In this chapter
The moment of inspiration that gave birth to Queen Mary’s Hospital has been vividly described by its founder, Mary Eleanor Gwynne Holford:
“One day in January 1915 when walking through the wards at Millbank Military Hospital with the Matron, just after the first exchange of our prisoners of war with Germany, I saw sitting at a table with a look of utter sadness and hopelessness on his face, a man who had lost both arms. In front of him lay what the Government had given him as a substitute for these arms, two leather sockets with hooks attached. I bent down and asked him to tell me his story. He looked up at me with eyes full of pathos and said: “Is this all my country can do for me?” This was Private F.W. Chapman of the 23rd R.W.F. with a record of over twenty one years’ service, who rejoined his regiment at the very commencement of the war, giving up good employment at the age of forty-six to serve his country once again. I then and there made a vow that I would work for one object and that was to start a hospital whereby all those who had the misfortune to lose a limb in this terrible war, could be fitted with those most perfect artificial limbs human science could devise.”
Private Chapman left his own account of that meeting, which was to have such far-reaching consequences, in a letter he wrote to Mrs Gwynne Holford just before Christmas 1934. When she approached him he had been reading through the catalogues of London limb-makers
“… and your words were right, we will go and see those limb-makers. You kept your word a few days later after you took me round most of the London limb-makers (it was quite a long tour, the taxi came to nearly £2 I remember).”
Mr Ferris of Museum Street, the only manufacturer of a mechanical arm in England, demon-strated his product but said, with remarkable altruism, that the arm being produced by the firm of Carne in America was highly superior. Private Chapman’s letter continues:
“I decided there and then to get a Carne somehow – but you took the responsibility from me by saying, if the arm is any good’ we will get them…”
By January 1915 it was becoming clear that the First World War, embarked upon with such confidence the previous year, was to last longer and have more devastating and far-reaching consequences than anyone could have foreseen.
One aspect of the crisis was the provision of medical services. The ambulance trains were bringing casualties, Belgian and then British, back from the continent in unprecedented numbers. Where were they to go for treatment? Existing military hospitals were full, as were beds made available in voluntary hospitals. In the crisis at the beginning of the War voluntary and civilian efforts produced faster solutions than government, and few volunteers were as energetic and determined as Mrs Gwynne Holford. She served the Hospital until her death on 18th December 1947; in recognition of her work she was appointed CBE in June 1918 and was also appointed Lady of Grace of the Order of St John. In time the problems of dealing with the casualties of world war were to result in the creation of a new government department (the Ministry of Pensions) and an extension of state provision which foreshadowed the coming of the Welfare State. It is clear that the foundation of the Hospital was due to the inspiration and the clear-headed forceful planning of two great ladies: Kathleen, Viscountess Falmouth (who used to tell of playing in the grounds of Roehampton House as a child) and Mrs Gwynne Holford.
From vision to reality
In order to turn her vision into reality, she needed to canvass support, raise funds and find a suitable building. The first letter to The Times was signed by Mrs Gwynne Holford, Lady Falmouth and Charles (later Sir Charles) Kenderdine. All three were to work for Roehampton for the rest of their lives.
An appeal was made to the public for funds. By 1st June 1915 Queen Mary had expressed a wish to become patron and desired that two beds be named after her in the men’s ward and two in the officers’ house and Mr A.J. Balfour, MP, First Lord of the Admiralty, had consented to become President. By the same date grants and donations had amounted to £19,715 including £10,000 from the National Relief Fund, £1,000 from the British Red Cross Society and the Order of St. John of Jerusalem and £1,000 each from Mr T. Fenwick Harrison (to name a bed) and Lady Wantage. This quick response to the appeal was of course a very great encouragement to the founders.
Filled with great enthusiasm and determination, Lady Falmouth and Mrs Gwynne Holford set up a committee and visited Roehampton with Charles Kenderdine, a London estate agent, to find a suitable house. The area between Roehampton and Barnes was still largely open, with parks and gardens surrounding the gentlemen’s residences, of which Roehampton House was the largest. It was considered that this area, with many palatial houses, would be most suitable. Their attention was drawn by the Mother Superior of the Convent of the Sacred Heart, to Roehampton House, which had been requisitioned by the War Office and at the time was used as billets for soldiers. With the cooperation of the War Office, Roehampton House was released and the soldiers billeted there were sent overseas. The owner Mr E. Kenneth Wilson of the Ellerman Wilson Shipping Line, lent the house and its thirty acres of grounds to the Committee rent-free and in June Mr Pierpont Morgan lent the smaller adjoining Dover House at a rent of 1 shilling (5p) a year. Dover House (since demolished) was used as separate accommodation for officers.
