,,milit>y ,,m$ical ,,manuals ,,g5]al ,,editor3 ,,sir ,,alfr$ ,,keogh1 ,g4,c4,b41 ,m4,d41 ,f4,r4,c4,p4 ,,artificial ,,limbs ,,artificial ,,limbs ,,by ,a4 ,,broca ,pr(essor ( ,topographical ,anatomy to ! ,faculty ( ,p>is ,,& ,,ducroquet ,or?opdic ,surgeon to ! ,ro?s*ild ,hospital ,,translat$ ,,& ,,edit$ ,,by ,r4 ,c4 ,,elmslie1 ,m4,s41 ,f4,r4,c4,s4 ,major ,r4,a4,m4,c47,t4,f47 ,or?opdic ,surgeon to ,/4 ,b>?olomew's ,hospital1 ,surgeon to ,que5 ,m>y's ,hospital1 ,roehampton ,,) #bjh ,,illu/rations ,,univ]sity ,,( ,,london ,,press1 ,,ltd4 #ah ,,w>wick ,,squ>e1 ,,london1 ,e4,c4 #d4 ,,p>is3 ,,masson ,,et ,,cie #abj ,,b\lev>d ,,sa9t-,,g]ma9 #aiah ,,g5]al ,,introduction ,! inf9ite v>iety ( injuries :i* any w> pres5ts to ! surgeon gives to milit>y surg]y a special int]e/ & importance4 ,! special int]e/ & importance1 9 a surgical s5se1 ( ! great ,european ,w> lies n s mu* 9 ! fact t examples ( e =m ( gross lesion ( organs & limbs h be5 se51 = if we read ! old] writ]s we f9d little 9 ! mod]ns t is new 9 ?is respect1 b is to be f\nd 9 ! enorm\s mass ( cl9ical mat]ial :i* has be5 pres5t$ to u & 9 ! production ( evid5ce suffici5t to elim9ate s\rces ( error 9 det]m9+ important conclusions4 ,= ! fir/ "t also 9 any campaign ! lab\rs ( ! surgeon & ! physician h _h ! aid ( ! bact]iologi/1 ! pa?ologi/1 ! physiologi/ & inde$ ( e =m ( sci5tific assi/ance 9 ! solution ( _! respective problems4 ,! cl9ician ent]$ ^u ! great w> arm$ ) all ! res\rces :i* ! advances ( fifty ye>s _h made available4 ,if ! surgical problems ( mod]n w> c be said n to diff] s5sibly f ! campaigns ( ! pa/1 ! =m 9 :i* !y h be5 pres5t$ is c]ta9ly z diff]5t z are ! me?ods ( _! solution4 ,! a*ievem5ts 9 ! field ( discov]y ( ! *emi/1 ! physici/ & ! biologi/ h giv5 ! milit>y surgeon an advantage 9 diagnosis & treatm5t :i* 0 d5i$ to 8 pr$ecessors1 & we are able to measure ! effects ( ^! advantages :5 we come to appraise ! results :i* h be5 atta9$4 ,b al?\gh we may admit ! g5]al tru? ( ^! /atem5ts x w\ld be wrong to assume t mod]n sci5tific k 01 on ! outbreak ( ! w>1 imm$iately useful to ^? to :om ! w\nd$ 7 to be confid$4 ,fix$ pr9ciples exi/$ 9 all ! sci5ces auxili>y to ! "w ( ! surgeon1 b our sci5tific res\rces 7 n imm$iately available at ! outset ( ! great campaign2 sci5tific "w be>+ on w\nd problems _h n be5 arrang$ 9 a mann] adapt$ to ! requirem5ts1 inde$ ! requirem5ts 7 n fully =ese52 ! work]s 9 ! v>i\s fields 7 isolat$1 or isolat$ !mselves pursu+ new rese>*es r ?an conc5trat+ _! p[]ful =ces ^u ! "o great que/4 ,h[ev] brilliant ! triumphs ( surg]y may be1 & t !y h be5 ( surpass+ spl5d\r no "o w be f\nd to d5y1 exp]i5ces ( ! w> h already produc$ a mass ( facts suffici5t to sugge/ ! complete remodell+ ( our me?ods ( education & rese>*4 ,! s]ies ( manuals1 :i* x is my pleasant duty to introduce to ,engli% read]s1 consi/s ( translations ( ! pr9cipal volumes ( ! ,horizon ,collection :i* has be5 appropriately nam$ aft] ! uni=m ( ! ,fr5* soldi]4 ,! au?ors1 :o are well-kn[n speciali/s 9 ! subjects :i* !y repres5t1 h giv5 a concise b em95tly readable acc\nt ( ! rec5t acquisitions to ! m$ic9e & surg]y ( w> :i* _h hi!rto be5 dissem9at$ 9 p]iodical lit]ature4 ,no high] praise c be giv5 to ! ,editors ?an to say t ! cle>ness ( exposition *>act]i/ic ( ! ,fr5* orig9al has n be5 lo/ 9 ! r5d]+ into ,engli%4 ,,m$ical ,,s]ies ,! m$ical volumes :i* h be5 translat$ = ?is s]ies may be divid$ into two ma9 gr\ps1 ! fir/ deal+ ) c]ta9 epidemic diseases includ+ syphilis1 :i* are mo/ liable to attack soldi]s1 & ! second ) v>i\s aspects ( ! neurology ( w>4 ,! la/ ^w on ,typhoid ,fev]1 hi!rto ! greate/ sc\rge ( armies 9 "t ( w>1 z x has be5 truly call$1 w be f\nd 9 ! monograph by ,,mm4 ,v9c5t & ,muratet :i* conta9s a full acc\nt ( rec5t progress 9 bact]iology & epidemiology z well z ! cl9ical features ( typhoid & p>atyphoid fev]s4 ,! writ]s combat a belief 9 ! comp>atively h>mless nature ( p>atyphoid & /ate t 9 ! pres5t w> hmorrhage & p]=ation h be5 z frequ5t 9 p>atyphoid z 9 typhoid fev]4 ,9 _! *apt] on diagnosis !y %[ t ! s]um te/ is ( no value 9 ! case ( ^? :o h und]gone anti-typhoid or anti-p>atyphoid vacc9ation & t precise in=mation c be ga9$ by blood cultures only4 ,! relative advantages ( a re/rict$ & lib]al diet are discuss$ 9 ! *apt] on treatm5t1 :i* also conta9s a description ( s]um-!rapy & vacc9e-!rapy & ! g5]al managem5t ( ! pati5t4 ,consid]able space is devot$ to ! important "q ( ! c>ri] ( infection4 ,a special *apt] is devot$ to ! prophylaxis ( typhoid fev] 9 ! army4 ,! "w concludes ) a *apt] on prev5tive inoculation 9 :i* its value is conclusively prov$ by ! /ati/ics ( all c\ntries 9 :i* x has be5 employ$4 ,,mm4 ,v9c5t & ,muratet h also contribut$ to ! s]ies a "w on ,dys5t]y1 ,*ol]a & ,typhus :i* w be ( special int]e/ to ^? ^: duties take !m to ! ,ea/]n ,m$it]ranean or ,mesopotamia4 ,! c>ri] problem 9 relation to dys5t]y & *ol]a is fully discuss$1 & special /ress is laid on ! epidemiological importance ( mild or abortive cases ( ^! two diseases4 ,9 _! monograph on ,! ,abnormal ,=ms ( ,tetanus1 ,,mm4 ,c\rtois-,suffit & ,gir\x treat ( ^? v>ieties ( ! disease 9 :i* ! spasm is conf9$ to a limit$ gr\p ( muscles1 e4 g4 ^? ( ! head1 or "o or m limbs1 or ( ! abdom9o-?oracic muscles4 ,! con/itutional symptoms are less sev]e ?an 9 ! g5]alis$ =m ( ! disease1 & ! prognosis is m fav\rable4 ,! volume by ,dr4 ,g4 ,?ilbi]ge on ,syphilis 9 ! ,army is int5d$ z a vade-mecum = m$ical (fic]s 9 ! army4 ,turn+ n[ to works ( neurological int]e/ we h two volumes deal+ ) lesions ( ! p]iph]al n]ves by ,mme4 ,atanassio ,b5i/y1 :o has be5 = sev]al ye>s assi/ant to ,pr(essor ,pi]re ,m>ie at ,la ,salptrire4 ,! fir/ volume conta9s an acc\nt ( ! anatomy & physiology ( ! p]iph]al n]ves1 toge!r ) ! symptomatology ( _! lesions4 ,! second volume is devot$ to ! prognosis & treatm5t ( n]ve lesions4 ,! monograph ( ,,mm4 ,bab9ski & ,from5t on ,hy/]ia or ,pi?iatism & ,n]v\s ,disord]s ( a ,reflex ,"* next claims att5tion4 ,9 ! fir/ "p ! old conception ( hy/]ia1 especially z x 0 built up by ,*>cot1 is set =?1 & is foll[$ by a description ( ! mod]n conception ( hy/]ia due to ,bab9ski1 :o has sugge/$ ! sub/itution ( ! t]m ,pi?iatism1 i4 e4 a /ate curable by p]suasion1 = ! old "n hy/]ia4 ,! second "p deals ) n]v\s disord]s ( a reflex "*1 consi/+ ( contractures or p>alysis foll[+ traumatism1 :i* are frequ5tly f\nd 9 ! neurology ( w>1 & a v>iety ( m9or symptoms1 su* z muscul> atrophy1 exagg]ation ( ! t5don reflexes1 vasomotor1 !rmal & secretory *anges1 etc4 ,an important section discusses ! future ( su* m51 especially z reg>ds _! disposal by m$ical bo>ds4 ,an in/ructive companion volume to ! above is to be f\nd 9 ! monograph ( ,,mm4 ,r\ssy & ,lh]mitte1 :i* embodies a description ( ! psy*oneuroses met ) 9 w>1 />t+ ) elem5t>y motor disord]s & conclud+ ) ! mo/ complex repres5t$ by pure psy*oses4 ,,surgical ,,s]ies ,:5 ! pres5t w> began1 surgeons1 "u ! influ5ce ( ! immortal "w ( ,li/]1 _h = m ?an a qu>t] ( a c5tury conc]n$ !mselves almo/ exclusively ) elaborations ( te*nique design$ to %ort5 ! "t occupi$ 9 or to improve ! results obta9$ by ! _m complex op]ations t ! g5ius ( ,li/] _h r5d]$ possible4 ,! good behavi\r ( ! w\nd 0 tak5 = grant$ :5ev] x 0 made1 z x ne>ly always 01 ?r\gh unbrok5 sk91 & h5ce ! /udy ( ! treatm5t ( w\nds _h become l>gely re/rict$ to ! /udy ( ! aseptic v>iety4 ,septic w\nds 7 r>ely se51 & antiseptic surg]y _h be5 almo/ =gott54 ,v few ( ^? :o 7 call$ ^u to treat ! w\nd$ 9 ! e>ly autumn ( #aiad 7 famili> ) ! treatm5t ( grossly septic comp\nd fractures & w\nd$ jo9ts1 & none _h any wide exp]i5ce4 ,to ^! m5 ! conditions ( ! w\nds came z a s9i/] & di%e>t5+ revelation4 ,!y 7 sudd5ly confront$ ) a /ate ( affairs1 z f> z ! physical conditions 9 ! w\nds 7 conc]n$1 = :i* x 0 necess>y to g back a hundr$ ye>s or m to f9d a p>allel4 ,h5ce ! e>ly p]iod ( ! w> 0 "o ( e>ne/ se>* aft] ! correct pr9ciples t %\ld be appli$ to ! removal ( ! unusual difficulties ) :i* surgeons & physicians 7 fac$4 ,x 0 necess>y to discov] :]e & :y ! treatm5t t suffic$ = affections among ! civil population fail$ :5 x 0 appli$ to milit>y casualties1 & !n to orig9ate adequate measures = ! relief ( ! latt]4 ,= _m reasons ?is 0 a sl[ & labori\s process1 9 spite ( ! multitude ( work]s & ! weal? ( sci5tific res\rces at _! disposal4 ,! ru?lessness ( w> mu/ necess>ily hamp] ! "w ( ! m$ical sci5ti/ 9 almo/ e direction except 9 t ( provid+ him ) an abundance ( mat]ial ^u :i* to "w4 ,x limits ! opportunity = delib]ate critical obs]vation & comp>ison t is s ess5tial to ! =mation ( an accurate e/imation ( values2 x (t5 compels "w to be done "u su* high pressure & su* unfav\rable conditions t x becomes ( little value = educative purposes4 ,9 all ! armies1 & on all ! fronts1 ! pressure caus$ by ! unprec$5t$ numb] ( casualties has necessitat$ rapid evacuation f ! front along l9es ( communication1 (t5 ( enorm\s l5g?1 & ?is means ! transf] ( cases ?r\gh _m h&s1 ) its consequ5t division ( responsibility1 loss ( cont9uity ( treatm5t1 & abs5ce ( prolong$ obs]vation by any "o individual4 ,9 addition to all ?is1 x mu/ be rememb]$ t 9 ?is w> ! e>ly conditions at ! front 7 s unc]ta9 t x 0 impossible to e/abli% !re ! completely equipp$ sci5tific in/itutions = ! treatm5t ( ! w\nd$ t are n[ available "u m assur$ circum/ances1 & t progress 0 !reby mu* hamp]$ until def9itive treatm5t c\ld be und]tak5 at ! e>ly /age t is n[ possible4 ,b ord] has be5 /eadily evolv$ out ( *aos & _m ?+s are n[ be+ done at ! front t w\ld h be5 deem$ impossible n _m mon?s ago4 ,z g5]al pr9ciples ( treatm5t are e/abli%$ x is f\nd practicable to give effect to !m to _! full logical ext5t1 & ?\gh !re are /ill _m obscure po9ts to be elucidat$ & _m me?ods 9 use t /ill call = improvem5ts1 x is n[ safe to say t ! position ( ! art ( milit>y m$ic9e & surg]y /&s ^u a s\nd f\ndation1 & t its future may be reg>d$ ) confid5ce & sangu9e expectation4 ,! views ( great au?orities :o d]ive _! k f ext5sive fir/-h& practical exp]i5ce ga9$ 9 ! field1 _c fail to s]ve z a mo/ valuable asset to ! less exp]i5c$1 & mu/ d mu* to enable !m to d]ive ! utmo/ value f ! exp]i5ce :i* w1 9 "t1 be !irs4 ,! s]ies cov]s ! :ole field ( w> surg]y & m$ic9e1 & its pr$om9at+ note is ! exhau/ive1 practical & up-to-date mann] 9 :i* x is h&l$4 ,x is m>k$ ?r\gh\t n only by a weal? ( detail1 b by cle>ness ( view & logical sequ5ce ( ?\ght4 ,its /udy w conv9ce ! read] t1 great z h be5 ! advances 9 all dep>tm5ts 9 ! s]vices dur+ ?is w>1 ! progress made 9 ! m$ical bran* may fairly *all5ge comp>ison ) t 9 any o!r1 & t n ! lea/ among ! s]vices r5d]$ by our great ,ally1 ,france1 to ! common cause is ?is brilliant contribution to our pr(essional k4 ,a glance at ! li/ ( surgical works 9 ! s]ies w %[ h[ completely ! gr\nd has be5 cov]$4 ,appropriately en\gh1 ! s]ies op5s ) ! volume on ,! ,treatm5t ( ,infect$ ,w\nds1 by ,a4 ,c>rel & ,g4 ,dehelly4 ,?is is a direct product ( ! w> :i*1 9 ! op9ion ( _m1 bids fair to become epo*-mak+ 9 ! treatm5t ( septic w\nds4 ,x is peculi> to ! w> & d]iv$ directly f x1 & ! "w ^u :i* x is bas$ is z f9e an example ( correlat$ "w on ! "p ( ! *emi/1 ! bact]iologi/ & ! cl9ician z c\ld well be wi%$ =4 ,?is volume w %[ _m = ! fir/ "t :at a precise & sci5tific me?od ! ,c>rel treatm5t really is4 ,! two volumes by ,pr(4 ,l]i*e on ,fractures conta9 ! practical application ( ! views ( ! great ,lyons s*ool ( surgeons ) reg>d to ! treatm5t ( injuries ( bones & jo9ts4 ,support$ z !y are by an appeal to an abundant cl9ical exp]i5ce1 !y _c fail to int]e/ ,engli% surgeons1 & to prove ( ! greate/ value4 ,x is only necess>y to say ! ,w\nds ( ! ,abdom5 are dealt ) by ,dr4 ,abadie1 ,w\nds ( ! ,vessels by ,pr(4 ,s5c]t1 ,w\nds ( ! ,skull & ,bra9 by ,,mm4 ,*atel9 & ,de ,m>tel1 & ,localisation & ,extraction ( ,projectiles by ,pr(4 ,ombr$ann & ,r4 ,l$\x-,leb>d1 to prove t ! subjects h be5 allott$ to v able & exp]i5c$ expon5ts4 ,,alfr$ ,,keogh4 ,,preface ,no attempt is made 9 ?is little book to describe all ! artificial limbs & appliances t h be5 inv5t$4 ,be=e ! w> ^! 7 v num]\s1 s9ce !n _! numb] has become c\ntless1 & n a day passes )\t ! appe>ance ( "s new model ( great] or less +5uity4 ,b all ^! special inv5tions1 ! utility ( :i* we %\ld n ?9k ( d5y+1 are only ( real practical value if ! mak]s h foll[$ out c]ta9 g5]al pr9ciples 9 _! manufacture4 ,9 ! foll[+ pages we h attempt$ to indicate :at ^! pr9ciples are4 ,our exp]i5ce has be5 ga9$ 9 connection ) ! ,fdration des ,mutils1 :]e hundr$s ( disabl$ m5 h be5 exam9$ & fitt$1 & :]e we h always tri$ to give to ea* t appliance :i* is be/ suit$ to 8 "w4 ,= ?is inde$ is ! vital pr9ciple1 & great disappo9tm5ts w result if1 = /hetic reasons1 e pati5t is giv5 ! same appliance1 :e!r x be ! leg kn[n z ! ,am]ican leg or an elaborate artificial arm4 ,m (t5 ?an might be believ$ accurate imitation ( ! ext]nal =m ( ! natural limb is incompatible ) good functional use4 ,?is is p>ticul>ly s 9 ! upp] limb4 ,p]haps ! read]s ( ^! pages w ga9 a cle> und]/&+ ( ^! pr9ciples2 & we %all h atta9$ our object if by enabl+ !m to und]/& c]ta9 typical appliances we make x possible = !m to devise o!rs :i* are at ! same "t /rong1 %apely & practical4 ,?r\gh\t ! volume x w be f\nd t we express a pref]5ce = ! con/ruction ( artificial limbs = ! l[] limb out ( wood1 ! me?od adopt$ by ! ,am]icans4 ,?is proc$ure1 because /r5g? & durability are s necess>y1 seems to u to con/itute a v real advance2 ^! consid]ations are1 h[ev]1 ( mu* less importance 9 ! case ( ! upp] limb4 ,x is a matt] = regret t ! ,fr5* (ficial in/ructions h n compell$ our manufactur]s to adopt ?is te*nique1 too (t5 ! latt] are incl9$ to keep to _! old r\t9e1 b !y c be induc$ to alt] x1 z we h prov$ by our success at ! ,fdration des ,mutils4 ,!re is no?+ revolution>y 9 su* a sugge/ion4 ,x has be5 adopt$ by ! ,belgian ,gov]nm5t 9 ! fitt+ c5tres :i* !y h e/abli%$2 ?is is also ! case ) ! ,engli% au?orities1 :o1 we und]/&1 h ev5 attract$ f ,am]ica special fitt]s = ?is "w4 ,we %\ld h ?\ght t we1 9 ,france1 might h develop$ our national supply ( artificial limbs 9 ! same direction4 ,,introduction ,,to ,,! ,,engli% ,,edition ,! details ( ! manufacture ( artificial limbs naturally diff] greatly 9 diff]5t c\ntries4 ,s mu* s t at fir/ sight x might appe> useless to introduce into ,engl& & ,am]ica ! acc\nt giv5 9 ?is "w ( ! me?ods adopt$ 9 ,france4 ,b1 z ! au?ors /ate 9 _! preface1 ! pr9ciples rema9 ! same :atev] ! details ( ! me?ods us$4 ,9 ! l[] limb ! ess5tials to be /udi$ are ! po9ts ^u :i* weight c be tak51 ! ,be>+ ,po9ts1 ! prop] me?od ( fitt+ ! /ump1 ! pr9ciples ( secur+ /ability & ! me*anism ( ! knee & ankle jo9ts4 ,^! rema9 unalt]able :atev] be ! mat]ial us$ & :atev] be ! details ( manufacture4 ,9 ,engl& x has = a long "t be5 und]/ood t e sailor or soldi] :o has lo/ a limb has ! "r to expect t he w be suppli$ ) a good artificial sub/itute4 ,&1 fur!r1 x has be5 tak5 = grant$ t ?is w1 9 ! case ( ! l[] limb1 be a full artificial leg & n a peg leg4 ,!re=e ! /&>d patt]n has 9 ,engl& be5 a full limb1 & ! peg has only be5 suppli$ z a tempor>y appliance1 & z an alt]native appliance to be us$ :5 ! o!r limb requires alt]ation or repair4 ,= ?is reason ! possibilities ( ! peg leg1 except 9 its simple/ =m1 h p]haps be5 neglect$ 9 ?is c\ntry1 & a /udy ( ! ,fr5* me?ods ( mak+ ^! peg legs1 p>ticul>ly ! conv]tible peg leg1 is well wor? :ile4 ,! introduction ( ,am]ican artificial legs into ?is c\ntry has n be5 s revolution>y 9 its results z x is app>5tly 9 ,france1 = we h be5 accu/om$ = _m ye>s to make ! bucket out ( a s+le piece ( will[4 ,! alt]ations 9 our me?ods introduc$ rec5tly f ,am]ica are ess5tially ! foll[+-- #a4 ,! use ( a sl+ :i* pass+ ov] ! %\ld]s is atta*$ to ! leg bel[ ! knee 9 su* a way z to act z a me*anism = ext5d+ ! knee4 #b4 ,! manufacture ( ! leg portion out ( a s+le piece ( wood4 #c4 ,! abolition ( ! old t5don action = ! ankle jo9t 7:i* resembl$ ! me*anism describ$ on page #eg7 & its replacem5t by ! ankle ) movem5t limit$ by indi>ubb] buff]s4 #d4 ,cov]+ ! wood5 "p ( ! limb ) a lay] ( raw hide or p>*m5t1 :i* c]ta9ly adds to ! /r5g?4 ,! sole rema9+ problem 9 ! design ( artificial legs appe>s to be ! inv5tion ( a knee me*anism :i* w lock 9 any degree ( flexion :5 a /ra9 is put ^u x1 s t ! we>] does n necess>ily fall :5 8 weight comes ^u ! limb ) ! knee flex$4 ,a rec5t inv5tion1 /ill on its trial1 seems to indicate t ?is problem is n incapable ( solution4 ,9 artificial arms ! diff]5ces betwe5 ! ,fr5* & ,engli% patt]ns are great] ?an 9 artificial legs4 ,b "h aga9 ! pr9ciples rema9 ! same4 ,9 ,engl&1 also1 we h work]'s arms & %[ arms1 b ! latt] t5d to be m elaborate ?an ! ,fr5* patt]ns1 me*anical movem5ts be+ m develop$4 ,= ?is reason ?is patt]n is usually call$1 9 ,engl&1 ! me*anical arm4 ,in/ead ( ! s+le cord1 loop$ r\nd ! opposite %\ld]1 & us$ to op5 ! spr+ ?umb 7see p4 #aja71 at lea/ ?ree su* cords are us$1 actuat$ 7#a7 by r\nd+ ! back2 7#b7 by exp&+ ! upp] "p ( ! *e/1 & 7#c7 by rais+ or l[]+ ! %\ld] on ! side ( ! amputation4 ,^! may be us$ = v>i\s purposes1 ( :i* ! *ief are 7#a7 flex+ ! artificial elb[2 7#b7 work+ ! elb[ lock1 & 7#c7 actuat+ ! ?umb1 f+]s or appliances us$ in/ead ( ! h&4 ,! *ief o!r diff]5ces 9 ! me?ods adopt$ 9 ,engl& are-- #a4 ,a small] enclosure ( ! %\ld] region = purposes ( susp5sion1 ! limb be+ held on by a h>ness ( /raps4 ,we1 9 fact1 value mobility ( ! %\ld]1 & ga9 x at ! exp5se ( /ability4 #b4 ,! use ( v>i\s alt]native patt]ns ( elb[ locks4 #c4 ,! appliances us$ in/ead ( ! h& are v diff]5t 9 patt]n1 al?\gh ! pr9ciples = _! con/ruction rema9 z describ$ "h by ! au?ors4 ,mu* +5uity has be5 exp5d$ on ! design ( me*anical artificial h&s1 ) results :i* are satisfactory s f> z !y g1 b :i* require mu* fur!r developm5t be=e ! h& c possibly replace ev5 a few ( ! appliances :i* c be sub/itut$ = x4 ,= ?is reason x %\ld be made an inv>iable rule t ! artificial h&1 h[ev] +5i\s & h[ev] app>5tly p]fect x may be1 %\ld be deta*able1 s t x may be replac$ by o!r appliances4 ,r4 ,c4 ,e4 ,,cont5ts ,,page ,,g5]al ,,introduction v ,,preface xiii ,,introduction ,,to ,,! ,,engli% ,,edition xv ,,*apt] ,i ,,g5]al ,,con/ruction ,,( ,,an ,,artificial ,,limb #a ,,*apt] ,,ii ,,g5]al ,,pr9ciples ,,( ,,fitt+ ,,= ,,! ,,l[] ,,limb #f ,,*apt] ,,iii ,,artificial ,,limbs ,,= ,,amputations ,,?r\gh ,,! ,,?igh #ab ,i4 ,app>atus ) be>+ ^u ! is*ium #ab #a4 ,! %ape ( ! top ( ! bucket #ac #b4 ,mode ( susp5sion #ba #c4 ,walk+ on a peg leg & simil> appliances #bh #d4 ,walk+ ) free flexion ( ! knee #cc ,,ii4 ,limbs )\t be>+ ^u ! is*ium #fj ,,*apt] ,,iv ,,artificial ,,limb ,,= ,,dis>ticulation ,,at ,,! ,,hip ,,jo9t #fd ,,*apt] ,v ,,artificial ,,limbs ,,) ,,free ,,knee ,,jo9t ,,= ,,amputation ,,?r\gh ,,! ,,leg #ff ,i4 ,appliances ) be>+ ^u ! tub]osities ( ! tibia #fg ,,ii4 ,appliances ) end be>+ only #gg ,,*apt] ,,vi ,,p>tial ,,amputations ,,( ,,! ,,foot #ha ,,*apt] ,,vii ,,artificial ,,limbs ,,= ,,amputation ,,?r\gh ,,! ,,=e>m #hd ,i4 ,po9ts ( atta*m5t #he ,,ii4 ,elb[ jo9t #ij ,,iii4 ,! artificial h& & appliances #if ,a4 ,! artificial h& #ig ,b4 ,appliances = use 9 place ( ! h& #ajh ,,*apt] ,,viii ,,artificial ,,limbs ,,= ,,amputation ,,?r\gh ,,! ,,arm #abi ,i4 ,artificial arm #acb ,,ii4 ,work]'s arm #ach ,,*apt] ,,ix ,,artificial ,,limbs ,,= ,,dis>ticulation ,,?r\gh ,,! ,,%\ld] ,,jo9t ,,& ,,amputation ,,?r\gh ,,! ,,deltoid ,,muscle #adc ,,*apt] ,x ,,"s ,,g5]al ,,pr9ciples ,,9 ,,! ,,re-,,education ,,( ,,! ,,disabl$ #ade ,,index #aei ,,artificial ,,limbs ,,*apt] ,i ,,g5]al ,,con/ruction ,,( ,,an ,,artificial ,,limb ,a pro/hetic app>atus = any amputation is compos$ ( two p>ts3 #a4 ,! artificial limb4 #b4 ,! atta*m5t ( ?is limb to ! trunk4 ,! artificial limb itself is divid$ into two p>ts3 #a4 ,a conical socket4 #b4 ,a "p :i* replaces ! miss+ limb & is 9 fact a t]m9al functional appliance4 ,two conditions mu/ be consid]$1 :e!r or n !re rema9s atta*$ to ! trunk a segm5t ( ! limb capable ( be+ fitt$ into ! base ( ! artificial limb1 to :i* x gives support1 & to :i*1 9 addition1 x c communicate movem5t4 ,accord+ly ! artificial limb diff]s ess5tially =3 #a4 ,dis>ticulation ( ! %\ld] & ( ! hip4 #b4 ,amputation ( ! arm & ( ! ?igh4 ,9 ! fir/ case we atta* to ! trunk an in/rum5t :i* is entirely passive4 ,9 ! second we attempt to turn to acc\nt ! active movem5ts ( ! /ump4 ,^! v>i\s p>ts d n l5d !mselves to a g5]al description applicable at once to ! upp] & l[] limbs4 ,n only are ! modes ( atta*m5t & ! functional artificial limb q diff]5t1 b ! bucket does n s]ve ! same purposes4 ,! position ( ! sc>4--,! /ump1 :i* fits ! bucket exactly1 transmits to x two k9ds ( =ce3 #a4 ,! =ce ( v]tical pressure4 #b4 ,lat]al =ce correspond+ to ! angul> movem5ts ( ! jo9t above4 ,! lat]al =ce is transmitt$ by ! :ole ( "o surface ( ! /ump to ! correspond+ lat]al surface ( ! bucket3 by ! ant]ior & po/]ior surfaces only 9 ! case ( h+e jo9ts su* z ! elb[ & ! knee3 by all surfaces 9 ! case ( jo9ts ) movem5ts ( circumduction su* z ! %\ld] & ! hip4 ,v]tical pressure ex]cis$ upw>ds or d[nw>ds may cause ! limb to press ^u ! bucket at two po9ts3 7#a7 on ! summit ( ! cone1 i4e4 on ! extremity ( ! /ump2 7#b7 on ! base ( ! cone1 i4e4 on ! bony prom95ces ar\nd ! la/ rema9+ jo9t4 ,! adju/m5t is nev] suffici5tly accurate = ! relief due to ! fitt+ ( ! /ump 9 ! bucket to be ( mu* importance4 ,we %\ld take x z a g5]al rule t a sc> _c /& pressure or friction2 & t 9 consequ5ce1 :5 we amputate "u fav\rable conditions1 we %\ld arrange to place ! sc> 9 su* a position t f our k ( ! suitable pro/hetic app>atus ^! two evils w be avoid$4 ,x %\ld be add$1 h[ev]1 t aft] p]fect prim>y union1 ! n>r[ & mobile sc> is v tol]ant1 b x mu/ also be rememb]$--especially z w be se5 9 ! l[] limb--t ?is condition is r>ely realis$ 9 w> surg]y4 ,! l5g? ( ! /ump is (t5 e/imat$ by ref]5ce to t ( ! o!r limb2 amputation at ! upp]1 middle1 or l[] ?ird ( ! ?igh1 ( ! leg1 ( ! arm1 or ( ! =e>m4 ,?is is conv5i5t1 />t+ f a c]ta9 m9imum l5g?1 b !re is an absolute m9imum l5g? bel[ :i* ! /ump has insuffici5t lev]age & t5ds moreov] to escape f ! bucket4 ,tempor>y & p]man5t app>atus4--,= ! irregul> amputations ( w> surg]y :i* h suppurat$1 m (t5 ?an = ^? ( civil practice1 x is g5]ally advisable1 p>ticul>ly 9 ! l[] limb1 to use a tempor>y app>atus1 ( fairly good fit1 = sev]al weeks or ev5 mon?s be=e ! p]man5t app>atus ( m precise fit4 ,! /ump has to s(t5 & %r9k gradually2 only :5 ?is has occurr$ c we make an accurately fitt+ bucket1 by means ( a ca/ if necess>y4 ,mat]ials = mak+ ! bucket4--,! fir/ me?od ( con/ruction is t ( lea!r re9=c$ ) metal2 a %ea? /r5g!n$ ) metal supports1 is lac$ ar\nd ! /ump2 ! supports fur!r give atta*m5t1 if !re is room1 to ! artificial jo9ts4 ,?is is an excell5t pr9ciple1 ei!r = /umps :i* are /ill likely to dim9i% 9 size1 or = ! upp] limb :]e exact fit is ( second>y importance4 ,= buckets accurately fitt$ on a ca/ we employ3 ,block$ lea!r1 :i* loses %ape & ought to be ab&on$ = artificial limbs = ! l[] extremity4#a #a ,?is we h atta9$ at ! ,fdration des ,mutils1 hav+ =c$ ! mak]s to ab&on _! r\t9e4 ,x seems to u !re=e t ! same result might be atta9$ = ! appliances furni%$ by ! ,/ate1 :i* are /ill made ( lea!r4 ,celluloid is ! mat]ial ( *oice1 b x has ! defect ( requir+ ! h& ( an arti/2 comm]cial attempts on a l>ge scale h s f> yield$ m$iocre results4 ,metal 7z9c1 %eet /eel1 alum9ium71 ! defect ( :i* is t ! app>atus1 p>ticul>ly = ! l[] limb1 is noisy4 ,?is is also an inconv5i5ce 9 ! metal jo9ts ( lat]al /eels ( lea!r appliances & ( ! spiral spr+s 9 c]ta9 wood5 app>atus1 = ?is reason indi>ubb] is m (t5 reli$ on = spr+s & accumulators4 ,wood1 = _m ye>s us$ = ! common] types ( limbs = ! l[] extremity1 is n[1 z ! result ( ,am]ican influ5ce1 utilis$ = ! mak+ ( app>atus hi!rto t]m$ de luxe1 b to-day s]viceable1 ?anks to ?is te*nique4#b #b ,work+ 9 wood1 to holl[ out ( a log ( wood a bucket :i* fits ! /ump accurately1 is no novelty4 ,"s sixty ye>s ago two ,fr5*man1 ,bailly1 !n ,xavi]1 succe$$ 9 su* con/ruction4 ,b ^! appliances1 l ! common1 *eap un%ap$ peg leg1 split easily & 7 only made /rong :5 ! ,am]icans conceiv$ ! idea ( cov]+ ! out] surface ) a lay] ( raw hide3 /rong1 & !re=e practical1 = ?