Authors: Juliet Nicolson
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’.
Dr W. R. Houston, a professor of medicine from the University of Georgia who had looked after many shell-shocked patients at the front, noted that some had emerged from battle with their vocal cords destroyed and their tongues paralysed, making them incapable of talking. Not only was speech denied them, but they had also become incapable of making ‘the slightest sound, to whistle or to blow, or even to imitate the movements of the lip in speech’. Silence had become an absolute way of life. Sight was often affected and memory weakened, and yet the intensity of hallucination brought the sufferer into a world filled with fire and battle that became a constant torture. It was
the agitation of the mind
, according to Dr Houston, that demonstrated the most acute form of this ‘wreckage of men’s souls’ and he was profoundly shaken by the time he spent with what had once been ‘the flower and vigour of youth,’ now become ‘doddering palsied wrecks, quivering at a sound, dreading the visions of the night’.
Robert Graves had recovered quickly enough from the physical symptoms of the flu but in the refuge of his bedroom, shells continued to explode with such ferocity on his bedclothes that the sound of his own screams woke him. Strangers suddenly assumed the faces of those friends he had last seen rotting in the trenches.
Graves made some effort to check his ‘unrestrainedly foul language’ picked up in the trenches, but the telephone became an instrument of terror to him, and he would relieve himself by the side of the road with no attempt at discretion. The effort of seeing more than two people in one day prevented him from sleeping. Peaceful fields became tactical challenges for wartime defence strategies. Wives were baffled by husbands who complained they had been covered with lice since 1917.
The medical establishment was at a loss as to how to deal with this mental plague. Sir Anthony Bowlby, Surgeon in Ordinary to the King, wrote in the
Lancet
that he had always been convinced that the remedy for shock was warmth and that the physical wounds should be given the greatest attention. ‘You can increase blood volume by fluids,’ he wrote, adding that when soldiers are unable to keep the fluids down ‘a rectal injection is most useful’.
C. S. Myers was one of the leading psychiatrists who tried to restore peace to troubled minds. Myers thought that if appropriate ideas were suggested to anaesthetised patients, memory might return. But when the words, ‘German shells’, were shouted into a soldier’s ear it took the strength of five men to restrain him. Another neurologist, the Canadian Louis Yealland who worked at the National Hospital in Queen’s Square in London, used a mixture of electrical therapy and chastisement. ‘Remember you must behave as the hero I expect you to be,’ he would tell his patients. ‘A man who has gone through so many battles should have better control of himself.’ Other ‘cures’ included the introduction of ‘galvanic currents’ as electricity was pumped into the patient, often ‘until the deaf hear, the dumb speak or those who believe themselves incapable of moving certain groups of muscles are moving them freely’.
A product called ‘Tabloid’ had been promoted in the pages of the
British Medical Journal
during the war as an antidote for ‘a vital war-time problem’. This codeine-based effervescent tablet was recommended as helping with ‘nervous disorder attributable to shock and acute tension’. Daily warm baths, a month in the country and the therapeutic exercise of basket weaving were also proposed as help for the condition. But a suspicion that cowardice lurked behind some of this mental distress prompted certain doctors to treat the
suffering men with impatience. Those reluctant to return to the trenches after being invalided home were suspected of deliberately affecting the shuddering and shaking common to shell-shock cases, and doubters would mutter cynically under their breath, in the colloquialism for a shirker, ‘He’s swinging the lead.’ Doctors saw dreadful self-inflicted wounds, cut inches deep into the hands, indicating the desperate lengths to which men would go not to be sent back to battle. There was little sympathy for those who stated simply that the prospect of returning to the front was intolerable. Cowardice and subsequent desertion was an offence punishable by death.
Shell shock was suspected of being open to calculated abuse. On 3 January 1919 an officer, Lieutenant Charles Robert Melsomm, was court-martialled for drunkenness at his mess in Peckham. Lieutenant Melsomm however denied the charges, alleging that he had been sent home from France suffering from neurasthenia and that his behaviour in the mess was caused by no more than a few alcoholic ‘appetisers’ that had an impact on a nervous state that was outside his control.
The Times
had reported the imaginative testimony given by James Kendall during his prosecution by Kent Police. The suspect milk that Kendall had been found to be selling had, he claimed, come straight from innocent cows, but as the poor animals had been milked shortly after an air raid, the milk had emerged tainted as a result of bovine shell shock.