The history of Roehampton House itself is interesting and a short account is given at the end of this book.
Similar houses and indeed schools, parish halls and any other available buildings were being turned into auxiliary hospitals all over the country. They were attached to military hospitals.
Recruiting the staff
Preparations went ahead at great speed: the buildings were cleaned and decorated; lifts, fire escapes and kitchen equipment installed, beds and linen bought and staff engaged. Rules were drawn up and approved. The War Office agreed to pay 3 shillings (15p) a day for each occupied bed and to supply working orderlies or to make an allowance of 1 shilling (5p) a day for their keep. Miss Amy Munn, Matron of Blenheim Palace Hospital, was appointed Matron and Captain Nicholson was appointed Adjutant and Quartermaster. The Queen consented to the institution being named ‘Queen Mary’s Convalescent Auxiliary Hospital’ and she and Queen Alexandra became the patrons. The aim was to provide 200 beds, and by the 20th June 1915 the first 25 patients were admitted.
The staff at Roehampton was headed by the Commandant (always an army surgeon) and the Matron who was in charge of the nursing and domestic staff. As well as the Commandant, army personnel included orderlies and police. With the pressure to send all available men to the front it was difficult to keep able-bodied orderlies but they were desperately needed to cope with lifting disabled patients. Roehampton was disciplined like any other military institution, though again the problem of maintaining the necessary numbers of sentries and military police increased.
Disabled officers and men were used when possible to augment the staff.
The Matron and sisters were trained nurses but, in order to recruit sufficient staff, volunteers were also employed. In an attempt to prepare for the anticipated war, a scheme to train unpaid auxiliary nurses had been set up in the preceding years under the management of the British Red Cross and St.John’s Ambulance. “Voluntary Aid Detachment” was the term coined for a group of such auxiliaries but in fact the initials VAD became used to describe an individual. The Matron engaged the help of the Surrey No. 2 Wimbledon Division of the British Red Cross which was “composed of upper middle class girls of good education, some of whom have had considerable experience”. In the divided society of 1915, transferring the skills acquired at bandaging parties in Wimbledon drawing rooms to practical work with disabled soldiers presumably broadened the experience of those upper middle class girls even further! The Matron also managed to secure the services of four masseuses (the forerunners of physiotherapists) though she had hoped for more.
Since the Hospital was intended to rehabilitate the amputees rather than treat the sick, no resident medical officer was engaged at first. A consultant surgical staff of considerable distinction promised their services.
The staff on site were responsible for patient care and the day-to-day running of the Hospital, but overall management was controlled by the General, Executive and Finance Committees which met in London. The minutes of these Committees form the main surviving source for this history. Sadly, the Committees were remote from the Hospital and provide only rare glimpses of daily life there. Occasionally, however, a row erupts through the bland official tone and illuminates what was actually happening. From just such a row (the subject matter of which is obscure) in 1916, we can learn much about the personalities involved.
Mrs Gwynne Holford did not like committees. Often she did not attend, giving her reasons in a letter to the Chairman which was read at an Executive Committee meeting in August 1916.
“I am almost in despair when I reflect upon the amount of time which is wasted by the Committee in futile discussions which lead to nothing and which I believe could be made impossible if the Chairman could spare the time to make himself acquainted with the real facts.”
Gwynne Holford and the Committee
Such outbursts did not endear her to her colleagues. Alone among them, Mrs Gwynne Holford spent much of her time during the War at the Hospital, helping with administration and generally involving herself in the life of the patients. She was an exceptionally tall woman, frequently wearing wide-brimmed hats, and in surviving photographs she appears towering over the men. Several patients, like Frank Chapman, continued to correspond with her for the rest of their lives.
