History of Social Rehabilitation in Burn Treatment: Guinea Pig Club
Buğra İpek1, Emre İnözü1, Ali Teoman Tellioğlu2
1Clinic of Plastic, Reconstructive and Aesthetic Surgery, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
2Department of Plastic, Reconstructive and Aesthetic Surgery, Yıldırım Beyazıt School of Medicine, Ankara, Turkey
DOI: 10.5152/TurkJPlastSurg.2017.2199
Letter to the Editor
Before World War II, psychological support and rehabilitation were neglected in burn treatments. However, this changed with the efforts of Sir Archibald Mclndoe, who was the chief of the burn unit in Queen Victoria Hospital that was founded for treating pilots and aircrew in the British Royal Air Force who were injured in World War II, and with the foundation of the “Guinea Pig Club” that was also established with his attempts.
At the beginning of World War II, most patients with high-degree burns died or healed with sequelae that would persist for their lifetime.
In the 1920s and 1930s, the principle used in burn treatment was coagulation. Because of excess fluid loss from burns, substances that coagulate the surface of burns, particularly tannic acid, were used for preventing this loss. This treatment decreased fluid loss but im- paired wound healing and deepened burn injury. Moreover, it caused immobilization in burn regions formed by the coagulum and thus contraction in the fingers and eyelids. Due to eyelid involvement, corneal damage and sequelae even leading to blindness occurred. In addition, high rates of secondary infection and septicemia were observed in patients receiving treatment with tannic acid. Treatment with tannic acid made reconstruction with grafts almost impossible. It was necessary to change the approach toward burn treatment, and Mclndoe did it.
Expected innovation occurred owing to Mclndoe’s observation. When he evaluated pilots admitted with severe burn injuries to the clinic, he observed that the outcomes of pilots whose planes crashed into the Atlantic Ocean were better than those of pilots whose planes crashed on land. Wounds that came into contact with sea water were cleaner and less painful, and it was easier to use grafting for these wounds. Burns were mechanically cleaned with saline based on his observation, and dressing was done using sulphonamide powder.
Reconstruction with skin grafts after the debridement of eschar tissues became the standard treatment, and the use of tannic acid was stopped.1 In this way, a significant decrease was observed in the morbidity and mortality rates of patients with severe burn injuries.
However, the work of Mclndoe did not stop here. He developed many techniques such as eyelid grafting and pedicled tube flaps for reconstruction in patients with burn injuries.
Mclndoe’s patients were those who had severe degree burns and large parts of affected bodies, hands, and faces. Most of them under- went several surgeries and stayed at hospitals for years. During those years, a standard military hospital approach was used that included serious discipline and an arm’s length relationship between the doctor and patient. Patients’ coming back to their lives and reintegrating them to society were disregarded. However, Mclndoe, who had hundreds of patients and who operated on 30 patients a day, recognized the psychological effect of deformities on patients and their depression levels and he began to study the social rehabilitation of these patients.
In the 3rd unit, which was the unit of Mclndoe, there was no ordinary hospital discipline. Patients were free to wear their own clothes or military uniforms instead of standard blue patient gowns and robes. They were also able to go into the town near the hospital and drink in local pubs, even within their unit.2 Patients were encouraged to return to their normal lives and communicate with other people. The res-
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Correspondence Author: Dr. Buğra İpek E-mail: [email protected]
Received: 03.02.2017 Accepted: 27.03.2017 Cite this article as: İpek B, İnözü E, Tellioğlu AT. History of Social Rehabilitation in Burn Treatment; Guinea Pig Club. Turk J Plast Surg 2017; 25(3): 159-161.
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idents of East Grinstead also got used to these patients, who had pedicles extending from their shoulders to their noses and surgical scars on their faces and who visited their town for years, and they accepted them as part of their routine lives.
Moreover, the town was given the nickname of “the town that did not stare.” Mclndoe created many opportunities for patients to socialize. He organized parties and dinners with patients (Figure 1). Furthermore, he helped patients whose treatment ended to find jobs and supported them financially if needed.
In June 1941, patients brought forward an idea of starting a club. Mclndoe supported this idea. The first members of the club were patients from the air force and surgeons and anes- thetists who operated them.
