MECHANICAL SURGERY. 
ARTIFICIAL LIMBS, 
APPARATUS FOR RESECTIONS, 
Apparatus for Ununited Fractures, 
FEET FOR LIMBS SHORTENED BY HIP DISEASE, 
arms and hands. 
BY 
Soldiers Provided 
COMMISSION 
OF THE 
SURGEON-GENERAL U. S. A. 
E. D. HUDSON, M. D., 
696 BROADWAY, CORNER OF FOURTH STREET, 
NEW YORK. 
(REMOVED FROM CLINTON HALL, ASTOR PLACE.) MECHANICAL SURGERY 
AS A 
SPECIALTY. 
Of late years the importance of bringing the treatment with 
apparatus of mutilations and deformities under the immediate 
supervision and control of professional men has merited and 
received increased recognition. The application of trusses, the 
application of apparatus for spinal and hip diseases, are but a few 
of the many callings which the past ten years has seen transferred 
from the mechanic to the physician and surgeon. 
Such disposition should be made of every practice which re- 
lates to surgery, and for which a scientific and practical knowl- 
edge of anatomy, physiology, surgical pathology, surgery, and 
therapeutics, in their most comprehensive sense, should be exacted. 
To commit the vital interests that are involved in an amputated 
or resected limb to a mere tradesman, who possesses no adequate 
appreciation of its condition, nor knowledge of what that condi- 
tion indicates, is to trifle with the most serious matters. In every 
such surgical operation and its final results, the credit of surgery 
and the cause of humanity are too heavily staked to leave to un- 
educated and unappreciative men its final disposition. Empiri- 
cism can be no more consistently tolerated in surgical than in 
medical therapeutics. All surgical apparatus should be scientifi- 
cally prescribed, constructed, and adapted to fulfill the special 
indications presented by each individual case, securing the greatest 
possible degree of restoration or amelioration, naturalness, com- 
fort, and usefulness. 
Irreparably damaged and diseased parts are to be well diag- 
nosticated; malignant predispositions, and morbid irritabilities 
well guarded ; paralyzed, and morbidly contracted tissues, invoked 
by continuous passive exercise. With the laudable efforts which 
are being made by the best constituted surgeons in conservative 2 
surgery, for the best interests of their patients, there should he a 
correlative intelligence, philosophical effort and result on the part 
of the specialist in mechanical surgery; otherwise, the one prac- 
tice renders the other a nullity. 
The great advances in military and general operative surgery, 
the many new and modified operations resultant from the experi- 
ence of the late war, and the demand upon mechanical surgery 
to meet with appropriate reparative apparatus the multiform mu- 
tilations and deformities, render the duties of its practitioner 
onerous yet honorable. The great variety of cases of resection, 
amputation, disarticulation, anchylosis, ununited fracture, &c., 
each peculiar in its individual requirements, calls for continuous 
study and the continued exercise of professional knowledge and 
scientific experience. 
Of resection is this especially true. Of the many cases treated 
thus far, no two have been exactly alike either as to mode of oper- 
ation or the nature and degree of functional disability. Hence 
the necessity of ascertaining in each case, by careful examination 
and experiment, the exact condition in which the parts are left— 
what nerves or muscles have been severed or injured, what actions 
lost or impaired, the length of bones removed, what muscular con- 
traction has taken place or may be expected, and the possibility 
of any future reproduction of the bone, and what modified appa- 
ratus is required. By the contemporaneous treatment of a greater 
number and variety of special cases than would come within 
years of the most extensive surgical practice, the opportunity is 
presented of making direct observation of the comparative safety 
and success of different operations, and those most favorable to 
the restoration of lost powers both by nature and by art. 
The collection and classification of data, while necessary in 
each individual case for its proper treatment, is of still greater 
value to the profession, and constitutes a powerful argument in 
favor of their lending their patronage and influence to the physi- 
cian or surgeon who earnestly and faithfully devotes himself to 
this specialty. 
The surgical statistics that have been demanded by the Sur- 
geon-General U. S. Army, of those who have had the mechanical 
treatment with appliances of the many thousands of cases of 
mutilations which the late war caused, fully illustrates the sound- 
ness of the foregoing premises. 3 
ARTIFICIAL LIMBS. 
The Artificial Limbs furnished and applied by myself, per- 
sonate all of the essential anatomical formations and physio- 
logical functions of the natural leg, in general configuration, for- 
mations of knee, ankle, and toe joints; of muscles and tendons of 
the foot, leg, and thigh for flexion and extension, for walking, 
standing, sitting, horseback-riding; for elasticity, naturalness of 
dress, action, and usefulness. It has been designed by my own 
study to fulfill every indication created by operative surgery or 
the pathological condition of retained parts. 
