Prosthetics

Prosthetics

Ambroise Paré, Les oeuures d’Ambroise Paré … (Lyons, 1685), p. 553.

Image 1 depicts a prosthetic hand and arm designed by Ambroise Paré (1510-90), the components of which are described by Paré in Dix livres de la chirurgie (Paris, 1564) as follows:

‘Description of iron hand.

  1. Gears serving each finger, which are of the same piece as the fingers, added and assembled in the back of the hand.
  2. Iron rod which passes through the middle of the said gears, on which they turn.
  3. Catches to hold each finger firm.
  4. Stocks or stops of the catches, in the middle of which are pegs to stop the catches.
  5. The large catch to open the four small catches, which hold the fingers closed.
  6. The button of the tail of the large catch, which, if pushed, the hand will open.
  7. The spring which is below the large catch, serving to make it return to its place and hold the hand closed.
  8. The springs of each finger, which bring back and make the fingers open of themselves when they are closed.
  9. The plates of the fingers.

The following figure shows you the outside of the hand and the means of attaching it to the arm and to the sleeve of the doublet.

Description of the iron arm put hereafter.

  1. The iron bracelet for the form of the arm.
  2. The tree put inside the large spring to extend it.
  3. The large spring which is in the elbow, which is to be of tempered steel and three feet or more in length.
  4. The ratchet.
  5. The catch.
  6. The spring which presses on the catch and stops the teeth of the ratchet.
  7. The screw to fasten the spring.
  8. The curve of the forearm which is above the elbow.
  9. The trunk of the gauntlet made to bend with the barrel of the forearm which is to the hand, which serve to make the hand prone and supine, that is, prone toward the earth and supine toward the sky’.[1]

Ambroise Paré, Les oeuures d’Ambroise Paré … (Lyons, 1685), p. 555.

Image 2 illustrates an artificial leg for an above knee thigh amputee devised by Paré, which comprises of a sheet metal plates exterior fabricated in the fashion of armour that conceals a peg leg inside. The leg has a joint at the knee that permitted sitting and horseback riding and a knee lock to make it rigid for walking.

‘The figures and portraits of the arms and legs which follow represent the voluntary movements as closely as possible. For the flexion and extension can be made by arms and legs artificially made according to those portraits, which I have by great begging obtained from one named Le Petit Lorrain, locksmith residing at Paris, a man of good mind, with the names and explanation of each part of the said portraits made in proper terms and words of the artisan, in order that each locksmith, clock maker, or other worker handling iron can understand them and make artificial and similar arms and legs which serve not only for the action of the amputated parts, but also for the beauty and ornament of these, as one can recognize and see by the following figures:

Artificial leg.

Description of the wooden leg.

0. The bond by which one pulls the ring of the catch in order to fold the leg.
1. The thigh guard with screws, and the holes of the screws to enlarge or restrict on the thigh, which will be within.
2. The pommel to place and support the hand and to turn oneself.
3. The little ring which is front of the thigh, to direct and guide the leg where one wishes.
4. The two buckles in front, and that behind, to hold and attach to the body of the doublet.
5. The little socket at the bottom, within which the thigh is put up to two fingers near the end, serving also to make the beauty and form of the leg.
6. The spring, to make the catch move which makes the leg firm.
7. The catch which holds the stick of the leg straight and firm, for fear that it may turn back.
8. The ring to which is attached a cord to pull the catch, in order that the stick can fold, when one sits and when one is on horseback.
9. The hinge to make the leg play and move, put in front of the knee.
10. A little stock or stop to keep the catch from passing beyond the thigh guard, for if it passed beyond, the spring would break and the man would fall.
11. The iron band in which the stick is inserted.
12. The other band at the end of the stick, which carries the hinge to make the foot move.
13. The spring to make the foot recover and throw it back into its place.
14. The stop which serves the spring for throwing the foot down again.

Dressed Leg.

  1. Plates for the beauty of the leg.
  2. The greave for the beauty and form of the leg.
  3. The thickness to finish the form of the leg.
  4. Plates for forming the ankle’.[2]

Johannes Scultetus, Armamentarium chirurgicum olim auctum triginta novem tabulis … (Leiden, 1693), plate XVIII.

