London, UK (Spring 2016)
The two World Wars that occupied the first half of the twentieth century are exceptional events primarily because of their immense loss of life made possible by new technical “advances.” This paper, however, is preoccupied with those who were forced to endure life beyond war, the soldiers and civilians who returned to Britain for treatment for burn injuries at the hands of new technologies and, in turn, drove advances in the fields of medicine and surgery. The narratives surrounding these two “outbreaks” of burns diverge significantly. Burn related injuries in the First World War were presented as a stigmatising and shameful indictment on British society and on individual humanity. Second World War conceptions of such injuries, however, were situated within a nationalistic rhetoric that permitted survivors to construct disfigured identities in patriotic terms.
Burns and the First World War
The use of new and unconventional arms started from the beginning of the First World War with the adoption of chemical weapons such as mustard gas grenades and chlorine shells.1 The French named mustard gas “L’Yperite,” after its first deployment at Ypres where it killed and maimed over ten thousand people. Mustard gas is a chemical vesicant, inflicting burns to the skin and eyes, as well as inducing acute respiratory distress. The military health system faced new challenges as these new weapons presented novel medical syndromes, which fell on particular domains such as the field of plastic surgery.
Harold Gillies was a New Zealander and a plastic surgeon working in the Royal Army Medical Corps during the war when he was placed in charge of the Queen’s Hospital for disfigured servicemen in Sidcup, England.2 It was here that he developed cutting edge surgical techniques such as grafting and pedicle tubes.3 Between 1917 and 1925 he treated 5000 of the most severely injured servicemen, conducting over 17,000 operations. Gillies described his patients as “men burned and maimed to the condition of animals”,4 and it is this sense of horror that remained permanently inscribed in the testaments of Gillies’ patients.
Henry Tonks, a surgeon and medical artist, employed by Harold Gillies as a painter, created an exceptionally rich archive of paintings and sketches at Sidcup.5 At the time of creation, his documentation of facial burns remained in use largely within medical circles as a means of tracing treatment trajectories; however, it also serves as a modern reminder of the intensity of trauma that the epidemic of burns unleashed on its victims.2 Tonks does not attempt to hide this trauma in his paintings, yet he himself admitted that the burned men made “rather dreadful subjects for public view.” It is this attitude that broadly defined the response of British visual culture and its aversion to representing the horror of such injuries.5 That burn injuries were represented in textual format in detail but hidden from visual aesthetic representations reflects the notion of disfigurement, particularly facial disfigurement as “the worst loss of all,” as a “loss of humanity” that was simply too challenging for a country overwhelmed by the horror and loss of war to reconcile.6
Stigma is a constant operator in contexts of disfigurement, thus it was particularly acute in this patient group. Biernoff (2010) has written of the serviceman’s body as a “site of bereavement and commemoration,” and it is this notion of the serviceman’s body as a site of collective appreciation of trauma that in some way explains British society’s aversion to these new forms of human bodies. The Queen’s Hospital was itself celebrated for its seclusion and the ability to keep the men away from sight of the nearby community.2,6 Wards were stripped of mirrors, patients cut ties with their families and fiancés, and images of the burned were censored in newspapers.6 This was in stark contrast to the experience of amputees at the time, who were presented in the media as war heroes, wounded but retaining essential masculinity and humanity. Joanna Bourke has argued in “Dismembering the Male: Men’s Bodies, Britain and the Great War” that the iconography of the male body in war was contingent on notions of heroic sacrifice that could not be sustained alongside the atrocity of mutilation.7 The imagery of the intact face draws on the logic of Christian art in which it is the site of Christ-like transcendence at the instant of destruction,13 and thus the mutilation rendered by facial burns cannot be reconciled with the “rightful” enterprise of a moral conflict.
Contemporary media provides a lens through which to discuss a core dimension of the historic response to First World War burn injuries: appropriation.5 The modern video game Bioshock uses Tonks’ portraits of wounded servicemen to inspire the artwork for the zombies that are the targets for reaping in the game’s post-apocalyptic universe.5 Returning to the idea of the body as a site of commemoration, the appropriation of images of named victims for modern pastimes challenges the discourse of the ritual remembrance of war. Bioshock’s zombie characters are now a legitimate site of violence, something to be heroically cleansed from the world of the game, and thus the historic victims of unimaginable trauma have become victims of the violence of modern imagination.
As is common in war narratives, the story of an individual death becomes subsumed by the imagery of the collective dead. Enmeshed in messages of fear, stigma and appropriation, the individual tragedies can be transformed into rhetorics of power and control. In the case of burned servicemen this power was transmitted by the erasure not only of their experience—but also their humanity—as part of the privileging of nationalistic discourses by the institutions of control, the media, and the state.
