A fate worse than death? Facial injuries and facial reconstruction at the King George Military hospital

The pioneering surgeon Harold Delf Gillies was born in Dunedin, New Zealand, in 1882. During the Great War he developed astonishing techniques of surgical facial reconstruction for troops who had suffered devastating facial injuries.  The collection of drawings and photographs of his patients is part of the Gillies Archive at St Mary’s Hospital, Sidcup (formerly the Queen’s Hospital, which opened in 1917). The work of Gillies and his colleagues has recently reached a wider audience after the publication of Pat Barker’s Toby’s Room, in which one character, the war artist Neville, is a patient at the Queen’s Hospital.

The watercolour sketches of patients from the Queen’s Hospital – some of which were painted by notable artists –  are not easy to look at. Serious facial injuries made pariahs of their victims, many of whom could never re-enter civilian life because of public reaction to their disfigurement. While a man with a missing arm or leg, a blind man, or even a mildly ‘shell shocked’ man could acquire the status of a ‘returning hero’ who had suffered for his country but in a socially acceptable manner, a soldier whose face had been half blown away by an explosion or made unrecognisable by a severe burn, was a particularly jarring example of the cruellest realities of conflict. While Gillies and his colleagues could work miracles, a patient had to undergo multiple operations, and the results could easily be undone by post-operative infection, or a patient simply being unable to sustain the stress and pain of repeated surgery. Added to this, the psychological effects of these injuries were huge: a patient might fear the reaction of friends and family to his face as he progressed through the surgical process, and for many the prospect of leaving the safety of the hospital to face the general public was terrifying. Gillies and his team recognised the importance of working to reduce the psychological damage, but sometimes their task must have seemed overwhelming.

Rather like victims of severe ‘shell-shock’ (see Peter Barham’s book Forgotten Lunatics of the Great War) or those whose multiple bodily injuries made them almost completely helpless, the victims of serious facial injuries – and especially those whom the skill of Gillies and his colleagues could not restore to some semblance of ‘normality’ – were a group whose lives and relationships were often made unendurable at the age of 19 or 20. If they were older, family men, their faces might terrify their children, and their futures were wrecked. Their trauma would, in turn, affect the future of their families and friends. The psychological reverberation of a single gun shot affected more lives than just that of the man hit by the bullet. Of course, this was not the case for everybody. That were were some wounds which were more acceptable that others, and that the suffering of all wounded troups was not regarded as equal is itself sobering. We often consider, for example, the plight of those wounded servicemen who could not find work in civilian life, and had to take menial jobs in the ‘Land fit for heroes’, but what about the servicemen who lived out their lives hidden from the world, either because they were too ill or mutilated to lead any sort of independent life, or whose sense of shame at their appearance made them isolate themselves? This disturbing legacy is something to reflect upon in 2014, the first year of Great War anniversary commemoration, especially as many of the problems I have just mentioned still affect injured servicemen today.

When I was doing a module on The History of Madness in Modern Europe, taught by Birkbeck College at the Wellcome Collection, I wrote ann essay on the treatment of ‘war neuroses’, and also spent some time looking at images from the Gillies Archive online. This week when I was at the Wellcome Library, I saw that Natalie Walters had written an article for the Wellcome Library Blog about the archive of another important surgical team which worked on facial injuries. This archive contains collections of photographs of patients in various stages of facial reconstruction at the King George Military Hospital, London.  Once again, these are often difficult photographs to look at, but they are also inspiring if one considers the surgical process. Presented with a man missing a large portion of his face, including bits of bone which seem vital, how did the surgeons decide upon a course of action? Their task had few precedents: this was truly pioneering work, and one marvels at the innovation and skill which restored these ravaged men. As Natalie Walters mentions, the suffering and bravery of the patients did serve a purpose: it prompted huge advances in facial surgery, as well as the treatment of severe burns, amongst other severe injuries. While contemplation of the archive from the King George Military Hospital is not easy, it provides an opportunity for reflection on what, paradoxically, was one of the positive medical advances prompted by the 1914-1918 War.

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