Excerpted from Extreme Medicine: How Exploration Transformed Medicine in the Twentieth Century by Kevin Fong, out now from The Penguin Press HC.
On Aug. 31, 1940, the Battle of Britain was reaching a critical phase when Hurricane pilot Tom Gleave’s aircraft came under enemy fire. In a few short seconds, the center of Gleave’s cockpit had become the head of a blowtorch. The aluminum sheet in which the dials of his control panel were set began to melt. Trapped with his plane ablaze and falling from the sky, Gleave’s hand fell to the butt of his service revolver and momentarily he considered a quicker, less painful end.
However, there was one last chance. If he could open the canopy, pitch the aircraft forward and flip it over onto its back, then perhaps the maneuver would fling him out. Gleave tore his flying helmet off, severing his last connections to the Hurricane. He slid the canopy open, shoved the control column forward, and then everything around him exploded.
He found himself propelled for many yards, enveloped in a ball of flames, finally breaking free into thin air and then tumbling toward the ground. Finding the D-ring of his ripcord, he pulled hard and felt the unfurling of his parachute and a comforting tug as its silk canopy inflated above him.
He hit the ground hard and fell onto his side, somehow managing to avoid further injury. Releasing his parachute, Gleave eventually found the strength to get to his feet. His boots and socks appeared to be intact and largely unburned. But that was where normality ended.
His trousers had gone except for a small patch protected by the parachute harness. Above his ankle, the skin over his right leg had blistered and ballooned along its whole length. His left leg was in much the same state, save for a patch of skin over his thigh, which had been relatively spared. The underside of his arms and elbows were burned, and the skin hung in charred folds from his hands and wrists.
His head and neck, too, had been exposed to the inferno, and his eyes were little more than slits. His nose had been all but destroyed. Somehow he staggered across the field toward a gate on its far side, shouting for help as he went. “RAF pilot,” he blurted out. “I want a doctor.”
You can just about bear to hang on to a mug of hot tea at 108 degrees. That’s just 10 degrees higher than your normal core body temperature. It’s pretty unimpressive, really, but that is where the limits of human endurance lie. The sensation that forces you to drop the cup is set in motion by a clever receptor: a weave of proteins in the dermis attached to an ion-channel control that opens or closes depending on how hot the channel is. The proteins convert the sensation of heat into pain.
The proteins that that receptor is built from, and those that stack together to build everything from your digestive tract to your DNA, start to fall apart at 113 degrees. That’s where the physiology of thermal injury starts. As temperatures climb, cells lose their capacity to self-repair; vessels begin to coagulate, tissues become irreversibly altered and later begin to die. All of this happens as you approach a temperature of around 140 degrees. Aircraft fuel, properly supplied with oxygen, can burn at over 1,800 degrees.
Tom Gleave woke underneath a bed in darkness. He was at Orpington General Hospital in the middle of an air raid; the bed was his makeshift shelter. He had survived, but the surgical teams at Orpington had little experience with such severe burns. The medical team at Orpington decided to transfer him to Ward 3 at the Queen Victoria Hospital in East Grinstead, which had developed a reputation for plastic reconstructive surgery under the leadership of Archibald McIndoe. Within resided a cadre of men disfigured by fire, and in 1940 the most severely injured of these were Hurricane pilots.
McIndoe came to Tom’s bedside and explained what needed to be done. It would take many months and dozens of surgeries, McIndoe explained. “You won’t like it,” he said, “but it’ll be worth it.”
Archie McIndoe was a New Zealander, originally invited to the United Kingdom to join the practice of his esteemed older cousin Harold Gillies, who had pioneered techniques of plastic surgery during the World War I, when a sailor burned at the Battle of Jutland was the first patient to undergo this type of surgery.
In retrospect, the cosmetic results of these surgeries look primitive at best. But at the time, the idea that badly damaged faces might be reconstructed in this way was revolutionary. It would fall to McIndoe to refine and advance these techniques, and the air war of the Battle of Britain would provide his defining challenge.
First, Gleave got new eyelids pinched from the unburned skin of his thighs. These tiny islands of skin were removed and sculpted into place. They were so small they could rapidly establish themselves at their new location on Gleave’s face, seizing upon the bed of vessels and perfused tissues that lay there waiting to be covered, like a minuscule sod of earth being transferred from one lawn to another. Oxygen and nutrients readily diffused into these small tokens of flesh. And the wounds left by taking these grafts were discrete enough that they could be left to heal spontaneously.