gillies arrived in the ward, carrying with him a sketchbook. ‘Well Paddy, your big day is here,’ he said to Sewell who was immediately reassured by ‘the friendly smile that gave us all so much confidence’. Taking out his pens Gillies asked him, ‘What sort of nose do you think we ought to give you?’ Paddy insisted he was not fussy, but Gillies was determined to construct the very best nose he could, drafting several choices on to his pad, before deciding that a fine Roman model would best complement Paddy’s rather round face.
Henry Tonks had originally trained as a surgeon, and with his thorough knowledge of the skeletal structure of the human body had been a professor of drawing at the Slade since 1892. Before the war, Professor Tonks’s students had included not only Augustus John, his sister Gwen and the popular artist Ambrose McEvoy, but the society pin-up Diana Manners and a shy, sublimely beautiful 14-year-old girl, Edna Clarke Hall.
During the war Tonks had volunteered for service in the Royal Army Medical Corps and his presence at Aldershot was brought to Gillies’s attention. Tonks came into the operating theatre and watched Gillies working, while making lightning sketches and pastels of the pre-operative faces. These pictures were invaluable to Gillies in helping him visualise the outcome of his proposed reconstructions. Tonks became one of Gillies’s closest working colleagues.
Next to Tonks was another studio for the sculptor John Edwards, who made three-dimensional plaster casts to give another perspective to Tonks’s drawings. Archie Lane, a dental technician, re-created whole missing jaws, and because he understood better than anyone the bone structure beneath a face, was able to make up small masks for eyes and noses.
Kathleen Scott, a talented sculptor and another former Slade student, also joined the team. The widow of Captain Scott, the explorer who in 1912 had frozen to death in the Antarctic, Mrs Scott had no sense of squeamishness and on the contrary found that ‘men without noses are very beautiful, like antique marbles’. Mrs Scott was honoured to be invited by Gillies to use her creative gift to sculpt missing noses, ears, cheeks and chins on to a model of the shattered face.
Without anaesthetic the operations would have been intolerable and pain-relief systems were not wholly reliable. But Rubens Wade worked out a way of delivering anaesthesia to a patient in the sitting position, reducing the risk of the airways becoming obstructed. Wade’s colleage, Ivan Magill, an Irishman originally in charge of the medical welfare of demobilised troops, enhanced the effectiveness of pain relief further with his technique of inserting the vapour directly into the windpipe.
Surgeons as well as patients benefited from these innovations. Chloroform pads often either fell off or obscured the operation site, w
hile ether involuntarily exhaled by a patient could sometimes send a surgeon to sleep in the middle of the job. Occasionally the anaesthetic failed to obliterate the extraordinary pain of having a new face sewn on to the remaining flesh and bone, and it was sometimes necessary to hold the man down, so excruciating was the experience.
Corporal Ward Muir at the Third London General Hospital described the distress involved in talking ‘to a lad who six months ago was probably a wholesome and pleasing specimen of English youth and is now a gargoyle and a broken gargoyle at that’. Conversing was ‘an ordeal’. But the staff of the plastic surgery unit learned not to betray the horrors that confronted them. Accompanied by his hand-picked professionals, Gillies would enter the operating theatre ‘head thrust forward from his slightly stooping shoulders, with the air of an artist who aspires to produce a masterpiece’. An assistant noticed that ‘all the actions of his hands were consistently gentle, accurate and deft’.
In his efforts to ‘restore beauty to the human form’, Gillies asked a good deal of his patients. The experimental and improvised surgical risks which these battered men were prepared to undertake were courageous, but the hope of having some level of normality restored to their lives was enough to sustain them.
The most daring of the new surgical techniques involved the detaching of a healthy flap of skin from another part of the body, most commonly the shoulder or the chest. This flap would then be joined to the damaged area in the expectation that healthy new tissue would grow. A young naval rating, A. B. Vicarage, had been severely burned during the Battle of Jutland: the fire had scarred all of his exposed face, leaving him without much of a nose and tightening his eyelids so he could not close them. In addition his mouth had contracted so severely after the wounds had healed that he arrived at Sidcup unable to open or close it. The acid in his saliva that dribbled out in a constant uncontrollable stream was causing dreadful sores. Even the resilient Gillies considered Vicarage’s injuries ‘appalling’.
