“A forgotten generation”: medical care for disabled veterans of the First World War in independent Ireland

ABSTRACT

The First World War is often regarded through the prism of commemoration and remembrance of the dead and missing of that conflict, a lost generation. The men and women that returned, especially those who were disabled by their wartime service can be considered a Forgotten Generation. Literature about casualties of the war tend to focus on shell-shock also known as neurasthenia. The physically injured tend to be overlooked, despite numbers that far outnumber neurasthenic cases. The British Ministry of Pensions established clinics and hospitals in Ireland to care for both physical and psychological casualties. After the war, and the later establishment of the Irish Free State, these facilities were retained for the continuing treatment of veterans who had been awarded a disability pension for wounds, injuries or illnesses that were directly attributable to their war-time service. Internal British government correspondence described the services as an Imperial Obligation to be maintained until the last surviving disabled veteran had passed away.

KEYWORDS:

• First World War
• disability
• treatment
• hospitals
• pensions
• Imperial Obligation

During the decade of commemoration in Ireland, the term Lost Generation is sometimes used to describe young men killed during the world war. Their deaths are usually brought to the attention of the public on commemorative occasions. An important message from such instances is that there was a diminution of a country’s post-war potential because of these losses. While it is normally considered in a British or Dominion context, the idea has often been applied to the fallen of other combatant nations.¹ The newly independent Irish Free State was not an exception to this experience, as evidenced by the many thousands of participants in Armistice Day commemorations in the post-war period.² Although the Great War dead might be considered to be a Lost Generation, their memory has been preserved through monuments such as the War Memorial Gardens at Islandbridge. The exact number of Irishmen who died differs according to the sources used, and in all probability is unlikely ever to be finalised. What is certain is that many more service personnel survived the ordeal to return to a country that had changed from the one they left. The men and women that returned, especially those disabled by their wartime service can be considered a Forgotten Generation. They have no public memorial except perhaps some entries in long neglected official documents and the fading memories of their families.

Since 1918, there are few aspects of the First World War that have not been examined or held up to scrutiny of academic, political and individual opinion. The experiences of Irish service personnel have been recounted in published general histories, biographies and diaries. Notable academics have examined the Irish involvement in the conflict. Keith Jeffery published a collection of his lectures on aspects of Ireland and the Great War and focused on enlistment in one piece, noting that the vast majority of Irishmen served voluntarily, before moving on to examine the history of the three Irish divisions. Irish cultural responses, particularly in art and literature are also discussed before addressing the topic of Irish politics and the collective memory of the war.³ Remembrance and commemoration form a very significant proportion of Great War publications. Catherine Switzer looked at the significance of the Somme battlefield in the memory and present consciousness of Ulster and Ireland. Her work, Ulster, Ireland and the Somme, is an acknowledgement of the different status the events and the memories of that battle have in the consciousness of the two jurisdictions on the island. It is a detailed examination of how battlefield memorials came to be erected and their position in the somewhat more inclusive climate of commemoration that has evolved in recent years.⁴

Enlistment across the four provinces with reference to the economic, religious and political circumstances that existed in Ireland has been explored by David Fitzpatrick. He addressed the fall-off in recruitment both north and south as casualties increased as well as the contentious topic of conscription in Ireland.⁵ Research on the post-war years has tended to focus on the remembrance and the associated commemorative ceremonies. Jennifer Wellington’s work on efforts to put the war on public display illustrates one aspect of this process.⁶ During the 1980s and 1990s, Jane Leonard collected oral histories of Irish veterans that dealt with more personal topics such as homecoming, hostile attitudes towards British servicemen, unemployment and interactions with the IRA.⁷ She continued with a contribution to an edited volume of First World War related essays.⁸ Both David Fitzpatrick and Peter Hart noted that ex-servicemen were both visible and easy targets for violence.⁹ This was investigated further by Peter Taylor who touched on the fate of disabled Great War veterans in southern Ireland.¹⁰

Disabled veterans often endured recurring surgeries or chronic illnesses there were constant reminders of the cost they had paid for their service. Progressing from the work of Joanna Burke and Deborah Cohen,¹¹ a significant amount of research on the health issues facing Great War veterans in the British Isles has concentrated on personnel suffering from various psychological issues.¹² These injuries are now widely acknowledged, but a century ago, this was not so. Personnel with diseases and other less visible injuries were often held in lower regard than those with more obvious wounds.¹³

