The apparatus here described is not identical with that illustrated in the text. It represents an improved design (see photograph).

When Sir Robert Jones did me the honour of asking me to take charge of the Massage Department of the Military Orthopaedic Hospital, Shepherd's Bush (now the Special Surgical Hospital), I had already seen enough of military practice to be able to realise the relatively small part that massage pure and simple should play, when compared with the vast scope which is open to us for treatment by exercises. It was also apparent that it was quite impossible to secure the services of an adequate number of fully-trained medical gymnasts to look after my prospective patients, and that, therefore, something had to be done to provide the staff with a scheme of exercises which they could master satisfactorily without prolonged training.

The use of apparatus was thus indicated, but it became apparent that, if we equipped our department with the usual outfit, there would be such constant moving about from one piece of apparatus to another that the inconvenience would be very great to all concerned.

I then conceived the idea of elaborating a sort of multum in parvo apparatus, and it was at this stage that I first called to my aid the assistance of A. J. Hobbs (A.M.I.C), R.N.A.S., carpenter to the Hammersmith Guardians. Stage by stage, through months of laborious work, he helped me to perfect the apparatus here figured. Without his aid my scheme would never have materialised at all. Many hundreds of our wounded owe him much; thousands will do so before all the tale is told. It is to his pen that I am indebted for the whole of the drawings here shown to scale.

The scheme is perfectly simple. The piece de resistance, as it were, is a combined vertical ladder and peg-post. Many gymnasts would prefer a wider space between the uprights than is here provided. It was found impossible to leave adequate room for all wall-bar exercises. This drawback is of less importance when we remember that the outfit is not intended to replace a gymnasium! It was designed for treatment during the comparatively early stages of recovery only. Two rungs of the ladder are omitted near the top to allow of backward hanging. The rung above the gap is set into the front of the uprights, and not as shown in the drawing. The place of the lowest rung is taken by a metal bar, which serves to support the sliding-seat, and is also of frequent service in various foot exercises.

(The figures refer to the detailed drawings, pp. 493 et seq)

On the face of the ladder are four metal slots (two only are figured for the sake of simplicity). Into the upper pair can be slipped the lower metal attachment of two vertical poles, while the upper ends pass through the wooden plate which forms the top-piece of the ladder. These not only provide loose rods for the performance of pole exercises, but also enable a patient, who is unable to rotate the forearm into pronation, to perform almost every exercise on the ladder.

Into the lower pair of slots can be fitted the metal pins that are attached to the back of the wrist machine. This is a very simple apparatus, and has this great advantage over those usually found upon the market, that the resistance is adjusted by attachment to the weight and pulley apparatus instead of being regulated by friction. In the base of the hollow wheel (shown at the left of the roller) is a small metal hook (not shown) to which can be attached one end of the pulley cord. To the right of this will be seen the roller which is arranged in three thicknesses. A ratchet and pawl at either end regulate the direction of movement. It is used thus. A patient with stiff fingers is first instructed to place the injured hand on the thickest part of the roller, and, with the sound hand pressing upon it, he simply rolls the hands to and fro. The weights meanwhile are unattached. The process is repeated on each of the two thinner portions as well, and then the thumb is slipped under the thinnest part of the roller, the fingers passing over it. This represents the first attempt to secure a true grip. The two larger portions are tackled successively, and then the weight is attached. The patient now learns to pull up the weights by means of rolling in either direction, and a useful exercise can be added by releasing the pawl and resisting the return of the weight to the ground by the grip alone.

Rotation exercises can be arranged for pronation and supination of either arm by means of the handles at the end (see Fig. 66, p. 135).

The weight-and-pulley apparatus is also simple. Six pulleys are attached to the ladder, three on either side. One is set forward by an iron rod so that it projects over the head of the patient. The other two are attached to the side of the ladder, the lowest near the floor, the other about one-third of the way up. Behind the ladder is a long wooden box, within which is fitted a smaller travelling box containing the metal weights. On the top of the latter is a twin pulley. The cord to which the handle is attached by a spring-hook (not illustrated) passes over the overhead pulley to a second pulley placed on the front wall of the main box. Thence it passes down to the twin pulley on the top of the travelling-box, up to a third pulley on the roof of the main box, down to the other side of the twin pulley, and up to a second pulley placed on the front wall of the main box. From this the cord passes out over the second overhead pulley to the second handle. Thanks to the use of the twin pulley the cord is long enough to allow full use of the apparatus, even if the cord on both sides is led down from the overhead pulleys and behind either of the pulleys attached to the sides of the ladder. The various possibilities are shown in the first drawing. The weights are placed in the travelling-box through the lower of the two doors shown in the main box; while the second or upper door is required solely for the purposes of repair should the rope wear out.