NATURE 



42 



THURSDAY, AUGUST i, iQiS.* 



ARTIFICIAL LIMBS AND WAR INJURIES. 1 

 (i) La Proth^se du Memhre Inferieur. Par Dr. F. j 

 ' Martin. Pp. viii+107. (Ambulance de I'Oc^an, 

 La Panne.) (Paris: Masson et Cie, 1918.) | 

 Price 5 francs. 

 (2) Troubles locomoteurs consecutifs aux Plaies de 1 

 Guerre. Par Prof. Aug. Broca. Pp. 155. 

 (Paris : Masson et Cie, 1918.) Price 4 francs, 

 (i) T N the autumn of 1914, La Panne, .the last 

 J- villag-e on the Belgian coast as one passes 

 towards the French frontier and Dunkirk, con- 

 sisted of a large hotel — Hotel de I'Ocean — and a 

 number of lodging-houses, then crowded with 

 refugees. It was to this site that the Queen of 

 the Belgians summoned Prof. A. Depage, who, in 

 peace time, was the distinguished occupant of the 

 chair of surgery in the University of Brussels, but 

 in the autumn of 1914, when summoned by his 

 Queen, was busy establishing a military hospital 

 in Calais. At the Queen's request Prof. Depage 

 undertook to organise a field hospital in La 

 Panne. He took over the hotel with its 150 bed- 

 rooms and surrounding villas ; in a year's time 

 he had more than a thousand beds at his disposal 

 with laboratories and work-rooms attached. 

 Under Prof. Depage La Panne became not only 

 a beneficent institution for the relief of wounded 

 Belgian soldiers, but also one of the great centres 

 of surgical progress. In 1917 tTiere began to be 

 issued from the " .\mbulance de I'Oc^an " a series 

 of scientific publications, of which the excellent 

 treatise here noticed is the latest number. Prof. 

 Depage confided the difficult task of inventing, 

 improving, and providing artificial limbs for muti- 

 lated soldiers to Dr. F. Martin. That he was for- 

 tunate in his choice tliere can be no doubt, for in 

 his treatise on the " Prosthesis of the Lower 

 Limb " Dr. Martin has produced a most useful 

 and scientific contribution to a subject which 

 medical men have hitherto totally neglected. 



Up to the outbreak of war the United States 

 was the only country in which the manufacture of 

 artificial limbs had been seriously studied. When 

 Dr. Martin commenced his investigations at La 

 Panne he recognised the merits of the American 

 models. But they were expensive, and had mani- 

 fest defects in functional qualities and in adapt- 

 ability. He saw that it was necessary to use a 

 substance with all the qualities of seasoned wood, 

 but one which could be moulded so as* to form 

 an exact socket or "bucket" for the stump of 

 the amputated limb. He found the ideal sub- 

 stance in wood shavings cemented together by a 

 particular form of glue. He saw that it was neces- 

 sary that the artificial limb, so far as length of 

 segments and axes of joints were concerned, must 

 be a counterpart of the patient's sound limb. He 

 invented a simple apparatus for obtaining the 

 exact measurements required for the modelling of 

 the artificial limb; he used the kinematograph to 

 analyse the movements of the lower limbs in walk- 

 NO. 2544, VOL. lOl] 



ing, and did not rest content until he found that 

 his artificial limbs could simulate the movements 

 of real ones. Thus he was able to improve on 

 American models and to produce a more efficient 

 article at a much lower price. 



At La Panne certain useful principles have been 

 laid down for the guidance of the surgeon when 

 amputating and when treating the stump prepara- 

 tory to the fitting of an artificial limb. At amputa- 

 tion the surgeon must leave as long a lever of bone 

 as is possible ; he must see that the muscles which 

 are to move that lever are rightly placed and 

 rightly fixed; he must see that the joint from 

 which the bony lever is to act is free and movable. 

 As the stump is shaped, the surgeon must foresee- 

 how the bucket of the artificial limb is to be given 

 a sure support. At La Panne crutches are for- 

 bidden ; their use is found to impair the mechanism 

 of the body needed for the right use of an artificial 

 limb. At the earliest date possible — in eight to 

 twenty-four days, according to the nature of the 

 amputation — the soldier is given a provisional 

 limb — a "bucket " which is moulded to the stump, 

 and remoulded as the stump atrophies — fitted to 

 a wooden peg or stump. We have no doubt that 

 the practice at La Panne — the practice of fitting 

 out the maimed at once with provisional limbs 

 instead of crutches — is right. We have, from 

 reasons of space, had to omit any mention of Dr. 

 Martin's original observations on the movements 

 of the lower limbs in walking, but for those who 

 are interested in the mechanism of walking, and 

 wish to help in relieving maimed soldiers, we 

 warmly commend this clearly and crisply written 

 treatise from the "Ambulance de I'Ocean." 



(2) A British surgeon may well feel somewhat 

 envious of the many excellent medical manuals 

 which have appeared recently in France to meet 

 the needs of the Army surgeon. The leaders of 

 the French medical profession have placed their 

 special experience, in the form of clearly and con- 

 cisely written booklets, at the disposal of their 

 colleagues in the field. In the booklet here re- 

 viewed Prof. Broca gives his experience and 

 advice in the treatment of the various disablements 

 which follow gunshot injuries of the limbs. 



These are of many kinds and degrees — partial 

 t or complete fixation of joints, or disablements 

 which follow injuries to muscles, nerves, or bones. 

 In some respects the treatment adopted or recom- 

 , mended by Prof. Broca differs from that practised 

 by the majority of British surgeons, but the under- 

 lying principles of treatment in both countries are 

 the same. It is recognised that if permanent 

 fixation or anchylosis of a joint is unavoidable. 

 1 then the limb must be placed and kept in a posi- 

 tion which will secure a maximum utility so far 

 I as the livelihood of the patient is concerned. In 

 j both countries it is recognised also — perhaps more 

 j so in Britain than in France — that the principles 

 j of treatment vary with the stage of recovery, com- 

 I plete rest by means of splints being the best treat- 

 ment in the acute stages of the injury, and free 

 I movement the best medicine when the acute stage 

 I is over. Many French surgieons have a fear of 



