Before the Great War there seems to have been little attention paid to the state of mind of the patient or to the psychological well being of the medical subject. Although psychology was emerging as a separate field of study, one of the major practitioners, Sigmund Freud (1856-1939) was not well known. Freud would work in Vienna, marginalized because of his Jewishness. After the Great War, his writings, which included Studies on Hysteria, co-authored with Josef Breuer in 1895, The Interpretation of Dreams in 1900, The Psychopathology of Everyday Life in 1901, Three Essays on the Theory of Sexuality and Jokes and Their Relation to the Unconscious, both in 1905, Totem and Taboo: Resemblances Between the Mental Lives of Savages and Neurotics in 1913, and, during the War, Introduction to Psychoanalysis, published in 1917. This was an astonishing outpouring of clinical and theoretical work, little of which was known in Europe. It was in America where Freud was first studied and, incidentally, where he was first reinterpreted to suit a different culture that the doctor first became famous. The point is that the entire medical profession in Europe, on both sides, entered the Great War with little or no preparation for the “iconic wounds” they would encounter–shell shock or psychic trauma and facial wounds that destroyed the psychology of the patients. Harold Gilles, who had studied briefly under a famous French reconstructive surgeon, Hippolyte Morestin, had learned from him the craft of rebuilding a face. But he also began to understand the importance of his work on the British soldier who came under his care in terms of giving a man a new face and a new state of mind. He convinced the authorities that his patients with facial wounds needed special care and insisted that the soldiers coming off the battlefield be given a special identification card so they could be directed to the correct facility for specialized care. This care would be holistic, healing the body and healing the mind as well. After the long and terrible battle of the Somme, when the number of facial injuries rose the new hospital specializing in damaged faces at Sidcup was set up. The existence of such a site was important was men with like injuries were gathered together and segregated from other more conventional injuries. Here at Sidcup, they were granted merciful privacy and the time and the experienced and trained physicians and their aides that were attuned to their particular needs.This new thousand bed hospital was modeled upon the Roehampton Hospital for amputees. Here at Sidcup the soldiers became patients, enduring many operations over months or years, without antibiotics to prevent infection.
According to Peter Liddle in his book, Britain and a Widening War, 1915-1916: From Gallipoli to the Somme, Harold Gilles had learned from the difficult Morestin who tended to isolate himself from his colleagues and assembled a large team to work with. Gilles brought together a group of surgeons including Ear Nose and Throat, Oral surgeons and dentists, the focus of the ire of Morestin, radiologists and anaesthetists. Faced with faces that were terrible destroyed, the physicians realized that existing medical illustrations and operative procedures were not helpful for these unprecedented wounds. As Liddle wrote, “By late 1915 Gilles decided that written operation notes needed to be supported by portraits of the patients. He realized that drawing an occasional diagram to illustrate a procedure was insufficient as an aide-memoire for the surgeons, but did not capture change over time, and did not allow case notes to serve as a basis for training other surgeons to undertake procedures successfully. Gilles arranged for a photographer to be attached to the unit, and developed a systematic approach to visual record-keeping, obtaining black and white photographs of full face, profile and oblique (right and left) for each patient. Some surgical detail could only be depicted in a color image, so Gilles was pleased when Henry Tonks turned up at Aldershot to help the war effort.”
Like his many students, art teacher Henry Tonks served in the Great War as an artist. But, as a former medical student, Tonks gravitated towards the soldiers who were among the most traumatized and the most in need: men without faces. As Gillies revealed decades later, “Unlike the student of today, who is weaned on small scar excisions and graduates to harelips, we were suddenly asked to produce half a face.” A doctor who believed that he should work towards an aesthetic outcome, Gillies worked with Henry Tonks, who did pastels of the men “before” that could be compared to the “after” recreated by Gillies. Tonks followed the New Zealand doctor to Frognal House at Sidcup to help take care of troops from Great Britain, including separate units for Canadian, Australian and New Zealanders.
