Lindsey Fitzharris on Visionary Surgeon Harold Gillies

The immense casualties of World War I shocked a generation that believed at the outset in 1914 that the war would last only a few weeks. Almost ten million soldiers were killed in combat and 21 million were wounded in the slaughter that dragged on until November 1918. Great Britain alone lost one million combatants killed and more than two million wounded. On the first day of the Battle of the Somme, July 1, 1916, the British suffered almost sixty thousand casualties including 19,240 men killed -- the bloodiest day in the history of the British Army.

This first large-scale, industrialized conflict produced gruesome carnage and massive casualties in enormous battles as the technology of war far outpaced the progress of modern medicine. New weapons such as machine guns, powerful new bullets, heavy artillery, flamethrowers, tanks, poison gas, and strafing airplanes tested the skills of medical personnel charged with treating wounded and dying men. The innovative weapons lacerated, punctured, macerated, incinerated, tore apart and atomized soldiers who fought from fetid, wet trenches, breeding grounds for infection and sepsis.

Disfiguring facial wounds became prominent and feared injuries because helmets left the face unprotected and the face was especially vulnerable to projectiles and shrapnel in trench warfare. The injuries were not only destructive to a patient’s appearance and expression but also interfered with function and sensation from breathing, swallowing, speaking and eating to seeing, smelling and tasting.

Early in the war, pioneering surgeon Dr. Harold Gillies took on the challenge of mending and restoring the mutilated faces of wounded British soldiers. The Cambridge-educated New Zealander developed a range of techniques to reconstruct broken faces as well as to restore function and optimize appearance. Each patient required novel approaches to address trauma such as crushing facial fractures, broken or lost jaws and noses, broken eye sockets, severe burns, bone loss, tooth loss, and other injuries.

Dr. Harold Gillies (Illustration by Robin Lindley)

Gillies’s innovations in skin and cartilage grafting, aesthetic repair, prosthetics, infection control, anesthetic use, and other advances transformed the rudimentary discipline of plastic surgery, and still inform surgeons today. He also was celebrated for his compassion toward all patients, regardless of rank, and his efforts to address the psychosocial aspects of disfiguring injuries.

Award-winning medical historian Dr. Lindsey Fitzharris recounts the inspiring story of Harold Gillies’s innovative medical work and the men he treated in her groundbreaking new book The Facemaker: A Visionary Surgeon’s Battle to Mend the Disfigured Soldiers of World War I (Farrar, Straus and Giroux). As she describes, the legendary Gillies transformed many lives as he treated the complicated physical and psychological trauma of grievous wounds. As Dr. Fitzharris stresses, he addressed broken spirits as he mended broken faces.

The Facemaker brings history to life thanks to Dr. Fitzharris’s gifts for lively storytelling, accessible scholarship, and extensive research. The book takes the reader into the sodden trenches of World War I, the shell cratered battlefields, the blood-stained aid stations, and the operating rooms of Queens Hospital in Sidcup, England, where Gillies performed his complex reconstructive operations. The book also captures the excruciating pain and suffering endured by the wounded as well as how Gillies and his remarkable team of physicians, dentists, nurses, artists, sculptors, mask makers and others brought empathy and profound caring to each patient through numerous surgeries and the protracted healing process.

Dr. Fitzharris’s book is based on meticulous scholarly research. She drew on a trove of material on medicine and the war as well as on Gillies and his patients, including previously unpublished letters, diaries, and other primary documents that inform this heart-wrenching yet inspirational story of the war.

The Facemaker seems destined to stand out not only a brilliant work of history and research, but also as an unflinching antiwar work as Dr. Fitzharris literally reveals the human face of war and the futility and waste of modern combat—concerns that resonate now as another brutal and senseless war rages in Ukraine.

Dr. Fitzharris is a medical historian who now focuses on sharing stories from the past with a general audience. She holds a doctorate from the University of Oxford and completed postdoctoral studies at the Wellcome Institute in London. Her debut book, 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 in the United States; and was shortlisted for both the Wellcome Book Prize and the Wolfson History Prize in the United Kingdom. She also created the popular blog, The Chirurgeon’s Apprentice, as well as the YouTube series, Under the Knife. She also hosts the TV series The Curious Life and Death of . . . that airs on the Smithsonian Channel. And she contributes regularly to The Wall Street Journal, Scientific American, and other publications.

Dr. Fitzharris generously discussed her background and her new book The Facemaker by Zoom from her office in England.

Robin Lindley: Congratulations Dr. Fitzharris on your new book The Facemaker and the many positive early reviews. Before getting to the book, I was interested in how you initially became interested in history?

Dr. Lindsey Fitzharris: That's a good question. I have a PhD in the history of science and medicine from Oxford University, but these days I consider myself first and foremost a storyteller.

When I think back to my childhood, I always was a bit of a storyteller. My grandmother raised me and she always had a lot of objects in the basement that were related to the past. I always loved going through these objects and learning their stories. And we would go to the cemeteries and she would tell me stories about the people who she knew who were by then long gone. I just was always interested.

