A Conversation with Author Lindsey Fitzharris, Author of The Facemaker

Join Alison Werner, co-chief editor of Plastic Surgery Practice, as she talks to Lindsey Fitzharris, author of the new book, The Facemaker: A Visionary Surgeon’s Battle to Mend the Disfigured Soldiers of World War I. The book chronicles the work of surgeon Harold Gillies as he develops procedures to treat the devastating facial injuries sustained on the World War I battlefield. Gillies’ and his multidisciplinary team pioneered procedures that laid the foundations for plastic surgery as we know it today.

Gillies, who trained as an otolaryngologist, joined the British war effort at the outbreak of World War I as part of the Royal Army Medical Corps. He was first assigned to a hospital near the battlefront where he saw up close how this new modern warfare was creating unique facial injuries that required new surgical techniques. The Facemaker chronicles Gillies’ work to establish not only a specialty hospital to treat these soldiers but also to institute a multidisciplinary approach to the field of facial plastic surgery. What’s more, the book shares how Gillies’ approach to reconstructive treatment differed from earlier procedures that focused on the patient’s appearance rather than function. Gillies recognized the two were “intrinsically linked” and chose to work from the “inside out” when treating his patients.

In this interview, Fitzharris shares how she came to this project and the patient stories that shaped Gillies and his work. Today, Gillies is considered the father of modern plastic surgery, but at the end of the war, despite all his work and his efforts to train surgeons and create teaching materials, including the first textbook on the subject—Plastic Surgery of the Face, he wasn’t confident that the specialty would thrive and still had to prove that one could have a successful career as a plastic surgeon. Fitzharris shares in this interview and in the book, The Facemaker, how Gillies continued to lead the profession in the years after the war, for example performing the first phalloplasty.

The Facemaker is Lindsey Fitzharris’ second book. Her first, The Butchering Art: Joseph Lister’s Quest to Transform the Grisly World of Victorian Medicine, won the PEN/E.O. Wilson Award for Literary Science Writing and has been translated into multiple languages. Her TV series, The Curious Life and Death of…, aired on the Smithsonian Channel. She contributes regularly to The Wall Street Journal and Scientific American and holds a doctorate in the history of science and medicine from the University of Oxford. The Facemaker: A Visionary Surgeon’s Battle to Mend the Disfigured Soldiers of World War I, published by Farrar, Straus and Giroux, is available now at bookstores.

Podcast Transcript

Alison Werner:

Hello. I’m Alison Werner, co-chief editor of Plastic Surgery Practice. Thank you for joining me for today’s podcast episode on the Medqor Podcast Network. Joining me today is Lindsey Fitzharris, author of the new book, The Facemaker: A Visionary Surgeon’s Battle to Mend the Disfigured Soldiers of World War I. The book chronicles the work of surgeon Harold Gillies as he and his team developed procedures to treat the devastating facial injuries sustained on the World War I battlefield. Gilleys and his team pioneered procedures that laid the foundations for plastic surgery as we know it today. The Facemaker is Lindsay Fitzharris’ second book. Her first, The Butchering Art: Joseph Lister’s Quest to Transform the Grizzly World of Victorian Medicine. Won the PEN/E.O. Wilson Award for Literary Science Writing and has been translated into multiple languages. Her TV series, The Curious Life and Death of… aired on the Smithsonian Channel. She contributes regularly to the Wall Street Journal and Scientific American, and holds a Doctorate in the History of Science and Medicine from the University of Oxford. Lindsey, thank you for joining me today. I’m so excited to have a chance to talk to you about the book.

Lindsey Fitzharris:

Yeah. Thank you for having me on because that… Quite a mouthful of titles there. The Curious Life and Death of… and The Butchering and all of those long subtitles that all these books must have.

Alison Werner:

Yeah. Well, I guess my first question is what brought you to medical history and these topics?

Lindsey Fitzharris:

Well, so I am a medical historian by training. I have a PhD from Oxford in the history of science and medicine. But these days I call myself a storyteller first and foremost. I’m a freelance writer. Obviously all my books are rigorously researched, but I really am about connecting readers who don’t have a background in history or background in medicine to these incredible stories from the past. As a kid, I was a weird kid. It’s not going to be a surprise to anybody who follows me on social media to know that. My grandmother and I used to go from cemetery to cemetery hunting ghosts. And I think that people thought I had this sort of macob curiosity, which is definitely true. But actually I was just really interested in the people who lived and died in the past. And I always say that regardless of how you feel about history, like, let’s say you hated history in school. You might like medical history because everybody knows what it’s like to be sick. And so that’s where I fill in that gap. What would’ve happened if you had a toothache in 1746, or what would happen if you had to have a leg removed in 1832? So that’s what I do as a medical historian.

