Alexander ‘Lippy’ William Lipmann Kessel, from ‘Surgeon at Arms’ to ‘Surgeon of Arms’

Abstract

Alexander William Lipmann Kessel (1914–1986) was as surgeon connected to the 16th Parachute Field Ambulance Royal Army Medical Corps and as such he was dropped in The Netherlands in September 1944 to care for the wounded during the battle for the Rhine bridge at Arnhem. His military and post military career were inspirational and led to preservation of lives during the war and progress in orthopaedic surgery after the war. In this paper, we discuss his biography and the contributions he made to orthopaedic surgery.

Introduction

With the 75th commemoration of the Battle of Arnhem in 2019, part of Operation Market Garden in September 1944, comes renewed interest in the recollection of stories of people and soldiers connected to this battle. One of these soldiers was Alexander William Lipmann Kessel. He served with the Royal Army Medical Corps (RAMC) and was attached to the 16th Parachute Field Ambulance at the time. After the war, he worked as an orthopaedic surgeon and contributed greatly to the development of shoulder arthroplasty.

Early life

Alexander William Lipmann Kessel was born on 19 December 1914 in Pretoria, South Africa. His parents were Jewish immigrants who settled in South Africa at the beginning of the 20th century. His father, Moses, was Lithuanian and his mother, Gertruda, was German. After attending the University of Witwatersrand in Johannesburg, South Africa, Alexander moved to London where he studied medicine at St Mary's Hospital in Paddington. He qualified as a doctor in 1937.

In March 1942, he was called to join the RAMC (Figure 1). During this time, he changed his name to Lipmann Kessel (Lipmann becoming his first name although his friends referred to him as Lippy).

Figure 1.

Picture of Lipmann Kessel from his service time with the RAMC. (Courtesy of the Kessel family.)

Second World War

After receiving his initial training, he volunteered for the Airborne Forces. He passed through Ringway in September 1942 and was posted as a Section Officer to 16th Parachute Field Ambulance (PFA) RAMC in December 1942, which was then based in North Africa as part of the 1st Parachute Brigade. He took over command of No. 3 Section in the early part of 1943, eventually becoming a Captain.

By March 1943, he had been upgraded from a General Duties Medical Officer to a Graded Surgeon. He took over one of the two Parachute Surgical Teams, the other being commanded by Major Longland. These two surgeons remained in charge of the 16th PFA until the end of the Arnhem operation in 1944.

The first action he should have taken part in was ‘Operation Fustian’ on the night of 12–13 July 1943. His brigade was tasked with seizing and holding the Primosole Bridge in Sicily. Unfortunately, it was not to be. Bound for Sicily, the aircraft received anti-aircraft and machine gun fire near the intended drop zone (DZ). When the time came to leave the plane, one ‘stick’ member (‘stick’ being the term for a load of paratroopers) collapsed and refused to jump, leaving four other ‘stick’ members, including Captain Kessel stranded on-board. The aircraft had already suffered damage and was forced to return to base. The soldier who had refused to jump was promptly ‘put on a charge’ by the Military Police. Lippy and other ‘stick’ members were unable to fly out again and missed the whole operation.

The Battle of Arnhem

After seeing service in Italy, Lippy returned with the rest of the 1st Airborne Division to England hoping to take part in the Allied invasion of Europe (Figure 2). The Division was passed over for the initial invasion and kept in reserve for the 6th Airborne Division. The 6th was dropped in Normandy and took the Bénouville bridge, which was later renamed Pegasus bridge because of the Pegasus on the shoulder emblem of the British paratroopers. Lippy's division took part in Operation Market Garden in September 1944.

Figure 2.

The 16th Parachute Field Ambulance prior Operation Market Garden. They are posing outside Culverthorpe Hall, Lincolnshire. Third from the left on the front row is Lipmann Kessel. Other known members of this group are on the back row Sgt. Bert Tennuci (far right), fifth and ninth from the left, respectively, are Private Frank Mumford and Major Cedric Longland. On the front row, first from the left is Private John Butcher. (Courtesy of the Museum of Military Medicine, Aldershot.)

The plan was for the 16th PFA to be based in a Dutch hospital – St Elisabeth's Hospital – in Western Arnhem, located about a mile from the ultimate objective of the Arnhem road bridge across the Rhine. After a flight over the North Sea, in which Lippy was airsick, he jumped and landed on DZ X on the afternoon of 17 September 1944. Lippy and the rest of 16th PFA later moved into Arnhem at the rear of the 2nd Parachute Battalion on the Lion route (one of the three routes from the DZ to Arnhem). The 2nd Battalion under command of Lieutenant-Colonel John Frost would end up being the only battalion to actually reach and defend the bridge despite the bitter fighting.

By late evening, Lippy's unit had arrived at the Dutch hospital and were offered the use of wards and operating theatres. The first contact was a bit awkward. Lippy used Afrikaans, which he thought was similar to Dutch, to introduce himself and his team. The Dutch however thought that he ‘looked and sounded German’ and so asked him to keep to English for further communication after making sure he was British. Lippy's team took the first shift, tending the wounded and worked all night. They were relieved by Major Longland's team the next morning (Figure 3). It was on this day (18 September) that the hospital was overrun by the Germans. Most of 16th PFA were marched off into captivity, but the two surgical teams and some others were allowed to stay.

