Human history becomes more and more a race between education and catastrophe.

Henry Lumley

COVER

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.

Yours sincerely,

Sister Agnes

Feb 20th

[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)

 1.-PaddyHartley.jpgBack in 2004, i stumbled upon a project called The Face Corset. Designed by Paddy Hartley to simulate the effects of cosmetic surgery, they were one of his first comments on and explorations of cosmetic surgery and our culture's obsession with beauty. Furthermore, the artist collaborated with Biomaterials Scientist Dr Ian Thompson to adapt the corsets into facial dressings that could protect and support the face during the recovery period after surgery or skin grafting. With Project Facade, the second step into this research, the artist is looking into the personal and surgical stories of soldiers who, disfigured in battle during the First World War, had to undergo pioneering surgical reconstruction. "The very nature of trench warfare, moreover, proved diabolically conducive to facial injuries: "[T]he...soldiers failed to understand the menace of the machine gun," recalled Dr. Fred Albee, an American surgeon working in France. "They seemed to think they could pop their heads up over a trench and move quickly enough to dodge the hail of bullets." (via) Working from original patient and surgical notes along with personal family archive material of the men, Hartley designs, modifies and embroids uniforms similar to those the servicemen fought in. Each garment tells the fragmented personal history of a man who had to go back to his families with a seamed and shattered face. Working in partnership with Gillies Archive Curator Dr Andrew Bamji at Queen Mary's Hospital Sidcup and Dr Ian Thompson at in the Oral Maxillofacial Dept, Guys Hospital London, the project allows Hartley to examine and respond artistically to the origins of surgical facial reconstruction, compare current techniques in facial surgery and the development and implementation of bioactive materials for the repair of facial bone injuries. 12.-Victor-T.jpg Victor T. What prompted your interest in the origins of surgical facial reconstruction techniques? Even though I trained in ceramics and sculpture, I've always been more interested in human biology, technology, and engineering, that sort of thing than in art. I see the Artistic/creative process as a vehicle for the examination and combination of ‘anything with everything’. So much of the work I produced at University and in my early career was about anything other than ‘Art or the Artist’. Examining the use/abuse of Steroid in bodybuilding, religious organizations shifting attitudes towards medical technologies and recently the origins of facial reconstruction. Having seen some of my previous work using medical equipment, I was invited by the Victoria & Albert Museum in London in 2002 to exhibit work for an evening-long event called ‘Short Cuts to Beauty’ which consisted of a series of public demonstrations, presentations and debates on ‘beauty industries’ and their impact on society today. Not having anything appropriate for the event in my back catalogue, I proposed I make new work for the event and considering one of the topics up for discussion was extreme cosmetic surgery and the use of facial implants, it seemed appropriate to make work based around a hypothetical of facial surgery as taboo. What if it was considered taboo in today’s society to alter the structure of the face surgically for cosmetics alone? How could an individual radically alter the structure of the face without the use of surgery? Corsetry immediately sprang to mind (particularly as I left the V&A after my meeting I left via the Dress Gallery and saw the collection of corsets on display). If it was possible to alter and ‘train’ the structure of the body with a garment, could I do the same with a ‘facial corset’ to shift the soft tissue of the face? Paddy's-studio2.jpg Paddy Hartley's studio So having never even sat at a sewing machine, I set about making patterns based on my own face (the only one readily available!) and getting to know the basics of garment construction. The original idea was to make ‘neutral’ looking garments from white fabric incorporating external ‘adornments’ using commercially available facial implants. This was how I came to meet Biomaterials Scientist Dr Ian Thompson at Imperial College London via recommendations from the Science Museum, London. I originally approached Ian to try and obtain some commercially available facial implants but when I saw the work he was doing making Bioactive glass facial implants for the repair of bone facial injuries, I thought I just had to incorporate these into the ‘Face Corsets’, which as it turns out, we did. As far as the Corsets themselves were concerned, an unexpected (yet with hindsight totally foreseeable outcome) was that the tighter the garment was fixed to the head, the more the wearer was able to reposition the exposed skin. The presentation of the work at the V&A event really was the start of a long working relationship between Dr Thompson and myself. My skills in developing the casting of the implants with Ian coupled with his vision of the ‘Face Corsets’ as potential pressure dressings cemented our working relationship and the logical next step was to seek funding to pursue our collaboration. Obtaining our first grant from The Wellcome Trust allowed us to develop the work full-time for a year but if the truth be known, quite early in the project my interest turned to the origins of facial reconstruction. 