Image 3 depicts an instrument to stretch out a crooked knee into the right posture; an instrument fitted to the arm like a sleeve to compress the artery of the wrist with a screw to stop a patient bleeding to death; an instrument to bend a stiff elbow little by little; and a pen knife to cut a seton in the neck, all of which are described by Scultetus as follows:

‘Fig. I. is an instrument made of iron, which must be applied to the knee that is crooked and drawn together, which consists of divers parts; namely of the iron Capsula A, which the screw B passes by, and it is fastned to a ring made of a plate of iron, so broad that it may cover the whole knee C; with the latchets D, that it may be shut and opened; with holes in the outside E, that it may be drawn back with the cotton and lint; and last of all with an iron key F, by the means whereof the iron ring may be drawn too, and the leg comes into a right posture.

Fig. II. is the inferiour and half part of the screw B, set forth Figure I.

Fig. III. is the screw B of Fig. I. out of its place, consisting of two parts; of which the upper part (a) after attraction is left fast in the ring; the other part (b) is drawn forth.

This instrument differs not a little from that which Guillielm. Fabritius Hildanus, in his little book de combustionibus, writes that he invented.

Fig. IV. is an instrument made of divers plates of iron, and perforated with very many holes, that it may be applied with cotton and lint, and fitted to the arm like a sleeve, and may be shut and opened. The artery of the wrist is pressed together with a screw having a broad head, which this instrument is made with, be it open of purpose or by accident, that the Patient may not pour forth his life with his blood.

Fig. V. is an iron instrument which we use when the arm cannot be bent. This instrument is bended by degrees, by means of a screw. The instruments of this Table, Fig. I. IV and V. must be prepared after the proportion of the part affected.

Fig. IV. is a pen knife with two edges, and resembling the form of a mirtle leaf, wherewith a seton is cut in the neck; the pincers of this knife is pictured and described before Table VII. Fig. X.’[3]

Jean Jacques Manget, Bibliotheca chirurgica, sive Rerum ad artem Machaonicam quoquô modô spectantium thesaurus absolutissimus; … (Geneva, 1721), plate XX.

Image 4 illustrates two devices for treating the congenital clubfoot deformity using manipulation and immobilization to restore the feet to their normal positions with the application of boot-shaped braces/splints tied with ribbons with one incorporating a screw-tightening mechanism to obtain correction.

Sources

Fliegel, O. and S.G. Feuer, ‘Historical Development of Lower-Extremity Prostheses’, Orthopedic & Prosthetic Appliance Journal, vol. 20, no. 4 (1966), 313-324.

Hernigou, Philippe et al, ‘History of clubfoot treatment, part I: From manipulation in antiquity to splint and plaster in Renaissance before tenotomy’, International Orthopaedics, vol. 41, no. 8 (2017), 1693-1704.

Paré, Ambroise, The works of that famous chirurgeon Ambrose Parey, translated out of Latin, and compared with the French, by Th. Johnson … (London, 1678). This is an English translation of Paré’s Les oeuures de M. Ambroise Paré … (Paris, 1575). Worth had the 1685 Lyons edition.

Paré, Ambroise, Ten Books of Surgery translated by Robert White Linker and Nathan Womack (Athens, Georgia, 2010). This is an English translation of Paré’s Dix livres de la chirurgie (Paris, 1564).

Scultetus, Johannes, The chyrurgeons store-house : furnished with forty three tables cut in brass in which are all sorts of instruments, both antient and modern ; useful to the performance of all manual opperations, with an exact description of every instrument … and faithfully Englished by E.B. (London, 1674). This is an English translation of Scultetus’ Armamentarium chirurgicum  … (Ulm, 1655). Worth had the 1693 Leiden edition.

Thurston, Alan J., ‘Paré and prosthetics: the early history of artificial limbs’, Australia and New Zealand Journal of Surgery, vol. 77, no. 12 (2007), 1114-1119.

Text: Mr. Antoine Mac Gaoithín, Library Assistant at the Edward Worth Library, Dublin.

[1] Paré, Ambroise, Ten Books of Surgery translated by Robert White Linker and Nathan Womack (Athens, Georgia, 2010), pp 146-8.

[2] Paré, Ambroise, Ten Books of Surgery translated by Robert White Linker and Nathan Womack (Athens, Georgia, 2010), pp 144-5.

[3] Scultetus, Johannes, The chyrurgeons store-house … (London, 1674), pp 44-6.