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tion and the nature of the work. In helping the patient to decide what work he is fitted for, the physician should have as consultant a staff of technical assistants versed in the details of all the handicrafts. Experience has shown that amputations of the forearm and of the upper arm if not more than 2 or 3 inches above the elbow, do not debar a man from becoming a carpenter, farmer, or some type of mechanician.
Fig. 164.—This patient suffered an amputation of the right arm 212 inches below the shoulder. Equipped with the Biesalski artificial arm shown in Fig. 153 he was able to do all forms of light gardening. Note the simple contrivance at the wrist consisting of a spool over which a strap passes. This device gives a firm grip and at the same time allows sufficient play to dump the wheel barrow.
Of course, those possessing an elbow-joint have a great advantage over those amputated above the elbow. When the amputation has occurred near the shoulder-joint, it is foolish to attempt training a man for these branches. He should then be taught some handicraft allied to his previous occupation. Thus, the carpenter should be taught sufficient mechanical drawing and building construction to enable him to act as
foreman; or, if he is not sufficiently well educated to assume this responsibility, he can be taught to be a furniture polisher. In this occupation, practically all the work is done with a sweeping motion of one arm; the other hand is used simply to hold the varnish or other polishing substance-a function which is quite as well filled by a small tray placed near the worker.
Fig. 167.—A simple toilet arrangement for the one-arm soldier. To permit proper cleansing of the hand, a scrubbing brush and a nail file are fastened firmly to the board which rests on the basin.
The artificial limb can be used to advantage in many instances, but for many men the stump is the best form of prosthesis. This applies particularly to a moderately long forearm stump. This can be used for filing, almost as effectively as the normal hand (See Fig. 169); for hammering, the
handle is gripped in the elbow between the upper arm and the stump, as shown in Fig. 170. At the turning lathe, the stump can easily be trained to turn the adjusting swivel. In learning to use the stump, it is of great assistance to have an amputated man himself act as instructor. It is remarkable to what extent the delicacy of the skin improves. In one instance, in which I tested the fineness of perception by the two-point test, used by the physiologists in determining the number of tactile corpuscles in the cutis, I found almost the same degree of sensitiveness of the forearm stump as that normally found over the finger tips.
Those suffering amputation of a lower limb do not require the same specialized training. All they need is the proper
Fig. 169.—The bracemaker's apprentice pictured in Fig. 170. Here he is shown in the act of filing. The stump had become so hardened that he was able to use it exactly as the ordinary mechanic uses his left hand.
stump treatment and the application of a well-fitting prosthesis to render them fit to return to their community. With rare exceptions, they are able to return to their previous occupations. The exceptions are the cases of double amputation or amputation near the hip in cases of men who previously did hard manual labor. They must be taught a trade which allows them to be seated most of the time.
Far and away the most difficult problem presented in the care of the amputated is that of those who have lost both hands. Provided the stumps are sufficiently long to allow
Fig. 170.—The one-armed bracemaker's apprentice already pictured in Fig. 169. This illustration shows his method of gripping the hammer between the stump, upper arm and chest.
them to be approximated, the loss is not as tragic as it at first appears.
In Fig. 171 is shown one of the teachers of the crippled children's home already referred to. He is seen in the act of buttoning his collar by means of a button hook held between the two stumps. This man had learned to dress