The Ministry of Pensions was formed on 22 December 1916 in order to deal with the medical treatment of discharged military personnel and the award and administration of pensions for wounds or injuries sustained during the war.¹⁴ Statistics published in the Annual Reports of the Ministry from 1918 to 1939, show that a surprising number of disability pensions were awarded for non-combat conditions, i.e. because of illness and disease, and not because of the effects of weapons.¹⁵ Closer scrutiny shows that an average of 6% of pensions granted were included as neurasthenic illnesses and these were in the non-combat category. The re-categorisation of neurasthenic pension awards into the wound classification still leaves over 50% of disability pensions awarded for diseases or illnesses. This seems at odds with the common perception of casualties of the war, one that has been challenged by some scholars.¹⁶ This article looks at the medical facilities available to all disabled veterans of the First World War in Ireland, but with particular emphasis on the more than 90% of personnel who received a disability pension for reasons other than a neurasthenic condition.¹⁷

Following the collapse of empires across Europe and the Middle East, many veterans found themselves within the borders of newly established countries, some of which had not existed before as independent states or had not been independent for many generations. In some cases veterans found themselves within a jurisdiction that was openly hostile to the regime they had fought for. Many found the transition to being a citizen of their new country uncomfortable, occasionally traumatic and sometimes violent. The Irish Free State was unique in that not only was it remote from the chaos of Central Europe, but also because it was part of an empire that not only still existed but had reached its greatest geographic extent after the war. More importantly for veterans in the Free State, the support structure established during the war years remained in place, albeit at a reduced capacity and under more demanding conditions than that prevailing in mainland Britain.

At the outbreak of the First World War, the Royal Army Medical Corps (RAMC) was responsible for the health and well-being of the British Army.¹⁸ However, as was the case with all armies, the early casualty roll all but overwhelmed the available medical services.¹⁹ To alleviate this and with the approval of the Army Council in London, organisations such as the British Red Cross stepped in to provide additional medical staff.²⁰ As the war continued an extensive network of hospitals, convalescent establishments and rest homes for sick and wounded personnel was established across Ireland. The Dublin area alone had at least thirty-three medical institutions ranging from the King George V military hospital (now St. Bricins Military Hospital), to smaller establishments such as the Monkstown Auxiliary Hospital in Kingstown.²¹

Because of the number and nature of the wounds and illnesses encountered many personnel often needed extensive surgery with long periods of aftercare. This was an unanticipated situation for the War Office and Admiralty. The government was sufficiently concerned to quickly accept the findings of the first substantial report on personnel discharged from the armed services because of wounds or illness that was published in April 1915. This stated that the rehabilitation and retraining of discharged personnel was a necessary function of central government. The report, prepared for the President of the Local Government Board in London, was the forerunner of subsequent pension and medical treatment legislation.²² The Naval and Military Pensions Act, &c, 1915 was the first of several acts that enshrined in law the government’s responsibilities and powers to provide pensions and medical treatment for personnel disabled by war service, including members of various nursing organisations who were disabled in the course of their duties. The act also made provision for the award of pensions to widows, orphans and other dependants of deceased service personnel.

The Ministry of Pensions, which was formed by the coalition government of David Lloyd George, combined the duties and powers of the various military and voluntary organisations involved in war pension administration and medical treatment, under the overall control of a government minister, although he in turn was under the strict oversight of the Treasury. As time passed, the minister was invested with wide-ranging powers and oversaw an organisation that rapidly grew to employ over 20,000 administrative staff by early 1920. Many of the workers were women, particularly in lower level clerical positions, or disabled veterans who were hired as a result of a policy of positive discrimination towards them.²³

Throughout the 1920s and 1930s, the various First World War pensions, allowances and grants paid by the British Exchequer made a significant contribution to the well-being of many thousands of Irish Free State citizens. The amount paid in military pensions to residents of the Irish Free State was not insignificant. By 1926, it was estimated to be at least two million pounds.²⁴ That total varied little until the end of the decade, when for a variety of reasons such as veterans dying, widows deciding to re-marry or children growing up and becoming ineligible for pensions, it gradually declined. Within the limits set by government social and financial policy, the Ministry of Pensions met its Imperial Obligation²⁵ to disabled veterans and other pensioners of the First World War, and Irish veterans and their dependants were treated no differently than their counterparts in Britain.²⁶ This was apparent as early as early 1917, when the Parliamentary Secretary Arthur Griffith-Boscawen stated that

The very last place we want to see the disabled soldier to go to, whether it be in England, Ireland, Scotland, or Wales, is the workhouse […] we are quite prepared to take any steps we can to see that some sort of national system for the treatment of disabled soldiers is formed in Ireland whereby all the different facilities for the treatment of those who require it and for training those who can be re-educated in a new way when they are no longer able to carry on their former vocation shall be pooled and placed at the disposal of the broken soldier.²⁷

Although seldom regarded as sufficient, the scheme of financial aid, medical treatment, combined with additional supports provided by organisations such as the Royal British Legion provided a level of succour that was not available to many other sections of the population.

