Henry Ralph Lumley was born in Marylebone in March 1892, son of barrister (and playwright) Ralph Robert Lumley and his wife Florence. Following his father’s death in 1900, young Henry was sent off the Christ’s Hospital (the Bluecoat School) for his education. He then returned to London and worked at the Eastern Telegraph Company as a telegraph operator until August 1915.
Having not being a member of the Officer Training Corps Henry went out of his way to train as a pilot sought special permission to do so for which he was granted and attended Central Flying School, Upavon from 15th April 1916. The first tragedy to strike was on the very day Henry graduated from flying school when his plane crashed; he suffered horrific facial burns, lost his left eye and could barely see out of the right eye. He had burns to his fingers and lost part or all of both thumbs. His legs were also both severely burned, resulting in restricted movement. A letter from Central Flying School to his mother stated on the same page that her son had graduated and that his aircraft ‘met with an accident’.
In early 1917, he was a patient at King Edward VII Hospital for Officers, on Grosvenor Gardens. While he was there, Sister Agnes wrote a letter about him:
I am writing for 2 Lieut H.R. Lumley R.F.C who has been most terribly burnt in a flying accident. He was boarded here a few days ago and they told him to apply for compensation. His face is burnt beyond recognition. One eye removed, the other practically blind. Legs burnt, arms burnt, thumbs and some fingers amputated. Of course they have the whole history on the [medical] board papers. He has very little to live for poor boy, but we are doing everything possible believe me.
[Sister Agnes and her sister set up the hospital for officers in their house. It is now – as a hospital for ex-service personnel – named in her honor]
(Source)Roughly a year after his crash, Henry was transferred to Sidcup for reconstructive surgery under Gillies who proposed removing Henry’s badly scarred face entirely and replacing it with a single, huge skin graft taken from Henry’s chest. A similar less extensive procedure had proved highly successful for the aforementioned Willie Vicarage a month earlier.
The two operations at Sidcup, in November 1917 and February 1918, are documented in detail in the case notes, and revisited in Gillies’ 1920 textbook, Plastic Surgery of the Face, which is now out of copyright and freely available online. A diagram shows Gillies’ ambitious plan to remove the existing scar tissue and raise a large flap of skin from Lumley’s chest with pedicle tubes providing a further blood supply to the graft. Despite ongoing complications, the initial signs were encouraging, but by day three after the second operation the graft had developed gangrene. Henry Lumley died twenty-four days later on 11 March 1918. He was twenty-six.
“One could have wished that this brave fellow had had a happier death.” Harold Gillies, “Plastic Surgery of the Face“
OPERATION, 3RD STAGE The chest flap was raised and sutured into position on the face where it arrived without much difficulty or tension. The exposed tissue on the chest and shoulders was skin grafted from two separate donors. Surgery duration of 5 hours Note: The patient was very collapsed during surgery, especially the pulse.
PROGRESS 1st Day. 7 hours. Very satisfactory with good blood supply. Improving.
2nd Day. Areas of stasis appeared and spread rapidly. Massage, pricking and cupping were kept up almost continuously.
3rd Day The whole flap has developed gangrene and the second Pedical Tubes appear to have ceased supplying blood within 24 hours of the procedure and on the 5th day became separated. These should have been tubed also.
10th Day All dead skin was removed and areas expelled a foul discharge. Pedical Tubes barely remained attached and all efforts were on keeping them in place. Cleansing and the addition of sprayed paraffin wax commenced and the patient was moved to an open air hut.
14th Day The face and chest are much cleaner with fresh eyelets of epithelium appearing on the chest. Majority of the grafts have however sloughed.
NEW TREATMENT 3/3/18 Commence exposure of the chest to Ultra Violet rays (Forbes Lamp) combined with lime dusting powder.
11/3/18 PATIENT DIED.
After Lumley’s death Gillies realized that he had tried to do too much too quickly, and that large facial grafts were more hazardous than expected. As a result he began using smaller staged grafts to create the overall result instead of a single large graft.
