Amputations & Prosthetic Limbs in the First World War

One of the most common and severe injuries suffered by soldiers of the First World War was the loss of limbs. Battlefield amputations were gruesome, followed by years of painful rehabilitation. The bloodshed necessitated an urgency in the development of effective prosthetics, and advancements in design and production were made during and following the War. Pensions to amputees were inconsistent and often underwent multiple changes with frequent review. Men who lost a leg or an arm also had to take on a new identity as a permanent invalid, grappling with more than just physical limitations. Thousands of young men suffered for the rest of their lives as amputees, existing in the public eye as a permanent visual reminder of the brutality of the Great War.

The estimated total amputees from both sides of the war ranges from 300,000[1] to 500,000.[2] Of that, 42,000 men were British[3] and 67,000 were German.[4] Because Great Britain led the way in surgical and prosthetic research and development during and following the War, the most accessible medical statistics involving amputations come from studies about and out of Britain. While prosthesis developments were largely made years after the Armistice signing, surgical advancements had to be made under pressure on the battlefield. The closer to the front, the more chaotic and brutal medical care became. Field hospitals were the rearmost medical bases on the front, and earned the nicknames “the chopping block” and “the butchers’ kitchen” because they were the primary areas where amputations were performed.[5] Soldiers distrusted and feared these casualty clearing stations, as rumours of inexperienced surgeons and minimal use of anaesthesia swirled through the trenches.[6] Indeed, both were true, as most surgeons were learning on the field, and even experienced medical officers had to adapt to the unprecedented carnage around them. Bullet wounds were the most common injury that resulted in amputation. This was most often not due to loss of limb functionality, but rather, to avoid the rapid effects of infection caused by open wounds in manured fields, which manifested most prominently in gas gangrene.[7] Surgeons had to make quick decisions to prevent this, and approximately 40% of all wounds down to the bone on extremities resulted in amputation because they had few alternatives.[8] Of 3000 British medical discharges in the first 8 months of the war, 336 were amputees, and they were the lucky ones; field surgeries involving amputation reached 33% mortality rate on the operating table, though varying injuries could reach much higher until 1916.[9]

Because amputation was so common on the Western Front, select hospitals on the Homefront were converted into amputee research and care centres, the most famous of which, Roehampton in London, opened in 1915. Most amputations required two or three additional surgeries for the “making of a suitable stump,” and were carried out at these hospitals.[10] They also made advancements in the use of antiseptics,[11] tourniquets,[12] and the Thomas Splint in 1916,[13] collectively helping surgeons drop the amputation rate to 10% by 1917 and the overall wound mortality rate to 8%.[14] It was said that there was a “complete revolution” in surgical practice from 1917-18, as the War pushed demand for standardization in sanitation and safe methodology.[15] Removing limbs saved lives, but it would take prosthetics to improve them.

Prosthesis development was dominantly conducted by the British Ministry of Pensions during the War, and “the Ministry can lay claim to have become a pioneer in the development of the modern surgery of amputations and in the design and construction of all types of artificial limbs and appliance”.[16] Roehampton was designated as the central facility for such developments, and became a hub for several international companies to test and design various models.[17] Uniformity became essential, however, as repairs and re-fittings became difficult when doctors were unfamiliar with certain models, and was “particularly problematic” when amputees returned to their homelands.[18] The ministry began mass-production on the Standard Wooden Leg in 1921, simplifying the process.[19] In the decade following, the Ministry fit an annual 11,000 prosthetics[20] across nineteen limb-fitting centres throughout Britain.[21] Prosthetics continued to advance up to and after World War II, when many other countries, including Canada, instituted their own Advisory Committees to continue research in improving artificial limbs in collaboration with Britain.[22]

Life without real limbs was difficult. Physiotherapy and rehabilitation became a military concern for the first time, and the Ministry took up the role of helping amputees adjust.[23] “Twenty years was required to attain maximum skill with an artificial hand,” putting immense strain on the disabled.[24] The cutting off of a man’s limb took with it his perceived masculinity, as strong arms and legs represented his ability to work and provide, and was therefore considered the most severe wound a soldier could sustain.[25] “Feminine handicraft therapies” such as knitting were assigned to help men familiarize themselves with their prosthetics as a part of therapy.[26] The ultimate goal was to get work after service and to marry, to prove that “a soldier’s manhood had been restored, his wounds healed, and his disability overcome”.[27]

