The Great Silence (10 page)

Derwent Wood promoted his work to the sceptical by explaining that ‘the patient acquires his old self-respect, self-assurance, self-reliance, takes once more a pride in his personal appearance. His presence is no longer a source of melancholy to himself nor of sadness to his relatives and friends.’ Usually all the patient wanted was to become a face indistinguishable in the crowd.

After the mutilated face had been surgically patched up and given time to heal, Derwent Wood’s work began. Once ‘the surgeon has done all he can to heal wounds, to support fleshy tissue by bone grafting’, he explained, he would try and restore the missing parts with his sculpting skills. The face would be smothered in wet clay. After a ghastly claustrophobic interlude, the cast would be dried and removed before a working model was produced from plasticine. From this model the basic copper mask would be made and the prosthetic pieces such as nose or chin would then be grafted on to fit. Eyebrows and eyelashes, glass eyes that had an impressively lifelike glint, hair made from copper wire and moustaches were all then added and glasses were usually used to hold the mask in place. When an eye socket was missing and there was no place into which a glass eye might be slipped, the paintbrush worked its magic, waking up the mask to the illusion of sightfulness.

The copper absorbed the painted facial characteristics with ease and these were added in enamel while the mask was in place in order to match the skin tone of the wearer more accurately. Sometimes a tell-tale sign of chipped paint or rust became visible to the observer and a touch-up visit to the artist was arranged. Enormous
trouble was taken to find the right colour of paint that would look natural when exposed to bright sunshine, dull weather, or to electric light. A balance was sought between a newly shaved shine with a trace of blue-tone and the faint stubble of later in the day. Sometimes electric light would catch the glint of the paint, the unnatural gleam on the face giving away the artificiality of the skin.

The mask weighed between four and nine ounces, the equivalent of anything from a half to a full cup of butter, and measured one thirty-second of an inch thick, or in the estimation of one society lady, the width of a visiting card. For most of the wearers the masks were horribly uncomfortable as the tin rubbed against the ravaged face beneath producing a nearly intolerable sensation. Anything that touched the acutely sensitive and delicate new skin was an irritant. However one grateful patient told Mrs Ladd in her Paris workshop that his emotional life had been totally restored. ‘The woman I love no longer finds me repulsive,’ he wrote, admitting, ‘as she had a right to do’.

In her French studio Anna Coleman Ladd was delighted that this newfound confidence encouraged her patients to ‘twirl their artificial mustachios with all the verve and aplomb so characteristic of your true Gaul’. Some men were so delighted with the chance to live a near normal life that they allowed the fitting to be filmed. The process demanded the frequent removal of the mask while the smallest adjustments were made and the camera closed in on the contrasting faces, the one destroyed, the other resurrected.

The mask was incapable of ageing, a gift not bestowed on other parts of the body, leading in later years to an incongruous mismatch. And all the ingenuity of the artist was defeated by the challenge of making the mask smile, laugh, frown, look surprised or even happy. The face was completely and eerily immobile. Unlike a living face, with its infinite variety of response, the tin mask remained capable only of the one expression imposed by the artist. The masks were as alive as the effigies on tombs in churches up and down the country, the effigies of the dead. And unresponsiveness, fragility and strange physical sensations were not the only drawbacks. The device for concealing a face, initially convincingly real but on closer examination absolutely
un
real, forced the imagination to concentrate on the truth of the dreadful Stygian picture beneath the mask.

Ladd and Wood expected their masks to have a lifespan of just a few years before wear and tear would cause them to rust and crumble. Some masks remained unworn in their boxes. The young plastic surgeon, Harold Gillies, was not surprised. At his own plastic surgery hospital in Sidcup, one of Gillies’s convalescent patients was halfway through a sequence of operations, recovering from one as the healing process took place before his damaged skin was well enough for the next session under Gillies’s restorative hand. This particular patient had been given a temporary leather mask to wear on a day’s visit to London. The patient would leave the reception desk with a jaunty wave, and make for the railway station. At the end of the day the front door would swing open to reveal a fearful sight. The man had long grown tired of being stared at in the railway carriage and it had become his habit and little private game with himself to whip the mask off when the maximum number of pale-faced ladies had gathered in his carriage. Returning to the hospital he would hold up the appropriate amount of fingers to indicate the number of victims he had succeeded in terrorising.

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.

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, while 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’.