World War I left so many veterans armless and legless that demand outstripped the supply of artificial limbs.
Thus, Charles Albert Blatchford and other artificial limb manufacturers “could virtually dictate the pace of output,” Gordon Phillips wrote in Best Foot Forward: Chas. A. Blatchford & Sons Ltd., (Artificial Limb Specialists) 1890-1900, a book written to commemorate the firm’s centennial.
In 1919, determined to match supply with demand, the British government expanded its Ministry of Pensions to include a Departmental Committee on Artificial Limbs. Summoned to testify were the chairman of the Limbmakers Association and representatives of the principal manufacturers: Blatchford, Desoutter, Rowley, Hanger and Grossmith.
“It was decided that no case had been made for a general increase in prices. A costing expert was to be brought in to examine the accounts of the five firms, and the matter was left for due consideration by the new Contracts Department,” Phillips wrote.
Progress leads to standardization
The committee recommended that the companies submit complete records of their work and that all production be subject to ministry inspection. Minimum wages were established for employees, and the companies were to hire “a fair number of limbless men,” Phillips wrote. Additionally, “if a limb was supplied at state expense, the limb maker could offer only the ministry-approved limb, unless otherwise sanctioned.”
In 1920, the committee approved a “standard limb” for amputees.
“Standardisation was not to stand in the way of progress, and the inventions of all manufacturers and their modifications were incorporated into sections of the so-called standard limb,” Phillips wrote [sic]. “In the lamentable absence of such a being as a standard person, personalised requirements allowed limb makers the final say in subtle expression of their finesse with, say, ankle joints tailored to give the amount of movement acceptable to the wearer” [sic].
The committee also suggested that the limb manufacturers “should allocate the proportion of arms and legs supplied over the next 2 or 3 years,” urged decentralization of supply operations and called for the companies to open branches nationwide to better serve amputee veterans. Blatchford had started Britain’s first-ever regional center at Cardiff, the capital of Wales, in 1916.
In October 1919, the Ministry of Pensions ordered component parts to be standardized. In addition, the government required that the companies keep records of their costs, subject to examination. The ministry would from time to time fix reasonable profit margins based on the amount it cost the companies to make a limb but would allow “exceptional profit because of special improvements and inventions,” Phillips wrote.
New name, new offerings
On Dec. 29, 1919, Blatchford became a limited private company. Records do not offer a reason, but it may have been due to the Ministry of Pensions’ order. Heretofore, companies kept records on a voluntary basis.
“Chas. kept nothing,” Phillips wrote. “Now, however, to satisfy systematic investigation, he had to give his company a modern accountancy profile.”
The company became known as Charles A. Blatchford and Sons. Tom and W.A. Blatchford were named managers.
In the 1920s, the company continued its innovative course by developing and patenting the “New Blatchford Leg,” which was made of a metal called duralumin. The leg weighed just 4.5 pounds and was designed for transfemoral amputees.
The artificial limb “was a blend of private inspiration and crafted artistry on the part of the company,” Phillips wrote. “This pioneer method of fitting artificial legs by totally enclosing the [residual limb] in a suction socket received its proper accolade in a special article in the British Medical Journal of 14 November 1925,” Phillips wrote.
He added that almost immediately, the New Blatchford Leg, which was marketed worldwide, “rendered obsolete the cumbersome contrivance of straps or suspenders passing over the shoulder, and, in the case of short stumps, the additional belt around the pelvis made of steel, leather or woven fabrics. The prosthesis moved with the [residual limb] as though part of it, and the entire absence of body harness made it eminently suitable for women.”
When Charles died at 64 years in 1926, his company was prosperous and its future seemed bright. But in 1935, Blatchford lost its contract with the Ministry of Pensions, which had found a less expensive supplier. As a result, the firm signed a contract with the British branch of Hanger.
Moving past its roots
“It may have amounted practically to an involuntary renunciation of the firm’s birthright but it was sorely necessary,” Phillips wrote. “By this agreement Blatchford (as licensor) made over to J.E. Hanger of Roehampton House full authority to ‘make, use, exercise and sell to the order of the Crown,’ Blatchford’s sole and exclusive license for the manufacture and sale of the ‘New or Improved Artificial Limb’ (Letters Patent No. 249, 269) and received a royalty of £2.10s. per limb” [sic].
Meanwhile, surgical opinion had turned overwhelmingly in favor of light metal limbs. But in 1927, a member of parliament argued that wooden limbs had improved so much that they had become lighter than metal limbs and, in some cases, were better suited for transtibial amputees. “More complaints had been received from pensioners wearing metal limbs, and many wished to exchange,” Phillips wrote.
Metal limbs proliferated in the 1930s.
“The Blatchford view on the subject, expressed in a 1920s brochure, was firm, sane and balanced,” Phillips wrote. “Metal limbs were billed by many people, new to the industry and whose claims to efficiency were extravagant, as a cure for all possible ills, but the selection of any one material did not spell salvation.”