Mrs Gwynne Holford continued to raise money, especially from wealthy American friends, which went into “Mrs Holford’s Comforts Fund”. When she was in disagreement with her colleagues, she usually acted unilaterally, for example by writing to the Queen of her displeasure. In fact, though she could and did embarrass her fellow Committee members, once the Hospital was established she no longer had the power to carry out her ultimate threat: to close it down because it was not being run in accordance with her wishes. The quarrel in 1916, whatever its cause, was smoothed over by the diplomacy of Lady Falmouth. The image of the “Lady Bountiful” is easily caricatured, and no doubt some of those ladies on occasion deserved the irritation expressed in private between Kenderdine and his male colleagues. The impression of Lady Falmouth that emerges from the minutes, however, is of a formidable blend of diplomacy and common sense. Repeatedly she was the one to reconcile the conflicting personalities and views of the Committee which she had been responsible for bringing together. She was involved in the affairs of Roehampton for nearly 60 years: it had no more able nor committed supporter.
The bringing together of different interests: the armed services, the orthopaedic surgeons, representatives from the relevant government departments, the London County Council and the major charities (the British Red Cross and Order of St. John were later joined by the British Legion and British Limbless Ex-Servicemen’s Association) – provided a power base without which the Hospital would not have made the transition from auxiliary hospital to national institution. Practical difficulties were many: the first Commandant resigned after 6 months because of “the irregular manner in which my control over the running of the Hospital has been interfered with by individual members of the Executive Committee”, and the Matron suffered many interruptions from enthusiastic members of the Ladies’ Visiting Committee. In spite of this cumbersome administrative machinery, however, the Hospital continued to grow at an unforeseen rate. The General Committee briefly considered the question of limiting the financial liability of members (which could be considerable) but did not consider it worthwhile to incur the legal expense in registering the Hospital as a limited liability company or obtaining a charter, so long as there was a careful audit kept and the Committee met every month. It was obvious they were going to get on with running the Hospital first and worry about the personal liability later.
With Roehampton House equipped and staffed, the next task was to notify prospective patients. This procedure was complicated as the existing arrangements for providing for amputees under the auspices of the Commissioners of Chelsea Hospital had all but collapsed under the weight of numbers. At the Hospital’s London offices a register of cases was begun, based on information obtained from the military hospitals and the Red Cross. Each man’s case was investigated to decide when he was fit to be admitted for limb-fitting. The amount of paperwork involved was enormous and expensive, and stretched the resources of the Committee. Before the end of the War the register was transferred to the newly created Ministry of Pensions. Administrative achievement is not glamorous, but this aspect of Roehampton’s work helped to create the infrastructure necessary for the emergence of the Welfare State.
By July 1915 the first lists had been compiled, and a prophetic sentence appears in the Executive Committee minutes:
“The position is far more serious than was at first anticipated.”
In fact, the problem was enormous. Such was the state of surgery in the First World War that a compound fracture with extensive loss of soft tissue and bone resulted in immediate amputation. The prevailing battlefield conditions, in the mud of well manured French farmland, meant that wounds were easily infected by tetanus or gas gangrene. Again, amputation was the inevitable result. The initial enquiries in 1915 revealed 672 men who had lost limbs, of whom only a few had been supplied with artificial ones. The numbers were to increase dramatically. In all, some 41,050 officers and men lost limbs in the First World War, of whom 26,262 were supplied with their first artificial limbs at Roehampton.
The Hospital expanded rapidly to meet the ever-increasing need: 25 beds in June 1915, 224 in October, 550 by June 1916 and 900 by June 1918, a number described by the Commandant as “the absolute limit of expansion possible.” The waiting list in June 1918 was 4,321. Shortly afterwards it was agreed to admit members of the forces who had limbs amputated owing to accident. It was also agreed to accept Australian soldiers.
On 5th August 1915 much discussion took place as to the urgent need for erecting huts to provide additional beds. Proposals were put forward for a further 92 beds, then 144 were considered. Finally it was unanimously decided, on the advice of the medical members of the Committee, to erect accommodation for 400 additional patients at a cost not exceeding £8,500. It was also decided to accept the Duchess of Beaufort’s offer of the hospital at Badminton as a convalescent home. Later in the year it was reported that owing to the lack of discipline among the men already discharged from the Services who were sent to Badminton, the Duchess of Beaufort reluctantly decided to close her hospital.
A recreation room was erected in 1915; a large number of games were obtained for the patients and weekly entertainment was organised. An annual event of great interest was the Sports Meeting for the disabled patients, started in 1916, when it is recorded that the Band of the Welsh Guards played an excellent selection of music. Prizes were awarded for the sports events; the public was admitted and money raised for the funds of the Hospital.
