In this chapter
A permanent Roehampton
Roehampton had been established in response to an emergency. Mrs Gwynne Holford’s original scheme had suggested that the Hospital would be needed for 6 months after the end of the War. Within 2 years the phrase “a permanent Roehampton” began to emerge. Obviously there would be a need to continue caring for the limbless, and in the case of young and otherwise fit men that care would need to be extended for the rest of their lives. But whereas at the beginning of the War the authorities had not been able to cope with the demand for artificial limbs, there was now a nationwide scheme to provide for them. The Ministry of Pensions had been established not just as an agency for administering financial claims, but to provide medical care, rehabilitation and support for the pensioners; the provision of limb-fitting centres in each of its regions being only one aspect of its medical services.
The Ministry thought that the Committee had promised to hand over control of the Hospital to the Ministry of Pensions so that it could become an integrated part of the national system. It claimed that there had been an agreement made in 1917 that the Government would contribute £10,000 to the purchase price of Roehampton House, in return for the Ministry taking over complete financial control. There was anger and consternation when it became known that the Committee had raised the £58,000 (£28,500 of which was provided by the Joint War Committee of the British Red Cross and the Order of St. John) and was proceeding with the purchase on its own. This was regarded by the Ministry as a “breach of faith”.
This charge was not accepted by the Committee, whose members seem to have considered that once they had raised the money they were free to act as they wished, although they would have turned to the Government for assistance in the last resort. The dominant figure in this episode seems to have been Sir Charles Kenderdine (he was knighted in 1918), who, in spite of the fact that he had worked for the Ministry as Director of Artificial Limb Supplies from 1917-1920 and had helped establish the regional network of centres, was fiercely determined that the Roehampton Committee should retain its independence.
At the end of the War it was by no means certain that the Hospital would continue on the site. Roehampton House itself was still the only permanent building, the factories, wards, workshops and so on had all been accommodated in temporary huts. (The last one of these finally went out of use in 1989). When, on 25th June 1918, the Finance Committee debated the issue of whether or not to take up the option to purchase Roehampton House offered by the owner, Kenneth Wilson, the members including Kenderdine, recommended that the offer be turned down. They argued that the site was inaccessible, being too far from the main London railway stations. The provision of transport to ferry disabled men from the stations at Barnes, Hammersmith or further afield had always involved considerable difficulty and expense. The 30 acre site, with its distinctive gardens and grounds, was too large. A smaller one could be managed more economically as a limb-fitting centre without the risk of the Committee being left with an expensive white elephant or the Government deciding to utilise the place as a home for men with disabilities other than the loss of limbs. Oddly, this decision does not seem to have been debated in the General Committee. Presumably, once the grant from the Joint War Committee had been secured the Committee felt confident enough to proceed with the purchase.
Kenderdine seems to have had no difficulty in carrying the Committee along with his views, with the unsurprising exception of Mrs Gwynne Holford. She had objected to the setting up of regional centres under the Ministry scheme, presumably because she saw them as a threat to Roehampton, and had unilaterally approached various Government ministers to express her views. They do not appear to have taken her seriously. Lord Derby, Secretary of State for War, wrote to Sir Matthew Nathan: “The real truth is that …amateurs like Mrs Holford were splendid in starting the work, but it really becomes too big for them, they are unable to manage it and yet they hate seeing it slip out of their hands.” When her actions became known, she was asked to resign from all Roehampton Committees. In 1925, when she next came into collision with Sir Charles, Mrs Gwynne Holford claimed to have argued at the end of the War that the Committee should have left the provision of artificial limbs to the Ministry and directed its financial resources to the welfare of limbless men, for example by providing a sheltered village for the most handicapped. No reference has been found to this suggestion in the period 1918-1920 and the Committee did not consider any large scale welfare schemes. Kenderdine’s attitude to Roehampton’s financial affairs was fundamentally conservative, aimed always at protecting its capital and increasing its assets. This view that the secure future of the institution, rather than response to individual need, should be the Committee’s concern, was not challenged. It was only much later, in the 1960’s, that the Roehampton Trust decided to direct its considerable financial resources to welfare.
