Sorry, this entry is only available in Italian.
I have wrote in the past about how plastic surgery was originally born during the Great War as reconstructive surgery. If a soldier missing an arm or a leg was indeed a familiar figure, the introduction of new weapons during the world conflict led to the appearance of a kind of wounds precedently almost unheard of: the gueules cassées, “disfigured faces”.
Helmets were able to protect the head from granade splinters, but not the face; therefore field hospitals began to receive an unimaginable number of soldier whose faces had been blown away in large portions by the explosions.
It was an injury rarely discussed in the press, where the more iconic and patriotic image of the veteran amputee was considered more suitable, but the numbers speak for themselves: within English troops alone, 41.000 amputations were carried out, as opposed to the 60.500 men who suffered head or eye injury.
One had a higher probability of finding himself without a face rather than without legs.
Practically on every front, experimental procedures were adopted to reconstruct faces destroyed by shrapnel or burned by mustard gas.
In January 1916, at the military hospital in Aldershot, England, pioneer surgeon Harold Gillies encountered doctor Henry Tonks, who was serving as a temporary lieutenant in the Royal Army Medical Corps.
Henry Tonks was a doctor and an artist: besides being part of the Royal College of Surgeons, he also taught drawing and anatomy at the Slade Academy.
Soldiers were sent back from the front in desperate conditions, and Tonks had the feeling that he could not handle, from a professional and humane point of view, such a catastrophe. As he himself confessed in a letter: “I have decided that I am not any use as a doctor“. And in another letter he recounted: “the wounds are horrible, and I for one will be against wars in the future, you have no right to ask men to endure such suffering. It would not matter if the wounds did well but they are practically all septic“.
And as the war progressed, things did not improve. After the Somme offensive, on July the 1st 1916, more than 2.000 patients flooded the hospital: “men without half their faces; men burned and maimed to the condition of animal“.
Thus, when Gillies asked Tonks to document his reconstructive operations by portraying the patients’ faces before and after surgery, Tonks happily accepted, as he was certainly more at ease in the artistic dimension.
To draw portraits could seem redundant, as photographs of the disfigured soldiers were already being taken, but both doctors were convinced that the cold-hearted objectiveness of film could be misleading in respect to the tactile and expressive qualities of a painting.
Thanks to his collaboration with Gillies, Henry Tonks produced a seried of facial wound portraits which still today stands unsurpassed for its emotional impact, scientific interest and subtlety of representation.
Sure, these pastel portraits had first of all a didactic intent, and the author himself did not wish them to be seen by the general public. And yet these works show a complexity that transcends their function of medical illustrations.
To understand how Tonks worked on his subjects, we have an extraordinary fortune: in some cases, the archives still have both his pastel portraits and the medical photographs. We can therefore watch, side by side, two images of the same patient, one recorded on film and the other one composed by the charcoal and colors of the artist.
Comparing Tonks’ drawings with the photographic shots, what emerges is the abstraction operated by the artist, which is meant to remove any hint at the patient’s suffering or interiority. These are accurate works, detached and at the same time compassionate, focusing mainly on the open wound, depicted with an almost “tactile” precision through the stratification of color (a consequence of the artist’s surgical training).
And yet the uncanny quality of these drawings lies in their absolutely modern ambiguity.
What could by all means be a portrait of a normal male face — ordinary traits, well-groomed hair, a knotted tie — becomes somehow “sabotaged” by the presence of the wound. It is as if our gaze, wondering over the painting’s surface, could register all these common details, just to be short-circuited the moment it meets the scandal of the injury. An inconceivable monstrosity, which appears impossible to integrate with the rest of the image.
It is then inevitable for us to fall back to the eyes of the portrayed subject, to his gaze fixed upon us, and to wonder about its impenetrable meaning.
Another peculiarity is the use of pastel, a medium considered “feminine” in respect to more virile, lively oil color or tempera; a choice that in this case allows for the lacerations of the flesh to be rendered in a softer and more tolerable way. What’s more, thanks to the lighter tone of these colors, Tonks provides his subjects with a delicate beauty and tenderness that no photograph could have ever captured.