To assist the spiritual welfare of the patients the Old Church, Roehampton, standing in the grounds of Grove House, originally known as “Roehampton Grove” (now occupied by the Froebel Educational Institute) and which had for some time been in disuse, was put in good repair and consecrated. The Church was immediately opposite the Hospital on the other side of Roehampton Lane.
Before the War, amputation and limb-fitting were totally separate processes. When the amputee had been discharged by his surgeon, he went to purchase an artificial limb. Presumably badly fitting prostheses were common and frequently discarded. In the case of a postal delivery there would be no personal fitting. Certainly no further surgical consultation was involved. The crux of the Roehampton idea was that the surgeon should recommend whatever limb was most suited to a particular patient, and that it should be fitted under his supervision. Furthermore, the patient should be trained in its use before leaving the Hospital.
It was not originally intended to have surgical facilities at Roehampton, but rather to admit patients whose stumps had healed and were ready for fitting. Where further surgery was considered necessary, patients were transferred to beds in whichever London hospital the consultant had connections. Its position close to London meant that the Hospital could attract the services of leading orthopaedic specialists. Mrs Gwynne Holford received early encouragement for her scheme from Thomas Openshaw, who became an honorary consultant and advised on subsequent appointments. Another supporter, Lord Horder, became honorary physician. As the number of patients increased, Openshaw was joined in time by A.H. Elmslie, A.S. Blundell Bankart, E. Muirhead Little and Eldred Corner. In addition, consultants were appointed to represent the governments of Canada, Australia and New Zealand (all of which sent servicemen to Roehampton) and a Scottish surgeon was appointed.
Consultants, Amy Munn and the limb makers
Initially, the consultants attended on Thursdays, but by March 1917 it was noted that Muirhead Little was a full-time consultant, visiting Roehampton every day (for which he was paid a salary of £1,500) while the others acted as a consulting board for special cases. It was the surgeons who persuaded the Committee to appoint a resident medical officer in 1916. They were concerned about the possibility of accident, emergencies such as appendicitis, and the spread of infection: a case of scabies went undetected for a fortnight. Medical emergency finally struck with the influenza epidemic towards the end of the War in 1918. There were 10 deaths: 6 soldiers, 2 nurses and 2 male staff. Since the staff on the whole had little experience of the treatment of illness it was felt they had coped well.
Roehampton rapidly became a centre of expertise in the treatment of amputation cases and began to assume the roles of teaching and research. In April 1916 the surgeons reported that, in response to a request from the War Office, they had prepared a memorandum on amputations and amputation stumps “which it is hoped may prove helpful to those who have charge of these cases when they reach Roehampton”. In September 1916 the Finance Committee granted the surgeons £200 “for experimental purposes”. The First World War saw the emergence of the orthopaedic surgeons among the elite of their profession. The Hospital’s significance is measured by the fact that the inaugural meeting of the British Orthopaedic Association was at Roehampton House on 2nd February 1918. Muirhead Little was the first President, and the subject under discussion was “nerve bulbs in amputation stumps”.
The relationship between patients and staff does not emerge from the surviving evidence, except for one curious reference in a report from Openshaw, written in May 1916, in which he was discussing the difficulty of finding enough beds for patients needing further surgery. Apparently, once away from Roehampton, some men were so troublesome that the Royal National Orthopaedic Hospital would not accept any more cases. Many men left the hospitals refusing their operations.
“The only way they are kept in order at Roehampton is by the Matron treating them with absolute good fellowship. She looks after them like a mother, and when they come out of Roehampton the surgeons find that they do not submit to discipline and they have endless trouble with them.”
In order to fulfil the original promise to supply “the most perfect artificial limbs human science could devise” the Committee organised an exhibition at Roehampton House from 20th-23rd July 1915. It was already apparent that the existing British limb-makers, small firms operating on a cottage industry basis, would not have the capacity to meet the unprecedented demand and so three American firms, Carne of Kansas City, I.E. Hanger & Co. Ltd. of Dayton, Ohio and J.F. Rowley of Chicago were invited to send representatives. All were awarded gold medals. A few days later the Committee decided to establish the limb-makers on the Roehampton site to maximise production, a pragmatic decision which was to have longterm consequences. At first some firms were accommodated in the basement of Roehampton House, though huts were provided for them all as pressure for space increased. These early workshops were very rough and ready. Raw materials used included wood, acetone and certalmid (an early form of plastic) which, combined with the almost universal smoking, represented a considerable fire risk. Fortunately, although there were a number of small incidents, the major disaster anticipated by the London County Council and the insurance companies never happened.