Both during and after the war, disability pensions could be awarded to personnel who were discharged as being unfit for further military service. A veteran who claimed a disability that was assessed as being at 20% or higher was normally awarded a pension, the amount of which was linked to their degree of disability. Pensions were often temporary at first, especially if a veteran was still receiving medical treatment. When the treatment ceased or had achieved the best possible outcome, a medical board fixed the level of a permanent pension, although this decision could be appealed if it was felt to be unfair. Veterans whose disability was assessed as less than 20% were awarded a gratuity to be paid weekly, typically for six months, after which time all liability of the Ministry of Pensions to that individual in regard to their disability ceased. Despite complaints about the inadequacy of pension levels, the free medical care that came as part of a disability pension award made them highly desirable.

As the war ended and demobilisation gathered pace, disabled veterans in Ireland could benefit from what was in effect a three-stage system of medical care. This might be considered the least that could be expected, especially for those who had been seriously wounded or who had contracted a chronic illness. The options available were, treatment by a local general practitioner; treatment as an outpatient at a civilian or Ministry of Pensions hospital; or treatment as an in-patient at a Ministry hospital or a civilian hospital if specialist care was necessary. This is not to suggest that they had a free choice in the level of service they could avail of. The type of treatment offered was normally decided by medical referees working on behalf of Local War Pension Committees. These committees, of which there were at least one in each county and major city in Ireland, consisted of civilian volunteers who worked for the benefit of disabled veterans, widows and all others in receipt of pensions or allowances from the Ministry of Pensions. It was they and their medical advisors who considered the degree of disability and the availability of an appropriate clinic or hospital in their area.²⁸ The preferred official option was normally for a medical establishment operated by the Ministry itself.

It was envisioned that the G.P. Treatment Scheme would cater for pensioners who could not attend at Ministry establishments, either because of an inability to travel or because the nature of their disability did not need expert care. While the war was still in progress, officials worked to develop a scheme whereby disabled veterans in Ireland received treatment based on their contributions under the National Insurance Acts. Arrangements were made with the National Health Insurance Commission (Ireland) to act as the agent for the Ministry of Pensions to process payments to G.P.s for every medical consultation with eligible veterans.²⁹ Across the British Isles it was estimated that less than 5% of men who joined the New Armies were uninsured when they enlisted, but this total was higher in Ireland. Initially it was thought that 25% to 60% of the estimated 168,00 Irishmen serving in the British forces might make claims of some sort under this scheme, but this was later reduced to about 6% of demobilised Irishmen.³⁰ The system was introduced to Ireland in October 1917³¹ and by April 1919, a total of 984 doctors had signed up to provide G.P. services for disabled ex-servicemen.³²

The G.P. scheme continued after the foundation of the Free State, with the National Health Insurance Commission continuing to act as the agent for the Ministry of Pensions even through the sometimes uneasy relationship between both governments. Payments to doctors for the medical treatment given remained as before, but there was ongoing concern among Treasury officials about the higher cost of the scheme in Ireland than in Britain. Treasury figures put the cost of the scheme for veterans in Britain at just under £700 each year. However in the Irish Free State, nearly three times as many Great War veterans availed of the service than did in Britain, approximately 27,000 personnel. The annual estimate should have been £2,100; however the actual cost was nearer £2,600. A Treasury memo noted that although “we do not have enough information as to the details of the work performed to be able to check that figure closely, but from our knowledge of what work must be done we can safely say that there cannot be gross extravagance in the administration.”³³

