Queen Victoria Hospital Archive Project: psychological rehabilitation

McIndoe and his team at QVH unquestionably accomplished great things in the treatment of severe burns, and in the subsequent surgical reconstruction of disfigured faces, hands and other parts of the body. Yet the achievements of McIndoe’s regime at the hospital extended far beyond physical repair. Many previous posts in this series, including the recent guest piece by consultant plastic surgeon Tom Cochrane, have alluded to the fact that a vital part of the Guinea Pigs’ recovery was determined by the much wider-ranging systems of support which came into play during – and beyond their time at East Grinstead.  Of these, the Guinea Pig Club was of course hugely significant, as, too, was the role played by the townspeople of East Grinstead – a topic which will be the subject of a forthcoming post.  Underpinning all of this was McIndoe’s belief in the importance of psychological – as much as physical – rehabilitation.

Memorandum relating to the importance of rehabilitation, 1949


Of course these two aspects of recovery were in many ways inextricably linked. In part, McIndoe’s concern with the mental well-being of his patients was very much connected with the effect that this had on the success of surgical repair. This was emphasised in his 1958 lecture, ‘Total Reconstruction of the Burned Face’ in which McIndoe pointed to the importance of ensuring the patient’s morale was ‘of the highest order’[1] when embarking on the long and exacting series of operations necessary for facial reconstruction.  At the same time, McIndoe was not simply being pragmatic; accounts make it clear that he had a very genuine and personal empathy for his Guinea Pigs, these young energetic men who had suffered such traumatic and life-altering injuries. He had a strong awareness of just how devastating must be the psychological impact of their sudden transformation into a ‘burned cinder’,[2] and saw that this had to be addressed in and of itself in order to facilitate the patient’s return to a ‘normal’ and productive life.

The piano was one of the diversions provided for patients in Ward III

McIndoe’s morale-boosting efforts on behalf of the patients took various forms. As Emily Mayhew has discussed, much focus lay in creating the right kind of ‘therapeutic environment’.[3] This began with the hospital surroundings in which the patients were to spend so much of their time. McIndoe arranged for Ward III, (whose original décor was described as resembling that of ‘a dimly lit Victorian public lavatory’[4]) to be repainted in soothing pastel shades, with new curtains and bedspreads, and filled with fresh flowers. Diversions for the patients included a piano and famously a barrel of beer on tap – although it should be added that this was well watered down and served the important medical purpose of encouraging the patients to stay hydrated.  Another significant area was the appointment of the right staff. It is widely recorded that McIndoe favoured employing nurses who were physically attractive, but even more important was that they were temperamentally suited to the uniquely demanding workload of Ward III and that they were well-prepared to interact with the Guinea Pigs without displaying any negative reaction to their disfigured appearance. Here, much of McIndoe’s influence lay in managing other people’s reactions to his patients and overcoming the natural instinct ‘…to be repelled, to turn away, to ignore.’[5] This was also famously exemplified in his success in prevailing on the East Grinstead community to accept and welcome the Guinea Pigs.

McIndoe recognised the importance of entertainment and a home-like atmosphere for his patients

Providing entertainment, lifting spirits and staving off boredom were all desirable outcomes, but there was also a longer-term goal. What was recognised in all of these initiatives was the importance of bringing the burn patients back to a place (in the emotional sense) where they could feel hopeful and optimistic about the future, and conceive of a life ahead of them which was worth living. Positive human interaction and social acceptance – amongst fellow patients, staff, and in the wider community was vital in helping the men to come to terms with their changed appearance and rebuild their image of themselves.

McIndoe was also mindful of the practical issues which arose for the Guinea Pigs in returning to everyday life. Being well aware of the wretched circumstances in which many of the First World War veterans had found themselves, McIndoe was determined that his patients must be well-looked after. Perhaps some of the most interesting records in the QVH archive are McIndoe’s files relating to the Welfare Committee, formed in October 1941. Based on McIndoe’s philosophy that ‘…the surgeon’s responsibility to the patient extended from the moment of injury until and beyond his resettlement into normal civilian life’, this committee, chaired by McIndoe himself, was concerned with the improvement of the patients’ quality of life outside of the operating theatre. Various initiatives involved providing facilities or equipment for the diversion of the patients whilst in the hospital, but a large part of the committee’s work also lay in ‘resettlement’ – ensuring that the Guinea Pigs had the necessary resources to create a fulfilling and sustainable life for themselves in the future.  This might be in the form of further education and training, assistance in finding employment, or even providing money or physical items where needed. The committee minutes in McIndoe’s files offer striking insight into the extent of the hospital’s involvement in this aspect of the patients’ rehabilitation.

Joanna McConville, Project Archivist

[1] Archibald McIndoe, ‘Total reconstruction of the burned face’ (The Bradshaw Lecture 1958), British Journal of Plastic Surgery 36 (1983): p. 143

[2] Leonard Mosley, Faces from the Fire, (London: Weidenfeld & Nicolson, 1962), p. 95

[3] Emily Mayhew, The Reconstruction of Warriors: Archibald McIndoe, The Royal Air Force and the Guinea Pig Club, (Greenhill Books, 2004), p. 202

[4] Geoffrey Page, Shot Down in Flames (originally published as Tale of a Guinea Pig, 1999), (London: Grub Street, 2011), p. 139

[5] Emily Mayhew, The Reconstruction of Warriors, p. 156

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