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II

Fig. 158.

Fig. 158.—Two diagrams illustrating the principle of the Carnes arm for a double amputation, with one arm amputated between the elbow and the shoulder, and the other arm disarticulated at the shoulder. I. View from in front. II. View behind. The functions of the different straps are as follows:

Strap No. 1. Bends or operates the elbow. This strap coming from the back, passing over pulleys in the upper arm, and being anchored to the forearm, enables the wearer to get the elbow movement, simply by moving his stump forward a little.

Strap No. 2. Locks the rotating wrist. To unlock the wrist, the elbow is bent up to the extreme. When the wrist is not locked, it turns or rotates as the elbow is bent, but can be locked in any position desired, by first bending the elbow until the wrist and hand are rotated to the position desired, then hold it in this position while pulling on Strap No. 2, to lock it there.

Strap No. 3. Opens and closes the fingers. On the amputation above the elbow, by throwing the shoulder down, a sufficient tension is had on this strap to open or close the fingers; then, by raising the shoulder, the cord is pulled back into the hand, allowing the mechanism to reverse, and then, by again pushing the shoulder down, the opposite movement of opening and closing the hand is obtained.

Straps Nos. 4 and 5. Opens and closes the hand on the shoulder or disarticulated amputation.

Strap No. 6. Simply an elastic support to hold the arm in place. For a single amputation on either side, the harness will be as shown, excepting that on the opposite side, it would simply be looped up under the good arm.

Straps No. 2 are the only ones which come across the chest and these are not tight, it being necessary to throw the arm out to the side, in order to lock the wrist.

For the diagrams and explanatory text I am indebted to the Carnes Artificial Limb Co., Kansas City, Mo.

(see Fig. 168). The blade is convex, so that the food is easily cut by a rocking movement.

When the right hand has been lost, the patient must at once be taught to write with the left. This can be learned by the average man in about 3 weeks. It is advantageous to stimulate the patients by the competition afforded by class-room work.

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Fig. 159.—Patient of Riedinger with very short upper arm stump.

In hundreds of ways, the physician can help the amputated to readjust themselves to the new mode of life; and in many instances the amputated will teach the physician and his comrades new methods of usefulness.

This training in proficiency, combined with the wholesome cheeriness of physician and instructor, does more than anything else to overcome the depression under which most of the patients are laboring, and fits them for the next important step in rendering them useful citizens of their communityspecialized training of the stump, for the particular purposes for which it is to be used. For this of course the men must be divided into groups depending upon the type of amputa

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Fig. 160.—The same patient as in Fig. 159, equipped with a Riedinger prosthesis. Note the broad circular pad which closely surrounds the shoulder and serves as support for the leather socket which is attached to it by a strong joint, permitting motion in all directions.

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Fig. 161.—The mechanic's tools employed by the patient shown in Fig. 160. These are inserted into the slot at the lower end of the forearm piece and fastened firmly in place by a turn of the screw.

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Fig. 162.—The same patient as in Fig. 160, illustrating the method of using

hammer and chisel.

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Fig. 163.—The same patient as in Fig. 160 at work at the turning-lathe.

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