Surgery of the First World War, with Lindsey Fitzharris

researching and writing my novel Anatomy, a love Story. But she's written a new book, The Face Maker, a visionary surgeon's battle to men the disfigured soldiers of World War One, all about sort of, I would say, the unsung hero of plastic surgery, Harold Jillies, who just I mean from this book, I knew nothing about him. He's an incredible man. Lindsay, Hi, welcome.

Thank you so much for having me on. I'm really excited to talk to you about this, as you say, really kind of unknown story about the grandfather of plastic surgery. So let's sort of back up a bit. How did you come to this story? I asked myself about many times, and it took five years to research and right so with the Butchering Art, which was about Victorian surgery and all the horrible things we used to do before anesthesia

and germ theory. Um, you don't have to navigate complications like patient confidentiality, which you do in the twentieth century. And I wasn't really prepared to take that on. What it happened was I have a PhD in the history of science and medicine from Oxford, but I call myself

a storyteller these days. And I didn't know much about Harrow Gillies or World War One in fact, but I knew that there was a really harrowing story there, and I knew that when I started the book, I wanted to drop the reader right in the middle of the battle to see what that felt like and smelt like, and what was it like to be in those trenches. You know, they used to say that you could smell the front before you could even see it, So I really wanted to build that vivid picture for readers. Oh

my god, there's a early on. I feel like the first thing I circled was you talked about like a bubbling mass of worms coming out of someone's wound. It's just so and it's horrible, you know. And I don't pull punches. I don't do it in the butchering art. But it's not because I relish the gore and the violence. It's because I feel like I wouldn't be doing these patients any justice if I wasn't explaining exactly what that

was like for them. And so Private Percy Claire who's hit in the face at the beginning of the book, he writes this amazing diary about his experiences, which is why I used him, and he talks about how this bullet went right through his face and he laid on the battlefield and he thought he was going to die, and it was a real struggle just to get the stretcher bearers to take him off that field because they

also thought he was going to die. It's that horrible thing where they have to protect the people they think of the best chance of survival. Yeah, and you know, a face is very vascular, so anybody who's had a face wounded leads a lot, even a minor cut. You know, there are photos in the Face Maker, and I didn't include those lightly. I actually consulted with a disability activist over this. I didn't want it to be medical voyeurism.

But I also think it's important that we look at these men's faces because during are in the war, they were often forced to sit on blue benches so that the public knew not to look at them. It was very isolating experience for them. So I think that we need to look at them today and we need to not put them on that metaphorical blue bench. I thought that was a brilliant note that you wrote in the beginning of the beginning of the book explaining your decision

to show the photographs. And yes, some of them are hard to look at, but I think they also go to show how amazing Dr Jilli's work was. Yes, yeah, and it's Gillies with Okay, I had asked you before, like right before this podcast started, but I will give the excuse that it's said and I am and left. Oh yeah, it's somebody. I mean. Also, if you've read it,

Jilly's in your head, because there was. My friend Karen Abbott also kept making that mistake when I was in New York, and I was like, once it's in your head, it's hard to kind of erase it. But yeah, it is Gillies. But yeah, the work he could do before antibiotics over a hundred years ago, with no textbooks to guide him to rebuild these faces as extraordinary. Plastic surgery

did pre date the first for war. In fact, the term is coined in se At that time, plastic meant something that you could shape or you could mold, so in this case a patient skin or soft tissue. Really, those early attempts focused on very small areas of the face, such as the ears and the nose. What Gillies is able to do is it goes much further beyond restructuring entire faces that have been obliterated by war. So backing up to sort of your story, you're an American who

then studied and got her PhD at Oxford. What was that journey like for you? What was that decision like? And then how did you come to medical history specifically? So we both are from Illinois, your Park and I'm from Arlington Heights. Oh my god, we're literally neighbors. We're literally neighbors. And I can't get rid of this Chicago accident. I've been in the UK now for twenty years. It's it's here to stay, Oxford trying to beat it out

