The Reconstruction of Warriors: Archibald McIndoe, the Royal Air Force, and the Guinea Pig Club (review)

This is a carefully researched and well-written analysis of how plastic surgeon Archibald McIndoe turned East Grinstead Cottage Hospital into a centre of excellence for the treatment of burns during the Second World War. As a civilian consultant to the Royal Air Force, the charismatic McIndoe was referred increasing numbers of horribly burned pilots from the Battle of Britain. In a short time he reversed medical orthodoxy and built up an impressive team of doctors and nurses, training juniors who then practised elsewhere in the U.K. Mayhew documents how he successfully campaigned against coagulation therapy (the use of tannic acid to seal burned tissue) and returned to more labour intensive methods involving saline baths, gauze dressings and Vaseline jelly to promote both healing and the creation of a suitable grafting surface. The preeminence achieved by McIndoe echoed that of his uncle Harold Gillies who had treated soldiers mutilated by shellfire at the Queen's Hospital, Sidcup, during the First World War. Driven by the need to return airmen to some form of purposeful life, this study shows how war accelerated the techniques of plastic surgery, though possibly to the detriment of other hospitals or disciplines denied such resources; it also shows the power of specialisation. It is perhaps more than a coincidence that each World War produced in the U.K. a plastic surgeon of determination, independence of thought, and dedication. Indeed, McIndoe, Gillies, and David Charters (who accomplished similar medical miracles in a German POW camp) all had an ambivalent view towards authority and almost, of necessity, had dominant personalities.

However, this is far from being just a medical history, and the aviation context in which aircrew fought and became casualties is explored. In 1939, the Air Ministry decided against installing self-sealing tanks in Hurricane and Spitfire fighter aircraft because of the additional weight and consequent loss of fuel capacity, thereby reducing its ability to engage the enemy. This policy inevitably meant that pilots would be horribly burned as the main tank in the Spitfire was located behind the engine and in front of the control panel. The calculation had perhaps failed to account for the time it took for burned patients to recover and the general effect on the morale of aircrew who knew that they were exposed to such frightening risks.

Mayhew destroys the popular myth that burned aircrew were largely fighter pilots from the Battle of Britain and demonstrates that from 1941 onwards the vast majority were bomber crew. By the end of the war, for example, 80 per cent of the Guinea Pig Club had served in bombers. Although the Canadian Wing at East Grinstead is carefully analysed, no mention is made of the therapeutic regime practised by the American Eighth Air Force engaged in daylight raids over Germany.

Although important clues are given, there is little overt analysis of the psychology of either aircrew or the medical staff who nursed them. It is difficult to imagine an injury more designed to cause psychiatric trauma than severe burns to the face and hands. It would have been interesting to know how many, if any, of these pilots became depressed or even suicidal and whether the RAF deployed liaison psychiatrists to East Grinstead. The Guinea Pig Club and its magazine undoubtedly provided an essential comradeship and a sense of shared adversity, while McIndoe's own personality served as an inspiration, stating in 1958 that "throughout the surgical period and for long after it the patient will lean heavily on the surgeon for mental support, for hope and encouragement." The part played by the citizens of East Grinstead in creating an environment in which horribly disfigured airmen could begin to adjust to their wounds and reintroduce themselves to society outside a hospital ward is well described. This open-minded approach contrasted...