And there's always been a sort of tactile element to history for me. Obviously, it's a living history to walk around the streets of Oxford. You feel like you're really in the past on some level and you get access to these incredible libraries where you can touch to these old books.

For me, I’m always immersing myself in the past. As you can see, even in my office, I have these World War I artifacts here that I use to tell stories in interviews.

So, I was always interested in the past and I ended up doing all my degrees at once. I did my postdoc at the Wellcome Institute in London but I got a bit burnt out in academia and I decided to move into the realm of storytelling through my blog, The Chirurgeon’s Apprentice, and through The Butchering Art, my first book, and now The Facemaker. I love connecting with a general reader with these incredible stories from the past.

Robin Lindley: Your work is a gift to readers. What sparked your interest in medical history? Did you have a desire to work in medicine or did you have medical professionals in your family?

Dr. Lindsey Fitzharris: Well, my mom was a nurse so there was always that kind of buzzing around in the background. But actually, when I went to Illinois Wesleyan University as an undergraduate, I had a professor named Michael Young who taught courses on intellectual history and on the scientific revolution, so I got really interested in the history of science first.

And when I went to Oxford, I got to study the history of science under Professor Robert Fox and my interest flourished and developed.

I always tell people of that, if you're not interested in history, you might be interested in medical history because everybody knows what it's like to be sick, especially today when we've been living through a pandemic. It's so relatable in that sense. What was it like if you had a toothache in 1792 or what would happen if you had to have your leg amputated in 1846? That's where I, as a medical historian, can fill in those gaps. In that sense, maybe military history or political history isn't as relatable to the people. The everyday experience of being sick and being scared and having to turn to the medical community for help is very understandable.

Robin Lindley: Thanks for those reflections, Dr. Fitzharris.  Did your award-winning first book, The Butchering Art on Joseph Lister and those grimy Victorian Era hospitals, grow out of your doctoral studies at Oxford?

Dr. Lindsey Fitzharris: My dissertation was actually on 17th century alchemy, so I was an early modernist. When I wrote The Butchering Art my supervisor asked why would you go into the 19th century? And now I'm in the 20th century with The Facemaker.

I go where the story is. And I was surprised that nobody had told that story of Joseph Lister to a general audience, which is such an incredible, world-changing story. And people weren't really familiar with who he was except through the product Listerine, which he never even invented. So, I felt compelled to tell that story, and there were so many great scenes and atmosphere. Walking into an operating theater of the Victorian period is so different from how we operate today. And I really wanted to paint that picture for readers and I had such a good time doing it, but my training is in much earlier, in 16th and 17th century history.

Robin Lindley: Thanks for that explanation, and congratulations on The Butchering Art, an evocative and vivid read.

Dr. Lindsey Fitzharris: That one and The Facemaker are very different. They're both narrative nonfiction for a general audience and I fell into both stories, but they are very different.

Robin Lindley: In The Facemaker, you follow the career of Dr. Harold Gillies. I've always had an interest in him and fellow physician/ artist Dr. Henry Tonks and their work on facial reconstruction, but I haven’t seen many resources on them, so I appreciate your groundbreaking book now.  Are there a few things you'd like to say about Gillies to introduce him to readers?

Dr. Lindsey Fitzharris: Yes. What's nice was some of Gillies relatives now contacted me when I first announced this book. He has a great, great nephew who is a Hollywood actor named Daniel Gillies and he's the reader for the audio book. I was told that occasionally, he'll stop and say he didn't know facts about his ancestors, and he learned about Harold Gillies through reading the book. It’s been really lovely to bring that to life for him and some of Gillies’ other relatives.

If people are familiar with Harold Gillies today, they might know him as the father of modern plastic surgery. Plastic surgery predated World War I and, in fact, the term plastic surgery was coined in 1798 by a French surgeon named Pierre-Joseph Desault. At that time, plastic meant something that you could shape or mold—in this case, the skin or the soft tissue of a patient. So, it predated World War I, but it was really through Gillies’s work and through the enormous need for facial reconstruction that came out of the war, that plastic surgery entered this new modern era where new methods were developed and tried and tested.

If you were to call Gillies anything, you might call him the father of modern plastic surgery. And he did incredible work. He was rebuilding these soldiers’ faces during the First World War when losing a limb made you a hero, but losing a face made you a monster because of the societal biases against facial differences.

He was able to not to just mend these soldiers’ faces but also their broken spirits because a lot of them would've ended up living a life of isolation. He's an unsung hero in that sense. I think a lot of people, when they think of the history of plastic surgery, they think of the Guinea Pig Club during World War II and the reconstructive work [on aviators with injured faces] that was done by Gillies’s cousin Archibald McIndoe who became quite famous. But it started with Gillies in World War I, so I tell people this is the prequel to the Guinea Pig Club, if they’re familiar with that.

Robin Lindley: Yes. Historian Emily Mayhew wrote a book on the Guinea Pig Club and McIndoe’s work.