Figure 3.

Personal items of Lipmann Kessel on display today at the Hartenstein Airborne museum at the former headquarters of Urquhart in Oosterbeek. Number 9 marks the parachute emblem worn on his uniform. Number 10 his beret emblem of the RAMC. Number 11 his watch, worn during his work at the Elisabeth Gasthuis.

Lippy is perhaps best remembered at this point for operating on and probably saving the life of Brigadier ‘Shan’ Hackett. When Brigadier Hackett was brought into St Elisabeth's Hospital, Lippy received him and made him lie on a table so he could examine his wounds. Hackett complained of a blow to his ‘solar plexus’ which made his stomach muscles sore and painful. Upon examination, the severity of his abdominal wound resulted in a German soldier suggesting to Lippy that Hackett would soon become a member of the ‘Bauchschuss oder Kopfschuss – Spritzen’ club. Basically, this meant, if there was a belly or head wound, give a morphine injection and expect a quick death. Lippy however went ahead and operated. He and his surgical team removed a splinter of about two square inches, which had cut 12 perforations in two sections in Hackett's lower intestine. Hackett was later to write that he ‘owed forty years of his life to Lipmann Kessel’. In fact it turned out to be 57!

Hackett (initially admitted under the name ‘Corporal Hayter’) spent around two weeks in the hospital, recovering from his wounds. However, it was eventually decided it would be necessary to try to assist his escape. Aided by a Dutch Resistance worker named ‘Piet van Arnhem’ Hackett was quite boldly walked out of the hospital to a Red Cross car outside, dressed as a civilian. Despite being severely weakened following his surgery, he walked and was half-carried from the hospital. He was given a Medical Card detailing his injuries and treatment. Escape supplies had been collected by Father McGowan, the padre of 16th PFA. The escape was a miraculous success and a new patient was soon moved into Hackett's bed. 16th PFA staff were perfectly aware however, that if any Germans asked after Corporal Hayter, they could say with some assurance and pride that no such person existed. Brigadier Hackett later reported that whilst in hiding in The Netherlands, a Dutch doctor examined his stomach wound and saw Lipmann Kessel's work. The doctor was full of admiration for this surgical miracle and did not fail to let Hackett know that, by right, he ought to be dead. This was an example of Lippy's brilliant surgery carried out in a very difficult situation.

Lippy remained at St Elisabeth's Hospital until 13 October when he and the rest of his team and patients were transferred to Apeldoorn. From 17 September to 12 October, he performed 96 surgeries.

He did not stay in Apeldoorn for long, escaping on 16 October (Figure 4) to Elspeet where he met a former Dutch orthopaedic surgeon who assisted him in his further escape plans. He missed a successful Rhine crossing, code-name Pegasus I. He did however take part in the second attempt to cross the Rhine in November (Pegasus II) with uncaptured survivors of the Battle of Arnhem. The attempt failed and Lippy had to return into hiding. Eventually, he chose to try and escape through the Biesbosch. He eventually succeeded and reached Allied lines in February 1945. He continued to serve and took part in the liberation of Bergen-Belsen concentration camp. He was promoted to the rank of Major.

Figure 4.

Official notice to Lipmann's mother that he was missing in action (MIA). This letter followed a telegraph send in December that stated that he was a prisoner of war. Following his escape from Apeldoorn, his status apparently changed to MIA. (Courtesy of the Kessel family.)

Lippy was made a Member of the British Empire and was awarded the Military Cross for his actions at Arnhem. Until demobilisation, he worked at the Shaftesbury Military Hospital.^1–3

Post-military career

Demobbed soon after the war, he resumed his civilian medical career. In 1946, he started working as a consulting orthopaedic surgeon at St Mary Abbot's in Fulham. He also had a private practice in Harley Street and was involved in the care of injured players of Fulham Football Club and later Chelsea Football Club. This was in complete symbiosis with his passion for soccer. In 1952, he was appointed orthopaedic surgeon at the Fulham (Charing Cross) Hospital in London, where he was the only orthopaedic surgeon. During this time, he developed treatment for tibia vara, in which he removed a small cube of bone, one centimetre below the inner aspect of the upper tibial physis at the maximum point of the varus deformity. After removing the cube, he turned it upside down and re-implanted it.

The effect was to increase the vascularity and cause that part of the physis to grow more quickly with the resultant straightening of the leg. This was a development of an earlier published treatment where he would perform a simple forage of the tibia. ⁴

He was a Professor of Orthopaedics and Director of Clinical Studies at the Royal National Orthopaedic Hospital from 1974 to 1980. He specialised in shoulder surgery. During his career, he made several contributions to the orthopaedic literature:

Clinical Surgery 1967 (contribution)

Fracture and Joint Injuries, 1977

Triumphs of Medicine, 1977

Colour Atlas of Clinical Orthopaedics, 1980

Clinical Disorders of the Shoulder, 1981

Shoulder Surgery, 1982

Rotator Cuff Rupture and Repair, 1986

Diagnostic Picture Tests in Orthopaedics, 1986 (posthumous)

Personal life

Lippy was married three times. His first marriage in 1941 to Mary W Morgan sadly did not last long and he then married Mary ‘Peggy’, G Oughton in 1946. They had two sons: David in 1947 and Paul in 1948. In 1975, after being divorced from Peggy, he married Beryl Anne Tilley. They had two daughters, Sara in 1973 and Abigail in 1975 (Figure 5).