2.-First-Face-Corset.jpg 4.-Paisley2.jpg First Face Corset and Paisley How has the public reacted to the Face Corset when you exhibited the work? Very mixed, sometimes with a raised eyebrow, sometimes with a knowing look, sometimes with a chuckle. Everyone brings their own interpretation which, to a certain degree is great because I didn’t intend to load the work with meaning. They are physical devices built around a ‘functional’ brief. What I have found though is that the majority of people see a facial garment as a device to hide the face, often referring to the Face Corsets as Face ‘Masks’. As I see it a mask is intended to hide the identity of the wearer whereas the Face Corsets are intended to alter the appearance of the wearer by manipulating the skin of the wearer. The intention is do ‘display the wearer in a different way’. Many people seem to assume that a facial garment has some kind of sexual connotation. I tell you, the amount of enquiries I've had from PVC clad ‘exotics’ looking for a bespoke PVC Face Corset. That’s not my scene and not why I made the work, which is why I've never sold or given a piece away. I don’t want to be responsible for making something that could cause physical harm to a wearer/user. There did come a point where I decided to make the Face Corsets out of fabric as far removed from the S&M scene as I could imagine. I used old suit material, my old shirts, that kind of thing but regardless, the facial locating of the Face Corsets was still read by viewers and having aesthetics which alluded to a sexual/menacing/disguising. This is why I ‘buried’ the Face Corsets. What exactly are the Bioactive© glass facial implants you mentioned earlier?3.-Bioglass-implants.jpg The implants are made from a special glass that contains a combination of other components that make the glass less prone to rejection by the body. Bioactive glass was invented by Prof Larry Hench as a material to repair massive bone injuries of US servicemen injured in the Vietnam War. Even though the Bioglass© in a powdered/paste form did bond bone fragments, the material was not load bearing. Dr Thompson (Ian) has recently been casting the glass into small monolithic forms to repair non-load bearing bone injuries, particularly of the face. When I came on the scene, Ian was by his own admission using fairly primitive casting and carving methods. The skills I acquired in mold making and casting I picked up at University and at a later post in bronze casting foundry enabled me to work with Ian to try out new lost-wax casting techniques for the production of patient specific implants. Since then, the production methods of the implants have advanced and this element of the collaboration has run its natural course. For ‘Project Façade’ you collaborated with Dr Andrew Bamji, Consultant Rheumatologist and Curator of The Gillies Archives, and Dr Ian Thompson from the Department of Oral Maxillofacial surgery at King's College. How did you get to work with scientists? It’s always the ideas for the work I make that lead me to meet the people I work with whether they be Dress Historians at the V&A, Scientists at University Hospitals, Family Historians based at the National Archives at Kew or Army Surplus suppliers in Portsmouth. I don’t have a specific desire to work with scientists, that’s just the direction the work has taken me. 00atopv.jpg 0aa3opo.jpg Top V: Sketch proposing grafting skin to replace scarred cheek and Skin from tubed pedicle 1. in place on chin and nose. How difficult has it been to trace the records of men injured and disfigured during the First World War? Can you tell us the story of one of those injured Servicemen that you found particularly touching/interesting/meaningful? In so far as tracing the medical records, this was pretty straightforward. When I first became interested in finding out more about the origins of facial reconstruction, I recalled seeing a very short clip of an interview on a TV documentary which mentioned the pioneering surgery developed by Sir Harold Gillies during the First World War to repair horrific facial injuries. A web search brought the Gillies Archive to my attention so I booked an appointment to meet the Curator Dr Andrew Bamji (who was the chap on the TV documentary) and see some of the records. On first sight I was overwhelmed by the amount of material Andrew had collated. The Archive holds somewhere in the region of 2500 documents recording with photographs, pre-op sketches, plaster casts and handwritten notes, the surgeries the patients underwent under Gillies. I was originally drawn to the Archive because of an interest in the surgery yet I found myself becoming incredibly curious to find out more about the post-surgery stories of the men treated by Gillies. However, only a handful of the records Andrew has collated tell the pre-injury and post-surgical stories of the men and this is largely due to Gillies patients sending him photographs and letters to let him know how they were getting along in life. 0aaplastichet.jpg The Plastic Theatre, Queen Mary's Hospital, 1917. Harold Gillies is seated on the right

The Plastic Theatre, Queen Mary’s Hospital, 1917. Harold Gillies is seated on the right

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

Surgery Notes:

Untitled-2OPERATION, 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.

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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:

CASE 388: 

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.


P33P6

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