Whether as a painting or as a photograph or even as a sculpture, portraiture is one of the main achievement of Western art. Perhaps no other culture has been so interested in the human likeness, focusing on the face, its moods, its expressions, as the revelation of a soul than the Europeans. Without a face, there can be no portrait, without a face there can be no human contact. The Great War presented society with a unique problem—men without faces, soldiers whose faces had been torn apart by shrapnel and ripped open by grenades and seared away by fire jetting out from flamethrowers or endured while their planes crashed to earth. This war also marked a point in medical science when a soldier could live with catastrophic wounds, even grievous harm to the face, removing the ears, eyes, mouth, nose, jaw, mouth and so on. In Otto Dix’s famous painting, The Scat Players (1920), the faces of the soldiers were maimed and disfigured, showing wounds that were, in the early twentieth century, survivable, but raised questions about the quality of that life.
Because of the lethal and damaging weapons used during the Great War, the soldiers of the Great War suffered a great and terrible loss—the face, that which gives each human being his or her sense of identity. In addition to this loss of self, these partial visages, hollowed out with craters like the dark side of the moon, frightened friends, family, wives and children. These men could not go out in public without prosthetic replacements and/or plastic surgery. Among the pioneers of modern reconstructive surgery in England were an artist and a doctor, Harold Gillies (1882-1960). The artist was Henry Tonks (1862-1937), a famed art teacher at the Slade School of Fine Arts in London, who was, despite his excellence as an instructor, a decidedly minor artist. In the first decades of the twentieth century, his paintings were at best a British version of Post-Impressionism, in line with the more famous painter, Walter Sickert (1860-1942), but Tonks produced a crop of some of the most important British military artists of the century. And when it was his turn, he joined the ranks of his student soldiers. Teaming with Harold Gilles, Tonks changed the definition of “portrait,” just as the Great War was challenging the definition of the “face.”
In his book, Making the Body Beautiful: A Cultural History of Aesthetic Surgery, Sander Gilman writes of the German surgeon Jakob Lewin (Jacques) Joseph, called the “Father of Modern Aesthetic Surgery.” Joseph trained under a pioneer in orthopaedics, but he developed his own interest in plastic surgery for aesthetic purposes, beginning with a child who was suffering from ears so large, he refused to attend school. After he was in private practice, Joseph operated on a similar case: an adult male who had heard of the successful ear operation and asked the surgeon to redesign his large nose. The importance of this early work late in the nineteenth century is that Joseph published a radical theory that people with facial disfigurements suffered psychologically as much as if they were physically impaired. He named the desire to look “normal” as “anti-dysplasia” and did not consider wanting to look presentable to society as vanity but as a natural desire to fit in. By the time the War began, Joseph was a famous reconstructive surgeon and his services were called upon by his country. A patriot, he helped a number of German soldiers, and the Emperor himself offered him the Chair for Plastic Surgery at the Charité Hospital in Berlin. But there was a condition to Wilhelm II’s offer: Joseph had to convert to Christianity. Proud of his Jewish heritage, the surgeon refused. A year later in 1916, the Prussian Ministry for Ecclesiastical and Educational Matters offered him, without condition, a Department of Facial Plastic Surgery at Charité. At the end of the War, he was awarded the Iron Cross for his services.
The mentor, of sorts, for the New Zealand surgeon, Harold Gilles, was Hippolyte Morestin, who was born in Martinique and was a renounced plastic surgeon in his own time. An article in 1972 by J. P. Lalardrie in the British Journal of Plastic Surgery explained that the surgeon published six hundred and thirty four articles in French, which limited his reputation in England, but he was a versatile doctor who started as a cancer surgeon, focusing on the mouth and cheek, a speciality, which led him to reconstructive surgery. Because he worked on the human fact, Morestin quickly came to understand the importance of achieving aesthetic effect in a time when surgeons never gave the psychology of their patients much thought. He even pioneered in breast surgery that spared the women’s bodies and even did early face lifts. When the Great War began, he was immediately drafted and sent to the Val de Grace Hospital in charge of facial injuries. But after a year, Morestin left the service and returned to Paris. Gilles, an ear, nose and throat specialist, found him at Val de Grace in 1915. Morestin allowed the doctor watch him remove a large cancerous growth on the face. Gilles, upon observing Morestin in action, wrote later: “In the space of a single moment he could reveal the gentleness of a kitten and the savagery of a tiger. He received me kindly, and I stood spellbound as he removed half of a face distorted with a horrible cancer and then deftly turned a neck flap to restore not only the cheek but the side of the nose and lip, in one shot. Although in the light of present-day knowledge it seems unlikely that this repair would have been wholly successful, at that time it was the most thrilling thing I had ever seen. I fell in love with the work on the spot.” When Gilles returned for a second visit, the moody Morestin refused to allow him in his operating theater.
Blair O. Rogers wrote about Morestin in 1982 for Aesthetic Plastic Surgery, stating that he was a quiet, moody, and unfortunately, a lonely man” of “part Negro background. ..even in enlightened France with its widespread colonial empire, his racial admixture might have left him with the feeling of being a member of a minority..” Sadly, he died of the influenza epidemic that swept Europe in 1918, after the War was over. Morestin was only forty-nine years old.
