Alan Morgan counts himself lucky. As Ella pointed out to him during the early days in Ward III, his hands were a mess but he was surrounded by men whose faces had been burned and broken, and many had lost part or all of their sight. But Alan didn’t feel lucky. The frostbite had taken eight of his fingers. He was twenty-one and each time he thought of the future he saw himself as useless, unable to work, and a burden on the people who loved him. With one full thumb and one half thumb he had little faith in the shallow clefts that McIndoe and his team had made around the knuckle joints of the fingers to allow for some movement. But Ella urged him on and he spent hours, every day for months, wearing out dozens of pencils as he practised writing his name. Slowly he built up mobility in his joints and eventually managed to persuade McIndoe and the RAF medical board that he could return to the service. He wanted to get back in the air, and to serve long enough to make promotion to flight sergeant, and he did just that, spending his last months in the RAF as a flight engineer. The extraordinary dexterity he had achieved with his stumps also impressed his pre-war employers and when he was demobbed, Alan returned to his original job. Ella, meanwhile, opened a small shop and the couple seemed set for the future, to the point where Ella eventually gave up the shop to concentrate on their family.
It wasn’t long after this that Alan’s employer was taken over by another company and he was made redundant. Prospective employers took one look at his hands and shook their heads, and although he begged for the chance to demonstrate his dexterity he was consistently denied the opportunity to do so. It was a dark period for the Morgans; Alan was at the end of his tether and deeply depressed. In this state of mind he didn’t realise that the Guinea Pig Club could help him; it had already taken a forceful stand with employers for other members, but Alan had not kept in touch and the future looked grim. Eventually, as the situation grew worse he got himself to an interview.
‘I just kept me hands in me pockets,’ he says. ‘Managed to do that the whole time I was there, and I got the job. Then a few days after I started work the boss comes up me and says, “You never told me about your hands.” So I just said, “Well, am I doing the job all right?” And he said I was. And that was the last I heard about it, no one mentioned my hands after that.’ Alan was a jig borer once again and proud to be able to work to 0.00015 of an inch on the jig boring machine. It was something he never dreamed he’d achieve when he first discovered the truth about his hands in Ward III.
Every Guinea Pig had to overcome extraordinary physical, psychological and emotional obstacles on the road to new personal and working lives. Hands burned to stumps, lost fingers, amputations, and impairment of mobility looked even more grim for men who were also facially disfigured, and in addition some had also lost wives or girlfriends. Archibald McIndoe was determined that everything possible would be done to prepare them for life after the war and after the service, and he set up an occupational therapy unit with a difference. Basket weaving was not on his agenda; he wanted real and meaningful work for his patients and sought support from the aircraft industry. In association with aircraft instrument manufacturers Reid and Sigrist, a small satellite factory was set up in the hospital grounds managed by five of the company’s staff to train the patients and check their work. In delivering the McIndoe Memorial Lecture in 1976, Russell Davis, the anaesthetist who worked with the surgeon for many years, spoke of the success of this initiative.
‘… the patients were put to work making turn and bank indicators and other instruments. The patients were paid a small hourly rate for their work. After one year’s operation two startling facts emerged: the production per man-hour was greater than that of the parent factory, while the rejection rate of tested instruments was less.’76
It was an extraordinary result from this first ever attempt to establish an industrial workshop within a hospital, a practice that is not uncommon today.
‘Those poor boys,’ Molly Tyler says, ‘they worked so hard, they were determined to get it right but it was such a struggle with their poor fingers, and there was quite a bit of cursing went on, but they kept at it. I loved them and admired them so much.’
Molly, an occupational therapist, was in her early twenties and living in East Grinstead when, in 1943, she was offered the job as a supervisor in the workshop. ‘I had to go away for two weeks to New Malden for training,’ she tells me, ‘and I had a baby boy and I left him with my mother while I was away. When I got back from the training on a Friday it was late in the afternoon, and raining. I was walking up from the station when I realised something was wrong and when I got to London Road I saw what had happened.’