\gh we may resign ourselves to ! frequ5t r5ewal ( a peg leg at #be francs1 x is ano!r matt] ) an appliance co/+ #cjj to #djj francs4 7,prices 9 peace "t47 7,9 ,engl& ! /&>d patt]ns ( artificial legs h = _m ye>s be5 made out ( wood4--,,ed47 ,! adju/m5t to ! /ump is v exact2 ! contact ) ! surface :]e !re is friction is s(t & com=table )\t padd+2 ! appliance is light1 /rong & sil5t4 ,! be/ woods appe> to be ,engli% will[ & lime4 ,! bucket %\ld n pres5t any flaw or knot1 ?is c be se5 on ! inn] uncov]$ surface4 ,b we mu/ emphasise ! g5]al fact t /&>disation is impossible :5 ! bucket is made ( wood4 ,= ! o!r p>ts x is possible b n = ! bucket1 :i* mu/ be made specially = ea* pati5t1 holl[s be+ made = ea* bony po9t1 :i* mu/ be m>k$ out & felt = ) ! f+]s4 ,a pla/] ca/ w\ld appe> m exact3 b by ?is means we d n m>k out ! bony po9ts4 ,good results _c be obta9$1 if1 z c]ta9 p h tri$1 l9e> measurem5ts are s5t to a work%op :5ce an app>atus is =?) despat*$ to a pati5t :om ! mak] has nev] se54 ,,*apt] ,,ii ,,g5]al ,,pr9ciples ,,( ,,fitt+ ,,= ,,! ,,l[] ,,limb ,:e!r we are deal+ ) an amputation ( ! leg or an amputation ( ! ?igh1 ! pr9ciple function ( ! artificial limb is to support ! weight ( ! body4 ,! bucket mu/ !re=e give support to ?is weight4 ,?ree be>+ po9ts are ?us possible3 at ! base1 ^u ! surface & ^u ! end ( ! /ump4 #a4 ,be>+ ^u ! base4--,! pr9cipal be>+ is t :i* is tak5 by fitt+ ! upp] edge ( ! bucket "u ! bony prom95ces situat$ ar\nd ! la/ jo9t pres]v$1 i4e4 ! tub]osity ( ! is*ium = ! ?igh1 ! head ( ! tibia = ! leg4 #b4 ,be>+ ^u ! surface ( ! /ump4--,c]ta9 mak]s attribute to ?is an importance :i* we believe to be imag9>y1 b :i* leads !m to errone\s conclusions4 ,x is evid5t t if a conical /ump :i* is jo9tless & :i* transmits ! weight is fitt$ exactly1 po9t d[nw>ds1 into a conical bucket1 support$ bel[ by a v]tical pill>1 ! weight is transmitt$ by ! friction ( ! "p enclos$ aga9/ ! bucket1 )\t any pressure ^u ! free end4 ,:5ce x may be conclud$ t1 z ! end ( ! /ump %\ld n s]ve z a be>+ po9t1 we %\ld pref] a t]m9al sc> to lat]al sc>s :i* might be r5d]$ pa9ful or ev5 ulc]at$ by friction aga9/ ! bucket4 ,b exp]i5ce %[s u t if ! pressure ( ! bucket at ?is po9t is h>mful to ! lat]al sc>s1 x is n less s = mo/ t]m9al sc>s4 ,! /ump 9 its bucket is 9 fact a bone1 furni%$ ) s(t p>ts ^u :i* we _c ex]t v]tical pressure1 )\t squeez+ !m back t[>ds ! base ( ! /ump1 ?us ex]t+ an upw>d t5sion ( ! t]m9al s(t p>ts ov] ! end ( ! bone4 ,?is is b\nd to occur unless !re is a consid]able l5g? ( s(t p>ts beyond ! end ( ! bone1 t is unless m bone has be5 sacrific$ ?an 0 necess>y4 ,9 ?is way we get all ! disadvantages ( an end be>+ )\t its advantages4 #c4 ,direct end be>+4--,?is is only ! pr9cipal be>+ 9 c]ta9 special /umps :i* we %all indicate 9 due c\rse2 9 "s ( ^! x is ! sole be>+4 ,9 ! case ( app>atus = ! usual amputations1 above ! epiphyseal enl>gem5ts1 x is nev] m ?an a complem5t>y or accessory be>+1 al?\gh a v useful "o4 ,to take pressure ^u ! end ( ! /ump x is only necess>y to /ret* across ! bucket at ! "r height a piece ( mat]ial cov]$ ) felt4 ,if ! app>atus is made ( lea!r1 ! support is tak5 ^u a circul> b& ( metal fix$ to ! lat]al /eels4 ,9 ord] t direct pressure ^u ! /ump may be possible1 two conditions are indisp5sable3 t !re is no t]m9al sc>2 & t ! extremity ( ! bone is well cov]$ ) a ?ick & nonadh]5t flap4 ,actually walk+ directly on ! /ump does n involve simply support by pressure1 b also inevitable friction1 ( great] or less importance1 caus$ by ! backw>d & =w>d movem5t4 ,?is is only realis$ "u ! mo/ p]fect conditions if ! sk9 is adapt$ by its /ructure to ?is movem5t4 ,?is is ! case ) ! sole ( ! foot3 :]e ! epid]mis & d]mis are ?ick & ! subcutane\s areol> tissue & deep fascia1 cont9u\s ) x1 enclose little cavities fill$ ) globules ( fat2 ^! =m a cu%ion1 l little globules ( liquid glid+ ov] ea* o!r4 ,! sk9 ( ! po9t & ( ! po/]ior surface ( ! heel is less suitable anatomically ?an t ( ! sole3 x is1 h[ev]1 good1 & x is = ?is reason t aft] amputation above ! malleoli1 x is possible to walk directly ^u ! cut surface ( ! tibia4 ,nev]!less sk9 :i* is n prep>$ 9 ?is way by its normal /ructure c adapt itself to pressure & friction1 provid$ t x is padd$ by a ?ick muscul> lay]1 %ea!d :5ev] possible ) fibr\s tissue4 ,a sk9 :i* is n s l9$1 especially 9 fair & /\t p1 ) ?9 & delicate sk91 ulc]ates easily z ! result ( friction or ev5 ( simple pressure1 & burs & callosities =m4 ,see :at happ5s to ! sk9 on ! dorsum & out] side ( ! foot 9 ! case ( talipes equ9o v>us4 ,! muscles ( ! flap w n rema9 ov] ! bone 9 ! condition ( muscul> tissue1 !y become fibr\s--b !y are useful because3 #a4 ,!y int]pose a fibr\s lay] ( great] or less ?ickness betwe5 ! bone & ! sk91 s t ! latt] rema9s movable ov] ! end ( ! bone & is n directly compress$2 #b4 ,!y adh]e to ! cut section ( ! bone =m+ a t5d9\s ins]tion1 :i* r5d]s _! action on ! bony lev] m p[]ful4 ,a flap be>s weight badly :5 ! muscles h retract$ ar\nd ! bone1 ov] :i* !re is !n no?+ b sk94 ,x is ! same :5 ! flap is /ret*$ tightly across ! end ( ! bone1 ! s(t p>ts mu/ rema9 s(t & free4 ,among ! hundr$s ( cases ( amputation ( ! leg or ?igh t h pass$ be=e u 9 be+ fitt$ at ! ,fdration des ,mutils1 !re 7 _m 9 :i* ! pres5ce ( a t]m9al sc> r5d]$ ! fitt+ ( an app>atus difficult2 we h nev] f\nd ?is ! case ) a lat]al sc>2 we h nev] se5 ! latt] ulc]ate rapidly z ! result ( pressure or friction 9 a prop]ly made wood5 bucket4 ,s t x _c be admitt$ t ! prop] cov]+ ( a /ump is ev] a matt] ( second>y importance4 ,consequ5tly we %\ld consid]1 z a matt] ( pr9ciple1 ! circul> me?od ( amputat+ only z a la/ resort1 & we ought to arrange ! section ( ! s(t p>ts s z to cov] ! end ( bone z adequately z possible1 & to br+ ! sc>s to "o side4 ,we realise t 9 practice w> surg]y (t5 necessitates deviations f ! ideal4 ,we (t5 f9d ourselves 9 a dilemma--ei!r ! /ump mu/ be good b too %ort2 or1 be+ long1 mu/ be poor or ev5 bad4 ,9 ! special case ( ! ?igh1 circul> amputation 9 ! l[] ?ird :5 x is c>ri$ out ?r\gh heal?y tissue & has n suppurat$ c be trimm$ & sutur$ 9 su* a way z to give an excell5t sc>1 :i* is transv]se & slightly po/]ior4 ,9 ?is situation aft] ^! r\t9e amputations1 a l9e> sc> :i* is supple & has heal$ by fir/ int5tion1 sep>at$ f ! bone by a good cu%ion ( muscul> & fibr\s tissue1 causes little emb>rassm5t1 :atev] its position2 at ! end ( a few mon?s x /&s pressure & friction )\t h>m4 ,b we are consid]+ w> surg]y & consequ5tly we are (t5 call$ ^u to fit /umps 9 :i* ! cicatrix is l>ge1 h>d1 & m or less irregul>1 9 :i* ! bone has suppurat$ & 9 :i* ! neighb\r+ s(t p>ts are indurat$ & sc>r$4 ,^! /umps are n1 h[ev]1 ! results ( ! "w ( ! wor/ surgeon4 ,amputat+ ?r\gh infect$ p>ts1 resign+ himself to heal+ by granulation & subsequ5t trimm+ by op]ation1 he mu/ take "t & tr\ble to atta9 9 ! end a result :i* is good functionally1 al?\gh at fir/ sight unsightly4 ,b x is ?is surgeon :o is on ! "r road1 r ?an he :o s5ds u good /umps :i* h n suppurat$1 because he has amputat$ ?r\gh ! ?igh = a w\nd ( ! middle ( ! leg1 or ?r\gh ! leg = a w\nd ( ! foot or ev5 ( ! front ( ! foot4 ,x is cle>1 t = ! /ump effectually to play its "p ( a lev] 9 its bucket1 a c]ta9 def9ite l5g? is necess>y2 & we ought to d ev]y?+ possible to secure a l5g? ( at lea/ #ae to #bj c5timetres 9 a ?igh /ump1 or #aj to #ab c5timetres 9 a leg /ump4 ,b :5 ?is l5g? is secur$1 !re is no great functional diff]5ce betwe51 = example1 an amputation ( ! leg 9 ! l[] ?ird or 9 ! l[] qu>t]1 p>ticul>ly if ! fitt] und]/&s h[ to utilise direct end be>+4 ,! k ( ?is is ( capital importance to ! surgeon call$ ^u to c>ry out second>y op]ations ^u imp]fect /umps1 9 det]m9+ :e!r x is possible to put an imm$iate /op to suppuration by dra/ic %ort5+1 or :e!r he mu/ pres]ve l5g? & lose "t by currett+ ! foci ( inflammation 9 ! bone4 ,,*apt] ,,iii ,,artificial ,,limbs ,,= ,,amputations ,,?r\gh ,,! ,,?igh ,!re are two entirely diff]5t modes ( fitt+3 ,i4 ,= amputations above ! condyles1 9 :i* weight mu/ always be borne ^u ! tub]osity ( ! is*ium ?r\gh ! top ( ! bucket4 ,,ii4 ,= amputations ?r\gh ! condyles 7or = dis>ticulation ( ! knee7 9 :i* a direct end be>+ may suffice4 ,i4 ,app>atus ) ,be>+ ^u ! ,is*ium 7,amputation above ! condyles47 ,9 ! con/ruction ( an artificial limb = amputation ?r\gh ! ?igh two entirely diff]5t pr9ciples may be us$1 accord+ z x is desir$ to make ! pati5t walk ^u a rigid %aft1 t is to say ^u a peg1 or ^u an artificial leg prop]1 9 :i* ! knee b5ds 9 walk+ 7kn[n z ! ,am]ican leg74 ,b :i*ev] pr9ciple is adopt$1 :atev] mat]ial is *os51 wood or lea!r1 & h[ev] exact ! fit 9 ! bucket may be1 c]ta9 common rules gov]n3-- #a4 ,! %ape ( ! top ( ! bucket by :i* x is fitt$ to ! top ( ! ?igh & its be>+ ^u ! is*ium4 #b4 ,! atta*m5t ( ! limb to ! trunk4 ,to beg9 ) we %all consid] ^! two que/ions1 & !n tempor>y & p]man5t app>atus1 ! peg leg & ! full artificial limb1 w be describ$4 ,i4 ,,! ,,%ape ,,( ,,! ,,top ,,( ,,! ,,bucket ,! tub]osity ( ! is*ium is ! sole bony po9t :i* c prev5t ! asc5t ( ! limb :5 weight is appli$4 ,?is tub]osity is situat$ 9 ! po/]ior "p ( ! p]9eum 7,fig4 #a71 ! ant]ior "p ( :i* is unable to /& pressure4 ,x is necess>y1 !re=e1 to cle> ?is "p by cutt+ d[n ! inn] bord] 9 its ant]ior "p1 =m+ a p]9eal concavity1 :i* rises po/]iorly aga9/ ! is*ium 7,fig4 #c74 ,x is ess5tial t ! is*ium %\ld n be able to slip inside ! bucket1 o!rwise ! inn] bord] w come 9 contact ) ! p]9eum3 !re=e ! diamet] ( ! bucket mu/ be less ?an t ( ! limb1 s t ! is*ium may re/ ^u its upp] edge4 ,if ! bucket is too l>ge1 ! pati5t abducts ! /ump1 s z to l[] ! inn] bord] & prev5t pressure on ! p]9eum2 he c>ries ! leg away f ! side z he walks1 & ?is is bo? unsightly & fatigu+4 ,:5 an app>atus is complet$1 x is v easy to asc]ta9 ! site ( ! pressure on ! is*ium4 ,! limb be+ put on1 ! is*ium is fix$ betwe5 ! ?umb & fir/ f+]1 & x c !n be asc]ta9$ :e!r x re/s on ! edge ( ! bucket or lies )9 x4 ,?is c be det]m9$ m exactly1 if :il/ ! f+]s :i* m>k ! position ( ! is*ium are kept )9 ! bucket1 ! pati5t is told to raise 8 /ump4 ,if ! bucket is suffici5tly n>r[1 x may be circul> )\t ! excavation = ! p]9eum 7,fig4 #b74 ,b ?is %ape is unsatisfactory = ano!r reason1 because x results 9 a t5d5cy = ! limb to rotate inw>ds4 ,at ! mom5t :5 ! artificial limb is com+ 9 contact ) ! gr\nd z x takes a /ep1 ! pelvis is oblique 7! iliac sp9e ( ! s\nd side ly+ po/]ior to t ( ! amputat$ side74 ,! s\nd limb z x executes its /ep is c>ri$ =w>ds1 & ! pelvis :i* 0 oblique 9 "o direction n[ becomes oblique 9 ! opposite direction4 ,?is movem5t is transmitt$ to ! femur 9 ! /ump1 s t ! artificial limb turns inw>ds relatively to ! /ump4 ,) ea* /ep ?is rotation becomes little by little m p]ceptible1 & aft] a "t ! pati5t is oblig$ to correct x by turn+ ! artificial limb ) 8 h&4 ,if1 on ! o!r h&1 ! front ( ! upp] bord] ( ! bucket slopes d[nw>ds & inw>ds at an angle ( ab\t #de degrees1 :5 z a result ( its weight ! bucket turns inw>ds z ! limb is swung1 ! base ( ! /ump w come aga9/ a high] "p ( bucket2 b :5 ! pressure ( ! weight ( ! body returns1 ! /ump1 be+ =c$ into ! bucket1 w desc5d aga9 along ?is slope1 t is to say a passive ext]nal rotation ( ! artificial limb w be br\ght ab\t1 correct+ at e /ep ! t5d5cy to int]nal rotation4 ,illu/ration3 ,,amputations ,,?r\gh ,,! ,,?igh ,,fig4 #a4 ,,fig4 #b4 ,,fig4 #c4 ,9 ! upright position ! rami ( ! pubis & is*ium1 betwe5 :i* /ret*es ! p]9eum1 slope d[nw>ds & backw>ds at an angle ( ab\t #de ) ! horizontal4 ,! tub]osity ( ! is*ium b\nds ! p]9eum po/]iorly1 & is its l[e/ po9t4 ,! rami ( ! pubis & is*ium1 correspond+ to ! g5ito-crural fold1 m>k ! b\nd>y betwe5 ! ?igh & ! p]9eum4 ,^! bones are unable to /& ! pressure ( an artificial limb4 ,if ! top ( ! bucket is n>r[] ?an ! circumf]5ce ( ! top ( ! limb1 measur$ bel[ ! is*ium1 x may be circul> & /ill give support to ! is*ium1 :i* w n slip into x4 ,if ! is*ium does slip into ! bucket1 ! result w be t x no long] s]ves z ! support1 ! pressure com+ in/ead ^u ! rami ( ! pubis & is*ium & ^u ! p]9eum4 ,! con/riction ?us ex]t$ ^u ! top ( ! /ump may easily become insupportable4 ,! correct solution ( ! problem is to cut d[n ! upp] bord] ( ! bucket opposite ! p]9eum1 lett+ x rise aga9 po/]iorly b5ea? ! tub]osity ( ! is*ium1 & ga9 a good support !re4 ,! same slope may be giv5 to bo? edges ( ! bucket 7,fig4 #e74 ,?is obliquity 9 ! po/]ior "p s]ves no useful purpose3 x is bett] on ! contr>y to l[] ! po/]ior bord] comb9+ ?is semioblique fitt+ ) a rise b5ea? ! is*ium & a depression "u ! p]9eum 7,fig4 #f74 ,^! conditions are easily c>ri$ out 9 a well-made wood5 bucket1 repres5t$ 9 figures #h & #i1 9 :i* x may fur!r be se5 t f ! front x is convex outw>ds2 f ! side1 convex =w>ds 7,fig4 #i74 ,?is =m1 :i* is t ( "s good ,am]ican appliances1 ought to be g5]ally us$4 ,! curve outw>ds1 by draw+ away ! s(t p>ts f x1 frees ! region ( ! is*ium & all[s ! tub]osity ( ! is*ium to press ^u ! bucket 7,fig4 #h74 ,if ! ?igh piece is curv$ =w>ds1 & p>ticul>ly if ! limb is built ) a v slight flexion ( ! knee1 ! /ump rema9s slightly flex$ at ! hip & ! pati5t feels z if he is sitt+ 9 ! app>atus4 ,:5 ! ?igh piece is /raight1 an uncom=table pressure is produc$ by ! edge ( ! bucket aga9/ ! is*ium4 ,x may be add$ t ext5sion ( ! hip is v (t5 impair$1 p>ticul>ly 9 pati5ts ) a %ort /ump3 ,! ext5sor muscles be+ divid$1 ! flexors cause contraction into a flex$ position1 ! m s ! %ort] ! /ump is4 ,if ! ?igh piece is /raight1 ! %ort /ump _c foll[ ! movem5t ( ext5sion necess>y 9 walk+2 x slips out ( ! bucket if ! ant]ior lip ( ! latt] is too l[4 ,! pr9ciples are ! same = ! lea!r bucket1 kn[n z ! ,fr5* patt]n4 ,illu/ration3 ,,fig4 #d4 ,,fig4 #e4 ,,fig4 #f4 ,,fig4 #g4 ,,fig4 #h4 ,,fig4 #i4 ,figure #d %[s ! circul> bucket 7almo/ always too l>ge7 ( ! poor man's peg leg1 atta*$ to ! body by a belt :i* is fa/5$ to a projection upw>ds f ! out] side ( ! bucket4 ,figure #e %[s ! oblique bucket1 ) symmetrical ant]ior & po/]ior bord]s4 ,figure #f "o ) ! ant]ior bord] oblique1 ! po/]ior bord] be+ cut away4 ,figure #g %[s ! d\ble obliquity1 d[nw>ds & backw>ds1 ( ! bucket4 ,! convexities ( ! bucket & ?igh piece1 9 ! type :i* we consid] to be ! be/1 are %[n 9 figure #h 7convexity outw>ds71 & figure #i 7convexity =w>ds74 ,9 ?is ! ?igh piece is /r5g!n$ by two lat]al /eels 7to ! l[] end ( :i* is fix$ ! leg piece7 jo9$ po/]iorly by a semicircul> cross piece on :i* ! is*ium %\ld re/ 7,fig4 #ac74 ,illu/ration3 ,,fig4 #aj4 ,illu/ration3 ,,fig4 #aa4 ,! usual =m hi!rto has be5 t %[n 9 figure #aj4 ,! cross piece 0 horizontal & =m$ simply a po/]ior semicircle2 ! lat]al /eels 7 /raight4 ,consequ5tly 9 ?is patt]n ^! /eels =m a cone1 9 :i* ! s(t p>ts are n compress$ on ! inn] side1 nor drawn outw>ds1 z 9 ! app>atus previ\sly describ$4 ,fur!r1 z long z ! /ump is n %runk51 ! is*ium cov]$ on its inn] side by s(t p>ts s9ks into ! bucket1 & x is ! p]9eum :i* becomes ! po9t ( pressure 7,fig4 #aa74 ,made ( lea!r1 ! p]9eal concavity soon loses its %ape & really no long] exi/s4 ,f9ally ! bucket is circul>1 ) ! faults insep>able f t %ape 7,fig4 #ab74 ,9 cases :]e x is felt necess>y to employ lea!r1 all ^! faults are easily correct$1 by giv+ ! cross piece ! %ape :i* we h describ$ = ! wood5 bucket1 & by prolong+ x =w>ds ?r\gh two-?irds ( ! correspond+ circumf]5ce1 9 ! %ape ( an oblique bucket4 7,dott$ l9e 9 ,fig4 #ab47 ,if x is n /r5g!n$1 an oblique bord] ( lea!r gives way1 & aft] a few mon?s' use all[s rotation4 ,! lea!r :i* ext5ds f ! t]m9ation ( ! metal asc5ds v /eeply t[>ds ! tro*ant]1 :il/ ! po/]ior bord] ( ! bucket1 :i* is horizontal1 curves d[nw>ds on ! inn] side to =m ! p]9eal concavity4 ,illu/ration3 ,,fig4 #ab4 ,,fig4 #ac4 ,,fig4 #ad4 ,! ord9>y lea!r bucket is m\nt$ ^u two lat]al /eels1 :i* are jo9$ by a po/]ior cross piece 7,fig4 #ac74 ,?is framework is %[n 9 figure #aj1 & cov]$ ) lea!r 9 figure #ab4 ,if ! lat]al /eels are /raight & div]g5t1 ?is has all ! defects ( ! /raight circul> bucket4 ,! concavity = ! p]9eum1 cut out ( ! lea!r1 soon loses its %ape4 ,x is1 h[ev]1 easy to %ape ! cross piece z %[n 9 figure #ad1 ) a p]9eal concavity & ! ant]ior bord] oblique1 foll[+ ! dott$ l9e 9 figure #ab4 ,by do+ ?is & curv+ ! /eel uprights appropriately1 ! correct =m ( ! wood5 bucket c be copi$ exactly 9 a lea!r & /eel app>atus4 ,su* a correct app>atus is %[n 9 figures #ae to #ah4 ,9 figure #ad is se5 ! metal framework2 9 figures #ae & #af t ( ! app>atus cov]$ ) lea!r2 9 figure #ag ! support ^u ! is*ium2 & ! possibility ( mak+ ?is appliance id5tical ) ! wood5 bucket w be obs]v$ 7,fig4 #ah74 ,illu/ration3 ,,fig4 #ae4 ,illu/ration3 ,,fig4 #af4 ,illu/ration3 ,,fig4 #ag4 ,illu/ration3 ,,fig4 #ah4 ,,ii4 ,,mode ,,( ,,susp5sion ,susp5sion ( ! ?igh piece is ess5tial1 & is all ! m important :5 ! /ump is %ort & consequ5tly m liable to slip out ( ! bucket4 ,= ?is purpose support may be tak5 ei!r f ! wai/1 ^u ! prom95ce ( ! iliac cre/s1 or f ! %\ld]s by means ( braces4 ,9 ! case ( a long /ump 7amputation bel[ ! middle ( ! ?igh7 only "o ( ^! me?ods is necess>y1 we %all describe ! usual me?ods3 ,! wai/ belt 7,fr5* sy/em7 = lea!r appliances4 ,braces 7,am]ican sy/em7 = appliances ( wood4 ,if ! /ump is %ort a comb9ation ( ! two me?ods is be/4 ,illu/ration3 ,,figs4 #ai & #bj4--,simple pelvic susp5sion1 ) details ( ! jo9t at ! hip4 ,a4 ,,susp5sion ,,by ,,means ,,( ,a ,,wai/ ,,belt4--,= ! peg leg made ( lea!r ! be/ me?od consi/s 9 plac+ a pelvic plate1 :i* is atta*$ to ! hip /eel1 bel[ ! iliac cre/ 7,figs4 #bj to #bd74 ,a belt atta*$ to ! extremities ( ?is plate surr\nds ! pelvis & passes above ! iliac cre/ on ! o!r side4 ,! ?igh piece is atta*$ to ?is support1 on ! out] side1 by articulation ( ! out] femoral /eel ) ! hip /eel2 on ! inn] side1 by a p]9eal /rap4 ,braces complete ! me?od ( susp5sion ( ! app>atus 7,fig4 #ba74 ,illu/ration3 ,,fig4 #ba4 ,! axis ( ! metal jo9t betwe5 ! out] femoral /eel & ! l[] end ( ! ,t piece %\ld be directly above ! great tro*ant] 7,fig4 #bj74 ,! femoral /eel (t5 breaks 9 ! neighb\rhood ( ?is jo9t 7,fig4 #bc72 we h got ov] ?is difficulty by add+ imm$iately b5ea? x a jo9t :i* all[s ( abduction 7,fig4 #ai74 ,a p]9eal /rap limits ?is movem5t4 ,illu/ration3 ,,fig4 #bb4 ,,fig4 #bc4 ,susp5sion f ! pelvis4 ,a metal hip piece is fix$ bel[ ! iliac cre/ & held 9 place by a belt :i* passes above ! iliac cre/ ( ! opposite side 7,figs4 #bj to #bd74 ,?is piece is atta*$ to ! ?igh bucket by a jo9t %[n 9 figure #ai 7see also ,fig4 #bb71 :i* all[s bo? flexion & abduction ( ! hip1 & :i* =ms ! susp5sion ( ! out] side ( ! limb4 ,! inn] bord] is susp5d$ by means ( a p]9eal /rap1 %[n 9 figures #ba & #bb4 ,9 figure #ba is %[n h[ a susp5d+ brace may be easily add$4 ,figure #bc %[s ! action ( a s+le h+e jo9t1 all[+ only flexion & ext5sion at ! hip jo9t4 ,on page #bg w be se5 simil> jo9ts :i*1 h[ev]1 move on ! pelvic atta*m5t z well z on ! ?igh piece4 ,! object ( ?is is to prev5t ! p9*+ ( ! abdom9al wall by ! top ( ! ?igh bucket :5 ! pati5t sits4 ,x is indisp5sable 9 %ort /umps4 ,on page #ba w be se5 a jo9t :i* all[s abduction ( ! hip1 & ?us relieves ! /ra9 ^u ! h+e jo9t2 )\t x ! latt] is easily brok54 ,b4 ,,susp5sion ,,by ,,means ,,( ,,braces 7,am]ican me?od74--,! ,am]ican me?od ( susp5sion has ! advantage ( leav+ ! pelvis free2 ! pati5t does n feel ! pull ( ! hip piece4 ,besides1 :5 ! belt is us$1 if ! pati5t sits d[n1 ! buttock on ! side ( ! /ump is rais$1 to an ext5t correspond+ to ! ?ickness ( ! bucket1 an obliquity ( ! pelvis1 :i* is bo? uncom=table & unsightly1 be+ produc$4 ,! braces be+ relax$ 9 ! sitt+ po/ure1 ! pati5t c avoid ?is inconv5i5ce2 = ! /ump may be slipp$ p>tly out ( its bucket1 ! upp] extremity ( :i* is !n beyond ! level ( ! edge ( ! *air4 ,?is position is v com=table1 because x is normal1 b ! pati5t mu/ replace 8 /ump 9 ! bucket :5ev] he /&s up4 ,illu/ration3 ,,fig4 #bd4 ,,fig4 #be4 ,braces compos$ ( /raps pass+ ov] ! %\ld]s & d[n ! front1 atta*$ to ! bucket by buckles4 ,po/]iorly !y are jo9$ toge!r by a cross /rap betwe5 ! scapul1 & beyond ?is are cont9u$ 9 ! =m ( ela/ic /raps4 ,?is =m ( susp5sion is ess5tial = ^? artificial limbs ) a free knee-jo9t1 9 :i*1 z we %all see1 ! braces s]ve to ext5d ! jo9t4 ,we illu/rate "h two me?ods ( atta*+ ! braces to ! ?igh piece1 t :i* we use 9 ! limb suppli$ by ! ,fdration 7,figs4 #bd & #be7 & t :i* is us$ 9 ! ,am]ican limb ( ,m>ks 7,figs4 #bf & #bg74 ,illu/ration3 ,,fig4 #bf4 ,,fig4 #bg4 ,,fig4 #bf4--;,braces :i* end bel[ 9 loop$ ?ongs ( lea!r4 ,,fig4 #bg4--,^! loops1 held 9 to ! ?igh piece by pass+ b5ea? a loop ( lea!r1 pass ov] two pulleys ab\t ! middle ( ! inn] & out] sides ( ! ?igh piece respectively4 ,! out] brace t5ds to abduct ! limb if x is tight5$4 ,c4 ,,comb9$ ,,me?od ,,( ,,susp5sion4--,if ! /ump is %ort ! artificial limb mu/ be atta*$ bo? by a belt & by braces2 ! latt] %\ld be #e to #f c5timetres wide4 ,illu/ration3 ,,fig4 #bh4 ,comb9$ susp5sion = %ort /umps4 ,,fig4 #bh4--;,complete appliance4 ,,fig4 #bi & #cj %[ ! value ( a flexion pivot betwe5 ! hip piece & ! pelvic plate4 ,if !re is no su* pivot1 ! ,t piece und\bt$ly rotates ^u ! belt1 b n to a suffici5t ext5t to prev5t ! ?igh piece 9 ris+ & p9*+ ! abdom9al wall 7,fig4 #bi74 ,if !re is a d\ble jo9t ! hip piece becomes oblique1 ?ru/+ ! ?igh piece =w>d & all[+ ! pati5t to sit erect 7,fig4 #cj74 ,9 ^! cases also1 to prev5t ! /ump escap+ f ! bucket :5 ! hip is flex$1 ! front ( ! ?igh piece is c>ri$ z high z possible2 b if ! appliance is furni%$ ) a metal ,t piece1 su* z has be5 describ$ 7,fig4 #bi1 see also ,fig4 #bc71 !n ?is rais$ bord] prev5ts flexion ( ! hip by com+ 9 contact ) ! abdom9al wall :5 ! pati5t sits d[n4 ,?is difficulty c be got ov] by mak+ ! top ( ! ,t piece movable2 :5 ! pati5t sits d[n ! v]tical piece ( ! ,t becomes oblique1 ! ?igh piece comes =w>d1 all[s ! /ump to escape a little way & no long] presses aga9/ ! abdom9al wall 7,fig4 #cj74 ,! belt may also be replac$ by a lea!r corselet1 hav+ fix$ to x ! hip piece t we h j describ$4 ,illu/ration3 ,,fig4 #bi4 ,! braces by !mselves are a poor me?od ( atta*m5t = a %ort /ump4 ,illu/ration3 ,,fig4 #cj4 ,9 ! sitt+ position ! /ump easily escapes f ! bucket4 ,:5 ! pati5t is /&+ ! /ump rema9s abduct$1 :il/ ! app>atus1 z ! result ( its own weight hangs v]tically1 9 ?is sway+ position ! l[] extremity ( ! /ump presses aga9/ ! out] side ( ! bucket1 :il/ ! inn] edge ( ! bucket cuts into ! fle% at ! top ( ! ?igh4 ,,iii4 ,,walk+ ,,on ,a ,,peg ,,leg ,,& ,,simil> ,,appliances ,! rigid peg & ! jo9t$ peg4--,! peg leg is a rigid rod1 end+ 9 a slight enl>gem5t1 :i* transmits ! weight ( ! body1 re/+ by means ( ! is*ium ^u ! top ( ! bucket1 directly to ! gr\nd4 ,! erect position is ?us v secure1 & /ability 9 walk+ is also v good ?r\gh\t ! "t :5 ! artificial limb be>s ! weight4 ,to raise ! limb f ! gr\nd & c>ry x =w>ds1 ! pati5t uses at ! same "t bo? flexion ( ! /ump at ! hip & movem5ts ( ! pelvis 7elevation1 !n rotation inw>ds7 v>y+ to "s ext5t ) 8 pr(ici5cy & ) ! l5g? ( ! /ump4 ,! old-fa%ion$ peg leg1 call$ ! poor man's peg1 consi/s ( a bucket cont9u$ into a rigid peg4 ,if ! support b5ea? ! is*ium is well made accord+ to ! pr9ciples describ$ above1 x is an excell5t tempor>y limb4#c ,?is bucket ( common wood1 :i* is n specially %ap$ to ! /ump1 is v economical2 its imp]fect fit is an advantage 9 t ! /ump1 :i* is /ill enl>g$1 _c be> friction2 z ! /ump assumes its true %ape & dim9i%es 9 size1 ! bucket is pack$4 ,we w\ld add t e pati5t1 :o is n ri* en\gh to possess two complete artificial limbs %\ld h 9 res]ve an em]g5cy peg leg1 = occasions :5 ! artificial limb requires repair4 #c ,a numb] ( tempor>y limbs h be5 design$1 ) buckets ( lattice "w or ( pla/]4 ,! old-fa%ion$ wood5 peg1 :i* is easily obta9$1 avoids all ?is additional "w )\t any disadvantage4 ,z a p]man5t app>atus1 ) accurately fitt$ bucket1 ! rigid peg leg has two defects3 x has n ! appe>ance ( a leg & foot1 & :5 ! pati5t is sitt+ ! rigid peg is unsightly & inconv5i5t to him & to 8 neighb\rs4 ,we h !re=e design$ & complet$ a jo9t$ peg leg1 ! pr9ciple ( :i* is z foll[s3 ,bel[ ! ?igh piece ! peg is atta*$ by a transv]se jo9t1 ?is jo9t be+ lock$ 9 ! ext5d$ position :5 ! pati5t is upright4 ,! pati5t sets x free by manipulat+ ! lock ?r\gh ! tr\s]s1 :5 he sits d[n2 :5 he gets up aga9 ! lock+ 9 ! ext5d$ position is automatic4 ,! fitt+ ( ?is transv]se jo9t may be c>ri$ out 9 two ways4 #a4 ,! upp] end ( ! peg ends 9 a /irrup-%ap$ =k & ! bolt passes ?r\gh ! two ends ( ?is =k & ?r\gh ! l[] end ( ! ?igh piece 7,figs4 #ca to #cc74 #b4 ,! l[] extremity ( ! ?igh piece has cut 9 x a c5tral mortise into :i* fits a v]tical plate1 prolong$ upw>ds f ! middle ( ! leg piece4 ,! bolt passes ?r\gh ?is artificial tibial sp9e & ?r\gh ! two sides ( ! mortise 9 ! ?igh piece4 ,if ! hole 9 ! tibial sp9e ?r\gh :i* ?is bolt passes is squ>e ! h+e works securely 7,figs4 #cd to #cf74 ,9 ?is =m ! axle turns ) ! leg1 9 ! fir/ =m ?is is also possible4 ,b mo/ (t5 :5 ! =k$ atta*m5t is us$ x is fix$ to a lea!r ?igh piece1 & ea* end ( ! =k is jo9t$ indep5d5tly to ! correspond+ end ( ! lat]al /eels ( ! ?igh piece1 )\t any complete transv]se bolt4 ,x is !n ! =k t revolves ar\nd ^! two jo9ts4 ,illu/ration3 ,,figs4 #ca to #cc4--;,fixation ( ! /irrup ( ! leg 7,fig4 #ca7 by a transv]se bolt 7,fig4 #cc71 ! ap]ture = :i* 9 ! ?igh piece is se5 9 ,fig4 #cb4 ,d\ble lock 7,fig4 #cb74 ,illu/ration3 ,,figs4 #cd to #cf4--;,atta*m5t by mortise & t5on1 ) a bolt1 squ>e 9 section1 pass+ ?r\gh ! knee4 ,s+le lock on ! out] side4 ,if !re is a complete transv]se bolt1 ! jo9t c be securely lock$ by a s+le lock at "o ( its extremities 7at ! out] extremity7 7,figs4 #cf to #ci74 ,if !re are two lat]al jo9ts ! s+le lock is insuffici5t1 bo? jo9ts mu/ be fix$ at once2 unless ?is is done1 t :i* is n fix$ has a c]ta9 am\nt ( play & is /ra9$4 ,x is1 h[ev]1 simple1 by means ( a po/]ior semicircle1 to jo9t ! two locks & to "w !m toge!r by a s+le movem5t 7,fig4 #cb74 ,= /hetic reasons ! wood5 leg piece may be made 9 ! %ape ( a leg & foot4 ,b if ! pr9ciple ( ! peg leg has be5 adopt$1 = an agricultural lab\r] = example1 on acc\nt ( its /ability1 x is bett] to use an appliance 9 :i* a %[ leg is fitt$ ar\nd ! simple peg on days :5 appe>ance is m important ?an "w 7,figs4 #cg to #de74 ,! limb is ?us r5d]$ light]1 = ! false calf consi/s ( a simple lay] ( felt & x is v easy to replace ! enl>g$ l[] end ( ! peg by a foot4 ,illu/ration3 ,,figs4 #cg to #dj4--;,atta*m5t by a mortise1 & %[ foot4 ,we %[ lat] two models ( ?is sort1 "o ) an ,am]ican ?igh piece ( wood & a s+le lock ^u a transv]se axle1 ! o!r ) a lea!r ?igh piece & a d\ble lock4 ,! fir/ 7,figs4 #cg to #dj7 is %[n ) an atta*m5t by braces1 & ! second 7,figs4 #da to #dg7 ) an atta*m5t by means ( a wai/ belt2 we h already expla9$ :5 ^! two mu/ be comb9$4 ,illu/ration3 ,,fig4 #da4 ,,figs4 #db to #dg4 ,lea!r & /eel peg leg1 ) %[ foot4 ,figures #da to #dg 7lea!r appliance7 %\ld be comp>$ ) figures #cg to #dj 7wood5 appliance7 :i* complete !m 9 c]ta9 po9ts4 ,x is unnecess>y to ref] fur!r to ! me?od ( fitt+ ! bucket to ! susp5sion1 or to ! me?od ( atta*+ & lock+ ! knee4 ,! peg--atta*$ above by a /irrup or by a mortise1 x does n matt] :i*--ends bel[ 9 a rectangul> t5on :i* fits into a correspond+ excavation 9 ! upp] surface ( ! t]m9al piece1 :e!r peg or foot 7,figs4 #ch & #dd74 ,a transv]se bolt1 squ>e 9 section1 ) a head at "o end & a ?read at ! o!r1 fixes ^! two p>ts toge!r4 ,by tak+ out ?is bolt ! peg c be replac$ by ! foot or vice v]s4 ,if ! atta*m5t ( ! foot is made 9 ! heel1 a fix$ foot is us$ 7,figs4 #dc & #de71 b x is easy1 by mak+ ! atta*m5t high]1 to use a foot ) movable ankle jo9t 7,fig4 #dj74 ,! atta*m5t ( ! %[ calf piece ar\nd ! peg is %[n 9 figures #dc & #de4 ,mo/ (t5 ! wood5 ?igh piece is to be pref]r$2 ! limb is light] & may la/ f\r or five ye>s in/ead ( ab\t two ye>s4 ,we may add t lea!r loses its %ape & ! bucket becomes enl>g$1 produc+ inconv5i5ces already describ$ on page #ah4 ,b lea!r--indesp5sable = c]ta9 /umps :i* _c /& a wood5 bucket--has ! advantage t x c be employ$ z a tempor>y fitt+4 ,dur+ ! fir/ weeks1 sometimes ev5 = ! fir/ mon?s1 ! %r9k+ ( ! /ump c be accommodat$ by lac+ up ! bucket1 &1 :5 %r9kage is complete1 ! leg "p ( ?is fir/ app>atus c be atta*$ to a wood5 bucket :i* ! improv$ condition ( ! /ump n[ r5d]s possible4 ,?is =m is a little m exp5sive 7#hj frs47 ?an ! poor man's leg1 b ,i believe a great deal m com=table4 ,x may be add$1 t x is easy :5 ! foot is fitt$ at ! end ( ! app>atus to r5d] flexion ( ! knee free & to atta9 ! ,am]ican walk1 ( :i* we %all speak lat]4 ,all t is necess>y is to atta* 9 front an artificial muscle ( indi>ubb]1 rea*+ f ! ?igh to ! leg & an ext5d+ sl+ l t 9 ! ,am]ican limbs 7see page #dg74 ,?is appliance :i* we call ! ,fdration ,leg1 because we design$ x at ! ,fdration des ,mutils1 has already be5 imitat$ )\t its orig9 be+ ackn[l$g$4 ,,iv4 ,,walk+ ,,) ,,free ,,flexion ,,( ,,! ,,knee ,a4 ,design4--,! olde/ type1 :i* w suffice = /udy+ ! g5]al conditions ( /ability1 is t ( ,m>ks1 ) a fix$ foot %ap$ out ( ! same piece ( wood z ! leg3 ! ankle jo9t--sev]al types ( :i* we %all describe lat]--does n affect ! "q ( /ability4 ,! appliance is made entirely ( wood2 x is /rong & light4 ,no?+ ne$ be add$ to ! description already giv5 ( ! fitt+ & me?od ( atta*m5t ( ! ?igh piece1 :i* ends bel[ 9 a curv$ condyle1#d :i* fits into ! top ( ! leg piece4 ,x is transfix$ by a metal bolt1 f ea* end ( :i* a metal plate desc5ds & is rivet$ into a correspond+ groove 9 ! leg4#e ,?is =ms ! axle :i* rotates 9 ! ?igh piece :5 ! knee flexes or ext5ds4 ,flexion ( ! knee is free4 ,ext5sion is /opp$ j %ort ( ! /raight l9e 7see p4 #af74 #d ,! bucket & ! condyl> portion are made ( two sep>ate pieces ( wood4 #e ,! hole ?r\gh :i* ! bolt passes be+ cut 9 s(t wood 7will[ or lime71 mu/ be /r5g!n$ by a cyl9d] ( metal1 ( lea!r1 or ( h>d] wood 7bee* or s]vice tree7 9 :i* ! axle revolves4 ,illu/ration3 ,,fig4 #dh4--,m>ks leg ) fix$ foot4 ,illu/ration3 ,,fig4 #di4--;,con/ruction ( ! foot4 ,! foot is 9 equ9us at an angle ( #be to #cj s t ! heel is #b or #c c5timetres f ! gr\nd 7! usual height ( ! heel ( a boot74 ,! piece ( wood :i* =ms ! in/ep & :i* is cont9u\s ) ! leg /ops at a po9t correspond+ to ! middle ( ! metat>sus1 & is only half ! ?ickness ( ! foot4 ,! re/ ( ! foot is %ap$ ( indi>ubb] /uck on to ! in/ep piece2 ! wood & rubb] be+ enclos$ 9 a %ea? ( lea!r4 ,! foot %\ld also po9t slightly outw>ds1 z 9 ! normal /&+ position4 ,to asc]ta9 :e!r ! limb is built s z to ensure equilibrium1 a ?read is /ret*$ aga9/ its side s z to pass ?r\gh ! axes ( ! knee & ankle jo9ts1 if ?is cuts ! is*ial be>+ po9t at its c5tre ! equilibrium ( ! pati5t is assur$4 ,equilibrium w be bett] /ill if ! cord lies entirely beh9d ! is*ial be>+ po9t1 leav+ 9 front ( x ! great] "p ( ! ?igh piece4 ,! be/ me?od ( asc]ta9+ if ! foot is prop]ly m\nt$ is to hold ! limb 9 front ( "o by ! ?igh piece1 ) ! knee b5t at a "r angle2 x c !n be se5 :e!r ! foot turns outw>ds at ! correct angle4 ,x is n necess>y to say any?+ m ab\t ! %ape ( ! ?igh piece 7page #ag74 ,! metal bolt :i* transfixes ! knee mu/ n all[ any play2 ! hole ?r\gh :i* x passes mu/ be l9$ ) h>d wood or lea!r4 ,! indi>ubb] sole %\ld be re9=c$ ) sev]al lay]s ( canvas incorporat$ 9 ! rubb]1 z ! latt] if n s re9=c$ p]i%es & cracks4 ,! appliance mu/ fur!r be exam9$ aft] x is appli$4 ,! level ( ! iliac sp9es mu/ be comp>$3 ! sp9e on ! side ( ! amputation %\ld be #b cm4 bel[ t ( ! s\nd side4 ,exam9e ! position ( ! po9t ( ! foot4 ,make ! pati5t sit d[n1 see if ! knees are on ! same horizontal plane2 if ! s\nd knee is ! high] ! leg piece is too %ort4 ,! foot be+ fix$ 9 ! equ9us position ! pati5t mu/ we> boots :ile ! exam9ation is be+ c>ri$ out4 ,b4 ,me*anism ( walk+4--,9 walk+1 a /ep be+ tak5 ) ! artificial leg1 ! toe ( ! foot is ! la/ to leave ! gr\nd1 ! heel be+ rais$ & ! knee /raight4 ,! limb is swung =w>d & rais$ by flexion ( ! hip3 active flexion ( ! knee is impossible1 b passive flexion occurs1 ow+ to ! weight ( ! leg piece1 z ! ?igh is rais$4 ,at ?is mom5t ! leg piece is v]tical1 =m+ an angle ) ! ?igh1 f ?is position x mu/ pass into "o 9 :i* x is oblique =w>ds & d[nw>ds1 9 a /raight l9e ) ! ?igh1 s t ! knee may be fully ext5d$ :5 weight is aga9 borne by ! limb z ! foot meets ! gr\nd4 ,if at ?is mom5t ! knee is flex$ ! limb w d\ble up "u ! weight ( ! body4 ,! fir/ contact ( ! limb ) ! gr\nd %\ld be at ! heel )1 z we h already said1 ! knee ext5d$4 ,aft]w>ds z ! limb1 :i* at fir/ po9ts obliquely =w>d & d[nw>ds1 passes into ! v]tical position 9 :i* x mu/ be at ! p]iod :5 x be>s ! :ole ( ! weight1 ?is complete ext5sion becomes lock$ & trans=ms ! limb into a rigid column4 ,?is is br\ght ab\t z expla9$ on page #dh by m\nt+ ! foot 9 equ9us1 & we mu/ "h describe ! me?ods by :i* ! comm5cem5t ( ! movem5t ( ext5sion may be communicat$ to ! leg s t ! heel may be ! fir/ "p ( ! foot to t\* ! gr\nd4 ,^! me?ods may be t]m$ knee ext5d+ me*anisms4 ,!y assi/ ! passive action ( ! weight ( ! leg4 ,9 fact ! recurr5ce ( ext5sion is br\ght ab\t by a p5dulum movem5t ( ! leg1 :i*1 at fir/ oblique d[nw>ds & backw>ds1 sw+s into a d[nw>d & =w>d obliquity4 ,b ?is movem5t is sl[ 7! p5dulum :i* m>ks "o second is "o metre long7 & incomplete4 ,! pati5t c make x complete ) a little in/ruction1 by ext5d+ ! ?igh slightly z soon z ! foot t\*es ! gr\nd4 ,?is may be suffici5t if ! /ump is long2 ! lev]age is good1 & :ile ! hip is be+ flex$ a sw+ c be giv5 to ! ?igh piece :i* acc5tuates ! p5dulum movem5t ( ! leg4 ,b ) a %ort /ump "s special me*anism is ess5tial to make sure t ext5sion w be complete1 o!rwise ! pati5t w be oblig$ to walk ) %ort & calculat$ /eps1 to wait :il/ ! p5dulum action produces ext5sion ( 8 knee & all[s him to put weight ^u 8 foot4 ,c4 ,me*anism = />t+ ext5sion ( ! knee dur+ ! "t ! leg is sw++4--,!re are two me?ods :i* are g5]ally comb9$3 #a4 ,ela/ic traction by an artificial muscle4 #b4 ,! ext5d+ sl+4 #a4 ,artificial muscle4--,! action ( an artificial muscle made ( ela/ic 7noiseless7 or ( a coil$ /eel spr+1 is easily und]/ood4 7a7 ,! simple/ me?od 7t :i* is commonly us$ = infantile p>alysis affect+ ! quadriceps7 consi/s 9 fix+ an ela/ic b& divid$ into two slips1 "o on ei!r side ( ! patella betwe5 ! front ( ! ?igh & ( ! leg1 ab\t ! middle ( ea*4 7,?is is repres5t$ 9 figure #ih 9 our conv]table leg47 7b7 ,:5 ! app>atus includes ! regul> artificial knee ! mak]s g5]ally place ?is me*anism 9 ! int]ior ( ! ?igh & leg pieces1 us+ me?ods :i* are (t5 v +5i\s4 ,( ^! we illu/rate "s on pages #dj onw>ds1 ) an explanatory description4 ,9 describ+ ^! me*anisms1 :i* may be call$ intra-condyl>1 x is necess>y to speak at ! same "t ( ! /op to limit ext5sion because1 z w be se51 x is comb9$ ) ! ext5d+ spr+4 ,we h already said t rigidity 9 ext5sion :5 ! limb is v]tical is ess5tial1 b :il/ x is necess>y = ext5sion to be complete at ?is mom5t x is also necess>y to prev5t ! knee be+ =c$ into ! hyp]ext5d$ position1 z ?is w\ld quickly /ra9 ! jo9t & r5d] ! limb useless4 ,?is limitation ( ext5sion c be effect$ q easily by ! t5sion ( a popliteal cord 7see page #da4 ,! knee 9 ,m>ks leg71 or by c>ry+ ! ant]ior bord] ( ! leg piece upw>ds 9 front ( ! ?igh piece s t x imp+es aga9/ ! latt]4 ,?is me?od is n v good because x is noisy4 ,moreov]1 ! repeat$ impact aga9/ ! leg piece may split ! wood1 s t if ?is me?od is adopt$ ! /op mu/ be re9=c$ by a b9d+ ( sev]al lay]s ( p>*m5t4 ,we w fir/ describe a me*anism ! association ( :i* ) ! ext5d+ sl+ w be se5 on page #dh4 4 ,to limit ext5sion ( ! knee all t is necess>y is to prolong ! ant]o-po/]ior diamet] ( ! knee bolt 7:i* turns ) ! leg7 by a horizontal w+1 :i* engages ) a correspond+ not* 9 ! femoral condyle4 ,we %[ "h 7,figs4 #ej & #ea7 a r m complicat$ b /ill simple me*anism :i* is int]e/+ because x c be comb9$ ) ! action ( ! ext5d+ sl+ 7see page #dh74 ,x consi/s ( a piece ( metal curv$ on ! flat1 end+ above 9 a cyl9d] ?r\gh :i* ! knee bolt passes1 cont9u$ bel[ into a cyl9drical tail piece1 :i* fits into a r+ :i* is fix$ inside ! top ( ! calf4 ,dur+ flexion ?is plate moves 9 a m$ian po/]ior w9d[ 9 ! femoral condyle1 becom+ oblique at ! same "t z ! tail piece s9ks into ! r+2 dur+ ext5sion ! tail piece rises 9 ! r+ & ! int]ior flat surface engages aga9/ a correspond+ groove 9 ! femoral condyle 7cov]$ ) lea!r to secure sil5ce74 ,illu/ration3 ,,figs4 #ej & #ea4--;,int]nal me*anism to limit ext5sion ( ! knee4 4 ,9 ! ,m>ks knee an int]nal sy/em ( cords & spr+s s]ves at ! same "t bo? to limit ext5sion & to produce an ela/ic ext5d+ =ce4 ,x is a sy/em :i* is fairly simple & mu* us$4 #a4 ,limitation ( ext5sion is secur$ by a ,u-%ap$ cord1 ! extremities ( :i* are fix$ to a wood5 cross piece 7,t71 fix$ 9 ! ?igh piece ?ree c5timetres above ! axis ( ! jo9t4 ,! cords leave ! ?igh ?r\gh two lat]al op5+s 9 ! back ( ! ?igh piece1 & ! loop passes ?r\gh a r+ halfway d[n ! calf4 #b4 ,! ext5d+ =ce consi/s 9 a coil$ /eel spr+ ! me*anism ( :i* is comb9$ ) t ( ?is cord4 ,! l[] half ( ! spr+ is enclos$ 9 a copp] tube l9$ ) *amois lea!r to secure sil5ce2 its upp] half or r m is coil$ ar\nd a wood5 p91 :i* t]m9ates above 9 a head :i* is cup %ap$3 x w be se5 7,fig4 #eg7 t if pressure is made on ?is head ! spr+ is %ort5$ & "u compression4 ,?is spr+ is fix$ bel[ 7by means ( a t5on :i* all[s ant]o-po/]ior movem5t7 ^u a bracket 9 ! calf :i* is cont9u\s ) ! r+ ?r\gh :i* passes ! *eck cord4 ,! cup-%ap$ upp] end is 9 contact ) a ball :i* projects f ! upp] surface ( ! ?igh piece betwe5 ! two op5+s = ! *eck cord 7,fig4 #ec74 ,x w be se5 t :5 ! knee is flex$ ! spr+1 ! head ( :i* lies bel[ ! axis ( ! jo9t1 w be compress$ at ! same "t z ! *eck cord is relax$ s t !re is an ela/ic recoil t5d+ to reproduce ext5sion4 ,! ball :i* re/s on ! top ( ! spr+ is fix$ 9 su* a mann] z to be 9 ! same horizontal plane z ! axis ( ! knee3 t is to say1 x is 9 ! same v]tical plane z ?is axis :5 ! knee is flex$ to a "r angle 7,fig4 #eb74 ,!re=e 9 ?is position ! spr+ has no t5d5cy to produce ei!r ext5sion or flexion1 t is to say ! me*anism is n[ at dead po9t1 & :5 ! pati5t is sitt+ flexion to ! "r angle is ma9ta9$ )\t any ef=t4 ,illu/ration3 ,! ,m>ks knee4 ,,fig4 #eb4 ,,fig4 #ec4 ,,figs4 #ed to #eg4 ,,figs4 #eb & #ec4--,o1 knee bolt4 ,t1 cross piece ( wood1 situat$ 9 ! ext5d$ position above ! knee bolt1 9 ! flex$ position beh9d x4 ,c1 bracket fix$ halfway up ! int]ior ( ! calf4 ,a ,u-%ap$ cord a passes ?r\gh a hole 9 ! bracket ,c & is atta*$ at ea* end to ! cross piece ,t2 x limits ext5sion4 ,! two ends ( ! ^w ent] ! ?igh piece by two ap]tures 9 ! po/]ior surface1 betwe5 :i* is fix$ a metal ball :i* projects #b cms4 ,! ext5d+ spr+ is ! rod b :i* is fix$ to ?is ball & to a socket 9 ! upp] surface ( ! bracket4 ,figs4 #ed to #eg %[ ! p>ts ( ?is spr+3 a tube1 a spiral spr+1 & a rod ) cup-%ap$ head4 ,:5 ! spr+ is 9 ! tube & ! rod 9 ! spr+ 7,fig4 #eg71 x w be se5 t pressure ^u ! head ( ! rod increases ! t5sion ( ! spr+4 ,9 ! knee %[n 9 figures #eh & #ei ! ext5d+ me*anism is z foll[s4 ,directly beh9d ! axis ( ! jo9t is a metal crossb>1 ^u :i* fits ! groov$ upp] extremity ( a piece ( wood1 ! o!r end ( :i* re/s 7l a lance7 9 a pocket :i* is susp5d$ 9 ! leg piece by an ela/ic b& 7! latt] be+ kept /ret*$ to a great] or less ext5t by a lace :i* em]ges f ! calf74 ,illu/ration3 ,,figs4 #eh & #ei4--;,ela/ic spr+ = ext5d+ ! knee4 ,! ela/ic be+ slightly /ret*$ :5 ! knee is ext5d$1 x w be se5 t ! crossb> turn+ r\nd ! axis ( ! knee becomes l[]$ z ! knee flexes1 s t ! ela/ic is /ret*$ & consequ5tly opposes flexion2 b :5 ! knee is b5t to a "r angle ! axis ( ! jo9t1 ! crossb> & ! wood5 rod are 9 ! same v]tical l9e2 ! me*anism is at a dead po9t j z we h already se5 9 ! ,m>ks knee1 & ! t5sion on ! ela/ic presses ! leg directly d[nw>ds )\t t5d+ ei!r to flex or to ext5d x4 ,lea!r pads dead5 ! noise ( ! impact4 ,ext5sion is limit$1 z w be se5 by comp>+ figures #eh & #ei1 by ! v]tical wood5 rod meet+ flat surfaces 9 ! ?igh & leg pieces simultane\sly4 #c4 ,ext5d+ sl+s4#f--,to ! sl+ :i* passes ov] ! %\ld] on ! side ( ! artificial limb1 is atta*$ a /rap :i* passes d[n 9 front ( ! ?igh piece & is atta*$ to ! upp] ?ird ( ! leg4 #f ,?is is an old ,fr5* me?od us$ 9 ,f\illoy's appliance1 :i* has1 h[ev]1 only become g5]ally us$ 9 ! susp5d+ braces ( ! ,am]ican appliance4 ,:5 ! pati5t raises ! leg f ! gr\nd1 ! weight ( ! appliance makes x slip d[n ! /ump1 t5sion is ?us produc$ ^u ?is /rap & z a result ! knee is ext5d$4 ,by an adroit movem5t ( ! %\ld] ?is ext5sion c be c>ri$ out actively4 ,:5 ! limb re/s ^u ! gr\nd ! weight ( ! body presses ! /ump d[n into ! bucket1 ! t5sion on ! /rap is releas$ & consequ5tly ! knee is free to flex4 ,on pages #dd to #dh w be f\nd figures %[+ ! pr9cipal po9ts 9 ?is ext5d+ brace4 ,! braces1 :e!r !y h or h n an ext5d+ /rap1 may be con/ruct$ 9 ?ree ways3 a4 ,to ease ! con/ant pressure ex]t$ on ! %\ld]s by ! /rap :i* is /ret*$ by ! weight ( ! artificial limb1 ! brace may be made ( ela/ic l ! ord9>y tr\s]s brace4 ,b ! limb !y c>ry is heavy1 s !y rapidly become ov]/ret*$ & x is difficult to keep !m prop]ly adju/$4 b4 ,! /ret*+ is naturally dim9i%$ if ! upp] "p ( ! brace is n ela/ic b an ela/ic section is ins]t$ 9 its l[] ?ird1 9 front & beh9d4 c4 ,b ! pati5ts almo/ always say t bett] comm& ( ! limb is obta9$ ) inela/ic braces4 ,if ! /rap is wide on ! %\ld]1 ! pressure is well borne1 & ! l[] atta*m5t may be made n>r[]1 consi/+ ( a lea!r ?ong 7,fig4 #fd74 ,illu/ration3 ,fig4 #fj4 ,fig4 #fa4 ,fig4 #fb4 ,fig4 #fc4 ,fig4 #fj4--;,f\illoy's ,braces4 ,figs4 #fa to #fe4--,m>ks' braces4 ,fig4 #fa4--;,g5]al con/ruction ( ! braces4 ,figures #fb & #fc4--;,atta*m5t at ! sides ( ! ?igh piece4 ,figures #fd & #fe4--;,g5]al view ( ! app>atus z worn4 ,to atta* ext5sion braces to ! front ( ! leg piece ! old & simple me?od adopt$ by ,f\illoy may be us$4 ,x consi/s 9 atta*+ an ela/ic /rap to ! brace :i* passes ov] ! %\ld] on ! side ( ! amputation 7& :i* is fix$ to ! top ( ! ?igh piece alongside ( ! o!r brace74 ,! ela/ic /rap ends 9 a bifurcat$ lea!r ?ong ea* bran* ( :i* 7held 9 place by a loop ( lea!r7 desc5ds obliquely alongside ( ! patella surface to be atta*$ to ! correspond+ side ( ! leg 9 its upp] ?ird 7,fig4 #fj74 ,9 ,m>ks' me?od ! braces end bel[ 9 loops made ( a lea!r ?ong 7,fig4 #fa74 ,^! are held aga9/ ! ?igh piece by pass+ "u lea!r b&s2 !y rea* z f> d[n z ! upp] ?ird on ! inn] & out] sides ( ! ?igh 7,figs4 #fb to #fe74 ,to ea* ( ! loops1 glid+ on !m by means ( a pulley1 is atta*$ a lea!r /rap :i* desc5ds v]tically to ! upp] ?ird ( ! correspond+ surface ( ! leg1 be+ held 9 place by pass+ "u a lea!r b&4 ,^! two /raps are atta*$ to ea* o!r 9 front by a lace1 :i* draws !m t[>ds ! middle l9e1 & 9 ?is way br+s _! l9e ( action =w>ds4 ,! tight] ! lace is drawn ! m p[]ful w be ! ext5d+ =ce4 ,illu/ration3 ,,fig4 #fd4 ,,fig4 #fe4 ,in/ead ( atta*+ ! ext5sion brace to ! leg piece x may be made to pass "u a pulley 9 ! int]ior ( ! knee4 ,:at actually happ5s is t ! ?igh piece drops1 ow+ to its weight1 :5 ! limb is swung free2 ?is ?r[s a /ra9 on ! brace :i* is transmitt$ to ! leg piece by ! foll[+ me*anism4 ,! metal /op describ$ on page #ci :i* limits ext5sion ( ! knee dur+ ! p]iod ( weight be>+1 is prolong$ upw>ds & =w>ds beyond ! hole ?r\gh :i* ! axis ( ! knee passes1 ?is prolongation be+ furni%$ ) two wood5 pulleys 7,fig4 #fi74 ,! loops atta*$ to ! braces ent] ! front ( ! ?igh piece1 ea* by a sep>ate op5+1 turn "u ! correspond+ pulley & em]ge aga9 po/]iorly 7,figs4 #ff to #fh74 ,illu/ration3 ,fig4 #ff4 ,fig4 #fg4 ,fig4 #fh4 ,?is mode ( atta*m5t has ! advantage t :5 ! limb is swung ! movem5t does n take place ^u ! %\ld]s--:i* easily become *af$ by ! ord9>y susp5d]s--b ^u ! pulleys ^u :i* ! lea!r ?ongs "w4 ,! me*anism %[n 9 figures #fi to #ga is int]e/+4 ,:5 ! metal lev] moves ar\nd ! axis ( ! knee jo9t1 its l[] end & ! pulleys at ! upp] end travel 9 opposite directions3 9 flexion ! pulleys move d[nw>ds & =w>ds1 ! l[] end upw>ds & backw>ds2 9 ext5sion !y move 9 ! opposite direction4 ,!re=e :5 ! limb is swung & ! knee b5ds 7,fig4 #ga71 ! ?igh piece drops ( its own weight1 ! braces tight51 raise ! pulley & consequ5tly make ! l[] end ( ! lev] move d[nw>ds & =w>ds1 ?us ext5d+ ! knee jo9t4 ,illu/ration3 ,fig4 #fi4 ,fig4 #gj4 ,fig4 #ga4 ,d4 ,me*anism to secure rigidity ( ! knee dur+ weight he>+4--,dur+ ! "t t ! heal?y limb is rais$ f ! gr\nd & c>ri$ =w>ds !re mu/ be complete rigidity ( ! artificial limb 9 ! ext5d$ position4 ,?is is secur$ by m\nt+ ! foot 9 ! equ9us position4 ,:5 x has be5 swung =w>ds1 9 tak+ a /ep1 ! limb comes 9 contact ) ! gr\nd heel fir/2 !n1 z ! leg becomes v]tical ! entire sole lies flat on ! gr\nd2 if ! foot is 9 equ9us ?is position is only possible ) ! knee hyp]ext5d$1 or ) full ext5sion x may be possible = a v %ort p]iod4 ,s t x is ! weight ( ! body t locks ! limb 9 ! ext5d$ position1 ! sole ( ! foot slop+ obliquely d[nw>ds & =w>ds2 & ! weight be+ tak5 on ! toe4 ,!re is always a t5d5cy to hyp]ext5sion1 & to avoid /ra9+ ! limb 9 ?is direction 7z occurs 9 a liv+ knee :i* is =c$ into ! position ( g5u recurvatum by a talipes equ9us7 x is z well1 z we h already said1 to oppose x by "s passive resi/ance1 ei!r 9 ! =m ( a simple popliteal *eck cord or by a /op fix$ to ! front ( ! leg4 ,illu/ration3 ,fig4 #gb4 ,fig4 #gc4 ,fig4 #gd4 ,fig4 #ge4 ,9 ,figure #gb ! foot is fix$1 ! weight comes ^u ! po9t ( ! foot1 & pressure ^u ! axis ,,ab t5ds to close ! angle ,,abc1 i4e4 to produce a g5u recurvatum1 & s to lock ! knee 9 ext5sion4 ,if ! foot is articulat$1 equilibrium is secur$ 9 ! same way4 ,figures #gc to #ge are int5d$ to %[ t 9 ord] t ! axis ,,abc may n be v]tical 7,fig4 #gc7 ! axis ,b ( ! knee mu/ be beh9d ! p]9eal concavity 9 ! bucket1 & x is bett] if at ! same "t ! axis ( ! ankle jo9t ,c is c>ri$ =w>d4 ,?is ext5sion is unlock$ automatically at ! mom5t :5 ! weight is ?r[n =w>d on ! heal?y limb1 ! artificial limb ris+ on its toe & ! knee comm5c+ to b5d because ! braces are relax$4 ,e4 ,movable ankle4--,we h tak5 z our type a limb ) a fix$ foot4 ,!re are1 h[ev]1 a numb] ( me?ods ( atta*+ a foot ) a movable ankle jo9t4 ,! g5]al pr9ciples & ! me*anism = secur+ /ability are ^? :i* we h already /udi$1 b ! gait is m supple1 at ! price x is true ( some:at delicate articulations & !re=e ( simplicity4 ,! foot is made ( a s+le piece ( wood2 x is divid$ transv]sely at ! level ( ! middle ( ! metat>sal bones1 & ! ant]ior "p 7%ap$ l toes7 is atta*$ by two pieces ( lea!r1 dorsal & plant>1 betwe5 :i* are two indi>ubb] cyl9d]s :i* keep ! toe piece ext5d$ #ae to #bj :5 at re/1 & :i* all[1 :5 ! foot is press$ on ! gr\nd1 an ext5sion to #de4 ,?is foot is m\nt$ on ! leg at an angle ( #de beyond ! "r angle1 ) an int]pos$ rubb] cyl9d]1 :i* all[s ( ! dim9ution ( ! angle to #be or #cj b no fur!r4 ,x is important t flexion to a "r angle %\ld n be possible4 ,9 fact1 a slight degree ( equ9us is ess5tial 9 ord] to secure ! lock+ ( ! knee 9 ext5sion1 exactly z ) ! fix$ foot 7comp>e figures #gc1 #gd & #ge ) figure #gb71 & z on ! %oe !re is always a heel :i* makes u walk normally 9 slight equ9us1 ! two feet w be simil> 9 appe>ance1 ! slight movem5t ( ! artificial foot be+ suffici5t to all[ a roll+ movem5t ( ! sole ^u ! gr\nd 7,figs4 #gg to #hf74 ,illu/ration3 ,,fig4 #gf4 ,illu/ration3 ,,fig4 #gf;,a4 ,! figures #gf & #gf;,a %[ ! simple/ & be/ kn[n me*anism4 ,on ! upp] surface ( ! foot two cavities are holl[$1 "o 9 front & "o beh9d ! bolt ( ! ankle jo9t1 9 ea* ( ^! is plac$ a cyl9d] ( rubb]2 ! po/]ior cyl9d] is ab\t twice z ?ick z ! ant]ior4 ,above !m ! leg piece is fix$1 x ends 9 front 9 a %ort in/ep :i* lies )9 ! cavity holl[$ out 9 ! foot4 ,! foot is atta*$ to ! leg piece by a bolt made z foll[s3 a /eel tube fitt+ into two correspond+ grooves 9 ! leg & foot1 is atta*$ to ! leg by be+ prolong$ upw>d into a v]tical rod1 :i* is secur$ by a nut inside ! leg piece4 ,^u ! /eel tube moves a brass rod %ap$ l an inv]t$ ,u1 ! two ends ( :i* pass ?r\gh ! foot & fa/5 b5ea? x by two nuts 7,fig4 #hb74 ,rais+ ! po9t ( ! foot fur!r compresses ! ant]ior piece ( rubb]1 l[]+ x relieves ! pressure ^u ?is piece & compresses ! po/]ior piece4 ,b ! t5sion & ! size ( ! pieces ( rubb] are su* t !y are "u slight compression 9 ! position ( re/1 ! foot be+ 9 #cj ( equ9us4 ,s t ?is foot is nev] loose4 ,:5 pressure is made on ! po9t ( ! foot x may come to )9 #ae or #bj ( a "r angle1 b x returns to its angle ( #cj z soon z ! pressure ceases4 ,illu/ration3 ,figs4 #gg to #ha4 ,contact ( ! sole ) ! gr\nd 9 normal walk+4 ,heel fir/ !n toe1 ) progressive dorsiflexion ( ! ankle jo9t4 ,comp>e ) ! contact ( ! artificial foot 9 figures #hb to #hf4 ,) boots on1 ) heels ( #be c5timetres ! two feet are 9 ! same position :5 ! soles are flat on ! gr\nd4 ,! =ep>t ( ! foot 7repres5t+ ! toes & ! ant]ior "p ( ! metat>sals7 is kept 9 ?is position 7,fig4 #gf7 9 slight ext5sion by a piece ( rubb]1 compression ( :i* all[s an increase ( ext5sion ( #ae to #bj4 ,:5 a /ep is tak51 ! heel ( ! foot fir/ meets ! gr\nd1 ! leg po9t+ d[nw>ds & =w>ds4 ,!n ! :ole sole comes to lie flat on ! gr\nd1 ! degree ( equ9us be+ increas$1 ! po/]ior rubb] compress$ & ! ant]ior relax$ 7,figs4 #hb & #hc71 b :5 ! limb is v]tical ! sole /ill be+ flat on ! gr\nd1 compression ( ! po/]ior dim9i%es & t on ! ant]ior increases 7,fig4 #hd74 ,?is rema9s un*ang$ up to ! mom5t :5 ! foot leaves ! gr\nd1 :il/ ! heel rises & ! weight is borne on ! toe piece ( ! foot1 :i* is =c$ into ext5sion 7,figs4 #he & #hf74 ,illu/ration3 ,,fig4 #hb4 ,,fig4 #hc4 ,,fig4 #hd4 ,,fig4 #he4 ,,fig4 #hf4 ,?is me?od ( us+ rubb] cyl9d]s is ! simple/4 ,ano!r me?od1 good b m delicate1 is %[n 9 figures #hg & #hh4 ,9 ! leg bel[ ! calf are two cross pieces ( wood2 ! l[] plac$ transv]sely supports ! upp] :i* is ant]o-po/]ior & s increases its resi/ance to ! cords :i* are atta*$ to x4 ,! %ape ( ^! pieces ( wood c be se5 9 ! figures & require no fur!r explanation4 ,! bolt ( ! ankle jo9t is ! same z 9 ! foot la/ describ$4 ,to ! ant]o-po/]ior cross piece are atta*$ two cords1 :i* pass ?r\gh ! foot & are atta*$ b5ea? x1 "o "u ! heel1 & ! o!r ab\t ! level ( ! midt>sal jo9t4 ,! po/]ior cord is inela/ic & /ops dorsiflexion ( ! foot4 ,! ant]ior has a section ( ela/ic 9 x2 x prev5ts ! dropp+ ( ! foot :il/ ! limb is be+ swung4 ,a small pad ( rubb] plac$ 9 front b5ea? ! ant]ior "p ( ! leg piece all[s1 by its compression1 ! p>tial correction ( ! equ9us :5 ! sole is press$ flat on ! gr\nd4 ,illu/ration3 ,,fig4 #hg4 ,illu/ration3 ,,fig4 #hh4 ,"s appliances all[ ! foot a little lat]al mobility1 by rotation ar\nd an ant]o-po/]ior axis1 s t x may adapt itself to irregul>ities ( ! gr\nd4 ,we "h illu/rate ! ,duplex foot1 :i* is v +5i\s b :i* has ! defect t aft] a "t ! me*anism grates4 ,! ankle atta*m5t is c>ri$ out 9 ! same way z 9 ! limbs la/ describ$ 79 ?is p>ticul> limb x is atta*$ by cords71 b ! foot piece is divid$ z 9 a sub-a/ragaloid amputation2 ! l[] surface ( ! a/ragaloid piece be>s a m$ian ant]o-po/]ior projection1 tap]+ po/]iorly & enl>g$ into a knob ant]iorly1 ?is lies 9 a correspond+ groove 9 ! heel piece2 alongside ?is are two rubb] cu%ions :i* are alt]nately compress$ & relax$ z ! foot incl9es to "o or o!r side4 ,illu/ration3 ,,fig4 #hi4--;,duplex ,foot4 ,comb9$ me*anism = knee & ankle jo9ts4 ,?is v +5i\s comb9ation1 :i*1 h[ev]1 necessitates a r complex me*anism1 0 devis$ by ,palm] 9 #ahej4 ,x is c>ri$ out 9 ! limb made by ,frees1 ! me*anism ( :i* w be se5 to resemble t ( ! articulat$ foot %[n on page #ed 9 figures #hg & #hh4 ,above ! axis ( ! knee jo9t & at "r angles to x is a wood5 cross piece1 to :i* are atta*$ ?ree cords1 two beh9d ! jo9t1 "o 9 front2 ^! cords em]ge f ! ?igh piece ?r\gh an op5+ 9 its l[] end 7,figs4 #ij to #ib74 ,! po/]ior ( ^! cords1 made ( hemp1 ends inside ! upp] ?ird ( ! leg4 ,x limits ! ext5sion ( ! knee1 exactly z describ$ 9 ! ,m>ks leg4 ,! o!r two cords ext5d d[n to ! foot1 :i* is atta*$ 9 a mann] v simil> to t %[n on page #ed1 b ) a s+le rubb] cyl9d] beh9d1 & ) ! in/ep cut obliquely s t :5 ! jo9t is 9 ! re/+ position ( equ9us !re is an op5+ 9 front am\nt+ to an angle ( #ae to #bj4 ,! po/]ior cord1 ( hemp1 is atta*$ 9 ! heel2 ! ant]ior1 made ( catgut ) an indi>ubb] section1 ent]s ! foot obliquely & is fix$ a little 9 front ( ! middle ( ! sole4 ,:5 ! knee flexes1 ! wood5 cross piece tilts1 its po/]ior end becom+ l[]1 its ant]ior high] 7,figs4 #ia & #ib71 ! ela/ic ( ! ant]ior cord is tight5$1 ?us rais+ ! front ( ! foot1 :il/ at ! same "t ! heel cord is relax$4 ,?us ! me*anism :i* produces ext5sion ( ! knee acts at ! same "t ^u ! foot2 :5 ! knee is /raight ! foot is plant> flex$ to #bj1 :5 ! knee flexes ! foot comes to a "r angle4 ,?us ! foot becomes dorsiflex$ at ! same "t z ! knee flexes1 z 9 ord9>y walk+4 ,if ! action 9 walk+ is wat*$1 x w be se5 t z ! limb is swung =w>d1 ! toe is rais$ s z to cle> ! gr\nd4#g #g ,! me*anism ( ?is artificial leg resembles t ( ! t5don leg1 :i* 0 9 su* common use 9 ,engl& be=e ! pres5t w> t x is (t5 call$ ! ,engli% patt]n4--7,,ed47 ,illu/ration3 ,,fig4 #ij4 ,,fig4 #ia4 ,,fig4 #ib4--7;,,figs4 #ij to #ib4 ,foot & ,knee ( ,frees47 ,9 ! sitt+ position ! ant]ior cord is n relax$1 !re is no dead po9t1 s t ! knee always t5ds to ext5d4 ,?is is some:at inconv5i5t4 ,conv]sion ( ! articulat$ peg leg into ! leg ) free knee movem5t & vice v]s4 ,:atev] advantage x may be ?\ght to possess1 9 our op9ion ! artificial leg ) free knee jo9t is only suitable = s$5t>y occupations2 x is n suitable = manual lab\r]s & p>ticul>ly = agricultural lab\r]s :o are oblig$ to get ab\t on r\gh gr\nd4 ,h5ce x is n uncommon = a pati5t :o has be5 provid$ ) an ,am]ican leg to come & ask = a peg leg4 ,9 figures #ic to #ie x w be se5 t x is a simple matt] to trans=m ! limb into an articulat$ peg4 ,x is only necess>y to atta* ! /irrup-%ap$ =k ( ! peg to ! ?igh piece by ! knee bolt1 & to add ! d\ble lock4 ,to ?is peg may be add$1 if desir$1 ! %[ calf & foot describ$ on page #cb4 ,! full artificial leg c be rebuilt :5ev] x is wi%$4 ,illu/ration3 ,,figs4 #ic to #ie4 ,on ! o!r h&1 an articulat$ wood5 peg leg1 su* z we h describ$ "u ! "n ( ! ,f$]ation leg1 c be easily adapt$ = walk+ ) a free knee4 ,x is only necess>y to unlock ! knee jo9t & to add ! artificial muscle or accumulator ( ela/ic %[n 9 figure #ih4 ,?is supplies ! ext5d+ =ce1 ! value ( :i* we h %[n on page #cf4 ,we consid] t ?is appliance is excell5t & we "k pati5ts :o almo/ always walk ^u ! peg1 b :o sometimes use a free knee = %ort walks4 ,! conv]sion is simple & requires no special c>e4 ,"u ^! conditions ! fix$ foot is almo/ always us$2 !re is no?+ to prev5t ! fitt+ ( an articulat$ foot1 b we h already se5 t !re is no great diff]5ce 9 walk+ betwe5 ! old-fa%ion$ fix$ foot ( ! ,m>ks leg & ! m or less complicat$ articulat$ feet ( m rec5t design4 ,illu/ration3 ,,fig4 #if4 ,,fig4 #ig4 ,,fig4 #ih4 ,,ii4 ,limbs )\t be>+ ^u ! ,is*ium ,= amputations ?r\gh ! condyles ( ! femur1 & simil> amputations 7dis>ticulation ( ! knee & v %ort /umps bel[ ! knee74 ,c]ta9 or?opdi/s d n "k h[ to fit an artificial limb to an amputation ?r\gh ! condyles ( ! femur2 !y come !re=e to ! conclusion t ?is is a bad op]ation1 & ought to be replac$ by an amputation above ! condyles4 ,! two objections rais$ to ?is amputation are3-- #a4 ,t x is impossible to fit a wood5 bucket because ! bone at ! l[] end ( ! /ump is l>g] ?an x is at a high] level4 #b4 ,t x does n leave en\gh room to fit an artificial knee jo9t at ! "r level4 ,^! two objections are n valid1 &1 on ! o!r h&1 ?is amputation all[s u to fit an artificial limb ) complete end be>+1 & ?is is a great advantage4 #a4 ,fitt+ ( ! bucket4--,! fir/ difficulty is easily got ov]4 ,all t is necess>y is to cut away ! front ( ! l[] half ( ! bucket1 & to cov] 9 ?is op5+ ) a lac+ piece ( lea!r4 ,! /ump passes into ! top ( ! bucket1 comes out ( ?is op5+ & !n falls back into ! enl>g$ l[] end :]e x takes a direct be>+ 7,fig4 #ii74 ,illu/ration3 ,,fig4 #ii4--,limb ) end be>+ = amputation 9 ! region ( ! condyles ( ! femur4 ,ant]ior "p ( ! ?igh bucket cut away to all[ ! ins]tion ( ! enl>g$ l[] end ( ! /ump4 #b4 ,level ( ! knee jo9t4--,x is cle> t if ! /ump is too long x is impossible to fit a knee jo9t ) a bolt "r ?r\gh at ! same level z ! opposite knee4 ,! ?igh piece w\ld h to be prolong$ d[nw>ds 9 ord] to all[ ( ! ins]tion ( ?is bolt4 ,?is arrangem5t w\ld n affect walk+1 b w\ld be unsightly 9 sitt+ because ( ! inequality 9 ! l5g? ( ! ?ighs4 ,x is easy to ov]come ! difficulty by atta*+ ! leg by two indep5d5t lat]al h+e jo9ts1 )\t a bolt "r ?r\gh1 us+ ! /irrup-%ap$ =k & ! d\ble lock1 if a peg is us$4 ,?is me?od1 z we h already /at$1 is n s /rong1 b ?is is to a l>ge ext5t comp5sat$ = by ! possibility ( gett+ a direct end be>+4 #c4 ,direct end be>+ & susp5sion4--,if ! /ump is well cov]$ ) a good ant]ior flap & if ! l[] end ( ! bucket is accurately m\ld$ ^u x ) an int]pos$ lay] ( felt1 ! pati5t c walk directly ^u ! end ( ! /ump1 )\t x be+ necess>y to c>ry ! bucket up aga9/ ! is*ium1 simple braces be+ us$ z ! means ( susp5sion4 #d4 ,!re is no?+ special ab\t ! braces or ab\t ! ext5d+ /rap if ! knee is free1 nor ab\t ! me?od ( atta*+ ! foot4 ,^! limbs = long /umps d n require any spr+ to ext5d ! knee1 if "o is want$ an artificial muscle is q easily fitt$4 ,we h tak5 z our type an amputation ?r\gh ! femoral condyles4 ,! cov]+ ( ! /ump is excell5t1 & pressure is tak5 ^u tissues :i* are naturally adapt$ to x 7! ?ick sk9 & fibr\s tissue ov] ! patella71 specially if x has be5 possible to keep ! patella 9 ! flap & fix x across ! cut surface ( ! femur 7,gritti's op]ation74 ,! me*anical po9ts 9 ! fitt+ ( an artificial limb = an amputation ?r\gh ! knee jo9t are ! same4 ,b ?is amputation seems to u to be inf]ior to t ?r\gh ! condyles4 ,! sacrifice ( ?ree c5timetres 9 l5g? is ( no importance 9 an appliance ) direct end be>+2 &1 on ! o!r h&1 dis>ticulation has sev]al disadvantages3-- #a4 ,! enl>gem5t ( ! femoral condyles1 )\t any comp5sat+ advantage4 #b4 ,! be>+ ^u ! two condyles1 sep>at$ by a groove4 #c4 ,! insuffici5t cov]+ ( ! condyles by ! ?9 sk9 ( ! front ( ! leg4 ,! pr9ciples ( fitt+ a limb are ! same 9 amputations ( ! leg 9 :i* we are oblig$ to make ! pati5t walk ^u ! b5t knee 7too %ort a /ump1 ! position ( ! sc>s1 p]si/5t o/eitis1 ! impossibility ( /raight5+ ! knee :5 x is ankylos$ or /iff 9 a flex$ position71 z 9 ! old-fa%ion$ kneel+ p9 leg4 ,a po/]ior transv]se b&1 pass+ ov] ! b5t /ump helps to hold ! limb on4 ,,*apt] ,,iv ,,artificial ,,limb ,,= ,,dis>ticulation ,,at ,,! ,,hip ,,jo9t ,attempts h be5 made to atta* to ! pelvis1 by means ( a wai/ belt or braces1 a wood5 artificial limb ^: upp] end is fitt$ directly on to ! tub]osity ( ! is*ium4 ,s f> ^! h met ) little success4 ,9 our op9ion1 ! only really practical me?od is to enclose ! :ole /ump & pelvis 9 a regul> corset1 & to atta* ! artificial limb to ?is corset4#h #h ,among/ ,engli% limb mak]s ?is m\ld$ corset ) ! /eel hip atta*m5ts is usually kn[n z ! tilt+ table4--7,,ed47 ,! m\ld+ ( ?is corset ^u ! /ump mu/ be accurate4 ,! tub]osity ( ! is*ium is ! only bony po9t 9 ! /ump ^u :i* pressure c be tak54 ,! corset may be made ( lea!r1 b1 until a new ord] is issu$1 ! mat]ial ( *oice is celluloid1 m\ld$ ^u a pla/] ( ,p>is ca/1 9 spite ( ! disadvantage m5tion$ on page #d4 ,! limb is an articulat$ peg leg1 ) conv]tible knee jo9t & d\ble lock1 exactly ! same z 9 ! limb = amputation ?r\gh ! ?igh4 ,x is atta*$ to ! pelvis 7i4e4 to ! tilt+ table71 z %[n 9 figures #ajj & #aja1 by a jo9t ) a d\ble ant]ior lock1 :i* all[s ! pati5t to sit d[n by flex+ ! hip4 ,illu/ration3 ,,fig4 #ajj4 ,,fig4 #aja4 ,?is g5]al description & an exam9ation ( figures #ajj & #aja w suffice to expla9 ?is appliance4 ,x is comp>atively r>ely requir$1 & its con/ruction is difficult2 we consid] t ! =ms %[n 9 ! illu/rations are ! be/4 ,x is only possible to fit su* an appliance :5 ! conditions are good1 :5 ! sc> is above & 9 front ( ! is*ium1 & :5 ! latt] is well cov]$4 ,,*apt] ,v ,,artificial ,,limbs ,,) ,,free ,,knee ,,jo9t ,,= ,,amputation ,,?r\gh ,,! ,,leg ,if ! leg /ump is t5 c5timetres long1 if ! knee jo9t is freely mobile & capable ( complete1 or almo/ complete1 active ext5sion1 & if !re are no adh]5t sc>s ar\nd ! tub]osities ( ! tibia1 ! ,am]ican app>atus ) free knee jo9t %\ld be adopt$4 ,walk+ on ! b5t knee 7z /at$ on page #fc7 ) ! poor man's peg may be all[$ z a tempor>y measure1 b ! pati5t mu/ be advis$ to give 8 knee a re/ frequ5tly 9 ord] to less5 ! risk ( /iffness 9 a flex$ position4 ,!re are two me?ods ( fitt+1 correspond+ ) ^? we h describ$ = ! ?igh4 #a4 ,= ! ord9>y amputations ) be>+ ^u ! top ( ! leg4 ,illu/ration3 ,,fig4 #ajb4--,limb fitt$ ^u ! pati5t4 ,note t he /&s ^u ! toe1 & t ! knee is flex$4 ,illu/ration3 ,,fig4 #ajc4--,po/]ior view ( ! same limb4 ,illu/ration3 ,,fig4 #ajd4--;,ant]ior view ( ! same limb4 #b4 ,= amputation v l[ d[n ) end be>+ ^u ! extremity ( ! /ump4 ,i4 ,,appliances ,,) ,,be>+ ,,^u ,,! ,,tub]osities ,,( ,,! ,,tibia ,an artificial limb = amputation ?r\gh ! leg ) a free knee jo9t is compos$ ( two p>ts3 a leg piece 7) foot7 :i* is fitt$ to ! bony prom95ces ar\nd ! top ( ! /ump & supports !m2 & a susp5sory app>atus :i* consi/s ( a lac+ ?igh corset4 ,a4 ,,leg ,,bucket4--,! po9ts on :i* ! top ( ! bucket mu/ be fitt$ are ! int]nal tub]osity & ! ant]ior tub]cle ( ! tibia1 & ! head ( ! fibula1 s t holl[s correspond+ to ^! mu/ be c>v$ out4 ,pressure ^u ! head ( ! fibula is (t5 pa9ful1 & a deep concavity is !re=e c>v$ out = x4 ,! pressure !n comes ^u ! ext]nal tub]osity ( ! tibia :i*1 h[ev]1 ord9>ily be>s little weight4 ,:5ev] possible direct end be>+ ^u ! t]m9ation ( ! /ump %\ld be us$ z an accessory to relieve ! weight ^u ! tub]osities ( ! tibia2 ?is is obta9$ z describ$ on page #g4 ,x is only possible if ! sc> is lat]al & if !re is a good ?ick po/]ior or ext]nal flap 79 ! upp] ?ird ( ! leg74 ,an ant]ior flap is ! lea/ satisfactory4 ,x is also advisable-- ,t ! inn] surface & ! ant]ior bord] ( ! tibia be divid$ obliquely1 & t ! fibula be divid$ at a high] level ?an ! tibia4 ,! fibula mu/ n take weight1 x is too sl5d]4 ,9 high amputations x has a t5d5cy to tilt outw>ds1 caus+ ! d\ble inconv5i5ce ( wid5+ ! /ump & ( project+ ?r\gh ! sk94 ,if only #d or #e cms4 ( ! fibula rema9 x is p]haps be/ to dis>ticulate & remove x4 ,) a fitt+ arrang$ 9 ?is way1 we consid] t ! conv5i5ce ( walk+ ) a free knee c be assur$ to pati5ts ^: /umps measure only #aj cms4 f ! l[] bord] ( ! patella4 ,^! pr9ciples c be appli$ to a limb con/ruct$ ei!r ( wood or ( lea!r4 ,! lea!r appliance 7,fr5* me?od7 is =m$ ( a lea!r cyl9d]1 /r5g!n$ by two lat]nal /eels :i* articulate at ! level ( ! knee jo9t ) two simil> /eels 9 ! ?igh corset4 ,its upp] edge may be /r5g!n$ ant]iorly by a metal plate1 b 9 practice ! latt] _c be made to fit ) precision ! bony prom95ces enum]at$ above4 ,x is actually ! edge ( ! lea!r1 adju/$ by lac+1 :i* supports tibial tub]osities1 & !re=e ! precision ( ! fit is soon lo/4 ,= ?is reason1 = amputation bel[ ! knee1 ! ,am]ican me?od ( con/ruction ) a wood5 bucket is demon/rably sup]ior4 ,^! limbs are inf9itely m durable ?an ! ,fr5*4 ,!y may la/ ?ree ye>s1 :]eas ! ,fr5* limb us$ by a "y & active pati5t is worn out at ! end ( ! fir/ ye>1 & x 0 = ?is reason t a limb ) a free knee jo9t us$ to be consid]$ a luxury4#i #i ,t is ! reason t amputation at f\r f+]s' bread? bel[ ! knee us$ to be call$ = ! work+ class1 amputation at ! seat ( election1 a "n :i* is no long] applicable & :i* is liable to mislead ! op]ator4 ,?is wood5 bucket is %ap$ v accurately to ! bony prom95ces1 & by pass+ ! f+]s ov] its inn] surface ! ?ree holl[s correspond+ to ! po9ts ( pressure enum]at$ above c be di/9ctly felt4 ,x is important to describe ! %ape ( ! upp] edge ( ! bucket 9 ord] to gu>d aga9/ two po9ts :i* may int]f]e ) flexion-- ,i4 ,p9*+ ( ! tissues beh9d ! knee4 ,,ii4 ,! t5d5cy ( ! /ump1 :5 x is %ort1 to tilt =w>d 9 ! bucket 7,fig4 #ajh74 ,p9*+ ( ! fle% beh9d ! knee 9 flexion takes place betwe5 ! edge ( ! leg piece & t ( ! ?igh corset4 ,if ! top ( ! bucket is horizontal1 x mu/ inevitably occur1 ev5 if ! edge ( ! ?igh corset is well cut away 7,fig4 #ajf74 ,x c be avoid$ by cutt+ away ^! two edges into concavities opposite ea* o!r4 ,illu/ration3 ,,figs4 #aje & #ajf4--,limb 9 :i* ! upp] edge ( ! leg bucket is almo/ horizontal2 9 ! sitt+ position 7,fig4 #ajf7 ! fle% at ! back ( ! ?igh is p9*$ ev5 if ! l[] end ( ! ?igh corset is well cut away4 ,9 ! ,fr5* limbs made ( lea!r x is usual to make ! leg piece v high 9 front1 i4e4 z high z ! middle ( ! patella4 ,?is is q useless4 ,! po/]ior bord] is cut d[n to a dep? ( two f+]s' bread? bel[ ! axis ( ! jo9t4 ,p9*+ is ?us avoid$1 b ! po/]ior support is insuffici5t1 ! /ump tilts =w>d z describ$ above & ! bucket gapes 9 front 7,fig4 #ajh74 ,if ! top ( ! bucket is horizontal--z 9 c]ta9 ,am]ican limbs--!re is1 z we h already said1 p9*+ ( ! popliteal tissues & compression ( ! popliteal vessels & n]ves 7,fig4 #ajf74 ,a concavity is !re=e necess>y1 b "o rea*+ to "o f+]'s bread? bel[ ! axis ( ! jo9t is suffici5t4 ,9 front ! edge ( ! bucket rea*es up to ! jo9t l9e1 ?is is q suffici5t to enclose ! bony prom95ces 7,fig4 #aji74 ,! po/]ior concavity ( ! leg piece is comb9$ ) a concavity 9 ! ?igh piece v>i$ 9 accordance ) ! ?ickness ( ! popliteal s(t p>ts4 ,illu/ration3 ,,figs4 #ajg & #ajh4--;,if ! leg bucket is holl[$ out too mu* at ! back1 ! /ump is tilt$ obliquely =w>d 7,fig4 #ajh71 ! knee loses contact ) ! bucket1 & ! fle% at ! back ( ! ?igh is p9*$4 ,to dim9i% fur!r ! t5d5cy ( ! /ump to tilt =w>d ! po/]ior edge ( ! bucket is flatt5$ s t ! %ape ( ! top ( ! bucket is triangul> ) curv$ sides & angles mu* r\nd$ 7! ant]ior angle ov] ! tub]osity ( ! tibia be+ obtuse74 ,?is is ! natural %ape ( a section ( ! top ( ! calf4 ,9 ?is way ! po/]ior muscles are flatt5$ & no long] t5d to escape f ! bucket :5 ! knee is flex$4 ,9 figures #aaj & #aaa are %[n two ways 9 :i* ?is flatt5$ po/]ior m>g9 may be %ap$4 ,illu/ration3 ,,fig4 #aji4 ,illu/ration3 ,,fig4 #aaj4 ,,fig4 #aaa4 ,b4 ,,susp5sion ,,app>atus4--,! leg is atta*$ 7a7 by a ?igh corset tak+ its hold on ! femoral condyles1 & 7b7 by braces ov] ! %\ld]s4 7a7 ,! ?igh corset is made ( lea!r lac$ 9 front4 ,two lat]al /eels curv+ 9 %>ply aga9/ ! upp] "p ( ! condyles 7,fig4 #aab7 =m ! mo/ effective "p ( ! support4 ,at _! l[] ends !y are articulat$ ) two /eels pass+ up f ! top ( ! leg to :i* !y are atta*$4 ,! jo9t 7,fig4 #aac7 is compos$ ( a nut1 ,a1 into :i* fits a screw4 ,ar\nd ! nut is a copp] r+ made to move ) ! femoral /eel by means ( a /op-not*4 ,:5 ! knee flexes & ext5ds ! we> comes ^u ?is copp] r+4 ,! /eels rema9 intact4 ,if ! jo9t works loose x is suffici5t to r5ew ! r+4 ,illu/ration3 ,,fig4 #aab4 ,,fig4 #aac4 ,,fig4 #aab4--,! ?igh /eels1 curv$ 9 above ! condyles1 hold ! limb on v securely4#aj ,,fig4 #aac4--;,details ( ! jo9t at ! knee4 #aj ,9 ?is illu/ration ! jo9ts are plac$ too l[4 ,!y %\ld be opposite ! c5tre ( rotation ( ! knee jo9t1 i4e4 a transv]se l9e pass+ ?r\gh ! femoral condyles4 7,,ed47 7b7 ,! braces are a v useful addition :i* ,fr5* or?opdi/s %\ld employ sy/ematically4 ,!y increase ! /ability ( ! limb & all[ ! ?igh piece to be lac$ less tightly1 s t contraction ( ! ?igh muscles is facilitat$4 ,illu/ration3 ,,fig4 #aad4 ,illu/ration3 ,,fig4 #aae4 ,support may be giv5 by a /rap f a wai/ belt z %[n 9 figure #aag1 b prop] braces are bett]4 ,^! braces pass ov] ! %\ld] ( ! s\nd side & are atta*$ ei!r to ! ?igh corset or to ! leg piece ( ! artificial limb4 ,atta*m5t to ! ?igh corset is made by a s+le /rap ei!r 9 front & beh9d 7,fig4 #aad7 or on ei!r side ( ! front lac+1 ! ends ( ! /rap cross+ 9 front ( ! gro9 7,fig4 #aae74 ,x is a simple matt] to add to ! brace an ext5d+ /rap1 su* z we h describ$ = ! artificial limb = amputation ?r\gh ! ?igh 7page #dd74 ,x is only necess>y to t]m9ate ! brace 9 a /rap f :i* two bran*es pass d[n 9 an inv]t$ ,v & are fix$ to ! sides ( ! front ( ! leg piece 7,figs4 #aaf & #aag74 ,?is is unnecess>y if ! /ump is long1 = its lev]age w !n be good4 ,x is1 h[ev]1 v useful = %ort /umps :i* give little p[] to ! action ( ! quadriceps4 ,9 ! case ( pati5ts ) a long /ump an attempt has be5 made to aboli% ! ?igh piece & susp5d ! limb exclusively by braces4 ,?is me?od1 we believe1 is inadequate ev5 if x is complet$ by a transv]se b& above ! knee 7,figs4 #aah & #aai74 ,illu/ration3 ,,fig4 #aaf4 ,illu/ration3 ,,fig4 #aag4 ,illu/ration3 ,,fig4 #aah4 ,illu/ration3 ,,fig4 #aai4 ,c4 ,,! ,,foot4--,! foot1 usually articulat$1 is fix$ 9 exactly ! same way z 9 a limb = an amputation ?r\gh ! ?igh1 i4e4 x is m\nt$ 9 ! equ9us position4 ,b 9 ?is case1 h[ev]1 precautions mu/ be tak5 aga9/ /ret*+ ( ! po/]ior ligam5ts ( ! knee jo9t1 because ! equ9us me*anically produces hyp]ext5sion ( ! knee1 & a g5u recurvatum may result4 ,= ?is reason a /rap mu/ be fix$ po/]iorly betwe5 ! ?igh corset & ! leg piece to prev5t full ext5sion ( ! knee 7popliteal *eck cord74 ,?is means t we make ! pati5t /& & walk ) slight flexion ( ! knee & ) a correspond+ elevation ( ! heel ( ! %oe 7#b-c c5timetres74 ,,ii4 ,,appliances ,,) ,,end ,,be>+ ,,only ,^! appliances are suitable = c]ta9 amputations v l[ d[n 9 ! leg :i* we mu/ fir/ def9e4 ,! or?opdi/ %\ld consid] ! foll[+ op]ations z v l[ amputations ( ! leg1 all[+ ( walk+ ) end be>+ only1 & suitable = ! same type ( appliance3-- ,supra-malleol> amputation4#aa ,dis>ticulation at ! ankle jo9t4 ,sub-a/ragaloid amputation4 ,o/eopla/ic amputations ?r\gh ! os calcis 7or amputation 9 :i* ! os calcis is reta9$ entire aft] removal ( ! a/ragalus74 #aa ,9 ,engl&1 ( c\rse1 ?is is always call$ ,syme's amputation4 ,x con/itutes ! type p> excell5ce ( ! end-be>+ /ump4 ,^u a good ,syme /ump a pati5t may be able to walk t5 miles )\t an artificial foot1 we>+ simply an elephant boot4 ,amputations above ! ,syme level are n end be>+1 h[ev] long ! /ump may be4 ,! o!r amputations 9 ?is region se5 9 ,engli% w> surg]y are ! v>i\s types ( o/eopla/ic amputations 9 :i* a "p ( ! os calcis is reta9$ 7,pirog(f's amputation1 etc474 ,^! h ! foll[+ defects3-- 7#a7 ,!re is (t5 sepsis betwe5 ! tibia & ! os calcis1 necessitat+ re-amputation4 ,o/eopla/ic amputations are unsuitable = septic surg]y4 7#b7 ,ankylosis betwe5 ! os calcis & ! tibia is (t5 imp]fect s t ! bulb\s end ( ! /ump is un/able4 7#c7 ,! /ump is too long to all[ ( ! fixation ( a good artificial ankle jo9t b5ea? x4 ,a ,syme's amputation leaves two to two & a half in*es cle>ance betwe5 x & ! gr\nd4 ,i h n yet se5 a sub-a/ragaloid amputation 9 w> surg]y1 & only once a dis>ticulation ?r\gh ! ankle jo9t1 ! latt] c\ld n be> pressure & x 0 necess>y to conv]t x into a ,syme's amputation4 ,9 fact1 9 ?is region !re is ,syme's amputation & a numb] ( o!r f> inf]ior amputations :i* %\ld nev] be consid]$ :5 a ,syme's amputation is possible4 7,ed47 ,c]ta9 limb mak]s consid] ^! op]ations are bad = ! same two reasons t we h already refut$ 9 connection ) amputation ?r\gh ! condyles ( ! femur1 viz4-- 7#a7 ,! /ump be+ enl>g$ at its l[] end w n fit into a wood5 bucket4 7#b7 ,! /ump is too long to all[ an artificial foot to be fix$ bel[ x4 ,f ?is x simply foll[s3 #a4 ,t complete enclosure ( ! /ump 9 a wood5 bucket is impossible2 #b4 ,t pressure mu/ be plac$ directly & exclusively ^u ! end ( ! /ump4 ,! latt] condition is only possible if ! /ate ( ! s(t p>ts all[s ! cutt+ ( a ?ick plant> flap to cov] ! cut surface ( ! bone & if c>e be tak5 to resect ! po/]ior tibial n]ve 9 ! flap4 ,we !re=e draw special att5tion to ! excell5t elliptical supra-malleol> amputation ) po/]ior flap 7,guyon's me?od7 9 :i* x is suffici5t to reta9 a b>e f+]'s bread? ( sk9 f ! plant> surface 9 front ( ! po9t ( ! heel4 ,x be>s direct pressure well1 p]fectly if a lay] ( ! os calcis is cut ) ! scissors f ! area adjac5t to ! t5do-,a*illis & appli$ "u ! cut end ( ! tibia4 ,= all ^! amputations ! ant]ior flap is bad4 ,! ?9 dorsal sk9 ( ! foot is incapable ( )/&+ ! direct pressure :i* is indisp5sable = ?is me?od ( fitt+4 ,ev5 if x 7 true t "u ^! long /umps x is impossible to ins]t an artificial foot = lack ( space1 ! op]ations :i* we h enum]at$ above %\ld be recomm5d$ if ! flap c be cut 9 ! way we h indicat$4 ,illu/ration3 ,,figs4 #abj & #aba4 ,_! great advantage--& ! reason = reta9+ z mu* l5g? ( bone z possible--is t !y all[ walk+ directly on ! /ump )\t an app>atus4 ,x is suffici5t to h a circul> %oe made by any %oemak] consi/+ ( a heel m or less ?ick5$ surm\nt$ by a lac+ gait] rea*+ halfway up ! leg4 ,guyon's amputation con/itutes ! limit up to :i* ?is elephant boot is possible4 ,x is an unsightly app>atus1 b its simplicity & *eapness %\ld be tak5 into consid]ation1 = x is q possible t a manual lab\r]1 especially a c\ntryman1 to :om an artificial foot & an elephant boot are giv51 w res]ve ! =m] = ,sunday & use ! o!r = 8 daily "w4 ,,appliances ,,) ,,artificial ,,foot4--,! wood5 piece :i* p>tly encloses ! /ump consi/s ( a block c>v$ to ! %ape ( ! /ump & padd$ ) felt1 x is prolong$ 9 front by an in/ep rea*+ to ! level ( ! middle ( ! metat>sus1 & above by a groov$ piece :i* rea*es halfway up ! leg & encloses ! ant]ior half ( ! latt]4 ,a lea!r gait] is fix$ at ! sides & back & ext5ds up ! leg1 be+ lac$ 9 front ov] ! wood5 piece z a field boot is lac$ ov] ! lea!r tongue4 ,! foot may be m\nt$ at "r angles to ! leg1 b x is bett] m\nt$ slightly 9 equ9us4 ,! sole & toes are ( rubb] z describ$ on page #ce4 ,9 /udy+ figures #abj & #aba ! foll[+ %\ld be not$3-- #a4 ,! %ape ( ! leg bucket 9 :i* an ap]ture beh9d p]mits ! introduction ( ! /ump :i* is enl>g$ at its l[] end4 #b4 ,! me*anism by :i* ! po/]ior gait] lac$ 9 front fixes ?is leg bucket4 #c4 ,! articulation ( ! foot on a transv]se axis4 ,,*apt] ,,vi ,,p>tial ,,amputations ,,( ,,! ,,foot ,?is "n %\ld be appli$ to amputations 9 :i* ! mobility ( ! ankle jo9t is reta9$1 i4e4 ,*op>t's amputation 7midt>sal dis>ticulation71 ,lisfranc's amputation 7t>so metat>sal dis>ticulation71 amputation ( sev]al toes ) _! metat>sal bones1 or amputation ( all five toes4 #a4 ,! amputations ( ,*op>t & ,lisfranc4--,*op>t's amputation has a grave defect3 ! ant]ior muscles h n suffici5t lev]age to oppose ?is ga/rocnemius & soleus1 & ! po/]ior t>sal bones tilt =w>d s t ! pati5t walks1 n on ! l[] surface ( ! os calcis & ! plant> sk91 b on ! head ( ! a/ragalus & ( ! os calcis & on a pa9ful cicatrix4 ,if c]ta9 precautions are tak5 7c>eful pres]vation ( ! fibr\s plant> flap & suture to x ( ! ant]ior t5dons7 ?is defect is n inv>iably pres5t1 & x is an exagg]ation to say t ,*op>t's amputation has nev] giv5 any?+ b disappo9tm5t4 ,x %\ld1 h[ev]1 only be practis$ if ! te*nique is well und]/ood1 & ev5 !n x is r>ely indicat$1 because x dem&s almo/ z mu* plant> sk9 z ,lisfranc's amputation4 ,nev]!less ,i h se5 "s good ,*op>t /umps ! result ( op]ations by myself or by o!r surgeons2 !y %\ld be fitt$ l ! /umps result+ f ,lisfranc's op]ation4 ,) reg>d to ! latt]1 !y c be easily & com=tably fitt$1 provid$ t ! sc> is dorsal & is n /ret*$ ov] prom95t bones4 ,if ! fir/ cunei=m is n well cov]$ x c simply be remov$1 no functional disability results4 ,x is ma9ly ^u ! plant> surface ( ! /ump t pressure is borne1 b pressure comes also ^u ! ant]ior surface :5 ! foot is tilt$ d[nw>ds4 ,illu/ration3 ,,fig4 #abb4 ,! =e "p ( ! foot :i* con/itutes ! pro/hetic app>atus consi/s ( a block ( wood1 :i* rea*es =w>d z f> z ! middle ( ! metat>sus & ends 9 a v]tical plate 9 front ( ! /ump4 ,?is block ( wood is c>v$ to ! %ape ( ! /ump & l9$ ) felt4 ,x is atta*$ to ! leg by a lea!r gait] :i* laces 9 front4 ,ant]iorly x is prolong$ into an artificial toe piece simil> to t already describ$ = ! artificial limb = amputation ?r\gh ! ?igh4 ,?is appliance is n indisp5sable4 ,x is suffici5t to use a piece ( cork %ap$ to ! ant]ior surface ( ! /ump & fill+ up ! ant]ior "p ( ! boot1 its advantage1 h[ev]1 is t once ! pati5t is fitt$ ) ?is appliance he c we> an ord9>y boot4 #b4 ,p>tial ,amputation ( ! ,=e ,"p ( ! ,foot4--,^! are-- ,transv]se amputation ?r\gh ! metat>sal bones4 ,dis>ticulation ( "o or m toes ) _! metat>sal bones4 ,dis>ticulation ( "o or m toes4 ,= any ( ^! amputations all t is requir$ is an ord9>y boot1 fitt$ ) a cork1 :i* is %ap$ to fit ! /ump & :i* fills up ! space left by ! amputation4 ,9 ord] t ! pati5t may walk well ! sc> %\ld be dorsal & %\ld n be t5se4 ,we consid] t ! difficulty ( ma9ta9+ equilibrium aft] removal ( ! head ( ! fir/ metat>sal1 or ev5 ( ! :ole ( ?is metat>sal bone1 has be5 mu* exagg]at$4 ,removal ( a m>g9al metat>sal bone 7ei!r alone or ) its neighb\r71 t5ds to make ! foot tilt into v>us or valgus2 s t ! boot ne$s to be /iff5$ & ! sole ?ick5$ to avoid ?is4 ,,*apt] ,,vii ,,artificial ,,limbs ,,= ,,amputation ,,?r\gh ,,! ,,=e>m ,! con/itu5t p>ts ( an artificial arm are ! same 9 pr9ciple z = ^? ( an artificial leg1 !y are-- #a4 ,a means ( atta*m5t prev5t+ ! appliance f dropp+ z ! result ( its weight4 #b4 ,a socket1 fitt$ to ! /ump & articulat$ ) ! la/ nam$ at ! elb[4 #c4 ,! t]m9al appliance1 int5d$ to replace z f> z possible ! amputat$ h& &1 if possible1 resembl+ x 9 appe>ance4 ,9 ! case ( ! upp] limb ! advantages t wood possesses 9 giv+ /r5g? & accuracy ( fit d n apply1 & ! arm & ! =e>m pieces are made ( lea!r1 ) lat]al /eels articulat$ at ! elb[3 ?is jo9t is active 9 ! case ( amputations ( ! =e>m b purely passive 9 amputations ( ! arm4 ,we w comm5ce by describ+ ! appliance = amputation ?r\gh ! =e>m1 tak+ z our type amputation 9 ! l[] half4 ,?is w furni% an example :i* illu/rates all ! pr9ciples t %\ld guide u1 ! ends we %\ld h 9 view1 & ! means by :i* we c atta9 !m4 ,:5 once we h /udi$ ! app>atus by means ( :i* ! functions ( ! h& c z f> z possible be replac$1 a %ort description w suffice to expla9 :at c be done :5 ! loss ( movem5t ( ! elb[ & !n a %ort] & %ort] /ump 9 ! upp] arm oblige u to dim9i% ! utility ( ! appliance4 ,we mu/ /udy 9 turn3 7#a7 ,! atta*m5t ( ! upp] arm socket2 7#b7 ! jo9t betwe5 ?is & ! =e>m socket2 & 7#c7 ! appliances atta*$ to ! extremity ( ! =e>m :e!r ^! take ! %ape ( a h& or n4 #a4 ,,po9ts ,,( ,,atta*m5t #a4 ,,susp5sion4--,9 ! exceptional amputation v l[ d[n1 9 :i* ! roots ( ! !n> & hyp]!n> em95ces rema91 ! enl>gem5t ?us =m$ at ! extremity ( ! =e>m may be us$ = ! atta*m5t ( a wri/let :i* may suffice to support ! artificial appliance1 provid$ t ! latt] is n int5d$ = heavy "w4 ,9 ! latt] case an atta*m5t f ! elb[ at lea/ mu/ be add$4 ,?is me?od w\ld evid5tly be out ( ! "q 9 ! usual class ( case1 viz4 ord9>y amputations ?r\gh ! =e>m4 ,9 ^! ! atta*m5t may be made 9 two ways3-- 7#a7 ,to ! hum]us above ! condyl> enl>gem5ts1 ! epicondyle & ! epitro*lea1 ! latt] be+ mu* ! m prom95t4 7#b7 ,to ! top ( ! %\ld]1 i4e4 to ! surface ov] ! acromion & clavicle4 ,a4 ,atta*m5t to ! ,elb[4--,! simple/ me?od ( atta*m5t is t 9 :i* pressure is ex]t$ ^u ! condyles ( ! hum]us 7,fig4 #abd74 ,a lea!r armlet lac$ 9 front is furni%$ ) two lat]al /eels1 curv$ 9 above ! condyles & articulat$ at ! level ( ! c5tre ( rotation ( ! elb[ jo9t ) two simil> /eels 9 ! =e>m piece 7! socket74 ,illu/ration3 ,,fig4 #abc4--,! ?ree regions us$ z po9ts ( support1 ! %\ld]1 ! elb[ & ! wri/4 ,illu/ration3 ,,fig4 #abd4--,susp5sion f ! elb[4 ,! side /eels ( ! arm piece are curv$ 9 to fit ^u ! supra-condyl> ridges ( ! hum]us4 ,a good me?od ( susp5sion = long /umps1 :5 ! appliance is n to be us$ = heavy "w4 ,x %\ld be supplem5t$ 9 o!r cases by direct susp5sion f ! %\ld]4 ,?is direct me?od ( atta*m5t is suffici5t = a l[ amputation1 9 cases :]e ! pati5t does n d h>d "w4 ,b if ! /ump is %ort & if ! pati5t has to c>ry fairly heavy weights ! appliance is only prev5t$ f slipp+ by a consid]able con/riction ( ! arm1 :i* results 9 a s]i\s int]f]5ce ) muscul> action4 ,b4 ,atta*m5t to ! ,%\ld]4--,= ?is reason x is usually advisable to supplem5t ?is by an indirect atta*m5t to ! acromion & clavicle by means ( a %\ld] cap4 ,illu/ration3 ,,fig4 #abe4 ,! firme/ & /ronge/ patt]n consi/s ( a piece ( block$ lea!r1 m\ld$ to ! %\ld]1 includ+ ! pectoral1 supra-clavicul> & scapul> regions4 ,?is is kept 9 place by a /rap :i* passes "u ! opposite axilla4 ,x is cut away on ! out] side ( ! acromion1 ! ant]ior & po/]ior bord]s be+ cont9u$ d[nw>ds on ei!r side ( ! deltoid z two tap]+ /raps to :i* ! armlet is atta*$4 ,9 ?is way full lib]ty ( movem5t is all[$ to ! %\ld] 7,fig4 #abe74 ,?is patt]n is /rong1 b cumb]some & heavy4 ,x c be light5$ by r$uc+ x to an ant]o-po/]ior /rap1 #f or #g c5timetres wide1 ov] ! clavicle & sp9e ( ! scapula1 end+ 9 front & beh9d at ! level ( ! axill>y folds 9 triangul> enl>gem5ts4 ,9 ! upp] & inn] angles ( ^! are atta*$ ! ends ( ! axill>y /rap1 to ! l[] & out] angles1 prolongations f ! armlet 7,figs4 #abf & #abg74 ,illu/ration3 ,,figs4 #abf & #abg4 ,! lighte/ me?od1 b obvi\sly also ! lea/ secure1 consi/s 9 susp5d+ ! armlet by two /raps1 ant]ior & po/]ior1 :i* cross above ! clavicle & !n pass 9 ! =m ( a loop "u ! opposite axilla 7,fig4 #abh74 ,illu/ration3 ,,fig4 #abh4 ,! *oice betwe5 ^! ?ree me?ods ( atta*m5t dep5ds ^u ! pr(ession ( ! pati5t & ! /r5g? requir$ by x4 #b4 ,,resi/ance ,,to ,,upw>d ,,pressure4--,! artificial limb %\ld be capable ( resi/+ upw>d pressure1 :5 a ?ru/+ =ce is ex]t$ by ! h&4 ,?is is secur$ 9 ! foll[+ ?ree ways1 ! h& be+ presum$ to hang v]tically ) ! elb[ /raight3-- 7#a7 ,by pressure ( ! end ( ! /ump 9 ! socket 79 amputations l[ d[n ) a palm> flap--= example1 9 dis>ticulation at ! wri/ jo9t74 7#b7 ,by pressure ( ! top ( ! =e>m socket on ! enl>gem5t ( ! =e>m bel[ ! elb[4 7#c7 ,by pressure ( ! inn] side ( ! upp] edge ( ! armlet aga9/ ! axilla4 ,b1 9 actual "w1 ?ru/+ movem5ts are ne>ly always made ) ! elb[ b5t to a "r angle or almo/ s1 !n ! pressure transmitt$ ?r\gh ! =e>m piece is borne almo/ entirely by ! /eels ( ! armlet4 #c4 ,,resi/ance ,,to ,,rotation4--,a well-adju/$ artificial arm _c rotate on ! limb because-- 7#a7 ,! =e>m is elliptical 9 section & n circul>1 ?is is specially s 9 ! l[] ?ird4 7#b7 ,flexion ( ! elb[ is only possible if ! artificial jo9t is 9 ! same plane z ! axis ( ! elb[ jo9t--t is1 ! sagittal plane4 7#c7 ,! axill>y /rap ( ! %\ld] atta*m5t prev5ts rotation4 ,illu/ration3 ,,fig4 #abi4--,! ?ree regions us$ z po9ts ( resi/ance to upw>d pressure4 ,illu/ration3 ,,fig4 #acj4--,! ?ree regions at :i* rotation ( ! app>atus may be prev5t$4 #b4 ,,elb[ ,,jo9t #a4 ,! ,concavity ( ! ,armlet4--,at ! elb[ jo9t ! p9*+ ( ! ant]ior s(t p>ts on flexion is liable to take place 9 j ! same way z occurs at ! back ( ! knee 9 amputations ?r\gh ! leg4 ,to avoid ?is x is necess>y-- 7#a7 ,t ! axis ( ! jo9t %\ld lie 9 a prolongation ( a l9e pass+ ?r\gh ! epicondyle & ! epitro*lea4 7#b7 ,t ! armlet & ! =e>m socket %\ld be cut away 9 front 9 cresc5t-%ap$ concavities4 ,illu/ration3 ,,fig4 #aca4--,limb = amputation 9 ! middle ?ird ( ! =e>m4 ,! dep? ( ^! concavities is e/imat$ :5 ! limb is fitt$4 ,bo? ! arm & ! =e>m may be cut away freely )\t any result+ inconv5i5ce1 provid$ t ! /ump is long2 b if ! /ump is %ort & includes only ! upp] ?ird ( ! =e>m1 x is impossible to cut away ! =e>m socket suffici5tly )\t depriv+ ! /ump ( a prop] hold 9 ! socket1 s t movem5ts are n transmitt$ to ! =e>m lev] ) _! prop] =ce4 ,consequ5tly ! socket = ! =e>m mu/ be cut away v little1 & mu/ be c>ri$ up to ! level ( ! fold ( ! elb[ :5 ! jo9t is flex$4 ,! fle% 9 front ( ! elb[ w n be p9*$ if1 ! =e>m be+ fitt$ v accurately1 ! muscles ( ! upp] arm are all[$ free play1 by cutt+ away ! front ( ! armlet to half its height1 b 9 ?is case an indirect atta*m5t to ! %\ld] is ess5tial4#ab #ab ,ano!r difficulty 9 fitt+ a %ort =e>m /ump arises f ! fact t ! ant]o-po/]ior diamet] ( ! =e>m imm$iately bel[ ! elb[ increases consid]ably :5 ! jo9t is flex$1 because ( ! contraction ( ! muscles aris+ f ! condyles4 ,if ! =e>m socket is made to fit closely :5 ! elb[ is ext5d$ x w be too small :5 ! jo9t is flex$ & w prev5t full flexion4 ,if x 0 made to fit ) ! elb[ flex$1 !re is risk ( ! /ump slipp+ out ( ! socket :5 ! jo9t is ext5d$4 7,ed47 ,illu/ration3 ,,fig4 #acb4--;,bad app>atus = amputation 9 ! upp] ?ird ( ! =e>m4 ,! front ( ! arm piece is insuffici5tly cut away4 ,illu/ration3 ,,fig4 #acc4--;,good app>atus4 ,! arm piece is well cut away1 consequ5tly ! fle% does n bulge out4 #b4 ,con/ruction ( ! ,jo9t4--,9 mo/ cases ?is is a simple articulation betwe5 ! /eels ( ! arm & ! =e>m pieces by two h+e jo9ts4 ,illu/ration3 ,,fig4 #acd4 ,,fig4 #ace4 ,,fig4 #acd4--,limb = amputation ?r\gh ! l[] ?ird ( ! =e>m1 ) elb[ jo9t ( /rong lea!r4 ,,fig4 #ace4--;,details ( ! jo9t4 ,! objection to ?is is t ! movem5ts ( pronation & sup9ation1 if ^! are pres5t 9 ! /ump1 are aboli%$4 7a7 ,long ,/ump4--,:5 ! /ump is long 7amputation 9 ! l[] qu>t]7 ! foll[+ may be us$3 ,! /eels ( ! =e>m socket are atta*$ to ! armlet1 :i* is n furni%$ ) /eels1 by two /raight /rips ( h>d lea!r jo9t$ at ea* end ) rivets to ! correspond+ piece ( ! limb4 ,?is all[s a c]ta9 am\nt ( torsion s t pronation & sup9ation are to "s ext5t possible4 ,x is necess>y to add an indirect atta*m5t to ! %\ld]4 ,n only mu/ ! armlet1 n be+ closely m\ld$ ov] ! condyles1 be ev5 :5 new lac$ s tightly z to be unbe>able1 b 9 addition ! inevitable loss ( %ape ( ! unsupport$ lea!r w 9 e case soon int]f]e ) prop] support direct f ! armlet 7,figs4 #acd & #ace74 ,illu/ration3 ,,figs4 #acf & #acg4--;,amputation ?r\gh ! =e>m above ! upp] ?ird4 ,! elb[ jo9t does n flex beyond ! "r angle4 ,illu/ration3 ,,fig4 #ach4--,limb = amputation ?r\gh ! upp] ?ird ( ! =e>m4 7,= a description ( ! rat*et see page #ace47 ,?is me?od is1 moreov]1 sc>cely applicable to pati5ts :o w h to c>ry out heavy "w4 7b7 ,%ort ,/ump4--,! /ump ( an amputation 9 ! upp] ?ird ( ! =e>m is too %ort to be securely held 9 ! =e>m bucket4 ,!re is consequ5tly a loss ( p[] 9 ! movem5ts communicat$1 p>ticul>ly 9 flexion1 ! arm ( ! lev] be+ too %ort2 9 addition1 ! elb[ jo9t 9 ^! cases is (t5 a little /iff1 s t flexion beyond a "r angle is impossible 7,figs4 #acf to #ach74 ,! *ief functional difficulty dep5ds ^u ! fact t1 ) ! elb[ at a "r angle1 ! ant]ior surface ( ! =e>m /ump is too %ort to support a weight2 = example1 a basket held by ! h&le4 ,! /ump escapes p>tly f ! bucket :5 ! =e>m ext5ds4 ,x is !re=e well 9 su* cases to fix ! elb[ at a "r angle by means ( a rat*et id5tical ) t us$ 9 ! artificial arm = amputation above ! elb[ 7,fig4 #ach74 #c4 ,,! ,,artificial ,,h& ,,& ,,appliances ,at ! extremity ( _! =e>m almo/ all pati5ts wi% 9 ! fir/ place to we> some?+ t is %ap$ l a h&4 ,_m p--& ev5 _m m$ical m5--consid] t ?is artificial h& is really useful4 ,9 actual fact1 by means ( fairly simple contrivances1 x c be us$ to enable ! pati5t to eat1 to write1 to put on & take (f 8 hat1 b x is out ( ! "q = x to d real "w4 ,= t an appliance1 a tool 9 fact1 adapt$ = use & n = appe>ance is necess>y4 ,! limb1 !re=e1 w1 z a rule1 end 9 a h&1 b = workm5 ?is h& w be capable ( be+ unscrew$ & replac$ easily by "o or m appliances4 ,attempts h be5 made to con/ruct s call$ univ]sal h&s & =ceps :i* w s]ve = any sort ( "w1 b up to ! pres5t none ( ^! inv5tions h giv5 satisfaction4 ,& ! practical solution ( ! problem 9 ! pres5t /ate ( affairs consi/s 9 devis+ a special appliance = a p>ticul> trade1 /udy+ c>efully ! movem5ts necess>y 9 ?is trade4 ,a workman :o 9 ! c\rse ( 8 occupation c>ries out a numb] ( diff]5t movem5ts may ?us h sev]al appliances1 :i* he selects z he requires !m4 ,= example1 a locksmi? mu/ be able to hamm]1 to file1 & to drill holes 9 succession4 ,we w describe fir/ ! h& prop]ly s call$1 !n ! appliances4 ,! =m] is suitable = cl]ks1 & x is = !m t ! v>i\s improv$ patt]ns t we %all describe are made4 ,! latt] are suitable = manual work]s to :om %\ld be giv5 a h& 9 :i* ! me*anism is r$uc$ to a spr+ ?umb grip & "o or m special appliances4 ,^! appliances w almo/ always be con/ruct$ to c>ry out ! movem5ts made by ! left h& 9 ! c\rse ( ! "w1 because ! fir/ /ep 9 ! re-education ( a pati5t :o has lo/ ! "r h& %\ld always consi/ 9 tra9+ ! rema9+ left h& to c>ry out ! "w hi!rto entru/$ to ! miss+ "r h&4 ,a4--,,! ,,artificial ,,h&4 ,! h&1 :i* is screw$ into ! end ( ! =e>m socket 9 su* a way t x is 9 semipronation :5 ! arm hangs v]tical1 is ne>ly always made ( wood1 b occasionally ( alum9ium4#ac #ac ,h&s are ne>ly always made ( lime wood1 :i* has ! advantage ( lightness1 b ! f+]s are fragile & easily break4 ,in/ead ( us+ hornbeam1 :i* is h>d b heavy1 z ! fragility only affects ! f+]s1 "s mak]s h ov]come ?is difficulty by re9=c+ ! f+]s by :at !y call a philippeau4 ,! f+] is divid$ ?r\gh\t its :ole l5g? by a mortise #ae millimetres 9 wid?1 9 :i* are glu$ two lay]s ( v5e]+ wood 7mahogany1 rosewood1 etc41 extremely h>d woods1 or else a lay] ( hornbeam74 ,x may be a simple %[ h& )\t any jo9t4 ,?is patt]n is no long] us$4 ,x may be jo9t$ 9 "o or 9 sev]al f+]s4 ,we %all fir/ consid] c]ta9 pr9ciples ( con/ruction :i* we c expla9 by describ+ ! *ief me*anisms us$4 ,simple ,spr+ ,grip ,?umb4--,! simple/ & mo/ useful articulation is t ( ! ?umb1 :i* :5 at re/ is kept by means ( a spr+ 9 ! flex$ position1 ) ! grip aga9/ ! index f+] :i* is p>tly flex$ 7z are also ! o!r f+]s74 ,9 _m cases ! pati5t is cont5t ) ?is simple me*anism4 ,he op5s ! spr+ ) ! o!r h& & all[s x to close on ! object he wi%es to grip 7,figs4 #aci-ade74 ,illu/ration3 ,,figs4 #aci to #adb4--,me*anism ( ! passive spr+ ?umb4 ,! ?umb turns on ! axle ,d ^u a piece :i* fits by a tap]$ extremity ,c into a holl[ cut out 9 ! !n> em95ce4 ,! base ( ! ?umb is r\nd$4 ,! spr+ ,,ab flexes ! ?umb4 ,illu/ration3 ,figs4 #adc to #ade4--,! ,beau=t ,?umb4 ,! model %[n on page #ih is m mobile ?an ?is1 9 :i* ! ?umb turns on ! axis ,,ab1 & is fitt$ directly into ! !n> em95ce4 ,b 9 ?is type x w be se5 t ! spr+ ,,cd :i* keeps ! ?umb flex$1 rea*es "r up to ! wri/1 & is !re=e long] & m p[]ful4 ,! ?umb is mu* /rong]1 & ?is is ! me*anism usually adopt$4 ,x has ! inconv5i5ce t x requires a deep excavation ( ! !n> em95ce1 encroa*+ ^u ! root ( ! index f+]1 s t x is impossible to m\nt ! ?umb 9 ?is way :5 x is desir$ to fit a movable metac>po-phalangeal jo9t to ! index f+]1 ei!r ) a spr+ 7,fig4 #aee7 or )\t 7,fig4 #adh74 ,! ,automatic ,?umb4--,active op5+ movem5t c be produc$ by ! me*anism %[n 9 figure #adf4 ,a cord fix$ beh9d ! scapula ( ! opposite side by a r+ :i* passes ov] ! clavicle & "u ! axilla1 ext5ds d[n ! po/]ior surface ( ! arm & =e>m pieces1 runn+ 9 pulleys :i* keep x 9 place4 ,if ! pati5t b5ds ! elb[ & at ! same "t br+s ! arm & bo? %\ld]s =w>d1 r\nd+ 8 back1 ! cord is tight5$ & pulls ! ?umb into ! position ( abduction & ext5sion4 ,?is n>r[ grip1 betwe5 ! tips ( ! ?umb & index f+] only1 is n always conv5i5t4 ,a comm]cial travell] or a =eman c\ld n easily hold ) x ! ord] book1 9 :i* he has to write4 ,b if ! ?umb1 held by a p[]ful spr+1 is p>allel to ! palm ( ! h& & grips aga9/ ! o!r f+]s1 :i* are /ret*$ out & n semiflex$1 ! grip w be /rong & conv5i5t1 especially if a me*anism is introduc$ betwe5 ! =e>m & ! h&1 all[+ ! latt] to be rotat$ at w into any position 7,fig4 #adh74 ,z 9 ! prec$+ case ! ?umb may h ei!r a simple grip or an automatic grip op5$ volunt>ily by a cord f ! %\ld]4 ,! foll[+ is a v int]e/+ me?od :i* all[s a =k or p5 to be held1 ! automatic ?umb be+ us$4 ,! f+]s are half flex$1 ! index be+ sep>at$ f ! middle f+]1 s t ! h&le ( a p5 c be ins]t$ betwe5 !m4 ,! grip ( ! ?umb is n aga9/ ! tip ( ! index f+] b aga9/ ! out] side ( ! la/ phalanx ( ! middle f+]1 aga9/ :i* 9 consequ5ce ! h&le ( ! object held w be press$ 7,fig4 #adg74 ,illu/ration3 ,,fig4 #adf--;,appliance ) automatic ?umb4 ,! cord is fix$ to a loop :i* passes r\nd ! s\nd %\ld]4 ,abduction & =w>d movem5t ( ! %\ld] & flexion ( ! elb[ op5 ! ?umb4 ,illu/ration3 ,,fig4 #adg4--;,h& ) space betwe5 ! index & middle f+]s1 wide en\gh to take ! h&le ( a =k1 :i* is held by pressure ( ! ?umb aga9/ ! side ( ! middle f+]4 ,! ext5d$ f+]s are bett] plac$ = gripp+ ?an ! p>tially flex$ f+]s1 al?\gh ! latt] are conv5i5t to ! pati5t 9 c]ta9 ways4 ,ball & socket jo9ts are ins]t$ at ! int]phalangeal jo9ts4 7,details are %[n 9 figures #aeb to #aed47 ,^! are s /iff t !y ma9ta9 ! position 9 :i* !y are plac$ passively1 z d ! jo9ts ( an arti/'s lay figure4 ,illu/ration3 ,,fig4 #adh4--;,articulat$ h& = comm]cial travell]s4 ,! ?umb1 ly+ p>allel to ! palm ( ! h&1 takes a secure hold ( su* an article z a memor&um book4 ,,fig4 #adi4--,! usual patt]n ( h&4 ,! grip is too small4 ,illu/ration3 ,,fig4 #aej4--,! index f+] is ! same l5g? z ! middle f+]4 ,! ?umb & index f+]s are furni%$ ) nails4 ,a small ball c be pick$ up4 ,,fig4 #aea4--,! middle f+] be+ long] ?an ! index1 ! latt] does n rea* ! surface ( ! table & ! ball _c be pick$ up4 ,if ! f+]s are rigid & 9 semiflexion x is possible to articulate all ! metac>po-phalangeal jo9ts1 fitt+ !m ) a spr+1 :i* keeps !m flex$1 & arrang+ = active ext5sion z already describ$ = ! ?umb4 ,all t is necess>y is to t]m9ate ! cord by five sep>ate /r+s in/ead ( "o4 ,9 c]ta9 special cases ?is arrangem5t may be useful 7,figs4 #aee to #aeg74 ,x seems to u useless to r5d] ! int]phalangeal jo9ts automatic4 ,z to ! attempt :i* ,beau=t appe>s to h made to give movem5t to ! wri/ also1 we d n believe t any practical result has z yet be5 atta9$4 ,= ! relative l5g? ( ! f+]s & ! utility ( a nail on ! ?umb & on ! index f+] see figures #aej & #aea4 ,%ape ( ! ,h&4 ,9 ! usual patt]n 7,figs4 #adi & #aea7 ! f+]s are semiflex$ & ! ?umb grips aga9/ ! index f+]1 :i* is %ort] ?an ! middle f+] z 9 ! natural h&4 ,if x is desir$ to pick up a ball1 = example 7,fig4 #aea71 x w be se5 t ! middle f+] projects & gets 9 ! way4 ,= ?is reason x is advisable t ! index f+] be long] ?an ! middle1 & 9 addition x is useful to furni% ! ?umb & index f+] ) a little projection repres5t+ ! nail 7,fig4 #aej74 ,9 figure #adh w be se5 an arrangem5t :i* all[s ! ?umb to grip n by ! tip1 b by ! :ole l5g? ( its palm> surface 7to hold1 = example1 a notebook74 ,! f+]s ( ?is h& h ball & socket jo9ts con/ruct$ 9 ! way %[n 9 figures #aeb to #aed4 ,! jo9ts keep passively ! position 9 :i* !y are plac$4 ,! atta*m5t ( ! ball ( ! jo9t on an int]m$iate t5on is simil> to t ( ! ?umb %[n on page #ih4 ,! articulation ( ! index f+] prev5ts ! suffici5t excavation ( ! !n> em95ce = ! ins]tion ( ! ,beau=t ?umb ) its p[]ful spr+4 ,! wri/ rotates ^u a bayonet jo9t4 ,illu/ration3 ,,figs4 #aeb to #aed4 ,! f+]s %[n 9 figures #aee to #aeg are jo9$ toge!r into a s+le piece1 :i* articulates ) ! metac>pal "p ( ! h& ^u a transv]se axis4 ,!y are held 9 a position ( flexion at ! metac>po-phalangeal jo9ts by f\r palm> spr+s & !y are op5$ away f ! ?umb by ! action ( a cord :i* bifurcates f ! ?umb cord on ! back ( ! h&4 ,! pull ( ?is cord is ex]t$ ^u ! upp] angle ( a triangle f ! l[] bord] ( :i* f\r cords pass on to ! back ( ! phalanges4 ,figure #aef %[s detail ( a f+]4 ,we "k t attempts h be5 made to isolate by surgical means ! masses ( ! ext5sor & flexor muscles 9 ! end ( ! /ump1 mak+ f !m little prom95ces1 p]=at$ ) a tunnel :i* is l9$ ) sk94 ,! cords pass ?r\gh ! tunnels1 & 9 ?is way are work$ volunt>ily4 ,we are n sure t ?is is practicable4 ,illu/ration3 ,,figs4 #aee to #aeg4--;,automatic f+]s4 ,9 figure #aee are se5 ! cavity 9 :i* ! f+] portion works & ! axis ^u :i* movem5t takes place1 also ! f\r palm> spr+s4 ,9 figure #aeg ! arrangem5t ( ! cords4 ,9 figure #aeh ! atta*m5t ( ! spr+ to ! f+]4 ,?is patt]n1 :i* we h design$ & :i* is n pat5t$1 seems to u to be simpl] ?an ^? 9 :i* ! int]phalangeal jo9ts are also articulat$ & are automatic4 ,x gives a m accurate grip betwe5 ! tips ( ! ?umb & index f+]4 ,! ,brunet ,grip4--,! ,brunet grip is describ$ "h because ( its resemblance to ! automatic ?umb1 bo? be+ work$ on ! same pr9ciples4 ,illu/ration3 ,,figs4 #aeh & #aei4 ,illu/ration3 ,,fig4 #afj4 ,illu/ration3 ,brunet's ,grip4 ,bel[ ! lea!r =e>m piece1 :i* laces up1 ! lat]al /eels are cont9u\s ) ea* o!r 9 ! =m ( an ar*1 to :i* ! grip is rivet$4 ,! latt] consi/s ( a /rong semicircul> piece ( metal fac+ d[nw>ds1 end+ 9 a pair ( wide & ?ick jaws1 l ^? ( a locksmi?'s pli]s4 ,:5 ! app>atus is at re/1 ^! are kept 9 contact by ! pressure ( two p[]ful fix$ spr+s1 atta*$ to ! semicircle on ! =e>m above & to ! jaws bel[4 ,! ext]nal & dorsal spr+ is atta*$ to ! tip ( its jaw1 ! int]nal & palm> 7! side on :i* ! manipulat+ cord is atta*$7 to ! base ( x4 ,! pli]s are op5$ 9 ! foll[+ way3-- ,inside ! semicircle to :i* ! jaws are atta*$1 lies a cyl9d] ) its ends cut obliquely2 ?is rotates ab\t a transv]se axis1 & :5 at re/ lies ) its long] side upw>d4 ,to ! palm> edge ( ! %ort] side is atta*$ a transv]se ecc5tric1 to :i* is hook$ a cord actuat$ z describ$ 9 figure #adf4 ,:5 ?is is drawn upw>d ! cyl9d] rotates s t ! wid] side comes betwe5 ! jaws ( ! pli]s & op5s !m2 :5 ! cord is relax$ ! spr+s turn ! cyl9d] back aga9 f9d ! jaws close4 ,figures #aeh & #aei %[ ! appliance at re/ & ) ! jaws op54 ,?is appliance is pat5t$ & is made 9 "o piece4 ,we demon/rate 9 figure #afj t x w\ld be v easy to make ! pli]s deta*able f ! =e>m1 ) a screw connection1 j z is done 9 ! v>i\s o!r appliances :i* w be describ$4 ,! grip ( ! automatic ?umb always lacks p[]1 = two reasons4 ,!re is no room 9 ! !n> em95ce to fit a p[]ful spr+ & ! grip has always a v n>r[ hold4 ,! ,brunet grip is an actual pair ( pli]s1 %ap$ l ^! & furni%$ ) a p[]ful spr+4 ,x is op5$ by a cord l t ( ! automatic ?umb4 ,figures #aeh to #afj expla9 ! me*anism4 ,x is an excell5t appliance ) :i* ! we>] c c>ry out ! majority ( ! actions ( ev]yday life4 ,x has1 h[ev]1 ! disadvantage t x is n %ap$ l a h&--a po9t to :i* pati5ts atta* mu* importance--&1 moreov]1 x is a "p ( a pat5t$ appliance1 = :i* an int]*angeable h& is n manufactur$4 ,s t 9 ord] to h 9 addition an artificial h&1 :i* is capable ( be+ remov$ & replac$ by "o or m ( ! appliances :i* w be describ$ lat]1 x w\ld be necess>y = ! pati5t to possess two complete artificial limbs1 & *ang+ f "o to ! o!r w\ld evid5tly be inconv5i5t4 ,we g5]ally prescribe ?is appliance = pati5ts :o h lo/ bo? arms1 = "o side & z a supplem5t>y appliance4 ,!re are o!r simil> models into details ( :i* x is unnecess>y to ent]4 ,^? 9 :i* ! grip is op5$ by movem5ts ( pronation & sup9ation are obvi\sly only suitable = c]ta9 r>e cases 7v long /umps1 ) free movem5t74 ,b4--,,appliances ,,= ,,use ,,9 ,,place ,,( ,,! ,,h&4 ,! g5]al pr9ciple is to fit to ! end ( ! =e>m piece an atta*m5t :i* c be screw$ on or unscrew$ at w & :i* c>ries an appliance :i* is adapt$ to ! v>i\s m or less specialis$ movem5ts ( ! pati5t's trade4 ,naturally ! results ?us atta9$ mu/ always be imp]fect2 b h[ev] little p]sev]ance & +5uity he may possess1 ! pati5t f9ds t he is able to educate ! rema9+ arm1 ev5 :5 x is ! left1 to replace ! amputat$ "o 9 a way t is (t5 rem>kable4 ,x is to ?is education t att5tion mu/ be specially direct$ 9 ! work%ops = ! re-education ( ! maim$4 #a4 ,knife & ,=k4--,! fir/ necessity is to be able to eat1 & by c]ta9 v simple devices a =k1 spoon or knife may be fix$ to a wood5 h&1 :e!r ! ?umb be mobile or n4 ,illu/ration3 ,,fig4 #afa4--,raynal's =k re/4 ,z a g5]al rule if ! pati5t has "o arm intact1 he uses ! s\nd h& only = ?is purpose1 b :5 bo? =e>ms h be5 lo/ an appliance is indisp5sable4 ,we h already describ$ h[ 9 ! h& ) an automatic ?umb1 room c be left betwe5 ! index & middle f+]s = ! h&le ( a spoon or =k4 ,a direct grip c also be obta9$ ) ! h& %[n 9 figure #adg4 ,! h& ) five automatic digits 7p4 #aje7 is usually arrang$ 9 su* a way t x is possible to hold a tumbl] = dr9k+2 b a pati5t ) an amputation ( "o h& dr9ks ) ! o!r1 & "o :o has lo/ bo? h&s c dr9k ) a /raw4 ,illu/ration3 ,,fig4 #afb4--,! t]m9ation ( ! =e>m is a hemisph]ical piece ( metal1 furni%$ ) a screw into :i* screw at w ! h&1 ! hook or ! r+4 ,^! appliances h replac$ t 9 :i* ! knife or =k is atta*$ to a block ( wood :i* c be fitt$ into ! palm ( ! h& :5 requir$4 ,x is inconv5i5t to be oblig$ to c>ry ^! special implem5ts ab\t4 ,raynal's =k-re/ has ! advantage ov] ! la/ m5tion$ t x fits any =k4 ,figure #afa %[s v cle>ly its con/ruction & ! way 9 :i* x is us$4 ,! small special atta*m5t1 :i* is screw$ 9 place1 is n cumb]some & c q well be c>ri$ 9 ! pocket2 x is1 h[ev]1 ev5 m conv5i5t to h an appliance :i* is capable ( gripp+ ! =k directly l ^? describ$ previ\sly4 ,illu/ration3 ,,fig4 #afc4--,v9e dress]'s hook4 7,grip\illeau74 ,illu/ration3 ,,fig4 #afd4--,! bran* is held 9 ! grip by a lev]age ex]t$ by torsion4 #b4 ,appliances = ,workm54--,all ! appliances t are atta*$ to ! arms 9 place ( ! artificial h& = p]=m+ v>i\s k9ds ( "w are elaborat$ f two simple =ms3 ! hook & ! r+ 7= cat*+ hold & c>ry+ a p>cel1 = hold+ a h&le1 etc474 ,a glance at figure #afb w %[ ! nature ( ^! & ! way 9 :i* !y are us$4 ,b x w also be und]/ood t if ! simple r+ & hook are useful = equally simple purposes !y are altoge!r insuffici5t = skill$ lab\r]s ^: "w entails a c]ta9 special adroitness1 e4g4 jo9]s1 locksmi?s1 agricultural lab\r]s1 etc4 ,_m mak]s h realis$ ?is & h devis$ v +5i\s implem5ts1 "s ( :i* we reproduce1 ?\gh we are oblig$ to limit ourselves to c]ta9 types1 = !y c be v>i$ 9 c\ntless ways accord+ to ! ne$s ( p>ticul> cases4 ,! same workman1 z we h already said1 may h sev]al appliances :i* he uses 9 turn z he ne$s !m 9 ! c\rse ( 8 "w4 ,^! appliances are con/ruct$ 9 two ways2 "s are fix$ to ! end ( ! =e>m & are immobile1 "s are atta*$ by means ( a jo9t or jo9ts & are capable ( rotation 9 v>i\s directions4 7a7 ,fix$ ,appliances4--,we illu/rate "h an appliance d]iv$ f ! simple hook1 ! v9e-dress]'s claw1 devis$ "s "t ago by ,grip\illeau2 bran*es ( v>y+ size c be held :ile ! o!r h& saws !m or cuts !m ) ! prun+ %e>s 7,figs4 #afc & #afd74 ,?is appliance ( ,grip\illeau1 ) a s]ies ( hooks1 =ms ! basis ( almo/ all ! p9c] h&s con/ruct$ by ,m4 ,b\reau & *>act]is$ by-- 7#a7 ,! closure ( ! upp] hook :i* is ?us trans=m$ into a r+1 ! two appliances be+ comb9$ 9 "o2 7#b7 ,! spr+ fix$ to ! /raight side ( ! hook provid+ ! grip necess>y = hold+ articles4 ,if ! free end ( ! spr+ is turn$ up l ! po9t$ toe ( a m$ival %oe a suffici5tly l>ge op5+ is left betwe5 x & ! /raight edge ( ! hook to enable an object :i* is fix$ me*anically or held by ! o!r h& to be pu%$ into & gripp$ by ! spr+4 ,! simple/ type ( ?is me*anism is ! po/man's h& 7,figs4 #afe & #aff74 ,illu/ration3 ,,figs4 #afe & #aff4 ,po/man's h&4 ,! left h& ( ! po/man :o sorts lett]s has = its "w to keep 9 ! prop] ord] ! envelopes :i* are arrang$ 9 little packets2 ! "r h& has only to pu% ! lett] into place betwe5 a flat spr+1 fix$ to ! wri/1 & ! back ( ! hook4 ,if two or ?ree spr+s are suppli$ ! po/man c arrange two or ?ree packets ( lett]s at ! same "t4 ,he c also b9d ! packet ) /r+4 ,! v9e-dress]'s h& is provid$ ) ?is spr+ to hold small flat objects1 b ! second spr+ is wavy 9 outl9e1 s t semilun> spaces are left betwe5 x & ! fir/4 ,into ^! bran*es slip :5 ! spr+ is press$ aga9/ !m1 & !y are ?us held m firmly1 :il/ be+ sawn or prun$1 ?an by ! twi/+ action ( ! old patt]n hook ( ,grip\illeau 7,figs4 #afg & #afh74 ,illu/ration3 ,,fig4 #afg4--;,horticulturi/'s h&4 ,illu/ration3 ,,fig4 #afh4--,me?od ( hold+ a bran*4 ,?is ?ru/ to seize ! bran* is some:at r\gh1 & is only possible 9 hold+ h>d wood :i* !re is no fe> ( bruis+4 ,= m delicate %oots 7graft+ v9es indoors1 prep>ation ( cutt+s71 a grip is necess>y :i* c be op5$ be=e seiz+ hold ( ! object4 ,?is is accompli%$ by prolong+ ! spr+ t[>ds ! =e>m z a h&le1 pressure ^u :i* aga9/ ! *e/ 7:5 /&+71 or aga9/ ! knee 7:5 sitt+71 op5s ! grip1 9 :i* ! graft1 = example1 is !n plac$ 9 ! op5+ ( ! correct size4 ,! pack]'s h& is v +5i\s 7,fig4 #afi74 ,x has ! hook pi]c$ by an eye enabl+ a ?read to be pass$ ?r\gh a basket z ) a curv$ ne$le4 ,! jaws ( ! p9c]s are smoo? at ! tips1 b fur!r back !y h a s]ies ( graduat$ not*es 9 :i* tacks ( diff]5t sizes c be held :il/ !y are driv5 9 ) ! hamm]4 ,b ( c\rse a workman c only "w quickly if he c hold a numb] ( tacks ( ! same size 9 ! palm ( 8 h&1 plac+ "o "u ! hamm]1 relax+ 8 hold ( x aft] ! fir/ g5tle bl[ has fix$ x1 & gett+ ! next ready :ile he drives x home4 ,illu/ration3 ,,fig4 #afi4--,pack]'s h&4 ,! plumb]'s h& 7,fig4 #agj7 is made 9 ! %ape ( a pair ( gas pli]s1 & ends 9 cutt+ edges ) :i* wires c be cut4 ,) !m a bolt c be held :il/ ! o!r h& screws on ! nut4 ,illu/ration3 ,,fig4 #agj4--,plumb]'s h&4 ,! lea!r-cutt]'s h& 7,figs4 #aga & #agb7 %\ld be able to hold ! sk9 :i* ! o!r h& cuts3 x consi/s ( a plate ) a r\gh surface fix$ to a ball & socket jo9t :i* all[s x to turn 9 any direction1 s t ! o!r h& c foll[ ! l9e to be cut :i* is (t5 s9u\s4 ,?is appliance may also be us$ to hold a draw+ pap]1 a rule = cutt+ c>dbo>d1 or %eets ( pap] = b9d+4 ,illu/ration3 ,,fig4 #aga4--,lea!r-cutt]'s h&4 ,! examples t we h *os5 among/ ,b\reau's appliances = craftsm5 w1 we believe1 be suffici5t to expla9 ! pr9ciples ( _! con/ruction4 ,^! consi/ 9 /udy+ ! movem5ts :i* are normally c>ri$ out by ! passive h& 7usually ! left h&1 b ! "r 9 left-h&$ p7 & to devise an appliance accord+ly1 ! s\nd h& always becom+ ! active h&4 ,illu/ration3 ,,fig4 #agb4--,lea!r-cutt]'s h&4 ,we c\ld h describ$ _m m examples1 b we %all only say a few words ab\t ! me*anic's h&1 :i* is simply an adju/able spann] :i* c be automatically clos$1 t]m9at+ 9 too!d pli]s to hold circul> objects )\t ! necessity = be+ screw$ up4 ,z a matt] ( fact1 9 all ! "w ( a me*anic 7saw+1 fil+1 drill+1 tight5+ screws1 hamm]+1 =g+1 & gr9d+7 ! left h& is only us$ = pick+ up & /eady+ ! article to be manipulat$4 ,m4 ,b\reau rightly consid]s t x is bett] to entru/ ?is rle to ! artificial h& r ?an to contrive to make ! latt] capable ( saw+ or ( fil+ by means ( ! devices :i* we %all describe fur!r on 7p4 #aba & foll[+71 +5i\s & int]e/+ ?\gh ^! may be4 ,f ^! appliances1 adapt$ to c]ta9 p>ticul> grips1 o!rs h be5 devis$ = *air can+1 sold]+1 & = enabl+ factory h&s to "w />t+ lev]s & brakes4 ,?us ea* case mu/ be /udi$ sep>ately & ! workman furni%$ ) "o or sev]al appliances accord+ to 8 ne$s1 mak+ ! necess>y modifications f ! exi/+ patt]ns4 ,sev]al ( ^! appliances are atta*$ by a ball-&-socket jo9t l t describ$ = ! lea!r cutt]3 ?is is an int]m$iate =m betwe5 ! fix$ appliance & ! jo9t$ appliances :i* w be describ$ lat]4 ,b\reau recomm5ds t ! l5g? ( ! =e>m %\ld be su* t ! artificial appliance rea*es only z f> z ! level ( ! s\nd wri/4 ,! "w w !n ga9 9 precision4 ,we believe t ?is pr9ciple holds good ev5 = ! true artificial h&1 :i* %\ld be made #c to #d c5timetres %ort] ?an ! s\nd h&4 ,b x mu/ be realis$ t we %all be met ) a difficulty1 :i* we h already exp]i5c$4 ,comm5ts are made ^u ! appe>ance ( ! arm & ! we>] may sometimes be made to believe t ?is is due to faulty con/ruction4 ,= c]ta9 special crafts ! subject may be /udi$ f ano!r /&po9t & an actual tool con/ruct$ :i* c>ries out ! necess>y actions l a ma*9e work$ by ! =e>m1 s t 9 ^! special cases ! artificial h& is ! active h&4 ,at ! ,val5t9 ,hauy ,in/itute = ! bl9d1 :]e !re has long be5 a bru%mak+ work%op1 we h se5 9 use a v +5i\s tool ( ?is description ) a comb9$ action = c>ry+ out ! entire manipulation ( ! ?read :i* fix$ ! little bundles ( bri/les into ! holes p]=at+ ! back ( ! bru%4 ,results are s good t a bl9d & maim$ work] us+ ?is app>atus works m quickly ?an 8 comrades :o h ! use ( bo? h&s4 ,x consi/s ( a two-prong$ claw surm\nt$ by a small ?imble-%ap$ projection & ) a small hook1 l a cro*et hook project+ 9 front 7,fig4 #agc74 ,! hook fir/ passes ?r\gh "o ( ! holes 9 ! back ( ! bru%1 cat*es up ! ?read & draws x ?r\gh ! hole 7,figs4 #agd & #age74 ,! ?read is !n loop$ ar\nd ! ?imble1 :il/ ! s\nd h& b9ds ! little bundle ( bri/les into a twi/ ( ! loop 7,fig4 #agf71 & f9ally ! bundle is fix$ into ! hole1 ! claw be+ us$ to draw ! bru% t[>ds ! work] 7,fig4 #agg74 ,illu/ration3 ,,fig4 #agc4--;,bru%mak]'s hook4 ,illu/ration3 ,,fig4 #agd4--;,fir/ movem5t4 ,! /r+ is pick$ up by ! hook4 ,illu/ration3 ,,fig4 #age4--,second movem5t4 ,! /r+ is pull$ ?r\gh "o ( ! holes p]=at$ 9 ! back ( ! bru%4 ,illu/ration3 ,,fig4 #agf4--,?ird ,movem5t4 ,cat*+ ! bundle ( bri/les4 ,illu/ration3 ,,fig4 #agg4--;,f\r? ,movem5t4 ,! bundle is fix$ 9 ! hole 9 ! back ( ! bru%4 7#c7 ,9 place ( an actual tool ! deta*able "p may consi/ ( a clamp on ! pr9ciple ( a r+ into :i* ! tool is ins]t$ by ! h&le4 ,! two pr9cipal me?ods are ! screw & ! ,am]ican *uck4 ,a glance at figures #agh & #agi w expla9 h[ ! l>ge h&le ( a tool int5d$ = heavy "w is controll$ by means ( a screw & r+s4 ,illu/ration3 ,,figs4 #agh & #agi4--,nyrop's grip = hamm] & saw4 ,at ,r\5 we h se5 ! disabl$ ,belgians :o _h be5 re-educat$ we>+ an +5i\s ,t-%ap$ clamp by means ( :i* ! h&le ( a tool may be held ei!r 9 ! l9e ( ! axis ( ! =e>m or at "r angles to ?is4 ,?is me?od is specially useful = manipulat+ a file :i* is work$ ) "o h& :ile ! o!r1 9 ?is case ! s\nd h&1 presses ^u ! free end4 ,usually ! fil+ is done backw>ds & =w>ds1 work+ f base to tip ( ! file1 b sometimes1 specially = f9al poli%+1 ! file is held ) bo? h&s & work$ f side to side4 ,! ,am]ican *uck consi/s ( a pair ( metal jaws fix$ at _! base into a cyl9d] & appe>+ some:at l ! petals ( a long corolla4 ,ano!r cyl9d] is screw$ ov] ! fir/ to control ! op5+ & %utt+ ( ! jaws4 ,:5 ?is cyl9d] is unscrew$ ! jaws op5 & ! h&le ( ! tool c be ins]t$1 :5 x is screw$ up x closes ! jaws & makes !m grip ! h&le4 ,illu/ration3 ,,figs4 #ahj to #ahe4--,! ,am]ican ,*uck4 ,! p9c]s are compos$ ( two jaws ) v]tical cyl9drical grooves 7to fit ^u a h&le71 jo9$ above by a r+ 7,fig4 #ahe7 & c\pl$ by a spr+ ,c :i* keeps !m ap>t4 ,! p9c]s fit into a piece ,b 7,fig4 #ahb7 cut on ! out] side ) a screw ?read 7,figs4 #ahb & #ahc7 ^u :i* ! piece ,a is screw$ up or d[n 7,figs4 #ahj & #aha74 ,:5 screw$ t[>ds ! po9t ( ! p9c]s x presses on ! two jaws & closes !m4 ,:5 screw$ 9 ! opposite direction ! p9c]s op5 automatically4 ,if ! jaws op5 widely1 ! wood5 h&le ( a tool c be held1 b if ! op5+ is small ! unm\nt$ tool mu/ be fitt$ into !m 7,figs4 #ahf & #ahg74 ,?is me?od is specially useful = files1 z x frequ5tly happ5s t sev]al files are requir$ = ! same piece ( "w & !y c be *ang$ rapidly4 ,illu/ration3 ,,figs4 #ahf & #ahg4--;,file fitt$ into ! ,am]ican *uck4 ,x mu/1 h[ev]1 be insi/$ ^u t ! pr9ciple ( giv+ a passive rle to ! artificial h& is to be pref]r$4 7b7 ,appliances ) ,mobile ,jo9ts4--,9 ! c\rse ( "w ! direction ( ! wri/ is *ang+ at e in/ant1 flexion1 ext5sion1 pronation1 & sup9ation occurr+1 sometimes 9 ord] to move ar\nd ! object1 sometimes 9 ord] to ma9ta9 a suitable position :5 ! movem5ts ( ! %\ld] & elb[ v>y ! direction ( ! =e>m4 ,! consequ5ce ( ?is is t ! work] le>ns to turn ! piece ( "w ar\nd ) 8 s\nd h&4 ,to get ov] ?is difficulty passive jo9ts are ins]t$ at ! wri/1 :i* all[ ! appliance to move :5 x is press$ aga9/ ! piece ( "w & to take up ! direction :i* suits ! incl9ation ( ! =e>m4 ,illu/ration3 ,,figs4 #ahh to #aij4--;,agricultural hook & r+4 7,grip\illeau47 ,illu/ration3 ,,fig4 #aia4--;,comb9$ hook & r+4 7,b\reau47 ,illu/ration3 ,,figs4 #aib to #aid4 #a4 ,tram driv]'s & *auffeur's bell4 #b4 ,me?od ( use by a tram driv]4 #c4 ,managem5t ( a motor c> lev]4 ,pressure at ! extremity & traction4 ,"o ( ! simple/ me*anisms--& "o ( ! olde/1 because x 0 design$ by ,grip\illeau--is t ( ! agricultural lab\r]'s r+1 int5d$ to grip & manipulate ! h&le ( a :eelb>r[ or a pl\gh4 ,! r+ is m\nt$ on a transv]se axis & moves 9 a horse%oe :i* 9 its turn revolves on a %ank :i* is screw$ into ! =e>m4 ,! r+ is provid$ ) a screw1 :i* may be tight5$ ^u ! h&le if desir$1 b :i* is1 h[ev]1 r>ely us$ 7,figs4 #ahh to #aij74 ,! tram-driv]'s bell1 repres5t$ 9 figure #aib1 is devis$ on ! same pr9ciple4 ,x moves on a transv]se axis1 & 9 figures #aic & #aid its utility 9 manag+ lev]s 9 driv+ a tram or a motor c> w be easily se54 ,! rotation ( ! horse%oe on ! axis ( ! =e>m is n requir$4 ,! c>dan jo9t also all[s movem5t 9 e direction3 x consi/s ( two semicircles ( metal1 plac$ at "r angles1 ea* work+ ar\nd a transv]se axis1 ^! axes be+ unit$ 9 ! =m ( a cross4 ,! con/ruction & work+ w probably be und]/ood )\t fur!r explanation by a /udy ( figures #aie to #aih4 ,! fir/ two repres5t a sy/em ) a ball 9 ! c5tre1 :i* is well kn[n comm]cially4 ,! la/ two repres5t ! simple univ]sal jo9t g5]ally us$ 9 or?opdic surg]y4 ,x is some:at m cumb]some ?an ! previ\s model4 ,illu/ration3 ,,figs4 #aie & #aif4--,univ]sal jo9t ) ball4 ,illu/ration3 ,,figs4 #aig & #aih4--,simple univ]sal jo9t4 ,illu/ration3 ,,fig4 #aii4--;,g>d5]'s cyl9drical spade hold]4 ,a univ]sal jo9t p]mits movem5ts 9 e direction4 ,! spade hold] us$ at ! agricultural c5tre at ,limone/ is m\nt$ on a c>dan 7,fig4 #aii74 ,! jo9t c be fix$ by a compression screw :i* is easily & quickly adju/$4 ,:]e sev]al tools are necess>y ea* %\ld be complete ) its own univ]sal jo9t4 ,o!r me?ods ( t]m9al passive articulations are-- 7#a7 ,ball jo9ts :i* h already be5 describ$ 9 connection ) ! f+]s & :i* may be appli$ to ! wri/4 7#b7 ,bayonet jo9ts :i* are only applicable to c]ta9 artificial h&s :i* are n subject$ to any great /ra94 ,illu/ration3 ,,fig4 #bjj4 ,figure #bjj expla9s ?is me*anism z x is appli$ to ! artificial h& repres5t$ 9 figure #adh4 ,,*apt] ,,viii ,,artificial ,,limbs ,,= ,,amputation ,,?r\gh ,,! ,,arm ,9 ?is *apt] we %all deal only ) amputation ( ! arm bel[ ! upp] ?ird1 i4e4 ) cases 9 :i* ! /ump is long en\gh to transmit movem5ts to ! artificial limb4 ,amputation ?r\gh ! deltoid muscle mu/ be consid]$ 9 association ) dis>ticulation ( ! %\ld]4 ,bel[ ! arm socket is atta*$ an artificial limb :i* repres5ts ! elb[ jo9t1 =e>m1 & h&4 ,!re are two types to be describ$3-- #a4 ,! artificial arm prop]1 :i* has ! ext]nal %ape ( ! natural limb4 #b4 ,! work]'s arm1 a t]m9al appliance 9 :i* outw>d appe>ance is n consid]$4 ,! consid]ations z to ! arm socket & its atta*m5t by a %\ld] cap are ! same = ! two types ( appliance4 ,atta*m5t & ,arm ,socket4--,! surface ov] ! acromion & clavicle is ! only po9t f :i* support c be giv5 to an appliance = an amputation ?r\gh ! arm2 ! atta*m5t is made by means ( a %\ld] cap4 ,! g5]al %ape ( ?is %\ld] cap & its atta*m5t by means ( a /rap pass$ "u ! opposite axilla are simil> to ^? describ$ = appliances = amputation ?r\gh ! =e>m4 ,illu/ration3 ,,fig4 #bja4 ,! l>g] ! %\ld] cap ! m x ext5ds =w>ds ov] ! ant]ior wall ( ! axilla1 upw>ds ov] ! supra clavicul> fossa1 & backw>ds ov] ! scapula1 ! m secure w be ! support4 ,! appliance is heavy & has no support o!r ?an ! axill>y /rap4 ,! latt] has a t5d5cy to ride upw>ds aga9/ ! axilla :]e x ex]ts a pressure :i* may be uncom=table4 ,?is may be reliev$ by atta*+ a v]tical /rap :i* is button$ to ! tr\s] belt4 ,illu/ration3 ,,fig4 #bjb4 ,b al?\gh ?is ext5sive enclosure ( ! ?oracic region may n h9d] ! movem5ts ( ! /ump =w>ds & backw>ds1 x mu/ obvi\sly int]f]e ) ! movem5t ( abduction4 ,no d\bt ?is movem5t is ! less important ( ! two1 b we ought to try to pres]ve x z f> z possible4 ,9 %ort /umps we mu/ ab&on x4 ,b if ! /ump is long & consequ5tly has no t5d5cy to escape f ! socket1 ev5 if ?is slips d[n a little1 movem5t may be reta9$ by two me?ods4 ,! fir/ consi/s 9 sep>at+ ! arm socket f a l>ge %\ld] cap1 & ins]t+ a jo9t betwe5 7see page #hg72 b ! appliance is !n heavy & cumb]some4 ,moreov]1 al?\gh abduction c ?us be easily atta9$1 ?ru/+ & pull+ movem5ts require a light appliance1 & f9ally x is impossible to secure rotation4 ,illu/ration3 ,,figs4 #bjc & #bjd4--,%\ld] fitt+ ( small ext5t all[+ abduction4 ,x is possible1 on ! o!r h&1 by means ( ! o!r me?od1 :i* consi/s 9 end+ ! %\ld] cap at a l9e cont9u$ v]tically upw>ds f ! ?oracic m>g9 ( ! axilla4 ,if ! /raps are /rong & c>efully adju/$ ! result is bett] ?an ) ! fitt+ ov] ! scapula1 s t ?is appliance is pref]able4 ,we "h illu/rate a me?od ( fitt+ ! /raps :i* we consid] a good "o4 ,f ! po/]ior "p ( ! ord9>y axill>y /rap1 a ,y-%ap$ bran* passes to ! upp] bord] ( ! %\ld] cap above & 9 front ( ! clavicle1 ?is makes up = ! small ext5t ( ! enclosure ( ! %\ld]4 ,= ! work]'s arm a consid]able enclosure )\t any jo9t is ess5tial1 9 ord] to secure /ability4 ,! arm bucket1 usually cont9u\s ) ! %\ld] cap1 is made ( lea!r /r5g!n$ ) /eels4 ,! artificial arm is (t5 abduct$ f ! trunk1 :i* con/itutes an inconv5i5ce4 ,?is is sometimes due to a fault 9 ! alignm5t1 ! arm piece n be+ at "r angles to ! %\ld] cap4 ,x is1 h[ev]1 m (t5 due to ! cyl9drical %ape giv5 to ! arm bucket :i* =ces x away f ! trunk4 ,! inn] side ( ! bucket %\ld be flatt5$ s t x may hang v]tically close to ! ?orax4 ,! details ( con/ruction are diff]5t = ! true artificial arm & ! work]'s arm4 #a4 ,,artificial ,,arm ,! arm & =e>m pieces are bo? made ( lea!r4 ,!re is no object 9 mak+ !m to lace1 ! /ump is enclos$ 9 a socket 9 :i* x ne$ n fit v tightly1 because1 z we %all expla91 ?is appliance is unsuitable = heavy "w4 ,^! two p>ts are /r5g!n$ ) /eels1 :i* are articulat$ by h+e jo9ts at ! level ( ! elb[4 ,we h to /udy-- #a4 ,! position ( ! /eels & ! direction ( ! axis ( ! jo9t4 #b4 ,! lock to fix ! elb[ jo9t 9 a flex$ position4 #a4 ,position ( ! ,/eels4--,! /ump c transmit to ! arm socket ! v>i\s movem5ts gr\p$ "u ! "n ( circumduction1 b its hold does n enable x to transmit rotation4 ,x is !re=e undesirable--al?\gh usual--to atta* ! /eels on ! arm & =e>m to ! inn] & out] sides ( ! limb4 ,if ?is is done1 z rotation is impossible1 flexion ( ! =e>m at ! elb[ c only be c>ri$ out 9 ! sagittal plane4 ,b ?is movem5t is only exceptionally requir$2 ! elb[ be+ flex$ to ! "r angle & fix$ 9 ?is position by a rat*et ! limb =ms a hook ^u :i* an object may be hung1 provid$ t ! =e>m lies transv]sely 9 contact ) ! abdom5 & n ant]o-po/]iorly4 ,flexion %\ld !re=e be 9 a plane :i* is almo/ ! frontal plane 7#bj or #cj 9 front ( ?is71 & n 9 ! sagittal plane4 ,z !re is no active rotation ( ! arm !re=e ! /eels mu/ be almo/ 9 ! sagittal plane 7! ant]ior a little ext]nal1 ! po/]ior a little int]nal74 ,9 c]ta9 c>efully con/ruct$ appliances ! arm bucket is cut transv]sely above ! elb[ & betwe5 ! two p>ts a bayonet jo9t is fix$ :]e ! arm c be rotat$ by ! s\nd h&1 s t ! direction ( ! elb[ movem5t c be alt]$4 #b4 ,rat*et to fix ! ,elb[ ,jo9t 9 ! ,flex$ ,position4--,:5 at re/ ! =e>m %\ld hang v]tically4 ,b ! h& c only be us$ :5 ! elb[ is flex$ to an obtuse angle or a "r angle1 ! latt] position be+ m (t5 us$4 ,!re=e :5 ! pati5t has b5t ! jo9t to ! requir$ angle ) 8 s\nd h&1 he mu/ be able to fix x 9 ?is position4 ,?is fixation is effect$ by means ( a rat*et atta*$ to ! out] side ( ! elb[1 :i* c be lock$ or unlock$ at w4 ,?is rat*et consi/s ( a flat metal plate ) a prolongation upw>ds %ap$ l ! h&le ( a =k4 ,! end ( ?is prolongation is atta*$ to ! arm /eel by a p9 jo9t ab\t #c c5timetres above ! axis ( ! elb[ jo9t4 ,! plate is pi]c$ by a rectangul> op5+1 "o bord] ( :i* is not*$2 x lies aga9/ ! =e>m /eel1 a cat* project+ f :i* fits into ! op5+1 ?is cat*1 situat$ #f c5timetres bel[ ! axis ( ! elb[1 is ( ! same diamet] z ! not*es ) :i* x engages4 ,! high] ! not* ) :i* engagem5t takes place ! m ne>ly flexion approa*es ! "r angle4 ,! wid? ( ! op5+ 9 ! plate is twice ! size ( ! cat*1 s t ! jo9t works freely :5 ! cat* glides on ! smoo? edge & becomes fix$ z soon z ! cat* engages 9 ! not*$ bord]4 ,x is only necess>y to arrange a lock1 manipulat$ ?r\gh ! sleeve1 to br+ ! smoo? or ! not*$ bord] 9 contact ) ! cat*4 ,suppose t ! h&le ( ! rat*et is prolong$ beh9d ! po9t at :i* x is h+$ to ! arm /eel z a little lev] furni%$ ) a button1 & t an ela/ic cord or spr+ is /ret*$ f ?is button to a po9t on ! po/]o-ext]nal bord] ( ! =e>m1 !n if ! lev] po9ts upw>ds & ! not*es are on ! upp] edge ( ! rat*et 7z is ! case 9 figure #bje71 ! ela/ic1 pull+ ! lev] =w>ds1 w press ! rat*et d[n & make ! not*es engage ) ! cat* on ! =e>m1 if1 on ! o!r h&1 ! lev] po9ts d[nw>ds ! ela/ic traction w release ! not*es4 ,! rev]se occurs if ! not*es are on ! l[] edge4 ,x is !n only necess>y to arrange a me*anism by means ( :i* ?is little lev] c turn1 ) a /op :i* arre/s x above at ! v]tical position1 bel[ at a po9t #de beyond ! horizontal4 ,illu/ration3 ,,fig4 #bje4--;,elb[ rat*et4 ,a simple me*anism ( ?is sort is %[n 9 figures #bjf & #bjg4 ,! jo9t surfaces ( ! rat*et & ( ! little lev] ea* be> a %\ld]1 ! =m] 9 front1 ! latt] beh9d1 ext5d+ ov] su* a proportion ( _! circumf]5ce z w make !m act z /ops 9 ! desir$ positions above & bel[4 ,a lock is ?us provid$ :i* c be manipulat$ ) ! o!r h&4 ,9 ! p>ticul> patt]n illu/rat$1 traction is made by an ela/ic cord fix$ to ! c5tre ( ! back ( ! wri/ & end+ above 9 a lea!r /rap pi]c$ ) holes :i* fix on ! button ( ! lev]4 ,?is arrangem5t all[s ( ! adju/m5t necessitat$ by ! gradual /ret*+ ( an ela/ic :i* is subject$ to cont9u\s t5sion4 ,a /eel spr+ ( ?is l5g? 7! :ole l5g? ( ! =e>m7 w\ld be too heavy if x 7 suffici5tly p[]ful4 ,if x is desir$ to use ?is me?od ! two ends ( a p[]ful spr+ %\ld be fix$1 "o to ! button on ! lev]1 ! o!r to ! cat* on ! =e>m ) :i* ! rat*et engages4 ,illu/ration3 ,,figs4 #bjf & #bjg4--,! elb[ rat*et & mode ( action ( its lock4 ,! spr+ %\ld always be 9 t5sion4 ,z ! di/ance betwe5 ! jo9t on ! arm & any po9t on ! =e>m increases z ! elb[ ext5ds1 x is bett] = ! rat*et1 ) not*es on its upp] edge1 to be engag$ :5 ! button po9ts upw>ds & free :5 x po9ts d[nw>ds4 ,9 ! opposite arrangem5t1 :i* is (t5 us$1 ! t5sion is consid]able )\t be+ useful :5 ! =e>m is v]tical1 & ! me*anism soon we>s out4 #c4 ,h& & ,o!r ,appliances4--,! h& atta*$ to ! end ( ! =e>m has a spr+ ?umb :i* may be passive or automatic4 ,9 ! latt] case1 if ! /ump is long en\gh to all[ consid]able movem5ts ( ! arm1 ! cord works 9 ! way describ$ on page #hg1 = amputation ( ! =e>m4 ,if ! /ump is %ort1 traction mu/ be ex]t$ by movem5t ( ! %\ld]s1 r\nd+ ! back4 ,! h& ) a mobile wri/ is nev] us$ ) ^! amputations except 9 c]ta9 exp5sive appliances1 9 :i* 9 addition ! f\r f+]s may be articulat$1 z describ$ on page #aja4 ,= ! ord9>y limb ^! delicate me*anisms are devoid ( practical utility4 ,x is easy to replace ! h& ) int]*angeable appliances1 b :5 ! pati5t has to d h>d "w ?is is n a satisfactory me?od4 ,! arm ) ! rat*et at ! elb[ is 9 fact suitable = use by a cl]k4 ,b x is n ei!r /rong en\gh or simple en\gh = manual lab\r4 ,9 our op9ion ! functional & practical value ( an artificial arm1 p>ticul>ly = amputation above ! elb[1 is (t5 exagg]at$1 h[ev] x does exi/1 especially 9 _m bran*es ( agricultural "w4 ,= ! latt] ! slightness ( ! lat]al /eels--& especially ( ! jo9ts at ! elb[--makes ! appliance insuffici5tly /rong4 ,! necess>y delicacy ( ! rat*et & its manipulation ?r\gh ! sleeve by ! s\nd h& are additional disadvantages4 #b4 ,,work]',s ,,arm ,if our object is to fit to an arm /ump an appliance :i* w be at ! same "t /rong & flexible1 capable ( c>ry+ out r\gh & ev5 vigor\s "w1 we mu/ ab&on ! attempt to imitate ! natural %ape ( ! arm4 ,! movem5ts & /r5g? ( ! /ump mu/ be transmitt$ to ! object held by means ( a rigid rod at ! extremity ( :i* ! appliance = gripp+ is fix$4 ,x is possible to fix ar\nd ?is rod a %[ arm ) a h& & a passive spr+ ?umb = we>+ on special occasions1 9 exactly ! same way z we fit ! %[ leg r\nd ! peg4 ,figures #bjh & #baj w %[ at a glance h[ ?is is done4 ,b1 z f> z our pres5t exp]i5ce goes1 ?is is only an accessory add$ = /hetic reasons4 ,! true work]'s arm consi/s ( a /rong metal rod fix$ to ! arm socket 9 a way t we mu/ n[ /udy4 #a4 ,! ,arm ,socket4--,we h already said t ?is mu/ be cont9u$ into a %\ld] cap ( consid]able ext5t1 :i* may be p]=at$ 9 ! region ( ! po9t ( ! %\ld] 9 ord] to r5d] ! appliance light]4 ,abduction at ! %\ld] is ?us sacrific$4 ,! arm socket is made ( lea!r1 op5 d[n ! front & lac$4 ,by be+ lac$ x fits ! /ump m securely4 ,x is /r5g!n$ by two /eels :i* may be fix$ 9 ! frontal plane because1 z we %all see1 a passive rotation at ! elb[ jo9t is possible4 ,^! /eels are directly cont9u\s bel[ ) a hemisph]ical /eel cap1 :i* is pi]c$ 9 ! axis ( ! limb by a hole into :i* is bolt$ ! connect+ piece to :i* ! rod :i* repres5ts ! =e>m is atta*$4 #b4 ,articulation at ! ,elb[4--,! =e>m consi/s ( simple metal tube1 atta*$ b5ea? ! arm socket by me?ods :i* dep5d ^u ! foll[+ pr9ciples4 ,illu/ration3 ,,figs4 #bjh & #bji4--,work]'s arm & %[ arm4 ,! work]'s arm consi/s ( a metal rod :i* sw+s backw>ds & =w>ds at ! elb[ & also rotates ^u ! arm socket4 ,to ! end ( ?is rod an appliance c be screw$ 7a r+ & hook are "h %[n74 ,ar\nd ! work]'s arm a %[ arm ) a h& 7,fig4 #bji7 c be fix$4 ,!y are %[n 9 place 9 ,figure #baj4 ,! only movem5ts t ! /ump c transmit to ! arm socket are =w>d & backw>d movem5ts h++ ab\t ! %\ld]1 & abduction4 ,! fir/ ( ^! movem5ts is ! only really useful "o = ! workman4 ,! d[nw>d pressure ex]t$ by active ext5sion ( ! elb[ no long] exi/s2 9 ord] to press ^u an object ! s\nd h& mu/ be us$1 = x is n practicable to make use ( ! weight ( ! body ?r[n =w>d = ?is purpose4 ,illu/ration3 ,,fig4 #baj4--,%[ arm 9 position4 ,9 backw>d & =w>d movem5ts--consid]+1 = example1 ! use ( ! file--! angle at ! elb[ op5s :5 ! arm is ?ru/ =w>d & closes :5 x is pull$ backw>ds4 ,^! passive movem5ts ( ! jo9t mu/ n be imp$$ 9 any way1 t is to say1 ! =e>m mu/ sw+ freely bel[ ! arm ^u a transv]se axis & x mu/ also be able to rotate freely ar\nd a v]tical axis4 ,^! movem5ts are secur$ 9 ! pl\ghman's h& :i* 0 design$ sixty ye>s ago by ,grip\illeau & 9 :i* ! jo9t :i* we h %[n z a me?od ( atta*+ ! mobile r+ to ! wri/ is utilis$4 ,! =e>m rod atta*$ by a /rong transv]se p9 sw+s freely 9 a little /irrup-%ap$ cap1 :i* itself rotates ar\nd a bolt by :i* x is firmly fix$ into ! metal or wood5 hemisph]e :i* t]m9ates ! arm socket4#ad #ad ,wood1 :i* 0 us$ by ,grip\illeau1 has be5 giv5 up4 ,x is cle> t ?is complete lib]ty ( action has its disadvantages2 ! elb[ jo9t c nev] be made to assume a fix$ position aga9/ any passive resi/ance2 moreov]1 9 actual practice ! useful range ( ei!r ( ^! movem5ts is small4 ,= ?is reason attempts h be5 made to devise me?ods by :i* !y c be limit$ 9 ! v>i\s work]'s arms :i* h be5 design$ s9ce ! beg9n+ ( ! w>4 ,9 all ^! arms ! me*anism ( ! elb[ jo9t is d]iv$ f t ( ! pl\ghman's arm ( ,grip\illeau4 ,un=tunately none ( ^! me*anisms 9 :i* a pressure screw is us$ = fixation possess any /r5g?4 ,at fir/ sight1 9 a new appliance !y appe> attractive & "w well1 b x is well kn[n to all me*anics t ! ?read ( a screw :i* is 9 con/ant use quickly we>s & !n x is impossible to tight5 x4 ,at ! extremity ( an artificial arm1 :e!r x be an arm ( natural %ape or a work]'s arm simplifi$ to ! =m ( a jo9t$ rod1 any ( ! appliances already describ$ = =e>m amputations c be screw$ on z requir$4 ,x is by ! use ( ^! appliances t ,grip\illeau's old pl\ghman's arm1 :i* end$ 9 an int]*angeable hook & r+1 has be5 improv$4 ,ap>t f _! actual economic value1 results h be5 obta9$ by use ( ^! t]m9al appliances1 9 _m diff]5t skill$ trades1 :i* are ( ! greate/ possible int]e/4 ,= reasons t we h indicat$ 9 describ+ ! atta*m5t ( ! elb[1 ! v>i\s attempts t h be5 made to give to ! wri/ a mobility t is "u control h n s f> l$ to ! inv5tion ( an appliance t is bo? /rong & durable4 ,= ?is reason we consid] t until some?+ new is design$ x is bett] to make ! t]m9al appliance a fix$ "o4 ,,*apt] ,,ix ,,artificial ,,limbs ,,= ,,dis>ticulation ,,?r\gh ,,! ,,%\ld] ,,jo9t ,,& ,,amputation ,,?r\gh ,,! ,,deltoid ,,muscle ,s f> z function is conc]n$ ^! op]ations are id5tical2 a %ort arm /ump is incapable ( transmitt+ movem5ts to ! socket ( ! artificial limb4 ,t is to say1 our appliance w be a purely passive "o1 & at ! pres5t "t x is useless to attempt to make any sort ( work]'s arm4 ,we mu/ aim simply at supply+ a limb :i* imitates ! ext]nal %ape ( ! arm1 ) an elb[ jo9t :i* c be lock$ ) a rat*et4 ,at mo/ x is possible by a movem5t ( ! opposite %\ld] to "w an automatic ?umb by means ( a cord1 z a rule1 h[ev]1 a simple spr+ ?umb is pref]r$4 ,no?+ ne$ be add$ to :at has be5 said 9 ! previ\s *apt] ab\t ! elb[ jo9t or ! h&4 ,9 ! fitt+ ( an atta*m5t ov] ! %\ld] ! amputation ?r\gh ! deltoid pres5ts an actual advantage4 ,= 9 ?is case ! %ape ( ! po9t ( ! %\ld] is pres]v$1 & ! atta*m5t c>ri$ out z describ$ on pages #hg & #acj fixes ! appliance v securely4 ,if ! entire hum]us has be5 remov$ a v ext5sive enclosure ( ! front & back ( ! *e/ is ess5tial & 9 ord] t ! axilla may be 9 close contact ) ! top ( ! limb x is a good ?+ to /ret* across ?is space a lay] ( "s firm mat]ial4 ,^! appliances c be us$ to /eady a piece ( pap] ^u :i* ! pati5t is writ+1 to c>ry a p>cel :i* is n too heavy ) ! elb[ flex$1 to grip an article ) ! ?umb4 ,a workman :o is be+ re-educat$ = "s occupation :i* is possible = a "o-arm$ man1 w usually--unless he is go+ out = pleasure--leave 8 artificial arm at home 9 ! cupbo>d4 ,,*apt] ,x ,,"s ,,g5]al ,,pr9ciples ,,9 ,,! ,,re-,,education ,,( ,,! ,,disabl$ ,,:5 a disabl$ man has be5 fitt$ ) an artificial limb he has to le>n a trade :i* w enable him to supplem5t 8 p5sion & provide = himself & 8 family4 ,9 our op9ion1 :i* we believe we h express$ m ?an once 9 ?is book1 x is ne>ly always advisable to det]m9e :at pr(ession w ultimately be possible be=e ord]+ ! artificial limb4 ,?is pr9ciple is p]haps n always ?or\ghly und]/ood1 al?\gh !re are fitt+ c5tres :]e x is fully recognis$ 7a pro( ( ?is may be f\nd 9 a rec5t article by ,nov-,joss]& & ,b\get74 ,x is unnecess>y to repeat t :il/ e ef=t mu/ be made to associate =m ) function1 ! latt] is b\nd to take prec$5ce ( ! =m]4 ,x is1 h[ev]1 n always easy to impress ^u pati5ts1 & m especially ^u _! protectors1 t =m is = ,sundays & holidays1 & function is = workdays4 ,! grave problem ( re-education ( amputation cases1 & 9 a m g5]al s5se ( all ! maim$1 n[ confronts u4 ,we believe x to be wor? :ile to indicate ! g5]al pr9ciples s f> z !y are at pres5t und]/ood4 ,i ,at ! outbreak ( w> ! idea ( ! disabl$ 9 g5]al1 & p>ticul>ly ( ^? :o _h _h a limb amputat$1 0 (t5 to give up any really active trade & to seek a situation g5]ally z an (ficial ) no actual manual lab\r4 ,x mu/ be confess$ t _m p1 especially ! nurses1 enc\rag$ !m 9 ?is1 & possibly ! latt] w\ld n d5y hav+ done s4 ,x has rapidly become evid5t t !re are too _m maim$ to be suppli$ ) situations z c>etak]s ( public g>d5s or doorkeep]s1 & t !y w n be able to ga9 a liv+ by mak+ tricol\r$ decant]-mats ( /r+ or raffia or artificial fl[]s1 :5 baza>s organis$ = _! b5efit by t5d]-he>t$ s\ls h gone out ( fa%ion4 ,"o ( u 0 pres5t a %ort :ile ago at ! foll[+ little sc5e3-- ,9 a hospital :]e !re 7 two amputation cases1 "o ?r\gh ! l[] f\r? ( ! ?igh1 ! o!r ?r\gh ! middle ( ! leg1 bo? agricultural lab\r]s1 a di/+ui%$ man ( lett]s1 actuat$ by ! be/ int5tions1 ask$ !m :at !y c\nt$ on be+ able to d aft] !y _h be5 fitt$ ) artificial limbs4 ,! fir/ repli$ t he hop$ to return to agricultural "w1 ! second t he w\ld nev] be able to d t b w\ld look out = a situation4 ,our fri5d 0 mu* surpris$ to he> u say t he w\ld be ill employ$ 9 us+ 8 influ5ce to obta9 8 desire = ! second pati5t1 because a man ) only "o leg c\ld "w on ! l& ) almo/ no dim9ution ( 8 ord9>y capacity1 ev5 ) ! old-fa%ion$ kneel+ peg leg4 ,z ,jean ,camus has well said 9 a rec5t article 9 ! ,p>is ,mdical1 ,we are beg9n+ to pass beyond ! phase :5 re-education ( ! maim$ 0 left to *ance4 ,x is felt n[ t ! frivol\s ef=ts ( b5efactresses :o1 act+ ) ! be/ int5tions b )\t reflections1 are delight$ to be able to trans=m into a %or?& typi/ an hone/ f>m lab\r] :o _h a /rong atta*m5t to ! soil & c\ld q well return to x1 mu/ be avoid$4 ,su* feats are bo? culpable & absurd4 ,^! fanta/ic ideas mu/ be got rid (1 & all our ef=ts mu/ be co-ord9at$1 ! complexity ( ! conditions to be dealt ) be+ duly weigh$4 ,giv5 a maim$ man ! fir/ c>e %\ld be to educate to ! maximum all ! un9jur$ & rema9+ p>ts4 ,x is too (t5 =gott5 t among ! p>ts rema9+ ! bra9 plays a lead+ rle1 ev5 ! *ief rle1 n only because x is ! organ ( good w )\t :i* all attempts at re-education are fruitless1 b also because good w be+ giv5 ! intellig5t man w succe$ bett] & w be able to adapt himself to m delicate "w4 ,physio!rapy _c be prescrib$1 says ,j4 ,camus1 z qu99e is prescrib$4 ,! mal>ial pati5t :o takes ! latt] m$ic9e b5efits :e!r he wi%es to or n4 ,! w\nd$ man :o submits ea* morn+ to 8 me*ano!rapeutic treatm5t does n recov] unless he wi%es4 ,x is v difficult to make ! layman und]/& ?is4 ,he inv>iably takes = grant$ ! good w ( ! pati5t1 ) all ( ^: compla9ts he sympa?ises1 )\t = a mom5t realis+ t !y sometimes deg5]ate into j]emiads1 (t5 ) an ult]ior motive4 ,an exam9ation by a doctor--& an exp]i5c$ doctor--is !re=e necess>y 9 ord] to det]m9e "u :at physical & m5tal conditions an amputation case c be re-educat$2 s t he may und]/& t x is entirely to 8 int]e/ to "w z quickly & z well z possible1 t begg+ is degrad+1 & above all t private *>ity is tempor>y & exhau/ible2 & t 9 consequ5ce he mu/ z quickly z possible put himself into a condition to supplem5t by a sal>y ju/ly e>n$ ! p5sion or gratuity :i* is c]ta9 to be insuffici5t = 8 ma9t5ance4 ,x c nev] be suffici5tly insi/$ ^u 9 deal+ ) ! maim$ t by resum+ "w1 & on acc\nt ( ! functional improvem5t result+ f do+ s1 !y ne$ h no anxiety t _! p5sion w be r$uc$1 because ! am\nt ( ?is is bas$ on ! ext5t ( ! injury itself & on ! man's rank1 & n on 8 pr(ession be=e he became a soldi]4 ,9 ! same rank ! p5sion is ! same = a surgeon or a lawy]1 if bo? h lo/ a h&4 ,x is a deep-seat$ notion1 in/ill$ into ! m9ds ( injur$ workm5 by ! (t5 suspici\s folk :o advise !m1 t if !y beg9 "w be=e _! case has be5 settl$ _! p5sion w be less4 ,x mu/ be ackn[l$g$ on ! o!r h& t ! civil exp]t is (t5 fac$ ) a difficulty4 ,z our law /&s--& x is unfair--"w _c be resum$ p>tially ) provisional half-pay foll[$ lat] by :ole-"t "w ) p]man5t sal>y4 ,?is diff]5ce is important to our w\nd$ soldi]s1 :o h ev]y?+ to ga9 by a rapid & complete re-education & ^: duty x is to d :ole or "p-"t "w :ile _! legal position is be+ arrang$ & be=e ! w\nd1 9 legal phraseology1 has become consolidat$1 t is to say1 be=e ! completion ( treatm5t4 ,x is only fair to add t ! pati5ts are n alone to blame & t ! adm9i/ration has = long be5 guilty ( an error aga9/ :i* reaction is gr[+1 viz4 delay+ re-education until ! "t :5 ! local condition has become p]man5t & ! pati5t has be5 dis*>g$ & has receiv$ 8 pro/hetic app>atus4 ,?is delay is deplorable1 on bo? m$ical & social gr\nds4 ,on m$ical gr\nds because 9 v _m cases be=e treatm5t is q complete ! addition ( c>efully graduat$ & sup]vis$ "w is an important "p ( ! treatm5t4 ,on social gr\nds because x is necess>y to fight 9 e possible way aga9/ ! common t5d5cy ( ! pati5t to fall into habits ( laz9ess & intemp]ance4 ,?is is n[ und]/ood1 & almo/ ev]y:]e to-day ! w\nd$ soldi] c resume "w 9 work%ops atta*$ to ! c5tres ( physio!rapy1 & ?us beg9 8 re-education :ile cont9u+ 8 treatm5t4 ,at a c]ta9 /age resumption ( "w becomes ! be/ !rapeutic ag5t ( all4 ,x is obvi\s t ?is resumption ( "w _c supply ! place ( c]ta9 special treatm5ts su* z electrical treatm5t dur+ ! reg5]ation ( a n]ve1 balneo!rapy1 or graduat$ gymna/ic ex]cises2 b is x n true t "w ) its cont9ual active movem5t is inf9itely sup]ior to passive mobilisation by means ( app>atus h[ev] +5i\sly ! latt] may be contriv$8 ,morov] x is surely a m efficaci\s c\rse ( me*ano!rapy :5 ! pati5t works = half or all ! day ?an is provid$ by ! special c\rse occupy+ only an h\r or two4 ,! t5d5cy to-day is 9 ?is direction1 z1 = example1 at ! ,gr& ,palais1 ?anks to ! ef=ts ( ,j4 ,camus1 & also 9 ! agricultural c5tre ( ! ,x,i,i,ith di/rict "u ! direction ( ,belot & ,privat4 ,at a giv5 mom5t all treatm5t may be susp5d$ & ! pati5t may devote himself exclusively to "w ) results ! excell5ce ( :i* ,nepp] & ,valle h demon/rat$4 ,! workm5 are !n eligible = "w 9 a t[n 9 private work%ops1 b s f> ?is fre$om has m inconv5i5ces ?an advantages4 ,a man ^: work+ capacity is mu* r$uc$1 & m especially a man :o requires re-education1 has no place 9 an ord9>y work%op :]e nei!r ! proprietor nor ! =eman nor 8 fell[-workm5 are 9 tru? mu* incl9$ to conc]n !mselves ab\t him4 ,:]e actual education is necess>y ?is is be/ suppli$ 9 special work%ops :]e ! pati5t w be among comrades h&icapp$ l himself1 ^: progress he w be able to wat* & ^: ef=ts he w imitate1 r ?an among able-bodi$ workm51 by comp>+ himself ) :om he is b\nd to be disc\rag$4 ,! problem has be5 solv$ by ! ,belgians 9 a rem>kable e/abli%m5t op5$ at ,port-,vill]z1 & by ! ,au/rians at ,vi5na "u ! direction ( ,spitzy1 z ,nov-,joss]& & ,b\get in=m u1 by delay+ a maim$ soldi]'s dis*>ge f ! army until 8 re-education is z complete z possible4 ,?is me?od has prov$ to be to ! int]e/ bo? ( ! individual & ( ! ,/ate1 b we d n seem to h consid]$ ?is solution1 & x is /ill to be fe>$ t x w\ld accord ill ) ! indep5d5ce ( our national "*4 ,! actual fact1 ?\gh x has n be5 br\ght into prom95ce1 is t our usual sy/em ( wat]tight comp>tm5ts has be5 appli$ by add+ to ! c5tres ( physio!rapy c5tres ( agricultural or indu/rial re-education1 ! results obta9$ 9 :i* are dep5d5t ^u ! effici5cy ( ! director ( physio!rapy4 ,?is matt] seems to h receiv$ v little special att5tion 9 connection ) amputation cases4 ,x is1 h[ev]1 ( great utility to develop ! /r5g? & agility ( ! rema9+ limbs by suitable gymna/ic ex]cises1 to tea* a man ) only "o leg1 = example1 to jump )\t an artificial limb & to climb a slipp]y rope or a ladd]2 or to tra9 ! left h& ( a man :o has lo/ 8 "r2 to develop ! greate/ possible /r5g? 9 ! /ump by tra9+ x 9 movem5t comb9$ ) ! ex]tion ( =ce4 ,9 addition to ?is1 e>ly & provisional equipm5t ) artificial limbs mu/ become g5]al4 ,^! tempor>y limbs are und\bt$ly rudim5t>y contrivances1 b !y are functionally good & are useful on acc\nt ( _! m]e weight4 ,9 ?is connection ! tempor>y arms us$ by ,nov-,joss]& & ,b\get 9 _! agricultural re-education c5tre are v int]e/+ models4 ,! great advantage ( us+ a tempor>y limb is t ! "t requir$ = ! con/ruction ( ! p]man5t app>atus1 (t5 a consid]able p]iod1 is n lo/ 9 idl5ess1 ! "m ( all ! vices4 ,,ii ,x 0 said at ! beg9n+ ( ! la/ *apt] t :5ev] possible a disabl$ man %\ld be giv5 a real trade & n "o ( ^? frivol\s & trifl+ occupations :i* 7 at "o "t ! fa%ion4 ,9 ! *oice ( a trade ! rul+ pr9ciple is t ( aim+ to re/ore z ne>ly z possible ! man's =m] occupation4 ,?is pr9ciple %\ld n1 h[ev]1 be c>ri$ to an extreme4 ,z ,camus has ju/ly said1 by 8 previ\s "w a man has /or$ up a mass ( ideas1 a fact :i* is too little realis$1 especially by himself4 ,^! include ! mann] ( *oos+1 hold+1 & attack+ ! mat]ials ^u :i* he works1 & ( appreciat+ _! qualities & faults2 k ( _! m>ket value1 ( ! value ( ! lab\r1 etc4 ,?is %\ld be utilis$ 9 8 future "w ev5 ?\gh x be realis$1 z ,m4 ,b\rillon has rem>k$1 t ! resumption ( 8 trade 9 its entirety may be impossible4 ,) ! tools t h be5 describ$ a man :o has lo/ 8 =e>m may be able1 = example1 to und]take a locksmi?'s "w & to execute correctly all ! movem5ts requir$ 9 ply+ ! trade4 ,grant$2 b h[ long w he take to make "o piece1 let u say1 z well z 8 neighb\r8 ,if he produces little he w n f9d an employ] to give him daily "w1 :ile if he does piecework1 ap>t f ! fact t x is n 9 good repute among ^? :o are ! actual lead]s ( ! work+ classes1 x w n be remun]ative1 & to e>n #c frs4 a day :5 a comrade e>ns #aj or #ab frs4 is practically an impossible solution4 ,! case may be cit$ ( a woman suff]+ f cong5ital defici5cy ( ! h& ) a v %ort rudim5t ( ! wri/ :i* is only slightly mobile4 ,by means ( contrivances :i* we ne$ n describe1 & ) no pro/hetic app>atus1 %e ?reads h] ne$le & sews z quickly & z well z anybody4 ,?is is n an argum5t1 =3 7#a7 x is a cong5ital lesion & ! educability ( a *ild is well kn[n2 7#b7 ! woman is extremely intellig5t1 & unhappily ?is fav\rable factor _c always be c\nt$ ^u4 ,x w\ld be wrong to conclude f ?is t a case ( amputation at ! wri/ %\ld be put to sew+4 ,x mu/ nev] be =gott5 t intellig5ce & w are factors ( ! fir/ importance1 s t h[ev] little intellectual capacity ! disabl$ man may h1 he is b\nd to pr(it by 8 passage ?r\gh ! s*ool ( re-education 9 le>n+ to read & write if he is illit]ate--?is is m frequ5t ?an is usually believ$--or to improve 8 k if he has already _h "s in/ruction4 ,x is1 9 fact1 by bra9 "w t _m le>n to replace _! physical defect4 ,let u take1 = example1 a disabl$ bricklay]4 ,if he is intellig5t & is giv5 a help+ h& 9 ! %ape ( ! necess>y in/ruction1 he may become a build] on 8 own acc\nt 9 a small way :5 he kn[s h[ to make plans1 "w out e/imates & keep acc\nts4 ,?is is n a ,utopian fancy4 ,9 ! small t[ns & villages !re are _m own]s ( bus9esses su* z masons1 decorators1 jo9]s1 etc41 workm5 :o _c spell1 b :o are intellig5t1 h bus9ess m9ds & a gift = ov]see+1 :o h giv5 up ! tr[el & w build y a h\se z well z1 or (t5 bett] ?an1 _m ar*itects4 ,x is ) simil> aims to ^! 9 view t a bricklay] %\ld be re-educat$ :5 x is judg$ t 8 intellectual capacity is suffici5tly great4 ,:]e !re is no intellig5ce education c d little4 ,!re are 9 civil life innum]able casual lab\r]s ) limbs intact :o h nev] be5 able to le>n a regul> trade & :o e>n a mis]able livelihood by do+ :at turns up4 ,_! situation becomes s]i\s :5 !y lose "s ( _! physical capacity4 ,!y c1 h[ev]1 be rescu$1 p>ticul>ly by enc\rag+ !m to become agricultural lab\r]s4 ,x is inde$ especially agricultural lab\r]s :o %\ld be urg$ to return to ! l&1 & ^? me*anics :o w be unable to "w 9 a factory = ! future %\ld also be enc\rag$ to take up ?is "w4 ,"o reason = ?is is t ! workman's arm--especially if x has n be5 too mu* elaborat$--is useful = ! execution ( a consid]able v>iety ( "w on ! l&4 ,x is unnecess>y to speak ( cases ( amputation bel[ ! knee1 s9ce _! usefulness on ! l& may be tak5 = grant$4 ,9 ! c\ntry z a matt] ( fact a man nev] dies ( hung]2 & ?is _c be said ( ! t[n4 ,ap>t f actual cultivation ( ! l&1 :i* is 9 "p impossible = ! maim$1 !re are num]\s & important occupations ( :i* a t[n dwell] w\ld n ?9k4 ,x is :5 he goes to ! c5tre ( re-education 9 agricultural "w1 fir/ ( all to view x & !n to "w1 t ! disabl$ man takes note ( :at he c or _c d1 & ( ! "w 9 connection ) agriculture :i* is op5 to him1 su* z p\ltry re>+ or bee keep+4 ,?is applies to o!r employm5ts ?an agriculture4 ,ap>t f 8 actual trade :i* ! workman c no long] ply ) a suffici5t return = 8 lab\r1 he may be able to "w at "o or two ( ! accessory employm5ts :i* w\ld n ( !mselves br+ him 9 a liv+ b :i* w\ld yield a satisfactory supplem5t>y income4 ,9 c]ta9 re-education c5tres !re seems to be a m>k$ pr$ilection = crafts 9 :i* ! appr5tice%ip is %ort & ! in/allation co/s little1 ?\gh ^! are 9 fact ! *>act]i/ics ( ^? trades :i* give ! lab\r] a poor return1 t is to say1 "t-"w 9 a l>ge or small work%op4 ,at ! beg9n+ ( ! w> an attempt 0 made to %[ t !re w\ld nev] be en\gh t9k]s1 sabot mak]s1 %oemak]s1 or saddl]s 9 ! c\ntry4 ,x is q a false idea t a disabl$ man c ga9 a liv+ at "o ( ^! crafts 9 a village4 ,x is true t he c d s if1 work+ z an agricultural lab\r]1 he c act z a b>b] 9 8 sp>e "t1 & is capable ( execut+ small jobs1 especially repairs1 :i* ! villag]s w\ld readily give to him r ?an h to g sev]al miles to get !m done4 ,:5 ! disabl$ man has ?is additional "w 9 8 h&s he w gradually be able to asc]ta9 :e!r ! ne$s ( ! c\ntryside & 8 own p]sonal capacity are compatible ) its developm5t4 ,9 t case1 h[ev]1 he w be1 9 fact1 a small proprietor buy+ 8 own tools & mat]ials & fix+ a retail price4 ,b ! great majority ( workm5 h no notion ( su* calculations & su* organisation z are indisp5sable :5 a man runs a bus9ess ev5 if he is alone4 ,x foll[s1 !re=e1 t ! education ( 8 m5tal1 & especially 8 comm]cial1 faculties mu/ be consid]$1 & x mu/ be asc]ta9$ :e!r ! man is likely to pr(it by su* education4 ,x is useless to in/all 9 a hamlet a %oemak] :o is incapable ( work+ except z an assi/ant1 & 9 ! t[n at ! actual factories ! prospects are poor4 ,moreov]1 conditions ( life 9 ! disabl$ man's native place mu/ be consid]$ z a matt] ( importance4 ,a man f ! ,m$it]ranean c\ntry has no idea beyond ! cultivation ( mead[s1 & "o f ,pic>dy none beyond ! mak+ ( cane baskets = pack+ fl[]s4 ,judgm5t is difficult1 & 9 ord] t ! *oice may be ex]cis$ z reasonably z possible1 ! c>eful collaboration ( ! pati5t1 ! doctor & ! manag]s ( ! work%ops is ess5tial4 ,we repeat t ?is is "o ( ! pr9cipal objects = :i* ! c5tres ( re-education are useful4 ,!re are "s effici5t m51 we "k1 :o )\t ask+ any?+ ( anybody f9d quickly & un]r+ly ! exact "w t suits !m4 ,!re is no ne$ ( anxiety 9 su* cases4 ,a c]ta9 metal work] f ! invad$ area suff]+ f pseud>?rosis ( ! %\ld]1 ^: w\nd we 7 treat+1 s5t = 8 wife1 & !y began to re> geese4 ,we "k two cases ( amputation ( ! "r arm1 an op]ative at an a]oplane works & a work] 9 /ucco1 :o dur+ _! /ay at hospital & be=e !y _h be5 suppli$ ) artificial limbs1 _h taught !mselves1 ! "o te*nical design ! o!r ornam5tal design4 ,bo? ( !m1 z soon z !y 7 dis*>g$1 h be5 tak5 on by _! =m] ma/]s1 :o no d\bt 7 fully consci\s t !y 7 ?us comb9+ a good de$ ) good bus9ess4 ,to come to a decision ( any value1 h[ev]1 cases ( ?is sort mu/ n be tak5 z a crit]ion1 = !y are 9 fact exceptional4 ,! majority ( ! m5 are 9 ne$ ( guidance4 ,! proc$ure employ$ at ! ,belgian c5tre ( re-education at ,port-,vill]z consi/s 9 all[+ ! pati5t to frequ5t ! work%ops at w = a few days1 dur+ :i* "t he sees :at is go+ on & is n sl[ to make 8 *oice1 :i* x appe>s r>ely ne$s to be am5d$4 ,we h dealt *iefly ) ! conditions :i* are suitable = ! re-education ( a man :o has lo/ an upp] limb1 or1 speak+ m g5]ally1 is disabl$ 9 "o arm1 = :om resumption ( "w 9 a work%op w (t5 be out ( ! "q4 ,! "q is easi] ( solution = ! l[] limb4 ,cases ( amputation ( ! leg c "w /&+1 if suppli$ ) an artificial limb1 at practically any trade4 ,cases ( amputation ( ! ?igh h num]\s manual occupations op5 to !m 9 :i* !y sit = at lea/ "p ( ! "t4 ,x mu/ be und]/ood1 h[ev]1 t ^! pr(essions :i* require skill c1 z a rule1 only be le>nt 9 well-equipp$ work%ops at ! price ( a fairly long appr5tice%ip4 ,two or ?ree ye>s are necess>y to make a good me*anic1 a good wat*mak]1 glass cutt]1 etc4 ,?is %\ld n det] u 9 ! case ( fairly "y m54 ,! difficulty is to organise special work%ops1 (t5 ) a complicat$ equipm5t1 :]e ! maim$ man c at lea/ pick up ! rudim5ts ( ! "w1 = x is n to be ?