BOOK REVIEW

Faces from the front: Harold Gillies, the Queen's Hospital, Sidcup and the origins of modern plastic surgery

Andrew Bamji
Warwick: Helion & Company
2022, 212 pages
ISBN 978-1-9151-1302-3

Faces from the front is not a fresh title recently hitting the shelves. The publication originally appeared in late 2017 with a reprint appearing earlier this year. The deceitfully 'thin-looking' publication contains unbounded treasures, which could be attributed to the author's passion for the subject clearly shining through. Andrew Bamji is not your average journalist or hobby writer turned amateur historian, but a physician in rheumatology by training, a published author, and a consultant archivist and researcher. In writing the book, Bamji drew from an estimated 2 500 case files, personal communication with a variety of individuals, and secondary literature. Given the depth of research, it is hardly surprising that the book has received much praise since its initial appearance and even won some awards, including the prestigious British Medical Association Medical Book Awards category 'Basis of medicine' in 2018.⁵⁹⁹ However, is such significant acclaim warranted, especially from a historian's perspective? All too often some popular history writer makes it to some best seller or must-read list but is riddled with over-exaggeration, over-simplification or inaccuracies.

As the title suggests, this publication deals with three dominant themes. The book is partly biographical, as it focuses on the contribution made to medicine by Harold Gillies, the proclaimed 'father of plastic surgery'. On the other hand, it is partly institutional history. It traces the development of the first medical unit in Aldershot dedicated to dealing with facial reconstruction and establishing a dedicated maxillofacial hospital named after Queen Alexandra in Sidcup in mid-1917. The other dominant theme is the origins and development of modern plastic surgery, with the emphasis on 'modern'. As Bamji acknowledges in the early pages of his book, plastic surgery dates back to antiquity, with the first rhinoplasty and other reconstructive surgeries performed long before Gillies made his mark. Bamji explored the birth of modern plastic surgery as a specialist area from the First World War 1914-1918 to the 1960s.

The Great War was different from its predecessors due to its industrialised nature. Arguably, for the first time in history, more soldiers succumbed to wounds rather than to disease. In addition, casualties reached an unprecedented scale. The use of high-power munitions, such as rifles, machine guns and artillery shells, caused untold damage to flesh, cartilage and bone. Artillery shells, in particular, caused significant injury as they exploded and broke into fragments of white hot metal. Underneath helmets, faces in the trenches were often at the right height and exposed to these weapons. Bullet rifles would often make minor entrance wounds but would blossom out on the other side of a cheek, exposing broken teeth, tongue and palate. Given the nature of these wounds and the lack of experience and knowledge in treating them, Gillies, with unofficial public financial support, assembled a multi-disciplinary team to reconstruct facial disfigurements. Each speciality made its own contribution - whether through surgery, the making of masks, tracing X-Rays or designing dental splints and prosthetics. The importance of such collaboration between individuals not only in the medical fraternity (and yes, most of them were men) but also in other disciplines forms another sub-theme in Faces from the front.

Gillies drew experts from medical specialties, such as dentistry but also the arts. Among them were some well-known names, such as Henry Tonks, the surgeon and artist, and lesser-known names, such as Archie Lane, a dental technician. Bamji opens up the world of personalities - or rather egos - in the medical realm in Britain and some parts of Europe. His writing on this theme is notable as he provides a realistic inside scoop on friction, conflict and disagreements between surgeons and other specialists.

Some healthy competition also existed between the Australian, Canadian and New Zealand sections of Queen's Hospital. In this, Bamji manages to shriek any accusations of hagiography and hero worship, as he even points out some flaws in Gillies himself. Rivalries, such as between Gillies and his younger contemporary, Archibald Mclndoe, persisted until the latter's demise. It was also here that an excitable moment passed, albeit admittedly stemming from this reviewer's bias, as mention is made of South Africa in the text, despite not necessarily being in the most favourable light. Bamji tells of Capt. John Law Aymard, the South African ear, nose and throat (ENT) surgeon attached to the Aldershot unit and later the hospital in Sidcup. Aymard allegedly claimed to have been the inventor, instead of Gillies, of a new technique known as the tube pedicle procedure. Apart from a few sentences on these accusations, Bamji provides little further information on the presence of a South African section - or for the reasons of its absence - which is a pity. As many other readers of this journal will agree, the wider Anglophone world often forgets South Africa in writings on war participation. Such neglect is usually forgiven, given the state of our research institutions and challenges to access primary sources.

Many local readers will be thrilled, however, if they continue reading, as Bamji even includes the impressive tale of a South African soldier patient, Walter Bown, who later made his own notable contribution to South Africans by aiding in the establishment of the South African Council for the Blind and the Athlone School for the Blind.⁶⁰⁰ Another sub-theme Bamji explored is the experiences both during and after the war of soldier-patients and later ex-servicemen. It is here in particular that Bamji makes a mark on contemporary historiography. As he himself argues, and with which many will agree, the leitmotif of most literature on post-war re-integration of those who sustained injuries is that of men being depressed, frustrated, unhappy and living in isolation, with limited career success. Bamji argues that post-war experiences were much more varied and diverse. As he states, "family accounts show that not all wounded men were pitiable, miserable wrecks, embittered and destroyed" (p. 201). Instead, many "returned to a mundane life after an intense period of activity" (p. 177). Overall, Bamji excels in balancing the different narratives relating the experiences of physicians, staff, patients and relatives, including public perception, all in perfect harmony. Unlike most writing on similar topics, Bamji provides continuity by following these individuals all the way through to as late as the period after the Second World War in some cases. He further humanises the experiences of these men while at the same time illustrating the overall significance of medical achievement during this period by including visual sources.

Perhaps too often, images are included in books to attract buyers as they flip through the pages deciding whether to buy it or not, or to distract those readers who quickly get bored of too much text. In contrast, the images in Faces from the front form an integral part of the discussion. The inclusion of photographs, sketches, and even the occasional photograph, elevates the content of the book to the next level. Occasionally, there is some disconnect between the images and the related discussions. And sadly, references are often missing. Even so, it is an absolutely fascinating read! However, for those tempted to broaden their horizons by ordering a copy, just heed this warning: the publication is not for sensitive readers.

Despite my initial scepticism, I would highly recommend this book to anyone interested in the history of medicine, including historians and other academics of the social sciences. Postgraduate students will also benefit by taking note of the well-written and structured introductions and conclusions of each chapter, even if they are not interested in the topic. Beyond this, Bamji deserves the already received praise and award as he helped return the hidden faces of these men to the annals of history. For many decades, their tale has been overshadowed by that of other wounded men. As Bamji himself remarks, even the official history has glossed over and made limited mention of the treatment of facial injuries. As recent as 2002, many foreigners to Sidcup and the surrounding areas would have been ignorant of the significance of the opening of Gillies Pub by the care home residents housed in the converted Queen's hospital.⁶⁰¹ However, the situation has changed much in recent years, as literature, such as Faces of the front, gradually restored this chapter in history to public consciousness.

Anri Delport

Stellenbosch University

599 Rye News. "Book wins BMA award". < https://www.ryenews.org.uk/news/book-wins-bma-award> Accessed on 2 October 2022.
600 See also H Marlow. Blindness and the power of inner vision: The inspiring story of Mike Bowen and Lil Gillies who met in the aftermath of the Great War. Vermont: Footprint Press, 2021.
601 News Shopper. "Sunrise care home in Frognal House, Sidcup opens its own pub". <https://www.newsshopper.co.uk/news/16301834.sunrise-care-home-frognal-house-sidcup-opens-pub/> Accessed on 2 October 2022.