60-752: It has been described as the most exclusive Club in the world, but the entrance fee is something most men would not care to pay and the conditions of membership are arduous in the extreme. Archibald McIndoe , 1947 The Guinea Pig Club , established in 1941, was a social club and mutual support network for British and allied aircrew injured during World War II . Its membership was made up of patients of Archibald McIndoe in Ward III at Queen Victoria Hospital , East Grinstead , Sussex, who had undergone experimental reconstructive plastic surgery , including facial reconstruction , generally after receiving burns injuries in aircraft. The club remained active after
120-610: A 15 and 25% loss of body water. Mild dehydration usually resolves with oral rehydration , but severe cases may need intravenous fluids. Dehydration can cause hypernatremia (high levels of sodium ions in the blood). This is distinct from hypovolemia (loss of blood volume , particularly blood plasma ). Chronic dehydration can cause kidney stones as well as the development of chronic kidney disease . The hallmarks of dehydration include thirst and neurological changes such as headaches , general discomfort , loss of appetite , nausea , decreased urine volume (unless polyuria
180-525: A career in Britain , and in 1930 McIndoe moved to London. When McIndoe could not find work, his cousin Sir Harold Gillies , an otolaryngologist specialising in plastic surgery (who now has an operation for reducing a broken cheekbone named after himself), invited him to join the private practice he ran with Rainsford Mowlem and offered him a job at St Bartholomew's Hospital , where he became
240-683: A civilian of being buried at the Royal Air Force church of St Clement Danes in London. McIndoe married Adonia Aitkin of Dunedin on 31 July 1924. They had two daughters, Adonia and Vanora. They were divorced in 1953. In 1954, McIndoe married Constance Belchem, the former wife of Major-General R. F. K. Belchem . On 22 March 1961, the British Minister of Health opened the Blond McIndoe Centre named in his honour at
300-713: A clinical assistant. In 1932, McIndoe received a permanent appointment as a General Surgeon and Lecturer at the Hospital for Tropical Diseases and the London School of Hygiene and Tropical Medicine . In 1934, McIndoe received a Fellowship of the American College of Surgeons , where he worked until 1939. That year, he became a consulting plastic surgeon to the Royal North Stafford Infirmary and to Croydon General Hospital. In 1938, he
360-540: A column "How I became a Guinea Pig", in which individual members recounted their personal experiences. Archibald McIndoe Sir Archibald Hector McIndoe CBE FRCS (4 May 1900 – 11 April 1960) was a New Zealand plastic surgeon who worked for the Royal Air Force during the Second World War . He improved the treatment and rehabilitation of badly burned aircrew. Archibald McIndoe
420-683: A dedicated Canadian wing was built at the hospital, on the initiative of the Royal Canadian Air Force and at Canadian expense. During the Battle of Britain , most of the patients at East Grinstead were fighter pilots, but by the end of the war around 80% of the members were from bomber crews of RAF Bomber Command . A minority of members had suffered non-burns-related injuries (for example, maxillofacial damage incurred in crashes); while another small minority came from army or navy rather than air force backgrounds. A few members even joined
480-421: A dehydrated state is accomplished by the replenishment of necessary water and electrolytes (through oral rehydration therapy , or fluid replacement by intravenous therapy ). As oral rehydration is less painful, non-invasive, inexpensive, and easier to provide, it is the treatment of choice for mild dehydration. Solutions used for intravenous rehydration may be isotonic , hypertonic , or hypotonic depending on
540-531: A few years earlier, would have led to certain death. The hospital was nicknamed "the Sty". The club was established informally in June 1941 with 39 patients, primarily as a drinking club , and rapidly won McIndoe's endorsement. The members were aircrew patients in Ward III and the surgeons and anaesthetists who treated them. Aircrew members had to be serving airmen who had gone through at least two surgical procedures. By
600-518: A guinea pig flanked by oversized RAF "wings" . Two artistic renditions were used: the first showed the guinea pig sitting upright with his ears swept back, perhaps in imitation of a pilot at the controls of his aircraft; while the second showed a more naturalistic guinea pig on all fours. The words to the club anthem were written by Edward "Blackie" Blacksell. They were inspired by the World War I song " Fred Karno's Army ", and (like that song) sung to
