Authors: Richard Hollingham
Unfortunately, after Tagliacozzi died in 1599 his reputation
collapsed. The Italian Church had been growing suspicious of his
activities. Now that he was in no position to defend himself, the
Church summoned its investigation team: the tribunal of the
Inquisition.
Tagliacozzi was accused of magical practices. He had modified
the human face and in doing so had been interfering with the will
of God. In the end the Church allowed his soul to rest in peace,
although stories persist that Tagliacozzi's body was removed from its
tomb and his bones dumped on unconsecrated ground.
At the time Tagliacozzi's method was a major advance on
anything that had gone before, although his techniques built on
more than two thousand years of surgical practice. The first
recorded case of plastic surgery took place in India around 1500 BC.
The Hindu epic poem
Ramayana
tells the story of Surpanakha, a
beautiful temptress (some say a demon with magical powers). With
her bewitching personality, Surpanakha attempts to seduce a young
prince who is promised to another. She is sentenced to a brutal
punishment for her actions and her nose is cut off. However, this is
far from the end of the story. Rather than live with the disfigurement,
she goes for reconstructive surgery.
An Indian medical text dated to around 600 BC gives an idea of
the sort of treatment Surpanakha would have received. First, the
doctor would have cut a nose-shaped flap in her forehead – narrow
at the bottom, above the nasal cavity, and wide at the top. The incision
would have been around a quarter of an inch deep, down to
the periosteum, the thin fibrous membrane covering the skull.
*
The
doctor would then have peeled the skin away from her forehead,
making sure not to tear the narrow part at the bottom. This strip of
skin, rich in blood vessels, would become the pedicle and keep the
skin flap alive. Twist the pedicle around and bend it down and there
you have a new nose. You also have excruciating pain and an
appalling (nose-shaped) scar on the forehead. It was a crude technique,
but better than having no nose at all.
*
Periosteum membrane covers all bones, but the forehead is one of the few places on the body
where the skin is right against the bone. Periosteum contains tough fibres of collagen and
nerves, as well as blood vessels to supply the bone cells.
Surprisingly, despite Tagliacozzi's advances, the cruder Indian
technique was still being practised by surgeons well into the nineteenth
century. Seemingly reluctant to try any surgery that took
more than a few seconds, Robert Liston (see Chapter 1) dismissed
the Italian method as too tricky. The Indian operation, on the other
hand, was 'less difficult in execution, not so liable to failure, and
more easily undergone by the patient'.
In his book
Elements of Surgery
, Liston describes in detail his
own variation on what he termed the 'rhinoplastic operations'.
Liston suggests making a wax mould of the nose and then flattening
it out so that it becomes a template for the skin flap. However,
he confesses that this can be a difficult process and it is often more
convenient to use a piece of cardboard (you can guess which
method he used).
The card was held firmly by an assistant as the surgeon traced
around it with a pen, 'or at once with a knife carried deeply through
the integuments'. It is hard to imagine Liston bothering with a pen
first. With the template removed, Liston describes pulling the skin
away from the forehead using his finger and thumb. If it becomes
difficult, he suggests the use of a hook. Finally, the flap is twisted
around and placed over the area of the nose, the wound in the forehead
is dressed and a couple of straws are stuck up the nostrils so the
patient can breathe. Understandably, many people opted for false
tie-on noses rather than endure the horrors of Victorian surgery.
However, it was another Liston innovation that revolutionized
plastic surgery: anaesthetic. Before pain relief, surgery was the last
resort of a desperate patient – whether it was to remove a diseased
limb or fix a disfigured face. Now, though, a whole glorious new
world of surgery was about to open up. People were no longer
coming to surgeons to fix their faces: they wanted to
improve
their
faces. Nose jobs, smaller breasts, facelifts or bigger lips – there was
nothing surgeons wouldn't try. And with infection defeated by antiseptic
techniques, operations were becoming much safer.
