Lindsey Fitzharris: In Conversation

Lindsey Fitzharris is an award-winning medical historian, whose books have reached the bestseller lists across the globe. In addition to writing fascinating - if occasionally gruesome - books on the medical advances of the last two centuries, she has written extensively for a number of newspapers, magazine and journals, as well as writing and hosting The Curious Life and Death of... television programme for the Smithsonian Channel . We caught up with Lindsey during the British leg of her new book tour to talk about The Facemaker and the amazing work of Harold Gillies.

Can you tell me about your new book, The Facemaker?

The Facemaker is about the pioneering surgeon, Harold Gillies, who rebuilt soldiers’ faces during and after the First World War. At this time, 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. What Gillies was able to do was not just mend these men's broken faces, but also their spirits. It was a hugely important moment in the history of medicine.

Was it just through the act of mending their faces that their spirits lifted, or was he basically a counsellor as well?

He established the first hospital dedicated to facial reconstruction ever, and that hospital became a community. If you went to a general hospital with a facial disfigurement, you might feel a little self-conscious about participating in activities. But at the Queen's Hospital in Sidcup, everybody was disfigured, so everybody was more likely to participate. They had courses that taught languages; they taught them how to barber; they taught all kinds of other things, like toy making. And so it really was a community and I think that led to their rehabilitation.

What became of the patients afterwards?

The Facemaker is mainly about that arc within World War One, but I deal a bit about what happens to these men afterwards. A lot of them went on to live very fulfilling lives. There was a man named Private Walter Ashworth, who laid on the battlefield during the Battle of the Somme for three days without a jaw and so was unable to scream for help. He was eventually taken off the field and found his way into Gillies's care. His fiancée broke off the engagement, which was really sad and quite a common experience for these men. But it has a happy ending because the fiancée’s friend got word of this and began writing him at the hospital, and soon they began exchanging letters; soon they had fallen in love, and soon they had married. So he went on to live a very fulfilling life. Many of these men did, again, to the credit of Harold Gillies.

There is the phrase, 'War, what is it good for?' Do you think you've provided one answer to that?

Yes, I think a lot of my readers will gravitate towards that positive message because it wasn't just the birth of plastic surgery and facial reconstruction: it was also advances in anaesthesia; the first blood banks appeared during World War One. That's all wonderful, and it's served us since the guns fell silent on the Western Front. But I did come to this grim realization halfway through my research that as wonderful as these advances were, they also served to prolong the war: as doctors and nurses got better at patching these men up, they were being sent back to the front and they were feeding the war machine. It was a vicious cycle. I think that's really important to acknowledge, especially as we see the return of old school warfare in Ukraine at the moment.

A lot of people have said that the war in Ukraine has made the relevance of history more obvious. Have you found that?

Over here in Britain, I'm getting a lot of questions about what we can learn from The Facemaker, about what was going on then and how that translates over into Ukraine. In the US when I was on tour, a lot of focus was on what we can learn about guns and the damage it does to bodies as well, and so that's on the forefront of people's minds there. I don't have an agenda when I set out to write a book. Some people have said this is an anti-war book; some people have said this is a story about heroes. I think it's a little bit of both. I think that you can go into The Facemakerand you can learn something that you can take forward into the future. But you can also just take it as a really harrowing story that might seem grim and relentless at times, but there's redemption and there's hope as well.

Have you found that people have been more attracted to your work since the pandemic?

I think so. I just spoke at my old department in Oxford, the Wellcome Unit, and we were talking about how medical historians are suddenly very relevant. A lot of medical historians are working with the government on policy. We can provide a context that maybe other scientists can't necessarily see. One of the biggest questions is when does a pandemic end and for whom? That's a political and societal decision, whereas the beginning of a pandemic tends to be a medical decision: the W.H.O. announces that we are now in a pandemic. And you see this because different countries are acting differently towards the 'end' – if you want to call it that – of the pandemic. I'm certainly not a virologist but this now would probably be considered endemic – it's going to be around for a very long time. So now it's about how we respond and deal with that going forward. That's where medical historians can offer glimpses into the societal reactions and how we've managed diseases in the past. But I'm always careful not to draw parallels too much, because we have very different responses and technology at hand to manage these things; our understanding of how disease spreads is very different.