Dr. Lindsey Fitzharris: Yes. And she also wrote Wounded on the [British World War I] stretcher bearers and the medical evacuation chain. I hope people will find that The Facemaker is a compliment to what has already been done on the subject.

Robin Lindley: I interviewed Dr. Mayhew on Wounded. I appreciate your meticulous research on this book. You comment in the introduction that all of the observations and comments in the book are based on documents you found and were not conjecture on your part.

Dr. Lindsey Fitzharris: Yes. I write narrative nonfiction, which isn't a style all historians even agree with.  But I very much write a book like a novel. And here, if Gillies is saying something and it seems like dialogue, that’s because it's documented somewhere. Or if I note a gesture, then someone witnessed that gesture, and so I put that in. I love that storytelling technique because I want people to feel like they're right there: they're in the operating theater or they're in the trench with these men. How does it smell? What does it feel like with all of those sensory experiences? I hope people can understand that better after reading The Facemaker.

Robin Lindley: And it seems that you uncovered archival material such as personal letters and diaries and family papers as well as other documents that hadn’t been previously recounted by authors.

Dr. Lindsey Fitzharris: Yes. With Percy Clare, who opens The Facemaker, I used his diary and some academic historians have used a little bit of what he said, but not to the extent that I've written his story. I was in touch with his relative and I asked, do you know this and that? She didn’t know anything about him. It's going to be fun for her to learn about her ancestor through this book. I think she said her father had found the diary in the garage and donated it.

I chose Percy Clare because he wrote beautifully and extensively about his facial wounds. That was unusual because sometimes a soldier might mention it, but it's only a letter and not a full account of that whole experience.

Unfortunately, a lot of patient records were destroyed during World War II. It’s ironic that these men couldn't escape injury even in World War II. Percy Clare's records were lost, so I only know about him getting to Gillies at the Queens Hospital through his diary. Otherwise, we wouldn't have known that he was even a patient at the Queens Hospital. So that's an interesting challenge for a historian in trying to piece together a story like this.

Robin Lindley: And Percy Clare had horrific facial wounds, but from the photographs in your book, it seems his appearance came out really well.

Dr. Lindsey Fitzharris: Amazingly so. I don't know what he looked like before. I can only share his description of the blood loss and wounds to both cheeks. I didn’t have his patient records. I asked his relative, Rachel Gray, do you have a photo album? And she said, I do, but she just had this flood in the garage a couple months before. She sent the album to me and, and these photos were in plastic so I couldn't take them out because that would ruin the photos. A friend of mine actually ended up restoring those photos for me. They were in terrible states, and he did amazing work. Again, there are all these kinds of unforeseen challenges when you're trying to piece together this kind of history. Luckily there were photos of him later in life and his face looked amazing.

Percy Clare, in later life (Courtesy of Rachel Gray; Restored by Jordan J. Lloyd).

Robin Lindley: I wanted to get a sense of your process when writing for a general audience. You provide detailed and accessible historical context to help the readers understand the past moments you present.

Dr. Lindsey Fitzharris: I went into The Facemaker knowing very little about World War I. If anybody out there is not familiar with World War I, don't worry. I was right there with you. This is why I took five years to research. It took an incredibly long time because I was really starting from zero, but I knew that there was a very human story.

I also knew that, although this is a book about Harold Gillies, it's really a story about many men. And I think that's reflected very well in the cover design of a surgeon's hand holding a scalpel and in the reflection is a bandaged soldier. I really wanted their voices to come through in this narrative.

One of the differences between writing this kind of book or writing an academic history is that part of my job as a narrative nonfiction writer is not to overwhelm the general reader with too much information. When it comes to World War I, there's a lot of information. There are so many letters and so many diaries, and it goes on and on. And, as an academically trained historian, it can get overwhelming because you could spend literally 15, 20 years just reading and not be ready to write the story. As a commercial writer, I don't have that luxury of time, but this book ended up taking about five years. A lot of what I do is trying to find the pulse of the story.

If someone picks up The Facemaker and they know nothing about facial reconstruction, and know nothing about medical history or World War I, I want them to be able to feel that they can read this book and understand it and enjoy it. They don't need to come to it with any prior medical knowledge or any historical knowledge.

Robin Lindley: Your academic background and your gifts as a storyteller are a powerful combination in writing for television and writing non-fiction for a general audience.

Dr. Lindsey Fitzharris: It's funny though because television executives have no imagination. It's really hard to convince them that medical history is something that people would be interested in, which is to me is confusing because there's so many medical shows on television. People love them. ER was a huge drama. In fact, when I was going around with The Butchering Art, I was telling people that the Victorians used to buy tickets to the operating theater, and people just thought that was crazy. And I said, but we're still buying tickets because we're tuning into ER, we're tuning into reality shows about hospitals, or whatever it is.

