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Archibald Hector McIndoe |
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More than just an Ordinary Doctor Archibald Hector McIndoe was born in Dunedin, New Zealand, on the 4th of May 1900. His father John McIndoe was a printer and his mother Mabel an amateur painter. His older brother was also a printer and it was thought that Archibald would similarly take up printing. But Archie, as he was then known, loathed the idea of following in his father's footsteps. Quick witted and academically astute, he had much greater ambitions. His friends were of a similar ilk, so when they applied to enter Otago University Medical School, Archie naturally followed. For Archibald McIndoe, matriculation into medical school turned out to be a mere formality. Indeed, McIndoe graduated in 1923 having been awarded the Junior Medicine Prize, the Senior Clinical Surgery Medal, a Bachelor of Medicine, and a Bachelor of Chemistry. After graduating he made no secret of his desire to be more than just "an ordinary doctor". The thought of general practice dismayed him and he considered hospital work out of the question.
McIndoe did end up doing hospital work but not for
long. Soon after starting an internship at Waikato Hospital, he received a
letter from Otago Medical School stating that he had been recommended for
a scholarship at the Mayo Clinic in Rochester Minnesota (USA). Founded by
William and Charles Mayo, the clinic had a reputation for producing some
of the world's best surgeons. This was the opportunity McIndoe had been
hoping for; to further his career overseas and to avoid being, as he put
it, "a doctor who just settled down to bring other people's children
into the world". |
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But it was not just McIndoe's quickness that set him apart from the other young surgeons. Everybody who came into contact with McIndoe liked him. The Mayo brothers considered him to be "one of their bright young men" and Balfour had taken him under his wing. A fellow student Walter Alvarez also recalls McIndoe's natural charm and social skills; "Sometimes when in my home and in a jovial mood, he and one of his Australian friends would take off their shoes, pull their trousers up to their knees and dance for us a Maori haka… He was the sort of man who made his mark and stood out from the crowd." By 1929 McIndoe had completed an MSc in surgery, published several papers and was destined for a partnership at the Mayo Clinic. However, it was a major discovery that really set him apart from the other young surgeons and it was this discovery that ultimately changed the course of his career. While working under Balfour, McIndoe discovered that the liver had two blood supplies. He theorised that when operating on the liver, one supply could be shut down and the other kept open. The first time he tried this operation his elderly patient died, but he was soon exonerated when it was found that the patient's death was due to an unrelated illness. With Balfour's encouragement, McIndoe continued to experiment and was
eventually successful. In fact, McIndoe was so successful that he was
asked to demonstrate his operation (later known as "McIndoe's
operation") to a convention of surgeons in Chicago. Attending the
convention was an English surgeon by the name of Lord Moynihan, a man that
McIndoe would later refer to as an "old English bastard".
Moynihan, the doyen of British surgery, was impressed by McIndoe's skills.
Taking the young surgeon aside, he said; "you should come to
England" and offered him a professorship in surgery at London
University. Despite the Mayo brothers protesting vehemently, Moynihan's
offer was too good to refuse and in November 1929, the ambitious young New
Zealander left the security of the Mayo Clinic and sailed for greener
pastures. |
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The Damp Streets of London McIndoe was beside himself. He had nowhere to go. He had severed his ties with the Mayo Clinic and his American qualifications were of no use to him in England. For the next few hours he walked the damp streets of London and eventually ended up at the zoo. Recalling what seemed like a nightmare, he wrote; "I thought the animals should be paying to see me. There wasn't an animal in the whole zoo that wasn't a bigger freak than me!" It was at this point that he pulled a piece of paper from his pocket. It was a letter from his mother. She had developed a passion for genealogy, and having heard that her son was going to England, she had written to him insisting that he look up a distant cousin from New Zealand — a plastic surgeon by the name of Harold Gillies.