A contributing factor to the extra expenditure in the Free State was that under the terms of an inter-governmental agreement all expenses for the work done by southern Irish officials was reclaimed by the Free State Ministry of Finance.³⁴ The requests for re-imbursement were sent from the Department of External Affairs in Dublin through the Dominions Office, to the Ministry of Pensions. They were comprehensive in itemising costs. Items listed included each civil servant employed and for how long. They often included other items such as stationery, postage and overheads such as rent and rates.³⁵ In the decades following the formation of the Irish state, the agreement was threatened by a series of claims and counter-claims from each side about the amount of money owed to each other. It was some time before this was resolved, mainly as a result of each side realising that they owed each other roughly the same amount. The payment of administrative costs carried on each year even through the diplomatic difficulties of the 1930s. The correspondence of the Minister for External Affairs in relation to the G.P. scheme is a model of polite, business-like communication that reveals nothing of the tensions that sometimes existed between the governments.³⁶ There is evidence however, that strongly suggests that British government officials sometimes deliberately avoided disagreements with their Free State counterparts over the size of financial claims in order to maintain the medical service for the disabled pensioners.³⁷ The G.P. treatment scheme remained in operation until the need ceased when the last Great War pensioner passed away. Throughout its operation there was an acceptance not only within the Treasury, but in all departments dealing with disabled veterans that G.P. treatment was part of a continuing Imperial Obligation despite it was said “being framed in such a manner as to give a disabled veteran more than his due even to the extent of getting treatment for a head cold”.³⁸

The second level of medical services available to disabled veterans of the Great War in Ireland were outpatient clinics that offered more specific treatment. They were located in either civilian or Ministry run hospitals and continued their work for some time after the war. For example, in November 1920, 2,199 ex-servicemen made 14,727 separate visits to civilian hospitals in Dublin city.³⁹ As time moved on concern arose that disabled servicemen did not receive the best possible care in civilian clinics, although through no fault of the establishments concerned. A Ministry of Pensions committee of enquiry identified prolonged periods of treatment, protracted waiting times and inconvenient opening hours as the main factors militating against the continued use of these facilities, although their continued use in special cases was not ruled out.⁴⁰ Another influencing factor was the drive to reduce administrative and medical expenditure in the harsh financial situation facing governments in the post-war years.

As a way of achieving this reduction, the Ministry in early 1921 decided to establish its own specialised clinics throughout the British Isles. In the South Ireland region, consisting of the whole island excluding the nine Ulster counties,⁴¹ the first was in Dublin treating neurasthenia and tropical diseases, both conditions being regarded as outside the experience of most G.P.s and civilian hospitals. It was proposed to open aural, cardiac and ophthalmic facilities in due course and an additional neurasthenic clinic in Cork city.⁴² By the middle of the following year, a widespread network of general clinics had been established along with revised instructions as to their use. Ministry of Pensions Instruction No. 241 addressed the main problems with the procedures previously in force by centralising as much aftercare as possible for disabled veterans under direct Ministry control.⁴³ Despite the uncertainty and danger of life in Ireland at that time, the network of clinics spread, and they did appear to achieve their dual purpose of cutting costs while providing continuing care for disabled veterans. Correspondence from the Deputy Commissioner of Medical Services for the Dublin General Medical Clinic confirms this. In June 1922, he told the Ministry of Pensions that practically every case previously dealt with by civilian clinics had been transferred to the Ministry run facility, apart from a few cases attending the Eye and Ear Hospital.⁴⁴

The resultant reduction in Ministry of Pensions expenditure was such that it elicited that most uncommon of official documents, namely a note of praise from the Lords of the Treasury, who wrote concerning

the reduction in expenditure consequent upon the establishment of General Clinics. In reply I am to request you to inform the Minister of Pensions that My Lords note with satisfaction the reductions in the quarterly expenditure on outpatient treatment which had taken place between September 30^th, 1921, and September 30^th, 1922.⁴⁵

Some ten years after they were first established, there were full or part-time clinics co-located with Ministry of Pensions administrative offices in eight sites in the Free State, at Cork, Limerick, Waterford, Drogheda, Birr, Kilkenny, Sligo and Galway, in addition to one at the Ministry headquarters for Southern Ireland in Merrion Street, Dublin.⁴⁶

As the number of veterans needing treatment fell, the temporary wartime hospitals were closed until there were only two Ministry of Pensions hospitals for sick and wounded ex-service personnel. They were the Special Orthopaedic Hospital in Blackrock and the Leopardstown Park Hospital, both in south county Dublin.

