On Paré and Prosthetics

By Johanna Goldberg, Information Services Librarian

Saturday marks the 424th anniversary of the death of Ambroise Paré (1510–1590).

The French army barber-surgeon—and later master surgeon to four French kings and Catherine de Medici—has many accomplishments to his name.1 In 1537, he discovered that dressing gunshot wounds was more effective than the accepted practice of cauterizing them with boiling oil.2 He championed the use of ligatures to control bleeding post-amputation, which became more successful with the gradual adoption of tourniquets. He also developed an early “flap amputation,” saving skin and muscle during surgery.2,3 He authored 25 books with topics ranging from medicine and obstetrics to natural history and demonology (we hold many editions of his works).2

Paré also invented prosthetic devices, including Le Petit Lorrain, “a mechanical hand operated by catches and springs worn by a French Army captain in battle.” His above-the-knee prosthetic had properties still used today—“a locking knee and suspension harness.”1

Le Petit Lorrain. From  our 1633 edition of Les oeuvres d'Ambroise Paré.

Le Petit Lorrain. From our 1633 edition of Les oeuvres d’Ambroise Paré.

Artificial arm in use. From  our 1633 edition of Les oeuvres d'Ambroise Paré.

Artificial arm in use. From our 1633 edition of Les oeuvres d’Ambroise Paré.

Paré's  above-the-knee prosthetic. From  our 1633 edition of Les oeuvres d'Ambroise Paré.

Paré’s above-the-knee prosthetic. From our 1633 edition of Les oeuvres d’Ambroise Paré.

Perhaps more surprisingly, he also developed artificial noses:

Artificial noses. From  our 1633 edition of Les oeuvres d'Ambroise Paré.

Artificial noses. From our 1633 edition of Les oeuvres d’Ambroise Paré.

To celebrate Paré and his contribution to the field, we are featuring images of prosthetic devices throughout the centuries from items in our collection.

1696

Dutch surgeon Pieter Adriaanszoon Verduyn (ca. 1625–1700) developed the first below-knee prosthetic that allowed for knee movement and developed one of the first “true flap amputations,”3 as described in his Dissertatio epistolaris de nova artuum decurtandorum ratione of 1696.

Verduyn's below-knee prosthetic. In Dissertatio epistolaris de nova artuum decurtandorum ratione, 1696.

Verduyn’s below-knee prosthetic. Table VII in Dissertatio epistolaris de nova artuum decurtandorum ratione, 1696.

1718

In 1718, French surgeon Jean-Louis Petit (1674–1750) developed an effective tourniquet, allowing for more successful control of bleeding during and after amputation.3 He wrote about his achievement in Traité des maladies chirurgicales, et des opérations qui leur conviennent.

1862

Douglas Bly’s new and important invention, advertised in pamphlets from 1859 and 1862, offered a “ball and socket ankle, which were made of an ivory ball resting within a rubber socket,” and allowed for increased mobility.4 Bly publicized his leg throughout the Civil War, but the U.S. government found it too expensive to provide to wounded soldiers. Instead, the government offered to pay the difference between a government-issued limb and Bly’s higher-end model.4

Pages one and two of Douglas Bly's "A new and important invention," 1862.

Pages one and two of Douglas Bly’s “A New and Important Invention,” 1862. Click to enlarge.

Amputated, in stockings, and pants rolled up to show the artificials. On page 24 of Douglas Bly's ""A new and important invention," 1862.

Amputated, in stockings, and pants rolled up to show the artificials. In Douglas Bly,  “A New and Important Invention,” 1862, p. 24. Click to enlarge.

1885/1889

Henry Heather Bigg published Artificial Limbs and Amputations in London in 1885, almost exactly thirty years after the Crimean War (1853–1856). Our library holds the 1889 edition. Bigg illustrates advances he witnessed at the Royal Hospital at Netley.

Regulation box leg and regulation boot. In Henry Heather Bigg, Artificial Limbs and Amputations, 1889, p. 110 and 111.

Regulation box leg and regulation boot. In Henry Heather Bigg, Artificial Limbs and Amputations, 1889, p. 110 and 111. Click to enlarge.

Regulation common stump arms. In Henry Heather Bigg, Artificial Limbs and Amputations, 1889, p. 122 and 123.