We still have that morbid curiosity. I think my job as an academically trained historian as well as a storyteller is to make sure that it's entertaining, but also in a way that isn't exploiting the past and that people. We can look back in the past and say, I can't believe they used to do that, but I always ask my audience what will we say in a hundred years? What will be the medical treatment that in a hundred years that people will just not believe that we used to do because that's what will happen. What we know today isn't what we're going to know tomorrow. I hope that when people pick up The Butchering Art or The Facemaker, they see that evolution or that revolution in medicine that's ongoing even today.

Robin Lindley: You mention in The Facemaker how plastic surgery has evolved and you conclude the book with the very recent face transplant procedures. In discussing the history, you vividly bring the reader right into the horror of the fighting in the trenches on the Western Front, and you stress the difficulty of getting medical care for the wounded in No Man's Land. Many with severe facial injuries waited for hours or even days just to be removed from the combat zone. If they got help, they were carried to aid stations and then to hospital ships and then to a hospital in Britain for treatment of their facial wounds.

Dr. Lindsey Fitzharris: Yes. The chain of evacuation was so difficult because the face is so vascular and the injuries bleed a lot. And a lot of times these stretcher bearers would step out onto the field and they're being shot at and they can die. They were making very quick decisions about who to take off the field and who to leave behind. And if you look at one of these wounds, they look very ghastly as you see in photos of the patients. I worked with a disability activist actually to discuss the inclusion of photos and the language to make sure that that was also inclusive.

And it was hard to get [the wounded] off the field. In fact, Private Walter Ashworth, you might remember, laid on the field for three days without a jaw, unable to scream for help. So that was a real difficulty.

I knew going into this book that I wanted to drop the reader right into the trenches. What was that like to be there into the middle of that action? And then to watch how difficult it was for one single patient.

The book opens with Percy Clare, and describes how difficult it was for him to get from being shot to getting to Harold Gillies back in Britain. There were a lot of detours along the way, and it could be a very frustrating process. And of course, some of these soldiers never ended up in Gillies’s care, and were probably worse for that.

Robin Lindley: Can you talk about the prevalence of facial wounds in this first modern industrialized war? You write about how medicine hadn't caught up with the technology of many terrible new weapons. Why there were so many facial wounds to treat?

Dr. Lindsey Fitzharris: As I said, plastic surgery predated World War I. There was a bit of facial reconstruction during the American Civil War, which I discussed in the book, but not on the scale that it was happening in World War I. The nature of warfare at that time led to high rates of injuries. There were huge advances in artillery and weaponry so that a company of just 300 men in 1914 deployed equivalent firepower as a 60,000 strong army during the Napoleonic Wars.

There were huge advances. You have the invention of the flamethrower and the invention of the tank, which left their crews vulnerable to new kinds of injuries. You had chemical weapons, even as gas masks were being rushed to the front. These lethal gas attacks became instantly synonymous with the ghastliness and savagery of the First World War and the medical community was struggling at first to keep up.

And these men weren't really given much protective gear, certainly in the first year. The Brody helmet [British “soup bowl” metal helmet] was invented in late 1915, and was the first helmet that was given to all men regardless of their ranks. It was an improvement over the soft caps that had been issued in the beginning of the war, but even so it didn't really protect the face as much as needed.

For all of these reasons, facial wounds were prevalent. And before the war is over 280,000 men from France, Britain and Germany alone suffered some kind of facial trauma. They were maimed. They were gassed. They were burned. Some were even kicked in the face by horses. So, this was a real problem in World War I, and of course it laid open this opportunity for plastic surgery to evolve.

Robin Lindley: To go back to Dr. Gillies, what motivated him to specialize in plastic surgery and then to mend the terrible facial wounds of soldiers—many wounds that were probably new to most surgeons at the time?

Dr. Lindsey Fitzharris: With The Butchering Art, Joseph Lister was the right man at the right time. And I feel like Gillies was also that person for his time. There were other surgeons who were working on facial reconstruction. It was a huge need and many required this kind of surgery.

Gillies was an ENT [ear, nose and throat] specialist going into the war. And he came across a figure named Charles Valadier, who was this French American dentist. He was a bigger than life character and one of my favorite people in the book. He had a Rolls Royce that he retrofitted with dental chair and he drove it to the front under a hail of bullets. Who does that?

And World War I was this crazy time when pilots were going up only several years after the Wright brothers had flown and they were bringing pistols with them. Nobody really knew what they were doing. Charles Valadier ended up working throughout the war for free, and he showed Harold Gillies the desperate need for facial reconstruction at this time.

And Gillies was well placed because he was actually one of those annoying people who was good at everything he did. He was a competent artist. He was a very good golfer. He was very well rounded, which I think is unusual for a surgeon. And facial reconstruction is partly a creative process. You have to be a very visual thinker. And Gillies was doing this without any textbooks. And he was working in a very collaborative manner, which was unusual as well for the time. So, he brings dentists on board, which a lot of surgeons wouldn't have done because they wouldn't have rated dentists highly at the time. He brings on artists who paint masks. He brings all kinds of people on his team and that's why the standards rose and he was able to do such amazing work in the end. So, he really was the right person at the right time.