On 8 March 1917, partly in response to the casualties from the Somme offensive, the Secretary of State for War took over the Meath Industrial School for Boys on Carysfort Avenue, Blackrock just north of Kingstown (Dun Laoghaire).⁴⁷ From the outset it was an important medical facility. By November 1918, it included an operating theatre with an x-ray room, a massage room, gymnasium and Y.M.C.A. hut. Wounded or sick officers had a separate ward and dining area away from the main building and the areas designated for enlisted men. The accommodation for the latter group was in eight wooden huts south of the main building. The huts were used as wards, each of which accommodated twenty beds, giving a capacity of 180 patients, plus an additional unspecified number of patients housed on the upper floors of the main building. The months before the armistice saw almost continuous offensive action by the British Army with resultant heavy losses.⁴⁸ To deal with the extra patients reaching Blackrock, five more hut wards were built, four of which could house forty patients each. This extra capacity allowed the number of patients to be doubled.⁴⁹ By the middle of 1919, the Blackrock hospital had beds for 20 officers and 500 enlisted men.⁵⁰

In the same year, ex-King Manuel of Portugal, as chairman of a special Orthopaedic Department of the Red Cross charged with establishing and equipping curative workshops in orthopaedic centres throughout the British Isles, reported that “there is not a doubt that this centre, although not a very large one, is one of the best”.⁵¹ The excellence of the hospital facilities provided by the Ministry of Pensions was recognised, not only within the British medical establishment, but also within the military hierarchy of the emerging Irish Free State. In a letter to the de facto Irish Minister of Defence concerning the Blackrock and Leopardstown hospitals, the surgeon of the south Dublin Brigade of the IRA reported that “they are splendidly equipped and if they are taken over by the Irish Government I suggest that they should be utilised for the treatment of suitable cases in the IRA”.⁵² Had these facilities passed into the hands of the new state, the lot of the sick and wounded of the years of conflict may have been greatly improved.

Leopardstown Park Hospital was originally set in 100 acres of land adjacent to the well-known racecourse in south county Dublin. It had been gifted to the Ministry of Pensions by Mrs Gertrude Dunning in 1917 for the treatment of wounded soldiers for as long as the Ministry needed it.⁵³ It became the main treatment centre for neurasthenic patients in southern Ireland. Although neurasthenia accounted for such a small proportion of disability pension awards, it may have been a contributing factor in other pension awards, an opinion that has been proposed recently.⁵⁴ The hypothesis cannot be verified or denied definitively, but using records such as newspaper reports, there are indications that many Great War veterans displayed behaviour similar to that of veterans of modern conflicts, behaviour that has been identified as Post Traumatic Stress Disorder.⁵⁵

A recent history commemorating the centenary of the Leopardstown Park Hospital, suggests that the only veterans treated at Leopardstown were those suffering from neurasthenic disorders.⁵⁶ However, an examination of the annual Ministry reports show that from 1925–6, Leopardstown was classified as a general hospital for the surgical and medical treatment of disabled veterans. At this time the hospital had accommodation for 136 patients. This was in addition to a total of 313 patients in Blackrock.⁵⁷ Leopardstown Park retained this general capability until the 1929–30 reporting year, when it seems to have reverted to a neurasthenic only hospital. A year later, in 1931, it was amalgamated with Blackrock. At this time it not only became the sole Ministry of Pensions owned and operated hospital in the Irish Free State, but it also became the only fully owned and operated Ministry of Pensions hospital outside mainland Britain.

The decision to close one of the Ministry hospitals evolved over a number of years and was driven by two important factors. The first concerned the number of patients. The numbers admitted for treatment had reduced year on year, a factor that produced surplus capacity in both hospitals. In the second half of 1928, the Ministry estimated that demand would be at a level that could be supported by just one hospital by 1930, but there were difficulties in deciding which hospital to retain. In early September, Mr. T.A. Pole from the Ministry of Pensions visited both hospitals in Dublin to consider the situation at first hand.⁵⁸ His report took several factors into consideration including accessibility of each site. He found little to choose between either hospital, but that Blackrock had an edge in regard to public transport,being closer to Kingstown (Dun Laoghaire) with its associated temptations for more ambulatory patients. It was considered that the hospital was situated in a poor class of locality and that it was also in a low-lying area. Leopardstown on the other hand was situated in a healthier environment at the foot of the Dublin Mountains which enhanced the case for selecting it.