Just after five o’clock that afternoon, a German bomber had dropped two 500-kilogram and eight 50-kilogram high explosive bombs across East Grinstead. One of each fell on the back of the stage of the Whitehall Cinema where the afternoon screening was coming to a close. The bombs fell without warning, and people streamed out of the cinema into the rain just as the aircraft flew back with the machine-guns turned on the panic-stricken survivors. Several people were killed outright, others were still trapped in the cinema, and the surrounding buildings were in flames.
‘I was so worried,’ Molly says. ‘My mother had told me she was going to go to the pictures that afternoon and I knew she’d take the baby with her. And then I saw her crossing the road with him. She’d been uncomfortable in the cinema, she’d had a premonition that something was going to happen, so she’d left early, before the picture finished.’
Molly was initially intimidated by having to supervise the Guinea Pigs’ work. ‘Some of them were really clever pilots and engineers and I didn’t feel right telling them what to do. I felt stupid trying to teach things to them but they were all for it. They were very cheeky too. They all had a sense of humour, and the sexy jokes and gestures they made with the pistons … well you wouldn’t want to know. They were wonderful boys. I was a bit of a favourite with them and they liked to flirt. I used to go dancing with them. Bill Foxley was a lovely dancer, and he took me to the other cinema, the Radio Centre, and I had to get out his money and put it on his hand so he could pay. They were such lovely boys.’
Public response to their appearance was the greatest challenge for Guinea Pigs once they left the hospital and the safe and friendly environment of East Grinstead.
Sandy Saunders was twenty-two and a lieutenant in the army when he was transferred to the Army Air Corps in 1945. ‘That town did so much for us,’ Sandy tells me. ‘Being treated as we were by local people gave us hope. Of course when you went somewhere else it was very different, but at least you could believe that it was possible that people would one day see through the way you looked to the person beneath.’
During his elementary flying training as a glider pilot, he was caught in crosswinds as he attempted to land. After three attempts the plane crashed and burst into flames. Sandy escaped from the wreckage with his clothes on fire, and sustained forty per cent burns to his face, legs and hands. He was taken to the Queen Elizabeth Hospital in Birmingham, but his navigator was killed in the crash.
‘That was a terrible time. I was trying to come to terms not just with my injuries but also with my failure which I felt had led to the death of the navigator. I was seriously depressed and suffering with flashbacks. I was suicidal. My face was horrible, I felt useless and I could see no life, no future. I couldn’t believe that any woman would be able to look at my face and love me. Twice I went up onto the roof of the hospital with the intention of killing myself, and on both occasions it was a nurse who talked me down.’
Sandy underwent nine operations in Birmingham and when he was discharged he was appointed second-in-command of a prisoner-of-war camp near Derby. It was there that he learned what was happening at East Grinstead.
‘I was having a lot of trouble closing my eyes, as the skin grafts on the lids had shrunk, and the medical officer at the camp told me what Archie McIndoe was doing at East Grinstead. So I picked up the phone and called the hospital and asked to speak to him, and he agreed to see what he could do.’
In a series of fourteen operations, McIndoe replaced Sandy’s eyelids, did a nose graft and made a number of adjustments to the reparations that had previously been carried out on his face.
‘That’s what inspired me to train as a doctor, because at East Grinstead I saw the way medicine can turn your life around. I used to watch Archie performing operations to learn what I could from him. But it wasn’t only surgery that saved me, but the town. Having a near-death experience gives you the inspiration to make the most of life and be more understanding of other people’s problems.’
Sandy Saunders was in his eighties when we met, and still in general practice close to Melton Mowbray.
The challenge of acceptance was ongoing. Even after the war and into the 1950s ignorance about facial disfigurement was still widespread and people with facial injuries had to tolerate the shock, disgust and fear of others who caught sight of them. But, like Jack Toper in his battle to be allowed out of the offices and into the store with Marks & Spencer, most managed to rise above it and many were supported by the intervention and advocacy of McIndoe and the Guinea Pig Club.
