Temporary and permanent apparatus.—For the irregular amputations of war surgery which have suppurated, more often than for those of civil practice, it is generally advisable, particularly in the lower limb, to use a temporary apparatus, of fairly good fit, for several weeks or even months before the permanent apparatus of more precise fit. The stump has to soften and shrink gradually; only when this has occurred can we make an accurately fitting bucket, by means of a cast if necessary.
Materials for making the bucket.—The first method of construction is that of leather reinforced with metal; a sheath strengthened with metal supports, is laced around the stump; the supports further give attachment, if there is room, to the artificial joints. This is an excellent principle, either for stumps which are still likely to diminish in size, or for the upper limb where exact fit is of secondary importance.
For buckets accurately fitted on a cast we employ:
Blocked leather, which loses shape and ought to be abandoned for artificial limbs for the lower extremity.[1]
[1] This we have attained at the Fédération des Mutilés, having forced the makers to abandon their routine. It seems to us therefore that the same result might be attained for the appliances furnished by the State, which are still made of leather.
Celluloid is the material of choice, but it has the defect of requiring the hand of an artist; commercial attempts on a large scale have so far yielded mediocre results.
Metal (zinc, sheet steel, aluminium), the defect of which is that the apparatus, particularly for the lower limb, is noisy. This is also an inconvenience in the metal joints of lateral steels of leather appliances and of the spiral springs in certain wooden apparatus, for this reason indiarubber is more often relied on for springs and accumulators.
Wood, for many years used for the commoner types of limbs for the lower extremity, is now, as the result of American influence, utilised for the making of apparatus hitherto termed "de luxe," but to-day serviceable, thanks to this technique.[2]
[2] Working in wood, to hollow out of a log of wood a bucket which fits the stump accurately, is no novelty. Some sixty years ago two Frenchman, Bailly, then Xavier, succeeded in such construction. But these appliances, like the common, cheap unshaped peg leg, split easily and were only made strong when the Americans conceived the idea of covering the outer surface with a layer of raw hide: strong, and therefore practical, for though we may resign ourselves to the frequent renewal of a peg leg at 25 francs, it is another matter with an appliance costing 300 to 400 francs. (Prices in peace time.)