“Many find courage in the face of death. Others need courage to face life.”
Before I start, I need to stress the fact that this blogpost is not, I repeat NOT about a group of people who own small squeaky rodents. I feel I need to make this clear sooner rather than later, because a few of you may get rather upset if you scroll down this page full of excitement at seeing cute pictures of small furry beasts and instead find…..well, it’s not cute, let’s put it that way. It is about a club whose membership requirements are perhaps the most exclusive of almost any group or society in the world, but it was formed in a spirit of camaraderie and shared experience that is both heart-warming and inspiring. I watched a documentary about it a while ago and found the story so gripping that I felt I had to share it with as many other people as possible – hence this blogpost.
The story of the Guinea Pig Club begins at the start of World War Two. The British Emergency Medical Service set up several units around London primarily for the treatment of injured fighter pilots. One of these was the Queen Victoria hospital in East Grinstead, which before the war had been a small cottage hospital. It was now designated to be used mainly for the treatment of severe burns, which were usually caused by exploding aviation fuel.
A man named Archibald McIndoe – originally from New Zealand – was placed in charge of treatment at the hospital. He had worked in several hospitals in the UK prior to being appointed consultant plastic surgeon to the RAF in 1938.
It was not until May 1940, when Germany attacked France and the British army was in full retreat, that McIndoe’s skills as a surgeon were finally put to the test, because now the Royal Air Force was in charge of both defending Britain and taking the battle to the enemy. At the time, the use of plastic surgery on burns-related injuries was not widely practised, simply because the patients did not live long enough. The survival rate was soberingly low – severe shock and fluid loss, combined with strong likelihood of infection through open wounds, led to dehydration and death in a very short period of time. In order to combat this, the most common technique used was the application of tannic acid – which I imagine is about as nasty as it sounds. Tannic acid is used to make leather – it works by drying the skin out. This means that less fluid will escape from the wound, so likelihood of death from dehydration is reduced. However, this method did not allow the wound to heal properly and left the patients with tough leathery faces, which did not help their subsequent rehabilitation into society. McIndoe recognised the limitations of this method and in 1941 he finally managed to get the RAF to ban the use of tannic acid in all of its hospitals. He himself experimented with various different methods and finally developed a simple procedure that cleansed and disinfected the burnt areas, whilst acting as a less painful and non-invasive dressing method. This was the saline bath technique, which was based on the observation that wounds tended to heal faster if the pilots had crashed in the sea rather than on land. By soaking the burnt areas in saline solution, all the dead skin and pus could be gently washed away, allowing the new skin underneath to start growing back in preparation for future skin grafts.
By 1942 a large number of Canadian airmen were also being treated at the Queen Victoria and around the same time, a Canadian surgeon named Ross Tilley joined McIndoe’s team. There were now so many patients at the hospital that they were in danger of running out of space, so Tilley appealed to the Canadian government, who built a separate wing for the Canadian airmen which opened in 1944.
By 1941, McIndoe had persuaded the RAF to open four more specialised burns units around the country, primarily staffed by people who had been trained at the Queen Victoria hospital. He and Tilley would visit all of these units bi-weekly and select the most challenging cases, who would be brought back to the Queen Victoria for treatment. Sometimes patients were referred to the hospital in more unusual ways. One Guinea Pig described how he had been at a hospital in Wales where the surgeon (who had clearly missed his true calling in life as a butcher) had a reputation for lopping off limbs if he thought they were too damaged to bother repairing. This particular airman was due to have both of his hands amputated, but one of the nurses told him that if he went to East Grinstead they might be able to help him. Some idea of McIndoe’s innovative approach to surgery can be gained from the fact that half an hour after arriving at the Queen Victoria, the injured airman underwent a four-hour operation and his hands were saved.
The Guinea Pig Club first formed on Sunday July 20th 1941. There are two different versions of how the Guinea Pig name came to be coined. One says that it was McIndoe himself who called the men his “guinea pigs”, because many of his surgical techniques were entirely new and experimental. The other account says that it was one of the men who said that they were bunch of guinea pigs. Either way, the name is a peculiarly apt one. The members could all be found in either Ward 3 or the Canadian Wing, which were the parts of the hospital specifically designated for burns treatment and reconstructive surgery. You got your badge after your first operation. If you had fractures or lacerations you were “mashed” and if you had severe burns you were “fried” or “hash-browned”. The Guinea Pigs had their own particular style of black humour: the treasurer was a man in a wheelchair (so he couldn’t run off with the funds!) and the secretary was a man with badly damaged hands (so he couldn’t take any notes). It was originally started as a drinking club, because in between their operations (the average number of operations per man was 25, but some had as many as 80) they were not actually ill, so they were allowed to drink beer on the wards and go out and socialise. In fact, they were actively encouraged to do so, as both McIndoe and Tilley recognised it as being an important part of the rehabilitation process. The serious disfigurement caused by their injuries meant going back to living a normal life again would be extremely difficult and McIndoe did everything in his power to make this process easier for them.