A wise decision
The purchase of Roehampton House was concluded in January 1920. Although he acknowledged Kenneth Wilson’s generosity in public, it was Kenderdine’s private opinion that the former owner had benefited from the deal, because the residential character of the area was being spoilt by the building of “small workmen’s dwellings” to the rear of the site and the mansion might otherwise have been difficult to sell. Sir Charles was referring to the Roehampton estate, built by London County Council (LCC) on the former parkland of Putney Park House as part of the drive to provide “homes fit for heroes” in response to the 1919 Housing Act. Dover House, lent to the Committee for use as a hospital for officers during the War, was sold to the LCC for development in 1921, and presumably Mr Wilson could have disposed of Roehampton House in a similar way. Officer patients from Dover House were sent to North House, Putney and in 1922 returned to Queen Mary’s.
In the early 1920’s (by which time War Pensioners had been fitted with a second limb) the level of in-patients fell to around 70 or 80, although out-patient attendances were still high. The Ministry’s capitation grants meant that functioning at this level was not possible for an institution of Roehampton’s size and the Committee was having to make up the shortfall.
In order to utilise Roehampton’s resources to the full and maintain the establishment, Kenderdine began to explore the possibilities of admitting limbless patients of categories other than War Pensioners. The Ministry of Pensions’ Warrant very strictly defined which patients could be treated, and did not cover, for example, servicemen injured after the end of the War.
Early in 1922 the Ministry received an enquiry from the London and South Western Railway asking if members of their staff who lost limbs through accidents at work could be admitted to Roehampton. (It is possible that Kenderdine had written to the railway companies inviting such an approach). The Ministry’s response was to refuse to admit civilians, but Kenderdine argued that the Committee was within its rights to do so, providing that no charitable funds were diverted and separate accounts were kept. This view was upheld by the Charity Commissioners.
The Committee covered its costs from charges but made no profit. The advantage for the railway companies was that they were able to obtain the latest artificial limbs at government rates. The popular Desoutter-type light metal limb made at Roehampton was cheaper than the limb made by Desoutters themselves. In addition, patients benefited from the expertise in fitting. Throughout this inter-war period similar agreements made the facilities at Roehampton available to additional classes of patient, including servicemen, miners, policemen, LCC hospital patients and later voluntary hospital patients. As Ministry of Pensions work declined, the Governors (as the Committee came to be called) worked towards Roehampton becoming a national centre for the civilian limbless. Special arrangements were made with the Board of Education in respect of school-age children and later for congenitally deformed infants. This scheme gained the approval of The Times in a leader on 28th July 1936 headed “A Wise Decision”.
In spite of the various forms of union agreements, insurance schemes, friendly societies and charitable support, not everyone who needed a limb could afford one. Among the surviving correspondence files there is a group of letters containing pathetic requests for secondhand discarded limbs. Apparently the problem was that the Governors would only accept single payments, not weekly contributions, and if a limb cost £10, there was little hope of a man earning in the region of £1 10 shillings [£1.50] a week being able to save such a lump sum. In spite of the proud boast that each limb was tailor made for one individual only, it seems that discarded limbs were sometimes made available at 10 shillings [50p] each.
The decision to admit other categories of patients as well as War Pensioners was a significant one in terms of Roehampton’s development, but it did not result in an immediate increase in patient numbers. The agreement allowed the Committee to admit up to 150 cases a year providing no expense fell on the Ministry or the Committee. In 1927 there were 190 pensioner in-patients and 77 civilians. But at the same time that this agreement was being hammered out another possibility was being raised which was to have even more significance for the future of Queen Mary’s, and that hinged on the future of the Military Orthopaedic Hospital at Shepherds Bush.
After much detailed negotiation the Ministry and the Committee undertook to redevelop the Roehampton site to meet the needs of transferring patients from Shepherds Bush. It was reckoned that the rebuilding would cost £30,000, of which £15,000 was to come from the Committee and £15,000 from the Joint War Committee of the British Red Cross and the Order of St. John.
For the first time there was to be a fully equipped hospital on the Roehampton site. The construction was considerable. Ward blocks were built on the north side of the lawns, together with operating theatres and specialist departments including X-ray, electro-therapy and a gymnasium. The Hospital was to be administered by the Ministry of Pensions, who employed their own surgeons, medical officers, nursing staff, plaster technicians and orderlies. The Committee, as landlords, provided special amenities such as the canteen and maintained the grounds. The limb-fitting services continued under the same system of dual control as before.