Alison Werner:

Okay. Well, as I said, this book looks at the career of British surgeon, Dr. Harold Gillies during World War I and his work advancing the specialty of plastic surgery. Well, his work advancing the field of plastic surgery as a specialty. Did your interest in the topic start with Gillies or in the history of plastic surgery?

Lindsey Fitzharris:

Oh, that’s an interesting question. And actually, I should say for any Kiwis out there that he was born in New Zealand, but he did most of that’s the bulk of his work in Britain and his family was originally from Britain. Yeah, that is a good question. I think it did start with Gillies and it started with his patients. And again, that storyteller in me, I didn’t know much about World War I or the history of plastic surgery going into this, which is why it took five years to research and write. But I knew what I wanted to do was drop the reader right into the middle of the battle. I wanted people to know what it was like to fight on those fields in those trenches. What did it smell like? What did it feel like? What did it look like at that time?

Lindsey Fitzharris:

And I came across a diary of a soldier named Percy Claire, and he writes beautifully about his experiences about getting hit on the face and laying on the battlefield, trying to get these stretcher bearers to pick him up, as well as through the process of trying to get into Gillies hospital because he gets sent to the wrong place. So we meet Percy Claire in the prologue and we see him throughout this book. So for me, it really started with the personal stories. And I think that’s where I always go to. With The Butchering Art, it was about Joseph Lister and this incredible man who changed the paradigm for us and introduced germ theory to medical practice. So it’s always about those personal stories for me.

Alison Werner:

Okay. Well, what was, in your research, what was Gillies awareness of the field of plastic surgery at that time? Because he studied or he trained as an otolaryngologist. I always pronounce that wrong. And he joined the British war effort as part of the Royal Army medical core. And he was first assigned to a hospital near the battle front. But then he started thinking we need to have more specialized care. So what was his awareness of plastic surgery at that point?

Lindsey Fitzharris:

So, yeah, as you say, he was an ENT doc, which actually put him well placed for what he ultimately was able to achieve. Plastic surgery certainly predates the first world war, but attempts at altering the face, really focus on small areas such as the ears or the nose, rhinoplasty being one of the oldest procedures on record. In fact, the term plastic surgery was coined in 1798, but at the time plastic meant something that you could shape or mold. So in this instance, a patient’s skin or soft tissue. So Gillies, as you say, he certainly wasn’t going into the war as a plastic surgeon, and that didn’t really exist as an expertise as such at that time. He was introduced to this great need for facial reconstruction by this character. And I call him a character because he was really sort of bigger than life.

Lindsey Fitzharris:

He was a French dentist named Charles Auguste Valadier and he retrofitted his Rolls Royce with a dental chair. And he literally drove it to the front under a hail of bullets, which is incredible. I mean, the guy is a legend. He is a badass of medicine. And he worked for free the entire war. And Gillies actually comes across him and has to oversee his work because at the time Valadier was just a dentist and so he needed medical oversight, and that’s where Gil starts to learn about this desperate need. And he goes back to Britain and he petitions to open a specialty unit. And eventually the need is so great that he opens an entire hospital. And before the end of the war, 280,000 men from France, Britain, and Germany alone needed some form of facial reconstruction. So this really was the time where plastic surgery enters this modern era.

Alison Werner:

Yeah. Well, what was the fate of those soldiers who didn’t end up on his specialty war that he first set up at Cambridge, and then later he set up Queen’s Hospital at Sidcup?