The club was originally called “Maxillonians Club” after Mcln- doe’s maxillofacial clinic. However, this name was changed to
“Guinea Pig Club” when one of the patients jokingly shouted out that “we are nothing but the Guinea pigs of plastic sur- geons.” Mclndoe was known as “the Boss”, “the Maestro,” and
“the Chief Guinea Pig” among patients because of his frank- ness and friendliness.3 (Table I)
After the end of World War II, club members from across the world continued to meet in East Grinstead every year and to support each other. The last annual meeting was conducted in 2007; club meetings were held for over 60 years (Figure 2).
Sixty of 97 members who were alive attended the last meet- ing. The ages of the members ranged from 82 to 102 years.
Considering the health conditions and ages of most members and the difficulty in travelling, it was decided to hold the final meeting of the club. Seventeen members are assumed to be alive as on October 2016.4
The story of Mclndoe and the Guinea Pig Club demonstrates that the main purpose of treatment is to return patients to their lives and that psychological and social support are im- portant for attaining this goal. It has been predicted that approximately 30% of adult patients with burn injury have permanent, moderate, or severe psychological and social problems.5,6
At present, we know that social support is important in the rehabilitation and resuscitation stages of treatment and that it can even affect survival in patients with severe burn inju- ries.7 Mclndoe recognized the significance of social support
Turk J Plast Surg 2017; 25(3): 159-61 İpek et al / History of Rehabilitation in Burn Treatment: Guinea Pig Club
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Figure 1. Guinea Pig Club meeting
Sir Archibald Mclndoe playing the piano for his patients at the meeting1
Figure 2. Final meeting of the Guinea Pig Club in 2007 The final meeting for the members of the club in 20078
Table I. The march of the Guinea Pig Club
The march sung by the club members at meetings.9
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 ready
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)
for treating patients and attempted to provide adequate sup- port to all his patients. Mclndoe emphasized the importance of the Guinea Pig Club and the importance of patient solidar- ity for recovery by stating that the secret of success was hold- ing patients together. We should also remember the effect of social support on treatment while approaching our patients and take lessons from these past events.
Peer-review: Externally peer-reviewed.
Author contributions: Concept - B.İ., E.İ., A.T.T.; Design - B.İ., E.İ.;
Supervision - E.İ., A.T.T.; Resource - B.İ., E.İ.; Materials - B.İ., E.İ.; Data Collection and/or Processing - B.İ., E.İ.; Analysis and/or Interpretation - B.İ., E.İ., A.T.T.; Literature Search - B.İ., E.İ.; Writing Manuscript - B.İ., E.İ.;
Critical Reviews - B.İ., E.İ.
Conflict of Interest: No conflicts of interest were declared by the authors.
Financial Disclosure: The authors declared that this study has recei- ved no financial support.
REFERENCES
1. Geomelas M, Ghods M, Ring A, Ottomann C. "The Maestro": A pioneering plastic surgeon-Sir Archibald McIndoe and his ınno-
vating work on patients with burn ınjury During World War II. J Burn Care Res 2011; 32(3): 363-8.
2. The Guinea Pig Club' BBC documentary 2004.
3. Kennedy E, Against All Odds: The Guinea Pig Story: Flying Ma- chines and Their Heroes Volume 2
4. Duke unveils tribute to war-wounded Guinea Pigs. BBC News.
2016-11-02. Retrieved 2016-11-03. (cited 24.03.2017) Available from http://www.bbc.com/news/uk-england-37839965 5. Faber A, Klasen H, Sauer E, Vuister F. Psychological and social
problems in burn patients after discharge: a follow-up study.
Scand J Plast Reconstr Surg 1987; 21: 307-9.
6. Patterson C, Everett J, Bombardier C, Questad K, Lee V, Marvin J.
Psychological effects of severe burn injuries. Psychol Bull 1993;
113(2): 362-78.
7. Muangman P, Sullivan SR, Wiechman S, Bauer G, Honary S, Heimbach DM, et al. Social support correlates with survival in patients with massive burn injury. J Burn Care Rehabil 2005;
26(4): 352-6.
8. The world's most exclusive club - which no-one wanted to join (document on the Internet). Eastgrinsteadonline, 2014 June (cited 24.03.2017): Available from: http://www.eastgrin- steadonline.com/2014/06/10/worlds-exclusive-club-one- wanted-join/
9. Sir Archibald McIndoe (document on the Internet). New Zea- land History, (Ministry for Culture and Heritage), 2013 July (cit- ed 24.03.2017) Available from https://nzhistory.govt.nz/media/
photo/archibald-mcindoe
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