\ght ( t he c rema9 !re dur+ ! :ole "t occupi$ 9 a complete tra9+4 ,9 conclusion1 we %\ld l to draw att5tion to ! law ( #ahca1 :i* regulates ! di/ribution ( p5sions by means ( gr\ps classifi$ accord+ z ! loss is ( two limbs or ( "o4 ,no di/9ction is made ) reg>d to ! seat ( ! amputation4 ,b a man :o has lo/ bo? legs & has be5 suitably equipp$ ) artificial limbs c e>n a fair wage1 :]eas a man :o has lo/ bo? arms is completely disabl$ s t he _c ev5 wa% or dress himself4 ,among ! amputation cases ! diff]5ce is also consid]able 9 ! l[] limb1 betwe5 amputation ?r\gh ! leg & ?r\gh ! ?igh1 & ev5 m 9 ! upp] limb1 betwe5 an amputation reta9+ ! movem5ts ( ! elb[ & "o 9 :i* !y are lo/4 ,!re is1 moreov]1 a great diff]5ce 9 ! quality ( /umps & ! consequ5t utility ( ! artificial limb4 ,x is ( c\rse impossible to all[ ) ma!matical precision = all degrees ( disablem5t1 b ! sev]al g5]al di/9ctions :i* we h enum]at$ c\ld be tak5 into consid]ation )\t difficulty4 ,,index ,am]ican *uck1 #abb ,angle at :i* foot is set1 #cd1 #di ,appliances = use in/ead ( h&1 #ajh ) mobile jo9t1 #abc ) univ]sal jo9t1 #abf ,artificial h&1 #if spr+ grip ?umb1 #ig automatic ?umb1 #ih ,beau=t ?umb1 #ii = comm]cial travell]s1 #ajb automatic f+]s1 #aje ,be>+ po9ts1 #f ^u is*ium1 #ac ^u condyles ( femur1 #fb ^u tub]osities ( tibia1 #fg ^u end ( leg /ump1 #gg ,b\get1 #ade1 #aea ,bonreau's appliances1 #aab function ( ! artificial h&1 #aag hook & r+1 #abd l5g? ( artificial =e>m1 #aah ,braces = susp5sion ( artificial leg1 #bd ) ext5d+ sl+1 #dc = amputation bel[ knee1 #gc ,brunet's grip1 #ajg ,bru%mak]'s hook1 #aai ,camus1 ,jean1 #adg ,c>dan jo9t1 #abf ,*auffeur's bell1 #abe ,comb9$ me*anism = knee & ankle jo9ts1 #ee ,comb9$ susp5sion = artificial leg1 #bf ,condyles ( femur1 amputation ?r\gh !1 #fj ,conv]tible peg leg1 #eh ,deltoid muscle1 amputation ?r\gh !1 #adc ,duplex foot1 #ed ,elb[ jo9t1 = above elb[ amputations1 #acc = bel[ elb[ amputations1 #ia = bel[ elb[ amputations1 %ort /umps1 #ie = work]'s arm1 #aci ,elephant boot1 #gi ,equilibrium 9 an artificial leg1 #ce ,f$]ation leg1 #cc ,flex$ knee1 walk+ ^u !1 #ff ,foot1 con/ruction1 #ce ) movable ankle1 #ej ) lat]al mobility1 #ed ,foot1 p>tial amputation ( !1 #ha ,=k re/1 ,raynal's1 #aji ,frees' foot & knee1 #eg ,grip\illeau1 v9e-dress]'s hook1 #aab agricultural hook & r+1 #abd1 #abf pl\ghman's h&1 #ada ,guyon's amputation1 #gh ,hip jo9t1 dis>ticulation at !1 #fd ,hook & r+1 agricultural1 #abd ,b\reau's1 #abd ,index f+]1 l5g? (1 #ajb ,knee ext5d+ me*anism1 #cg artificial muscle1 #cg ext5d+ sl+1 #dc comb9$ ) ankle movem5t1 #ee ,knee jo9t1 amputation ?r\gh !1 #fj ,knee jo9t1 = amputation ?r\gh ! leg1 #gc ,lea!r-cutt]'s h&1 #aaf ,leg bucket1 %ape (1 #fg mat]ial1 #fh ,m>ks' leg1 #cd knee jo9t1 #da braces1 #de ,mat]ials = bucket1 #c = artificial arms1 #hd ,nov ,joss]&1 #ade1 #aea ,nyrop's grip1 #aba ,pack]'s h&1 #aae ,peg leg1 #bh ) jo9t at knee1 #bi ) %[ leg & foot1 #ca conv]sion into leg ) free knee jo9t1 #eh ,p]9eal concavity1 #ae ,plumb]'s h&1 #aae ,po/man's h&1 #aac ,rat*et at elb[1 #acc ,re-education ( amputation cases1 #ade ,rotation ( artificial arm1 prev5tion (1 #hi ,%\ld] jo9t1 dis>ticulation at !1 #adc ,spade hold]1 #abg ,/op to limit ext5sion ( knee1 #ch = amputation bel[ knee1 #gf ,/ump1 l5g? (1 #c condition ( all[+ end be>+1 #g ,susp5sion ( artificial arms1 #he1 #abi to condyles ( hum]us1 #he to %\ld]1 #hg = work]'s arm1 #ach ,syme's amputation1 #gg ,?igh bucket1 %ape (1 #ac wood51 #ag lea!r & /eel1 #bj = amputation ?r\gh knee jo9t or condyles1 #fj ,?igh corset1 #gc ,?umb1 spr+ grip1 #ig automatic1 #ih ,beau=t1 #ii ,tram driv]'s bell1 #abe ,v9e-dress]'s h&1 #aac ,wai/ belt1 #bb ,work]'s arm1 #ach ,pr9t$ 9 ,great ,brita9 = ! ,,univ]sity ,,( ,,london ,,press1 ,ltd41 by ,,ri*>d ,,clay ,,sons1 ,ltd41 ,london & ,bungay4 ,,! ,,univ]sity ,,( ,,london ,,press1 ,,ltd4 h pleasure 9 ann\nc+ ! publication ( ! foll[+ s]ies :i* cov]s ! :ole field ( ,w> ,m$ic9e & ,surg]y ,,milit>y ,,m$ical ,,manuals4 ,a ,s]ies ( h&y & pr(usely illu/rat$ manuals translat$ f ! ,fr5* "u ! g5]al ,editor%ip ( ,,sir ,,alfr$ ,,keogh1 ,g4,c4,b41 ,,ll4,d41 ,m4,d41 ,f4,r4,c4,p41 ,hon4 ,f4,r4,c4,s4 ,late ,director-,g5]al ,army ,m$ical ,s]vice ,,& ,lt4-,g54 ,t4 ,h4 ,j4 ,g4 ,,goodw9 ,c4,b41 ,c4,m4,g41 ,d4,s4,o4 ,director-,g5]al ,army ,m$ical ,s]vice ,ea* translation has be5 made by a practis$ h& & is edit$ by a speciali/ 9 ! bran* ( surg]y or m$ic9e cov]$ by ! volume4 ,x 0 felt to be a matt] ( urg5t necessity to place 9 ! h&s ( ! m$ical pr(ession a record ( ! new "w & new discov]ies :i* ! w> has produc$1 & to provide = ev]yday use a s]ies ( brief & h&y monographs ( a practical nature4 ,! pres5t s]ies is ! result ( ?is aim4 ,ea* monograph cov]s "o ( ! _m que/ions at pres5t ( surpass+ int]e/ to ! m$ical _w1 is writt5 by a speciali/ :o has himself be5 9 close t\* ) ! progress :i* he records 9 ! m$ic9e & surg]y ( ! w>4 ,ea* volume ( ! s]ies is complete 9 itself1 :ile ! :ole w =m a compreh5sive picture ( ! m$ic9e & surg]y ( ! ,great ,w>4 ,f ! ,,briti% ,,m$ical ,,j\rnal3 ,! books are %ort & practical1 & are f\nd$ ^u ! mo/ rec5t cl9ical & laboratory exp]i5ce4 ,,! ,,treatm5t ,,( ,,infect$ ,,w\nds4 ,by ,a4 ,c>rel & ,g4 ,dehelly4 ,translat$ by ,h]b]t ,*ild1 ,capt4 ,r4,a4,m4,c41 ) ,introduction by ,sir ,an?ony ,a4 ,b[lby1 ,k4,c4,m4,g41 ,k4,c4,v4,o41 ,f4,r4,c4,s41 ,surgeon-,g5]al ,army ,m$ical ,s]vice4 ,) #ig illu/rations 9 ! text & six plates4 ,second ,edition1 ) additions4 ,price #f_/- net ,is z f9e an example ( correlat$ "w on ! "p ( ! *emi/1 ! bact]iologi/1 & ! cl9ician z c\ld well be wi%$ =1 & bids fair to become epo*-mak+ 9 ! treatm5t ( septic w\nds4 ,! co/ ( po/age p] volume is3 ,inl& #e;d42 ,abroad #h;d4 ,,london3 ,,univ]sity ,,( ,,london ,,press1 ,,ltd41 #ah1 ,,w>wick ,,squ>e1 ,e4,c4#d ,,milit>y ,,m$ical ,,manuals ,,! ,,spectator3 ,x w\ld be h>d to imag9e a bett] set ( books2 !y are well writt51 well translat$1 well illu/rat$1 mod]ate 9 l5g?1 & mod]ate 9 price4 ,,! ,,psy*oneuroses ,,( ,,w>4 ,by ,dr4 ,g4 ,r\ssy1 ,assi/ant ,pr(essor 9 ! ,faculty ( ,m$ic9e1 ,p>is1 & ,j4 ,lh]mitte1 sometime ,laboratory ,director 9 ! ,faculty ( ,m$ic9e1 ,p>is4 ,edit$ by ,colonel ,william ,aldr5 ,turn]1 ,c4,b41 ,m4,d41 & ,consult+ ,neurologi/ to ! ,=ces 9 ,engl&4 ,translat$ by ,wilfr$ ,b4 ,*ri/oph]son4 ,) #ac full-page plates4 ,price #f_/- net ,! ,psy*oneuroses ( ,w> be+ a book :i* is address$ to ! cl9ician1 ! au?ors h endeav\r$1 be=e all else1 to pres5t an exact semeiology1 & to give _! "w a didactic "*4 ,aft] describ+ ! g5]al idea ( ! psy*oneuroses & ! me?ods by :i* !y are produc$1 ! au?ors survey ! v>i\s cl9ical disord]s :i* h be5 obs]v$ dur+ ! w>4 ,,! ,,cl9ical ,,=ms ,,( ,,n]ve ,,lesions 7,vol4 ,i74 ,by ,mme4 ,a?anassio ,b5i/y1 ,h\se ,physician ( ! ,hospitals ( ,p>is 7,salptrire71 ) a ,preface by ,pr(essor ,pi]re ,m>ie4 ,edit$ ) a ,preface by ,e4 ,f>quh> ,buzz>d1 ,m4,d41 ,f4,r4,c4,p41 ,capta9 ,r4,a4,m4,c47,t471 etc4 ,) #ha illu/rations 9 ! text1 & sev5 full-page plates4 ,price #f_/- net ,9 ?is volume w be f\nd describ$ "s ( ! mo/ rec5t acquisitions to our k ( ! neurology ( w>4 ,b its pr9cipal aim is to initiate ! m$ical man :o is n a speciali/ into ! exam9ation ( n]ve injuries4 ,he w quickly le>n h[ to recognise ! n]v\s t]ritory affect$1 & ! developm5t ( ! v>i\s cl9ical features2 he w be 9 a position to pron\nce a precise diagnosis1 & to =esee ! consequ5ces ( ?is or t lesion4 ,,! ,,treatm5t ,,& ,,repair ,,( ,,n]ve ,,lesions 7,vol4 ,,ii74 ,by ,mme4 ,a?anassio ,b5i/y4 ,edit$ by ,e4 ,f>quh> ,buzz>d1 ,m4,d41 ,f4,r4,c4,p41 ,capt4 ,r4,a4,m4,c47,t471 etc4 ,) #fb illu/rations 9 ! text & f\r full-page plates4 ,price #f_/- net ,?is volume is ! necess>y complem5t ( ! fir/4 ,x expla9s ! nature ( ! lesions1 _! mode ( repair1 _! prognosis1 & above all _! treatm5t4 ,x provides a s]ies ( p>ticul>ly useful data z to ! evolution ( n]ve-w\nds--! opportunities ( int]v5tion--& ! prognosis ( imm$iate complications or late sequelae4 ,! co/ ( po/age p] volume is3 ,inl& #e;d42 ,abroad #h;d4 ,,london3 ,,univ]sity ,,( ,,london ,,press1 ,,ltd41 #ah1 ,,w>wick ,,squ>e1 ,e4,c4#d ,,milit>y ,,m$ical ,,manuals ,! importance ( ?is compreh5sive s]ies c h>dly be exagg]at$4 ,! ,fr5* g5ius 9 its application to sci5tific m$ic9e w be discov]$ "h at its be/ & x w be f\nd to be a di/9ct ga9 to h _h ?is me?od ( collaboration appli$ to s important an ent]prise4 ,,! ,,treatm5t ,,( ,,fractures4 ,by ,r4 ,l]i*e1 ,assi/ant ,pr(essor 9 ! ,faculty ( ,m$ic9e1 ,lyons4 ,edit$ by ,f4 ,f4 ,burgh>d1 ,c4,b41 ,m4,s41 ,f4,r4,c4,s41 =m]ly ,consult+ ,surgeon to ! ,=ces 9 ,france4 ,vol4 ,i4--,fractures ,involv+ ,jo9ts4 ,) #ig illu/rations f orig9al & specially prep>$ draw+s4 ,price #f_/- net ,! au?or's prim>y object has be5 to produce a h&book ( surgical !rapeutics4 ,b surgical !rapeutics does n mean m]ely ! te*nique ( op]ation4 ,te*nique is1 & %\ld be1 only a "p ( surg]y1 especially at ! pres5t "t4 ,! purely op]ative surgeon is a v incomplete surgeon 9 "t ( peace2 9 "t ( w> he becomes a public disa/]2 = op]ation is only ! fir/ act ( ! fir/ dress+4 ,vol4 ,,ii4--,fractures ( ! ,%aft4 ,) #aef illu/rations f orig9al & specially prep>$ draw+s4 ,price #f_/- net ,vol4 ,i4 ( ?is "w 0 devot$ to ,fractures ,involv+ ,jo9ts2 ,vol4 ,,ii4 7:i* completes ! "w7 treats ( ,fractures ( ! ,%aft1 & is conceiv$ 9 ! same _s--t is1 ) a view to ! production ( a "w on cons]vative surgical !rapeutics4 ,! au?or /rives on e page to develop ! idea t anatomical cons]vation mu/ n be conf\nd$ ) functional cons]vation4 ,! two ?+s are n s closely alli$ z is suppos$4 ,!re is no cons]vative surg]y save :]e ! function is cons]v$4 ,! ess5tial po9t ( ! treatm5t ( diaphysial fractures consi/s 9 ! e>ly op]ative dis9fection1 prim>y or second>y1 by an ext5sive sub-p]io/eal removal ( fragm5ts1 bas$ on exact physiological k1 & 9 con=mity ) ! g5]al me?od ( treat+ w\nds by excision4 ,:5 ?is op]ation has be5 c>efully p]=m$ ) ! aid ( ! rug9e1 ) ! object ( sep>at+ & reta9+ ! p]io/eum ( all t ! surgeon consid]s %\ld be remov$1 ! fracture mu/ be correctly r$uc$ & ! limb immobilis$4 ,,fracture ,,( ,,! ,,l[] ,,jaw4 ,by ,l4 ,imb]t1 ,national ,correspond5t ( ! ,socit de ,*irurgie1 & ,pi]re ,ral1 ,d5ti/ to ! ,hospitals ( ,p>is4 ,) a ,preface by ,m$ical ,inspector-,g5]al ,fvri]4 ,edit$ by ,j4 ,f4 ,coly]1 ,f4,r4,c4,s41 ,l4,r4,c4,p41 ,l4,d4,s4 ,) #ig illu/rations 9 ! text & five full-page plates4 ,price #f_/- net ,previ\s to ! pres5t w> no /omatologi/ or surgeon possess$ any v ext5sive exp]i5ce ( ?is subject4 ,claude ,m>t91 ( ,lyons1 :o p]haps gave m att5tion to x ?an anyone else1 aim$ p>ticul>ly at ! re/oration ( ! occlusion ( tee?1 ev5 at ! risk ( obta9+ only fibr\s union ( ! jaw4 ,! au?ors ( ! pres5t volume take ! contr>y view1 ma9ta9+ ! consolidation ( ! fracture is above all ! result to be atta9$4 ,! au?ors give a cle> acc\nt ( ! v>i\s displacem5ts met ) 9 gun%ot injuries ( ! jaw & ( ! me?ods ( treatm5t adopt$1 ! latt] be+ v fully illu/rat$4 ,! co/ ( po/age p] volume is3 ,inl& #e;d42 ,abroad #h;d4 ,,london3 ,,univ]sity ,,( ,,london ,,press1 ,,ltd41 #ah1 ,,w>wick ,,squ>e1 ,e4,c4#d ,,milit>y ,,m$ical ,,manuals ,,! ,,spectator3 ,= our physicians & surgeons on active s]vice abroad or 9 milit>y hospitals at home ^! are ! v books = !m to dip into1 if n to read ?r\gh4 ,,fractures ,,( ,,! ,,orbit ,,& ,,injuries ,,( ,,! ,,eye ,,9 ,,w>4 ,by ,felix ,lagrange1 ,pr(essor 9 ! ,faculty ( ,m$ic9e1 ,bordeaux4 ,translat$ by ,h]b]t ,*ild1 ,capta9 ,r4,a4,m4,c4 ,edit$ by ,j4 ,h]b]t ,p>sons1 ,d4,sc41 ,f4,r4,c4,s41 ,temp4 ,capta9 ,r4,a4,m4,c4 ,) #gg illu/rations 9 ! text & six full-page plates4 ,price #f_/- net ,gr\nd+ 8 rem>ks on a consid]able numb] ( obs]vations1 ,pr(essor ,lagrange arrives at c]ta9 conclusions :i* at _m po9ts contradict or complete :at we h hi!rto believ$ conc]n+ ! fractures ( ! orbit3 = in/ance1 t traumatisms ( ! skull caus$ by fire-arms produce1 on ! vault ( ! orbit1 nei!r fractures by irradiation nor indep5d5t fractures2 t s]i\s lesions ( ! eye may (t5 occur :5 ! projectile has pass$ at "s di/ance f x4 ,!re are1 moreov]1 betwe5 ! seat ( ^! lesions 7due to concussion or contact7 on ! "o h&1 & ! c\rse ( ! projectile on ! o!r h&1 con/ant relations :i* are v]itable cl9ical laws1 ! exposition ( :i* is a highly orig9al feature 9 ?is volume4 ,,hy/]ia ,,or ,,pi?iatism1 ,,& ,,reflex ,,n]v\s ,,disord]s4 ,by ,j4 ,bab9ski1 ,memb] ( ! ,fr5* ,academy ( ,m$ic9e1 & ,j4 ,from5t1 ,assi/ant ,pr(essor & ,physician to ! ,hospitals ( ,lyons4 ,edit$ ) a ,preface by ,e4 ,f>quh> ,buzz>d1 ,m4,d41 ,f4,r4,c4,p41 ,capta9 ,r4,a4,m4,c47,t471 etc4 ,) #cg illu/rations 9 ! text & eight full-page plates4 ,price #f_/- net ,! numb] ( soldi]s affect$ by hy/]ical disord]s is great1 & _m ( !m h be5 immobiliz$ = mon?s 9 hospital1 9 ! abs5ce ( a correct diagnosis & ! application ( a treatm5t appropriate to _! case4 ,a precise1 ?or\ghly docum5t$ "w on hy/]ia1 bas$ on ! num]\s cases obs]v$ dur+ two ye>s ( w>1 0 !re=e a necessity "u pres5t conditions4 ,moreov]1 x 0 desirable1 aft] ! discussions & ! polemics ( :i* ?is "q has be5 ! subject1 to inquire :e!r we ought to return to ! old conception1 or :e!r1 on ! o!r h&1 we might n f9ally adopt ! mod]n conception :i* ref]s hy/]ia to pi?iatism4 ,,w\nds ,,( ,,! ,,skull ,,& ,,! ,,bra94 ,cl9ical =ms & m$ico-surgical treatm5t4 ,by ,c4 ,*atel9 & ,t4 ,de ,m>tel4 ,) a ,preface by ! ,pr(essor ,pi]re ,m>ie4 ,edit$ by ,f4 ,f4 ,burgh>d1 ,c4,b41 ,m4,s41 ,f4,r4,c4,s41 =m]ly ,consult+ ,surgeon to ! ,=ces 9 ,france4 ,) #ig illu/rations 9 ! text & two full-page plates4 ,price #g_/f net ,( all ! m$ical works :i* h appe>$ dur+ ! w>1 ?is is c]ta9ly "o ( ! mo/ orig9al1 bo? 9 =m & 9 matt]4 ,x is1 at all ev5ts1 "o ( ! mo/ individual4 ,! au?ors h pref]r$ to give only ! results ( _! own exp]i5ce1 & if _! conclusions are n always 9 con=mity ) ^? g5]ally accept$1 ?is1 z ,pr(essor ,pi]re ,m>ie /ates 9 8 preface1 is because important advances h be5 made dur+ ! la/ two ye>s2 & ( ?is ! publication ( ?is volume is ! be/ evid5ce4 ,! co/ ( po/age p] volume is3 ,inl& #e;d42 ,abroad #h;d4 ,,london3 ,,univ]sity ,,( ,,london ,,press1 ,,ltd41 #ah1 ,,w>wick ,,squ>e1 ,e4,c4#d ,,milit>y ,,m$ical ,,manuals ,f ,,! ,,times3 ,a s]ies ( really fir/-rate manuals ( m$ic9e & surg]y 444 ! translations are admirably made4 ,!y give u 9 ,engli% t cle>ness ( ?\ght & t purity ( /yle :i* are s delightful 9 ,fr5* m$ical lit]ature & are z good 9 =m z 9 sub/ance4 ,,localisation ,,& ,,extraction ,,( ,,projectiles4 ,by ,assi/ant ,pr(essor ,ombrdanne1 ( ! ,faculty ( ,m$ic9e1 ,p>is1 & ,m4 ,l$\x-,leb>d1 ,director ( ! ,laboratory ( ,radiology ( ! ,hospitals ( ,p>is4 ,edit$ by ,a4 ,d4 ,reid1 ,c4,m4,g41 ,m4,r4,c4,s41 ,l4,r4,c4,p41 ,major 7,temp47 ,r4,a4,m4,c4 ,) a ,preface on ,extraction ( ! ,globe ( ! ,eye1 by ,colonel ,w4 ,t4 ,li/]1 ,c4,m4,g44 ,) #bbe illu/rations 9 ! text & #cj full-page photographs4 ,price #aj_/f net ,?is volume appeals to surgeons no less ?an to radiologi/s4 ,x is a summ>y & /atem5t ( all ! progress effect$ by surg]y dur+ ! la/ two & a half ye>s4 ,,mm4 ,ombrdanne & ,l$\x-,leb>d h n1 h[ev]1 attempt$ to describe all ! me?ods 9 use1 :e!r old or new4 ,!y h rightly pref]r$ to make a critical selection1 &--aft] an exposition ( all ! indisp5sable pr9ciples ( radiological physics--!y exam9e1 9 detail1 all ^? me?ods :i* are typical1 conv5i5t1 exact1 rapid1 or int]e/+ by reason ( _! orig9ality3 ! te*nique ( localisation1 ! compass1 & v>i\s adju/m5ts & =ms ( app>atus4 ,,w\nds ,,( ,,! ,,abdom54 ,by ,g4 ,abadie 7( ,oran71 ,national ,correspond5t ( ! ,socit de ,*irurgie4 ,) a ,preface by ,dr4 ,j4 ,l4 ,faure4 ,edit$ by ,sir ,arbu?not ,lane1 ,b>t41 ,c4,b41 ,m4,s41 ,colonel 7,temp471 ,consult+ ,surgeon to ! ,=ces 9 ,engl&4 ,) #fg illu/rations 9 ! text & f\r full-page plates4 ,price #g_/f net ,dr4 ,abadie has be5 enabl$1 at all ! /ations ( ! army s]vice dep>tm5ts1 to weigh ! value ( me?ods & results1 & consid]s ! foll[+ problems 9 ?is volume3 7#a7 ,h[ to decide :at is ! be/ treatm5t 9 ! case ( p5etrat+ w\nds ( ! abdom52 7#b7 ,h[ to in/all ! mat]ial organisation :i* p]mits ( ! application ( ?is treatm5t1 & h[ to recognise ^? conditions :i* prev5t its application2 7#c7 ,h[ to decide exactly :at to d 9 ea* special case--:e!r "o %\ld p]=m a radical op]ation1 or a palliative op]ation1 or :e!r "o %\ld resort to m$ical treatm5t4 ,,w\nds ,,( ,,! ,,blood-,,vessels4 ,by ,l4 ,s5c]t1 ,assi/ant ,pr(essor 9 ! ,faculty ( ,m$ic9e1 ,nancy4 ,edit$ by ,f4 ,f4 ,burgh>d1 ,c4,b41 ,m4,s41 ,f4,r4,c4,s41 =m]ly ,consult+ ,surgeon to ! ,=ces 9 ,france4 ,) #fh illu/rations 9 ! text & two full-page plates4 ,price #f_/- net ,hospital practice _h long famili>is$ u ) ! vascul> w\nds ( civil practice1 & ! exp]im5ts ( ! ,val-de-,grce ,s*ool ( ,m$ic9e _h %[n u :at ! w\nds ( ! blood-vessels caus$ by mod]n projectiles w\ld be 9 ! next w>4 ,b 9 #aiad ^! data lack$ ! ratification ( ext5sive practice4 ,two ye>s h elaps$1 & we h h5ce=? solid f\ndations on :i* to e/abli% our treatm5t4 ,9 a fir/ "p1 ,pr(essor ,s5c]t exam9es ! w\nds ( ! great vessels 9 g5]al2 9 a second "p he rapidly surveys ! w\nds ( vascul> trunks 9 p>ticul>1 insi/+ on ! problems ( op]ation to :i* !y give rise4 ,! co/ ( po/age p] volume is3 ,inl& #e;d42 ,abroad #h;d4 ,,london3 ,,univ]sity ,,( ,,london ,,press1 ,,ltd41 #ah1 ,,w>wick ,,squ>e1 ,e4,c4#d ,,milit>y ,,m$ical ,,manuals ,,glasg[ ,,h]ald3 ,! :ole s]ies is he>tily comm5d$ to ! att5tion & /udy ( all :o are int]e/$ 9 & responsible = ! treatm5t ( ! injuries & diseases ( a mod]n w>4 ,,! ,,aft]-,,effects ,,( ,,w\nds ,,( ,,! ,,bones ,,& ,,jo9ts4 ,by ,aug4 ,broca1 ,pr(essor ( ,topographical ,anatomy 9 ! ,faculty ( ,m$ic9e1 ,p>is4 ,translat$ by ,j4 ,r5frew ,:ite1 ,m4,b41 ,f4,r4,c4,s41 ,temp4 ,capta9 ,r4,a4,m4,c41 & edit$ by ,r4 ,c4 ,elmslie1 ,m4,s41 ,f4,r4,c4,s42 ,or?opdic ,surgeon to ,/4 ,b>?olomew's ,hospital1 & ,surgeon to ,que5 ,m>y's ,auxili>y ,hospital1 ,roehampton2 ,major ,r4,a4,m4,c47,t47 ,) #aab illu/rations 9 ! text4 ,price #f_/- net ,?is new "w1 l all books by ! same au?or1 is a vital & p]sonal "w1 conceiv$ ) a didactic int5tion4 ,at a "t :5 all physicians are deal+1 or w %ortly h to deal1 ) ! aft]-effects ( w\nds receiv$ 9 w>1 ! "q ( sequelae pres5ts itself1 & w pres5t itself m & m4 ,:at has become--& :at w become--( all ^? :o1 9 ! hospitals at ! front or 9 ! re>1 h ha/ily receiv$ initial treatm5t1 & :at is to be done to complete a treatm5t (t5 inaugurat$ "u difficult circum/ances8 ,,artificial ,,limbs4 ,by ,a4 ,broca1 ,pr(essor 9 ! ,faculty ( ,m$ic9e1 ,p>is1 & ,dr4 ,ducroquet1 ,surgeon at ! ,ro?s*ild ,hospital4 ,edit$ & translat$ by ,r4 ,c4 ,elmslie1 ,m4,s41 ,f4,r4,c4,s41 etc42 ,or?opdic ,surgeon to ,/4 ,b>?olomew's ,hospital1 & ,surgeon to ,que5 ,m>y's ,auxili>y ,hospital1 ,roehampton2 ,major ,r4,a4,m4,c47,t474 ,) #baj illu/rations4 ,price #f_/- net ,! au?ors ( ?is book h s\ght n to describe ?is or t piece ( app>atus--m or less newfangl$--b to expla9 ! anatomical1 physiological1 practical & te*nical conditions :i* an artificial arm or leg %\ld fulfil4 ,x is1 if we may s call x1 a manual ( appli$ me*anics writt5 by physicians1 :o h con/antly kept 9 m9d ! anatomical conditions & ! pr(essional requirem5ts ( ! artificial limb4 ,,typhoid ,,fev]s ,,& ,,p>atyphoid ,,fev]s 7,symptomatology1 ,etiology1 ,prophylaxis74 ,by ,h4 ,v9c5t1 ,m$ical ,inspector ( ! ,army1 ,memb] ( ! ,academy ( ,m$ic9e1 & ,l4 ,muratet1 ,sup]9t5d5t ( ! ,laboratories at ! ,faculty ( ,m$ic9e ( ,bordeaux4 ,second ,edition4 ,translat$ & ,edit$ by ,j4 ,d4 ,rolle/on1 ,m4,d4 ,) tables & temp]ature *>ts4 ,price #f_/-net ,?is volume is divid$ into two p>ts1 ! fir/ deal+ ) ! cl9ical features & ! second ) ! epidemiology & prophylaxis ( typhoid fev] & p>atyphoid fev]s ,a & ,b4 ,a full acc\nt is to be f\nd ( rec5t progress 9 ! bact]iology & epidemiology ( ^! diseases1 consid]able space be+ giv5 to ! important "q ( ! c>ri] 9 ! dissem9ation ( infection4 ,! co/ ( po/age p] volume is3 ,inl& #e;d42 ,abroad #h;d4 ,,london3 ,,univ]sity ,,( ,,london ,,press1 ,,ltd41 #ah1 ,,w>wick ,,squ>e1 ,e4,c4#d ,,milit>y ,,m$ical ,,manuals ,f ,,! ,,lancet3 ,! names ( ! editors are suffici5t gu>antee t ! subject matt] is treat$ ) fairness & discrim9ation4 ,,dys5t]ies1 ,,*ol]a1 ,,& ,,exan!matic ,,typhus4 ,by ,h4 ,v9c5t1 ,m$ical ,inspector ( ! ,army1 ,memb] ( ! ,academy ( ,m$ic9e1 & ,l4 ,muratet1 ,sup]9t5d5t ( ! ,laboratories at ! ,faculty ( ,m$ic9e ( ,bordeaux4 ,) an ,introduction by ,&rew ,balf\r1 ,c4,b41 ,c4,m4,g41 ,m4,d41 ,lieut4-,col4 ,r4,a4,m4,c4 ,edit$ by ,george ,c4 ,l[1 ,m4,a41 ,m4,d41 ,temp4 ,capt4 ,i4,m4,s4 ,price #f_/- net ,?is1 ! second ( ! volumes :i* ,pr(essor ,v9c5t & ,dr4 ,muratet h writt5 = ?is s]ies1 0 plann$1 l ! fir/1 9 ! laboratory ( ,val-de-,grce1 & has pr(it$ bo? by ! p]sonal exp]i5ce ( ! au?ors & by a mass ( record$ data :i* ! latt] ye>s ( w>f>e h v greatly enri*$4 ,x w be all ! m welcome1 z hi!rto !re has exi/$ no compreh5sive h&book treat+ ^! great epidemic diseases f a didactic po9t ( view4 ,,abnormal ,,=ms ,,( ,,tetanus4 ,by ,,mm4 ,c\rtois-,suffit1 ,physician ( ! ,hospitals ( ,p>is1 & ,r4 ,gir\x1 ,resid5t ,pr(essor4 ,) a ,preface by ,pr(essor ,f4 ,widal4 ,edit$ by ,surgeon-,g5]al ,sir ,david ,bruce1 ,k4,c4,b41 ,f4,r4,s41 ,,ll4,d41 ,f4,r4,c4,p41 etc41 & ,fr$]ick ,golla1 ,m4,b4 ,price #f_/- net ,( all ! infections :i* ?reat5 our w\nd$ m51 tetanus is t :i*1 ?anks to s]o!rapy1 we are be/ able to prev5t4 ,b s]o!rapy1 :5 x is late & insuffici5t1 may1 on ! o!r h&1 t5d to create a special type ( att5uat$ & localis$ tetanus2 9 ?is =m ! contractions are z a g5]al rule conf9$ to a s+le limb4 ,?is type1 h[ev]1 does n always rema9 /rictly monoplegic2 & if examples ( su* cases are r>e ?is is d\btless because physicians are n z yet v well aw>e ( _! exi/5ce4 ,we owe to ,,mm4 ,c\rtois-,suffit & ,r4 ,gir\x "o ( ! fir/ & mo/ important obs]vations ( ?is new type2 s t no "o 0 bett] qualifi$ to def9e its *>act]i/ics4 ,?is !y h done 9 a rem>kable mann]1 support+ _! rem>ks by all ! docum5ts hi!rto publi%$1 fir/ exp\nd+ ! *>act]i/ics :i* individualise ! o!r atypical & p>tial types ( tetanus1 :i* h long be5 recognis$4 ,,w> ,,otitis ,,& ,,w> ,,deafness4 ,diagnosis1 ,treatm5t1 ,m$ical ,reports4 ,by ,dr4 ,h4 ,b\rgeois1 ,oto-rh9o-l>yngologi/ to ! ,p>is ,hospitals1 & ,dr4 ,s\rdille1 =m] int]ne ( ! ,p>is ,hospitals4 ,edit$ by ,j4 ,dundas ,grant1 ,m4,d41 ,f4,r4,c4,s47,eng472 ,major ,r4,a4,m4,c41 ,presid5t1 ,special ,aural ,bo>d 7"u ,m9i/ry ( ,p5sions74 ,) _m illu/rations 9 ! text & full-page plates4 ,price #f_/- net ,?is "w pres5ts ! special aspects ( inflammatory affections ( ! e> & deafness1 z !y occur 9 active milit>y s]vice4 ,! in/ructions z to diagnosis & treatm5t are int5d$ prim>ily = ! regim5tal m$ical (fic]4 ,! sections deal+ ) m$ical reports 7exp]tises7 on ! valuation ( degrees ( disablem5t & claims to dis*>ge1 gratuity or p5sion1 w be f\nd ( ! greate/ value to ! (fic]s ( invalid+ bo>ds4 ,! co/ ( po/age p] volume is3 ,inl& #e;d42 ,abroad #h;d4 ,,london3 ,,univ]sity ,,( ,,london ,,press1 ,,ltd41 #ah1 ,,w>wick ,,squ>e1 ,e4,c4#d ,,milit>y ,,m$ical ,,manuals ,,guy',s ,,hospital ,,gazette3 ,! s]ies is a mo/ valuable addition to ! m$ical lit]ature ( ! w>4444 ,we deem x to be almo/ indisp5sable to a m$ical (fic]1 & h no hesitation 9 unres]v$ly recomm5d+ x4 ,,syphilis ,,& ,,! ,,army4 ,by ,g4 ,?ibi]ge1 ,physician ( ! ,hpital ,sa9t-,l\is4 ,edit$ by ,c4 ,f4 ,m>%all1 ,f4,r4,c4,s4 ,price #f_/- net ,x seem$1 ) reason1 to ! editors ( ?is s]ies t room %\ld be f\nd 9 x = a "w deal+ ) syphilis consid]$ ) ref]5ce to ! army & ! pres5t w>4 ,! frequ5cy ( ?is infection 9 ! army1 among ! work]s 9 munition factories1 & 9 ! mid/ ( ! civil population :]e ?is is 9 contact ) soldi]s & mobilis$ work]s1 makes x1 at ! pres5t "t1 a true epidemic disease1 & "o ( ! mo/ widespread ( epidemic diseases4 ,dr4 ,?ibi]ge1 ^: previ\s lab\rs gu>antee 8 peculi> compet5ce 9 ^! difficult & important que/ions1 has1 9 writ+ ?is manual1 v notably assi/$ 9 ?is "w4 ,b ! treatm5t ( syphilis has1 dur+ ! la/ six ye>s1 und]gone consid]able modifications2 ! new me?ods are n yet v famili> to all physicians2 & c]ta9 details may no long] be pres5t to _! m9ds4 ,x 0 !re=e opportune to survey ! diff]5t me?ods ( treatm5t1 to specify _! indications1 & _! occasionally difficult te*nique1 :i* is always important if complications are to be avoid$4 ,x 0 necess>y be=e all to /ate precisely & to retrace1 = all ^? :o h be5 unable to foll[ ! rec5t progress ( ! !rapeutics ( v5]eal diseases1 ! *>act]s & ! diagno/ic elem5ts ( ! manife/ations ( syphilis4 ,,mal>ia ,,9 ,,mac$onia3 ,cl9ical & ,hmatological ,features4 ,pr9ciples ( ,treatm5t4 ,by ,p4 ,arm&-,delille1 ,p4 ,abrami1 ,g4 ,paisseau & ,h5ri ,lemaire4 ,preface by ,pr(essor ,lav]n1 ,membre de l',in/itut4 ,edit$ by ,sir ,ronald ,ross1 ,k4,c4,b41 ,f4,r4,s41 ,,ll4,d41 ,d4,sc41 ,lieut4-,col4 ,r4,a4,m4,c4 ,) illu/rations & a col\r$ plate4 ,price #f_/- net ,?is "w is bas$ on ! writ]s' obs]vations on mal>ia 9 ,mac$onia dur+ ! pres5t w> 9 ! ,fr5* ,army ( ! ,ea/4 ,a special int]e/ atta*es to ^! obs]vations1 9 t a consid]able portion ( _! pati5ts _h nev] _h any previ\s attack4 ,! disease prov$ to be "o ( exceptional gravity1 ow+ to ! exceptionally l>ge numb]s ( ! ,anopheles mosquitoes & ! malignant nature ( ! p>asite 7,plasmodium falcip>um74 ,=tunately an ample supply ( qu99e enabl$ ! prophylactic & curative treatm5t to be bett] organis$ ?an 9 previ\s colonial campaigns1 ) ! result t1 ?\gh ! incid5ce ( mal>ia among ! troops 0 high1 ! mortality 0 exceptionally l[4 ,pr(essor ,lav]an1 :o v\*es = ?is book1 /ates t x w be f\nd to conta9 excell5t cl9ical descriptions & judici\s advice z to treatm5t4 ,*apt]s on p>asitology & ! laboratory diagnosis ( mal>ia are includ$4 ,an e>ly ann\ncem5t w be made 9 reg>d to fur!r volumes "u consid]ation4 ,! co/ ( po/age p] volume is3 ,inl& #e;d42 ,abroad #h;d4 ,,london3 ,,univ]sity ,,( ,,london ,,press1 ,,ltd41 #ah1 ,,w>wick ,,squ>e1 ,e4,c4#d ,transcrib]'s ,note3 #a4 ,all obvi\s spell+ & punctuation errors h be5 correct$4 #b4 ,italics are %[n z text & bold z text4