Wartime Injuries

At the outbreak of the Second World War, there were only four fully experienced plastic surgeons in Britain: Sir Harold Gillies, Sir Archibald McIndoe, Rainsford Mowlem and T. P. Kilner.

At the request of the Government, they were appointed to head four separate plastic surgery units to treat the expected influx of wounded servicemen.

Sir Archibald McIndoe moved to the recently rebuilt Queen Victoria Hospital in East Grinstead, where he founded a Centre for Plastic and Jaw Surgery and treated RAF casualties.

A New Era of Military Injury

As airborne warfare intensified, injuries began arriving on a scale and severity never seen before. East Grinstead became a pivotal site for treating catastrophic burns and blast injuries.

The phrase “airman’s burn” entered the medical vocabulary. These injuries — typically to the face and hands — were most often caused by igniting fuel tanks as pilots attempted to escape burning aircraft. In Spitfires, fuel tanks sat just in front of the cockpit. Many pilots flew without gloves or goggles to improve visibility and control, tragically increasing their vulnerability to severe burns.

Why These Burn Injuries Mattered So Much

The injured airmen deserved the best possible care — they had volunteered to fight and were suffering devastating wounds.

But the urgency was also strategic: experienced pilots were a critical wartime resource, especially during the Battle of Britain. Burn injuries removed them from combat for weeks or months. Restoring them as quickly as possible was vital to protecting the nation.

Fortunately, there were surgeons such as Sir Archibald McIndoe and Ross Tilley, whose skills and innovations transformed outcomes for thousands of servicemen.

The Nature of Burn Injuries Before Modern Treatment

For decades before the war, severe burns were considered terminal.

Patients were given saline, morphine and instructions to return home to die among loved ones.

It was not the burn itself that killed most patients, but a deadly sequence of complications:

massive fluid loss
severe shock
failure of multiple organ systems
infection

Medical care of the time simply could not halt this downward spiral.

Treatments available were chemical interventions intended for minor burns and rarely involved surgery. Advances in shock therapy saved more patients initially — but created a new, urgent need for effective long-term burns treatment.

Improving Treatments

The Problem with Coagulation Therapy

When the war began, the dominant treatment for severe burns was coagulation.

A coagulating agent — usually tannic acid, used in leather production — was applied to form a tough, scab-like layer over the burn. It was believed this would:

protect the wound
prevent fluid loss
guard against infection

Tannic acid tubes were so widely distributed that they appeared in almost every Allied first-aid kit.

In theory, the coagulated layer stayed in place until new tissue grew beneath it.

In reality, treating airmen’s burns with tannic acid proved disastrous.

McIndoe’s Campaign

Sir Archibald McIndoe recognised the severe harm caused by tannic acid and led an uncompromising campaign to end its use.

He persuaded colleagues and the wider scientific community that the treatment was dangerous and ineffective. Its use was eventually abandoned across Europe.

New Approaches at Queen Victoria Hospital

At East Grinstead, McIndoe and Ross Tilley pioneered new techniques that laid the foundation for modern burn management.

These included:

washing burns extensively with saline, rather than sealing them under tannic acid
refining and adapting plastic surgery methods to rebuild skin and tissue
challenging outdated practices with evidence-based approaches

Their methods rapidly improved patient survival and recovery and were adopted at centres across Europe.

Multiple Operations and Long Rehabilitation

Burned airmen typically required 10 to 50 operations, spending at least three years going in and out of hospital.

A typical schedule involved eight operations per year, alternating:

3–4 weeks in hospital
2–3 weeks at home

Overall, the treatment was gruelling, prolonged and deeply transformative — physically and psychologically.

The Beginning of Rehabilitation and Reintegration

McIndoe and Tilley innovated not only technically, but also culturally.

They were among the first surgeons to recognise the importance of emotional recovery, social reintegration and psychological resilience for burns survivors.

In 1941, McIndoe founded the Guinea Pig Club, a pioneering patient support group that fostered camaraderie, humour, resilience and lifelong friendships.

Their work helped reshape how the medical community thought about rehabilitation, long before formalised psychosocial care existed.

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