The Second World War – What Was Different the Second Time Round?
Unlike the Great War, the majority of Second World War burn victims were airmen who gained their injuries in air-to-air combat which was a new and critical feature of warfare at this time.10 These burns were more difficult to treat than those seen before, yet survival rates had increased significantly, thus even more patients were being admitted to Royal Air Force hospitals for treatment of their disfiguring injuries.8
Archibald McIndoe, the cousin of Harold Gillies, came to the UK from New Zealand in order to train in plastic surgery.9 McIndoe was placed in charge of the Queen Victoria Hospital in East Grinstead and rapidly gained a reputation for his innovation in surgical techniques.10 He introduced the saline baths that remain standard treatment today, and he revived and refined techniques such as eyelid grafting, pedicle tubes and hand reconstruction that are still fundamental techniques of plastic surgery.2 McIndoe would conduct regular tours of RAF hospitals and would select the most severely injured amongst the patients to come to East Grinstead to be his “guinea pigs.” This led to the formation of the Guinea Pig Club— a drinking club of 650 burnt airmen.9
In addition to the reconstruction of his patients in hospital, McIndoe was insistent that they also be reconstructed as social beings within the community. He was forceful in encouraging his patients to go into East Grinstead, and upon hearing of some initial reticence from the community, he pleaded with local people to “look them directly in the face,” framing his request in the narrative of young men sacrificing their faces for the freedom of all.9 McIndoe had something of the Weberian charisma about him for his direct approach was extremely successful; the village even named a pub “The Guinea Pig” after the men who came to be a cornerstone of the community. The Reader’s Digest of October 1943 wrote a piece about this phenomenon.11
McIndoe’s ethos was that his guinea pigs should not simply be repaired but celebrated and that this “requires the personal attention of the surgeon.”10 Through McIndoe’s efforts, the public meaning of war injury shifted from amputees and slings to “ordeal by fire”— a major move from the conceptions of burn injuries during the First World War.2,10 Disfigurement therefore became a badge of honour, of masculinity, and of heroism. Finally the faces of the burned became the sites of commemoration that had failed to materialise in the Great War.
The lessons of these burn events teach us that no burden of illness is asocial. Whilst stigma is almost ubiquitous in contexts of disfigurement, it is by no means inevitable; the conscious reframing of narratives as directed by McIndoe presents us with an alternative way of seeing disfigurement as heroic rather than threatening. In viewing these burn events in terms of their medical and social implications, the value of caregiving emerges as a crucial paradigm in which to conceptualise national and professional responses to challenging new forms of illness. Burn injuries continue to be highly stigmatising despite the ongoing work of burn professionals, however the lessons of these two wars demonstrate the potential to present highly specified forms of injury in ways that counter the lazy narratives of disfigurement and horror that persist in contemporary culture.
- O’Graphy T, 1914-1918: La médecine et la chirurgie pendant la Première Guerre Mondiale, http://wp.me/p1hB6m-1P5 – last accessed 12/08/15, translated by the author.
- Joshi R, The Art and Wartime Surgery of GIllies, Pickerill, McIndoe and Mowlem, Otago University Press 2015
- Gillies H, Plastic Surgery of The Face, London, 1920
- Pound R, Gillies: Surgeon Extraordinary, Michael Joseph, London, 1964
- Biernoff S, Medical Archives and digital culture: from WW1 to BioShock, Med Hist. 2011 Jul;55(3):325-30
- Biernoff S (a), Flesh Poems: Henry Tonks and the Art of Surgery, Vis Cult Br. 2010 Mar;11(1):25-47
- Bourke J, Dismembering the Male: Men’s Bodies, Britain and the Great War, Reaktion, 1996 p.213
- Atiyeh BS, Gunn SWA, Hayek SN, Military and Civilian Burn Injuries During Armed Conflict, Anns Burns Fire Disaster 2007 Dec 31; 20(4): 203-215
- Piercy S (director), The Guinea Pig Club (motion picture). Canada: Infinity Films (2009)
- Mayhew ER, (2004) The Reconstruction of Warriors, Frontline Books, Barnesley. pp170, 171, 201, 202
- Reader’s Digest, November 1943, Published in The Guinea Pig, January 1983
Gemma Bowsher is a clinical medical student at King’s College London, currently undertaking a master’s in medical anthropology at Harvard University where she is researching burn care and surgery. Gemma completed her Bsc in Global Health, also at King’s, and is now a research fellow at Conflict and Health Research Group at the King’s Centre for Global Health, where she pursues work on intelligence, global security and health, as well as the role of surgery in war. email@example.com/