Surgical appliances, when therapeutic, prove inestimable sub- 
stitutes and auxiliaries to nature. To be such, they must, to a 
greater or less degree, compensate lost parts and functions, and 
restore those which are impaired. All disease is not remediable, 
neither are all mutilated limbs or impaired functions restorable. 
A very large majority of amputated limbs are compensable to a 
useful extent; in very many instances so completely as to render 
the operation comparatively trifling, and to challenge detection. 
Ankle-joint amputations, for instance, are scarcely appreciable, so 
appropriate is the mechanical treatment and perfect the restora- 
tion. Of tbe leg and knee-joint amputations, a lesser but very 
great restoration is experienced. The improvements in amputa- 
tions of the inferior extremities, and the extent to which artifi- 
cial legs have been brought to similate the natural ones, indicate 
an advancement in philosophy and art. 
The extreme loss of the thigh in continuity, and even in con- 
tiguity of the great trochanter, is remediable to a very useful 
extent, depending largely upon the sthenic powers, skill, and per- 
severance of the patient, as the following case illustrates, viz.: 
J. C., private 104th Beg’t H. Y. Infantry, suffered an ampu- 
tation of his thigh in its upper third, leaving a stump of only two 
inches’ length. ILis condition and habits rendered him one of the 
most unpromising patients at the Central Park U. S. General 
Hospital. The surgeon in charge, and staff, however, decided that 
the experiment should be made for his benefit. By a studied and 
persevering effort, a limb was successfully applied in July, 1864. 
With a little initiatory practice, he soon became an object of ad- 
miration, astonished the entire medical corps and inspector, by his 
expert and natural locomotion. His ready perceptions and in- 
domitable will greatly compensated his extreme physical disad- 4 
vantages. He was discharged a little time after the limb was 
applied, immigrated to northern Illinois, where he is at work get- 
ting out bedstead timber and running a buzz saw. lie wrote in 
July, 1866, that he seldom used a cane (only for long walks), car- 
ried his timber in and out of his mill, and that he was prepared 
to compete in walking with any one who had suffered a thigh am- 
putation, even though possessed of a more favorable length of 
stump. 
ADAPTATION OF ARTIFICIAL LIMBS. 
The adaptation of artificial legs by adjustable and thickly 
padded sockets, inserted into wooden, metallic or rawhide sockets, 
is always prejudicial, by the heat thus generated, and debilitating 
effect upon the stumps. Profuse perspiration is induced, and the 
fomenting process effects a softened, parboiled state of the skin 
and cicatrix, with a debility that often extends to indolent 
ulcerations. 
The sockets for stumps should always be solid. They should 
be carefully adapted to the angles, protuberances, crests, and every 
irregular shape and pathological condition of the stump, by the 
nicest manipulations. Their lining should be, generally, only one 
thickness of fine soft flannel—a material less calculated to irritate 
the skin than any other fabric. The socket should be well venti- 
lated. 
The health and efficiency of stumps, after having become 
thoroughly healed, depends much upon the sanitary treatment by 
the patient. 
The utility and satisfaction afforded by an artificial limb will 
depend much upon the anatomical and physiological principles 
which govern its construction. An artificial leg that is constructed 
without naturally constituted ankle and toe-joints, extensor and 
flexor tendons of the foot and toes, is radically and essentially 
defective. 
The Tibio-Astragaloid ankle-joint, which I instituted several 
years ago for artificial legs, is the closest possible imitation of the 
Tibio-Tarsal ginglymoid joint of nature, in its exact formation and 
action. Its opposing articular surfaces are composed:—the infe- 
rior of hard sheet brass over the astragalus ; the superior of thick 
lubricated leather over the concave articular surface of the Tibia. 
ANKLE-JOINT MOTION. 5 
These opposing surfaces are not subject to corrosion, impedi- 
ment of motion, or noise. The foot has all the elasticity, lifelike 
action, and adaptation to irregular surface as the natural foot, 
which never accommodates a grade nor obstacle with impunity. 
Arthrodial and semi-rotary motions pertain exclusively, in prin- 
ciple and action, to the head of the femur, mediotarsal, and 
metatarso-digital joints of the inferior extremity. 