The team of two artists, amateur and professional, Harold Gillies and Henry Tonks, was well matched. Tonks was a painter, who had trained in medicine, and Gillies, a surgeon, was an amateur artist. Horrified by the sight of “men burned and maimed to the condition of animals,” Gillies pioneered in modern plastic surgery, a practice he termed “a strange new art.” And Tonks asked, “faced with crushed faces and torn flesh, what is the surgeon supposed to draw?” A soldier needed to trust Tonks completely to sit quietly before the artist, gaze at the artist in a straight level look that was needed for the artist to study and for history to remember. Each pastel softly rendered by Tonks is intimate, an exchange of looks between a victim and a possible deliverer, who are face to face, so to speak. In hospitals, such interactions are matter of fact, masking the great sensitivity necessary to work with the patient to recreate the face.
Copying pre-war photographs of his patients, Gillies would then do his best to recover a resemblance, a likeness, enough recognition of his former self—his face–to allow the veteran to return home, perhaps even have a productive life. As Liddle noted, “Photographs played other important roles. Each patient had his own photographic record to remind him of his progress and improvement. This record was also a permanent reminder that even if his new appearance were not entirely satisfactory, it was far better at the end than at the start, and certainly better than nothing at all. Photographic series were often shown to new patients, often as traumatized by the expectations of continuing disfigurement as by the injury itself, to give them hope of eventual improvement..This approach was psychological support even before it was even recognized as such. Patients also developed their own self-help structure. The long stays allowed them to get to know each other, and they supported each other as new patients arrived and they moved to and from the hospital, convalescent unit and home.”
According to Jenny Edkins in Face Politics, that although Tonks was part of the team, drawing diagrams of the operations for the case record of each patient, it was not clear what his function was. “Whatever the intention,” she wrote, “Tonks’ drawings represented an encounter between patient and artist. They were drawing from life, not from a photograph, as was the practice with other medical artists. They involved a direct interaction with the sitter–whether this was at the person’s bedside or in a more conventional portrait sitting or studio setting is not known.” As was pointed out in the previous chapter, in France and in Germany, the men who suffered from facial injuries defiantly in public as political gestures, but in England, this history of facial reconstruction was hidden away. In her article, “Losing Face: Trauma and Maxillofacial Injury in the First World War,” Fiona Reid compared these casualties to those of the men with shell shock and explained, “In Britain, it is the shell-shocked man who has become emblematic of the collective trauma of the Great War; his mental anguish was a direct result of the strain and the violence of trench warfare and his inability to fight appeals to a wider popular sense that this was a futile war. Men with facial injuries occupied a different category. Their trauma was not a direct result of war but was a response to the disfigurements caused by battle and so their histories highlight not just the horrors of war but also the difficulties of homecoming, primarily the fear of being ostracized and marginalized. Unlike shell-shocked men, the facially wounded could not be removed from the site of trauma; on the contrary, their trauma was an inescapable and permanent feature of their own bodies.”
Reid pointed out that while there is a vast trove of visual documents, drawings and photographs, there was no attempt to record the thoughts of the men during the process. As Suzannne Biernoff wrote for Portraits of Violence: War and the Aesthetics of Disfigurement, “Tonks was aware that every artwork has its own life; that the drawings he was so satisfied with could be ‘dreadful’ in a different context. Unapologetically elitist, he produced drawings at Aldershot and Sidcup with two kinds of viewers in mind–medical and artistic–both, in his view, professional..”
Biernoff called his work “anti-portraits,” an interesting terminology indicating that they were private not for public viewing, which is the main purpose of any portrait. But to continue her thought, Tonks, in this context, could not produce a “portrait” because there was no face to replicate. What was was gone and what would be was not to come. Tonks could capture “before” and “after” but he would have rarely seen the “result,” the eventual face after the surgical procedures had stopped and the body had settled into its final state. Tonks was working in an interstitial site, where the outcome was unknown. What he drew was less a face than a design; less a portrait than a map to reconstruction; and more of a process of refabricating another face. As Biernoff said, “Tonks..regarded his surgical studies as inappropriate for public consumption, and complained of the visitors to the hospital who treated the drawings as one of the ‘sights.’”
No doubt because he was mindful of the emotional impact of his many studies of the effects of modern war on the human face, Henry Tonks refused to allow the public to see these intimate and terrifyingly frank drawings and kept his studies hidden. Finally, the collection was acquired by the Royal College of Surgeons in London and was not see again until the Faces of War exhibition at the National Army Museum in 2008.