Becoming Bespoke: When One Size of Prosthetic Does Not Fit All

Black and white photo of three people posed for a group photo. Left to right: a white man in military uniform with both legs amputated nearly at the hip, resting on a small platform with wheels. A white woman in a dark-colored dress sitting in a rocking chair. A white man wearing a suit sitting in a rocking chair with a crutch leaning on a pillar behind him. The woman has her arm around the shoulders of the man on the left and her hand on the arm of the man on the right.
Black and white photo of a man wearing goggles and welding an object. His left arm is artificial.
Man welding, using artificial arm. Courtesy Library of Congress. Learn more →

World War I changed many things, including the approach to healing damaged bodies in the wake of violent conflict. The lessons learned about battlefield amputation and prosthesis use in the years surrounding WWI shaped the way the world approaches artificial limbs today.

While the need and use of artificial limbs goes back centuries, WWI introduced mass production to prosthesis development – unlike anything previously seen in the medical field. Prior to 1900, those who experienced limb differences (whether caused by war or not) could have a limb built specifically for their body. Fittings, therapy and maintenance would often take months, if not years, to refine the limb to the user’s needs and desires. Bodies became bespoke.

By 1900, the advent of mass production and new materials allowed companies to prefabricate components for artificial limbs. Across the globe, from Japan to Germany, prosthetic manufacturers began experimenting with new materials and technologies to blend form and function into standardized limbs. In the United States, patents for various types of prostheses were posted to the U.S. Patent Office throughout the war, with small companies vying for business with international aid organizations. Carnes Arms, E-Z-Fit Liberty Legs, Hangar Artificial Limbs, Rowley legs…the market was vast and fiercely competitive. Many manufacturers sought a coveted partnership with the U.S. War Department and Walter Reed Military Hospital for the ability to mass-produce limbs for returning injured veterans.

 

Sepia photo of two men. One man is in military uniform, standing up, with his left pants leg pulled up or removed to show that his left leg is artificial. The second man is kneeling, dressed in medical uniform, making adjustments to the first man's artificial leg.
Man from General Hospital Number 3, Rahway, New Jersey, being fitted for an artificial leg by E-Z Fit Artificial Limb Company. Courtesy National Archives. Learn more →
Black and white photograph of a French soldier using two prosthetic arms to move soil with a pitchfork.
A French soldier who had both of his arms amputated during the War. He uses prosthetic arms to move soil with a pitchfork. Learn more →

 

While a missing limb’s form could be replicated, regaining the limb’s function was another matter. Many of the new mass-produced artificial limbs lacked reliability and durability for industrial labor or agricultural work. Other limbs lacked the dexterity and fine motor skills required for crafts work. A vast majority of the one-size-fits-all limbs were uncomfortable or ungainly. The U.S. Government had sought to replace limbs to make people whole again and prevent an over-reliance on charity. Instead, they exposed a difficult friction point between the expectations and realities of rehabilitation. Some soldiers began adapting to their limb loss with unique solutions.

Scan of a vintage newspaper headline. Text: 'Loss of both legs in battle hasn't spoiled life for this Texan'
Headline from the Austin American-Statesman, Sept. 8, 1920. Learn more →

2nd Lieutenant Robert Stell Fletcher, a Texan in the 36th Division, had both legs amputated after suffering shrapnel wounds during in the Meuse-Argonne Offensive. With both legs amputated nearly to the hip, doctors had trouble attaching prosthetic legs to his body. Most artificial legs of the time were attached by straps to the thigh. For mobility, Fletcher adapted a roller seat with hand blocks to propel himself.

His persistence caught the attention of many at Walter Reed Hospital. Newspapers across the country wrote stories, gaining him an introduction with President Warren Harding. Eventually, he was able to drive a car, climb ladders and swim without his legs. Following his rehabilitation in Washington D.C., he returned to Texas, married, and had four children before his death in 1947.

 

Black and white portrait photograph of an American soldier wearing military uniform. Soldier is missing both legs from the hips down. He sits on a flat, three-wheeled cart and holds blocks with handles to help him move.
Robert Fletcher. Entry in Online Collections Database →
Black and white portrait photograph of an American soldier seated, wearing military uniform.
Robert Fletcher pre-injury. Entry in Online Collections Database →
Black and white photograph of a white man (a double amputee) doing a handstand on a diving board over a swimming pool below.
Robert Fletcher at Walter Reed Hospital in Washington, D.C. Entry in Online Collections Database →
Black and white photograph of a wounded soldier sitting on the edge of car. The soldier has lost both of his legs.
Robert Fletcher sitting on the edge of a car. Entry in Online Collections Database →
Black and white photo of three people posed for a group photo. Left to right: a white man in military uniform with both legs amputated nearly at the hip, resting on a small platform with wheels. A white woman in a dark-colored dress sitting in a rocking chair. A white man wearing a suit sitting in a rocking chair with a crutch leaning on a pillar behind him. The woman has her arm around the shoulders of the man on the left and her hand on the arm of the man on the right.
Robert Fletcher and another double amputee (Corporal Adolphus McKenzie) sitting with the French nurse, Henri Raquin, who attended to them when they were hospitalized in France. Courtesy Library of Congress.
Black and white portrait photograph of a veteran wearing civilian clothing. Man is missing both legs from the hips down. He sits on a flat, three-wheeled cart and holds blocks with handles to help him move.
Robert Fletcher later in life. Entry in Online Collections Database →

Fletcher’s story, like that of many others returning from service with limb loss, is one of adaptation. In the years between WWI and WWII, prosthesis development would evolve with the lessons and experiences of medical professionals and amputees with prosthetic limbs. The Artificial Limb Laboratory at Walter Reed continued experimenting with interchangeable and standardized components to build new limbs, but it also recognized that the one-size-fits-all approach for amputee care needed adaptation as well. New leadership at Walter Reed after WWI adopted a multidisciplinary approach to surgery, therapy and prosthetic construction and refinement. More importantly, they recognized that continuity of care would be a lifelong and personalized necessity for all amputees.

Walter Reed and the Department of Veterans’ Affairs still produce prosthetic limbs for thousands of veterans across the country and around the world. Each limb is built and fitted to the individual: a bespoke lesson from World War I.

 

To learn more about the evolution of prosthetic limbs during and after the First World War, visit special exhibition Bespoke Bodies: The Design & Craft of Prosthetics, on display in Wylie Gallery until April 2024.

Modern photograph of a man wearing a camouflage uniform sitting on the ground leaning against a wall. His left leg is extended and pant leg pulled up to reveal that it is a modern prosthesis, wearing a khaki-colored work boot.