The manufacturers (which included one- and two-man businesses as well as the larger firms) were in the first instance charged uneconomically low rents, but in the busy period just after the War Kenderdine was able to renegotiate at a far more favourable rate. He wrote in 1932:
“when these leases were granted (1924-25) the limb-makers were making a small fortune out of Roehampton and 1 was therefore able to make exceptional terms with regard to rentals.”
Standardisation, military procedure and medical snobbery
In fact rentals came to succeed donations as the Committee’s main source of income. During the less buoyant 1930s, some of the smaller firms failed and there were takeovers as the larger firms, Hangers, Steepers and Blatchfords, consolidated their positions. As the Ministry of Pensions took over from the Committee in establishing a national artificial limb service the awarding of government contracts became a major force in shaping the future of the industry. Though the suggestion has come from many quarters in the course of Roehampton’s history, the state has never taken over the manufacture of artificial limbs.
At first no attempt was made to standardise the design of limbs because Openshaw thought the limb-makers would be able to work more quickly producing familiar designs. Standardisation came gradually, and levels of charges were agreed although the surgeons argued that they should be able to supply whatever limb was most appropriate; for example, there was much debate about the Came arm, which was particularly expensive, costing £40 in 1915.
How closely did the treatment at Roehampton measure up to Mrs Gwynne Holford’s dream? Prostheses were still crude by modern standards, and had hardly advanced beyond the traditional peg-leg. Although experiments were made with light metal, wood was still the predominant material at the end of the First World War period. The sheer number of cases had increased clinical knowledge of the preparation of stumps but co-operation between surgeon and limb-fitter seems to have fallen short of the ideal. The new profession of limb surgeon, a product of the Ministry of Pensions Medical Service, had not yet emerged. George Perkins, the orthopaedic surgeon who came to Roehampton during the Second World War, claimed then that medical snobbery was hindering co-operation between the two branches of the profession. The number of patients cannot have allowed for much individual attention, and rehabilitation was fused with military procedure in a way wholly characteristic of Roehampton. Leg cases were paraded in front of the medical officer and senior fitter in the main “Parade Hall”. Most men with artificial arms apparently discarded them (except when a specific attachment aided a mechanical process) unless under orders to wear them.
A testimony to Roehampton’s reputation is given in the autobiography of Sir Brunel Cohen MP, a double amputee who became a founder member of the British Legion and spokesman for the War disabled in the House of Commons. Having left hospital he spent a month at the Berkeley Hotel, going almost daily to a limb-maker in South Molton Street, where he received the most rudimentary walking training.
“I suffered… from my rank; being a field officer I was not required to go to a convalescent home, nor was I sent to Roehampton to be fitted with limbs and taught how to walk. Had I gone there, I feel sure the example of others and the competition engendered would have made me walk infinitely better than I ever did.”
Sir Brunel spent most of his life in a wheelchair.
Comradeship, Dudley Myers and training for re-employment
Perhaps the value of a stay in Roehampton lay as much in the comradeship as the treatment. Although “counselling” was not yet a recognised part of treatment for the disabled, there must have been a therapeutic value in the continued camaraderie of military life. Sister D’Arcy of the Convent of the Sacred Heart remembered being sent as a schoolgirl during the First World War to help clean the floors in
Roehampton House. She particularly remembered being told always to be cheerful and optimistic when talking to the men. “You will be playing football in a couple of weeks” was a frequent remark. Sydney Holland-Brown, a VAD, remembered an atmosphere of constant high spirits and although the horseplay sometimes made his own life difficult (as when pillows were thrown at him when he attempted to remove chamber pots from the wards) he claimed that he himself gained a new vision of what it was possible for disabled men to achieve, which inspired him throughout his own very adventurous life.
The promise which Roehampton made to its patients was not just to provide an artificial limb but also training opportunities and help with employment. The General Committee minutes of 2nd November 1915 stated:
“Judging from the results so far achieved and numerous offers of help received, it is hoped to find every employable man a good situation on leaving the hospital.”