Robin Lindley: Gilles was very creative and a remarkable visionary, as you recount. And he was dealing with horrific wounds that you describe vividly. These men came in without jaws or noses or broken eye sockets or completely cratered faces, or all that. He dealt with compromise of breathing, eating, vision, speaking, taste, smell and more. And Gillies had to create new types of surgery for every unique disfiguring wound that came to him.

Dr. Lindsey Fitzharris: Yes. The earlier attempts at altering someone's appearance really focused on small areas of the face. Rhinoplasty was one of the most ancient procedures in medical history. But, as you say, Gillies really had to reconstruct almost entire faces. In some cases, the damage was so extensive that he had to be very creative.

Bringing on dental surgeons like William Kelsey Fry, who worked on the hard surfaces as Gillies worked on the soft surfaces, helped the reconstructive process. In fact, one of Kelsey Fry’s grandsons tweeted me on Twitter and asked if Kelsey Fry was going to be in the book. I said, actually he is in the book because he ended up having this horrible experience on the battlefield when he was rescuing a man with a facial injury. He had the man lean forward onto his shoulder and carried him to a casualty clearance station and the medics put the man on his back and he ended up drowning in his own blood. And so, it was Kelsey Fry who ended up getting the protocols and the advice changed so that if men had facial injuries, they were supposed to be laid face down on the stretcher. And so, I said [to Kelsey Fry’s grandson], think about how many lives your grandfather saved just by changing that advice alone.

So, Kelsey Fry was an important part of Gillies's team. He doesn't [get the same attention as] Gillies, who was a bigger than life personality. And a lot of people who know about this period tend to focus on Gillies. But definitely other people contributed to the enormous advances of this time and are featured in The Facemaker.

Robin Lindley: As you point out, each facial surgery was unique and demanding and took a very long time. Gillies must have had enormous energy and resilience.

Dr. Lindsey Fitzharris: Yes. And there were setbacks too. Some of his patients died in his care as I document in The Facemaker. There were setbacks and there wasn't at all a linear progression, but certainly he never gave up on them. I think it's fair to say they never gave up on him either. They continued to believe in him and in what he could do. And that built a really strong bond and the result was amazing in the end.

Robin Lindley: You also emphasize that Gillies early on decided to create an interdisciplinary team. I find the trained physician and renowned artist Henry Tonks fascinating.

Dr. Lindsey Fitzharris: I love Tonks. Another character, like a lot of the people in The Facemaker, who had a big personality. Joseph Lister in my book The Butchering Art was a Quaker and a quiet, solemn figure. But in The Facemaker, everybody has a bombastic personality.

Tonks was a famous artist before World War I and, as you say, he was actually a trained physician as well. He was known to be extremely critical of his art students and his students really feared him. He was brought on board by Gillies by happenstance. He was working at the same hospital in an administrative role and someone told Gillies, you know, Henry Tonks the artist is working here. And so, Gillies brings him on board. And several other artists are eventually brought on at the Queens Hospital at Sitcup, the hospital that Gillies founded for facial reconstruction. And thank goodness for them because they created amazing pictorial records.

I didn't include the Tonks portraits of these men in the book because I felt they should be reproduced in color as they were meant to be seen, and to do that drives up the cost of the book. But you could find all of his wonderful artwork online if you just Google Tonks and World War I. His portraits are beautiful because they are in color and they allow you to see [Gillies’s patients] in a more vivid way than the photographs allow.

Robin Lindley: It’s powerful art. I've seen some of Tonks’ color drawings that portray the wounded men, usually showing the wound and then the reconstructive process and the results after healing.  

Dr. Lindsey Fitzharris: Yes. He would be in the operating theater and be sketching and drawing. And sometimes he did formal portraits of the men. There's one of Walter Ashworth who's injured during the Somme offensive, and the expression on his face is just so human. I think that the portraits are really lovely in a way that the photographs can't be because the photographs are more clinical. They are staged and their purpose is to document the reconstructive work whereas Tonks really captures the humanity of these men.

Robin Lindley: Gillies was aware of the psychological trauma as well as the physical damage caused by these wounds. These men were suffering and usually endured a long series of operations. And Gillies had great compassion for them and their plight as they returned to society.

Dr. Lindsey Fitzharris: Absolutely. Surgeons working near the front were hastily doing surgery. They were trying to stop the hemorrhaging. They were trying to save lives. They were not developing relationships with these patients. A lot of times they don't even know these men's names, whereas Gillies was operating on these soldiers over a long period of time, sometimes even spanning over a decade. He really develops friendships with these men. Some of them even go on to work for him. There's a guy named Big Bob Seymour who ends up being his personal secretary for the rest of his life. So it's nice to see that kind of relationship.

I had a disability activist named Ariel Henley who was helping me with the language. We were having a great discussion about the word disfigured, which might not be used today. But the feeling was that these men were disfigured to the society that they lived in, and I didn't want to lessen that experience by using a more modern term. But I think it's valid to talk about whether that term is useful today. Some people say facial difference rather than disfigured. Ariel has Crouzon syndrome and she lives with a facial disfigurement. Those are her words. That's how she describes herself.