The ankle-joint is purely a hinge one—as a careful and critical 
dissection will demonstrate—and every lateral motion which is in- 
troduced into the ankle-joint of an artificial leg is a violation of 
anatomical and physiological principles. The text books of all 
anatomists and physiologists, which are received authorities, bear 
witness to the correctness of the above premise, viz.:— 
PHYSIOLOGICAL ANATOMY OF THE ANKLE-JOINT. 
a and 5, Inferior Extremity of the Tibia and Fibula ; e, Astragalus; 
<?, OsCalcis; e, Scaphoid; f, Cuboid; <7, Internal Cuneiform ; k, Middle 
Cuneiform ; i, External Cuneiform ; 1, 2, 8, 4, and 5, First, Second, Third, 
Fourth, and Fifth Metatarsal Bones ; k, k, k, k, k, Phalanges of the T. es; 
*, Ginglymus joint of the ankle. 
BONES OF TIIE FOOT AND ANKLE-JOINT. 
“ The form of the Astragalus is that of a 
pulley which, of course, admits of but one direct 
motion, viz.: forwards and backwards. Its sides 
are plain, smooth, and flat, and closely locked 
in by the inner and outer ankle, so as to prevent 
luxation or awkward motions to either side. 
“ The two points (malleoli), projecting so as to 
enclose the bones of the foot, making a pure 
hinge, prevent all lateral motion ; make the joint 
firm and strong, and will not allow of luxation, till one or both 
ankles be broken.” (Bell.) 
“ The movements of the ankle-joint are limited to flexion and 
extension. There is no lateral motion.” (Henry Gray.) 
The premises of Mr. Ward—Human Osteology—are so philo- 
sophical and demonstrative as to induce me to quote them at 
length ; viz., “ The articulation of the ankle is a ginglymus or 
hinge joint. It is effectually secured from lateral dislocation by 
the projection of the malleoli, which descend, one on each side of 
the Astragalus, forming a sort of box for its reception, &c. An- 
other provision, tending to maintain the bones firmly in their rel- 6 
ative position, consists in the shape and adaptation of the opposed 
surfaces. The trochlea of the Astragalus presents a median groove, 
and two lateral elevations, respectively receiving and received into 
a median ridge, and two lateral depressions on the terminal sur- 
face of the Tibia. In the median position of the foot, when it 
rests horizontally on the ground, the Astragalus receives the 
pressure of the Tibia at right angles, and none of the ligaments of 
the ankle-joint are put upon the stretch—a circumstance which 
may be noted as one of the conditions on which the aptitude of 
man for the erect posture depends. From this median position 
the foot is raised in flexion, and depressed in extension. 
In flexion, the wide anterior extremity of the trochlea of the 
astragalus is brought between the two malleoli, and completely 
tills the intervening space ; so that in this attitude no lateral move- 
ments of the joint are possible ; but, in extension, the narrow pos- 
terior extremity of the trochlea comes between the malleoli, only 
partially tilling the space bounded by those processes; so that in 
this posture of extension only slight rotary movements, by which 
the toes are pointed a little inward or outward, may be performed.” 
(No lateral motion of ankle.) “ This I take to be the true ex- 
planation of the fact that the trochlea of the Astragalus is narrower 
behind than before. Bourgery attributes to the ankle-joint move- 
ments of adduction and abduction, by which the sole is turned 
inward or outward. Each of these movements would involve 
partial separations of the opposed surfaces; so that the Tibia 
would touch the Astragalus on the inner side only in adduction, 
on the outer side only in abduction.” 
“ I have satisfied myself by repeated observation that the liga- 
ments permit no such separation of the bones; which even, if 
possible, would probably injure the joint by causing an undue 
accumulation of pressure on particular points of its articular sur- 
faces.” Those who indulge the idea of Bourgery respecting adduc- 
tion and abduction, lateral motion of the ankle-joint, will surely 
correct themselves of the error by careful dissection and a studied 
examination of the matter. 
ARTIFICIAL KNEE-JOINT. 
The condyloid knee-joint I some time since instituted for knee 
and thigh amputations constitutes a new and essential adjunct to 
an artificial leg, particularly for the treatment of those cases of 
amputations at the extreme upper third of the leg, which require 7 
a knee-supporting leg; and of the knee-joint with thigh and leg 
parts of the natural length. The same is applicable for thigh 
stumps, when of extra length, the amputation being in immediate 
proximity to the condyloid enlargement. The trunnion-joints used 
for such occasions are so arranged as to leave the interior and 
lower part of the thigh socket, and the supporting parts of the 
knee-bearing leg, free of all interference with the end of the stump 
or the knee-supporting basis. 
