Amputation; Artificial limbs; Orthopedics; Surgery, Military
_Temporary and permanent apparatus._--For the irregular amputations
of war surgery which have suppurated, more often than for those of
civil practice, it is generally advisable, particularly in the lower
limb, to use a temporary apparatus, of fairly good fit, for several
weeks or even months before the permanent apparatus of more precise
fit. The stump has to soften and shrink gradually; only when this has
occurred can we make an accurately fitting bucket, by means of a cast
if necessary.
_Materials for making the bucket._--The first method of construction
is that of _leather reinforced with metal_; a sheath strengthened
with metal supports, is laced around the stump; the supports further
give attachment, if there is room, to the artificial joints. This
is an excellent principle, either for stumps which are still likely
to diminish in size, or for the upper limb where exact fit is of
secondary importance.
For buckets accurately fitted on a cast we employ:
_Blocked leather_, which loses shape and ought to be abandoned for
artificial limbs for the lower extremity.[1]
[1] This we have attained at the _Fédération des Mutilés_, having
forced the makers to abandon their routine. It seems to us therefore
that the same result might be attained for the appliances furnished by
the State, which are still made of leather.
_Celluloid_ is the material of choice, but it has the defect of
requiring the hand of an artist; commercial attempts on a large scale
have so far yielded mediocre results.
_Metal_ (zinc, sheet steel, aluminium), the defect of which is that
the apparatus, particularly for the lower limb, is noisy. This is also
an inconvenience in the metal joints of lateral steels of leather
appliances and of the spiral springs in certain wooden apparatus,
for this reason indiarubber is more often relied on for springs and
accumulators.
_Wood_, for many years used for the commoner types of limbs for the
lower extremity, is now, as the result of American influence, utilised
for the making of apparatus hitherto termed "de luxe," but to-day
serviceable, thanks to this technique.[2]
[2] Working in wood, to hollow out of a log of wood a bucket which
fits the stump accurately, is no novelty. Some sixty years ago two
Frenchman, Bailly, then Xavier, succeeded in such construction. But
these appliances, like the common, cheap unshaped peg leg, split
easily and were only made strong when the Americans conceived the
idea of covering the outer surface with a layer of raw hide: strong,
and therefore practical, for though we may resign ourselves to the
frequent renewal of a peg leg at 25 francs, it is another matter with
an appliance costing 300 to 400 francs. (Prices in peace time.)
(In England the standard patterns of artificial legs have for many
years been made out of wood.--ED.)
Public-domain text, read in full here on John Shaqi.
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