As Gillies lifted the skin flap from Vicarage’s chest it rolled over and he had the idea to sew the grafted skin into a tube before fixing it on to the damaged part of the face. This procedure, which became known as the pedicle method, ensured that the underside of the healthy tissue was no longer open and exposed to possible infection. The tube embedded itself into the damaged skin and at the join, new tissue began to grow. Gradually Vicarage’s new face began to form from the ‘slender pink orchidaceous stalks’.
Some of Gillies’s work involved repairing the hasty, unfeeling botched jobs made on prisoners of war by German surgeons. Gillies was appalled to find a nose full of hair growing in the centre of one unfortunate man’s face because a graft on the nose had been taken from above his hairline.
Not every operation was successful. Herbert Lumley from the Royal Flying Corps, a jaunty pipe-smoking lad, was so badly wounded on his very first solo flight that although Gillies operated on him with particular urgency the skin graft would not settle and soon turned gangrenous. Survival was impossible. The terrifying ulcerous sight prompted the ever conscientious Gillies to remind himself, ‘Never do today what can honourably be put off to tomorrow.’
The healing period between bouts of surgery meant the hospital corridors were full of hideous faces with slits instead of eyes, vacant bloody spaces which had once contained noses, skewed and distorted mouths with tongues lolling uncontrollably, huge and grotesque from a jawless chin. These were the patients, as Ward Muir observed, ‘at whom you are afraid to gaze unflinchingly: not afraid for yourself but afraid for him’.
Often the convalescent men could not eat or drink and were given unlimited quantities of egg nog to provide the protein their bodies needed. Chickens were kept on the hospital estate, their eggs vital for the nourishing drink, while the huge demand for milk to make up the other component of the ‘nog’ was provided by the herds of cows that munched their way along the nearby grassy Sidcup fields.
Captain Jono Wilson had been sitting in front next to the tank driver in 1917 as they rolled towards Cambrai when for one moment he had raised his helmeted head over the top. His nose was the least protected part of the face. A German shell made a direct hit. The driver crumpled lifeless into his seat while Jono plastered his field dressing on to the hole in his own face and took a swig of rum. German prisoners carried him along the quayside at Boulogne and within the day he was ‘happily ensconced in Major Harold Gillies’s Face Hospital’. From there he was able to hear the bells of Sidcup ringing out to celebrate victory.
Although Captain Wilson acknowledged that ‘a face hospital is perhaps one of the most depressing’ of all such places, the atmosphere at Sidcup was often buoyant. The patients gave themselves the exclusive licence to describe each other as ‘ugly’. There was laughter and music. A pilot strummed the piano with the burned bones of fleshless fingers and through lips that had been restored by Gillies, sang the refrain, ‘And now I’ve got a mother-in-law from drinking whisky through a straw.’ He had married his nurse.
Between operations men would leave the hospital grounds to go into Sidcup village wearing their distinguishing uniform of bright cornflower blue jackets and red ties, objects of curiosity and fear to almost all but themselves and those who cared for them. Blue benches were placed in strategic parts of the town, the colour a warning code that fearful sights might be seated on them. Publicans were forbidden to serve the patients alcoholic drinks for fear that tempers might suddenly fray. One man, Jocky Anderson, on celebrating the end of his fiftieth operation, managed to get hold of some alcohol and had returned to his ward, paralytic with drink, and smashed up everything in sight.
