Sir Archibald McIndoe is not the only name synonymous with the wartime work of the Queen Victoria Hospital in East Grinstead. The name of another man who came from Canada and helped to rebuild lives became equally linked with this period. He made such an impact that the main ward at Queen Victoria Hospital now bears his name - Dr Ross Tilley.
Albert Ross Tilley was born in Bowmanville, Ontario, on November 24, 1904. His interest in medicine was piqued at an early age, as he had the privilege of accompanying his father, a general practitioner, while he visited patients. Ross graduated from the University of Toronto Medical School in 1929 as a silver medallist. Following medical school, he travelled extensively for five years, studying surgery at the Toronto Western Hospital in Ontario, the Roosevelt and Bellevue Hospitals in New York, The Royal Infirmary of Edinburgh in Scotland, and with the renowned pathologist Sternberg in Vienna.
By 1935, he was ready to open a private practice working at the Wellesley and Toronto Western Hospitals. In the same year, he joined the No. 400 City of Toronto Squadron of the Royal Canadian Air Force (RCAF) as a medical officer, and began what would turn out to be the most important training of his career. Dr. E. Fulton Risdon, a protégée of Sir Harold Gillies, and widely regarded as the father of modern plastic surgery in Canada, would guide Ross’s focused training in plastic surgery.
At the time, Dr. Risdon was one of only three plastic surgeons in Canada, and Ross became the fourth upon the completion of his training just prior to the outbreak of World War II. Ross was called up to active service in 1939, and by 1940 he was a Commanding Officer and C Surgeon at Trenton Memorial Hospital. A year later, he was appointed Principal Medical Officer at the RCAF headquarters in London, England. Shortly after arriving in London, he received a life-altering invitation, the acceptance of which would set into motion a chain of events that literally changed the faces of hundreds of airmen burned in WWII.
Equipped with his newly honed skills in plastic surgery, Ross travelled to the Queen Victoria Hospital in East Grinstead, Sussex in January of 1942. There he was charged with the task of treating the most difficult burn injuries.
The scale of burn casualties had never before been witnessed, and was not predicted by Allied strategists. A certain pattern of burn injury presented so frequently to hospitals that it was given its own designation. “Airman’s Burn” was described in numerous wartime medical texts as ‘a burn of almost unwavering characteristics due to the sudden exposure of unprotected parts of the body to intense dry heat or flame, as though the patient were thrust into a furnace for a few seconds and withdrawn.’ The product of this process was ‘deep, searing burns, usually of third degree to areas of tremendous functional importance -- the hands and eyelids in particular. The position of the fuel tank often resulted in its contents exploding in the face of the pilot, which accounts for the characteristic facial burns sustained.
In addition to the hands and face, airmen commonly suffered burns to their wrists, neck, thighs, and scalp. The motivation of the RAF and RCAF to commit whatever resources necessary to ensure the best treatment possible for its burned airmen was two-fold. Firstly, these young men had volunteered to fight in the service of protecting their country, and the indebted nation demanded they receive care of the highest quality. Secondly, pilots were an invaluable resource in the war campaign, especially during the Battle of Britain. During the autumn of 1940, experienced pilots proved a commodity more critical to victory than steel or oil. Burn injuries served to remove airmen from combat for weeks to months at a time, and therefore, the RAF needed to rehabilitate its most valuable resource as quickly as possible under the threat of an air campaign failure. Luckily for the multitude of victims, there were men like Ross Tilley and Sir Archibald McIndoe who were willing and able to set themselves to the task of rehabilitating these heroes.
Shortly after arriving at East Grinstead, it became apparent to Ross that the increasing number of Canadian burn casualties flooding the hospital would need their own ward. Under his planning and leadership as the newly appointed Chief Surgeon and Commanding Officer, Royal Canadian Engineers prepared to erect a 50-bed wing that would cost $80,000 and take a year to build. Upon its completion in 1944, the Canadian wing had a staff of over 50 people including orderlies, specialist nurses, and clerks.
For decades before WWII, patients with severe burns were deemed terminal and the standard of care consisted of administering minute amounts of saline, a gargantuan dose of morphine, and orders for the patient to return home so they could be surrounded by their loved ones as death swiftly followed. Burn patients were scarcely encountered in teaching hospitals because their case was viewed as hopeless and admission rarely occurred. The reason that major burns rapidly killed nearly everyone sustaining them was shock, and the inability of the medical profession to administer effective treatment to halt its progression.
Severe burns would initiate a chain reaction of events beginning with massive fluid loss from the wound, followed by shock and the successive failure of multiple organ systems until the patient was no longer able to cling to life. If by some divine intervention the patient persevered through the shock, the next hurdle to their recovery was infection. With odds stacked so highly against recovery from severe burns, the treatments that developed were largely chemical interventions geared towards minor burns, with surgical involvement a rare occurrence. Advances in shock therapy inadvertently created a new patient population that needed treatment desperately. The physicians of the day did all they could using the tools available to them.
