Posts tagged ‘McIndoe’

March, 2014

Surviving Burns and Overcoming Burns

Dr Jonathan Reinarz

One of the most interesting aspects of burns work undertaken by Archibald McIndoe during the Second World War (see Wednesday’s post) was the establishment of the Guinea Pig Club. The Guinea Pigs were members of WWII Royal Air Force air crews who had undergone at least two operations for their burns injuries at East Grinstead Hospital, where McIndoe was based. Originally intended to be a drinking club for patients whose injuries could be dangerously dehydrating (see Monday’s post), it counted 39 members at its launch in June 1941, a year after the Battle of Britain. By the end of the war, there were 649 Guinea Pigs, most of whom were British (62%), but it also included Canadians (20%), Australians (6%) and New Zealanders (6%); 80% had served as bomber crew during the war. As war historian Emily Mayhew has suggested, the Club was ‘an attempt to institutionalise the unique spirit of the patient community at East Grinstead’ in order to aid the psychological recovery of burn victims. Patients collectively attended operations, assisted newcomers and otherwise offered support to each other when necessary.

‘Dealing with Disfigurement’

Rather than hide away these severely disfigured airmen, McIndoe considered both their physical and (as he termed it) psychical wellbeing. He recognised that patients relied on their surgeon ‘for mental support, for hope and encouragement.’ But he also encouraged his patients to resume ordinary lives, often commencing with a joint visit to a local pub. Most wanted to resume normal lives, but their wounds often made this more difficult than expected. McIndoe knew that his patients would inevitably attract much attention the moment they ventured into town to frequent pubs or restaurants, so he prepared the residents of East Grinstead for potential encounters with patients, some of whom were mid-operation, with tube pedicle grafts nearly in place to reconstruct missing chins or noses. He also invited key members of the town into the wards, encouraging them to become ambassadors in the community by regularly hosting concerts and balls, where patients mingled with locals. In this way, he made the residents of East Grinstead recognise and accept his patients and focus on their contributions to society, rather than their disfigurements. In the process, East Grinstead became known as ‘the town that didn’t stare’, while the hospital developed an international reputation for its Maxilla-Facial Unit. The staff was so successful at its work that 80% of aircrew patients eventually returned to flying duties. Such success continued into peacetime, but the details of McIndoe’s civilian work has been less documented. Despite the positive experiences of East Grinstead Guinea Pigs, many inevitably faced challenges when they re-entered their former communities. That said, many had learned how to deal with these difficult encounters from their membership of the Guinea Pig Club; a group of about 60 original members continue to meet.

Psychological support for burns patients has continued to grow since 1941. The emotional load on staff at burns units has also been recognised, with many practitioners expressing their own challenges coping with the onerous duties involved in caring for these unique patients. Unusually, when Guinea Pigs visited America following the war, their faces were kept out of the press for fear of alarming the public. Americans would inevitably learn about the psychological impact of burns in their own ways. The 1942 Coconut Grove nightclub fire in Boston was not the worst urban fire in twentieth-century America, but it had a huge impact on burns treatment. Besides directing attention to the consequences of inhalation injury, it provided valuable insights into the immediate and long-term psychological impact of severe burns and the importance of supporting patients after their physical wounds healed. As obvious as some of these lessons were, it seems they need to be relearned every decade or so. More often these days, the memories of disasters, collective and individual, are kept alive by patient groups. Many American victims of burns and scalds owe their emotional recovery to the Phoenix Society for Burn Survivors, a national organisation dedicated to burns patient support, public education and advocacy.  In Britain, patients with burns receive the support of similar organisations, including Changing Faces, BurnAid and the Katie Piper Foundation. So successful have burns units become at saving humans that their challenges have shifted. Many victims now expect medical teams to save lives and even restore former appearances. It is with such expectations that support groups also help a new generation of patients.

New portrait of Simon Weston recently unveiled at the National Portrait Gallery.

New portrait of Simon Weston recently unveiled at the National Portrait Gallery.

Jonathan Reinarz wishes to thank Emily Mayhew, Rebecca Wynter, Naiem Moiemen, Tony Metcalfe, Shah Mamta, Ken Dunn and James Partridge for their help with his research.

Dr Jonathan Reinarz is Director of The History of Medicine Unit and a Reader in the History of Medicine at the University of Birmingham.