The Greatest Partnership in
20th Century Surgery Touched by McIndoe's "tale of woe", Gillies was more than happy to help out his cousin and using his influence, he got McIndoe a temporary position at St Bartholomew's Hospital (London). McIndoe stayed in this position for less than a year, obtained his British qualifications — at typical breakneck speed, and was subsequently made a member of the Royal College of Surgeons. Using his influence again, Gillies put McIndoe forward for another position, this time as lecturer at the Hospital for Tropical Diseases. McIndoe was successful but he soon became disgruntled with this position; "teaching students was a chore and a bore" he said, and furthermore, there was no outlet for his considerable talents. It was therefore a godsend when Gillies offered to take him on as his partner at his new Harley Street practice, thus beginning what has been described as "one of the greatest partnerships in twentieth century surgery". From 1931 to 1939 the two New Zealanders did hundreds of operations together. They also devised new techniques and pioneered what is more commonly known today as cosmetic surgery. Face-lifts were a specialty but Gillies also pioneered a breast reduction technique which McIndoe helped perfect. In 1938 they published their first joint paper on this technique and that same year McIndoe rocked the medical fraternity when he published his own paper entitled; "An Operation for the Cure of Congenital Absence of the Vagina". Pioneered by McIndoe, this operation was later perfected and unabashedly named "McIndoe's Vagina".
During the early years it was Gillies who did most of the work. However, by 1938, Gillies was forced to concede that "the tail was beginning to wag the dog". By Gillies' own estimate, McIndoe had become; "a first-class plastic surgeon", and was now receiving more referrals than the older man. As had been the case at the Mayo clinic, his popularity was due in large part to his natural charm and social skills. Indeed, this charm is reflected in the following poem which was published at the time in a book entitled "The Plastic Surgeon; Its Habits, Diet and Behaviour" (1938);
Gillies could not match McIndoe's charisma. Nor could he match his cousin's quickness; "His cousin could accomplish with a few bold scalpel strokes what would take the older man an hour to think about." But it was Gillies who had taught McIndoe the art of plastic surgery, and as noted by one observer; "Gillies, more than any other single influence, was the man that made the McIndoe who became known during and after the war." Indeed, following the outbreak of World War 2, Gillies recommended that McIndoe succeed him as Plastic Surgeon to the Royal Air Force. Unaware that this position would ultimately thrust him into the forefront of plastic work, McIndoe accepted but with one proviso; that he remain a civilian rather than become a commissioned officer. The Royal Air Force pressed the issue for more than a year but McIndoe stood his ground and in April 1939 it finally yielded to his request, giving him the title of "Civilian Consultant". His rejection of a commission would turn out to be a brilliant slight of hand, enabling him to eventually challenge the military and its outdated medical practices.
Upon being made Civilian Consultant, McIndoe set up a plastic surgery unit in an old country cottage at Queen Victoria Hospital, East Grinstead. In the months that followed, it became clear that Queen Victoria Hospital would deal with the bulk of British air casualties. However, these casualties were like nothing seen before. Most of them were young men, some as young as 17, burnt beyond recognition after being trapped in the cockpits of their fighter planes. Often described as "faceless", the severity of their burns could not be overstated. Ben Bunions, who was brought to McIndoe in 1940 recalls the horror of seeing his first badly burnt airman; "I'd never seen anything like it before. He came towards me, propelling his wheelchair and, as he got closer, I saw that his hands were badly burned and his feet as well. And his ears and his nose. His whole face. It was terrible." Although McIndoe was able to make these men new faces, he knew that they would never look normal again. Furthermore, these men were highly educated and career oriented. He might have seen some aspect of himself in them and being only too aware of his own struggle to succeed, he wondered how these young men would cope; "How were they going to work? To eat? How were they going to attract a pretty girl? How were they going to manage courtship, making love". These questions began to consume McIndoe.