With the permission of Queen Mary, the words “Convalescent Military” were dropped and the institution became Queen Mary’s (Roehampton) Hospital. The Queen agreed to open the new extension: she had visited the Hospital on several occasions since her first visit with the King on 11th March 1916. It was at this point that Mrs Gwynne Holford made her displeasure with these developments known. She approached various friends and supporters, apparently suggesting that the money which she had helped to raise had been misappropriated. J.A. Spender, a well known journalist, forwarded her views to the royal household, as a result of which, a week before the official opening, Kenderdine received a letter from Buckingham Palace discreetly suggesting:
“if there is ever to be any difficulty on the subject… it would be better that the Queen should cancel her visit.”
His reaction on reading this can only be imagined, but he was able to convince the Palace that all the changes had been agreed with the Charity Commissioners, and the ceremony took place as planned on May 6th 1925.
The Charity and The Ministry of Pensions
In fact the Charity Commissioners’ amended scheme for managing the Hospital was not finalised until 1928. A governing body was appointed to administer the charitable funds. Mrs Gwynne Holford became a governor at her own request, and, apparently in response to her demands, £15,000 was allocated over ten years as a welfare fund, though Kenderdine in private fully expected “the ladies to make a hash of it”. Roehampton was still attracting donations and legacies; at a Governors’ meeting in June 1919 the subject under discussion was the great surplus in the general fund. Under the terms of the new scheme, however, the Governors were very restricted in how they could spend the money, and they could not touch the invested capital.
After 1925 the Ministry had virtually taken over the administration of the Hospital and Limb Centre. The Trust’s role consisted of individual welfare case-work, provision of additional Hospital and Limb Centre amenities and estate management over the thirty acres of land and buildings. One suspects the working relationship between Ministry and Trust worked more smoothly after Kenderdine’s retirement in 1933. Nevertheless the Ministry’s failure to gain overall control at the end of the War probably delayed the entry of Roehampton into the National Health Service, which did not take place until 1961. There was a view, however, amongst disabled ex-service organisations, including the Roehampton Trust (and expressed in 1994 by John Williams, then Clerk to the Trustees) that the disabled ex-service community had been better served by Queen Mary’s (and other former Ministry of Pensions hospitals) keeping separate identities instead of being enveloped in the National Health Service.
An agreement was entered into between the Charity and the Ministry of Pensions for a term of 21 years from 1st April 1925. Under the terms of the agreement the Ministry of Pensions was to bear the cost of considerable extensions and it was agreed that so long as priority was given to the needs of limbless ex-servicemen, beds could be used by the Ministry for any of its patients requiring general medical and surgical treatment, including tropical cases, plastic surgery cases – in short, all types of treatment except for tuberculous or mental diseases.
The Governors continued to be responsible for the provision of factories, for the maintenance of all buildings and the upkeep of the extensive grounds.
The arrangements between the Ministry of Pensions and the Charity were carried on with practically no alteration until September 1939 when the Ministry of Pensions assumed responsibility for the maintenance and administration of the ‘Hospital area’ of the estate.
The scheme for the permanent administration of the Hospital was approved by the Charity Commissioners on 4th May 1928 which defined its primary objects as a Limb Fitting Institution for disabled sailors, soldiers and airmen and sanctioned its extension for the treatment of other classes of ex-servicemen and civilians.
On 11th July 1928 at the first meeting of the newly constituted Board of Governors the net assets of the Governors apart from the Estate, amounted to £44,824. 38 beds were available for officers and 464 for other ranks and civilians.
Surgery made many dramatic advances in the face of the wartime casualty rate, and many of the most distinguished names became linked with Roehampton. The newly established Hospital dealt largely with orthopaedic cases at first. For some severely disabled, Roehampton became their home. Several of the team at Shepherds Bush transferred to Roehampton. From 1929, however, patients suffering from conditions resulting from chest injuries were admitted and Tudor Edwards, Roberts, Price Thomas and Brock all operated on thoracic and general surgical cases. During the Second World War, these cases were dispersed to other hospitals under the Emergency Hospital Scheme.
