Old white man of the day

Moving towards an old white man series for ANZAC week we pick up the story from yesterday, how Harold Gillies made plastic surgery a reality in Britain for World War One victims and move on to World War Two.

There is a long, involved back-story but in late 1929, Dunedin born,??Archibald Hector McIndoe?found himself wandering the streets of London in deep despondency.? His job offer had failed, his qualifications were not acceptable in Britain and he was at a loss. Quote:

[…] 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.

When McIndoe was greeted by Gillies at his Queen Ann Street practice, he would not have known then that this famous figure was about to become his mentor and one of the greatest medical partnerships was about to commence.

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. […]

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. […]

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 sleight 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.? […]

Initially, it had not been McIndoe?s intention to address his patients? mental state but his antipodean manner soon turned out to be the perfect antidote. The shift from cold, clinical professionalism to mate-ship and egalitarianism came naturally and as such, he had no qualms about supplying his patients with beer, joining them for a drink, or having them sit in on operations. Even getting their opinion on what they thought should be done was not below him. Ward Three, McIndoe?s maxillofacial unit, was laid back and literally devoid of a single rule. In the words of patient Alan Morgan; ?It resembled a big comfortable hotel. It was mad; everybody was doing their own thing. There was a big barrel of beer at the end of the ward and you could help yourself?

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.[…] to help returned servicemen recover from the psychological effects of war.[…]

Motivated by a desire to be more than just an ordinary doctor,? McIndoe pursued greatness and became much more than an ordinary surgeon. […] 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?. End of quote.