Figure 5.

Lippy visiting the Hartenstein museum in the 80s with his daughters Abigail (in pink) and Sara (in blue). (Courtesy of the Kessel family.)

He became a member of the Communist Party in 1938 and served as Chair of the Society for Cultural Relations with Union of Soviet Socialist Republics (USSR) for over a decade. In 1956, however, he left the Communist Party after the Soviet Union invaded Hungary. He however continued to believe in the Marxist principle and remained active in politics eventually joining the Labour Party. He was asked to become a member of the House of Lords by the then Labour leader Michael Foot, but after Foot lost the election to Margaret Thatcher in 1983, this never materialised.

Eponymous shoulder arthroplasty

Being especially interested in the shoulder joint, Lippy added a lot to the knowledge and treatment of shoulder disorders. He developed (what the authors at the time called) a reverse semi-captive shoulder prosthesis and described results in 24 patients ⁵ (Figure 6). The prosthesis comprised a single large self-tapping lag screw with spherical head fixed into the central glenoid and scapular neck without using bone-cement. Although the prosthesis was designed for non-cemented use in the scapula, cement fixation was used in three cases because of bony insufficiency of the glenoid. The humeral component was a high-density polyethylene cup cemented into the shaft of the humerus. The two parts were connected to each other so that the final device consisted of a reversed semi-captive shoulder prosthesis. The operations were performed using a standard deltopectoral approach.

Figure 6.

The original brochure for the Kessel shoulder arthroplasty.

Broström et al. described a series of 23 predominantly rheumatoid patients with Kessel prostheses followed for a minimum of five years. Six patients underwent revision surgery within three years as radiolucent lines were observed around all glenoid components. ⁶ For the non-revised patients, the prosthesis continued to provide pain relief and improved shoulder function. Wretenberg and Wallensten showed that some arthroplasties were still working after 16 years of follow-up. ⁷ However, based on limited publications of this prosthesis, it is probable that the long-term results were complicated by a high incidence of glenoid component loosening. The design was later improved by Bayley and Walker; the glenoid screw was coated with hydroxyapatite and the centre of rotation was moved medially and distally. The humeral stem was changed to metal with a polyethylene retentive liner. ⁸

Eponymous surgical approach to the shoulder

Kessel and Watson described ‘a transacromial approach to the shoulder’. This approach can be used for rotator cuff surgery and for open reduction and internal fixation of greater tuberosity fractures. Kuz et al. also used this approach for performing shoulder arthroplasty.

The skin incision runs in the coronal plane across the middle of the acromion just posterior to the acromioclavicular joint. The incision extends about 3 cm proximally and 5 cm distal to the acromion. The trapezius and deltoid muscles are split in the line of their fibres up to the acromion. Anterior and posterior osteo-periosteal flaps are then raised on the acromion with an osteotome to allow for later closure. This maintains continuity of the trapezius and deltoid muscles. The acromion is divided with a saw or sharp osteotome. The two halves of the acromion are retracted with a self-retaining retractor and the subacromial bursa and rotator cuff are exposed. The arm can be rotated externally or internally to visualise the entire cuff.^9–11

Death and burial

Lippy died in 1986, aged 71 and according to his wishes, was buried at Oosterbeek civilian cemetery, across the road from the Commonwealth War Graves Commission cemetery. The trip to his funeral from London to Arnhem was almost as complicated as the escape from Arnhem in 1944. The plane bringing the guests from London landed safely in Amsterdam but without the coffin. This was placed on the next plane and Lippy arrived just in time for his own funeral, escorted by four police motorbikes. His wife received condolences from orthopaedic surgeons across the world.

His headstone bears the Pegasus image. It reads ‘Professor of orthopaedics, Surgeon Teacher Humanist Fighter for Freedom’ (Figure 7).

Figure 7.

Headstone of Lipmann Kessel's grave at the Oosterbeek municipal cemetery.

Conclusion

The Second World War significantly influenced Lipmann Kessel's life and work. As many of his age, he joined the army to serve his country. During his service, he was part of one of the largest allied (airborne) operations of the Second World War. Although the battle was short and in the end lost, Lippy was able to save a lot of lives by his work.

After the war, his life was dedicated to his patients and orthopaedic practice. He published and developed new orthopaedic approaches and contributed to the development of a new shoulder prosthesis. The contemporary reverse shoulder arthroplasty was influenced by the design made by Lipmann Kessel. His colleagues round the world, became friends. Although his eponymous arthroplasty and approach are no longer in common use, the former residents trained by him, remember him fondly.