660-486: A side effect from many different types of drugs and medications. In the elderly, blunted response to thirst or inadequate ability to access free water in the face of excess free water losses (especially hyperglycemia related) seem to be the main causes of dehydration. Excess free water or hypotonic water can leave the body in two ways – sensible loss such as osmotic diuresis , sweating , vomiting and diarrhea , and insensible water loss, occurring mainly through
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#1732779530071720-461: A social club and mutual support network: members included Richard Hillary , Geoffrey Page , Bill Foxley and Jimmy Edwards . The club grew to 649 members by the end of the war. McIndoe was a brilliant and quick surgeon. He not only developed new techniques for treating badly burned faces and hands but also recognised the importance of the rehabilitation of the casualties and particularly of social reintegration back into normal life. He disposed of
780-540: A stately home converted to a burns unit in which the patients are encouraged to drink beer, wear their own clothes and organise entertainment. McIndoe is mentioned in passing. Joseph Randolph Richard's novel Incendo (2015) tells the story of a badly burned pilot and his membership of the club. A film entitled The Guinea Pig Club , starring Richard E. Grant as McIndoe, was reported to be planned for production in 2018. (Listed in order of date of first publication) In addition, The Guinea Pig magazine regularly featured
840-497: Is contained within the cells. This consists of approximately 40% of the total body water. Fluid inside the cells has high concentrations of potassium, magnesium, phosphate, and proteins. Extracellular fluid consists of all fluid outside of the cells, and it includes blood and interstitial fluid. This makes up approximately 60% of the total body water. The most common ions in extracellular fluid include sodium, chloride, and bicarbonate. The concentration of dissolved molecules and ions in
900-676: Is required. Fluids containing a proper balance of replacement electrolytes are given orally or intravenously with continuing assessment of electrolyte status; complete resolution is normal in all but the most extreme cases. The prognosis for dehydration depends on the cause and extent of dehydration. Mild dehydration normally resolves with oral hydration. Chronic dehydration, such as from physically demanding jobs or decreased thirst, can lead to chronic kidney disease . Elderly people with dehydration are at higher risk of confusion, urinary tract infections , falls, and even delayed wound healing. In children with mild to moderate dehydration, oral hydration
960-515: Is the cause of dehydration), confusion , unexplained tiredness , purple fingernails, and seizures . The symptoms of dehydration become increasingly severe with greater total body water loss. A body water loss of 1-2%, considered mild dehydration, is shown to impair cognitive performance. While in people over age 50, the body's thirst sensation diminishes with age, a study found that there was no difference in fluid intake between young and old people. Many older people have symptoms of dehydration, with
1020-422: Is typically seen in dehydration due to free water loss. A urinalysis, which is a test that performs chemical and microscopic analysis of urine, may find darker color or foul odor with severe dehydration. Urinary sodium also provides information about the type of dehydration. For hyponatremic dehydration, such as from vomiting or diarrhea, urinary sodium will be less than 10mmol/L due to increased sodium retention by
1080-498: Is usually due to excessive sweating, disease, or a lack of access to water. Mild dehydration can also be caused by immersion diuresis , which may increase risk of decompression sickness in divers . Most people can tolerate a 3-4% decrease in total body water without difficulty or adverse health effects. A 5-8% decrease can cause fatigue and dizziness . Loss of over 10% of total body water can cause physical and mental deterioration, accompanied by severe thirst . Death occurs with
1140-669: The African Medical and Research Foundation (AMREF). He became a member of a council of the Royal College of Surgeons in 1946 and its vice-president in 1958. His marriage to Adonia ended in 1953, and he married Constance Belchem in 1954. In 1958, McIndoe delivered the Bradshaw Lecture at the Royal College of Surgeons on the topic of the reconstruction of the burned face. He took part in the founding of
1200-484: The Iraq and Afghan wars of the 21st century. Charles MacLean, himself a Guinea Pig, published a novel, The Heavens are not too High , in 1957, telling the story of a fighter pilot who suffers severe burns. Guinea Pig Club was the title of a play centred on McIndoe's work produced at York Theatre Royal in 2012, featuring Graeme Hawley as McIndoe. Foyle's War , series 3, episode 2, " Enemy Fire " (2004) features