Of course, it's not your first book: you've also done The Butchering Art, and you're a historian of science. What draws you to these terrible subjects?

My sole purpose in life is to destroy the romanticCharacterised by expressions of love; or an idealised way of looking at something; or someone who followed the Romantic artistic movement, that focused on individualism and emotion. notions about what it was like to live in the past! I'm going to tell you exactly what it was like, for instance, if you had a toothache in 1792 or you had your leg removed in 1843. But we have a morbid curiosity. I always say that if you don't like history, you might like medical history because everybody knows what it's like to be sick, especially coming out of a pandemic. It's very relatable in that sense because we can compare these problems in the past to our own experiences and how lucky we are to live today. I always say that today is the best day, medically speaking, that you can live in, and tomorrow will be better, and hopefully that will always be true. So when you do look back in the past and you think about how nice it would have been to wear those beautiful dresses, just think about the dental care and no anaesthesia and all of the things that would have made that experience a little more painful for the average person.

I am a medical historian by training, and I was an early modernist – I have a PhD from Oxford in seventeenth-century alchemy – but I call myself a storyteller these days. I really go where the heart of a story is. For The Butchering Art, it was about Joseph Lister, who saves more lives than any other person who's ever lived because he introduced his germ theory to medical practice. It's all about what the Victorians did before anaesthesia and before antiseptics. This story is about Harold Gillies, the pioneering surgeon who becomes the grandfather of plastic surgery. Then I have another book coming, which I can now talk about, called Sleuth Hound. It’s about a guy named Joseph Bell, who was the real-life inspiration of Sherlock Holmes, and he was also Conan Doyle's professor. So it's going to be a romp through Victorian forensics and all the fun things that they were doing in the nineteenth century.

I’ve got a book coming out next year in the fall and it's with my husband, Adrian Teel, who's the lead caricaturist for Spitting Image. It's a bloody tour through medical history for kids, and it's going to be illustrated. It will be really fun: smallpox, tuberculosis, bubonic plague will all be in there. Kids love that stuff. So we're looking forward to that. I've said that I've scared the adults long enough; I'm coming for your kids in 2023! Sleuth Hound will come after that.

Is there a particular knack to writing for kids?

It's so hard! When I first started I thought, ‘This will be a breeze’, but it's harder than people think; it certainly was harder than I expected it to be. For instance, let's take Edward Jenner, who comes up with the first ever smallpox vaccine. That's a complicated scientific story, but there are a lot of wonderful things that kids will connect with, like its link to cowpox, and so we bring all of that in. But Adrian and I have managed to get through it: we've gotten it all in place, and now we're going to start illustrating the cover. We tentatively called it Scourge, but we heard that that might be too complicated a word for kids, so we're rethinking that.

Even with The Facemaker, I didn't have a title for five years of working on the book. It was only in the epilogue I came across a letter to Harold Gillies congratulating him on his knighthood, and it said, 'Dear Facemaker', and I thought, ‘Oh, this is perfect!’ The cover, too, has been a lot of work. The Facemaker is as much about the disfigured soldiers as it is about Gillies, so the cover, with the illustration of the TommyA British private soldier. whose face is made up of many different faces, captures the idea that it's not just about one man, but about many men. The US cover's different – different publishers, different covers – and was actually done by my husband: Harold Gillies wrote a book on plastic surgery, and on his book cover is a picture of his hand holding a scalpel. So we took that, but in the reflection of the scalpel blade is a bandaged soldier.

It's been a difficult concept to bring to life because there are so many aspects. There are so many soldiers, who do you pick to feature in it? Also, I worked with a disability activist who has a facial disfigurement and we talked about the inclusion of photos, because I didn't want it to be medical voyeurism. But I thought it was very important that we look at these men's faces: they were often made to sit on blue benches so that the public knew not to look at them in 1917, and I didn't want to put them on that metaphorical blue bench today. The exception is that if the men died in Gillies's care, we decided not to include their photos. I also use the word ‘disfigurement’, which you might not use today, but these men were disfigured to the society they lived in, so it was an appropriate word for this book.

The history of science and medicine is such an interesting area because it's a crossover: you need both the scientific and the historical skills.

