Prosthetic progress

Henry Fry

Adjusting to life after war has always been difficult. For amputees, artificial limbs are an essential requirement for attempting to get back a semblance of normality. In 1948, just three years after the Second World War, two University of Otago fifth year medical students, P. J. Dowsett and J. H. Heslop, did their public health dissertation about wartime amputees and aspects of artificial limbs.

Not surprisingly, they found that after the First and the Second World War, the need for prosthetics spiked. Before the Great War, there was little development or focus on artificial limbs. For centuries, the wooden leg was the most common example of what was possible. At the tail end of the First World War, the return of veteran amputees led to a great demand for prosthetic limbs. An estimated 41,000 returning British soldiers required prosthetics. The high demand prompted the introduction of more standardisation in the manufacturing process. During the interwar period, the metal artificial limb started to take over from the traditional wooden leg for the first time. By the Second World War, advances meant that prosthetics had become far more intricate than their basic predecessors.

The medical students looked at common conditions affecting older amputees from the Great War. They discovered that many of these veterans had developed a “roll of flesh” as they gained weight with age. The problem was that the artificial limbs were designed for younger amputees, which meant that their limb no longer fitted well as they aged. Those older First World War veterans had to develop a new technique for putting on their artificial limbs. This became known as the Plug-Fit. While there had been some progress in terms of the amputee’s comfort, the industry was mainly focused on the initial amputation, with little follow-up. One reason for this was the large number of young veterans coming home from the Second World War, whose needs had overtaken the needs of older amputees from previous conflicts.

First World War veterans with below-knee amuptations were usually fitted with fibula-bearing artificial limbs. These could cause issues for the amputee, with veterans developing a bursa (a fleshy pouch) on their stump. The condition could become inflamed and painful. During the interwar period, this problem was identified and ischial-bearing corset fittings became a common requirement when fitting lower limb prosthetics. This fixed the problem of increased pressure and friction on the amputee’s stump. The medical students found that at the place where they carried out their research, there had only been one bursa finding since 1931, suggesting that comfort for amputees, rather than only the practicalities of the prosthetic, had become a priority.

Circulatory defects often affected amputees, mainly in above knee amputations. For First World War veterans, the students found that this problem was often incorrectly attributed to a poorly-fitted limb. The real problem, identified later, was that some of the remaining bone was unhealthy. Re-amputation could help, with the new section made through healthy bone and at a high level to ensure that healthy skin was left for healing. Second World War veterans benefitted from more effective treatment when problems developed post-amputation.

Treatments were not the only thing that changed between both World Wars: how the state dealt with amputees altered too. After the First World War amputees were only given an economic pension if they could meet certain strict requirements. This  changed in 1945 when veterans were given £1.15 for themselves and another £1 for their wives. This was not the only aid given by the state. Postage costs for artificial limb repairs were free, when previously veterans had to pay. The Amputees Association lobbied for a better deal for members since many found it difficult  to find work, and training courses were provided. In 1949, older veteran amputees called for an increase in their pension every year after the age of thirty five. They felt left behind by the state, who refused to recognise  their increasing difficulties in continuing to work after a certain age.

Second World War Veterans had many questions on how the state would look after them when they reached old age. Work, particularly manual labour, was more difficult for the amputee compared to the average worker, which was why the New Zealand War Amputees Association called for early retirement in 1949. At the time of these complaints, the New Zealand Branch of the British Medical Association would not admit the connection between heart conditions and limb amputations. Veterans called for biannual medical check-ups by heart specialists after the age of fifty. Despite the many advances Second World War amputees experienced in their quality of life over their Great War counterparts, there was still much more to be done for their future to feel secure.

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Henry Fry is an English-Kiwi student finishing his law degree at Otago University, who is currently interested in the effects war has on its veterans.

Sources:

• P.J. Dowsett and J.H. Heslop. “Some aspects of artificial limbs and the war amputee.” (Prev. Med. diss., Hockens Library, 1948).
• Guyatt, Mary, “Better Legs: Artificial Limbs for British Veterans of the First World War.” Journal of Design History, 14(4), (2001): 307-325.
• “Amputees, Then and Now.” Otago Daily Times. 27 June 1945.
• “War Amputees.” Otago Daily Times. 11 February 1949.