She pointed out a lot of things that maybe I wouldn't have noticed. For instance, Gillies banned mirrors on his wards. This was done to protect the patients from getting frustrated throughout the reconstructive process because a lot of times the face could look worse before it looked better. Ariel pointed out also that that could be really isolating and that it instilled in these men this belief that they had faces that weren't worth looking at. I think that kind of perspective was really helpful for me as a writer in bringing The Facemaker to life and making sure that these men were always at the front of that narrative and that their voices and their experiences were always being honored.  

Robin Lindley: And your book brings forth the stories of the patients and their concerns. The blue benches are such a powerful image. The men with facial wounds sat on these blue benches around Gillies’s hospital and the benches were a warning to members of the public that these men had injuries that might be disturbing to see.

 Dr. Lindsey Fitzharris: Yes. And mask makers offered nonsurgical solutions to these disfigured soldiers. Someone tweeted me and said that she couldn't imagine that these men would ever have wanted to get rid of them, but the masks broke and they didn't age with the patient. So, ultimately a lot of these men did actually turn to surgery. I told this woman that a lot of these men hated the masks and they weren't wearing the mask for themselves. They were wearing it to protect the viewer and they were uncomfortable to wear and they were hot. And there were a lot of reasons why they wouldn't be the best thing put on your face.

People have to remember that the mask is for the viewer. It's not for the person wearing it. And they did it to blend into society.

Gillies himself hated the masks because they reminded him of the limitations of what he could do as a surgeon. But he also understood that sometimes a patient needed a mask. Perhaps Gilles had taken surgery as far as it could go. He also employed mask makers in between in the process because the surgeries could span several years. So perhaps while you're awaiting your next surgery, you would feel more comfortable wearing a mask when going out into society so people wouldn’t stare at you.

The masks were wonderful on one level. The artists were able to produce very startling, real masks for these patients. But on another level, they were really sad because, if society could have accepted these men and their injuries, then arguably we wouldn’t have had to have the mask makers.

Robin Lindley: Your description of the masks and the artists in your book is fascinating. You note a woman in France who made extremely realistic masks.

Dr. Lindsey Fitzharris: Yes. Anna Coleman Ray. She was amazing. And photos of the masks go viral because they look very realistic. But if you were sitting next to someone wearing one, it could be unsettling because it doesn't move like a face. Ultimately, a lot of the soldiers found that the masks scared their children. In a still photo, the masks look amazing and realistic, but if you were talking to someone wearing one, I think it could be quite unsettling.

Robin Lindley: And you have heartrending accounts of what these wounded men went through once they'd completed the surgical process. Many didn't want to see their relatives or friends again because they thought their wounds were too horrifying. And, you have patients breaking off relationships. And there were also suicides.

Dr. Lindsey Fitzharris: Yes, there were. One of the things I really wanted to show was that a lot of the men, especially those in Gillies’s care, did go on to live very happy and fulfilling lives. They went through the reconstructive process.

But there were other stories. A nurse that worked for Gillies's told of a corporal who caught sight of his face and he ended up breaking off his engagement. He told the woman that he had met someone else in Paris because he felt that it would be too much of a burden for her to be married to him.

But on the flip side of the coin, you have Private Walter Ashworth whose fiancé breaks up with him. But then her friend gets wind of this and she begins writing him and the two fall in love and they end up getting married, which is a really kind of lovely alternative story.

A lot of these men were able to go on and rehabilitate, but certainly there were a lot of prejudices at the time. And probably some of the prejudices that that corporal was facing in 1917 would not be that dissimilar to what someone with a facial difference might feel today.

I'm certainly not a spokesperson for that community, but all you have to do is look to Hollywood to know that this is true. A lot of movies portray villains who are disfigured. You have Darth Vader. You have Voldemort. You have Blofeld. You have the Joker from Batman. So, it's a really lazy trope about evilness that continues in society today. We haven't moved on in some ways. I think that the men who were disfigured in World War I would feel very similar prejudices today.

Robin Lindley: I appreciate you emphasizing that, more often than not, these men who were disfigured in war went on after Gillies’s work to heal and to lead normal lives.

Dr. Lindsey Fitzharris: Some of them went on to serve in World War II—even after those earlier wounds. One was a patient named Lieutenant William Spreckley who had one of Gillies best nose jobs. Gillies tried a new technique on him, and none of his colleagues thought this would work. And when Spreckley came out of the operation, his nose was so big, they said it was like anteater’s snout. All Gillies’s colleagues laughed at him and said this didn't work. But once all of the swelling subsided, and he began to heal, actually the nose looked amazing and it became one of Gillies star cases. And he said in his case notes something like Spreckley and his nose went off to serve in World War II. So some of these men went right back into the act.