The results from these tools however, proved unacceptable to physicians like Ross. When the first wave of severely burned airmen presented to hospital, the major treatment method centred on coagulation. A coagulating agent would be applied to the burn, which caused a tough hide of scab-like tissue to encase the wound. This functioned as a physical dressing of sorts, and was thought advantageous by many physicians in its ability to protect the wound, prevent life threatening fluid loss, and guard against sepsis. The coagulant that was administered nearly universally was tannic acid, the very same substance used in the leather industry to stiffen hides.
Metal tubes of tannic acid were so widely distributed, that at the outset of the war, they could be found in almost every first-aid kit in Allied territory. In theory, coagulation therapy served both as immediate first aid, as well as a long-term treatment that remained in place until new tissue had grown underneath, after which the coagulum could be removed. The reality of treating airmen’s burns with tannic acid turned out to be so disastrous that it prompted Sir Archibald McIndoe to undertake a crusade against its continued use.
Fortunately for the hundreds of patients who suffered burns of the hands and face, McIndoe was able to persuade the majority of his colleagues, and the scientific community at large, that the heinous results of tannic acid justified the banishment of its use across Europe. The new approaches cultivated by Sir Archibald and Ross at the Queen Victoria Hospital served as the prototype for burn management, and was duplicated at centres across Europe.
Most men would need between ten and fifty operations, requiring them to be in and out of the hospital for at least three years. It was customary to plan eight surgeries per year, alternating three to four weeks in hospital, with two to three week breaks outside. During his tenure at Queen Victoria hospital, Ross would replace countless noses, reform a multitude of ears and eyelids, and re-establish facial features for hundreds of men; all of this with the objective of giving his patients the chance to return to a normal state of existence.
After operating all day and into the evening, Ross would rest briefly in his living quarters only to make his way back to the hospital at 23:00h to check how his patients were faring after their surgeries, In a medical landscape dominated by rampant paternalism, Ross was another pioneer of patient empowerment who went to great lengths to educate his patients about every aspect of their care, every nuance of their surgeries, and the intricate details of what they could expect during recovery.
By 1944, the Canadian wing at Queen Victoria Hospital opened, and Ross was promoted to the rank of Group Captain. In June of the same year, he found himself standing in front of King George VI at Buckingham Palace with the Order of the British Empire being bestowed upon him. This prestigious award was fitting recognition of his success in Britain; along with the work of McIndoe and the hospital staff, they had become “the most formidable and effective response to burn injuries, anywhere in the world.”
Ross also served as president of the Canadian branch of the Guinea Pig Club, and continued to operate on over two hundred of its members for the next forty years continuing to dedicate a tremendous amount of personal attention to the emotional and psychological condition of his patients.
Upon his return from Britain in 1945, Ross became a consulting physician at Christie Street Hospital and Toronto Wellesley Hospital. For several years between 1949-1965, he also spent three days every month in Kingston where he worked as a staff physician at the Hotel Dieu, Kingston General, and Kingston Military Hospitals.
As one of only ten plastic surgeons practicing in Canada after the war ended, he was extremely busy laying the framework for the future of his specialty. His colleagues viewed him as a physician capable of breaking new ground and as an assistant professor at Queens University; he became the first to offer formal accredited courses in the specialty.
Ross was one of the twelve founding fathers of the Canadian Society of Plastic Surgeons in 1947. At its second annual meeting on June 2, 1948, the society’s members empowered him to draft a fee schedule for the operations performed most commonly by plastic surgeons. Appointed vice-president in 1953 and then president in 1954, his leadership of The Canadian Society of Plastic Surgeons helped establish the profession in Canada and paved the way for the exponential growth and prosperity it would experience in subsequent years. As his specialty flourished across the country, he continued to infuse his discipline with respect and integrity as he campaigned for years to develop burn treatment facilities in Ontario.
In 1984, his vision came to fruition and a burns centre named after him was opened at Wellesley Hospital and was later moved to Sunnybrook Health Sciences Centre in 1998, the Ross Tilley Burn Centre. Only three years after becoming the first plastic surgeon to be appointed a member of the Order of Canada, Ross also assumed the role of Founder and Director of the first adult burn centre in Canada. Even after retiring from practice at Wellesley and Sunnybrook hospitals in 1981, he continued to be recognized for his outstanding career.
The Dr. A. Ross Tilley Foundation was created in 1989 by several plastic surgeons and Jean Tilley, the widow Ross. The original goal of the Foundation was to award a scholarship in his honour and to commemorate his achievements. An elementary school in his hometown of Bowmanville was named in his honour, and he was inducted into Canada’s Aviation Hall of Fame in 2006. After dedicating much of his 84 years of life to his patients, Albert Ross Tilley passed away on April 19, 1988.
This article is based on: Albert Ross Tilley: The legacy of a Canadian plastic surgeon
Kevin S. Mowbrey
University of Alberta Health Sciences Journal • April 2012 • Volume 7 • Issue 1
Read more stories about the work at East Grinstead during WW2.