These portraits seem as vulnerable as the mutilated youth they represent.
Suzannah Biernoff, in her wonderful essay Flesh Poems: Henry Tonks and the Art of Surgery (from which I stole most of the information for this post — you can read it in Visual Culture in Britain, n. 11, 2010) defines Henry Tonks’ works as “anti-portraits, in the sense that they stage the fragility and mutability of subjectivity rather than consolidating the self portrayed“.
Henry Tonks’ studies are set apart from classic medical illustration by virtue of this research of a particular beauty. They do not recoil from the horror they intend to portray, but cover it with a veil of elusive sensuality, in which a face becomes the sign of the uncertainty of existence, and a symbol of the cruelty Man inflicts upon himself.
Along the cove named Mallows Bay, the Potomac River flows placid and undisturbed. It’s been doing that for more than two million years, you’ll have to forgive if the river doesn’t seem much impressed.
Its fresh and rich waters glide along the banks, caressing the hulls of hundreds of submerged ships. Yes, because in this underwater graveyard at least 230 sunken ships lay on the bottom of the river — a surreal tribute, here in Maryland, 30 miles south of Washington DC, a memento of a war among “featherless bipeds”, and of a military strategy that proved disastrous.
On April the 2nd, 1917, President Woodrow Wilson called Americans to arms against imperial Germany. This meant carrying dietary, human and military resources across the Atlantic Ocean, which was infested by German submarines. And supporting an army overseas meant to build the most majestic fleet in the history of mankind. In february 1917, engineer Frederic Eustis proposed an apparently irreproachable plan to lower costs and solve the problem: the construction of wooden ships, cheaper and faster to assemble than iron ships; a fleet so vast as to outnumber the inevitable losses due to submarines, thus able to bring food and weapons to European shores.
But, amidst beaurocratic and engineering delays, the project ironically did not hold water right from the start. Deadlines were not met, and in October 1918 only 134 wooden ships were completed; 263 were half-finished. When Germany surrendered on November 11th, not a single one of these ships had left port.
A legal battle to assert responsibilities ensued, as only 98 of the 731 commissioned ship had been delivered; and even these showed a weak and badly built structure, proving too small and costly to carry long-distance cargo. The maintenance costs for this fleet soon became excessive, and it was decided to cut out the entire operation, sinking the ships where they stood, one by one.
Today Mallows Bay harbours hundreds of fallen ships, which in time turned into a sort of natural reef, where a florid ecosystem thrives. As they were made of wood, these ships are by now part of the river’s habitat, and host algae and microorganisms that will in time erase this wartime folly, by turning it into a part of Potomac itself.
Mallows Bay is the largest ship graveyard in Western Hemisphere. As for the Eastern one, we should look for Truk (or Chuuk) Lagoon in Micronesia.
Here, during the course of another bloody war, WWII, hundreds of airplanes and other Japanese outposts were taken down during the so-called Hailstone operation.
On February 17, 1944, hell broke loose over this peaceful tropical lagoon, when US airforce sunk 50 Japanese ships and aorund 250 airplanes. At least 400 Japanese soldiers met their end here. Most of the fleet still remains in the place where it went down, under the enemy fire.
Foating on the surface of the lagoon’s clear waters, it is still possible to see the impressive structures of these wrecks; and several daredevils dive to explore the eerie panorama, where plane carcasses and battleship keels cover the ocean floor.
Rusted and sharp metal sheets, fluctuating cables and oil spills make the dive extremely dangerous. Yet this graveyard, the largest of its kind in the world, seems to offer an experience that is worth the risk. Among the bended metal of a by now ancient battle are still trapped the remains of those fighters Japan never managed to retrieve. Broken lives, terrible memories of a momentous conflict that claimed more victims than any other massacre.