AMPUTATION OF THE INFERIOR EXTREMITIES. 
RADICAL PRINCIPLES. 
“You shall cut off as little of that which is sound as you pos- 
sibly can; and so that the patient may most fitly use the rest of 
his leg, by walking on an artificial leg.”—Pare. 
Notwithstanding the above axiom was enjoined three hundred 
years ago, it is not unfrequent, even now, that the principle rela- 
ting to conservatism, and that like unto it, the subsequent useful- 
ness of the patient with “the rest of his leg,” and the most useful 
artificial leg, are inexcusably and culpably violated, particularly 
so on the persons of the poor! 
Cask.—I nave a patient at this time, with amputation of the 
shaft of the femur, in whom the extent of disease wras not such as 
to have required a removal of its condyles, which would have 
been of the greatest service to him, a poor laboring man. 
It is an important fact to be considered that those who are 
poor now may soon become rich, and vice versa. 
Another Case.—An enterprising lady, residing in this vicin- 
ity, now well to do by the avails of her own efforts, suffered an 
amputation of her leg at its upper third, when she was both young 
and poor, and regarded a proper candidate for a “ peg leg;” while 
the sound parts admitted of the amputation at the lower third, 
with which she might now use an appliance that would render her 
loss comparatively trifling. The favor with which the moral sense 
of her surgeon is regarded will be seen intuitively. This case is 
no exceptional one. Similar disregard of the comfort and useful- 
ness of such subjects is often manifested in the still frequent cases 
of Chopart and tibio-calcaneum operations. 
Laboring men and women comprise a very large majority of 
those who suffer amputation of the inferior extremities; most of 
SOCIAL AND ECONOMIC CONSIDERATIONS. 8 
them obtain artificial legs to compensate their loss, and thu3 are 
enabled to pursue their usual vocations. Of this class nearly one- 
half obtain limbs by the gratuities of the sympathizing and con- 
siderate, who entertain the philosophical principle that their inter- 
ests are involved in the interests and greatest usefulness of their 
suffering neighbors. 
In every such instance they are the benefactors of mankind 
who contribute to the greatest usefulness and happiness of the 
mutilated, and who, by their moral and scientific efforts, both 
conserve and restore. Such, in brief, are the considerations which 
every surgeon should magnify while determining an amputation. 
More diverse views and practice do not exist than respecting 
the best modes of amputating to secure the most useful stumps. 
The great variety of operations performed in the United States 
military service during the war, and in civil practice, which have 
been presented to my observation for final treatment, indicate an 
undetermined general rule. 
The most creditable and serviceable stump that I have ob- 
served, viewed in its every feature, has been the product of the 
bilateral-tegumentary flaps, and circular incision of the muscles. 
A strongly formed and scarcely perceptible cicatrix is effected by 
more or less of primary healing. It secures a smooth, round, and 
finely-composed end; and generally there is an equal retraction 
of the muscles. Its symmetrical proportions and healthy tone 
render it an admirable work of nature and art. In no instance, 
when sloughing and other unfavorable events have not occurred, 
has the final result of this method been otherwise than gratifying. 
The results of the circular and bilateral varieties singly have 
been eminently superior to those of any other, excepting their 
compound. Agreeably to my personal observation, the bi-lateral 
operation is the most favorable to a primary union, in general or 
in part. I judge it to be favorable, also, to make speedy second- 
ary union, by the drainage it affords and escape of sanguineous 
and purulent matter. It will, I venture to predict, eventually 
be adopted in all amputations of the leg and thigh in the contin- 
uities. 
YARIETIKS OF INCISIONS AND THEIR RESULTS. 
Uo practice of surgery is possessed of greater interest, or of 
more practical importance, than an amputation of the inferior 
TIIE PLACES OF INCISION. 9 
extremity; and yet no other part of the human system is subject 
to so much bad surgery. 
In the cases where conditions have been equal, and surgeons 
were favored with the choice of site for the greatest good of their 
subjects, the diverse places and variety of their operations have 
borne witness that no rule of economy governed their choice. 
Mr. Ferguson has, with cause, styled much of surgery a 
fashion; to operate at one period just above the malleoli; at 
another, near the tuberosity of the tibia; and at other times, at 
all of the intermediate places, regardless of the good or evil results 
to their patients. 
Such factitious practice, I judge, must be influenced more or 
less by the unphilosophical ideas entertained respecting the man- 
ner of compensating the loss of limb with apparatus. 