A Saline Solution
Reconstructing the patient physically, however, presented a major challenge. There had only been small advances in general surgery between the two world wars and the methods being used to treat badly burnt people were somewhat primitive. Of greatest concern to McIndoe was the medical professions use of tannic acid. McIndoe had good reason to believe that this treatment was doing more harm than good and his suspicions were confirmed when a young fighter pilot by the name Richard Hillary arrived at Queen Victoria Hospital. Hillary was destined to become a legend but when he was wheeled into McIndoe's surgery, he was completely covered in tannic acid. The acid had coagulated thus immobilising his fingers and toes. His eyelids had also stiffened and it looked as if he would be permanently blind. Fortunately, McIndoe's nurses were successful in removing the solution with lukewarm brine and the young pilot was eventually able to see again. But McIndoe was shocked by what he had seen! Laying down his scalpel he began writing letters, firstly to his superiors in London and then to the War Wounds Committee demanding that tannic acid no longer be used as a treatment. The challenge facing McIndoe was to find a suitable replacement. At the
time, a number of badly burnt airmen had come to him via the Atlantic.
These young men appeared to be in better shape than those who had ended up
on dry land. The salt water, it seemed, had in some way benefited them.
They appeared to be in less pain, their burns were cleaner and it was
easier for the surgeon to graft on new skin. Ingeniously, the New
Zealander translated these observations into an idea; 'the saline bath'.
Patients, he reasoned, could be lowered by stretcher into a salty solution
and receive the same soothing benefits afforded to them by the ocean. |
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To the Forefront of Burns
Treatment
McIndoe's saline bath literally placed the plastic surgeon at the forefront of burns treatment. Prior to its introduction, the burns victim was the sole responsibility of the general surgeon. The plastic surgeon was only called in to cover or remove ugly scars after the tissue had healed. Incidentally, although saline has been replaced by more effective solutions, it is a legacy of McIndoe's brilliance that the bath or 'burns tank' is still being used as a treatment. While the saline bath made McIndoe's job easier, making the patient a new face proved to be a long and arduous task. Some of his patients required more than 70 operations over a period of several months' - sometimes years. During that time numerous skin grafts were undertaken, noses replaced, eyelids reformed, and facial features (chins and cheek bones) re-established. However, it soon became apparent to McIndoe that the physical pain of having to undergo one operation after the next was no more gruelling than the mental anguish that each patient had to endure. In a somewhat sombre note, McIndoe wrote;
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Pioneer of the
World's First Therapeutic "Community of People"
Indeed, McIndoe's patients were free to do whatever they wanted as long as their behaviour did not interfere with the well-being of others. In addition to generating an atmosphere of camaraderie and mutual responsibility, this laissez faire approach helped to counteract the despair of disfigurement. As noted by patient Bill Simpson, they all felt like brothers in misfortune; "A community of people who all, and were all suffering in the same way [and hence] cheerfulness invaded the consciousness of even the most unreceptive patients". As a "community of people", McIndoe's patients became more responsible for themselves and one another. Australian fighter pilot Geoffrey Page recalls that;
It would be some time before a similar "community of people" were established in a hospital outside of East Grinstead. An almost identical regime would later be formalized at nearby Belmont and Northfield hospitals to help returned servicemen recover from the psychological effects of war. Army psychiatrist Tom Main would later coin the phrase "therapeutic community" to describe it, while he and Maxwell Jones would largely be credited with starting it - more than three years after the establishment of Ward III From Ward III to the East Grinstead Community The New Zealand born maestro was on a mission to mobilise the resources of an entire community; to literally move his brand of therapeutic community into the streets of East Grinstead and the hearts of its people. The scope of this mission was breathtaking to say the least and as E H Mayhew has pointed out, it was McIndoe himself who;
