biomedicalephemera:

Amputation of foot and leg with prostheses examples

Given that we largely only need our legs for balance and ambulation, and that we’re (usually) perfectly capable of balancing with one leg, making functional prostheses for the lower extremities was much simpler than making functional arms and hands. Heck, even a peg leg could work fine in most situations, at least if it was fitted well.

Most prostheses in the early-to-mid 19th century were focused more on aesthetics than on true usability. They looked like the real thing, and could easily be masked by pants and shoes, but they were often clunky, heavy, and ill-fitted (causing sores at the articulation point). Some doctors were trying to work on functional knees for prosthetic legs by that point, but those were even worse to use, as the “joint” was difficult to control.

Traité complet de l’anatomie de l’homme comprenant la medecine operatoire, par le docteur Marc Jean Bourgery. Nicolas Henri Jacob (artist), 1831.

Gas gangrene in amputated arm of injured soldier

In WWI, most cases of gas gangrene were caused by infection with Clostridium perfringens, and Group A streptococcus. Other bacterial infections were occasionally found, as well.

The infecting bacteria could be pretty easily differentiated by the type of pus that was exuded or found when the necrotic tissue was cut into. C. perfringens produced very thin, “dishwater”-like pus, and smelled “sweetly putrid”. The other bacterias produced much thicker pus, and did not smell sweet.

Not that it made any difference what bacteria was causing the gas gangrene - in the Great War, antibiotics weren’t nearly effective enough to halt the progress of infection, and amputation was the default treatment modality for cases brought in from the front.

British Medicine in the War, 1914-1917. British Medical Association, 1917.

sutured-infection:

Young man wearing a pair of artificial arms and two artificial legs, 1890-1910

While I doubt they were terribly functional (the most functional prostheses then - and for most of the 20th century - were very disparate from “real” hands in their appearance, but who cares? they worked!), those are some impressively crafted arms and legs, that man has!

I wonder why he needed them? Gangrene from an infection? War wounds? There were so many things that would have led to amputation back then…

Ways to Die: Gangrene of the Foot

On Jan 8, 1687, Jean-Baptiste Lully was conducting a Te Deum, in honor of Louis XIV’s recovery from illness, and became so impassioned with the music that he struck his staff (a precursor to the baton used today) against the front of his foot.

An abscess developed that night, and despite treatment, Lully developed gangrene in his foot. Several court physicians strongly recommended amputation at the initial stage of gangrene, and again when it spread to his leg, but Lully would have none of it; he was much too interested in being able to conduct his own compositions, and having only one foot would not allow that.

Jean-Baptiste Lully died on March 22, 1687, due to gangrene of the foot, caused by enthusiastic conducting of his orchestra.

[image: army medical center, gangrene from war abscess, 1865.]

Amputation avec wigs!

The far-right image depicts a clamp, which halted bloodflow to the limb being amputated. So, you know, people didn’t bleed to death and stuff.

A General System of Surgery in Three Parts. Laurence Heister, 1745.

Amputation of foot and leg with prostheses examples

Given that we largely only need our legs for balance and ambulation, and that we’re (usually) perfectly capable of balancing with one leg, making functional prostheses for the lower extremities was much simpler than making functional arms and hands. Heck, even a peg leg could work fine in most situations, at least if it was fitted well.

Most prostheses in the early-to-mid 19th century were focused more on aesthetics than on true usability. They looked like the real thing, and could easily be masked by pants and shoes, but they were often clunky, heavy, and ill-fitted (causing sores at the articulation point). Some doctors were trying to work on functional knees for prosthetic legs by that point, but those were even worse to use, as the “joint” was difficult to control.

Traité complet de l’anatomie de l’homme comprenant la medecine operatoire, par le docteur Marc Jean Bourgery. Nicolas Henri Jacob (artist), 1831.

Philippe Verheyen (1648-1711) Dissecting His Amputated Limb

By an anonymous artist, ca. 1715. Postmortem painting in honor of a famous Belgian anatomist and surgeon.

Medium: Oil on Panel. Size: 16.3”X16.5”

From the collection of Pieter Deheijde.

Avulson of Tendon with Terminal Phalanx of Thumb.

This case involved a man whose thumb was caught in the reins of a runaway horse, which separated the terminal phalanx (last bone) of the thumb, and with it, the deep flexor tendon involved in the movement of that digit.

While the injuries were non-life-threatening, movement of the thumb was unable to be restored.

Manual of Surgery. Alexis Thomson, 1904.

professorquack:

Iron German Prosthetic circa 1580

Specimen of gangrenous foot

Arterial insufficiency in diabetic patients is still a problem today, and can still cause ulceration and necrosis in extremities if not attended to in a timely way. Gangrene of the feet has long been one of the most common complications of long-term poorly-managed diabetes.

A Text-Book of Pathology. W. G. MacCallum, 1916.

Late 16th century artificial arm and hand for the well-to-do man designed by Pare.

Orthopraxy: the Mechanical Treatment of Deformities, Debilities, and Deficiencies of the Human Frame. Henry Heather Bigg, 1877.

Anatomy of the Human Body. William Cheselden, 1712.

Bandaging lacerations and amputating limbs: Part II.

Sculteti was well-known for his innovative bandage cuts and bandaging techniques.

Armamentarium Chiurgicum. Ioannis Sculteti [Johannes Schultes], 1665.