March, 2014

War burns and the birth of plastic surgery

Dr Jonathan Reinarz

The majority of historical research into burns has concentrated on the remarkable reconstructive work undertaken on burns casualties during the First and Second World War. In fact, some argue that plastic surgery as a specialty first emerged during the First World War. Soldiers in both wars sustained horrific injuries and dreadful deformities from high velocity missiles, explosives and burns, many of which would previously have defied repair. A young ear, nose and throat (ENT) surgeon from New Zealand, Harold Delf Gillies, began the war in a surgical unit at the Cambridge Hospital, Aldershot. Alarmed by the number of face and jaw reconstructions he was having to perform, Gillies visited two plastic surgeons in France before setting up a larger surgical unit in 1917 at Sidcup, where he brought together a team of specialists, including ENT colleagues and dental surgeons. Gillies is best remembered for the tubed pedicle, a flap of skin which was harvested from the arm or chest, for example, stitched into a tube, so as to retain a blood supply and gradually migrated to the area where it was required. By the end of the war, Gillies had developed many other surgical techniques and performed over 11,500 operations. Many of these are included in his best known publication, Plastic Surgery of the Face (1920), which, along with Gillies’s archives, has recently been digitised and made available online as part of activities to mark the centenary of the First World War.

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From Airman’s Burns to Hiroshima

In one of those accidents of history that historians have become used to over the years, many severe burns in the Second World War were placed in the hands of another young surgeon, Archibald McIndoe, who happened to be the cousin of Harold Gillies. Unlike most of the casualties seen by cousin Harold, McIndoe treated primarily flame injuries that largely resulted from a decision to relocate the petrol tanks of fighter aircraft in front of the cockpit and pilot. The consequences of placing 48 gallons of fuel in the nose of a Spitfire rapidly became apparent during the Battle of Britain in 1940, when burn casualties mounted and the medical community defined a new injury, ‘Airman’s Burn’. Nearly 400 Royal Air Force (RAF) crew sustained serious burns to their face and hands in 1940 alone, Richard Hillary becoming perhaps the best known due to his memoir, The Last Enemy, in which he described his injuries.

‘I looked at my watch: it was not there. Then for the first time I noticed how burnt my hands were: down to the wrists, the skin was dead white and hung in shreads: I felt faintly sick from the smell of burnt flesh.’

While the smell of burn victims and high fatality associated with serious burns had led many to be isolated, removed or even excluded from nineteenth-century hospital wards, Hilary was lucky to be treated in a specialist burns unit by one of only four plastic surgeons operating in Britain at this time (including Gillies who would spend his second war at Park Prewitt Hospital in Basingstoke). Appointed civilian consultant surgeon to the RAF, McIndoe became responsible for Hillary and many other air-force casualties at a surgical unit which was established in a cottage hospital in East Grinstead, 40 miles outside of London. Here, he treated hundreds of burned airmen and developed surgical techniques in order to improve on existing plastic surgery techniques, which often left much to be desired. According to Mcindoe, in these early years of reconstructive surgery ‘the end result seemed to convert the pathetic into the ridiculous’. Rarely satisfied with his first attempts, McIndoe worked 12-hour days and frequently subjected his patients to more than a dozen operations. He rapidly became recognised as the authority in the field, influential in developing new operations and discarding older treatments, such as the use of tannic acid to coat burns injuries. He hosted many visiting surgeons at East Grinstead, which had trained 60 surgeons by 1943, and secured his reputation in 1944 when 50 North American plastic surgeons attended his unit for ten days to train in preparation for the D-Day landings. He also increased the levels and training of nurses on his wards and introduced saline baths into burns treatment.

After the 1945 atom bomb attacks on Japan, the attention of doctors turned to the impact of modern warfare on both military and civilian casualties. McIndoe himself argued that burns would likely outnumber all other injuries in future wars. McIndoe’s colleagues similarly promoted such ideas, suggesting that ‘atomic flash’ burns necessitated whole hospitals be transformed into burns units, arguments reinforced in the aftermath of Hiroshima and Nagasaki and during the Cold War. Many more units like that at East Grinstead were established in the 1950s, and McIndoe continued to work in his 50-bed Burns Centre at East Grinstead until his retirement in 1959. In a lecture to the Royal College of Surgeons in 1958, he comprehensively outlined his views on reconstructive surgery and paid homage to ‘the greatest plastic surgeon of all times’, Harold Gillies. McIndoe died in 1960, aged 59. A statue is being planned to recognise his work; if realised this will be one of only three existing British public monuments in England commemorating surgeons.

Dr Jonathan Reinarz is Director of The History of Medicine Unit and a Reader in the History of Medicine at the University of Birmingham.

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