Blood and Guts (26 page)

However, while society mocked her for her medical mistake
(behind her back, of course), Gladys continued her climb up the
steps of the social ladder. In 1921 she finally made it into the British
aristocracy by marrying the 9th Duke of Marlborough and taking up
residence at Blenheim Palace in Oxfordshire. But despite being a
duchess, she was becoming more and more depressed.

By the 1940s, her marriage having failed, she was to be found
living in a ramshackle farmhouse. She slept on a broken mattress
surrounded by the squalor of cats, rotting food, papers and books.
Gladys was becoming increasingly frail, isolated and paranoid, and
it wasn't long before four men in white coats came to literally drag
her away.

Gladys Deacon died in her sleep in a Northampton psychiatric
hospital in 1977. The funeral was poorly attended. Most people had
forgotten Gladys Deacon, Duchess of Marlborough. People said that
in her later years she would sit by the fire, letting the heat of the
flames soften the paraffin beneath her skin so that she could move
it around her face. Gladys never did get the perfect nose.

Queen's Hospital, Sidcup, Kent, 1917

It was difficult to look at Lieutenant William Spreckley without
experiencing a feeling of utter revulsion. Even the man himself
sometimes wished he had been killed when the bullet hit him. His
existence, he felt, was almost a living death. He had been passed
from the trenches at Ypres to casualty station to hospital before
finally ending up in Sidcup, but he didn't hold out much hope for
his chances. He would be disfigured for the rest of his life, shunned
by society – perhaps even by his own family.

William had a sad, haunted look in his eyes. Although lucky to
be alive, he was feeling sorry for himself. Bullets sliced through
whatever material they met – whether it was wood, metal or human
flesh. Most of his comrades had been cut down: some were killed
instantly, others wounded fatally, the rest permanently disabled.
William could remember a bright flash of light but, strangely, experienced
little pain. He was stretchered away to the crowded tents of
the field hospital, where he expected to be left to die. Instead, over
the next few weeks he started to recover. He knew his face was
damaged, but the nurses and doctors refused him a mirror. The
surgeons stitched him up and nurses changed his dressings. By the
time William arrived at Sidcup his wounds had healed well. He was
fit and healthy. Everything was fine, except for his face.

Instead of a nose he had an ugly, gaping hole. The skin had
grown inwards, and what remained of the interior – red tissue
and bone – could be seen through the black hollow. The left side
of his face was distorted around the hole; a series of lateral scars
had healed to draw down the skin beneath his eye, revealing the
lower part of his eyeball. But this was nothing compared to the
missing nose.

Queen's in Sidcup was the first hospital in the world dedicated
to plastic surgery, and the surroundings couldn't be more different
from what William had experienced in the trenches. Built in the
grounds of a stately home, the hospital was encircled by gardens
and tall trees, and even boasted a beautifully manicured croquet
lawn. The single-storey wards, treatment rooms and operating
theatres were arranged in a horseshoe shape around a central
admissions block. Each ward was designed to hold twenty-six
beds and included a veranda so that patients could lie outside in
the fresh air to help their convalescence (fresh air was considered
vital for recovery).

Queen's was the brainchild of surgeon Harold Gillies. He had
entered the war as a junior Red Cross doctor in 1914, and had been
horrified by the injuries he saw. But Gillies was even more shocked
to discover how little British surgeons were able to do to piece
soldiers back together. Their techniques were primitive and wholly
inadequate. No one had anticipated the terrible carnage – the faces
that were blown apart, the missing noses or jaws, the melted flesh
and jagged scars. All the surgeons could do was draw the edges of
the wounds together, wait for the scars to heal and post their
patients back to the trenches to fight another day.

Gillies decided to dedicate his life to plastic surgery, and taught
himself everything there was to know about facial reconstruction.
Over the next three years (while continuing to work in hospitals in
France and England) he studied obsessively, wading through textbooks
and research papers. He even enrolled in an art school so
that he could learn how to draw detailed diagrams of his surgery.
Eventually, he managed to convince the army medical authorities
that they needed a dedicated hospital to treat facial deformities.
When Queen's Hospital opened in the summer of 1917, Gillies –
now Britain's foremost plastic surgeon – was appointed to run it. He
was ready to put his vast knowledge of plastic surgery to the test.

