World War One had in many ways led to the invention of modern plastic surgery with its abundant supply of new and horrific ways for soldiers to lose parts of their faces. However, the escalation of the air war in World War Two presented further new challenges to the nascent field. Aircraft of the time were particularly susceptible to fuel fires not only when shot down but also in the course of normal operation. Such was the frequency with which doctors encountered burned beyond recognition members fighter and bomber crews that ‘Airman’s Burn’ became a medical condition all of its own.
At the start of the war only four plastic surgeons were practicing in Britain. The RAF obtained the services of Archibald McIndoe, the younger cousin and protégé of Sir Harold Gillies, the surgeon who pioneered specialized plastic surgery in the First World War. McIndoe was to operate in a burns unit at the Queen Victoria Hospital at East Grinstead alongside his long time colleagues, anaesthetist John Hunter and nurse Jill Mullins. Having already garnered the attention of contemporaries for his surgical finesse and intuitive problem solving McIndoe proved to be every bit the innovator that his cousin had been.
Beyond the occasional household or industrial accident surgeons rarely dealt with severe burns before the Second World War, not least because until 1939 the chances of surviving major burns were extremely low. Consequently they were treated in the same way as minor ones: with tannic acid. Tannic created a firm leathery coating over the wound which was useful with small burns, but when used on more severe cases McIndoe found it increased the chances of infection and made reconstructive grafting near impossible. Inspired by the swift recovery of men who crashed at sea McIndoe took to bathing his patients regularly in saline which kept their wounds clean and the skin in good condition for grafting. His innovation led to Tannic treatments being banned.
Where McIndoe really came into his own though was the psychological rehabilitation of his charges. That they should like and trust those caring for them was, to McIndoe, as much a part of their treatment as surgery. He dealt honestly and informally with the men, dispensing with the straightjacketed formality of both military and hospital hierarchy. Rank meant nothing to his patients, nor did conventional hospital regulations; the ward was colourfully painted with comfortable beds, a radio and a free flowing supply of beer.
Outside of the hospital too McIndoe did all he could to keep them in the best possible frame of mind. He rejected the convalescent uniforms provided by the RAF and instead encouraged his patients to continue to wear their RAF uniforms which provided a sense continuity with their lives before their injuries. He spoke to East Grinstead residents and encouraged them to be accepting of the men and pay as little attention to their injuries as possible. In this they surpassed all expectations, saving them tables in pubs and restaurants and inviting them into their homes. To this day it is known proudly as ‘the town that didn’t stare’.
By 1941 the uplifting mood of McIndoe’s unconventional ward had spawned the Guinea Pig Club. Anyone treated by McIndoe at East Grinstead joined automatically and in the end membership totalled 647 men. The club became the main organ by which the recovering airmen organised their social events and later provided support to one another as they adapted to civilian life. The last official meeting of ‘Pigs’ was Christmas 2007.
The Guinea Pig Club and its relationship to the people of East Grinstead prefigure modern notions of peer support and therapeutic community which few of McIndoe’s contemporaries would have considered let alone put into practice in such a bold and far reaching manner. The consequences of his work have been felt beyond plastic surgery influencing the relationship between doctors and their patients in all branches of medicine.