of me. It's here to stay. I went to Oxford because they had a great program in medical history, which is a really niche subject, and I did my masters and my PhD. And then I got really burnt out intellectually. So I started a blog called the Surgeons of Apprentice, and I started to write for a general audience and I found that really rewarding. But what really happened that kind of was the catalyst into my career was my ex husband left me in very abruptly. He wrote me

an email. I was in Chicago. This was a ten year relationship and the email an email. Yeah. So I returned to the UK. His stuff is gone, he's disappeared. He then reports me as illegally in the UK. He says that the marriage is over. She can't stay, so they take my passport. I can't work. So during that time I worked on a five page petition to remain in the UK. I had no money. I fought him in court and I ended up writing the proposal for the Butchering Art and selling it. And it changed my life.

And you know, I say that that you know Joseph Lister, whom the books about, I say that he saved a lot of lives but he also saved mine because this book just lifted me out into a whole new career in situation. And I love engaging the public about medical history. Now, Oh my god, I mean, that is an amazing story. I'm so glad for your sake, but also for all of our sakes that you're doing this work. What I think is so incredible about your writing is it's deep.

I mean academic level history obviously, but at a level that anyone can read. It reads like a novel. It's fascinating. That are just amazing. I mean, I love Eric Larson's books, and I'm good friends with him. If anybody has read his books, narrative nonfiction is is what I love to do. It's it's as you say, it reads like a novel.

It's all true. I think that even people who don't like history might like medical history because everybody knows what it's like to be sick, especially coming out of a pandemic. So you might not be interested in history and politics and work. You might know what it's like to be sick, and you might be able to relate to medical history.

You know, what would happen if you had a toothache in seventeen two, or what would happen if you had to have a legra moved in eighteen forty three, And that's kind of where I come in as a medical historian. So obviously, as you alluded to, the situation with Robert Lister was very different than it is in nineteen seventeen, But were the obstacles of surgery at nineteen seventeen where sort of war away in technology and what did we

still have to achieve? Well, so at the point of the First World War, surgeons understood germ theory, so that was at least good, but actually in a weird way that created problems because they had grown up on aseptic and antiseptic techniques, so they weren't used to identifying infections. So at the beginning of the war there is a

high rate of infections. You can imagine the mud of the trenches and it's just very unhygienic, and these surgeons are quickly and hastily stitching these wounds up to stop the hemorrhagene, and in doing so they're literally sealing up these men's faith. They're stitching in this bacteria, So that does become a problem. Also, anesthesia hasn't really progressed since eighteen forty six when ether was first discovered, which I

talked about in the Butchering Arb. And that was a wild time, by the way, guys, because when doctors discovered ether, they started drinking it and taking it themselves, and they had these ethereal experiences. That's where we get the term ethereal.

So it's like the wild wild West of Edison. But nothing had really progressed since eighty With anesthesia, so you're talking about a rag with chloroform or a rudimentary mask, and in fact, Harold Gillies, at one point in the face maker is leaned over a patient and the patient is breathing ether back into Gilly's face. So this is

a real problem for your facial reconstructive surgeon. So you have advances happening in anesthesia in parallel with plastic surgery for these very reasons, because putting a mask over a damaged face was problematic anyway, would obscure the area that Gillies needed to work on, but also it caused other kinds of issues in the operating theater. Oh my god, of course. So who was Harold Gillies? How did he

come to be this pre eminent surgeon. So he was an E. N T surgeon before the war ear nose and throats, so he had a very good understanding of head anatomy. Well, what happens is he volunteers with the Red Cross. He ends up going to France and he meets this character named Charles Vladier. And anybody who's read The Butchering Art will know that I love telling the story about Robert Liston, who was the fastest knight in the West End. He could take your your leg off

and under three seconds. Vladier is the Robert Liston of my story because he's bigger than life. He's an American French dentist. He has a Rolls Royce which he retrofits with a dental share and he literally drives it to the front under a hail of bullets. This guy is a legend. I mean, there's so many weird stories too, because people they were just throwing themselves into these dangerous situations.