William Spreckley was one of the first patients to be admitted
to the new hospital. When Gillies examined the young soldier
he decided he could do better than simply give Spreckley a new
nose. He wanted to improve on the crude efforts of previous generations
of surgeons and give Spreckley a nose that really looked
like a nose, not some crude flap of skin twisted down from the forehead
or grown from the upper arm. He made careful measurements
of Spreckley's face and set about planning a series of
intricate operations.

Because Spreckley's nose was missing completely, Gillies
planned to re-create both the skin and the cartilage supporting it.
Rather than repeat the disastrous experiments of his Victorian
predecessors and use animal cartilage or synthetic alternatives,
Gillies chose to take the cartilage from elsewhere on his patient's
body. After drawing up a complicated set of diagrams and technical
notes – he believed in the importance of preparation – he was
ready to operate.

In the whitewashed, airy operating theatre, with its powerful
electric lighting and enormous picture windows, Lieutenant
Spreckley is put to sleep.
^*
Gillies, dressed in his sterilized surgical
gown, his hands washed in alcohol and covered with fresh rubber
gloves, is ready to make his first incision. He cuts into William's
chest. The first part of the operation is ingenious and involves
removing a small, rectangular piece of cartilage from the soldier's
ribcage. Gillies intends to shape this into the support for the nose.

^*
A major advance in anaesthetics was made at Queen's Hospital. In 1919 Ivan Magill
developed endotracheal intubation – the technique of passing a rubber tube through the
patient's nose or mouth to allow the gas to flow directly into the trachea. This was not only a
more precise means of delivering an anaesthetic, it also overcame a problem that had plagued
reconstructive surgery. During the many hours surgeons spent leaning close to their patients'
faces, and therefore the gas intake pipe, they often ended up breathing in the anaesthetic. It
was not unknown for surgeons to fall asleep during operations.

Cutting the cartilage carefully, he bends it along the middle and
then cuts away part of the central section to leave a narrow stem. He
is left with a shape that resembles an arrow. It has a wide piece at
one end, a narrow shaft and a bow-shaped tip. The wide part will
form the bridge of the nose; the lower arrowhead will support the
nostrils. Once Gillies is confident that the cartilage is the right
shape, he slices open a flap of skin on William's forehead and transplants
the cartilage under the surface.

When Spreckley recovered from the operation, he looked even
more deformed than when he had first been admitted to the hospital.
Instead of a flat forehead – which had been undamaged by the
bullet – he now had a pronounced, arrow-shaped bump under his
skin. The arrow was pointing diagonally upwards from the centre of
his lower forehead towards the line of his hair. Gillies was, in effect,
growing Spreckley a new nose in the middle of his forehead. Several
weeks later, once Spreckley's forehead was fully healed, Gillies
moved on to the next operation.

Cutting carefully, to leave the cartilage intact, Gillies slices a
flap of skin from Spreckley's forehead. Making certain not to
damage the pedicle, he twists the skin around to form a new
nose. The cartilage keeps the structure from collapsing, although
the resulting protrusion is hardly attractive. Beneath the angry,
triangular-shaped scar on Spreckley's forehead, the new nose
balloons out across the soldier's face. He has gone from having
no nose to having a swollen, comic representation of a nose. It is
horrible. Other patients joke that Gillies has transplanted a trunk
in the middle of the poor man's face. Even the surgeon himself
remarks in his case notes that 'the new, bloated columella stuck
ahead like an anteater's snout and all my colleagues roared with
laughter'. But the surgeon is far from finished.