In September 1915 the Committee secured the voluntary services of Dudley Myers (who had been working for the Government Committee for the Employment of Belgian Refugees in the early days of the War) as secretary of the Employment Bureau. He established training workshops on site, several as a result of generous donations from Lady Wantage, a founder member of the Committee who had a special interest in this aspect of the work.
Training for re-employment began immediately and an employment bureau was set up, both proving most successful. This was a great step forward, acting as it did as a wonderful boost to the morale of the men. By October 1915, 86 had been placed in good situations through the bureau.
It must be remembered that employment agencies had only recently been set up in 1912 by Lloyd George in some parts of the country and this centre was all the more important because of the limited training facilities elsewhere.
The training centre was soon giving instructions in the following trades: architecture; art and design; bakery; basket making; brush making; boot making; carpentry and cabinet making; chemistry; cinema work; clerical work; confectionery; diamond polishing; draughtsmanship; electrical work (all branches); engineering; hairdressing; light leather work; metal turning and fitting; photography; silver and metal mounting; tailoring; telegraphy; toy making. In all some 25 trades were offered at different times.
In addition, arrangements were made with various training institutions for the men to move on to continue their education, supported by charitable agencies if necessary. George Clark of Clark’s Commercial College and Robert Mitchell of the Regent Street Polytechnic helped so many men throughout the War that both were made honorary members of the Roehampton staff. Several employers took amputees on a regular basis and the Ministry of Munitions absorbed an increasing number. Some were trained as limbfitters on a special scheme devised by the Commandant, and then employed by the various manufacturers at Roehampton. A journalist, Margaret Chute, wrote in the Daily Graphic after a visit to Roehampton in November 1916, that in every room there were posters urging the men to “learn a trade”.
Myers was both energetic and committed and his series of reports to the Committee provide a number of insights into life in the Hospital. For example, on the general question of the success of treatment, he wrote in 1916:
“I have no hesitation whatever in asserting that whereas in leg amputation cases the providing of suitable employment is second only in importance to the providing of artificial limbs, in arm amputation cases, on the contrary, the opposite is the case and suitable work is more important than an artificial limb, which, in most cases, is of no assistance to the wearer and is probably rarely worn.”
To Myers’ frustration, not all the men took advantage of the opportunities offered. He was constantly urging that more time be made available for training classes.
“The promise of free tuition after leaving the Hospital has encouraged some to persevere, but many are unable to keep regular attendance by their being required to attend limbmakers, masseurs and parade. If the hours fixed for the latter could be conveniently altered so that the hours of study clash as little as possible, it would greatly assist workshop tuition.”
He frequently deplored the
“system which tempts men to leave the precincts of the Hospital during the whole of the afternoon”
to the detriment of their classes. His colleague, Mr Andrews, the very popular workshop superintendent, was more realistic. During a spell of hot weather in July 1916 he wrote:
“I am not prepared to condemn the liberty given as the men on the whole appear to be more cheerful and healthy for the relaxation.”
The training scheme suffered as the Hospital became more efficient. The initial average stay of around 6 weeks was reduced, under pressure of numbers, to 4 weeks for a leg case and 2 for an arm. Some men did not want to train out of “apathy” (a word much used by Myers), some intended to let the State support them, while others worried that training for employment would affect their pension rights. Here Myers’ department developed another service, that of advising on entitlement and helping to negotiate over disputed claims (the Ministry of Pensions was established to take over this area in 1916) and there was a programme of weekly lectures on pensions and employment.
Myers gradually came to accept that his department could not provide comprehensive training but should act instead as a “clearing house” giving the men practical experience of various processes and arranging for them to continue their training elsewhere if possible. By March 1917 he wrote a report in which he divided the men into 3 categories: 25 per cent “who are prepared to work anywhere and for whom employment should be found before they leave the Hospital”; 40 per cent “whose jobs are open and on discharge will return to their former employers” and 35 per cent “who will only consider work near their homes”, i.e. married men whose cases would best be helped by the local war pension committees. He was most concerned about the first group of single men, thinking they would be the most likely to drift into destitution and argued, unsuccessfully, that they should not be discharged until they had a job.