And here, life flourished back again, covering the wrecks with luxurious corals and sea animals. As if to remind us that the world goes on anyway, never worrying about our fights, nor about the heroic victories we like to brag about.
(Thanks, Stefano Emilio!)
Sometimes the most unbelievable stories remain forever buried between the creases of history. But they may happen to leave a trail behind them, although very small; a little clue that, with a good deal of fortune and in the right hands, finally brings them to light. As archaeologists dig up treasures, historians unearth life’s peculiarities.
If Paul Grappe hadn’t been murdered by his wife on the 28th of July 1928, not a single hint to his peculiar story would have been found in the Archive of the Paris Police Prefecture. And if Fabrice Virgili, research manager at the CNRS, scrutinizing the abovementioned archives almost one hundred years later to write an article about conjugal violence at the beginning of the century, hadn’t given a look at that dossier…
The victim: Grappe Paul Joseph, born on the 30th of August 1891 in Haute Marne, resident 34 Rue de Bagnolet, shot dead on the 28th of July 1928.
The culprit: Landy Louise Gabrielle, born on the 10th of March 1892 in Paris, Grappe’s spouse.
This is how the life of Paul Grappe ended. But, as we go back through the years starting from the trial papers, we discover something really astonishing.
In the 1910s Paris sounds like a promise to a young man coming from Haute-Marne. It was mainly a working-class context and like everybody else the twenty-year-old Paul Grappe worked hard to make ends meet. He hadn’t received a proper education but the uncontrollable vitality that would mark out his entire existence encouraged him to work hard: with stubborn determination he obliged himself to study, and became an optician. He also attended some mandolin’s courses, where he met Louise Landy.
Their modest financial means didn’t interfere with their feelings: they fell in love and in 1911 they tied the knot. Shortly afterwards, Paul had to leave for military service, but managed to be appointed to stand guard over the bastions of Paris, in order to be close to his own Louise. Our soldier was a skilled runner, he could ride, swim (which was quite uncommon at the time) and he quickly distinguished himself until he was appointed corporal. Having spent the required two years on active service, Paul thought he was finally done with the army. But the War clouds were gathering, and everything quickly deteriorated. In August 1914 Paul Grappe was sent to the front to fight against Germany.
The 102nd Infantry division constantly moved, day after day, because the front was not well defined yet. Then gradually came the time to confront the enemy: at the beginning there were only small skirmishes, then came the first wounded, the first dead. And, finally, the real battle began. For the French, the most bloody stage of the entire world war was exactly this first battle, called Battle of the Frontiers, that claimed thousands of victims – more than 25,000 in one day, the 22nd of August 1914.
Paul Grappe was at the forefront. When Hell arrived, he had to confront its devastating brutality.
He was wounded in the leg at the end of August, he was treated and sent back to the trenches in October. The situation had changed, the front was stabilized, but the battles were not less dangerous. During a bloody gunfight Paul was wounded again, in the right index finger. A finger hit by a bullet? He was strongly suspected of having practiced self-mutilation, and in such situations people were not particularly kind to those who did something like that: Paul risked death penalty and summary execution. But some brothers in arms gave evidence for him, and Paul escaped the war court. Convalescent, he was moved to Chartres. December, January, February and March went by. Four months seemed to be too much time to recover from the loss of one single finger, and his superiors suspected that Paul was willingly reopening his wounds (like many other soldiers used to do); in April 1915 he was ordered to go back to the front. And it was here that, confronted with the perspective of going back to that horrible limbo made of barbed wire, mud, whistling bullets and cannon shots, Paul decided that he would change his life forever: he chose to desert.
He left the military hospital and, instead of going to the barracks, he caught the first train to Paris.
We can only imagine how Louise felt: she was happy to learn that her husband was safe and sound, far from the war, and afraid that everything could end at any moment, if he was discovered. During the spring of 1915 the army was desperately in need of men, even people declared unfit for military service were sent to the front, and consequently the efforts to find the missing deserters were redoubled. For three times the guards burst into the home of his mother-in-law, where Paul was hidden, but couldn’t find him.