1260-733: The National Memorial Arboretum , Staffordshire. An exhibition in East Grinstead Museum honouring the members of the club was opened in December 2016 by Susan Piper , Lord Lieutenant of West Sussex , with four club members in attendance. In 2017, the Guinea Pig Club directly inspired the formation of the CASEVAC Club, a similar mutual support group for service personnel badly injured in
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#17327795300711320-745: The Queen Victoria Hospital , East Grinstead. The Blond McIndoe Centre, now named the Blond McIndoe Research Foundation, continues research into pioneering treatments to improve wound healing. The Blond McIndoe Research Foundation is a registered charity. The McIndoe Burns Centre at Queen Victoria Hospital was dedicated in 1994, and there is a burns victim support group centred there which also bears his name. Specialist science laboratories at Otago Boys' High School , built in 1967, are named in his honour. The school later named one of its houses after McIndoe after
1380-429: The skin and respiratory tract . In humans, dehydration can be caused by a wide range of diseases and states that impair water homeostasis in the body. These occur primarily through either impaired thirst/water access or sodium excess. Water makes up approximately 60% of the human body by mass. Within the body, water is classified as intracellular fluid or extracellular fluid. Intracellular fluid refers to water that
1440-514: The "convalescent uniforms" and let the patients use their service uniforms instead. With the help of two friends, Neville and Elaine Blond, he also encouraged the locals to support the patients and invite them to their homes. McIndoe referred to the patients as "his boys", while the staff called him "the Boss" or "the Maestro". Important work included development of the walking-stalk skin graft , and
1500-489: The British Association of Plastic Surgeons (BAPS) and later served as its third President. The Guinea Pig Club continued to meet after the war, and McIndoe remained its President until his death. Archibald McIndoe died in his sleep of a heart attack on 11 April 1960, aged 59, in his house at 84 Albion Gate , London. He was cremated at Golders Green Crematorium , and his ashes were given the unique honour for
1560-462: 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) Sixteen members of the club wrote books about their experiences, some of them during the war. The best known, and most influential in raising public awareness of McIndoe's work, was Richard Hillary 's The Last Enemy , originally published in
1620-677: The United States as Falling Through Space (1942). One of the pubs in East Grinstead adopted the name "The Guinea Pig". It closed in 2008 and was demolished in 2009 to make way for a social housing development named Guinea Pig Place. A painted Roll of Honour is displayed in a corridor of the Canadian Wing at Queen Victoria Hospital. A bronze monument commemorating McIndoe, sculpted by Martin Jennings (whose own father
1680-411: The cause of dehydration as well as the sodium concentration in the blood. Pure water injected into the veins will cause the breakdown ( lysis ) of red blood cells ( erythrocytes ). When fresh water is unavailable (e.g. at sea or in a desert), seawater or drinks with significant alcohol concentration will worsen dehydration. Urine contains a lower solute concentration than seawater; this requires
1740-858: The club after the war's end, through injuries sustained in peacetime accidents, as Ward III remained operational until 1948. Before the war the RAF had made preparations by setting up burns units in several hospitals to treat the expected casualties. At East Grinstead, McIndoe and his colleagues, including Albert Ross Tilley , developed and improved many techniques for treating and reconstructing burns victims. They had to deal with very severe injuries: one man, Air Gunner Les Wilkins, lost his face and hands and McIndoe recreated his fingers by making incisions between his knuckles. Aware that many patients would have to stay in hospital for several years and undergo many reconstructive operations, MacIndoe set out to make their lives relaxed and socially productive. He gave much thought to
1800-420: The discovery that immersion in saline promoted healing as well as improving survival rates for victims with extensive burns – this was a serendipitous discovery drawn from observation of differential healing rates in pilots who had come down on land and in the sea. After the end of the war, McIndoe returned to private practice. His speciality was the "McIndoe nose". McIndoe was created CBE in 1944 and after
