The terrible global human cost of the First World War was an estimated 9.5 million dead and 20 million injured.
In Britain alone, almost 1 million soldiers, sailors and airmen had been killed. Around two million came home with some disability. Over 40,000 were amputees. Some had facial disfigurement or had been blinded. Others suffered from deafness, tuberculosis or lung damage caused by poison gas.
There were thousands of cases of shell shock from the horrors of warfare, diagnosed today as a post-traumatic stress disorder.
There was a national debate about how best to care for veterans with disabilities. The majority were young men who had their whole lives before them. To avoid a future of misery and hopelessness and an enormous drain on the state, they needed to try and live independently and support their families.
The government, burdened with war debts, mainly emphasised providing war pensions based on the level of impairment.
These ranged from a full pension for the loss of two or more limbs, loss of sight and very severe facial disfigurement to 50% for amputation of a leg below the knee or right arm below the elbow and 20% for the loss of two fingers on either hand. Many considered the pensions inadequate to live on.
Businesses that employed the men were given preferential consideration for contracts and could display the royal crest. However, the tendency was to employ those with low level disabilities, leaving the severely disabled out of work.
The state did not create sheltered employment opportunities or provide retraining. Britain was the only European state to rely entirely on the voluntary effort to employ disabled ex-servicemen.
There was also no comprehensive government plan to provide suitable long-term accommodation for housing.
However, there were developments in disabled housing, largely driven by the voluntary sector, along with early initiatives in rehabilitation and retraining and major advances in prosthetics and plastic surgery.
Prosthetics and plastic surgery
Before the First World War, prosthetic legs and arms were primarily wooden and heavy and caused pain and discomfort.
There was little regard for functionality, and, as a result, they were almost useless as limb replacements. A new generation of comfortable prosthetic limbs was created in the 1920s, made of light aluminium with adjustable joints.
Renowned sculptor Frances Derwent Wood, too old to join up, volunteered at the Third London General Hospital. Having seen the terrible injuries that the war’s new mechanised weaponry – such as shells and machine gun bullets – inflicted on soldiers, he dispensed with the prosthetic rubber masks of the past.
He pioneered masks of thin metal, sculpted and meticulously painted to replicate a patient’s pre-war appearance.
Harold Gillies is considered the father of reconstructive surgery. He pioneered the use of the patient’s tissue, rather than the practice of attempting skin grafts from other people or animals, and focused on aesthetics to try and make the patient appear as they were before their wounds.
About 25% of those discharged from active service during the war were ‘psychiatric casualties’.
Most were suffering from shell shock, a condition viewed by the public as a sign of emotional weakness or cowardice. A growing number of centres, such as the Royal Victoria Hospital in Southampton and Seal Hayne in Newton Abbot, specialised in such cases.
Arthur Hurst, an army major at Seal Hayne, pioneered revolutionary treatments for ‘war neurosis’, which had puzzled doctors who often prescribed harsh treatments such as electric shocks and solitary confinement.
Hurst believed in occupational therapy. The men worked on a farm in the peace of the countryside and were given intensive therapy sessions, including hypnosis. 90% of his patients were cured.
Rehabilitation and learning new skills
The Queen Mary’s Workshops, one of many such centres across the country specialising in rehabilitation and retraining, opened in Brighton’s Royal Pavilion grounds.
It had the slogan: ‘Hope welcomes all who enter here’ – a positive reworking of Dante’s ‘Abandon all hope ye who enter here.’
Amputees learned skills in a wide range of trade and professional occupations, including electrical engineering, carpentry and motor mechanics, to prepare them for civilian life.
Pilkington Special Hospital also specialised in treating and rehabilitating disabled veterans through re-educative workshops and provided a room for remedial gymnastics.
St Dunstan’s – established by Sir Arthur Pearson, who lost his sight due to glaucoma – provided a hostel where ex-servicemen went to ‘learn to be blind’.
The emphasis was on pioneering vocational training, often involving adapted forms of technology, including typewriters and telephones. Pursuits such as music, dancing and sport were also encouraged.
The men learned braille and were given symbols of independence, such as braille watches, once they left St Dunstan’s.
For most disabled veterans who didn’t need lifelong care in an institution, there was an urgent need to provide independent living, suitable homes and a way of earning an income for themselves and their families.
With no national plan from the government, the voluntary sector stepped in, building new housing ranging from cottages to mansion flats and entire villages.
This memorial village, built after the war and including sheltered workshops, was specifically created for disabled soldiers and their families. Such villages were few and far between and were reliant on voluntary donations.
The leading landscape architect and town planner of the time, T.H. Mawson, saw such segregation as protecting disabled veterans from ‘the struggle of the crippled man with those who are able-bodied.’ Other voices felt that disabled veterans’ housing should be integrated into urban communities.
Stoll was a philanthropist whose Oswald Stoll Foundation built the London mansion flats pictured – with lifts, a medical centre and a gymnasium – for disabled veterans and their families. Work was available across the road at the Lord Roberts Memorial Workshops. Family accommodation was relatively rare as much was for single disabled men only.
Veterans from modern conflicts occupy the flats today.
The Poppy Factory, originally established by The Disabled Society in 1922 to make poppies for the British Legion poppy appeal, was staffed entirely by disabled servicemen.
Three years later, with 350 veterans producing poppies in its sheltered workshops, it moved from its original home in London’s Old Kent Road to new premises in Richmond. The Howson flats close to the factory were built in 1926 to house its most severely disabled workers, with the larger flats for employees with dependents.
This move was made possible by the British Legion, founded on 15 May 1921, to campaign for better support for disabled ex-servicemen and women.