The second factor involved the overall running and maintenance costs of the hospitals. Pole estimated that the overhead charges for rent, rates, and utilities in Blackrock at £2,737 per annum. At Leopardstown due to the circumstances of its acquisition as a gift for use as long as was necessary, there was no rent, rates were not mentioned, and utilities came to £344 per annum. Finally, there was the condition of the buildings at each location. In Blackrock because many of the wards, kitchens, stores and workshops were housed in standard war utility huts, their deteriorating condition was considered and the increasing maintenance costs calculated. The report concluded that remedial building work at Blackrock would cost approximately £7,000 in addition to the recurring overheads. The cost of the work at Leopardstown was estimated at £13,500 plus recurring overheads that were less than one eighth of those at Blackrock. The report came down in favour of Leopardstown because of its security of tenure, its lower current and future expenditures and especially because of the healthier location. It should be noted that unlike the extra cost of the G.P. Treatment Scheme in Ireland compared to the UK, the cost of maintaining patients in Blackrock and Leopardstown Park had remained well within acceptable limits as shown by Table 1.⁵⁹

Table 1. Running costs of Ministry of Pensions Hospitals in Irish Free State and comparison with UK mainland hospitals with highest and lowest running costs

	Total cost of in-patients (excluding rent, rates and taxes) per annum	Average cost per annum per bed occupied	Average cost per in-patient per day
Blackrock	£45,212	£158 12s 9d	8s 8d
Leopardstown	£17,260	£141 9s 6d	7s 9d
Irish Free State Total	£62,472 (10.4% of UK budget)
		Highest & Lowest average cost in UK	Highest & Lowest average cost in UK
British Isles Total	£599,464	£247 7s 4d	13s 6d
		£87 16s 5d	4s 10d

Statistics drawn for House of Commons written reply regarding Ministry of Pensions Hospitals given on 10 March 1927 for the period 1 February 1926 to 31 January 1927.

It is difficult to determine the number of disabled pensioners who availed of these medical facilities with absolute accuracy. The statistics presented in the annual reports from the Ministry of Pensions were for the whole of the British Isles without differentiation between the jurisdictions. However, it is possible to find snapshots at two moments in time almost a decade apart. At the end of 1924, the Ministry of Pensions informed the National Health Insurance Commission that there were about 28,000 veterans entitled to treatment under the G.P. scheme.⁶⁰ Later in 1932, a British government memo stated there were 21,200 ex-service personnel, 2,700 widows and 6,000 dependants of dead or disabled veterans across the Irish Free State getting some form of pension or allowance from the Ministry’s budget.⁶¹

In the aftermath of the Great War, the Irish Free State was unique as the only nation state to break away from a victorious allied power, but there are similarities between it and the nation states that emerged, for instance, from the Austro-Hungarian empire.⁶² Much work remains to be done on how demobilised service personnel were regarded in states that were unable or unwilling to contribute to the aftercare of the military veterans of fallen empires. With this in mind, the commitment of successive British governments to the care of its veterans in Ireland must be recognised, despite many faults and harsh economies that existed, the sometimes Byzantine bureaucracy and the varying political motivations of the parties involved. Disabled Irish veterans enjoyed the benefits of the support system on an equal basis with their old comrades in the United Kingdom. No evidence has been found to suggest that any other course of action was seriously considered. That they were not considered a significant grouping by Irish governments in the decades following independence is scarcely surprising given the contentious manner in which veterans of the Irish revolution were treated in their own land.⁶³ Irish veterans of the Great War seldom feature in the historiography of the early years of Irish independence. The absence of disabled or able-bodied Great War veterans from the narrative of the early decades of the Irish state, along with disregarding of families of the dead and missing of the First World War except as sometimes as victims of a mean and small-minded welfare system,⁶⁴ has meant that secondary literature does not embrace the story of this extended community. This article deals with just one of the practical procedures that were put in place to assist disabled veterans in their post-war lives. This account gives only a brief glimpse into an extensive and complex system that cared for many thousands of Irish people over many years.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. Winter, “Britain’s ‘Lost Generation’ of the First World War”; Hucker, “Battle and Burial”; and Goebel, “The ‘Sleeping Dead”.

2. The Irish Times, November 14 &17, 1925; and Weekly Irish Times, November 21, 1925.

3. Jeffery, Ireland and the Great War.

4. Switzer, Ulster, Ireland and the Somme.

5. Fitzpatrick, “The Logic of Collective Sacrifice”.

6. Wellington, Exhibiting War, the Great War, Museums, and Memory.

7. Leonard, “Facing ‘The Finger of Scorn’”.

8. Leonard, “Survivors.”

9. Fitzgerald, The Two Irelands 1912–1939, 95; and Hart, The IRA and Its Enemies, Violence and Community in Cork.

10. Taylor, Heroes or Traitors?

11. Bourke, Dismembering the Male; and Cohen, The War Come Home.

12. Robinson, Shell-Shocked British Army Veterans in Ireland.

13. Annual Reports of the Minister of Pensions 1918–1939. In the compilation of official figures for disability pensions awarded by the Ministry of Pensions, psychological conditions were included in the disease or non-combatant category and as such are retained in that category for this study.