Regulation common stump arms. In Henry Heather Bigg, Artificial Limbs and Amputations, 1889, p. 122 and 123. Click to enlarge.

1906-1926

The A. A. Marks Company of New York regularly released A Manual of Artificial Limbsour library holds seven editions, published from 1906 to 1926. There are only slight variations in the volumes, most notably the mention of services for Great War veterans in the later editions. The manuals aim to convince customers of the value of the devices throughout a person’s daily tasks and career (even when performing a magic show).

"It never occurs to anyone that his lower extremities are not real." A. A. Marks Co., Manual of artificial limbs, 1906, p. 108-109.

“It never occurs to anyone that his lower extremities are not real.” A. A. Marks Co., Manual of Artificial Limbs, 1906, p. 108-109. Click to enlarge.

"I am a professional prestidigitateur." A. A. Marks Co., Manual of artificial limbs, 1906, p. 265.

“I am a professional prestidigitateur.” A. A. Marks Co., Manual of Artificial Limbs, 1906, p. 265. Click to enlarge.

1945

Atha Thomas, associate professor of orthopedic surgery at the University of Chicago School of Medicine, and Chester C. Haddan, president of the Association of Limb Manufacturers of America, co-wrote Amputation Prosthesis, published in 1945 and heavily influenced by both world wars. They conclude their first chapter: “Where amputations were once considered only as a life-saving measure they are now performed yearly by the hundreds in a deliberate attempt to substitute a useful prosthesis for a useless, unsightly, or hopelessly deformed extremity” (12).

"Below-knee prosthesis equipped with rubber foot." In Thomas & Haddan, Amputation Prosthesis, 1945, p. 97.

“Below-knee prosthesis equipped with rubber foot.” In Thomas & Haddan, Amputation Prosthesis, 1945, p. 97.

"Great dexterity is possible also with this type of mechanical hand."  In Thomas & Haddan, Amputation Prosthesis, 1945, p. 212-213.

“Great dexterity is possible also with this type of mechanical hand.” In Thomas & Haddan, Amputation Prosthesis, 1945, p. 212-213. Click to enlarge.

1954

In 1945 the U.S. National Research Council established the Committee on Prosthetic Devices, later called the Advisory Committee on Artificial Limbs. The Committee published Human Limbs and their Substitutes in 1954, describing such progress as the electric arm, new methods of knee stabilization, and advances in suction sockets.

An electric arm. In National Research Council, Human Limbs and their Substitutes, 1954, p. 398.

A suction socket leg. In National Research Council, Human Limbs and their Substitutes, 1954, p. 665.

1962

In Upper and Lower Limb Prostheses (1962), author William A. Tosberg includes a brief history of the materials used in prostheses: after WWII, plastics predominated. The post-WWII era also lead to professional certifications and education programs for prosthetists (no longer called “limbmakers,” as they are by Thomas and Haddan) and orthotists.

Cosmetic hand for partial amputation. In William A. Tosberg,  Upper and Lower Limb Prostheses, 1962, p. 17.

Cosmetic hand for partial amputation. In William A. Tosberg, Upper and Lower Limb Prostheses, 1962, p. 17.

Adjustable above-knee leg. In William A. Tosberg,  Upper and Lower Limb Prostheses, 1962, p. 67-68.

Adjustable above-knee leg. In William A. Tosberg, Upper and Lower Limb Prostheses, 1962, p. 67-68.

References

1. Thurston AJ. Paré and prosthetics: the early history of artificial limbs. ANZ J Surg. 2007;77(12):1114–9. doi:10.1111/j.1445-2197.2007.04330.x.

2. Dunn PM. Ambroise Paré (1510-1590): surgeon and obstetrician of the Renaissance. Arch Dis Child Fetal Neonatal Ed. 1994;71(3):F231–2. Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1061134&tool=pmcentrez&rendertype=abstract. Accessed December 4, 2014.

3. Sellegren KR. An Early History of Lower Limb Amputations and Prostheses. Iowa Orthop J. 1982;2:13. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2328816/. Accessed December 4, 2014.

4. Dr. Bly’s Artificial Leg. The Shelf: Preserving Harvard’s Library Collections. 2014. Available at: http://blogs.law.harvard.edu/preserving/2014/01/13/dr-blys-artificial-leg/. Accessed December 9, 2014.

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