FHC #54: The incredible rulebreakers of medicine’s past

Dr. Lindsey Fitzharris headshot in front of quote reading "Never let routine methods become your master." Attributed to the fixing healthcare podcast.

Author and historian Dr. Lindsey Fitzharris is fascinated with medicine’s grisly past and the extraordinary physicians who changed the profession by breaking the rules.

One of those rule-breaking doctors of yore is the protagonist of her newest book, The Facemaker: A Visionary Surgeon’s Battle to Mend the Disfigured Soldiers of World War I (available June 7). In it, Dr. Fitzharris tells the riveting and true tale of Sir Harold Gillies, a pioneering reconstructive and plastic surgeon.

Set against the backdrop of the first World War, the book takes place in a time when military technology was radically outpacing the science of medicine. The machines of war were ravaging human bodies. And so, Gillies, a Cambridge-educated New Zealander, dedicated his career to picking up the pieces, rebuilding the broken and burned faces of frontline heroes. Along the way, the surgeon didn’t just break the rules of medicine. He rewrote them.

This interview, the first since the book’s publication, pairs Fitzharris with hosts Jeremy Corr and Dr. Robert Pearl—the latter is, himself, a reconstructive and plastic surgeon who has published two highly acclaimed books on medicine.

Interview Highlights


On plastic surgery 100+ years ago

“It wasn’t really until the First World War that there was this huge need suddenly for facial reconstruction. And that had to do with the brutality and savagery of this kind of war. 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. So Gillies really filled in there to help these men, and to mend their faces and their broken spirits.”

On advances in war vs. advances in medicine

“[There were] so many advances in weaponry at this time that a company of just 300 men in 1914 could deploy equivalent fire power to a 60,000 strong army during the Napoleonic war. You have the invention of the flame thrower, the invention of tanks. You have chemical warfare at this time. So really the medical community was just playing catch up when all of this began. And there was this huge need to figure out how to mend these broken bodies.”

On what made Gillies unique among his surgical peers

“Harold Gillies, what is extraordinary about him is that he’s a very creative individual. He’s one of those annoying people that’s good at everything he does. He’s a competent artist. He’s a great sportsman. And that creative aspect to his personality served him very well going into reconstructive surgery. He’s also very collaborative. He’s willing to work with other technicians and practitioners at this time.”

On Gillies’ ethical conflict as a wartime doctor

“One of the terrible tensions for Gillies in World War I was the fact that he had a duty to his patients, but he also had a duty to the army. And so, in some instances, I’m sure he would’ve wanted to continue working on the reconstructive process, but perhaps the function had been returned to the face. And the feeling was that the man could be returned back to the trenches. And I think that was a really heartbreaking tension that played out throughout the war for him.”

On staying positive in terrible circumstances

“Gillies’ attitude, this positive attitude, and the way he could look at the humorous side of things, really served him well because he had such a heavy burden on his shoulders. If you imagine the psychological damage as well to these men coming into the hospital, I think he was really able to nurse them in many ways, not just fixing their faces, but he was able to fix their spirits.”

On what connects history’s greatest rulebreakers

“I think that the biggest trait is perseverance. When you look at Joseph Lister, he could have given up quite easily in the face of the pushback because he received enormous pushback when he started to champion germ theory … And it was a huge leap of faith, but he persevered. Also with Gillies after the war, he could have just given up and gone back to his old practice … But he really believed that what he was doing was transformative, that it was important, that it would serve humanity beyond the war.”

READ: Full transcript with Lindsey Fitzharris

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Dr. Robert Pearl is the author of a book about medicine’s invisible yet highly influential physician culture. Check out “Uncaring: How Physician Culture Is Killing Doctors & Patients.” All profits from the book go to Doctors Without Borders.

Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify, Stitcher or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn.