The chief functional difficulty depends upon the fact that, with the elbow at a right angle, the anterior surface of the forearm stump is too short to support a weight; for example, a basket held by the handle. The stump escapes partly from the bucket when the forearm extends. It is therefore well in such cases to fix the elbow at a right angle by means of a ratchet identical with that used in the artificial arm for amputation above the elbow (Fig. 138). 3. THE ARTIFICIAL HAND AND APPLIANCES At the extremity of their forearm almost all patients wish in the first place to wear something that is shaped like a hand. Many people--and even many medical men--consider that this "artificial hand" is really useful. In actual fact, by means of fairly simple contrivances, it can be used to enable the patient to eat, to write, to put on and take off his hat, but it is out of the question for it to do real work. For that an appliance, a tool in fact, adapted for use and not for appearance is necessary. The limb, therefore, will, as a rule, end in a hand, but for workmen this hand will be capable of being unscrewed and replaced easily by one or more appliances. Attempts have been made to construct so called universal hands and forceps which will serve for any sort of work, but up to the present none of these inventions have given satisfaction. And the practical solution of the problem in the present state of affairs consists in devising a special appliance for a particular trade, studying carefully the movements necessary in this trade. A workman who in the course of his occupation carries out a number of different movements may thus have several appliances, which he selects as he requires them. For example, a locksmith must be able to hammer, to file, and to drill holes in succession. We will describe first the hand properly so called, then the appliances. The former is suitable for clerks, and it is for them that the various improved patterns that we shall describe are made. The latter are suitable for manual workers to whom should be given a hand in which the mechanism is reduced to a spring thumb grip and one or more special appliances. These appliances will almost always be constructed to carry out the movements made by the left hand in the course of the work, because the first step in the re-education of a patient who has lost the right hand should always consist in training the remaining left hand to carry out the work hitherto entrusted to the missing right hand. A.--THE ARTIFICIAL HAND. The hand, which is screwed into the end of the forearm socket in such a way that it is in semipronation when the arm hangs vertical, is nearly always made of wood, but occasionally of aluminium.[13]