McIndoe - World War 2 and beyond

"A nice little hospital on the edge of a nice little town"

- Sir Archibald McIndoe

The Second World War

On the 11th of June 1938 as war clouds gathered, and at the behest of Sir Harold Gillies, the previous post-holder, Archibald McIndoe was

invited to be the Royal Air Force representative consultant in plastic surgery. He had deputized for Sir Harold on many previous occasions. Though offered an officer’s commission in the Royal Air Force, he declined, reasoning that he could get more done as a civilian. This would become pivotal in his ability to make innovative change. 

At the outset of The Second World in 1939 McIndoe was one of only four experienced plastic surgeons in the UK. There were another six at the registrar level of training. Four main units were established for plastic surgery around London. These were supposedly relatively safe from potential bombing. Each concentrated on selected types of military and civilian casualties.  McIndoe was told to go and set up a plastic surgery and burns unit at the small cottage hospital in East Grinstead, West Sussex. The Queen Victoria, opened only 3 ½ years before, would concentrate on the wounds suffered by RAF personnel. McIndoe noted - “It’s a nice little hospital at the edge of a nice little town, and I think something can be made of it”. A new building was constructed for these casualties behind the existing in-patient facilities, and designated “Ward 3”.  His private and cosmetic practice, and income, ceased overnight.

McIndoe packed his somewhat reluctant family back off to Minnesota to stay with friends near the Mayo Clinic, and to avoid the expected bombing in London. 

At first, during a period known as the “Phoney War”, things were quiet in East Grinstead. That soon changed in September 1940, during the Battle of Britain. Pilots from this air war started to be injured in numbers. They were surviving hideous “Airmans burns” in a previously unseen distribution pattern. Ward 3 rapidly became the hub of a new wave of innovation in burns surgery. McIndoe climbed a steep learning curve in order to manage the terribly injured pilots, at first from the Battle of Britain, but as the conflict progressed, predominantly from Bomber Command and the RAF ground crews. Some civilians and children were also treated there.

McIndoe arranged for all RAF burns to be sent to East Grinstead, but some didn’t arrive. This prompted him to go on a tour of his new peripheral RAF hospitals looking for patients and deciding whether they needed transfer to East Grinstead. It was at this point he realised the evils of tannic acid as a first aid measure and initial treatment in burns. Eventually, he had it banned. It destroyed the chances of successful finger and eyelid reconstruction. [Read more about Tannic Acid here] He also further developed and popularised the use of the “Saline bath” for management of burns.

The Guinea Pigs

McIndoe understood early on that reconstructing severely injured servicemen not only meant dealing with their devastating physical injuries, but also returning them to functional members of society. They became a familiar sight in East Grinstead, living their lives to the full in local

hostelries and entertainment venues. The many books and records these men left attest to the reverence in which they held “the Boss”. It resulted in his presidency of the airmen’s own self-help organisation. This often raucous, unmanageable bunch of airmen called themselves the “Guinea Pig Club” .They recognized themselves as the recipients of pioneering techniques. McIndoe also educated the public to look upon these injured people as normal humans, not curios, to be pointed out, felt sorry for, or feared. East Grinstead became known as the “Town that didn’t stare”. McIndoe became world famous due in no small part to his ability to attract publicity and funding for his “project”. Stars of stage and screen flocked to QVH, and he also extended the clinical facilities with funding from the Canadian and American governments.

Post War

The partnership of Gillies, McIndoe and Mowlem did not survive the war, being wound up, but still practicing from the same offices. Each had gained independent reputations. None wanted to take second place to the others. During this period, McIndoe began to work between East Grinstead and Harley Street. In 1947, he also got involved in the formation of BAPS with Gillies and Mowlem. He was determined that only fully accredited plastic surgeons should become eligible for membership.

This was also the period during which the NHS was formed. He feared the consequences, believing that it would lower medical standards. He was also apprehensive about what State control of the Queen Victoria Hospital would mean for its infrastructure and the quality of plastic surgery training. QVH was now a state-of-the-art unit, which he planned to turn into a postgraduate teaching centre for plastic surgery. He proposed to take six young men of promise with a background of general surgical experience and turn them into accomplished plastic surgeons over two years of intensive training.

Archibald McIndoe was Knighted in July 1947. He died the day before his election to the Presidency of the Royal College of Surgeons had become a certainty following the withdrawal of the only other candidate, Sir Arthur Porritt.

Legacy

McIndoe was a visionary “workaholic”, with great manual, intellectual and organisational skills, who made very significant contributions to plastic surgery and the surgical profession in general. It is said that he made reconstructive surgery respectable whilst being a fierce advocate of the power of aesthetic surgery for the right individual.

He was also a didactic teacher, but intolerant of repeated failure. McIndoe became world famous not only for his work in plastic surgery, but as a fundraiser and advocate for the surgeon as scientist. 

He campaigned tirelessly, right up until his death, to make the lives of the injured airmen in his care tolerable, more productive and for their rights to decent pensions and post conflict employment. It is said that he made reconstructive surgery “respectable” whilst being a strong advocate of the powers of aesthetic surgery for the right individual.

His most enduring legacy is the Blond McIndoe research unit. Initially housed at QVH, he hoped it would unravel the complexities of human skin and tissues. However, he did not live to see it opened. Now the Blond McIndoe Research Foundation, it funds groundbreaking research into burns and wound healing, developing future techniques and technologies to repair, restore and regenerate tissue, as well as reducing debilitating scarring.