Child’s prosthetic leg

By Jo Merrey
Child’s prosthetic leg held in the collection of the St Bartholomew Hospital Museum and Archive

The earliest identified prosthetic is a big toe made of wood and leather that was found attached to a female mummy, named Tabeketenmut, in a burial site in the Theban necropolis in 2000. Testing of the toe has led to it being dated to between 950 and 710 BCE. The degree of wear on the toe suggests that it is possible it was worn during life and is not a post-mortem addition as part of the ancient Egyptian burial rites. [1]

The first known artificial leg is the Roman Capua Leg. Made of bronze, the Capua leg was discovered in 1910 and dates to around 300BCE. It is believed the leg was worn by an individual with a below knee amputation. The Capua leg was destroyed during WWII, but a copy had been made and is part of the collection at the Science Museum, London. [2]

M0012307 Roman artificial leg of bronze.
Image 1: M0012307; Wellcome Library, London. Roman artificial leg of bronze plates fastened to a wooden core, excavated from a tomb near Capua. CCA only licence CC BY 4.0

The 3D model of the prosthetic leg you can see here was supposedly designed specifically for a child patient who was a ‘below right knee amputee’:

‘The leg is perforated to avoid suction when being taken off, and is of wood and leather construction. The leather loop for the suspensory harness is attached by wood screws and the leather “sole” is fixed with cobblers’ nails.’

The 3D model gives a good sense of the wear and tear that the object has suffered. The leather encasing the leg is so scuffed that it is worn away in places, and there are evident scratches in the black paint on the wooden pylon. The leg has a leather sole which allowed for a softening of the ‘footfall’ of the wearer and also the potential for the leg to be re-soled. During this period there was certainly a different attitude towards the use and re-use of hospital equipment. The pragmatics of cost, and perhaps the limits of charity, might have meant that an instrument which required intensive manufacture would not be considered disposable. Additionally, people went to great lengths to construct and repair makeshift prostheses fashioned from everyday items.

The leg bears a brand label that identifies it as being made by Arnold and Sons, London. Arnold and Sons manufactured prosthetic limbs and other medical equipment under this name from 1866 to 1928.  The Arnold and Sons’ sales catalogue for 1873 prices the ‘best quality’ artificial leg for a below knee amputation at £20. In comparison, the cost of an alternative ‘best quality’ wooden ‘pin leg’ for a below knee amputation is priced at £1.1s and ‘with leg rest’ costing £1.7s6d. The difference between what could be considered luxury and utilitarian models was significant. [3]

capture

Benjamin Franklin Palmer, an American, patented his artificial leg in 1846. Equipped with ‘smoothly articulated knee, ankle, and toe joints’ the Palmer Patent Leg won many awards, including a silver medal at the Great Exhibition in London in 1851. [4] Palmer was not alone in refinements and innovations to prosthetic limb design in the nineteenth-century. Other advances were made by James Potts, Sir James Syme, Douglas Bly, Dubois Parmlee, Gustav Hermann and James Hanger among others. Common to these advances were solutions involving articulated joints and lighter, more durable, approaches to construction.

In Automatic Mechanism published by Frederick Gray in 1855, the effectiveness of prosthetic legs are presented through a series of case studies and testimonials. One such case describes Miss B. who lost her leg (‘amputated at the lower third’) at the age of 13. After ongoing problems with excoriation for the first two years following her injury, after eight years she no longer has such issues and, according to Gray, ‘can ride and walk as well as ever she did, and exhibits no appearance of lameness. She is an elegant dancer, and rides very gracefully’. [5]

Other cases reported in Automatic Mechanism indicate pride, and also relief, that the use of a prosthetic limb was not detectable. The ‘naturalness’ achieved by the prosthesis diminished any shame experienced by users from not being ‘whole’. However, the modelled leg from Arnold and Sons does not feature any joints or means of articulation. The gait of the child-wearer is unlikely to have approximated the ‘natural gait’ sought after by wearers of articulated legs. Nevertheless, the appearance of ‘grace’ aside, the leg may have gladdened its young wearer by the possibility of physical independence.

The nomenclature associated with disability in nineteenth-century England is now discomforting, and has the power to elicit strong negative emotional responses. Amputees were referred to by terms such as ‘cripple’ and ‘physically defective’, including in official discourse and the bureaucracy. [6]

During this period, charitable benefactors such as Grace Kimmins founded the ‘Guild of Brave Poor Things’ (1893), a society that developed into an organisation of schools and hospitals that aimed to provide a vocational education along with medical care and therapy. The Guild and its schools have endured to the current day in the form of the Chailey Heritage Foundation. [7] In the Victorian era, the principles of organisations such as the Guild of Brave Poor Things was that:

Physically, work was occupational therapy to unlock and develop bodily powers; economically, it was thought to promise cripples financial independence; morally, it promoted the self-help essential to combat self-pity. [8]

Confronting language and attitudes aside, there are points of continuity between the Victorian and current notions of rehabilitation. In both periods, there was a social imperative to ensure that children with a disability such as a limb deficit had as many opportunities as possible. Nowadays,  this process is couched in terms of empowering individuals as opposed to ‘saving children from pity’. [9]

The modelled leg is not an aesthetically pleasing approximation of a healthy leg. Then again, nor are many current prostheses. What the modelled leg represents is an opportunity for a child to have a degree of independent mobility that they might otherwise not have had. When you look at the model of the child’s leg, how do you feel? Do you think you would feel differently if the leg was intended for an adult? How do you think you would feel if you were viewing a model of an articulated prosthesis, such as that in Image 2?

About the author

Jo Merrey is a doctoral candidate at the University of Western Australia. Her thesis explores the narrative and symbolic function of clothing in relation to women’s agency in late-medieval English texts. Her broader research interests include travel narratives, theories of audience and spectatorship, Renaissance and Restoration theatre, creative writing and feminist fiction.

References

[1] Jacqueline Finch, ‘The art of medicine: The ancient origins of prosthetic medicine’ The Lancet 337 (2011): 548-549. doi: 10.1016/S0140-6736(11)60190-6

[2] Roman Capua Leg, Object number A646752, Science Museum, London http://www.sciencemuseum.org.uk/broughttolife/objects/display?id=91684

[3] Arnold and Sons. A Catalogue of surgical instruments manufactured and sold by Arnold and Sons (1873).

[4] “The Palmer Patent Leg,” Nineteenth-Century Disability: Cultures & Contexts accessed December 1, 2016. http://www.nineteenthcenturydisability.ord/items/show/59.

[5] Frederick Gray, Automatic Mechanism, As Applied in the Construction of Artificial Limbs in Cases of Amputation (London, 1855), 147.
http://search.wellcomelibrary.org/iii/encore/record/C__Rb2233182?lang=eng

[6] Seth Koven, ‘Remembering and Dismemberment: Crippled Children, Wounded Soldiers, and the Great War in Great Britain’ The American Historical Review 99.4 (1994): 1167-1202

[7] Chailey Heritage Foundation http://www.chf.org.uk/foundation-our-history.html

[8] Koven, p. 1175

[9] Compare the language and focus of the Elementary Education (Defective and Epileptic Children) Act 1899 (England and Wales) and the Disability Discrimination Act 1992 (Australia).

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