1. Facial injury and disfigurement since the First World War
1914FACES2014 Educational Resources: Teacher’s Pack
Part 1: What are we looking at?
· Image 1: Soldier with facial wounds by Henry Tonks (1916-1918)
This portrait of a serviceman shows severe burns and facial injuries. Tonks, a surgeon, became a lieutenant in the Royal Army Medical Corps in 1916. Tonks worked with Harold Gillies - the plastic surgery pioneer - treating British serviceman who had being severely injured in combat in Sidcup, south-east London, and also in Aldershot. His role was to record the work that had been done and to provide diagrams before surgery was carried out. Although he was a trained surgeon he was also an accomplished artist who had studied in the evenings at the Westminster School of Art. He painted a series of portraits of men before and after they underwent surgery.
· Images 2-3: William Kearsley
William Kearsley, a 25-year-old infantryman from Inverell, NSW. In October 1917 shrapnel struck Kearsey in the face, severely gashing his face.
See also http://www.theguardian.com/world/postcolonial/2014/may/26/broken-gargoyles-the-disfigured-soldiers-of-the-first-world-war
· Image 4: English army medical officer making a mould for a soldier's facial injury
See also http://www.theguardian.com/world/postcolonial/2014/may/26/broken-gargoyles-the-disfigured-soldiers-of-the-first-world-war
· Images 5-7: The Officers’ Ward (French, La chambre des officiers)
Originally a novel by Marc Dugain, published in 1998 (1999 in English). The novel was made into a film in 2001, directed by François Dupeyron and starring Eric Caravaca as the central character.
A young, handsome, French officer -- Adrien Fournier – is disfigured by shrapnel early in the First World War and meets the similarly scarred and disfigured Marguerite (Isabelle Renauld) in the Val-de-Grâce Hospital in Paris. She had been wounded while nursing on the Western Front.
See also: http://www.themakeupgallery.info/disfigured/facial/officiers.htm
Discussion questions:
- What are you looking at?
- How do you feel when you see these images?
- Which war do these pictures relate to?
- What do you think happened to William Kearsley?
- How did doctors/surgeons try to treat people like William?
- Why was it important to record what happened to these men, before and afterwards?
- Why were women also at risk of sustaining facial injuries in the First World War?
- Why were books written/films made about the facially injured of the First World War? Why were they made at the 80th anniversary of the war?
- Would you watch a film/read a book on this topic? Why/why not?
- Should only actors with facial injuries play the parts of facially injured characters?
Part 2 (slides 6-10)
How did this happen?
Why were there so many facial injuries in the First World War?
· Image 1: Recruitment poster
An example recruitment poster from the Parliamentary Recruiting Committee, London. Production date unknown but likely to be c.1914-15 prior to the introduction of conscription in January 1916.
· Image 2: British Army Training in the UK, WWI
See also: http://www.iwm.org.uk/history/15-photos-of-first-world-war-london
· Video 1: British Pathé: Collection of footage of army artillery in action
Includes: “6-Inch Howitzers in action shelling the German First Line Trenches of Mametz.”; “Firing Plum Puddings From Trench Mortars.”; “Bombarding the Germans with 9-2 Inch Howitzers.”
See also: http://www.britishpathe.com/video/first-world-war-artillery
· Image 3: ‘A Howitzer Firing’ by Paul Nash (1918)
See also: http://www.britishpathe.com/video/first-world-war-artillery
Discussion questions:
- Why do you think men were persuaded to fight by recruiting posters that featured references to their King and country?
- How many British men volunteered for the war? Why did these men volunteer?[2.5 million by 1915; a further 2.5 million via conscription]
- What do you see in the contemporary footage/images of artillery? What are the weapons like?
- What kind of damage could they do? What is their purpose and how is that linked to winning a war?
- Why were weapons like these given names like ‘Big Bertha’, ‘Whizz bangs’ or ‘Plum puddings’?
- Why has the First World War been described as a mechanised, industrial war?
- It what ways (related to weaponry and artillery) was the First World War the first of its kind?
Part 3 (slides 14 – 19): Plastic surgery in the First World War: ethics & collaboration
Slide 14: Why was it important to repair the damaged faces?
· 1st objective: Return the men to the front as quickly as possible
· Avoid disheartening others
· Facilitate return home
Who was Harold Gillies?
In order to care for the thousands of combatants who came back with facial injuries, several specialised units were set up across Britain. The largest one was in Sidcup, Kent, where a whole maxillofacial hospital was created in 1917. One of the key people involved was surgeon Harold Gillies.
Harold Gillies was born in New Zealand but he studied medicine at Cambridge University, in Great Britain. When the war broke out he went to the front and served in France. He worked with French dentist Charles Valadier and realised that there were far more facial injuries than the authorities had anticipated, and that something needed to be done. Upon his return in England he opened a special unit for facially wounded combatants at the Cambridge military hospital. He later supervised the foundation of The Queen’s Hospital. This was a dedicated maxillofacial centre where about 8,000 soldiers and officers from Britain and the Empire, were treated. There was a Canadian, an Australian and a New Zealand wing.
