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holders designed for special articles, such as knife, fork, spoon, pen or pencil, knitting needle, etc. Some of these are shown in Figs. 144, 145, 146 and 147. Several excellent devices have been invented by Judge Corley, of Dallas, Texas. One of these, a most ingenious arrangement enabling the wearer to button his own collar, is illustrated in Fig. 148.

For the business man, or the professional, a more suitable type is the arm designed by Carnes. In this, the mechanism

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Fig. 140—The Keller artificial hand. Keller pruning a small tree.

is far more complicated, and the cost therefore proportionately greater. Despite the delicate mechanism, however, it is capable of standing the usual amount of wear and tear, and a break of any constituent part can readily be replaced. The essential feature of the arm is the voluntary control of motion of the fingers and of the wrist by means of bands which become shortened or lengthened by motion of the elbow-joint. The arm requires considerable practice before the technic of its use can be acquired. To give a patient such an artificial limb and expect him to be able to use it at once, is as illogical as presenting a man with a violin and telling him to play upon it. When, however, its use has been mastered, it gives surprisingly good results.

The mode of attachment of the artificial limb to the stump is of importance. The hinge-joint at the elbow with an upper

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Fig. 141.—The Keller artificial hand. The hand attachment can be removed, permitting the insertion of various instruments. In this instance a hammer has been inserted, which Keller is able to use with the same dexterity as a normal individual.

arm cuff, the usual type found in the brace-maker's shop should not be employed, since it gives no opportunity for proand supination. A simpler and far more advantageous method of attachment is the figure-of-eight strap, which passes just above the condyles of the humerus and crossing the posterior surface of the humerus descends again over the anterior surface (see Fig. 138).

2. Types of Arm Designed for Disarticulation of the Elbow or Amputations of the Upper Arm.—The classical type of limb is a useless encumbrance and is almost always relegated to the garret by the intelligent patient. To be of any assistance to its wearer, the prosthesis must, even more than in the case of that for the forearm amputation, be particularly designed for the special work to be performed. Fig. 149 shows a fourteenyear-old patient to whom belongs the credit of evolving a prac

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Fig. 142.—The Keller artificial hand. For aesthetic purposes Keller draws

a glove over the hooks. This he terms his “Sunday” hand.

tical working arm for disarticulation at the elbow. When this lad was placed in the carpenter shop, I suggested that he construct an artificial limb to help him at his work. I expected to see the usual hinge-joint at the elbow, prolonged downward to serve for the attachment of a hook or a clamp. To my great surprise, after a few days the lad showed me the artificial limb pictured in Fig. 150. It will be noted that instead of a hinge-joint, there is a ball-and-socket joint at the

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Fig. 143.-Keller splitting wood. Note the double turn of the leather strap around the handle of the axe. This gave Keller so strong a grip on the handle that the united strength of three men was unable to pull the axe away. Keller's dexterity equalled that of an expert woodsman.

Fig. 144.—The Fischer clamp for the use of the one-armed. The three prongs facilitate holding objects obliquely as well as in the axis of the limb.

elbow, which, according to the patient's statement, he had constructed because he wished not merely to bend at the elbow but also to turn the forearm. In other words, he had solved a problem which makers of artificial limbs had for centuries

FIG. 145.—Clamp and hook serviceable for the amputated workman. The clamp serves to hold a file, brush, small hammer, etc. The hook can be used to carry a pail or to lift heavy objects.

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Fig. 146.—A professional pianist, whose right hand had to be amputated because of gunshot injury. Equipped with a special device of Hoeftemann's, he was able to continue his profession. It was possible for him to strike single notes and chords with facility.

failed to answer; namely, the best method of combining flexion and extension with pro- and supination. Between the con

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