Of course, the sheer scale of McIndoe's work meant that he could not do everything himself. So he employed people who were able to take on more than just one role. Orderlies for example would not only wheel patients around ward III but accompany them to pubs, clubs and restaurants. Nurses would not only dispense medicine but encourage locals to open up their homes. Physical Education Trainer, Edward Blacksell took on the role of "welfare officer" advising the men on social and financial matters. He was also instrumental in helping set up community workshops. Workshops were set up to assist with future employment and local businesses were encouraged to help teach McIndoe's patients new skills. As noted by one observer, many of McIndoe's patients were involved in high-tech manufacturing, including the manufacture of aircraft instruments. Most of these jobs had a therapeutic value, for example, by helping patients rediscover how to use their badly mutilated limbs. Often undertaken between operations, this approach to helping the patient cope with their disability was not unlike modern-day occupational therapy. Nonetheless, according to E.H Mayhew; "the last piece of the burn treatment infrastructure" was not the East Grinstead community but the now famous 'Guinea Pig Club'. The Guinea Pig Club: The Unique Spirit of the Patient Community
As "the last piece of the burn treatment infrastructure", the Guinea Pig Club formalised the relationship between McIndoe and his patients. The club was not McIndoe's idea but he strongly endorsed it and in 1943, he became its first president. It was originally called the "Maxillonians Club" after McIndoe's maxillofacial unit but this name did not last long. A patient who was being wheeled into surgery, yet again, shouted out jokingly; "We're nothing but a plastic surgeons guinea pigs." The term "Guinea Pig" quickly gained traction and less than a year after the club had been formed, its name was changed accordingly. As membership grew and as each airman left East Grinstead, "happy to try to cope with life with what he had", the club became more than just a name. Regular get-togethers were organised to ensure that the "spirit of Ward III" continued; a welfare fund was set up to help out needy members; and the club assisted the men in finding employment. Indeed, the club protected the dignity of the burnt airmen by ensuring that their "other face" was not compromised, as they began to seek their place in society again. According to founding member Tom Cleave;
Over the years, the Guinea Pig Club has been the subject of numerous books plays and documentaries. The club's history, its members and their antics have been well documented. However, the Guinea Pig Club was more than just a support club for badly burnt airmen. It was, as E.H Mayhew has so astutely put it; "an attempt to institutionalise the unique spirit of the patient community"; to ensure that this spirit would continue over time, in the absence of McIndoe and outside of East Grinstead. The "unique spirit" of Ward III did continue over time and well beyond the confines of East Grinstead. Membership continued for than 60 years across 19 countries and 5 continents. Amazingly, McIndoe's Guinea Pigs gathered for the last time in October 2007 by which time worldwide membership had dwindled from over 600 to just 96. Nonetheless, the Guinea Pig Club had served its purpose by enabling the burnt airman to "take his place once more in society" and this was never more evident than the success that he forged for himself after leaving East Grinstead.
In one way or another, all of McIndoe's 'Pigs' were successful just by virtue of the fact that they were able to face the world again and live normal lives. However, some stood out more than others. Noel Newman, whose hands had been badly damaged, went on to pursue a career in community medicine and eventually became Deputy Medical Officer of Health. A badly disfigured Bertram Smith returned to Queen Victoria Hospital but this time as a fully qualified surgeon and ended up being trained by McIndoe in the art of plastic surgery. RAF cameraman Jimmy Wright pursued a career in film production, despite being totally blind and went on to produce a string of successful television documentaries. Others, such as Richard Hillary and Geoffrey Page went on to became World War II aces, while Tony Hodgkinson ended up flying Vampire jets as the world's only legless test pilot.
There were many other Guinea Pigs, too, who left an indelible mark on the world and their stories have been well documented. But their success, confidence and will to succeed, is owed entirely to the effort and courage of one man. That man was known as the "Chief Guinea Pig". He was also known as "The Boss", "The Maestro" and "God". He not only rebuilt their faces but also their lives. New Zealander Archibald McIndoe took his unique treatment plan from the theatre to the ward and from the ward to the community. He was instrumental in institutionalising the "unique spirit of the patient community", thus making his guinea pig stock outstanding members of their own societies.
Fame & Fortune With fame came new opportunities and now that the war was over, McIndoe made no secret of his desire to make money. Turning his attention to cosmetic surgery, he opened his Harley Street practice to patients of a different kind; wealthy actors, models, princes and princesses who were seeking to look increasingly more beautiful. His clients included Kay Kendall and Ava Gardner (actresses), the Duchess of Windsor, and the granddaughter of Queen Victoria. He could even claim an Indian prince; the "Maharajah of Rajpipla".
