McIndoe's path to plastic surgery

Archibald Hector McIndoe never intended to become a plastic surgeon. 

He graduated from Otago University, New Zealand, MBCHB in1923, becoming house surgeon at Waitako Hospital in Hamilton in 1924. There his talents were spotted early on the University recommending him for the first fellowship to be awarded to a New Zealander by the Mayo foundation of Rochester, Minnesota.

He commenced surgical training at the Mayo in the pathology department, rapidly gaining himself a reputation in pathology of the liver. Gaining an MSc in Pathology from the University of Minnesota in 1927, he progressed to learning abdominal surgery. Indeed, he rapidly became a talented operator, specialising in liver diseases, and developing a technique to remove part of the organ to manage tumours. This was revolutionary at the time.

Offered a post on the permanent staff at the Mayo clinic, this required him to become a US citizen. However, fate led him down a completely different career path. His citizenship application became problematic, even after one of the Mayo brothers discussed it with President Hoover. In the meantime, McIndoe decided to travel to London, funded by a temporary travelling scholarship, to try and get on the surgical ladder there. Carrying letters of recommendation to several of the most prominent surgeons in town, all rebuffed him.  So he returned to the U.S..

The Job Offer That Wasn’t

Just after this, surgeon Lord Moynihan of Leeds witnessed McIndoe demonstrating his partial liver resection technique at a meeting in Chicago. Afterwards, on a visit to the Mayo Clinic, the pair met. Moynihan, perhaps in a polite, off the cuff manner mentioned to McIndoe potential jobs at a new academic hospital planned in London. McIndoe’s American citizenship had finally come through, but he had determined that Moynihan’s comment was a real offer, and decided once more to make his future in London. 

McIndoe arrived by ship with his whole family in the winter of 1931. Presenting himself to Moynihan, he found to his consternation, that the advertised hospital proposed for Hammersmith, hadn’t even been built. Moynihan was slightly surprised that McIndoe had taken him seriously. All he could do was advise the New Zealander, already a holder of the American surgical qualification, the FACS, to pass the English equivalent FRCS as soon as possible.

The Cousins Meet

Jobless, and almost penniless, McIndoe’s mother had discovered that her paternal grandmother was one Elizabeth Gillies. Like the McIndoes, the Gillies family had left Scotland for New Zealand a couple of generations before. It transpired that one of their descendants had gone back to England to establish himself as a surgeon, now quite well known in the new discipline of Plastic Surgery. His name was Harold. McIndoe wrote to Gillies, who was slightly non-plussed by an unknown relative. But compassionate man that he was, Gillies had found out a little of McIndoe’s background.  Realizing he was quite a talented surgeon, he took pity on the distant cousin and arranged for his employment at Saint Bartholomew’s Hospital, London, Here, he partly worked alongside Thomas Kilner, Gillies first real protégé and the second full-time plastic surgeon in the UK.

Living in a dingy basement flat with his wife, McIndoe achieved the remarkable feat of passing the FRCS in nine months. Adonia meanwhile gave birth to their second daughter, Vanora.  Gillies then arranged for McIndoe to be appointed a lecturer in general surgery at the Hospital for Tropical Diseases. Effectively a promotion with prospects, he hated lecturing. Despite his talent and academic background, McIndoe could not gain a foothold in general abdominal surgery. 

The Plastic Bug Bites

Increasingly, McIndoe found himself helping Sir Harold with plastic surgical procedures at his central London practice. Like many a surgical trainee in the years to follow, he became quickly beguiled by these “plastic” operations and their potential to transform. He eventually decided to forgo general surgery deeming plastic surgery “the surgery for me”. Adonia, was reportedly unkeen on the idea, worried on the effect it might have upon family finances. It is said that she went to remonstrate with Gillies, complaining that she had not given up her life as a great pianist to have Archie become a “Bond Street quack”, lifting faces. Even then, the specialty had an image problem, but this story may well be a later embellishment rather than being based in fact. Certainly the McIndoe family believe it to be incorrect.

Eventually, Gillies’ workload increased to an extent that he offered McIndoe an assistant’s post, with the carrot that there may be a partnership in it for him if it worked out. McIndoe jumped at the prospect. 

Gillies worked McIndoe hard. Gillies remarked that “he must’ve cut enough skin to cover a cricket pitch before I had finished with him. You couldn’t have played a league match over some of the stuff he did at first. But he learned. Soon he was skinning as smoothly as a groundsman at Lords”. Eventually, Gillies did cement the partnership, and McIndoe’s own practice grew rapidly, alongside those of another two, Thomas Kilner and Rainsford Mowlem. 

McIndoe -Plastic Surgeon

In the years immediately prior to the Second World War, McIndoe perfected a mammaplasty procedure (reduction and reshaping surgery of the breast) alongside Sir Harold, and also wrote his seminal papers “An Operation for the Cure of Adult Hypospadias”, correcting a common male genital birth anomaly, and “An Operation for the Cure of Congenital Absence of the Vagina”. This became known as a “McIndoe Vaginaplasty”. It was during this time that he also started working with John Hunter, a renowned anaesthetist, who was to become his right-hand man for many years, particularly at East Grinstead.

In 1938 war was already on the horizon. Gillies alongside the dentist, Kelsey Fry became members of a committee planning how and to where London hospitals would be evacuated in the event of conflict. On the 11th of June 1938, at the suggestion of Harold Gillies, McIndoe was invited to become the Royal Air Force representative consultant in plastic surgery. He thus replaced Sir Harold, previously the principal consultant in plastic surgery to the RAF, and for whom he had deputised on many occasions. He was detailed to set up a plastic surgery unit at a small cottage hospital in the small west Sussex town of East Grinstead.