As for Paul – that had always had a wild and untamed temper – he couldn’t stand the pressure of secrecy. He was obliged to live as a real prisoner, he didn’t dare stick his nose out of the door: simply walking down the streets of Paris, a young man in his twenties would have aroused suspicion at that time because all the young men – maybe with the exception of some ministry’s employees – were at the front.
One day, overcome by boredom, joking with Louise he chose one of her dresses and wore it. Why not dress up as a woman?
Louise and Paul took a turn. He had a careful shave; his wife put a delicate make-up on him, adjusted the female clothes, put his head into a lady’s little hat. It wasn’t a perfect disguise, but it might work.
Holding their breath, they went out in the streets. They walked down the road for a little while, pretending to be at ease. They sat down in a café, and realized that people apparently didn’t notice anything strange about those two friends that were enjoying their drinks. Coming back home, they shivered as they noticed a man that was intensely gazing at them, fixing them… the man finally whistled in admiration. It was the ultimate evidence: disguised as a woman, Paul was so convincing that he deceived even the attentive eye of a tombeur de femmes.
From that moment on, to the outside world, the two of them formed a couple of women who used to live together. Paul bought some clothes, adopted a more feminine hairstyle, learnt to change his voice. He chose the name of Suzanne Landgard. For those who take on a new identity, it is very important to choose a proper name, and Landgard could be interpreted as “he who protects (garde) Landy?”.
Now Paul/Suzanne could go out barefaced, he could also contribute to the family economy: while Louise worked in a company that produced educational materials, Suzanne started working in a tailor’s shop. But maybe she struggled to stay in her role, because, as far as we know, she frequently changed job because of problems concerning her relationship with her colleagues.
War was over, at last. Paul wanted to stop living undercover, but he was still in danger. Like many other deserters used to do at the time, also our couple left for Spain (a neutral country) and for a short time took shelter in the Basque Country. They returned to Paris in 1922.
But the atmosphere of the capital had changed: the so-called “crazy years” had just begun and Paris was a town that wanted to forget the war at any cost. It was therefore rich in novelties, artistic avant-gardes and unrestrained pleasures. Louise and Suzanne realized that after all they may look like two garçonnes, fashionable women flaunting a masculine hairdo and wearing trousers, shocking conservative people. Louise used to paint lead toy soldiers during the evening, after work, to make some extra money.
Paul couldn’t find a job instead, and his insatiable lust for life led him to spend some time at the Bois de Boulogne, a public park that during those years was a well known meeting point for free love: there gathered libertines, partner-swappers, prostitutes and pimps.
Did Paul, dressed as Suzanne, whore to bring some money home? Maybe he didn’t. Anyhow, he became one of the “queen” of the Bois.
From then on, his days became crowded with casual intercourses, orgies, female and male lovers, and even encoded newspaper ads. Paul/Suzanne even tried to convince Louise to participate in these erotic meetings, but this only fuelled the first conflicts within the couple, that was very close until then.
His thirst for experience was not yet satiated: in 1923 Suzanne Landgard was one of the first “women” that jumped with a parachute.
“You are not tall enough, my dear, I am a refined person, I want to get out of this mass, this brute mass that goes to work in the morning, like slaves do, and goes back home at evening”, he repeated to Louise.
In January 1924 the long awaited amnesty arrived at last.
The same morning in which the news was spread, Paul went down the stairs dressed as a man, without make-up. The porter of the apartment building was shocked as she saw him go out: “Madame Suzanne, have you gone crazy?” “I am not Suzanne, I am Paul Grappe and I am going to declare myself a deserter to apply for the amnesty.” As soon as the authorities learnt about his case, even the press discovered it. Some newspaper headlines read: “The transvestite deserter”. Prejudices started to circulate: paradoxically, now that he was discovered to be a man (so the two supposed lesbians were a married couple) Paul and Louise were evicted. The Communist Party mobilized to defend the two proletarians that were victims of prejudices, and in a short time Paul found himself at the core of an improvised social debate. The little popularity he gained maybe went to his head: believing that he may become a celebrity, or have some chance as an actor, he started to distribute autographed pictures of him both as a male and as a female and went as far as to hire a book agent.