By the late 1940s, "he was earning money by the fistful" but this success had come at a great price. As consultant plastic surgeon to the Royal Air Force, he had worked 15-hour days, 7 days a week, without a break for more than 6 years. He had gained little in the way of financial reward and his marriage had suffered miserably. The burden of responsibility had been great and as noted by his biographer, Hugh McLeave, this burden became even greater after the war;
Tired and overworked, McIndoe purchased a farm in East Africa where he began taking lengthy breaks in order to convalesce but his work-load did not decrease, and the physiological effects of stress were becoming increasingly more apparent. Exploratory surgery for stomach cancer was followed by the removal of his gall bladder and in 1958, a rigorous examination revealed a "diaphragmatic hernia" and mild angina. Two years later, he sailed with his wife to Spain where a delicate operation on one of his eyes was carried out in order to save his sight. The man who had expended so much energy in pursuing his dream of being "more than just an ordinary doctor" was now feeling the ill-effects of a life lived at pace, and on the flight back from Spain he suffered a mild heart attack. Although he was able to walk off the plane without any apparent difficulty, a picture taken at the time shows him looking much older than his 58 years. On the 12th of April 1960, less than 6 months after returning from Spain, McIndoe died in his sleep. Sadly, he never made it back to his native New Zealand but for him, the most symbolic part of that nation had been living nearby since 1945. His mother had decided to settle in England and McIndoe had arranged for her to live in a cottage on St. Johns Road (East Grinstead) which they named "Aotearoa" — McIndoe's reverence for his mother and his country were never in doubt. After her death in 1951 he wrote; "she knew me as no other woman has ever done. I shall miss her more than I can say." Indeed, it had been the hand of fate delivered in a letter from his mother on that damp day back in 1937 which had been so instrumental in establishing him as one of the world's greatest plastic surgeons. "All patients were people"
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Books and Written References: Mosley, Leonard (1962). Faces from the Fire. Weidenfeld And Nicolson, London Williams, Peter; Harrison, Ted (1979). McIndoe's Army, The injured airmen who faced the world. Pelham Books, London Mayhew, E. R (2004).The Reconstruction of Warriors: Archibald McIndoe, the Royal Air Force and the Guinea Pig Club. Greenhill Books, London Manning, Nick (1991). Maxwell Jones and the Therapeutic Community Movement: A Sociological View. The International Journal for Therapeutic and Supportive Organisations, 1999, Volume 12: Numbers 2 and 3, pp.83-97 Pound, Reginald (1964). Gillies; Surgeon Extraordinary. Michael Joseph Ltd, London. Whitcombe & Tombs, New Zealand Pines, Malcolm (1999). Forgotten pioneers: The unwritten history of the therapeutic community movement. The International Journal for the Therapeutic and Supportive Organizations, 1999, Volume 20: Number 1. Internet References: Campling, Haigh, Douglas (1997). Canadian Society of Plastic Surgeons - 'Tribute to our founders'. The Canadian Journal of Plastic Surgery, 1997, Volume 5, Number 1. http://www.pulsus.com/Plastics/05_01/foun_ed.htm STORY BY CJ WILLIAMS,
SEPTEMBER 2008. CJ WILLIAMS IS A BA, BSc (HON) AND MSc GRADUATE OF
VICTORIA UNIVERSITY, WITH MAJORS IN HISTORY, SOCIOLOGY AND PSYCHOLOGY. HE
IS A SOCIAL AND BEHAVIOURAL SCIENTIST, MULTI-MEDIA PRODUCER AND WRITER OF
VARIOUS FORMS. HIS MAIN AREA OF INTEREST IS THE INTERPLAY BETWEEN FREE
CHOICE, FATE, INDIVIDUAL BEHAVIOUR AND SOCIAL ENVIRONMENT. |
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COPYRIGHT THE AUTHOR AND NZEDGE.COM IP HOLDINGS LIMITED 1998-2008. EXECUTIVE EDITOR BRIAN SWEENEY |
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Motivated by a desire to be more than just an ordinary doctor,
Archibald Hector McIndoe pursued greatness and became
much more than an ordinary surgeon. Appointed plastic surgeon to the Royal Air
Force in the midst of
World War II, McIndoe brought plastic surgery to the forefront of burns
treatment and became a pioneer of what is more commonly known today as
'therapeutic community'. As noted by one of his patients;
"McIndoe, as well as being a great surgeon, was also a great
psychologist".