The lessons learned from the failure of Henry Ralph Lumley’s surgery brought about an entire reassessment as to how to treat such injuries and hundreds of patients benefited; this paved the way for the highly successful skin grafting surgery performed on the self styled World War 2 pilots ‘The Guinea Pig Club’ over 25 years later.
From Harold Gillies Case Notes:
There was a very pathetic sequel to this most terrible case, in that the patient after
having survived the ordeal of the burn, lived and regained a certain amount of strength
twi-nty months after the injury, died as a late result of a plastic operation.
He was admitted to my care fifteen months after the injury. The picture of the con-
dition shows the injury remarkably well. The colour of the scar tissue, which was an ugly
red made the appearance more ghastly than the illustration portrays. In addition to the
left eye being burned and to all the other destruction in evidence, the right eye was prac-
ticallv blind, as a result of staphyloma of the cornea.
He had received most painstaking and careful treatment prior to his admission to my
department ; included amongst other things, a skin-graft to the upper lid had been done,
which undoubtedly saved the remaining sight.
In view of the success of the two cases of burns described before this one, it was decided
to replace the whole skin of the face by a chest-flap. The flap was designed larger than
those for the two previous cases, and was of sufficient size to cover the whole face. As a
preliminary, the neck pedicles were tubed. At this stage also incisions were made into the
area of ski’n which was going to form the face, and they represented the slits necessary to
make the mouth, nostrils, and palpebral fissures. These incisions are distinguishable as
scars in the illustration, fig. 742, and it should be noted that they became keloidal scars and
did not heal up at all quickly ; they were sewn up with horsehair.
After the pedicles had been made, a rest of two and a half months was given, as the
patient was obviously slow in recovery, both generally and locally, after which it had to be
decided whether to give this unfortunate airman a further year’s rest or whether to carry
on with the procedure, knowing that the latter might not succeed.
The patient had got used to a considerable amount of morphia and a certain amount
of stimulants since the time of injury, which was certainly derogatory as far as his treatment
was concerned. Having pinned his faith on the result of the forthcoming operation, he
was bitterly disappointed and exceedingly depressed at the thought of having to wait another
long period, and it was feared that he would not wait so long.
Owing to the generally poor healing powers of the patient, it was decided to add two
more pedicles to the flap, the design of which is visible in the illustrations. The operation
was duly carried out, and was an exceedingly tedious one. Skin to cover the raw area of
the chest was taken from a volunteer, which part of the operation was very kindly
undertaken for me by Lieutenant-Colonel H. S. Newland, D.S.O., A.A.M.C.
The appearance at the end of the operation was pleasing, and the blood supply to the
flap seemed sufficient to ensure its persistence. When the patient had recovered from the
shock of the operation and the long ana>sthetic there was, quite obviously, good blood
supply in the flap. Next day, however, the patient was considerably collapsed, and the
flap itself suffered in the general depression of circulation, and in thirty-six hours became
blue. From then onwards there was a steady progress of the gangrene, which went from
dry to moist over all the flap, except a small portion of each pedicle. The skin-graft to
the chest failed to take, and despite the most unremitting care of the sister in charge, and
Captain R. Montgomery, R.A.M.C., the patient gradually sank and died twenty-four days
after the operation. Both the chest area and that of the denuded face became infected,
and towards the end mctastatic abscesses occurred in various regions.
In reviewing the case, the attempt to reconstruct the whole face is a procedure which
is obviously justifiable, and it would, in a more reposed patient, have succeeded. It
is possible that, had the author taken a very firm attitude, and could he have persuaded
the patient to wait a year, the operation, as planned, would have had more chance of success.
The author is convinced that the operation should have been done in piecemeal perhaps
that one only of the face should have been done at a time. By this means a very
presentable result mi^ht have been gained ; but it obviously would not have been as good
as the single replacement method, and the author feels that his desire to obtain a perfect
result somewhat over-rode his surgical judgment of the general condition of the patient.
The operation took much longer than was anticipated, the shock was greater, and with the
failure of the skin to take on the chest and of the flap to live on the face, the severity of
the operation was enormously increased. One could have wished that this brave fellow
had had a happier death.