A new era of cosmetic surgery had arrived, and surgeons (some
more qualified than others) were, once again, in the exciting business
of experimenting on their patients. Bizarrely, rather than
perfecting operations to move flaps of skin around, they developed
operations that involved inserting a whole range of novel substances
beneath the skin. It seemed there were few products of the
Industrial Revolution that weren't brought to the operating table.
Surgeons attempted rebuilding noses with ivory, they experimented
with metal, celluloid and gutta percha (a substance derived from
tree sap); they tried oil and coal extracts; even bits of animal cartilage.
One surgeon brought a live duck into the operating theatre,
slit its throat and attempted to repair his patient's nose with the
bird's breastbone. They notched up their failures to experience
until, finally, they hit upon the perfect new substance.
Paris, 1903
Twenty-two-year-old Gladys Deacon lay in bed contemplating her
own beauty. She was, undeniably, exceptionally beautiful. She was
also extraordinarily vain.
Intelligent, charming and wonderful company, Gladys was all
these things and more. Why, hadn't a young gentleman told her that
this very evening? He was handsome certainly, but a mere plaything
to Gladys, who had set her sights on marrying into royalty (or
landed gentry at the very least). Still, it was nice to be admired;
although few people could come as close to admiring Gladys as
much as Gladys herself.
Raised in Boston, Massachusetts, she moved in all the right
circles. She then burst on to the European social scene, mixing with
aristocrats and artists, princes and politicians. A friend talked of how
Gladys traversed Europe 'like a meteor in a flash of dazzling beauty'.
The press adored her, men courted her, other ladies envied her. She
was becoming famous for being famous – a true Edwardian
celebrity. But as she lay on her bed thinking about herself, she
started to have doubts. Could she possibly become more beautiful?
Like many Edwardians, Gladys was fascinated with the classics
and the concept of classical beauty. She toured the galleries and
museums of London, Paris and Rome, examining statues and
studying paintings. She admired the profiles of Hellenic faces;
their strong foreheads and straight noses. She even took to recording
the distances between the eyes and noses of statues to see how
they measured up. But when she compared herself with them, her
observations brought her to an alarming conclusion: she wasn't
perfect after all. Her nose dipped between her forehead and the
tip, creating a slight hollow. She wanted a straight classical nose,
and she knew just what to do to get one.
Gladys went to see a professor at the Institut de Beauté in Paris.
He examined her and advised that she try the latest advance in
cosmetic surgery: paraffin wax. Unlike previous innovations, the
wonder of this new treatment (invented only a few years before)
was that there was no actual surgery involved. All the surgeon had
to do was inject a measure of hot paraffin wax under the skin: as it
hardened, he could mould and shape it to create the perfect
profile. Paraffin wax had been injected into faces, breasts, buttocks
and even the occasional penis. It really was a remarkable invention.
It sounded almost too good to be true.
The surgeon wears thick, black rubber gloves as he prepares the
paraffin. The solid white block of wax is gradually turning to a slushy
liquid as he heats it on a small oil burner. The large glass syringe,
with its formidable wide steel needle, is lying alongside in a basin of
hot water. The surgeon has learnt from experience that unless the
syringe is also hot (hotter by several degrees than the wax), the
paraffin will solidify before it can be successfully injected. Reaching
over, he checks the temperature of the paraffin with a thermometer.
It is a careful balance: too cold and he can't inject it, too hot and it
will burn the patient. The ideal temperature is around 30°C, but it
is difficult to get it just right. He has heard of cases where the skin
has simply sloughed away from the patient's face, presumably due to
excessive heat. Still, there are risks with all types of surgery.
Gladys lies back on the couch. She has tied back her hair to
expose her beautiful, smooth, (near) perfect face. The surgeon's
assistant dabs the bridge of the young lady's nose with some dilute
carbolic acid to clean her skin. The surgeon sits on a stool beside
her, the pan of hot melted paraffin wax and warm syringe at the
ready. She gasps as he makes a small nick in her nose with a scalpel.