But the more prosaic reality was that Paul told the fantastic story of his endeavours mostly in the cafés, to be offered some drinks. He showed the picture album of him as Suzanne, and also kept a dossier of obscene photographs, that are lost today. Little by little he started to drink at least five litres of wine per day. He lost one job after another, and turned aggressive even at home.
As he recovered his manhood – that same virility that condemned him to the horror of the trenches – he became violent. Before the Great War he had shown no signs of bisexuality nor violence, and most probably the traumas he suffered on the battlefield had a share in the quick descent of Paul Grappe into alcoholism, brutality and chaos.
He used to spend all the salary of his wife to get drunk. The episodes of domestic violence multiplied.
In a desperate attempt of reconciliation, Louise accepted to participate in her husband’s sexual games, and in order to please him (this is what she declared later in her deposition) took an attractive Spanish boy named Paco as her lover. But the unstable Paul didn’t appreciate her efforts, and started to feel annoyed by this third party. When he ordered his wife to leave Paul, Louise left him instead.
From that moment on, their story looks like the sad and well-known stories of many drifting couples: he found her at her mother’s home, he threatened her with a gun, and begged her to go back home with him. She surrendered, but she quickly discovered she was pregnant. Who was the father? Paul, or her lover Paco? In December 1925 the child was born, and Louise decided to call him Paul – obviously to reassure her husband about his fatherhood. The three of them lived a serene life for some months, like a real family. Paul started again to look for a job and tried to drink less. But it didn’t last. Crises and violence started again, until the night of the murder the man apparently went as far as to threaten to hurt his child. Louise killed Paul shooting twice at his head, then ran to the police headquarters to give herself up.
The trial had a certain media echo, because of the sensationalist hues of the story: the accused, the wife that shot dead the “transvestite deserter”, was represented by the famous lawyer Maurice Garçon. While Louise was in prison, her child died of meningitis. Therefore the lawyer insisted on the fact that the widow was also a mourning mother, a victim of conjugal violence that had to kill her husband to protect their infirm child – on the other hand he tried to play down the woman’s complicity in her husband’s desertion, transvestism, and shocking behaviours. In 1929, Louise Landy was declared innocent, which rarely happened in the case of trials for murder of the spouse. From that moment on Louise disappeared from any news section, and there was no more news about her except that she got married again, and then died in 1981.
The story of Paul Grappe, with all that it suggests about those troubled times, the traumas of the soldiers, the inner conflicts implied by gender, was discovered by Fabrice Virgili who told it in his book La garçonne et l’assassin : Histoire de Louise et de Paul, déserteur travesti dans le Paris des années folles (the title is ironical, and the garçonne is obviously Paul, whereas Louise is the murderer), and also inspired the comic strip by Chloé Cruchaudet entitled Mauvais genre.
L’uomo, sudato e terrorizzato, non smette di lamentarsi per il dolore, mentre due energumeni lo tengono fermo sul tavolo operatorio. Dalle gallerie superiori, gli studenti di medicina si sporgono per vedere meglio: la gamba del paziente è spezzata, l’osso esposto e la ferita in suppurazione. Di colpo, con grande fracasso, si aprono le porte del teatro anatomico ed entra il chirurgo. Indossa un grembiule di cuoio reso ormai rigido dalla quantità di sangue che l’ha intriso negli anni – un indumento che è uno status symbol perché dimostra l’esperienza di chi lo porta, ed induce rispetto e reverenza, in quegli anni in cui di “sterilità” e “germi” non si è ancora sentito parlare.