1860-425: The end of the war the club had 649 members. (643 names are listed on the "Roll of Honour" memorial at Queen Victoria Hospital.) The original members were Royal Air Force (RAF) aircrew who had severe burns, generally to the face or hands. Most were British but other significant minorities included Canadians, Australians, New Zealanders and by the end of the war Americans, French, Russians, Czechs and Poles. In 1943,
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1920-408: The end of the war, and its annual reunion meetings continued until 2007. The name " Guinea Pig " – the rodent species commonly used as a laboratory test subject – was chosen to reflect the experimental nature of the techniques and equipment used for reconstructive work at East Grinstead. The treatment of burns by surgery was in its infancy, and many casualties were suffering from injuries which, only
1980-435: The fluid is described as Osmolarity and is measured in osmoles per liter (Osm/L). When the body experiences a free water deficit, the concentration of solutes is increased. This leads to a higher serum osmolarity. When serum osmolarity is elevated, this is detected by osmoreceptors in the hypothalamus. These receptors trigger the release of antidiuretic hormone (ADH). ADH resists dehydration by increasing water absorption in
2040-399: 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 surgeons' 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
2100-610: The heat. When such large amounts of water are being lost through perspiration, electrolytes , especially sodium, are also being lost. In most athletes exercising and sweating for 4–5 hours with a sweat sodium concentration of less than 50 mmol/L, the total sodium lost is less than 10% of total body stores (total stores are approximately 2,500 mmol, or 58 g for a 70-kg person). These losses appear to be well tolerated by most people. The inclusion of sodium in fluid replacement drinks has some theoretical benefits and poses little or no risk, so long as these fluids are hypotonic (since
2160-559: The introduction of a house system in 2013. The Gillies McIndoe Research Institute, a major medical research centre in Wellington , New Zealand, is named in honour of McIndoe and his cousin Sir Harold Gillies. In 2000, an English Heritage blue plaque was erected on McIndoe's former London home at Avenue Court, Draycott Avenue, Chelsea . A bronze monument commemorating McIndoe by Martin Jennings , whose own father
2220-816: The kidneys and constricting blood vessels. It acts on the V2 receptors in the cells of the collecting tubule of the nephron to increase expression of aquaporin. In more extreme cases of low blood pressure, the hypothalamus releases higher amounts of ADH which also acts on V1 receptors. These receptors cause contractions in the peripheral vascular smooth muscle. This increases systemic vascular resistance and raises blood pressure. Dehydration occurs when water intake does not replace free water lost due to normal physiologic processes, including breathing , urination , perspiration , or other causes, including diarrhea , and vomiting . Dehydration can be life-threatening when severe and lead to seizures or respiratory arrest, and also carries
2280-490: The kidneys in an effort to conserve water. In dehydrated patients with sodium loss due to diuretics or renal dysfunction, urinary sodium may be elevated above 20 mmol/L. Patients may also have elevated serum levels of blood urea nitrogen (BUN) and creatinine . Both of these molecules are normally excreted by the kidney, but when the circulating blood volume is low, the kidney can become injured. This causes decreased kidney function and results in elevated BUN and creatinine in
2340-416: The kidneys to create more urine to remove the excess salt, causing more water to be lost than was consumed from seawater. If a person is dehydrated and taken to a medical facility, IVs can also be used. For severe cases of dehydration where fainting , unconsciousness , or other severely inhibiting symptoms are present (the patient is incapable of standing upright or thinking clearly), emergency attention
2400-540: The kilner cheek retractor), went to Queen Mary's Hospital, Roehampton , and Mowlem to St Albans . McIndoe moved to the recently rebuilt Queen Victoria Hospital in East Grinstead , Sussex , and founded a Centre for Plastic and Jaw Surgery. There, he treated very deep burns and serious facial disfigurement like loss of eyelids. With McIndoe's support, patients at the hospital formed the Guinea Pig Club ,