And it's Vladier who teaches Harold Gillies about one the importance of dentistry when rebuilding a face, and also just shows him this desperate need for facial reconstruction. Near the front. So that's really what sets it all off. You know, in the Butchering Art you talk a lot about sort of the distinction between barber surgeon of the early eighteen hundreds that transitioned into what we now consider surgery. Being a barber surgeon was not at like the same academic

level as being a physician. Where sort of are we in that understanding in the early twentie entry. Yeah, I mean, so, as you say, in the earlier periods, so you're looking at like the seventeenth eighteen centuries, you had these people called barber surgeons, and they would pick the lights out of your hair, and they would pull teeth, and most people would see the barber surgeon rather than a physician,

which was very expensive. Also, the barber surgeons would blood lat patients, and so that's where we get the red and white barber's pole, because they would advertise by putting these bloody rags on the pole, and it would twist in the wind and it would create that red and white pole that we're all familiar with. Oh my god, as I said, most and I have I have a barber's pole somewhere in this People can't hear me because

we're on a podcast right now. But I have a lot of weird stuff in my office because I think that objects are a great way into the past. But the barber surgeons were sort of the first porter call for most people in that period. Surgeons in general were seen as people who worked with their hands, so it was seen as less than being a physician, which was someone who worked with their mind. So the physician rarely touched the patient or laid their hands on the patient.

It was a much more cerebral activity. By the time World War One comes about, you know, surgeons are much more respected, thanks in part to Joseph Lister in his work in the nineteenth century and this kind of professionalization of surgeons at this time. So Gillies was, you know, at the top of his game as an E. N. T surgeon. He was working in a very lucrative practice in London. But when the war starts he finds his new passion, which is plastic surgery, which isn't a subspecialty

of medicine at this point. And it's really after the war that it becomes quite tenuous because at that point he has to decide whether he's going to pursue plastic surgery, because again, at this point it wasn't really a specialty in medicine. Amazing. What I'm always curious when I bring on historians, what was your research process? Like? Obviously this book goes a multi year endeavor and it absolutely shows in the detail and depth of research, But where did

you start? Well, my process is a lot of tears and going why did I take this on? I mean, I think that as a narrative nonfiction writer, a lot of my job is getting rid of material because I don't like to overwhelm readers. I don't know if anybody listening out there, you know, for me, I get turned off if I go into a bookstore and there's like this huge TomEE on John Adams, Like, I mean, that's too much of John Adams, right, So I like my

books to be really fast paced. I want people who never thought about facial reconstruction or World War One to enjoy it and not feel swamped by the material. Now, when you're dealing with World War One, there is so much material. I mean it's literally there's so many letters and diaries. This is the time of war poetry. Everybody's writing about their experiences. So you can get very overwhelmed by it. I said at the beginning of the book that The Face Maker is not a definitive history of

World War One. It's certainly not a definitive history of war medicine, and it's not even a definitive history of Harold Gillies. I really cherry picked a number of soldiers that really stood out to me, and so there's about twelve of them that are featured in the book, because again, I feel like it would just get not miss, that would get overwhelming. So a lot of what I do really is just absorbing material and then getting rid of

it for everybody. So I I kind of a digest it for you so that you don't have to do all of that. That's sort of the noble blood ethost we try to condense. It's like the sweet spot is thirty minutes. If I can tell this the whole story in thirty minutes without getting bogged down in the extraneous details, no, we we don't. We don't have time. Who's got time for the big John Adams biography? You know, I certainly don't.

I mean, there's an art to those long form biographies, But for me, again, like you know, I write in the style of Eric Larson, or hopefully people feel that way, and he writes such thrilling books. I mean, you forget that these are true stories. You know, he just wrote a book on Churchill, and you think, well, I know everything there is to know about Churchill. Yeah, he tells it in such a way that you forget in the moment.