Lindsey Fitzharris:

Yeah. Well, so there were other surgeons doing facial reconstruction this time. I talk about some of these people in the book. There’s a French surgeon. There’s a German-Jewish surgeon working on the other side as well, doing some incredible work. They tend to be working solo though. So they don’t necessarily work, for instance, with dental surgeons. This becomes really crucial to what Gillies is able to accomplish. He takes a very collaborative approach. He brings artists in. He brings x-ray technicians, dentists, all kinds of people working together to rebuild the face. So some of these soldiers did end up with other surgeons and they would’ve had pretty decent care. But I think Gillies was the one who was really performing the miracles because he was taking that collaborative approach. Some of these men end up in the hands of general surgeons, and then they end up in Gillies care later and Gil’s has to unpick all of this work. And that was really painful and probably very frustrating and demoralizing for these soldiers as well. So it could be a very circular route to get into Gillies care at that time.

Alison Werner:

Yeah. Well, you talk about how the modernization of warfare changed the need for these procedures to be developed. So you had developments in artillery, poison gas, naval and aerial warfare. And you write about there was a soldier wounded at The Battle of the Somme in 1960 that provided Gillies with his first opportunity to perform a rhinoplasty, as most of his previous patients had suffered damage to their lower jaw and face.

Lindsey Fitzharris:

That’s right.

Alison Werner:

Can you talk about… Because he focused on… What was it, William Spreckley and how he was focused on rebuilding the bridge of the nose or the cartilage that had been destroyed. Can you talk about why that case was so significant to Gillies?

Lindsey Fitzharris:

So yeah, Spreckley was a really interesting case and his photos are in The Facemaker for anybody interested in seeing these patient photos. And I actually worked with a disability activist about the language and the inclusion of the photos because they are sensitive material and we want to always remember that these were real people going forward. Spreckley ends up sort of being one of Gillies famous of rhinoplasties, as you say. He tries a new technique and all of the surgeons at the hospital think this isn’t going to work. And when Spreckley comes out of the surgery, his nose is enormous. All the surgeons were worrying with laughter and they said that it looked like an anteater snout. That’s their words, not me. And Gillies thought, oh my gosh. This has completely failed. But what happened was when the swelling subsided and everything sort of normalized into the space it was supposed to be, it looked really quite good.

Lindsey Fitzharris:

And Gillies even said in his case notes that Spreckley and his nose went back into the army during World War II, and so he went and served again in the second world war. But remember, these rhinoplasties, this wasn’t about reshaping. It was about literally rebuilding an entire nose in some cases. Spreckley had basically no nose at all. It was just a hole in his face. So to go from that in a pre antibiotic era and to build using various types of flaps, to rebuild a nose to that extent and for it to look that good, I think is quite incredible for the time.

Alison Werner:

Yeah, no, exactly. One of the interesting things about Gillies work during this time is he was perfecting these procedures or advancing them, but he was also setting up a teaching hospital.

Lindsey Fitzharris:

Yes.

Alison Werner:

And he seemed very focused on… He had extensive documentation of his procedures. Like you said, he had a full team. He brought in artists to document because at the time they just had basically black and white photography but you couldn’t see the color changes. And so he had artists, as you mentioned, Henry Tonks.

Lindsey Fitzharris:

And they were literally in the operating theater with him. They were diagramming. It was very forward thinking. I think Gillies recognized that his work was pioneering at the time he was doing it, which is amazing as well because all the stresses that he was undergoing at that time to recognize that and to recognize the importance of documenting that. So he did. He brought in artists like Henry Tonks, as you said, who’s quite a character himself. He was a very well known artist at the time. And he was really feared by his students because he could be quite critical. But he sat there painting portraits of these men that are really beautifully rendered and they capture the humanity of these patients in a way that I don’t think that the photos can capture and they’re in color. I didn’t include them in the book because I really felt they would have to be reproduced in color for the full extent for them to be appreciated. And that would drive up the cost of the book. And ultimately I want people to be able to read the book. But if you Google Henry Tonks in World War I, you’ll see these wonderful portraits.

Lindsey Fitzharris:

And so yeah. Gillies recognized that it was important to document this. When you are reading his case notes, I’m sure a lot of plastic surgeons are going to be listening to this. It would all make sense to you, but I have no degree or background in medicine. But my husband is a caricaturist and interestingly he knows faces very well. And so he would read these case notes and he would draw what Gillies was doing to try to help me visualize, okay. So where is the flap going to rebuild this part? And so that was really helpful, but it could be very confusing just if you picked up his case notes. So the artists and the photographers were very important to documenting that work.