What challenges did plastic surgeons face during WWI?
· Delay with which the wounded reached hospital
· High rate of infection (due to mud, transport conditions…)
· The sheer number of patients needing care
· Only the beginnings of anaesthesia, blood transfusion and skin/bone graft
SLIDES 13-15: Examples of facial reconstruction: case studies (slides ©Royal College of Surgeons of England)
Slide 15: What problem did Lieutenant Stacey have?
His nose had been badly damaged. Here we see how it was reconstructed.
Firstly, we see Stacey with the tubed pedicle raised from his forehead and joined to his nose. The tubed pedicle would stay in position connected to the injury for anything between 3-6 weeks on average. The tubed pedicle is cut severed mid-length the portion attached to the nose is opened and used to repair the hole in the face just below the eye. The portion attached to the forehead is opened and returned to the forehead from which it was originally taken. After further surgical refinement, the graft to repair Stacey’s injury is barely noticeable.
The treatment was recorded through photographs, drawings, pastels like Tonks’s and plaster casts.
SLIDES 20-23: Collaboration
Who contributed to the process of facial reconstruction?
· Nurses
· Dentists
· X-ray specialists (X-rays just starting)
· Photographer
· Sculptor for plaster casts. Sculptors also worked alongside the surgeons, their portraits recorded the treatment but they also contributed to the success of the surgery. Wax models and plaster casts for instance gave a better idea of volumes and pastels of colours. The relationship between the artists and the patients was also different from their relationship with the surgeons.
· Artists such as Tonks. Henry Tonks was both an artist and surgeon trained at The Slade School of Art. Gillies discovered he was working in the hospital as a secretary, and requested that Tonks joined the clinical team at Sidcup. He painted many of Gillies’ patients. What difference do you notice between Tonks’ pastels and photographs? (colour, realism, empathy…)
Discussion points
Why did plastic surgery boom during the First World War?
Who was involved in the development of this medical speciality?
Why did artists/sculptors and surgeons work together?
What do photographs, pastels and casts add to our understanding of early plastic surgery?
How do these examples change the ways we think about disfigurement?
Part 4 (Slides 20-24)
How were the facially injured men helped?
In addition to reconstructive surgery, other factors contributed to helping the facially injured combatants.
Slide 19: Masks and epitheses: Francis Derwent Wood and Anna Coleman Ladd
Masks and facial attachments were used by some facially injured soldiers as a temporary cover, for example when they wanted to travel outside of hospital. Some masks were made with the idea that the men could wear them permanently, however they were rather uncomfortable and deteriorated rapidly.
Sources: Horace Nicholls, ‘Repairing war’s ravages: renovating facial injuries. The patient after a plate was fixed for the spectacles to cover the wound. The sculptor was Captain Derwent Wood, RA, 3rd London General Hospital’ © IWM (check copyright)
Slide 20: The nurses’ role.
Facially injured men spent often long periods of time in hospital, and the nurses and ward orderlies who took care of them got to know them well. They were there when the men realised the extent of the damage to their faces, they sometimes helped them feed themselves, watched over them after an operation. They also taught them skills, and sought to enable the wounded to become independent again, to gain their self-respect back.
Sources: Catherine Black, King’s Nurse – Beggar’s Nurse: An Autobiography (London: Hurst & Blackett, 1939), pp. 84–89
Slide 21: Training: Lobley paintings
Offering workshops and classes to the patients was a way not only to keep them busy in between operations, but also to prepare their return to civilian life. Some of the wounded could not return to their previous jobs, and measures were taken to train them in different trades.
Sources: John Hodgson Lobley, The toy-makers’ shop and The commercial class (c. 1918), IWM 6756 and 3767
Discussion questions:
What types of different help were offered? (i.e. examples of practical, emotional support …)
Who could help the disfigured men? (medical staff, but also families and themselves)
Why was it important to offer classes and workshops for patients in hospital?
Part 5: Slides 22 – 24
How did people react?
Slide 23: Testimonies of Percy Clare describing the first moments after his injury, and of Ward Muir, ward orderly at the 3rd London General Hospital where sculptor Francis Derwent Wood also worked. Both of these texts underline the difficulty for others to face wounded soldiers.
On the battlefield: rescue parties prioritised more ‘promising’ cases.
In hospital: even experienced staff found it hard to support facially wounded servicemen
Slide 24: Descriptions of non-combatants’ reactions. There were as many different reactions as people but facial disfigurement did not always lead to a break-down in relationships.
The mother’s reaction: she gets over her initial shock
The newspaper article: encourages readers to help facially injured combatants through supporting the newly-opened Sidcup Queen’s Hospital. It also reveals the fear that the men would not reintegrate and wold become ‘burdens’ for the rest of society.
Discussion questions
How did people react to people with a disfigurement at the time?
How do you think these attitudes have changed today?
Why, in popular films/TV series/books, are people with facial disfigurement often depicted in a negative way?
How do these examples change the ways we think about disfigurement?
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