In direct defiance of RAF protocol, he allowed the men to wear their military uniforms whilst on the wards, rather than the hated “hospital blues”. This meant that they could retain their identities as airmen, rather than victims,which helped to act as a shield against some of the difficulties they would later face, and also encouraged the same camaraderie that they had shared with their RAF mates prior to sustaining their injuries. In addition to this, McIndoe ensured that the nurses working on the wards were all very attractive and (just as important) completely unfazed by the men’s injuries – this meant that the men (some of whom had been abandoned by wives and girlfriends after the full extent of their injuries had been revealed) could be reassured that women would still want to spend time with them and be around them. Taking this into account, it is perhaps not so surprising that at least 40 of the Guinea Pigs ended up marrying nurses who had looked after them during their time at the hospital.
Trips into the local town of East Grinstead were also encouraged. McIndoe met the townsfolk and asked them to socialise with his “boys” as a kind of therapy – to chat and drink and smoke – and make them feel like normal men again. Some of the older residents of the town still remember meeting the Guinea Pigs for the first time. Even with McIndoe’s introduction, it must have been somewhat unnerving to meet men with such badly disfigured faces: some had no ears, others no eyelids or lips, and most had no noses left either. In addition to this, many of the men had pedicles attached to their faces. Although skin grafting was already being used for large areas of the body – for example the limbs – it was much more difficult to graft skin on to faces and hands. Eyelids were usually reconstructed from skin taken from the inside of the arm, which is almost totally hairless. Noses were more difficult to re-build, and this is where the pedicles came in. A pedicle is a piece of skin that is lifted up from the rest of the upper arm, almost like a jug handle, whilst the skin underneath is sewn up again. Then the bottom part of the “handle” is cut from the arm and attached to where the nose needs to be, on the face. This is left for several weeks, to allow new blood vessels to form. The third operation involves cutting the pedicle away from the arm and finally taking the excess skin off from the nose. This leaves a shapeless blob which takes about a year to “settle” before it can be shaped into a proper nose during later operations. Obviously this meant that in between the second and third operations, the men would be walking round with their noses attached to their shoulders (see below for pictures of what the pedicle-noses looked like). It may seem a primitive and outdated method these days, when skin can be grown virtually from scratch in a laboratory, but it worked. Another term for the pedicles was “walking-stalk skin graft”, which describes the procedure rather well.
Although the people of East Grinstead showed great kindness and consideration to the Guinea Pigs – so much so in fact that it became known as “the town that never stared” – trips up to London to see shows etc could be much harder, as people frequently stopped to gawp at them, stunned by their – admittedly somewhat freakish – appearance. However, it helped that the men were seen as heroes – many people had witnessed the Battle of Britain and understood the sacrifices that the men had made for their country.
I keep saying “men”, but it is worth remembering that most of them were barely more than boys, aged between 18 and 20. To have all their hopes and dreams and aspirations taken away from them at such a young age must have been devastating. To go from being dashing young heroes to damaged wrecks of men in one cruel blow and then face the rest of your life with no apparent hope of recovery, normality or acceptance is just unimaginable. I feel that this is what makes McIndoe and Tilley’s work so commendable and inspiring. They did everything they could possibly think of to give these men the very best chance at a normal life, and in an astonishingly high number of cases, they succeeded. They employed radical new surgical techniques and worked to extremely high medical standards, but this would still not have been enough without the time and care and energy they put in to the men’s rehabilitation. Their holistic approach made an enormous difference to their patients’ chances of recovery, particularly their understanding of the mental and emotional impact such devastating injuries can have. One tactic used by McIndoe was to fully explain to his patient exactly what their next operation would involve, even to the point of letting them watch the same operation being carried out on a fellow patient. This might sound like he was taking it a bit far, but in fact psychological studies have shown that the more a person knows about their medical problem and how it will be tackled, the less pain they will suffer after the procedure and the faster their recovery will be. In this sense, McIndoe was very much ahead of his time. This was also true of Tilley, who was seen as a father-figure by many of the Guinea Pigs – in fact, if he had operated on any of the men during the day, he would always cycle back to the hospital in the evening around 11pm to check on his patients. As a mark of the respect and love the men felt for McIndoe, he was elected President of the Guinea Pig Club, and retained this title until his death, when the role was taken up by HRH Prince Philip. When the original BBC documentary was aired, the Guinea Pig Club was celebrating its 60th anniversary and still holding annual reunion dinners and in addition what I believe is an annual service in the local church of St Swithin’s in East Grinstead.