One of the most successful reconstructive surgeon of her time, was Suzanne Nöel (1878-1954), whose learning curve in redesigning faces spanned two world wars. She interned under Morestin in Paris and learned reconstructive surgery from the master, who coined the term “aesthetic surgery.” Her early career was quite remarkable, as she moved from being the upper class wife of dermatologist who encouraged her to study medicine, to being a brilliant student and intern on track to enter into elite medical circles. She left her husband and lived on her own with her daughter, while she worked in the dermatological department at La Pitié Hospital with Professors Morestin and Brocq. When war broke out, she was with Brocq at the Saint-Louis Hospital in Paris, following her interest in aesthetic surgery. Her estranged husband went into the field to work at the Front, winning medals for his courage and his service. Meanwhile, the soldiers with the worst facial wounds were sent to Saint Louis Hospital. In 1916, Nöel joined her mentors–Brocq at Saint Louis and Morestin at Val-de-Grâce. As her biographer, Paula J. Martin wrote, “This is perhaps the greatest learning experience in her academic career as she gained incredible skills performing reconstructive surgery on wounded soldiers whose faces had been partially amputated and were in need of severe facial reconstruction. In sort, she was in the right place to significantly increase her knowledge of cosmetic surgery; she was interning at the precise time in history when a war provided a large number of patients with previously unheard of physical damage, and she was working with the best reconstructive surgeons in the world–specifically her mentor Morestin, who taught her to be bole and steadfast, and to take calculated risks on the operating table.”
Nöel also apprenticed herself to Dr. Thierry de Martel who was a neurosurgeon with extensive knowledge in facial nerves. As Martin tells it in her book, Suzanne Noël: Cosmetic Surgery, Feminism and Beauty in Early Twentieth-Century France, she continued to hone her surgical skills and worked as a reconstructive surgeon with the Association of Refugees in Aisne. In addition, Nöel volunteered at the American Hospital in France, a haven for those with the most severe facial injuries were treated. She won a silver medal of National Recognition for distinguished conduct in 1918. Using the knowledge she gained on remaking the human faces torn by war, Nöel became a plastic surgery after the War was over. The author Sander L. Gilman explained that during these early years of plastic surgery, there was a “tension” between “serious reconstructive” work and “frivolous” aesthetic surgery, a professional quarrel that dogged the careers of the early surgeons. Gilman also made an interesting point about the new breed of reconstructive surgeons serving on the Western Front. “It is striking,” he wrote, “that many of the major figures in European reconstructive (as well as aesthetic) surgery in the generations from 1880 to World War I were themselves perceived as ‘marginal’ to the cultures where they worked. They were colonials or Jews or people of mixed race or women–for whom the problem of ‘passing’ was and remained a central feature in the psychic lives. Their new roles as aesthetic surgeons gave the the ‘neutral’ status of physicians..”
It was up to these marginalized doctors to perform miracles for desperately wounded men. In her book, Medicine in First World War Europe: Soldiers, Medics, Pacifists, Fiona Reid pointed out that these soldiers suffered from what were termed “iconic wounds,” which included gas and shell shock, along with facial injury. “These were not necessarily the most debilitating of wounds; nor were they the most devastating in terms of wastage. They have, however, come to symbolize the war on the Western Front, albeit with some national variation: facial wounds have become tremendously important in the French social and political history of the First World War, while shell shock occupies a similar position in British understandings of the war. In all of these cases, the wounded soldier exemplifies the ‘pity of war‘ rather than the progress of medicine.” She noted on her chapter on these iconic wounds, that “bad cases” of facial wounds “invoked horror or revulsion rather than sympathy. In French, the term les gueules cassées (literally ‘broken mouths’) refers to the gaping mouth of an animal not a human being, rendering the term essentially dehumanizing. In Germany, men with severe facial wounds were most commonly described as Gesichts-Entstellten, using the pejorative ‘twisted’ to describe the face. Alternatively, they were Menschen ohne Gesicht, men without faces, or men without the most significant marker of humanity.” She continued, “It was not easy to care for these men, and medical staff were so affected by these wounds because the social, cultural, and emotional value of the face can be hardly overstated: ‘losing face’ is shameful, we ‘face up’ to the world when we are courageous, we ‘show a face‘ when we are needed and women even ‘put on a face‘ when leaving the house..Men with damaged faces were isolated, even from themselves, as they endured long periods in hospital where mirrors were forbidden and men could only guess at their own appearances by looking at the faces of one another..during the Napoleonic Wars facially wounded men were generally killed by their comrades ‘to spare them further misery.‘“
According to the BBC series on facial wounds during the Great War, when the soldiers were finally discharged after years of surgery they re-entered the world with caution and difficulty. “Nearby park benches were painted blue to designate them for men with facial injuries. However it was also done to warn local residents that the appearance of men using them may be distressing. Some men could re-enter the workforce, but they were often too embarrassed to be in public and so would be hidden away in back-rooms.” It was these terrible medical problems that forced artists to become doctors and doctors to become artists and the medical profession to redesign the human body.