2460-597: The last surgical operations and only then were invalided out of the service. McIndoe also later loaned some of his patients money for their re-entry into civilian life. A club magazine, The Guinea Pig , was first published in April 1944. The club was not disbanded at the end of the war, but continued to meet for over sixty years, offering practical support and a sense of community to former patients. The Guinea Pig magazine also continued to be published until 2003. Annual meetings at East Grinstead attracted visitors from all over
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2520-583: The mainstay of dehydration prevention is the replacement of free water losses). The most effective treatment for minor dehydration is widely considered to be drinking water and reducing fluid loss. Plain water restores only the volume of the blood plasma, inhibiting the thirst mechanism before solute levels can be replenished. Consumption of solid foods can also contribute to hydration. It is estimated approximately 22% of American water intake comes from food. Urine concentration and frequency will return to normal as dehydration resolves. In some cases, correction of
2580-460: The most common being fatigue. Dehydration contributes to morbidity in the elderly population, especially during conditions that promote insensible free water losses, such as hot weather. Risk factors for dehydration include but are not limited to: exerting oneself in hot and humid weather, habitation at high altitudes, endurance athletics, elderly adults, infants, children and people living with chronic illnesses. Dehydration can also come as
2640-436: The patient's body, in a location such as the forearm or the back of the hand, and watching to see how quickly it returns to its normal position. The skin turgor test can be unreliable in patients who have reduced skin elasticity, such as the elderly. While there is no single gold standard test to diagnose dehydration, evidence can be seen in multiple laboratory tests involving blood and urine. Serum osmolarity above 295 mOsm/kg
2700-501: The reintegration of patients into normal life after treatment, an aspect of care that had previously been neglected. They were encouraged to lead as normal a life as possible, including being permitted to wear their own clothes or service uniforms instead of "convalescent blues", and to leave the hospital at will. Local families were encouraged to welcome them as guests, and other residents to treat them without distinction: East Grinstead became "the town that didn't stare". The Guinea Pig Club
2760-668: The risk of osmotic cerebral edema if rehydration is overly rapid. The term "dehydration" has sometimes been used incorrectly as a proxy for the separate, related condition of hypovolemia , which specifically refers to a decrease in volume of blood plasma . The two are regulated through independent mechanisms in humans; the distinction is important in guiding treatment. Common exam findings of dehydration include dry mucous membranes, dry axillae, increased capillary refill time, sunken eyes, and poor skin turgor. More extreme cases of dehydration can lead to orthostatic hypotension, dizziness, weakness, and altered mental status. Depending on
2820-498: The serum. For routine activities, thirst is normally an adequate guide to maintain proper hydration. Minimum water intake will vary individually depending on weight, energy expenditure, age, sex, physical activity, environment, diet, and genetics. With exercise, exposure to hot environments, or a decreased thirst response , additional water may be required. In athletes in competition, drinking to thirst optimizes performance and safety, despite weight loss, and as of 2010, there
2880-525: The sky he cannot fly in any more". In 2017, The Hollywood Reporter and Deadline reported, a film named The Guinea Pig Club by Roger Donaldson has been made on McIndoe as a maverick surgeon in World War II and his radical methods of healing severely burned bodies. Dehydration In physiology, dehydration is a lack of total body water that disrupts metabolic processes . It occurs when free water loss exceeds free water intake. This
2940-461: The tune Aurelia by Samuel Sebastian Wesley , best known as the tune of the popular hymn " The Church's One Foundation ". The final line of the second verse is an example of a mind rhyme . 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
3000-405: The underlying cause of dehydration, other symptoms may be present as well. Excessive sweating from exercise may be associated with muscle cramps. Patients with gastrointestinal water loss from vomiting or diarrhea may also have fever or other systemic signs of infection. The skin turgor test can be used to support the diagnosis of dehydration. The skin turgor test is conducted by pinching skin on