This last brings me to the next part of my story. A few weeks ago I decided to entertain myself at the weekend by going to Victoria station and picking a destination at random from the departures board. I was scanning the names of various towns without much enthusiasm, when I suddenly caught sight of one that filled me with excitement. East Grinstead. I doubt there were many people on the platform who felt quite so thrilled at the idea of visiting this town as I did. I remembered seeing bits of the documentary that were filmed inside St Swithin’s church, and also that a local pub – the Rose and Crown – was mentioned as one of the places that the townsfolk encountered the Guinea Pigs for the first time. The thought of actually visiting these places was wonderful – I even entertained a vague idea of trying to reach the Queen Victoria hospital – although it looked rather a long walk on GoogleMaps.
Upon arrival in East Grinstead, I discovered to my delight that it was in fact a very attractive and pedestrian-friendly town, even the Queen Victoria hospital was only a 15 minute walk from the town centre. I visited St Swithin’s church and the local museum and even sat and had a drink in the Rose and Crown pub, where the Guinea Pigs were first welcomed and befriended by the townsfolk all those years ago. On reaching the Queen Victoria hospital, it soon became apparent that there was no danger of McIndoe’s pioneering work being forgotten anytime soon. Almost every other building seemed to be named after him, there was also a ward named after Ross Tilley and even a McIndoe Burns Support Group. And on one wall inside the hospital, just past the main reception, there was something that pleased me immensely – an enormous wooden plaque with every one of the 649 Guinea Pig Club members listed on it. (Pictures of all this can be seen below). It was wonderful to see that these extraordinary men and their remarkable story were still remembered – there was even an small information leaflet about the Club at the reception desk, although I did take the last one – hopefully someone has now replaced them!
A short epilogue to wind up the tale. The last Guinea Pig undergoing treatment at the Queen Victoria hospital left in 1951. McIndoe received a knighthood for his work in 1947 and continued working till his death in 1960. Ross Tilley was given an OBE in 1944 and the Order of Canada in 1981. In 1945 the Canadian government presented the Canadian wing of the hospital as a gift to the residents of East Grinstead as a thankyou for the kindness and compassion they had shown towards the Guinea Pigs. Of the 649 members of the club, 422 were British, 176 Canadian, 19 Australian, 19 were Kiwis and the remaining 13 come under the all-embracing Other.
The Guinea Pig Club still exists – as of 2001 there were 139 members left. The objectives of the club are still those outlined by McIndoe at its very beginning:
“We are the trustees of each other, we do well to remember that the privilege of dying for one’s country is not equal to the privilege of living for it.”
If you want to know more about the Guinea Pig Club, I have included some links below which contain footage from the BBC documentary and also I think from the other documentary I watched: “The Reconstruction of Warriors”.
“A man disfigured in battle fights that battle for the rest of his life.”
Below are the lyrics of the Guinea Pig Club song. No one is sure who first wrote it, but it has apparently been adapted from the WWI song “Fred Karno’s Army”:
We are McIndoe’s army,
We are his Guinea Pigs.
With dermatomes and pedicles,
Glass eyes, false teeth and wigs.
And when we get our discharge
We’ll shout with all our might:
“Per ardua ad astra”
We’d rather drink than fight
John Hunter runs the gas works,
Ross Tilley wields the knife.
And if they are not careful
They’ll have your flaming life.
So, Guinea Pigs, stand steady
For all your surgeon’s calls:
And if their hands aren’t steady
They’ll whip off both your ears
We’ve had some mad Australians,
Some French, some Czechs, some Poles.
We’ve even had some Yankees,
God bless their precious souls.
While as for the Canadians –
Ah! That’s a different thing.
They couldn’t stand our accent
And built a separate Wing
We are McIndoe’s army,
(As first verse)
http://www.youtube.com/watch?v=kct2bJJsgN8 – The Guinea Pig Club, BBC4
http://www.youtube.com/watch?v=3ZkmYmLLyrA&NR=1 – Surgery: McIndoe
http://www.youtube.com/watch?v=wU3FhgkaUyQ&NR=1&feature=fvwp – Archibald McIndoe
The first 15 or so pictures in the slideshow are from Google Images, the rest were taken by me during my visit to East Grinstead.