In this chapter
New techniques and a new lease of life
The Ministry requested that the Governors provide another 550 beds to bring the Hospital’s capacity up to about 900. Some of the Committee were disturbed by the loss of amenities that further expansion and loss of garden would result in for the War Pensioners, but after “long and earnest consideration” 17 new brick wards were erected to replace the old huts, with an air-conditioned underground theatre and resuscitation wards, new kitchen and dining hall, recreation building, stores and ancillary buildings. These new buildings were declared open by Lord Horder, Honorary Consulting Physician to the Hospital, an eminent physician, who was also physician to King George V. Residential patients were moved to the Star and Garter Home at Richmond.
“… in short, a further new Hospital has been built within and adjacent to the old… Roehampton may be said to have taken another lease of life and to have entered upon a new sphere of usefulness in the service of mankind.”
In an attempt to simplify the cumbersome dual arrangements whereby the Hospital was administered, a new agreement was reached with the Ministry of Pensions which assumed sole control.
The Limb Fitting Centre and factory space was also extended and new staff trained. The plan under the emergency scheme was to use the Hospital initially for all casualties and then, as the system settled down, to reserve it for the treatment of ex-service amputees, fractures and facial injury cases. No doubt the rush to expand facilities was prompted by memories of the appalling statistic of over 40,000 men losing limbs in the First World War. In fact, the casualty pattern that emerged in the Second World War was not the same, and as new needs emerged, new facilities had to be developed to cope with the changing situation.
There were approximately half the number of amputation cases in the Second World War. Leon Gillis, consultant surgeon at Queen Mary’s from 1943-67, summarised the reasons as follows: advances in surgical technique, in chemotherapy and in the general management of any injury, better treatment of infection and the availability of blood transfusion.
“Generally the men of World War II were fitter than World War I… they fought under better conditions and their wounds were cleaner – less likely to develop tetanus or gas gangrene.”
Altogether 20,000 ex-servicemen and 2,000 civilians were treated at Roehampton between 1939 and 1945. The civilians included women and children admitted under various agreements negotiated by the Governors. Improved co-operation between the different professions and experience gained since 1915 had improved the quality of their treatment. Gillis again:
“Observations made on the results of large numbers of World War I amputations led to changes in the site and technique of the operations.”
By 1939, the specialists were agreed on 4 standard sites (2 for each limb) for major amputations. British surgeons were considered conservative in this respect, and, according to Gillis
“opposed experimentation with the more unorthodox types of amputation stumps practised abroad.”
Writing in 1965, he remained convinced that this well-proved policy, in conjunction with the progressive improvements in prostheses, was justified by its results.
During the war, George Perkins (later Professor of Surgery at St. Thomas’) came to work at Roehampton. Recalling this experience in 1972, he was scathing about the lack of communication between the Hospital and the Limb Fitting Centre.
“The orthopaedic surgeons were cutting off legs, but they had no idea of the length of stump and the shape that the limb-fitters preferred. However, the limb-fitters did their best, but they did not know how to teach the men to balance and walk on their limbs, whereas the orthopaedic surgeon is experienced in rehabilitating the patients with broken legs…Partly it was caused by their having different bosses, but mainly it was a matter of ‘us and them’.”
He did his best to break down this barrier, and co-operated with R.D. Langdale-Kelham, the head limb-fitting surgeon in a book called Amputations and Artificial Limbs published in 1942.
Perkins developed a technique, which remained in use for many years, of fitting a temporary plaster pylon which helped the patient to become mobile as soon as possible. He could then be discharged and fitted with an artificial limb at his nearest centre. In this work he was assisted by physiotherapists.
Far East Prisoners of War
As well as Orthopaedics, the established departments of Plastic Surgery, Neuro-surgery and General Medicine expanded to cope with the influx of casualties. In addition a new need arose, this time from among the men stationed in countries where tropical diseases were endemic, of whom the worst affected were those captured by the Japanese in the Far East. The prisoners who returned were suffering from harsh treatment and malnutrition in addition to severe illnesses. The Ministry decided to establish a Department of Tropical Diseases at Roehampton under the direction of Dr J.P. Caplan. By 1950 the unit had 120 beds and was the largest of its kind in the country.
The successful treatment of tropical disease was dependent upon meticulous nursing care, and in the early days the department was hampered by a shortage of suitable staff. In 1949 a 6 month post qualification course for the Certificate in Tropical Nursing was established which helped raise standards to the required level. The department became a clinical teaching centre, attended by post-graduate students from the London School of Hygiene and Tropical Medicine.
The largest group of cases was suffering from intestinal amoebiasis, and a standard 10 day course of treatment introduced at Roehampton in 1946 gave excellent results. A report produced in 1950 claimed that malaria had ceased to be a clinical problem in spite of “an increasing tendency on the part of the pensioners to ascribe any febrile illness to Malaria”. The same report, however, commented on an increase of patients admitted with intestinal helminthiasis (worms), although it was 5 years since most of the prisoners had been released; it also expressed concern about possible future cases of cirrhosis among those suffering from liver complaints caused by poor nutrition. In other words, treatment would need to continue well into the future. FEPOW (Far East Prisoners of War Association), through the National Federation of Far Eastern Prisoners of War Clubs and Associations became one of the organisations closely associated with Roehampton.
Bomb damage and new patients
Roehampton suffered considerably from air attack during the war. A high explosive bomb and 55 incendiary bombs fell in the autumn of 1940, the bomb causing extensive damage to Roehampton House, destroying the ceiling and wall paintings by Sir James Thornhill and the freestone mantelpiece attributed to Grinling Gibbons.
Further damage was caused in November 1940 when a high explosive bomb hit a factory and the major part of the curative workshops. The Managing Director of J.E. Hanger & Co Ltd(principal tenants of the artificial limb fitting centre), T. Bryant Smith was killed by the bomb. After this damage extensive camouflaging of buildings took place.
In February 1944 a high explosive bomb seriously damaged Roehampton House and the quarters of some of the nursing staff. Also in 1944 there were intensive attacks by flying bombs and the Hospital was evacuated for a brief period. Some of the older wooden buildings were destroyed and the opportunity was soon taken to erect new buildings. Over this period 5 members of staff were injured but there were no casualties among the patients.
In 1941 a new agreement was drawn up between the Hospital and the Ministry of Pensions including a lease to the Ministry of the Hospital area for a term of 60 years at a peppercorn rent. Providing limbless ex-servicemen received full priority for the whole period of the lease, the Ministry were permitted to use the Hospital for general medical and surgical cases; the maintenance of the grounds, the factories and the Limb Fitting Centre remaining the responsibility of the Governors. The Ministry continued the practice of training patients for employment. A research department was equipped by the Ministry and much original work was carried out under the direction of the Standing Advisory Committee on Artificial Limbs appointed by the Ministry.
The admission of children was agreed in 1942/3.
By 1944 the Ministry of Labour, the Ministry of Pensions and the Roehampton Governors had arrived at a scheme by which artificial limbs could be made available to certain classes of civilian on a contributory basis. When the NHS came into being, Roehampton was at the centre of the system for supplying artificial limbs.
A new Limb Fitting Centre was opened on 22nd,February 1944 by the ChineseAmbassador Dr V.K. Wellington Koo. It had facilities for lectures and films and in addition to treating patients was used for teaching purposes and demonstrations for visitors from all parts of the world.
In the last year of the war 21,769 war cases were treated in the Limb Fitting Centre and 13,540 limbs were sent by post. The limbs posted were repaired limbs or limbs sent to other centres for fitting. 1,933 civilian cases were treated and 452 limbs sent by post to civilians.