Il chirurgo si dirige velocemente al tavolo, impugna un enorme coltello e si rivolge al pubblico: “Cronometratemi, signori – chiede con voce stentorea e teatrale – cronometratemi!”. Gli studenti tirano fuori tutti assieme i loro orologi da tasca.
Di colpo il coltello affonda nel polpaccio dell’uomo, che urla come un forsennato, mentre il chirurgo taglia velocemente la sua carne. Il dottore in pochi secondi ha esposto la tibia, per non perdere tempo serra il coltello insanguinato fra i denti, e con la destra afferra una grossa sega con cui comincia a lavorare sull’osso, mentre il terribile rumore riecheggia, assieme alle grida del paziente, nel teatro ovale. Dopo un po’ di avanti e indietro con la sega, la gamba si stacca. Il chirurgo la butta in un secchio colmo di segatura, e comincia immediatamente a ricucire la ferita. Appena taglia l’ultimo filo, scatta l’applauso e si controllano gli orologi: l’operazione è durata soltanto due minuti e mezzo.
Forse pensate che questa scena sia frutto di fantasia, e che quel chirurgo sia un macellaio. Invece il suo nome è Robert Liston (1794-1847), ed è stato uno dei più importanti medici mai esistiti.
Fra il ‘700 e l’800 la medicina moderna era ancora agli albori, non esistevano misure sanitarie sicure e la mortalità dei pazienti, per forza di cose, era altissima. In questo quadro, la rapidità dell’operazione chirurgica era di vitale importanza: perdere anche soltanto qualche secondo poteva significare condannare il paziente a morte certa per emorragia (oltre che prolungare il suo dolore, visto che non c’era anestesia). Certo, le condizioni igieniche fuori e dentro la sala operatoria erano tali che il poveretto sarebbe quasi certamente morto qualche giorno dopo di cancrena o varie infezioni. Ma almeno aveva qualche possibilità in più.
Liston era uno dei chirurghi più veloci dei suoi tempi. Secondo alcune fonti era riuscito a rimuovere un arto in 28 secondi, un’impresa eccezionale, tanto che i testimoni raccontavano che passare dal coltello alla sega era per lui questione di un unico, armonico movimento. Certo, questa sua rapidità non poteva essere sempre associata alla precisione e talvolta Liston si rese protagonista di alcuni clamorosi errori. Una volta amputò una gamba in due minuti e mezzo, ma nell’entusiasmo asportò anche i testicoli del paziente.
Ma forse il più famigerato incidente avvenne durante un’operazione nella quale per sbaglio, nell’agitare il coltello, recise le dita al suo assistente, e tagliò attraverso il vestito di un distinto spettatore: anche se non era stato ferito, quest’ultimo ebbe un infarto dallo spavento e crollò morto; l’assistente e il paziente morirono in seguito di cancrena. Questa incredibile tragedia è passata alla storia come l’unica operazione chirurgica che abbia mai avuto una mortalità del 300%.
Per ridimensionare questo ritratto che rischia di apparire caricaturale, ricordiamo però che soltanto uno su dieci dei pazienti di Liston morirono sul tavolo operatorio, quando la media dell’epoca era di uno su quattro. Medici meno esperti e veloci di lui rischiavano di rendere il dolore davvero insopportabile per il paziente, che spesso lottava e non di rado si liberava dalla stretta dei medici e scappava a metà dell’operazione.
Nonostante la teatralità delle sue operazioni, Liston ci viene descritto come severo ma eticamente irreprensibile, “immancabilmente caritatevole verso i poveri e gentile con i malati”, tanto da attirarsi le ire dei suoi colleghi della Edinburgh Royal Infirmery perché si permetteva di operare quei pazienti che loro avevano giudicato senza speranza. Lo osteggiarono e lo fecero addirittura trasferire, ma questo si rivelò la sua fortuna, poiché ottenne l’invidiabile posto di professore di chirurgia allo University College Hospital.