The operations continue. The swelling gradually subsides and
the pedicle is severed. Gillies closes the forehead scar and cuts away
the excess tissue. He shapes the nostrils and defines the shape of the
new nose, cutting or pulling in excess skin. By the time Spreckley is
discharged his face is almost as good as new. The transformation is
truly remarkable. Looking at him, you would never know that his
nose had been rebuilt from his ribcage and forehead.

Spreckley was so grateful that he named his son Michael Gillies
in honour of the surgeon who had restored his face.

The techniques Gillies had used for Spreckley were courageous,
innovative and largely experimental. Although his operations were
meticulous and his antiseptic techniques rigorous, there was always
a risk that something could go wrong. The thing Gillies feared most
was infection. If a wound became infected, there was little he could
do.
^*
Nevertheless, the cases that were coming to the hospital
demanded that he try even more daring operations.

^*
There were no effective antibiotics until the discovery of sulphonamide drugs in the 1930s.
By the end of the Second World War, military surgeons also had penicillin at their disposal,
which dramatically cut the number of hospital deaths.

Second Lieutenant Henry Lumley of the Royal Flying Corps was
barely recognizable as human. His face was no longer covered in
skin – it had melted into a red shiny mask of thin epithelium. His
eyes were wide sockets with no eyelids or brows. His nose was pulled
upwards, his lips – if they could even be called lips any more – were
wide and inflamed, and his mouth scarred.

Lumley had never seen combat. During his first mission, in the
summer of 1916, his plane crashed to the ground in a ball of flames.
Pilots were not issued with parachutes, so when the fuel tank caught
alight, Lumley was trapped in a fireball of petrol. His face, scalp,
hands, fingers and legs were all severely burnt. Some areas of his
head were protected by his helmet and scarf, but no one knew how
he had managed to survive. He might well have been better off
dead. Lumley was admitted to Queen's Hospital on 22 October
1917. He had spent the previous year being patched up by various
medical centres before he was finally referred to Gillies. It was the
surgeon's toughest case yet.

Over the next month, Lumley was made as comfortable as
possible while Gillies planned a series of operations. The surgeon
proposed using skin from the pilot's chest to re-create his face.
He would connect it with pedicles from the pilot's neck, and
augment it with flaps of tissue from his shoulders. Gillies also
decided to use paraffin wax and even attempt using a skin graft
from another patient.

The first operation to prepare Lumley's face goes reasonably
well and the patient seems to be making good progress. The second
operation is about to begin. Lumley is anaesthetized on the operating
table, his body propped up so his head is high. He has been
stripped to the waist and his chest painted yellow with iodine. On
the skin of his chest Gillies has drawn a face. There are spots for the
eyes, marks for the nose and a long, narrow gap for the mouth. This
outline will be Lumley's new face. It is a daring plan.

Gillies cuts and scrapes away the scar tissue from Lumley's face,
leaving it horribly raw and red – blood seeping through to cover it
in a glistening sheen. He then carefully cuts along the pencil lines
on Lumley's chest until he has created a large (face-shaped) flap of
skin. He lifts this up and places it across the airman's face, making
sure to line up the holes for the eyes, nose and mouth. Then he
begins to sew. Carefully and methodically, he attaches the new face
across the remains of the old. When he has finished, he dresses the
chest wound. The whole operation takes five hours. The surgeon is
exhausted. The patient is terribly weak, his pulse faint. Now it is a
question of waiting.

The first day after the operation, Lumley is definitely improving.
The blood supply from the pedicles to the face seems to be
working. On the second day, the graft starts to become infected.
The doctors work desperately to stop the infection spreading.
They try massaging the skin, pricking it with needles and cupping
it (see Chapter 1) to increase the blood supply. By the third day,
Lumley's new face is completely gangrenous. The pedicles from
the shoulders are no longer supplying any blood and are gradually
withering away.

By the tenth day, the dead skin has to be scraped off. Gillies
records in the case notes that a foul discharge was expelled. The
remaining pedicles are now only barely attached, and Gillies does
what he can to save the blood supply. The doctors cleanse the
wounds and spray them with paraffin wax. Later that day the patient
is moved to an open-air hut in the hospital grounds.