Alison Werner:

Yeah. Today Gillies is recognized as the father of modern plastic surgery. But at the end of the war, despite all his work and his efforts to train surgeons and creating teaching materials, including the first textbook on the subject of plastic surgery of the face, he wasn’t confident that the specialty would thrive, and still had to prove that one could have a successful career as a plastic surgeon, right?

Lindsey Fitzharris:

Yeah. He was really kind of setting out on his own. I deal with his sort of after career in the Apple blog. Because I write narrative non-fiction, it’s focused heavily on a story and an arc. And so that arc is really World War I for my book. But I do deal with the postwar career. And Gillies continues to push the boundaries of what is being done. In fact, in 1949, he completed the first successful phalloplasty on a trans man named Michael Dillon. This is an incredible story too, because Michael Dillon was eventually outed by the British press. He was driven from Britain and Gillies stood by him. And I said in the book that there were a lot of people who would not necessarily have seen Michael Dillon as a man in 1949, but Harold Gillies wasn’t one of them.

Lindsey Fitzharris:

And I think at the core of what he was always doing was it was about identity. And so after the war, he does branch out into cosmetic surgery, not just reconstructive surgery. And that brings new challenges that he finds exciting. He said that reconstructive surgery was about returning something to normal, whereas a cosmetic surgery was about surpassing the normal. And he felt that people had a right to control how they looked essentially. And if something was bothering them as small as it might be, they had a right to change that about themselves. But you’re right. It wasn’t an established specialty. And he had to sort of make the case that a doctor could even survive as a plastic surgeon, which is crazy to us today because of course plastic surgery is at the top of its game and it’s a huge industry now. But there was definitely some dark days where he wasn’t sure he was going to be able to sustain financially that life as a plastic surgeon after the war.

Alison Werner:

Yeah. In your research of Gillies and in writing the book, what really stood out to you about him?

Lindsey Fitzharris:

Well, he was such a character. In my first book, The Butchering Art about Joseph Lister, Lister is a Quaker. He’s very unimpeachable really. I mean, he’s such a good upstanding character. And some of that has to do with the way the Victorians of course write about their heroes at the time. But Gillies, he was a bit of a prankster. He really connected and joked with the patients and he kept their spirits up. He had this alternative persona, which he called Dr. Scroggy and he would dress up in the evening and he would sneak in alcohol and oysters, the things that were banned at the hospital and he would gamble with the boys. And so he really… I think he really connected with so many of his patients.

Lindsey Fitzharris:

And of course that also speaks to the nature of his work because he’s working on some of these men for several years, sometimes even over a decade. So they really have a very firm relationship. Some of these men ended up working for him. One of the men, Big Bob Seymour, he had his nose shot off during the Somme. He ends up being Gillies private secretary for the rest of his life. So I loved that about Gillies. He had such a great attitude. He had a bit of Gallo’s humor, which I think you also need working through World War I. And seeing that kind of trauma, don’t you? But, yeah. He was an incredible character as well.

Alison Werner:

Yeah. For, you know, modern plastic surgeons, today’s plastic surgeons looking for something to read, what would you say they can take away from this book?

Lindsey Fitzharris:

Well, that’s yeah, no, one’s asked me that actually. I mean, I always say that as a medical historian, when I, what I hope to convey to people is that what we know today, isn’t going to be what we know tomorrow, and we need to keep an open mind. I think if Gillies was alive today, he would be very excited by things like face transplants, which I hit upon in the Apple blog. Fascinating tech. I mean, face transplants are both reconstructive surgery and also transplant surgery. And I think he would’ve been right there wanting to know more and pushing those boundaries of what you can do for patients. So I think that it’s always about keeping an open mind and knowing that medicine is always evolving and changing and to keep pushing forward for the patients as Gillies had done during the first world war.

Alison Werner:

Yeah. Well, Lindsey, thank you again for joining us today. It’s been a pleasure to talk to you about your book and get this insight into Dr. Harold Gillies. Thank you.

Lindsey Fitzharris:

Thank you so much.

Alison Werner:

The Facemaker: A Visionary Surgeon’s Battle to Mend the Disfigured Soldiers of World War I is now available at bookstores. And thank you for joining me today. Until next time, be sure to subscribe to the Medqor Podcast Network to keep up with the latest Plastic Surgery Practice podcast, and to keep up with the latest industry news visit plasticsurgerypodcast.com. Thank you.

 

Published at Wed, 08 Jun 2022 16:22:30 +0000