Al di là dei tratti più coloriti e grotteschi, però, l’importanza di Liston non si limita ai record di tempestività. Inventò alcuni strumenti chirurgici, tra cui alcuni forcipi ancora in uso oggi, scrisse diversi saggi fondamentali, ma soprattutto fu il protagonista della prima, epocale anestesia praticata in Europa. Nel 1846, un anno prima della sua morte, Liston entrò nella sala dove sarebbe stato operato un certo Frederick Churchill, e invece di gridare il suo usuale “cronometratemi, signori!”, disse: “Oggi proveremo un nuovo stratagemma Yankee per rendere gli uomini insensibili”. Il suo collega, il dottor William Squire, mise un tubo sulla bocca di Churchill in modo che potesse respirare l’etere, e lo addormentò. Liston operò il ginocchio dell’uomo in soli 25 secondi. Quando Churchill si svegliò, a quanto si racconta, chiese al dottore quando sarebbe cominciata l’operazione, provocando l’ilarità e lo stupore generale.
L’etere verrà sostituito, nel corso del ‘900, con sostanze dagli effetti collaterali meno nocivi; ma l’episodio testimonia la dedizione al lavoro e la lungimiranza di Liston, disposto per primo in Europa a sperimentare proprio quella nuova tecnica che avrebbe reso la sua famosa destrezza meno essenziale e, in definitiva, sorpassata.
Ecco la voce di Wikipedia (in inglese) su Robert Liston.
La Prima Guerra Mondiale fu un vero e proprio massacro. Ma il peggio non venne per chi restò sotto il fuoco delle prime mitragliatrici, o per chi rimase vittima dei gas o delle bombe. Molti furono così fortunati da salvarsi, e così sfortunati da tornare a casa con ferite assolutamente agghiaccianti. I ritardi nei soccorsi non fecero che peggiorare la situazione dei feriti, che spesso non si ripresero più integralmente.
Una categoria particolare di reduci con ferite di guerra è costituito dalle cosiddette gueules cassées, termine francese che significa pressappoco “facce fracassate”. Erano i militari che avevano riportato estese ferite al volto, e che erano per così dire “impresentabili” e dunque difficilmente reintegrabili nella società. Per la prima volta nella storia, però, la medicina aveva i mezzi per cercare di ovviare a questi incidenti. Stiamo parlando, qui, degli esordi pionieristici della chirurgia plastica ricostruttiva del maxillo-facciale. Sulla base di queste prime esperienze i chirurghi furono in grado di sviluppare un’esperienza che, affinatasi nel tempo, permette oggi di restituire una vita quasi normale a persone sfigurate. (È triste ammetterlo, ma questi soldati fecero anche inconsapevolmente da cavia per quelle tecniche che successivamente portarono alla chirurgia estetica vera e propria, quella delle labbra al silicone, del lifting o dei seni rifatti).
In questo blog abbiamo già parlato di terapie piuttosto crudeli relative agli albori della medicina. Quello che colpisce sempre nel riesaminare a distanza di quasi un secolo queste tecniche mediche primitive, è la scarsa considerazione che i medici sembravano avere della sofferenza del paziente. Confrontate i tentativi odierni di essere sempre meno invasivi, delicati, poco intrusivi, con queste tecniche antiquate: il dolore era qualcosa che andava sopportato, punto e basta, mentre i dottori cercavano di salvarti la pelle o migliorarti la vita.
Prendiamo ad esempio i sistemi per aprire la bocca del paziente. Molto spesso, dopo un trauma facciale, i muscoli della mascella rimanevano tirati e in tensione e aprire la bocca risultava impossibile. A seconda del grado di gravità, venivano utilizzati diversi sistemi. L’apri-bocca più comune era questo:
Si trattava di una sorta di morsa “al contrario” che veniva aperta gradualmente per allentare la tensione dei muscoli. Aveva effetti poco rilevanti nel tempo. Altri metodi, però, erano ancora più drastici e dolorosi.