McIndoe’s concern for his patients was always whether, once having repaired their bodies, he and the Guinea Pig Club could also help to restore something of their shattered lives. Part of Edward Blacksell’s role was to prepare the men for the outside world and build bridges with potential employers. In this respect it was Bill Foxley who presented the greatest challenge; he had lost his hands, had very limited sight, and an expressionless face. McIndoe and Blacksell felt he might be the one person who was unemployable. The work that went into restoring his body and face had been long and hard for Bill and for McIndoe’s team, and it was Bill’s faith in what they had done, and in his own physical fitness, along with his irrepressible spirit, that completed the task of rebuilding his life.
He worked on his fitness and developed a reputation as a runner, and when he was finally discharged he and his wife, Catherine, opened an ironmonger’s shop in Devonshire. But Bill discovered that he was not an ideal shopkeeper and he struggled to handle nails, nuts and bolts. Eventually the club assisted the Foxleys out of the shop and they moved to Crawley, not far from East Grinstead. Bill spent most of his working life commuting to London where he worked with the Central Electricity Generating Board. Until his death in 2010 he, like many other members of the Guinea Pig club, remained committed to doing what he could for burned servicemen, especially those wounded in the Falklands War. There are many extraordinary tales of courage and determination on the part of English, Canadian and European Guinea Pigs who returned to active service, and built new lives after the war. But some fared less well, and one of those was Richard Hillary.
Following his treatment at East Grinstead, Hillary was determined to return to flying and had several bruising encounters with the medical board in order to be pronounced fit. In 1941 he came up with a plan to visit the USA, touring industrial sites, talking to war workers about the war effort, and also visiting community groups. He put his plan to the Ministry of Information where Duff Cooper and Sir Walter Monckton could see the potential of the idea but also foresaw problems. In the end it was the approval of the Air Ministry that was needed and eventually Hillary’s enthusiasm and determination won through. McIndoe was cautious but backed him all the same, and arrangements were made for the trip.
Richard Hillary arrived in New York to be met by a small but enthusiastic media contingent at the Plaza Hotel. But in Washington things looked rather different. Senior officials at the British Embassy were shocked by the sight of his face and believed that public appearances could only be counterproductive. They feared that the mothers of America ‘would take one look at him and express their concern, saying: “We don’t want our boys to die for Britain”.’77 Hillary was told he could not be allowed to tour, but officials agreed to have his planned speeches distributed as pamphlets, and he was allowed to record radio broadcasts during his stay.
Hillary appealed to Lord Halifax, then British Ambassador to the US, who in turn approached President Roosevelt urging him to support the tour, but was faced with a veto from the White House. Americans were not accustomed to seeing the wartime disfigurements that were becoming increasingly common in Britain, and it was felt that Richard Hillary’s appearance would not be a useful or effective propaganda exercise.78 Hillary was devastated and returned to London, his self-esteem, spirit and pride in tatters. Eventually he recommenced his efforts to return to flying despite the fact that his colleagues noted he could barely hold a knife and fork. His persistence was rewarded and he was declared fit for service but was unable to fly solo and retrained with the Operational Training Unit at Charterhall.
McIndoe, who had been away for a desperately needed break, was horrified when he heard the news. Not only was he anxious about Hillary’s physical state and problems with his eyes that he felt could not stand the strain of night flying, but he was deeply concerned about his state of mind, believing him to be suffering from depression. McIndoe urged the RAF to ground Hillary until he had undergone further treatment. But no action was taken and by July 1942 he was back in the air flying light aircraft, and was cleared for operational flying by the medical board in November that year. But there were immediate problems: handling the heavy aircraft was almost beyond the capability of his badly damaged hands, and weather conditions exacerbated the difficulty of keeping control. He also struggled with operating some cockpit equipment. Despite being counselled to give up flying, at least until he made more progress towards full recovery, he persisted. In the early hours of the morning of 8th January 1943, shortly after take-off for a training flight in a Blenheim, Hillary was orbiting the airfield in low cloud cover accompanied by his radio operator Sergeant Wilfred Fison. The ground controller told him to circle a flashing beacon. David Ross writes that the controller asked, ‘Are you happy?’ and that Hillary replied, ‘Moderately. I am continuing to orbit.’ He was waiting ‘for a decision to be made regarding a partner for the exercise … When he was spoken to again a few minutes later there was no reply.’ There was a high-pitched whine followed by a terrible crash.’79
Both Hillary and Fison were killed and their deaths were followed by recriminations over whether or not Hillary should have been allowed back into the air. But his bullish determination had been convincing, and officers had believed in him and admired his persistence and courage. Had Hillary been the sort of person who could have fully integrated himself into the brotherhood of the Guinea Pig Club, perhaps it is possible that he might have been persuaded to settle for living out the war on the ground. But flying was his passion, it was part of who he was and how he saw himself, and brotherhood did not transcend his need to remain a flyer. He had spoken and written of the solitary nature of the flyer and how those who volunteered for the war in the air needed a confident indifference to life and death. He never grew to accept the limitations of his wartime injuries, and his facial wounds seem to have done nothing to discourage the attentions of the many women attracted to him. Questions about a death wish have always been in the slipstream of his death, but his story lives on in The Last Enemy as a significant and poignant contribution to the literature of the Second World War.
Archibald McIndoe was enduring a gruelling war during which he worked very long days in the operating theatre, visited other RAF hospitals to advise on treatment, and fought long and robust battles with bureaucracy on behalf of his patients. He had created a therapeutic community in a small country town, and developed the instruments and procedures of plastic surgery that led to the sophisticated treatments being used in the twenty-first century. He took few breaks, fewer than he needed, and spent too little time attending to his own life and particularly to his family. And in 1943 he also faced problems with his hands that threatened his ability to operate, and his postwar career as a surgeon.
The problem began with stiffness in the ring finger of his left hand and a feeling of deadness in the right. For a while he continued operating and practised exercising his hands by squeezing a ball, just as many of his patients were doing to restore the movement and grip in hands stiffened by burns and trauma. It didn’t take McIndoe long to diagnose Dupuytren’s contracture — a condition in which the fingers slowly contract and curl into the palm. It is mainly found in men and usually men over the age of forty. Actors Bill Nighy and David MacCallum, US president Robert Reagan, prime minister Margaret Thatcher, playwright Samuel Beckett, and cricketers David Gower and Graham Gooch all suffered with this condition. It can begin rapidly and then slow down or, conversely, start slowly and rapidly speed up. McIndoe knew he must act swiftly before any finger contracted to a point at which it would be frozen for life. For a man who had spent his war in the effort to restore function in his patients, this was first-hand experience of the fear of being rendered useless in his chosen field.
The surgical procedure for Dupuytren’s contracture was then, and still is, complex and risky, requiring an incision in the palm of the hand and extreme surgical skill in identifying the digital nerve for each finger so that the tissue causing the contraction can be cut away. Mosley comments that in this operation there is ‘danger of a kind which only a pianist, an artist or a surgeon can understand.’80 McIndoe entrusted his hand to his friend and partner, the surgeon Rainsford Mowlem, and was recovering in hospital in London two days after the operation when he got news of the bombing of the Whitehall Cinema in East Grinstead. Casualties were being admitted to the hospital, which was also faced with accommodating the bodies of those who had been killed. McIndoe was supposed to rest and particularly to take great care of his hand, but his concern over what might be happening at the hospital made rest impossible. Late that night he discharged himself from hospital, put his bandaged hand in a sling and drove home to East Grinstead, arriving in the early hours of the morning to supervise the management of the patients. His inability to do more than that frustrated him, and it gave him a horrifying insight into a possible future in which he might no longer be able to operate.
Stress and anxiety took their grip on him; he became irritable and depressed and although his hand continued to heal well, the darkness did not lift. A few months later he developed stomach pains, which eventually led to his belief that he had liver cancer. But as discussed earlier the scare proved to be due to a problem appendix. Once that was successfully removed the pain did not abate and the problem of the forgotten surgical swab was discovered and he underwent surgery again. It was a period of extreme pain and distress. McIndoe was unused to being vulnerable and unable to take control, and the pressure of this, along with the physical effects, took its toll.
As the war drew to its close the pressure lifted a little but McIndoe continued to work on every front: in the theatre, in teaching young surgeons, and in taking on various authorities on behalf of his ‘boys’. He and Edward Blacksell fought battles for improvements in war and disability pensions and, always a devoted Tory, he believed the new socialist Labour government would level off living conditions in Britain with deleterious effects. Most of all he feared the introduction of the proposed National Health Service, believing it would lower standards of health care. He was determined to fight to save the Queen Victoria Hospital from State control and attempted to take on health minister Aneurin Bevan head to head. There were many more battles to come.
His involvement with and advocacy for his Guinea Pigs continued, as did his enjoyment of their company over a sing-song around the piano, and pint or two in The Guinea Pig, a local pub close to the hospital which had been named for the men. Eventually, in 1947, he took a break to visit a friend, Robin Johnston, in Tanganyika and fell in love with Africa. Together with Johnston he bought a farm, which the latter ran for many years. McIndoe returned many times, combining work on the farm with some medical and surgical work in the local community. Time moved on and his marriage to Connie Belcham, his knighthood, and the widespread recognition and respect he commanded, ensured that the surgeon moved in powerful circles and high society. But he still kept working at East Grinstead and in London, ensuring that the ongoing operations needed by his Guinea Pigs were maintained, as well as operating on celebrities including Kay Kendall and Ava Gardner.
In 1960 the McIndoes took a trip to Spain, ostensibly for a holiday, but in fact to enable Archie to undergo cataract surgery in privacy. His eyes had been bothering him but he wanted to avoid creating doubt and uncertainty among current and future patients. The operation went well, but on the flight home he suffered a serious heart attack. It was another sign that his body was failing and in the months that followed he felt that decline in many ways.
On the 11th April, after an evening spent eating and drinking with friends at White’s club in London, Archibald McIndoe was driven home in the small hours. Later that morning, a maid who went to wake him with a cup of tea discovered that he had died in his sleep. The hospital staff, his patients and former patients reeled in shock at their loss.
‘That was a terrible time,’ Bob Marchant recalls. ‘It was like a great big black cloud came over all of us. But we had to carry on because there were patients needing operations. It took a big effort and the place just wasn’t the same, but somehow we kept going.’
The funeral of Sir Archibald McIndoe was held at St Clement Dane’s and the church was packed with fellow surgeons and those he had trained, with friends, admirers and grateful former patients. Prominent among the guests were his beloved Guinea Pigs. His legacy has become a legend and his pioneering work in plastic surgery built the foundations for the future. He had hoped that within his lifetime he would be able to develop a research unit that would uncover some of the mysteries of human skin and tissue, and the possibilities of the surgical replacement of limbs and organs. Sadly he did not live to see it happen, but the Blond McIndoe Research Foundation was built, and it remains as a national and international tribute to his extraordinary skill, talent, innovativeness and sheer bloody-minded determination to push out the boundaries of surgery and take on the bureaucracies that stood in the way of progress. Now, decades later, the men with McIndoe’s faces are proof not only of his pioneering surgery but his innovative work in establishing a therapeutic community in a small town, and a patient support group that is still working for its members.
‘We are the Trustees of each other,’ Archibald McIndoe wrote in the Guinea Pig magazine in 1944. ‘We do well to remember that the privilege of dying for one’s country is not equal to the privilege of living for it.’81