The Airman's Burn
The Air War
The second World war was the first large-scale conflict fought partly by an intense aerial campaign. Between 1940 and 1945, some 4,500 airmen were recovered from crashed aircraft. Some crash-landed. Others, who survived being shot down, baled-out and parachuted to safety, sometimes from high altitude and in flames. Whilst devastating injury was common, 3600 sustained a newly-encountered, but typical pattern of injury, predominantly to the face and hands. This became known as “The Airman’s Burn”.
The Problem
Although provided with some protection, in the form of leather gloves and helmets, many airmen had a tendency not to wear either gloves or goggles, thus exposing their central face and hands. The main fuel tank of the Spitfire fighter and small “header tank” of the more numerous Hurricane aircraft, were situated behind the engine, immediately in front of the pilot. The Mark I Hurricane also had main tanks in the wings, the roots of which were open to the cockpit. Both configurations proved perilous for the pilots should high temperature engine parts and incendiary “tracer” bullets ignite spilt aviation fuel. Many pilots likened the effect of fire being directed into the cockpit by the high-speed airflow of an uncontrolled descent as being like sitting in a furnace being blasted by a “blowtorch”. The “Airman’s Burn” itself thus resulted from sudden intense dry heat and flame injury to exposed and unprotected body parts, or direct contact with extremely hot metal aircraft parts.
The Injury
Early on in the conflict, plastic surgeons, who were somewhat prepared for burns, started to see pilots surviving hitherto fatal injuries and with these characteristic and intense patterns of burn to the whole hands and central face. These were usually “full thickness” injuries (previously referred to as “Third Degree”), to the whole depth of the skin, and would not heal without surgery. The RAF medical service itself defined what became known as the “Airman’s Burn” as comprising “deep searing burns usually of third-degree involving areas of tremendous functional importance – the hands and eyelids in particular.” This meant both whole hands, the central face and neck above the collar not covered by clothing, oxygen masks and helmet.
Plastic Surgeon Archibald McIndoe’s saw most of these injuries at The Queen Victoria Hospital, East Grinstead. He pioneered treatment of the “Airmans Burn” with what he termed “Total Reconstruction”. This involved surgery, usually in the form of skin grafts and skin flaps, taking place during sometimes up to 50 operations over many months. Many of these procedures were recorded in incredible detail by medical illustrator Mollie Lentaigne.
The Aftermath
Those who survived, such as Geoffrey Page, Richard Hillary and Tom Gleave, ended up dubbing themselves, McIndoe’s “Guinea Pigs” at East Grinstead. Several wrote accounts of how they were injured, the agonising pain, seeing the skin of their hands melt away and the terrible smell of burnt flesh. As Archibald McIndoe discovered, even relatively small area, but full thickness injuries incapacitated pilots, if not permanently, then for many months before being fit for any form of active service. Between 350 and 400 pilots received incapacitating burns in 1940 alone, contributing to a severe pilot shortage. McIndoe focussed not only upon surgical outcomes, but developed the concept of a team approach to maximising the long-term psychological outcome for these airmen, and returning them to being functional members of society.
BBC "Blood and Guts" on the Airman's burn and Guinea Pig Club