Part 3

3. The abolition of the old tendon action for the ankle joint (which resembled the mechanism described on page 57) and its replacement by the ankle with movement limited by indiarubber buffers.

4. Covering the wooden part of the limb with a layer of raw hide or parchment, which certainly adds to the strength.

The sole remaining problem in the design of artificial legs appears to be the invention of a knee mechanism which will lock in any degree of flexion when a strain is put upon it, so that the wearer does not necessarily fall when his weight comes upon the limb with the knee flexed. A recent invention, still on its trial, seems to indicate that this problem is not incapable of solution.

In artificial arms the differences between the French and English patterns are greater than in artificial legs. But here again the principles remain the same. In England, also, we have worker's arms and show arms, but the latter tend to be more elaborate than the French patterns, mechanical movements being more developed. For this reason this pattern is usually called, in England, the mechanical arm. Instead of the single cord, looped round the opposite shoulder, and used to open the spring thumb (see p. 101), at least three such cords are used, actuated (1) by rounding the back; (2) by expanding the upper part of the chest, and (3) by raising or lowering the shoulder on the side of the amputation. These may be used for various purposes, of which the chief are (1) flexing the artificial elbow; (2) working the elbow lock, and (3) actuating the thumb, fingers or appliances used instead of the hand. The chief other differences in the methods adopted in England are--

1. A smaller enclosure of the shoulder region for purposes of suspension, the limb being held on by a harness of straps. We, in fact, value mobility of the shoulder, and gain it at the expense of stability.

2. The use of various alternative patterns of elbow locks.

3. The appliances used instead of the hand are very different in pattern, although the principles for their construction remain as described here by the authors.

Much ingenuity has been expended on the design of mechanical artificial hands, with results which are satisfactory so far as they go, but which require much further development before the hand can possibly replace even a few of the appliances which can be substituted for it. For this reason it should be made an invariable rule that the artificial hand, however ingenious and however apparently perfect it may be, should be detachable, so that it may be replaced by other appliances.

R. C. E.

CONTENTS

PAGE

GENERAL INTRODUCTION v

PREFACE xiii

INTRODUCTION TO THE ENGLISH EDITION xv

CHAPTER I

GENERAL CONSTRUCTION OF AN ARTIFICIAL LIMB 1

CHAPTER II

GENERAL PRINCIPLES OF FITTING FOR THE LOWER LIMB 6

CHAPTER III

ARTIFICIAL LIMBS FOR AMPUTATIONS THROUGH THE THIGH 12 I. Apparatus with bearing upon the ischium 12 1. The shape of the top of the bucket 13 2. Mode of suspension 21 3. Walking on a peg leg and similar appliances 28 4. Walking with free flexion of the knee 33 II. Limbs without bearing upon the ischium 60

CHAPTER IV

ARTIFICIAL LIMB FOR DISARTICULATION AT THE HIP JOINT 64

CHAPTER V

ARTIFICIAL LIMBS WITH FREE KNEE JOINT FOR AMPUTATION THROUGH THE LEG 66 I. Appliances with bearing upon the tuberosities of the tibia 67 II. Appliances with end bearing only 77

CHAPTER VI

PARTIAL AMPUTATIONS OF THE FOOT 81

CHAPTER VII

ARTIFICIAL LIMBS FOR AMPUTATION THROUGH THE FOREARM 84 I. Points of attachment 85 II. Elbow joint 90 III. The artificial hand and appliances 96 A. The artificial hand 97 B. Appliances for use in place of the hand 108