It's great because it also appeals to so many people. The book has been reviewed in New Scientist as well as the humanities magazines, and medical history appeals to a broad range of people. You've got a lot of the doctors and nurses who want to learn about the profession. So that's why I love it.

I'm a big proponent of trying to get academics to do more writing for a general audience because I love history, I love medical history, I'm passionate about sharing that with people. There is no bigger joy for me than getting someone interested in medical history who never thought about it. The Facemaker is about a man probably nobody has really heard about, about a war that many Americans at least never really think about, and it elbowed its way onto The New York Times bestsellers list two weeks ago, amongst a lot of celebrity memoirs and similar stuff. It keeps me going to think that people really are connecting with these stories, that they feel that the past is immediate and relevant. I had four people faint while I was on tour with The Butchering Art. This time I've gotten people crying. I love that the response is so strong and that the history feels so immediate to them that they would react in that way. If they can care about these people, then I've done a good job.

Both books have covered quite modern history. Do you think that actually that emotional response is based upon how close, say, the First World War is to our own time?

The reason I haven't done an early modern book is because I write narrativeA story; in the writing of history it usually describes an approach that favours story over analysis. nonfiction, so my books read like novels. I have to be able to move people around in a way that is factually correct and the further back you go, the more difficult it is to do this because the records are much more sparse.

I do think that it being recent history helps people connect in a way that's more real than if you went back five hundred years. Especially with The Facemaker, people think of their great-grandfathers. I've had people pick up the book and say, ‘My great-grandfather was a stretcher bearer, and I never really thought about that until I read your book’. Often, they wouldn’t want to talk to relatives about it, and suddenly that becomes understandable. It could take 12 men hours to remove a single man, and a lot of times stretcher bearers had to make life-and-death decisions over who got off the field and who didn't. With a face injury, it's so ghastly and so bloody, they would often just leave these men behind. You can't really blame them when you see the photos.

Did you manage to track down any of the relatives?

Harold Gillies actually has a very famous great-grandnephew named Daniel Gillies. He's a Hollywood actor who’s been in The Vampire Diaries and The Originals. I tweeted and joked that he should read the Audible book, and he agreed. The joke came about because the man who read The Butchering Art was named Ralph Lister, who just happened to be related to Joseph Lister. I didn't set out for that: when they were giving me these voice actors, I said, ‘Wait a second, is he related?’ They said he was, so I really had to choose him! But now I've set up this problem as a writer that I'm going to have to find someone from Joseph Bell's family for the next Audible book. But when Daniel Gillies was reading the book, he would keep stopping and saying, ‘I didn't know that’, so that's been a real joy. The book also opens with a man named Percy Clare getting shot in the face. I use his diary extensively and I've talked to his great-grandniece. She didn’t really know much about him, so it's fun that she learnt about him and that he can live again through The Facemaker.

If you were to have a safety bubble – so there's no smallpox; you don't have to breathe in the smells; and you can get back – where would you go?

I'm glad you said that because otherwise I would say 'I don't want to go back to the past.' You know, the moment I went back to the past, I would break an ankle or I'd get a toothache. You know that movie with Tom Hanks, Castaway? You knew right at the beginning when that tooth started to ache that it was going to become a moment of tension in the movie.

I guess I would like to go back to probably the mid-nineteenth century, even though this book was about Gillies. I would love to meet Lister, to meet all of the brilliant doctors and surgeons at that time, to meet Joseph Bell, who's going to be the subject of the next book. It was such an exciting time in science: when they discovered ether in 1846, the doctors began taking it themselves, and they had ‘ethereal’ experiences. It was like the Wild West of medicine. So I would have loved to be there, to witness it, maybe partake in it a little bit! I think that would be good fun as long as I had the safety bubble around me.

If you were to throw a dinner party for people from history and there weren't any language barriers, who would you invite?

I'd love to have a dinner party with Gillies and some of his patients later on in life to see how they would pay homage and tell about their experiences and what happened to them after. That would be really lovely to see all of that come together. They wrote to him when he got knighted and one of them said, 'You won't remember us, there was many of us, but we remember you.' I think that really encapsulates what Gillies did for them, so I'd love to get them all together in a room at a dinner party.

Cover image © Damien McFadden.