3060-632: The war he received a number of British and foreign honours, including a Commandeur de la Légion d'honneur (Commander of the Legion of Honour) and was knighted in 1947 for his remarkable work on restoring the minds and bodies of the burnt young pilots of the Second World War through his innovative reconstructive surgery techniques. That same year he visited East Africa for the first time, and took up farming on Kilimanjaro . In 1957, with two former pupils, Michael Wood and Tom Rees, he co-founded
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#17327795300713120-538: The world), their ages ranging from 82 to 102. In the event, 2007 marked the last reunion. It attracted over 60 attendees, but in view of the survivors' age and frailty the decision was then taken to wind the club down. There were believed to be 29 survivors by April 2015, and 17 by November 2016. The last members of the club were Sam Gallop and Jan Stangryciuk-Black, who were both aged 101 when they died only days apart in October 2023. The club symbol, or "brevet", depicted
3180-607: The world. McIndoe had been elected life president at the club's foundation: after his death in 1960, Prince Philip, Duke of Edinburgh , became president. Geoffrey Page was the first chairman; and Tom Gleave served as the first and only Chief Guinea Pig until his death in 1993. In 2001 (the 60th anniversary of the club's foundation) the members agreed to continue holding their annual reunions at East Grinstead until there were only 50 members left. By 2004, there were 120 survivors; and by 2007 there were 97 (57 in Britain; 40 elsewhere in
3240-561: Was a Guinea Pig), was unveiled in East Grinstead High Street in 2014. It depicts a seated airman, with his burned hands clawed together, and his scarred face turned to one side. Behind him, resting a reassuring hand on each shoulder, stands the figure of McIndoe. The two figures are encircled by a stone bench. In November 2016, a monument honouring members of the club was unveiled by the Duke of Edinburgh, its president, at
3300-463: Was appointed consultant in plastic surgery to the Royal Air Force . When the Second World War broke out, plastic surgery was largely divided on service lines. Gillies went to Rooksdown House near Basingstoke , which became the principal army plastic surgery unit; Tommy Kilner (who had worked with Gillies during the First World War , and who now has a surgical instrument named after him,
3360-745: Was awarded the first New Zealand Fellowship at the Mayo Clinic in the United States to study pathological anatomy . The fellowship was for an unmarried doctor and as McIndoe had recently married Adonia Aitkin they had to keep their marriage secret and he sailed without her. When it was no longer possible to maintain the secret she joined him 12 months later. He worked in the clinic as First Assistant in Pathological Anatomy 1925–1927 and published several papers on chronic liver disease. Impressed with his skill, Lord Moynihan suggested
3420-570: Was born 4 May 1900 in Forbury , in Dunedin , New Zealand , into a family of four. His father was John McIndoe , a printer and his mother was the artist Mabel McIndoe née Hill . He had three brothers and one sister. McIndoe studied at Otago Boys' High School and later medicine at the University of Otago . After his graduation he became a house surgeon at Waikato Hospital . In 1924, McIndoe
3480-431: Was no scientific study showing that it is beneficial to stay ahead of thirst and maintain weight during exercise. In warm or humid weather, or during heavy exertion, water loss can increase markedly, because humans have a large and widely variable capacity for sweating. Whole-body sweat losses in men can exceed 2 L/h during competitive sport , with rates of 3–4 L/h observed during short-duration, high-intensity exercise in
3540-421: Was one of his patients, was unveiled by Princess Anne in East Grinstead High Street, in front of Sackville College , in 2014. It depicts the standing McIndoe resting his hands reassuringly on the shoulders of a seated injured airman, whose burned hands are clawed together, and whose scarred face is turned to one side. The two figures are encircled by a stone bench. Jennings described the airman as "looking up at
3600-544: Was part of these efforts to make life in hospital easier, and to rebuild patients psychologically in preparation for life outside. There were even barrels of pale ale in the wards – partly in the interests of re-hydrating patients whose injuries had left them dangerously dehydrated , but also to encourage an informal and happy atmosphere. Later, many of the men also served in other capacities in RAF operations control rooms, and occasionally as pilots between surgeries. Those unable to serve in any capacity received full pay until
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