One speciality to emerge during the First World War was that of plastic surgery, established by the pioneering work of Major (later Sir) Harold Gillies at the Queen’s Hospital, Sidcup. Sidcup, like Roehampton, was an Auxiliary Convalescent Hospital, and the indefatigable Sir Charles Kenderdine was Secretary to its Committee. When the number of facial injury cases declined it was decided to transfer the remainder to Roehampton in 1923. Gillies was disgu sted with the move and did not visit until the 1950’s but his colleague T.P. Kilner and the dental surgeon Mr Fraser did transfer to establish the Department.
Sidcup’s history was parallel to that of Roehampton, in that, as facial injury cases declined it made accommodation available to the Ministry of Pensions who moved 500 general medical cases there. By the autumn of 1928, however, only half of those beds were being used, and the Ministry decided to pull out. The Hospital was closed the next year, and the remaining patients (some of whom were long stay) transferred to Roehampton. Frognal House, Sidcup was sold to the London County Council (which re-opened it as a convalescent home) and the remaining funds were divided between a Welfare Fund, the Star and Garter Home in Richmond, and Roehampton.
During this inter-war period Queen Mary’s was becoming the largest Ministry of Pensions hospital and various services were transferred there, including the pathology laboratory in 1929. For the first time the Hospital had female patients, when a ward was opened for nursing sisters.
In 1930 the old wooden huts used for the Limb Fitting Department were replaced by brick buildings and the Ministry of Pensions redecorated the whole Hospital. In the same year the first case was admitted under arrangements made with the National Union of Seamen.
The work of the Hospital was further extended in 1932 by taking patients from LCC hospitals and institutions and voluntary hospitals for limb fitting. At the same time Sir Stanley Woodwark, Consulting Physician to Westminster Hospital, was appointed Honorary Consulting Physician to Roehampton.
On 27th September 1933 Sir Charles Kenderdine, who had served the Hospital as Honorary Secretary and Treasurer since the beginning, resigned owing to ill-health. A message was received from the Queen regretting the news of his resignation.
On 28th July 1936 The Times under the heading ‘A Wise Decision’ recorded that:
“The Minister of Pensions stated yesterday that he felt it would be deplorable if the knowledge and skill developed in this service were allowed to lapse and that he had accordingly agreed to a suggestion made by the Committee of the Hospital that the services of the limb fitting surgeons of the Ministry, both in Roehampton and in the provincial centres, should be made available to the committee for the expert adjustment of artificial limbs for further classes of civilian cases.”
Plans were accordingly made for further expansion of the Hospital. A new artificial limb factory was opened and by 1939 plans were approved for an additional 550 beds.
An ageing community
In the year 1938/9 attendances of War Pensioner cases for artificial limbs totalled 10,978 in addition to 355 civilians and 16,251 limbs sent by post. 184 officers and members of the nursing staff were admitted to the wards, 1,624 other ranks and 50 civilians. The artificial limb fitting factories used by 5 firms employed a total staff of 300.
By the late 1930’s Roehampton was an ageing community. Apart from the patients, as many of the staff as possible were ex-servicemen. We are given a brief glimpse of life there in the surviving correspondence about a request from the artificial limb-makers to make use of Roehampton Hospital Sports Club ground. The grounds at Roehampton, characterised by the lawns and great cedar trees, though gradually eroded from their Edwardian splendour, were still a special feature of the Hospital, and provided the setting for many community events as well as the annual garden party, first held in 1916.
In 1938 the Medical Superintendent was T.C. Buchanan. In making his case to the Committee for the factory-workers’ application to be rejected, he wrote:
“its decision is for the benefit of the patients who may be forced to spend many years (in some cases the remainder of their lives) in the hospital… It is possibly not realised to what extent the ground is used and appreciated by the patients and their visitors. For those cases unable to go out especially cases who can only get about in wheelchairs – this field is a blessing and…in the summer evenings it is not unusual to find several sitting reading, etc., under the trees. The sisters are not now in their first youth, and after a hard and exacting period of duty do not feel like leaving the precincts of the Hospital…”
This stable, settled community was in marked contrast to the pace and activity of Roehampton at the end of the First World War.