In 1938, with war looming in Europe, Blatchford and other limb makers met with the Ministry of Pensions to determine the need for artificial limbs in case fighting broke out.
“Against a backdrop of evacuation and transfer of patients known as the Emergency Hospital Scheme (EHS), the peacetime annual output of some 5,000 new artificial legs and 500 arms was seen as woefully inadequate,” Phillips wrote.
Because the government might need duralumin for war production, there was talk of making limbs of willow, a wood common in Britain. In any event, the government lowered its quality standards and stockpiled discarded or condemned artificial legs. Blatchford wanted to make sure the country knew it was still a premier limb maker and spent more than £500 on advertising. Simultaneously, the company invested another £350 on air-raid precautions, Phillips wrote.
War broke out in 1939 when Adolf Hitler invaded Poland. At first, Blatchford and the other limb makers were able to keep up with the demand for limbs.
“This could not last, and even as the number of orders received for artificial limbs rose inexorably from 4,079 in 1939-40 to 6,738 by 1943, enemy air attack and heavy military traffic slowed production and distribution from the factories to the fitting centers,” Phillips wrote.
Need for prostheses expands and changes
In 1944, new or enlarged centers opened in Manchester, Cambridge, Reading, Birmingham, Nottingham and Aberdeen. A new center at Tunbridge Wells eased the burden at Roehampton, which also underwent expansion. “The pressure of new war primary arm cases eventually forced the centralisation of new arm supplies and training in their use to Roehampton, Leeds and Glasgow, thus reducing the workload on, for instance, Cardiff, where Blatchfords had in the inter-war years maintained their own representatives,” according to Phillips [sic].
The Blatchford company had last earned a patent in 1932. But the company earned another one in 1942, the first in another cluster of patents connected to improvements in artificial arms and elbow joints, according to Phillips.
At first, the government supplied free limbs only to veterans. In 1940, civilian air raid victims were given one limb, “duplicates being added by March 1943.” Schoolchildren who lost limbs other than from enemy action were not entitled to free artificial arms or legs, but “were fitted on a contributory basis under the aegis of the Ministry of Health,” Phillips wrote.
After the war, the patient base for artificial limbs greatly expanded when the Labour Party won a majority in parliament and moved toward the creation of a National Health Service (NHS), which began in 1948.
“Money no longer stood in the way of advice, early diagnosis and speedy attention became paramount, and hospitals were taken into public ownership,” Phillips wrote.
From the start, Blatchford supplied limbs to the NHS, which operated under the Ministry of Health. Ultimately, the ministry requested Blatchford to concentrate on lower limb prostheses. In the 1950s, the company developed a new knee that would stabilize while bearing weight yet swing freely during walking, thereby creating a natural walking pattern.
Innovation continued apace after 1963, when the company moved to Basingstoke, a town in Hampshire, about 48 miles southwest of London. In the 1970s, Brian Blatchford, the founder’s grandson, designed Britain’s first modular assembly prosthesis. The limb could be built from stock parts, thus enabling larger numbers of amputees to be fitted more quickly. The innovation won Blatchford the coveted Queen’s Award and Design Council Award.
Additional innovations throughout the years included:
- 1980s: The Endolite Carbon Fiber System, which employed lightweight, high-strength components developed from the aircraft industry and led to the development of flexible feet and shins that would allow energy return to enhance walking and sports activities;
- 1990s: The Intelligent Prosthesis, or “IP,” the world’s first commercially available hard-wired microprocessor-controlled prosthetic knee;
- 1990s: An injection-molded volume limb system for widespread use in developing countries;
- 2004: Endolite’s first full carbon fiber foot and expanded the microprocessor knee range. The foot featured a patented independent heel and toe for better ground compliance. The adaptive knee was a hybrid pneumatic/hydraulic microprocessor controlled knee, able to detect ramps, stairs and speed changes and respond accordingly, helping the wearer achieve a more natural gait;
- 2006: The Brio, the first independent heel height adjustment device;
- 2008: The Echelon, the first commercially available hydraulic ankle foot system;
- 2012: The Elan, the first microprocessor-controlled ankle-foot system with patented assist and brake features; and
- 2013: The Avalon, the first commercially available hydraulic foot system for K2 users.
In 2014, Endolite’s product line expanded to include silicone liners. This year, in conjunction with the company’s 125th anniversary, Endolite introduced the Linx, the world’s first fully integrated microprocessor-controlled lower limb system.
“The Linx utilizes an integrated system of microprocessors, sensors and actuators for simultaneous control of the foot and knee,” Sue Borondy, Endolite USA marketing and communications manager, told O&P News. “This is the only lower limb system utilizing bi-directional communication to coordinate the response to variations in terrain and speed, adjusting for the situational needs of the user.”
- Phillips G. Best Foot Forward: Chas. A. Blatchford & Sons Ltd., (Artificial Limb Specialists) 1890-1900. Cambridge, Mass.: Granta Editions, 1990.