Of course, most amputees could not maintain typical masculine jobs, and suffered economically.[28] Pensions were meant to compensate men for their service and any inability to work after the fact. There are limited statistics concerning Canadian amputees and pensions, but a brief case study of five privates of the CEF with leg amputations (four were due to gunshot wounds) finds that, with the exception of one (Ernest Parsons, 180784), each received full 100% pension entitlement at some point in their recovering years.[29] Most were not awarded this until the 1930s or later, and each underwent many reviews and fluctuations to their pensions. Comparatively, the British Ministry only awarded 100% pension to “a double amputation, total paralysis, or ‘a very severe disfigurement’”.[30] Perhaps British Pension laws were stricter or these Canadians are exceptions, but they are examples that can be studied to learn more about the experience of Canadian veterans who underwent amputation in the First World War.

Amputation was a daily occurrence in Europe from 1914-18, as modern warfare tore men apart in unprecedented ways. Surgeons had to learn how to save lives under harsh conditions, resulting in high amputation rates which lowered over the course of the war due to research and practice at designated amputee hospitals. Survivors returned home as fractions of themselves, having to learn how to operate with artificial limbs that took years to develop proper functionality and modern design. Countries supported amputees through standardizing practices and prosthetics, opening more hospitals and rehabilitation centres, and with pensions. Despite all that, thousands endured the war to live in pain, disability, and poverty.  A man with a limp or visible prosthetic reminded the public of the cost of war.

 

Citations

[1] Mark Guyatt, “Better Legs: Artificial Limbs for British Veterans of the First World War,” Journal of Design History, 1, 4, Technology and the Body (2001): 311, JSTOR, accessed July 10. 2017.

[2] Richard Gabriel, Between Flesh and Steel, (Virginia: Potomac Books, 2013), 216.

[3] “Artificial Limbs and Amputations,” The British Medical Journal, 2, 4110 (Oct. 14, 1939): 777, JSTOR, accessed July 10, 2017.

[4] Leo Van Bergen, “Medicine and Medical Service,” International Encyclopedia of the First World War, 4, last updated Oct. 8, 2014, accessed July 12, 2017.

[5] Van Bergen, “Medicine and Medical Service,” 4.

[6] Ana Carden-Coyne, The Politics of Wounds: Military Patients and Medical Power in the First World War, (Oxford: Oxford University Press, 2014), 99, 101-103.

[7] Carden-Coyne, The Politics of Wounds, 94, 97.; Gabriel, Between Flesh and Steel, 216.

[8] Gabriel, Between Flesh and Steel, 216.

[9] Carden-Coyne, The Politics of Wounds, 107.

[10] Ibid, 105, 108.

[11] Gabriel, Between Flesh and Steel, 216-217.

[12] Carden-Coyne, The Politics of Wounds, 105-107.

[13] Carden-Coyne, The Politics of Wounds, 109.; Gabriel, Between Flesh and Steel, 217.

[14] Gabriel, Between Flesh and Steel, 217.

[15] Carden-Coyne, The Politics of Wounds, 112.

[16] “Artificial Limbs and Amputations,” 777.

[17] “Artificial Limbs,” The British Medical Journal, 2, 4423 (Oct. 13, 1945): 502, JSTOR, accessed July 10, 2017. Guyatt, “Better Legs,” 311-12.

[18] Carden-Coyne, The Politics of Wounds, 113.

[19] For a comprehensive history of the Standard Wooden Leg and later developments of it, see Guyatt, “Better Legs,” 312-321.

[20] “Medical Work of the Ministry of Pensions,” The British Medical Journal, 2, 4010 (Nov. 13, 1937): 971, JSTOR, accessed July 12, 2017.

[21] “Improvements in Artificial Limbs: Ministry of Pensions Demonstration,” The British Medical Journal, 1, 4509 (June 7, 1947): 817, JSTOR, accessed July 12, 2017.

[22] “Improvements in Artificial Limbs,” 816.

[23] Carden-Coyne, The Politics of Wounds, 113.

[24] “Improvements in Artificial Limbs,” 816.

[25] Carden-Coyne, The Politics of Wounds, 344.

[26] Ibid, 268.

[27] Ibid, 271.

[28] “Medical Work of the Ministry of Pensions,” 971.

[29] For full recorded service, injury, and pension timelines see pension files of Philip Blyde, 1650, William Frank Lee, 863178, Charles Owen Ockenden, 231319, Ernest Parsons, 180784, & Joseph Shaeen, 712.

[30] Carden-Coyne, The Politics of Wounds, 344.

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