Developments in the 19th Century

The Napoleonic wars resulted in a flood of amputees, proving a stimulus to more sophisticated and functional prostheses, at least for the wealthy. Thus,the Earl of Uxbridge,later Marquess of Anglesey, whose right leg was amputated above the knee at the Battle of Waterloo (see Fig. 5.4), was in a position to criticise his initial "clapper leg" and to commission an improvement from Potts, a leading London limb-maker, at his own expense. The resultant prosthesis evolved with knee and ankle movements coordinated, employing interconnecting catgut tendons, so that knee flexion produced synchronous ankle dorsiflexion (Fig. 13.5). In addition, its manufacture in

19th Century Artificial Limbs

Fig. 13.5. a. Marquess of Anglesey's leg made by Potts of London, c. 1820. This light limb in wood also coordinated ankle and knee movements, proving a successful solution for above-knee amputees over many years. This prosthesis is exhibited in Plas

Newedd, Anglesey. (© National Trust.) b. Anglesey's leg to show internal construction including cords to connect joint movements. (From Little EM. Artificial Limbs and Amputation Stumps: A Practical Handbook. London: Lewis, 1922: fig. 185.1)

Fig. 13.5. a. Marquess of Anglesey's leg made by Potts of London, c. 1820. This light limb in wood also coordinated ankle and knee movements, proving a successful solution for above-knee amputees over many years. This prosthesis is exhibited in Plas

Newedd, Anglesey. (© National Trust.) b. Anglesey's leg to show internal construction including cords to connect joint movements. (From Little EM. Artificial Limbs and Amputation Stumps: A Practical Handbook. London: Lewis, 1922: fig. 185.1)

Bailiff Prosthesis
Fig. 13.6. Bailiff's prosthesis for forearm amputation, the first to utilise the trunk muscles to open an artificial hand otherwise kept closed by springs, 1818. (From Watson AB. A Treatise on Amputations of the Extremities and Their Complications. Philadelphia: Blak-iston, 1885: fig. 159.4)

hollowed-out wood created a light prosthesis, much appreciated by wearers, leading to its adoption as a standard leg in the United Kingdom and America for many years.20

An important advance introduced at this time by Bailiff, a Berlin dental surgeon, involved harnessing the muscle power of the trunk and shoulder girdle to motivate finger flexion and extension of forearm prostheses, a mechanism which has persisted to the end of the 20th century (Fig. 13.6). The same mechanism was applied to above-elbow prostheses by Von Peterssen, a Dutch sculptor, in 1844, who extended catgut cords from behind the sound shoulder into the artificial upper arm segment, to the elbow and finally into the forearm segment. Other cords extended the fingers by elbow extension and shoulder abduction whilst the fingers were automatically flexed by springs.21 Similar arm prostheses were improved in 1867 by the Comte de Beaufort, who made particular efforts to ensure these were supplied to the poor, although he warned that limitations of function at the expense of power were inevitable, stating:

"Certain combinations may be made in order to vary the workings of the fingers, so as to produce diverse movements of the wrist and forearm in imitation of nature; but to overcome these difficulties it is necessary to use artifices which weakens the means of action and necessitates great expenditure of force. The marvellous, moreover, can only be obtained at the price of certain sacrifices."22

Others tried to manufacture hands with normal function but, for most manual trades and crafts, simple working arms with devices such as hooks were significantly more practical for power activities, especially for lifting. Bigg displayed several of these for soldiers after the Crimean War (Fig. 13.7); provision of working hands was usually accompanied by a nonfunctioning dress hand for social occasions. However, until the 20th century the function of many artificial hands and arms depended on the normal limb and especially the power of the good hand to change hooks and other tools.

In 1846, Palmer of Philadelphia's leg was claimed a great improvement over the Anglesey leg, having a spring in the foot to impart lifelike firmness to the step. It was awarded first prize at the International Exhibition of 1851 in London.23 This design was followed by the Bly's anatomical leg, patented in 1858, which incorporated an ivory ball in a vulcanised rubber socket to provide

Artificial Legs Diagram
Fig. 13.7. British Army regulation devices for forearm and arm amputees, established after the Crimean War: 44., fork; 45., hook; 46., knife; 47, quill pen. These components were changed and attached by the sound hand. (From Bigg H, Artificial Limbs and Amputations, 1885.30)

polycentric ankle motion (Fig. 13.8), an advance which Bly claimed to be:

"... the most complete and successful invention ever attained in artificial limbs." Yet he hinted at limitations, adding: "Though the perfection of my anatomical leg is truly wonderful, I do not want every awkward, big-fatted or gamble-shanked person who always strided or shuffled along in a slouching manner with both his natural legs, to think that one of these must necessarily transform him or his movements into specimens of symmetry, neatness and beauty as if by magic—as Cinderella's frogs were turned into sprightly coachmen."2*