By the end of the war 11,572 major facial operations had been performed and gradually Gillies saw the number of cases before him diminishing. Men were returning to civilian life. Sydney Beldham, a new nose replacing the cobbled mash that had arrived in the operating theatre a year earlier, was employed in the proud job of chauffeuring his saviour. Infantryman Herbert Alfred Palmer had, in his enthusiasm to fight for his country, signed up at the beginning of the war at the age of 15, using his elder brother Edward’s identity to mask his age. Five years later, with the broken structure of his face rebuilt, he founded the Bromley and Bickley Working Men’s Club. Harry Reynolds met his wife at a hospital dance and trained as a radiographer. Mickey Shirlaw, a Motherwell miner, became fascinated by dental reconstruction and was trained by Archie Lane as a dental technician.
Another patient, Guardsman Maggs of the Welsh Guards, gave his surgeon such professional satisfaction that he was persuaded to make something of an exhibition of himself and his exemplary new nose in front of the British Medical Association. Invited to enter the room, Gillies spoke to him. But Guardsman Maggs did not recognise the French words that Gillies used and in his embarrassment flushed scarlet from neck to forehead. ‘Look, look,’ said a delighted Gillies as the blood travelled to all parts of the man’s face, even reaching the tip of the guardsman’s nose.
But some post-operative men did not have the self-confidence of Guardsman Maggs. Many continued to find it impossible to muster the courage to appear in daylight, seeking refuge in work as projectionists in the screened-off booths of cinemas. Others were beginning to risk public reaction. Stanley Cohen had been injured two months before the end of the war, his face seared in a tank fire. Having survived the gruelling post-operative recovery period, Stanley Cohen remained fearful of testing public reaction to the still shocking sight of his face. With Gillies’s help he had become the Sidcup nightwatchman, reassured that the cover of darkness would give him the protection he craved. And yet his friends were perplexed when Cohen started teaching at the local Sunday school. Where had he found the courage to expose his face to the judgment of other human beings? The explanation was simple. While adults showed revulsion, children merely greeted Cohen with curiosity. With children he was safe.
Devastating as the physical scarring could be, damage to the mind was sometimes even more catastrophic and those
outwardly blemish-free suffered just as deeply. The wounded and limbless were obvious to those who came across them in almost every town and village in the country. Those scarred in mind were not. Men collapsed under the strain of an inability to tolerate or escape the memory of their war experience - Freud’s ‘unendurable realities’ of the physical world. In the trenches the men had whispered to one another, ‘He’s a bit rocky upstairs’, or ‘He’s gone a bit barmy’ - a misleadingly anodyne term, from a pre-war abbreviation for the Barming Hospital at Maid-stone. Flesh on shell-shocked faces shook with fear, and teeth continually chattered. ‘A thousand-yard stare’ was often used to describe the dazed vacancy in the eyes of a severely damaged soldier. Some doctors thought the condition was a result of extreme disturbance of the fluid around the brain caused by long-term exposure to gunfire.
Robert Graves had heard the lasting mental trauma of war explained as ‘a morbid condition of the blood due to the stimulation of the thyroid gland by noise and fear’. But a correspondent in November 1919 in the Illustrated London News went deeper, attributing the signs of hysteria to ‘aboulie or will-less-ness. The patient, worn out by the struggle against external circumstances, abandons the exercise of his own will and drifts with the stream of things, unaware of where he is going.’
The chief outward signs, easily recognisable, included the dropping of the corners of the mouth, a lolling tongue and a lack of movement in the eyes, with the lids partially closed. In addition an irritation to the sole of the foot made many of those who suffered from shell shock spread their toes apart. Some could barely stand upright, and walked with a jerky movement that was termed ‘the hysterical gait’. Many adopted a stoop and a shuffle that resembled the tentative steps of a nervous skater. Seizures and shuddering fits were frequent. Many lived in a silent world. The effect of the guns had made them completely deaf. Sometimes the behaviour of a shell-shocked victim was fitful, unpredictable, miserable, embittered, sometimes physically violent, and sometimes – and for the wives, fiancees, daughters, lovers, aunts and grandmothers, perhaps worst of all – these men were simply silent. The Italian term for the apathy induced by shell shock was ‘depressive-soporose amentia’ – the last word denoting ‘absence of mind’.
The Great Silence: Britain from the Shadow of the First World War to the Dawn of the Jazz Age Page 8