He places the tip of the needle in the hot wax and draws the
asbestos piston (rubber would have melted) of the syringe upwards
to fill it. Even with gloves on, the surgeon can feel the heat as he
places his fingers through the loops at the top of the syringe and
prepares for the injection.
Gladys is proud of how brave she is being. She has been warned
that it will be painful, but pain is surely a small price to pay for
perfection. As the surgeon sticks in the broad needle and depresses
the plunger, Gladys feels as though molten metal is being injected
into her head. The paraffin wax squirts out through the needle
and beneath the skin of her nose. The surgeon keeps pressing until
the syringe is almost empty, then he flings it aside and begins to
mould Gladys's new face.
He has between fifteen and thirty seconds to get it right.
The fingers of his bulbous gloves push, knead and press. He
glances down at a picture Gladys has provided so that he can check
his work. He runs his fingers along her nose, smoothing any
bumps, moulding the paraffin like putty beneath her skin. The
paraffin wax is hardening rapidly and time is running out. The
surgeon presses as hard as he can to stop the wax clumping. A few
seconds later and it has set; but he is finished. Gladys Deacon has
a new nose.
The surgeon explains to Gladys there may be some swelling at
first, but this will soon disappear. In just a few days, he tells her, she
will have a classical nose to be proud of. He applies a compress of
lint dipped in icy water to numb the pain and sends her home.
The swelling was indeed quite bad to start with. Only it didn't
get any better. Instead it got worse, the bridge of her nose bursting
into an angry open sore. Doctors were summoned to examine her,
but when she was questioned Gladys denied having had any
surgery. Instead she blamed her inflamed features on an accident,
telling people she must have knocked it. But the nose got worse:
the wax began to wander; lumps appeared beneath her skin. Her
beauty was slowly being destroyed from within. Far from achieving
the classic looks of a Greek statue, her quest for perfection was
turning her into a freakish waxworks dummy.
It was little consolation to Gladys that she wasn't alone. Despite
the ringing endorsement of many eminent surgeons, including
England's Stephen Paget, who recommended the use of paraffin
wax in the
British Medical Journal
,
*
others had begun to notice that
these injections often led to unwanted side effects. In fact, the list
of side effects was alarmingly extensive. The condition was even
given a name: paraffinoma, although some doctors simply called it
wax cancer.
*
Stephen Paget was considered one of Britain's finest surgeons. In a gushing
article in the September 1902 edition of the
British Medical Journal
, he described how paraffin
wax was simple to use and produced excellent results. In his own practice, he said, the
outcome was 'absolutely satisfactory'; he even gave the name of the company from which the
paraffin wax could be purchased. To be fair, the wax did sometimes produce excellent results
but, given that no one had carried out any proper trials, it is impossible to know what proportion
of injections was successful and what proportion ended in disaster.
Symptoms ranged from the odd lump to wide abscesses where
skin withered and died. Paraffinoma caused infection and destroyed
muscle. If the paraffin got into the bloodstream it led to blood clots
in the lungs and was held responsible for blindness, strokes and
heart attacks. The price of perfection was quite possibly death.
In his 1911 book on plastic surgery, American surgeon
Frederick Kolle highlighted the dangers of paraffin wax injections.
He also warned doctors against the 'unreasonable' demands made
by patients who were 'bent upon having the alabaster cheek ideal
of the poets, the nose of a Venus, the chin of an Apollo'. He
referred to these people as 'beauty cranks' – those seeking perhaps
'very desirable marriages'. Surprisingly, it seems he had never met
Gladys Deacon.
By the 1920s the wax injection had really taken its toll on poor
vain Gladys. She wore a hat low over her face to disguise the worst
ravages of paraffinoma, but female rivals recorded bitchily how
the wax had given her face the appearance of a gorgon. Others
remarked that she looked heavy jawed, her hair too yellow, her lips
too red. She no longer looked like a lady (the implication being that
she looked more like a whore). A princess who had once been jealous
of Gladys noted with ill-disguised satisfaction how the wax had
run down her face to create blotchy patches in her neck.