And some of the men who were patched up by Gillies went back to the front in World War I, and they ended up dying later. It's really harrowing. I can't imagine experiencing what these men did and then also signing up to fight in World War II. That to me is very extraordinary.

Robin Lindley: You note in discussing these patients that many of the wounded were left with deformed noses and other damage—damage that in earlier times suggested a history of syphilis or other dread diseases connected with supposed moral weakness.

Dr. Lindsey Fitzharris: Yes, exactly. That’s where this idea it comes from and why Hollywood can lean so heavily into the idea that morality is connected to a facial appearance. Even our language: someone's two-faced, or they tell a bald face lie, or you take them at face value. Our language reflects how important the face is still, and this is linked to older beliefs.

And as you say, morality and disease are reflected in the face, because if someone contracts syphilis and it's allowed to continue on into its final stages, something develops called saddle nose where the nose caves into the face much like the Harry Potter villain Voldemort, and it looks very similar to that kind of disfigurement.

People aren't aware today of where these ideas come from, but they're still alive and reflected in our culture, and certainly in the movie industry.

Robin Lindley: I appreciate your comments on our attitudes toward disability and difference. As I wrote to you recently, I think your book will stand as a great antiwar book as you literally reveal the human face of war.

Dr. Lindsey Fitzharris: I found it really interesting that you called this an anti-war book, which I love by the way. I love if people think of it that way, but I did another interview with someone who's in the army and he said that this was a book about heroes, which of course it also can be seen as that.

I lean heavily into the violence of the First World War because I don't want to sugar coat it. I don't think I'm doing the patients any favors by not telling the readers exactly what it was like in that time.

It certainly should be seen as anti-war. What we do to bodies in conflicts with the return of old school warfare like we're seeing in Ukraine at the moment, we need to all be thinking about that. But it is interesting because everybody has a slightly different take when it comes to a story like this.

For me, I just tell the story as I feel it should be told and let everybody make their own decisions about what that story is. It was nice to hear that you felt it was a great anti-war book.

Robin Lindley:  Yes, it is. I think it may be illuminating for some people to think about the cruelty and brutality of war in these visceral and painful terms. Didn’t the Germans have a different attitude about the facially wounded?

Dr. Lindsey Fitzharris: The Germans really embraced that, whereas in Britain, the disfigured face certainly was hidden for a really long time. People didn't engage with that and it was very sanitized, but the Germans leaned heavily into it. The images of wounded bodies disappeared in Britain, and certainly the disfigured face doesn’t make it into the public.

Robin Lindley: And it was moving for me to learn from your book that there were French veterans called “the mutilated” with severe facial wounds who had a place of honor at the conference table during the signing of the Treaty of Versailles in 1919.

Dr. Lindsey Fitzharris: It was amazing. And there’s a picture of those men that were at the signing of the treaty in The Facemaker. I think it’s incredible that they were included and they should have been. It should make us question war and conflict.

People say to me but all these amazing medical advances came out of the war, which is true, and all of this has served us long after the guns fell silent on the Western Front. But also, I came to the grim realization halfway through my research that it also prolonged the war. As doctors and nurses got better at patching these men up, they were being sent right back to the front. It was really feeding the war machine. It was a vicious cycle that definitely needs to be acknowledged again, as we see the return of this old school warfare. We have to realize that even if advances do come that benefit us, they tend to prolong these conflicts as well.

Robin Lindley: As you note, Gillies goes on after World War I to continue work as a plastic surgeon, and he does both cosmetic surgery and complex reconstructive surgery. He treated one woman who fell on her face into a fire for hours. You capture the horror of her injuries.

Dr. Lindsey Fitzharris:  Awful. I didn't include her photos, but they can be found in his published book. The woman had epilepsy and she had a seizure. She fell face first into the fire with her infant child and they laid there for some time. And by the end, she just had no face. I can't even describe the photos. There was no skin there. It was just completely gone. And there was a moment when Gillies's was approached about this patient and he wondered if he should even do anything because obviously reconstructive surgery is painful. He didn't know if he would be able to help her, but in the end, he was able to reconstruct a face of sorts for her.

She does end up healing but she had another seizure later and she died. Gillies is told about this on the golf course, and he had a moment of reflection about this poor woman that he had helped.

Gillies continued to do reconstructive surgery and moved into the cosmetic realm, as you say. And he also operated on soldiers in World War II. He introduced his cousin Archibald McIndoe to plastic surgery with the burnt aviators of the Guinea Pig Club. I'm guessing Gillies felt his nose a bit out of joint because McIndoe overshadowed him later. Some of that was because it was such a romantic thing to be a pilot in World War II, and McIndoe’s extraordinary work got a lot of media coverage. Gillies work in World War I didn’t get that same kind of attention and he was overshadowed a bit.

People ask if my book is about the Guinea Pig Club. I say, it's the prequel to that. But Gillies is definitely part of that story because he actually convinces McIndoe go into plastic surgery. It's all interconnected.

Robin Lindley: And I learned from your book that Gillies wrote groundbreaking plastic surgery textbooks that represent foundational works for the specialty now.