As with other developments at Roehampton, state provision followed the lead set by private initiative, and the local pension committees and trade advisory committees began to undertake the task of finding employment for disabled ex-soldiers. Myers on the whole disapproved of state intervention which he saw as a threat to his freedom of action, but his work at Roehampton attracted a great deal of notice and (as in the case of limb-fitting) the work was widely reported by various means including cinema. Many visitors came to examine his methods, including the Minister of Pensions and many local committee members. Indeed, one wonders in what spirit Mr Andrews, following a visit by the Duke and Duchess of Connaught in January 1917, wrote:
“visits of well-known people are of almost daily occurrence.”
There is no way of knowing from the sources available how far the hope of finding a job for every employable man was realised, though it seems that the scheme provided an opportunity for the energetic and well-motivated rather than comprehensive coverage. The Hospital profited from many of the schemes, and was provided with furniture from the woodwork shop, telephone communication between the various huts, electric light, eggs from the poultry farm, produce from the kitchen garden, there were even pigs on the site. Myers became increasingly interested in the “psychological aspect of the problem” and felt that morale was lower among the men who, towards the end of the War, had perhaps had a long stay at home before they could be admitted to Roehampton. His constant condemnation of “apathy” among those who, presumably, included men suffering from degrees of stress and disturbance has a harsh ring to modern ears, but even so Myers had an imaginative vision of the need for rehabilitation and worked towards it with great energy. Lack of time and resources in the face of ever increasing numbers prevented Roehampton from developing a comprehensive service equal to that which St. Dunstans, for example, provided for those blinded in the War but many individuals must have been grateful for his efforts. Myers always felt that his work was undervalued and his sense of frustration caused him to offer his resignation to the Committee on several occasions, but in the end he stayed until the spring of 1920. The employment bureau and training workshops closed later in the same year, bringing a brave experiment to an end.
The challenge of artificial arms
C. Jennings Marshall, Assistant Surgeon and Junior Orthopaedic Surgeon to Kings College Hospital wrote in Modern Artificial Limbs of 25th June 1921:
“While the function of a lost lower limb has for centuries been capable of replacement with a fair degree of success, the achievements with the arm have remained on a very much less satisfactory basis…The work of the arm-training centre at Roehampton is an object lesson in successful methods of overcoming such problems…
The patient is admitted there for a while as an inpatient in beautiful and healthy surroundings. He mingles with numbers of others with the same kind of disablement, hears them talk of their progress, sees what they can do. He begins to understand that restoration of function is taken for granted as a thing beyond doubt. He is able to go freely anywhere, seeing armless men at work – digging, hoeing, using a pitchfork, wheeling a barrow even up an acute slope, swinging heavy hammers in driving for instance a pile – and doing all these things without effort or discomfort. A visit to the workshops will show him all branches of carpentry in progress: there are fellow armless men using plane, hammer, spokeshave, chisel and the like. While most of the men have a chief preoccupation – their means of livelihood – and pay most attention to the factors bearing on this, there is another most heartening aspect of the centre. This is the world of sport and play. It will not be long before the athlete will find that there is no need for armless men to forego the pleasures he derived from sport. He can see men who held a cricket bat with the best, drive a golf ball, play billiards – instances which could be multiplied.”
The success of the arm-training school at Roehampton was largely due to the work of Captain Rowlatt Maxwell, Chief Arm Instructor who started first at the Charterhouse Military Hospital and then from 1915 at Queen Mary’s. His work at Roehampton and at other centres in the United Kingdom has been of the first importance to orthopaedics.
In July 1916 a levelling off of admissions caused Kenderdine some anxiety. He was worried that any fall in demand could make limb manufacturers leave the site, and the Committee decided to admit civilian casualties, for example anyone who lost a limb during air bombardment. It seems that only one individual was admitted under this rule, because in fact the respite was very temporary and in August 1,271 notifications of men seeking admission were received, nearly 4 times greater than in any previous month. The rise continued to reflect the fighting on the Somme, but early in 1917 this waiting list figure disappears from the minutes on the instruction of the War Office, who did not want it widely published. In addition to the new admissions, men were beginning to come back to the Hospital for readjustment to their limbs. Routine repairs could be dealt with on an outpatient basis or by post, but even so resources were stretched to capacity and when the War ended in 1918 the Hospital was busier than it had ever been.
By the end of the War, Queen Mary’s was not the only limb fitting hospital in the United Kingdom. Under the auspices of the Ministry of Pensions, which came into being in 1916, a network of regional centres was opened, but Roehampton remained the “motherhouse” to which any particularly difficult cases were referred.