In addition, Bly introduced a mechanism representing the cruciate ligaments to give the knee natural action and diminishing shock to the stump when weight-bearing. A cheaper and simpler device, introduced by de Beaufort, eliminated true ankle motion, substituting a short rocker made of wood and cork for both below- and above-knee amputees; his knee joint was only flexed when sitting25 (Fig. 13.9). The concept of a suction socket for above-knee prostheses was developed by Parmalee in 1863, to which he added a polycentric knee and a multiarticulated foot.26 Despite these advances,many leg prostheses remained basic and virtually unchanged for centuries, especially for

Leg Prosthesis

Fig. 13.8. Section of Bly's above-knee leg of 1858 with improved ankle control centred on a glass or ivory ball, resting in a rubber bed, controlled by cords; right, the Bly below-knee leg. (From Watson AB. A Treatise on Amputations of the Extremities and Their Complications. Philadelphia: Blakiston, 1885: figs. 205,206.4)

Fig. 13.8. Section of Bly's above-knee leg of 1858 with improved ankle control centred on a glass or ivory ball, resting in a rubber bed, controlled by cords; right, the Bly below-knee leg. (From Watson AB. A Treatise on Amputations of the Extremities and Their Complications. Philadelphia: Blakiston, 1885: figs. 205,206.4)

With Leg Amputee Short Stump

Fig. 13.9. Cheap Beaufort legs made of wood, cork and leather, with short rocker feet without ankle joints: left, a kneeling prosthesis for below-knee amputees;right, a prosthesis for above-knee amputees, the knee only flexing on sitting, c. 1867. (From Little EM. Artificial Limbs and Amputation Stumps: A Practical Handbook. London: Lewis, 1922: figs. 14,1s.1)

Fig. 13.9. Cheap Beaufort legs made of wood, cork and leather, with short rocker feet without ankle joints: left, a kneeling prosthesis for below-knee amputees;right, a prosthesis for above-knee amputees, the knee only flexing on sitting, c. 1867. (From Little EM. Artificial Limbs and Amputation Stumps: A Practical Handbook. London: Lewis, 1922: figs. 14,1s.1)

amputee soldiers supplied from official British Government sources as late as 1885 (Fig. 13.10). Offered from stock without individual measurements in the pursuit of economy and durability, they were not approved by Bigg, although he admitted the results were "generally pretty fairly good."27 Even in 1914, kneeling prostheses were still commonplace although, in France at least, more sophisticated with a choice of fixed or mobile knees during weight-bearing (Fig. 13.11).

The numerous amputees resulting from the American Civil War had stimulated the activity of highly competitive limb-makers in the United States, including D.W. Kolbe of Philadelphia (founded c. 1849), A.A. Marks of New York (c. 1853), J.E. Hanger of Philadelphia (c. 1861), B.W. Jewett of Washington (c. 1865) and R. Clement of Philadelphia (c. 1868). Increasingly intensive competition resulted in dominance by Marks and Hanger; Marks introduced a resilient rubber foot which eliminated Bly's complicated ankle joint

Below Knee Amputation Instruments

Fig. 13.10. Royal Hospital pensioner, Chelsea, with regulation box kneeling peg for a left below-knee amputation and a regulation boot for a right Syme's amputation,c. 1885. (From Bigg H, Artificial Limbs and Amputations, 1885, fig. 41.30)

Left Syme Amputation
Fig. 13.11. Sophisticated kneeling prostheses, c. 1914: left, knee fixed when walking; centre, knee free to move when walking, both flexed on sitting; to right, diagram of measurements for fitting. (From Collin's Catalogue d'Instruments, Paris: Chez Collin, 1914, figs. 2090-2092.52)

Fig. 13.12. Bigg's explanation of knee locking mechanism: 6., anatomical section showing axis posterior to weight-bearing line; 7, prosthetic arrangement for below-knee amputee; 8, for above-knee amputee. (From Bigg H, Artificial Limbs and Amputations, London: author, 1885, figs. 6-8.20)

Fig. 13.12. Bigg's explanation of knee locking mechanism: 6., anatomical section showing axis posterior to weight-bearing line; 7, prosthetic arrangement for below-knee amputee; 8, for above-knee amputee. (From Bigg H, Artificial Limbs and Amputations, London: author, 1885, figs. 6-8.20)

Amputation Century

and Hanger introduced and popularised wooden sockets for stumps.28 Thomas and Haddan commented:

"A review of all the available literature describing prostheses made during the latter half of the nineteenth century indicates that many of the limb-makers wore artificial limbs themselves, and while many of them actually thought they had achieved the maximum improvement in artificial limbs, newcomers were constantly announcing something better. Admittedly, many of the claims for their products were ridiculously extravagant; nevertheless a great development in artificial limbs in the United States was made during this period."29

However, it was Bigg in London who pointed out the significance of alignment, in 1885, especially in placing the axis of knee joint prostheses posterior to the knee centre to approximate to normal knee movement (Fig. 13.12).30

Was this article helpful?

0 0
How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

Get My Free Ebook


Post a comment