14. No Author, “New Ministries in the British Cabinet,” 770–1.

15. First Annual Report of the Minister of Pensions to March 31, 1918, 140. Wounds and injuries accounted for 42.4% and disease for 57.6% of pensions awarded. Re-categorising neurasthenic conditions as wounds results in 48.3% for wounds and injuries and 51.7% for disease.

16. Griffith, Battle Tactics of the British Army.

17. For more on neurasthenic patients in Ireland, see Kelly, He Lost Himself Completely, Shell Shock and Its Treatment at Dublin’s Richmond War Hospital for a survey of the clinical files of a number of service personnel. For a view over a longer timescale, see Robinson, Shell-Shocked British Army Veterans in Ireland.

18. The Museum of Military Medicine, History of the Royal Army Medical Corps. May 1, 2020. https://museumofmilitarymedicine.org.uk/about/corps-history/history-of-the-royal-army-medical-corps/.

19. Mayhew, Wounded, the Long Journey Home from the Great War, 4–7; and Hastings, Catastrophe, Europe Goes to War, 301.

20. Reports of the Joint War Committee and the Joint War Finance Committee of the British Red Cross Society and the Order of St. John of Jerusalem in England on Voluntary Aid Rendered to the Sick and Wounded at Home and Abroad and to British Prisoners of War, 1914–1919, 1–4 & 74–83.

21. Hospitals identified are Blackrock Military Orthopaedic Hospital, Corrig Castle Hospital, Fetherstonehaugh Convalescent Hospital, Leopardstown Park Hospital, Linden House Auxiliary Hospital, Monkstown Hospital (Naval), Monkstown House Auxiliary Hospital (Officers), Rockfield Auxiliary Hospital, St. Michael’s Auxiliary Hospital, Stillorgan Auxiliary Hospital, Temple Hill Auxiliary Hospital. The list has been compiled from the following sources: Baker, “Military hospitals in the British Isles 1914–1918,” The Long Long Trail, May 1, 2020. http://www.longlongtrail.co.uk/soldiers/a-soldiers-life-1914-1918/the-evacuation-chain-for-wounded-and-sick-soldiers/military-hospitals-in-the-british-isles-1914-1918/; Fleetwood, The Military Orthopaedic Hospital Blackrock; and No author, Royal Irish Automobile Club War Services, 35.

22. Report of the Committee appointed by the President of the Local Government Board upon the Provision of Employment for Sailors and Soldiers Disabled in the War, 3–5.

23. Third Annual Report of the Minister of Pensions from April 1, 1919 to March 31, 1920, 11 & 44.

24. Kiernan, “The National Income of the Population of the Irish Free State in 1926”.

25. Ministry of Labour memo dated July 27, 1923-1924 (NAUK, Admin of Training Scheme as Result of Government of Ireland Act 1920, LAB2-528-TDS1181-1921). The term is capitalised in original.

26. Robinson, “Nobody’s Children?” 321.

27. Hansard, HC March 19, 1917 vol 91 c1678, Ministry of Pensions.

28. The Local War Pensions Committees, Handbook.

29. Ministry of Pensions Memo dated February 14, 1918 (NAUK, GP Treatment in Ireland 1918–19, PIN15/139).

30. Ministry of Pensions memo dated December 13, 1918 (NAUK, GP Treatment in Ireland 1918–19, PIN15/139).

31. The War Pensions Gazette No 20 December, 1918, 256.

32. Correspondence from National Health Insurance Commission (Ireland) to Ministry of Pensions dated 17 April 1919 (NAUK, GP Treatment in Ireland 1918–19, PIN15/139).

33. Treasury memo dated December 15, 1924 (NAUK, GP Services for Pensioners in Irish Free State, T160/1174/10).

34. Expenses of administration. Letter from Ministry of Finance to The Treasury dated January 5, 1925 (NAUK, GP Services for Pensioners in Irish Free State, T160/1174/10).

35. Correspondence from the Department of External Affairs, Dublin to the Dominions Office, London dated November 10, 1937 (NAUK, GP Services for Pensioners in Irish Free State, T160-1174-11).