It feels very real and it feels like you're actually there, and that's what I hope I can achieve with my books. I mean, it does. I read this in like two days. It does read like a novel, like a story, especially because you focus on the individuals as characters. They feel like real people and sort of to that end, do you have a favorite case study that you went into in this book. No, it's a good question. There's a couple of men who are featured in the book. I mean,

Percy Claire, as I said, opens it. But I think if there was a favorite, it's this guy named Private Walter Ashworth. Ashworth is injured on the first day of the Battle of the Song, which if you don't know anything about World War One, you probably recognized the Battle of the Song because it was a blood bath of the hundred thousand British soldiers who took place in the

advance that day. Sixty thousand were killed or injured. Never before or since has a single army suffered such losses on a single day and a single battle, So it was horrible. Now Ashworth survives, but in doing so, a bullet rips through his face and removes part of his jaw. At that point he falls forwards, which is key to his survival, and he lays on the battlefield for three days. People are like, how could you lay on the battlefield for three days? First of all, he had no jaws,

so he couldn't really scream for help. But the other aspect was that the structure bearers became targets themselves, so it took a lot to convince them that you were worthy of saving. It could take as many as twelve meant to remove a single man off the battlefield, so it's very laborious and dangerous. So Ashworth lays there for quite a long time. He's finally rescued. Now, as I said, key to his survival was falling forward, and that was because a lot of times these men fell backwards and

they would choke on their own blood. Or they would choke on their tongues because their tongues would slip back into their throat, which was awful. So just getting off the battlefield was literally half the battle for these men. He ends up in Gilly's care his fiance breaks off their engagement. That was not uncommon for these men. But then later his fiance's friend gets word of this and she begins writing him at the hospital, and soon they

fall in love and soon they get married. But one of the sad bits about his story is that when he's discharged from the British Army, he goes back to work as a tailor's assistant and his boss makes him work at the back of the shop because he doesn't want Ashworth to frighten the customers. And so I think one of the strongest themes in The Face Maker is that not all wounds during the First World War are

inflicted on the battlefield. That's so heartbreaking when you think about the devastation that happened there, and then also that the devastation that came home. Yeah, and that's why I said Gillies didn't just mend these broken faces, he mended their broken spirits. But I think it's really important also to remember that Gillies is a product of facial biases of his day. I mean, arguably, we wouldn't need a Harold Gillies if we could have accepted these men's faces

as they were. There was a need to restore function. Of course, you want to make sure that someone can swallow and to eat and to breathe. But Gillies was going far beyond this. I often say that this was a time when losing a limb made you a hero, but losing a face made you a monster to a society that was largely intolerant of facial differences. That's a great quote. I mean that that really sums it up.

It's the movie. Yeah, it's the movie tagline. Yeah, you're out in l a. I'm We're always thinking about movie taglines, and you know how things can get adapted, and that's always the big dream as the writer. But all of that aside, I actually would love to see an adaptation because if you think about Hollywood, there's this really lazy

trope about evilness within disfigurements. So yeah, oh my god, you have a Darth Vader, you have Baltimore, you have Blowfeld, you have Harvey Dent becomes evil after he becomes man like. He's fine until he is injured. So I would love to see an adaptation, if only because I'd love to see these disfigured men as the heroes of their own story, which they absolutely were at the time. Oh that's wonderful, you know. And another thing, I also read that Harold

Gillies went on to sort of pioneer gender affirmation surgeries. Yes, this is amazing. So in the apologue I talk about his postwar career, and he does work through World War Two. He's actually working on genital reconstruction of sailors who are injured during that war. And his cousin works very famously on the burned pilots, and they become known in Britain as the Guinea Pig Club. In fact, I think there are still some guinea pigs still alive. It's it's like

the world's most exclusive club. And they got a ton of media at the time for these burns and for the reconstructive process. In nine Harold Gillies performs the first successful falloplasty on a train ends man named Michael Dylan. This is an incredible story for so many reasons, not least it happened in nine. What happened was Dylan eventually was outed by the British press. It was terrible, there

was a media circus. Dylan ended up fleeing Britain. But Harold Gillies really stood by him, and I think that really speaks to his progressiveness at the time, both as a surgeon and a human being. Absolutely, I mean being able to push the envelope in terms of just human dignity. It feels like he was like, yeah, did you really think that people should control their identities? Even in he moves into the cosmetic realm as well, because a lot