Dr. Lindsey Fitzharris: Yes. They're extraordinary. I have the two-volume set. He documented everything and his personality really shines through. Even if you don't have any interest in a medical textbook, it's the way he talks about his patients and jokes about some of them and his relationships with them that is quite amusing at times. And I'm guessing there's still value in these texts today. Plastic surgery really isn't that old, so a lot of these techniques are probably still used on some level or they've been adapted. The ghost of Gillies is still lingering around in those operating theaters.

Robin Lindley: And wasn’t Gillies actually called “The Facemaker” during his lifetime?

Dr. Lindsey Fitzharris: Yes. I didn’t have a title for this book for five years. I was finishing up, and I came across the letter to Harold Gillies congratulating on him on his knighthood after the war, and it was addressed to “Dear Facemaker” and I thought that's perfect because he was certainly was the face maker.

Robin Lindley: Do you have another book in the works now, Dr. Fitzharris?

Dr. Lindsey Fitzharris: Yes. I'm not an academic anymore, so I have to keep writing in order to keep feeding myself. My next book actually is a children's book called Scourge, which my husband Adrian Teal is illustrating. He's a caricaturist over here and he works on Spitting Image, a quite a famous television show.

And my next adult nonfiction project is Sleuth-Hound on Joseph Bell who was a 19th century surgeon and the real-life inspiration for Sherlock Holmes. His student Sir Arthur Conan Doyle based Sherlock Holmes on Bell, and I'm making my way through his 500-page diary as we speak. It’s going to be a really fun kind of romp through Victorian forensics and this fictional character and the real-life inspirations.

I hope that it’s not five years between books this time. I'm going to speed up the process. Going back to the 19th century is like slipping into a bath. It's comfortable. I know that world because of Joseph Lister. I've done a lot of research in the 19th century and it should be a little bit faster process this time.

Robin Lindley: I'll look forward to that one. And please tell Adrian that I admire his work. The Spitting Image caricatures are amazing. It seems that you've taken a deep dive not only into medical history, but also the history of surgery.

Dr. Lindsey Fitzharris: Yes, and again, I didn't do anything like that for my PhD. So, my supervisor is completely baffled, but also delighted that I'm enjoying engaging with people with medical history and where the stories are. And people seem to really love the surgical stories as well. I think Joseph Bell is more of a forensic story, so that will have a slightly different feel to it, but I don't know until I start writing. I'm just at the research phase right now.  

Robin Lindley: I wish you the best on this new project. Who are some of your influences as a nonfiction writer and a historian?

Dr. Lindsey Fitzharris: One of my favorite writers is Erik Larson. I've actually become friends with him which has been a joy because I've been reading his books since I was in high school. He wouldn't call himself a historian. He has a journalism background, but the way he tells a story is incredible.

I read his book Dead Wake about the sinking of the Lusitania when I was going through a rough time in my life. I couldn't get out of my bed and I was involved in my own problems, but that book got me to forget everything. It was told in such a gripping way. So, I love Eric Larson. And I love Karen Abbott who wrote a book called Sin in the Second City, which is about a famous brothel in Chicago at the turn of the 20th century. That's a ripping book. So, there's a couple of people who it's a privilege to call friends now and they just write incredible narrative nonfiction.

Robin Lindley: I also admire Erik Larson’s work and have talked with him about a couple of his books. He was very thoughtful and generous and has a gift—like you—for bringing the past to life.

Dr. Lindsey Fitzharris: He's loves storytelling, and he goes where the story is. And he's given me a lot of advice in my own career. He blurbed this book and it was good to hear his thoughts. It's so good to follow in his footsteps because he's incredibly talented

Robin Lindley: Thanks Dr. Fitzharris for your thoughtful comments on Dr. Gillies, plastic surgery, the wounded in the Great War, and more. Is there anything that you'd like to add that you want readers to know?

Dr. Lindsey Fitzharris: I hope that people will find that I've done these men's stories justice. I entered into the book hoping that I could bring this history to life for people. As I said, you don't need to know anything about World War I and you don't need to know anything about medical history. Hopefully you can pick up The Facemaker and fall in love with this story, with these men, and come away with a better understanding of this incredible period.

Robin Lindley: Thanks again for sharing your insights Dr. Fitzharris. I know readers will appreciate your generosity and thoughtfulness. And congratulations on your engaging and groundbreaking new book The Facemaker. Best wishes on this book and your upcoming work.

Robin Lindley is a Seattle-based attorney, writer, and features editor for the History News Network (historynewsnetwork.org). His work also has appeared in Writer's Chronicle, Bill Moyers.com, Re-Markings, Salon.com, Crosscut, Documentary, ABA Journal, Huffington Post, and more. Most of his legal work has been in public service. He served as a staff attorney with the US House of Representatives Select Committee on Assassinations and investigated the death of Dr. Martin Luther King, Jr. His writing often focuses on the history of human rights, conflict, medicine, art, and culture. Robin's email: robinlindley@gmail.com.