36. Correspondence from Minister of External Affairs to Secretary of State for Dominion Affairs dated September 10, 1932 (NAUK, GP Services for Pensioners in Irish Free State, T160/1174/10).

37. Correspondence from Treasury to Ministry of Pensions dated September 9, 1935 (NAUK, GP Services for Pensioners in Irish Free State, T160-1174-11).

38. Treasury memo dated December 12, 1924 (NAUK, GP Services for Pensioners in Irish Free State, T160/1174/10).

39. Summary of returns from Regional Financial Officers in respect of outpatient treatment at the cost of the Ministry in non-Ministry institutions for December, 1920 (NAUK, Ministry of Pensions Clinics, PIN15/134).

40. Report of the Departmental Committee of Inquiry into the Machinery of Administration of the Ministry of Pensions, 102.

41. Ministry of Pensions memos dated October 28, 1919 & March 24, 1920 (NAUK, Reports from Regional Directors 1919–21, PIN56/24).

42. List of proposed Ministry of Pensions clinics in towns in UK dated February 23, 1921 (NAUK, Ministry of Pensions Clinics, PIN15/134).

43. Ministry of Pensions Instruction No. 241 dated June 19, 1922 (NAUK, Ministry of Pensions Clinics 1920, PIN15/136).

44. Correspondence from Ministry of Pensions Ireland (South) to Ministry of Pensions London dated June 28, 1922 (NAUK, Ministry of Pensions Clinics 1920, PIN15/136).

45. Correspondence from Treasury Chambers to Ministry of Pensions dated March 24, 1923 (NAUK, Ministry of Pensions Clinics 1920, PIN15/136).

46. Correspondence from Ministry of Pensions to Dominions Office dated June 21, 1932 (NAUK, Leopardstown Park Hospital, political situation in Irish Free State, MH79/451).

47. Correspondence from Office of Public Works, Dublin to H.M. Office of Works dated June 26, 1931 (NAI, Leopardstown Park Hospital adaptation, OPW 6439/32).

48. Neillands, The Great War generals on the Western Front, 483–505.

49. Architectural plans dated November 19, 1918 (NAI, Military orthopaedic hospital Blackrock, OPW/5HC4/938).

50. Architectural plans dated September 2, 1919 (NAI, Military orthopaedic hospital Blackrock, OPW/5HC4/938) & Reports of the Joint War Committee and the Joint War Finance Committee of the British Red Cross Society and the Order of St. John of Jerusalem in England on Voluntary Aid Rendered to the Sick and Wounded at Home and Abroad and to British Prisoners of War, 1914–1919, 737.

51. Reports of the Joint War Committee and the Joint War Finance Committee of the British Red Cross Society and the Order of St. John of Jerusalem in England on Voluntary Aid Rendered to the Sick and Wounded at Home and Abroad and to British Prisoners of War, 1914–1919, 737.

52. Fleetwood, The military orthopaedic hospital Blackrock, 13–4.

53. Eighty-sixth Annual Report of the Commissioners of Works in Ireland with Appendices for the Year Ending March 31, 1918, 10.

54. Winter, Keynote Speech, What Tommy did Next Symposium.

55. Irish Independent September 18, 1928, 9; and Cork Examiner September 4, 1928, 2.

56. Kinsella, Leopardstown Park Hospital a Home for Wounded Soldiers, 96.

57. Ninth Annual Report of the Ministry of Pensions from April 1, 1925 to March 31, 1926, 30.

58. Correspondence from Ministry of Pensions to Office of Works, Dublin dated September 10, 1928 (NAI, Blackrock and Leopardstown MoP Hospitals proposed amalgamation, OPW/1600/29).

59. Hansard, HC 10 March, 1927 vol 203 c1377.

60. Correspondence from Ministry of Finance, Dublin to the Treasury, London dated December 2, 1924 (NAUK, GP Services for Pensioners in Irish Free State, T160-1174-10).

61. Correspondence from Ministry of Pensions to Dominions Office dated June 21, 1932 (NAUK, Leopardstown Hospital – Situation in Irish Free State, MH79-451).

62. Cornwall and Newman, eds, Sacrifice and Rebirth.

63. Coleman, “Military Service Pensions for Veterans of the Irish Revolution,” 201–21.

64. See Kildare County Board of Health minutes 15 February 2021 June and December 17, 1926 for examples of investigations of, and legal actions against, alleged false claims for Home Assistance by individuals while in receipt of British military pensions.