of people asked, you know, what is plastic surgery? We come today, but if you think of plastic surgery is a heading and then underneath you have reconstructive and cosmetic, and both of those continued to be very important to the practice of plastic surgery. But Gillies himself, he moved into the cosmetic realm after the war, and he would say that, you know, reconstructive surgery was about returning something to quote normal, that was his word, but that the

cosmetic realm was about surpassing the normal. And he was cited by both of those challenges wonderful, you know. And as we spoke a little bit before we started recording, Gillies actually has a living relative talking about how he got in contact with him. This is really funny. So the Butchering Art. If people have listened to the audiobook of the Butchering Art, it's read by a voice actor named Ralph Lister. This just happened to be coincident. He

just happens to be related to Joseph Lister. In fact, when my publisher came to me with various actors, I said, wait, is Ralph Lister related to Joseph Lister? And they and they say, oh, yeah, he is. And I was like, well, okay, I don't even care what he sounds like. He's got to read it. That's just too weird. And he's like a real audiobook narrator. I'm looking aim up now he's done, like, you know, dozens of audio books. Yeah, it was just a total coincidence. It's not like, you know, I went

and sought this guy out. So he did a great job with the Butchering Art. And then I found out that Harold Gillies has a very famous great great nephew named Daniel Gillies. He's been in The Vampire Diaries and various other television shows, and so I tweeted at him and I said, well, Daniel Gillies should read the Audible book, and he tweeted back and said, yeah, let's do it. So he's actually recorded it. It's been brilliant. I guess as he was recording it, he would stop and occasionally say, oh,

I didn't know that about my ancestor. He of course knew a bit about Gillies, but you know, and his father wrote me too and said that this book is so wonderful because Harold Gillies was about to cease to exist in people's imaginations and now we can live again through the Facemaker. That's so sweet. I imagine if you're an actor and you get to read a book and know that this is like a direct ancestor of you,

that's probably just such a weird. Yeah. I actually we'd love to do like a joint event at some time and talk about this because I just think it would be so because you know, Daniel Gillies being an actor in Hollywood, he is in the business of image, and so was Sir Harold Gillies. That makes time image is very important, so it would be interesting to kind of have a little chat with him about, you know, his process of learning about Gillies through this book. So yeah,

it was just really a joy. And actually someone left a review of the audible book that said they thought that this was kind of a gimmick at first, but Daniel Gillies is so chapro and he did such a great job with the reading of it, so I think people listeners have been generally very happy with it. I also have to say I was like looking at his picture being like, where do I know this guy from? And he's in because I didn't watch the Vampire Diaries,

so maybe I should. He's in Spider Man too, the like Sam Raimi one and he plays Mary Jane Watson's like perfect fiance. He's like a football quarterback astronaut with like oh my gosh. Oh he's had a beautiful face. He has the face that is a platonic ideal where you're like, I know and right, And I said, I said, what is the You know, it's ironic that Harold Gillies has this great great nephew who has this perfect masculine face.

And as I dream up my adaptations and stuff. I used to think like, oh, he should play Harrold Gillis and that I was like, no, he should play one of the soldiers. His face is ruined and restored by Harrow Gillies and the man un rapid and it's like this beautiful face. But yeah, he's a very good looking man. Amazing. It's just just like, what a perfect coincidence that it

all comes together. Yeah. Absolutely, So when you were, uh, in the metaphorical trenches of this sort of I don't want to say like grewsome research, but so much of World War One is so heavy and heartbreaking. What do you do to take care of yourself? But you're like a mental break well with the pandemic as you know out in l A. I mean, we were locked down and having this book during that time was also terrible

on some level. But my new husband, who have been married to now for quite a few years, he's a caricaturist for a show over here called Spitting Image, and he's an illustrator, and so we're working on a children's book which we're still working out the title for that book, which will be out next year, and it's going to be an illustrated romp through medical history, all the kind of grossest diseases and what doctors tried to do. So

that's been a nice creative relief. And then also I've now sold my third book, which is going to be called Sleuth Hound, and it's about Joseph Bell, who was the real life inspiration for Sherlock Holmes, was Conan Doyle's professor. It's going to be a romp through Victorian forensics. So I can't wait. I hope we can have a chat about that because I think it's going to really be in your wheelhouse. Oh my got I already love it. Please send me a copy. I get an advanced copy.