Il “procedimento del sacco”, esposto dal dottor Pitsch nel 1916, è un esempio di terapia davvero brutale. Una volta trovato un interstizio tra i denti, due assicelle venivano inserite nella mascella del paziente.
Appena dischiuse le due pareti dentarie, un uncino veniva attaccato alla mascella inferiore e a questo veniva attaccato un sacco pieno di sassi o carbone il cui peso veniva velocemente aumentato per consentire l’apertura della bocca.
Il procedimento era dolorosissimo e non aveva effetti notevoli a lungo termine, perché i muscoli, troppo bruscamente e violentemente stirati, si ricontraevano poco dopo. Anche se la trazione veniva bilanciata da una banda che tratteneva il capo del paziente, le vertebre della nuca risentivano comunque dello stress.
Più complesso ancora era il caso dei volti sottoposti a un vero e proprio trauma che li aveva lasciati a brandelli e con ferite aperte. La protesi immediata veniva effettuata mediante maschere di contenimento che riportassero assieme i vari frammenti di volto, in modo che non si allontanassero ma anzi si fondessero assieme. L’idea era quella di cicatrizzare l’area più grande possibile, favorendo il consolidamento in buona posizione delle fratture, per permettere in seguito la riparazione delle parti lese. Il casco di Darcissac teneva insieme i diversi “pezzi” di faccia finché non si fossero riattaccati e cicatrizzati. L’intera procedura durava due o tre settimane, di immobilizzazione assoluta.
Passarono alcuni anni, prima che nel 1918 si arrivasse alla rivoluzionaria tecnica di Dufourmentel. Egli scoprì infatti che la pelle del cuoio capelluto reagiva meglio ed era più solida rispetto a quella del braccio. Tagliando quindi ampi lembi di pelle dal cranio dei pazienti, Dufourmentel riuscì a ricostruire elementi fino ad allora inapprocciabili della ricostruizione facciale. Ecco una mandibola “rimodellata” a partire dal cuio capelluto.
Anche gli italiani ebbero una parte in questa “corsa” alla ricostruzione dei volti dei reduci. I medici, infatti, provarono anche a ricorrere a una metodologia già inventata e spiegata addirittura nel XVI secolo dal chirurgo italiano Tagliacozzi, modificando qua e là il procedimento e le indicazioni di questo storico precursore. Questa tecnica si applicava soprattutto alle perdite moderate di tessuto nell’area nasale e del mento.
L’idea era quella di “rialzare” un lembo di pelle dal braccio, connetterlo al tessuto mancante del volto e lasciare che la pelle facesse il suo lavoro, “ricucendosi” con le parti mancanti. Ovviamente bisognava assicurarsi che il braccio fosse immobilizzato, per due o tre settimane, al fine di permettere la vascolarizzazione dei nuovi tessuti. Questa tecnica era stata, nei secoli precedenti, violentemente ostracizzata dalla Chiesa, a motivo della presunta interferenza con i piani del Creatore, e la Santa Sede dispose addirittura la riesumazione del Tagliacozzi e la sua sepoltura in terra non consacrata.
Infine la tecnica di ricostruzione prevedeva degli esperti dentisti che, a partire dai calchi del volto dei pazienti, progettavano e scolpivano protesi che potessero ridare loro la fisionomia perduta.
Le protesi alle volte includevano occhiali per dissimulare l’artificio.
Infine, ecco un raro filmato della Croce Rossa, datato 1918, in cui alcuni dottori e infermiere posizionano e controllano l’efficacia delle protesi facciali su alcuni reduci.
Le tecnologie di ricostruzione del maxillo-facciale hanno da allora fatto un passo in avanti decisivo, e ad oggi costituiscono la fortuna di chirurghi plastici proprietari di atolli e isolotti, così come di onesti medici che cercano di ridare il sorriso e un’integrazione maggiore alle vittime di incidenti terribili.
Per ironia della sorte, la chirurgia estetica è nata proprio da uno dei più grandi e sanguinosi confilitti che il mondo abbia mai conosciuto.