And yeah, I'm excited about that one because it lets me go back to the nineteenth century. It feels like slipping into a comfortable, warm bath. I don't have to deal with patient confidentiality or anything like that. And it's going to be really fun looking at the various crime techniques in their early infancy at that time. The one thing I do have to say, sort of as like my self disclaimer, because this is noble blood and we

usually find the noble connection. Harold Gillies was knighted. He was yes, absolutely, So he was knighted a little bit late, I would say, actually he should have received his knighthood bit earlier after the war, and there was a feeling amongst his colleagues that he had been sort of overlooked. But he did eventually received his knighthood and he was

really pleased about it. And actually that's how I came up with the name the Face Maker, because it wasn't until I was working on the Apologue that I came across a letter to Gillies congratulating him on his knighthood, and it was addressed to dear face Maker. And I such a perfect title. I mean, you probably know the hell of titles and subtitles and all the things that go into kind of making a book successful. And with the Butchering Art, I sold it as the Butchering Art.

It remained the Butchering Art, but the Face Maker. There were so many different titles. There was one that was war Torn, and we went through a lot of different iterations, but I think I finally nailed at the Face Maker. And the cover as well, which was designed by my husband Adrian Teal. It pays homage to Gilly's book The Principles and Art of Plastic Surgery, in which the cover

pictures Gilly's hands holding the scalpel. So this cover is illustrated and it shows the hand of a surgeon, but in the blade you see the reflection of a bandaged soldier. So I like it because it gives the sense that this is a book not just about one man but about many men. Oh, that's so great. And then there's also another cover that the British cover that, yeah, so this one, So it's different publishers as you know, you know,

different covers. Everybody asked me that the British and Penguin really nailed this, so I had like, really no notes on this one because again this is a podcast, so people can't picture it. But it's basically an illustrated cover and it's a silhouette of a Tommy from World War One. In his face is made up a composite of many different faces, and it's it's kind of disturbing, which I think is good. You know, I think, like, you know, people need to know that they're entering into this violent,

graphic book. But I do think that there's redemption and there's hope. But you know, you've got to keep it real. It's the past, and I don't like to sugarcoat it for people. And I will also say that, like the fingers holding the scalpel on the cover are bloody, but it's like a cartoon blood. It's not like, yeah, it's totally you could read this book in public and no

one's going to be Yeah. It has a bit of a like a you know, nineteen fifties the the US cover it has like a movie poster feel to its, kind of like it was so hard again my US. I don't know if you have ever had any cover issues where yeah, I'm nodding. Sorry again. Every every writer is like, oh, we've always had like that moment where the publishers goes, here's your cover and you're like, oh no,

all right. Yeah. So the original iteration for the U s cover looked like a puzz a book like that you buy your grandmother, and it had Victorian font which was all wrong for this. So I really kind of took control and thankfully Adrian is an artist and he helped guide me through that. It helps to have very visual people, you know, circulating around you. So we finally nailed it. But it will be interesting to see what the foreign covers are, because it's going to be translated

into about fifteen languages. So, oh my god, that's incredible. Well, thank you so much for I mean, this book, for telling the story of Harold Giles in the world. Gillies, Jesus Gillies. Oh my god, don't worry. It's because I read it and I didn't have his exactly, had some great great grand nephew telling the story of Sir Harold Gillies to the world. And thank you so much for having this conversation. I've been such a fan for so long.

This is just like we gotta get drinks when I'm in l A. Oh absolutely, okay, thank you, thank you so much. Noble Blood is a production of I Heart Radio and Grimm and Mild from Aaron Mankey. Noble Blood is hosted by me Danish Wortz. Additional writing and researching done by Hannah Johnston, hannah's Wick, Miura Hayward, Courtney Sunder and Laurie Goodman. The show is produced by rema Il Kayali, with supervising producer Josh Thayne and executive producers Aaron Mankey,

Alex Williams, and Matt Frederick. For more podcasts from I heart Radio, visit the i heart Radio app, Apple podcasts, or wherever you listen to your favorite shows.