It is an unfrequent exigency that requires an amputation of 
the leg or thigh so extreme as to prevent the application of useful 
apparatus of a compensating character. For the greatest benefit 
of the subject 
THE FIRST PLACE OF ELECTION 
is the ankle joint—a place that can never he disregarded with im- 
punity—and by Mr. Syme’s method. 
ANKLE-JOINT AMPUTATIONS. 
]STo amputation of the inferior extremity can ever compare, in 
its value to the subject, with that of the ankle-joint originated by 
Mr. Syme. Twelve years of experience with that variety of oper- 
ation have afforded me assurance that it is “ a fact complete,” not 
capable of being improved in its general character. It is scientific, 
practically of the utmost use, and subservient to the best interests 
and happiness of the patient. 
Mr. Ferguson avowed that he “knew of no kind or style of 
amputation which deserved more high considerations ; and so far 
as the subject is concerned, it is one of the greatest improvements 
in modern surgery.” Mo other operation has resulted so benefi- 
cially and satisfactorily. The subjects of such an amputation 
scarcely realize their loss, with legitimate appliance. They appear 
every way whole. The sensations of the stump are normal; the 
articular surface and thickened tissues are accustomed to the 10 
hardest service, and to hear the heaviest burdens, which, with ap- 
paratus, enables the patient to engage in his accustomed walks 
and vocations with unabated naturalness and endurance. One 
gentleman, for whom I applied a foot, has walked thirty-live miles 
in a day, on a hunting excursion, while his companions did not 
suspect that he was otherwise than whole. So beneficent have 
been the results of this operation as to have induced many a 
sufferer from congenital malformations, varieties of talipes, and 
troublesome Chopart operations, to demand it as an “ amputation 
of convenience.” 
It is an operation that has for its support the soundest princi- 
ple of surgical economy. 
It retains, in addition to the entire length of leg, nature’s foun- 
dation—the articular portion of the shaft of a long bone—as a 
base of support. 
Iis accustomed service is concurrent and coequal with that of 
the calcaneum, to sustain the weight and forces of the body which 
are reflected to it. 
To remove the calcaneum, and to substitute the articular base 
of the tibia, is merely a change of place, not of its functions. 
A cogent reason in support of amputation of the ankle-joint 
is, that to the compacted hardened tissue of the lower termination 
of the tibia are transferred and united, for a cushion, the thick- 
ened tissues, which have effectually served to protect the os calcis. 
The place of those tissues is changed; their accustomed func- 
tion is unchanged and normal. 
When the change of base and healthy union of the hard and 
soft parts are successfully perfected, the same condition and ser- 
viceableness of the end of the stump are gained as that of the 
natural heel. After a very short period of exercise the sensations 
become perfectly natural, and the end of the stump as enduring 
as the heel of the natural foot. 
I have been led to a very great interest and persistent advo- 
cacy of Mr. Syme’s method by a regard for the humane principles 
of rational conservatism, and by the numerous cases of ankle-joint 
amputations which have demonstrated to me the superior utility 
of that operation to any amputation of the leg, or any modifica- 
tion of the general one of Mr. Syme. Of fifty recent cases which 
have come to my hands for final treatment by mechanical means, 
not one has failed of a highly gratifying success. Both patients 
and surgeons who have witnessed their results have been every 11 
way pleased with their exceeding benefit. Not every subject is in 
immediate condition for the adaptation of apparatus, for reasons 
that will readily be apparent to every surgeon. 
Some require treatment for ulcerations, thickened tissues, swel- 
lings, and tenderness; others require some inuring treatment, 
before the application of apparatus. In no instance do I venture 
to apply apparatus until the patient can endure the end of the 
stump upon either the bare floor or some unyielding support with 
ease. 
Those leg-makers who have only stereotyped apparatus to 
apply indiscriminately for amputations in the continuity of the 
leg, and who find this new method incompatible with their highest 
ideas, have, to my personal knowledge, treated such cases by ap- 
paratus as for amputation, which allows no weight at the end of 
the stump, but distributes it upon the walls of the leg, beneath 
the head of the tibia, and up around the thigh. 
Those who have no discriminating knowledge of surgical oper- 
ations, nor of physiological, anatomical, and pathological princi- 
ples, can hardly be expected to appreciate and sustain an amputa- 
tion of the ankle-joint; nor can they treat it legitimately with 
apparatus which fulfills the design of such an operation. 
To illustrate: Captain , who had suffered an amputation 
of the ankle-joint—Syine method—came to this city and applied 
to for apparatus. He was informed that, because of a 
slight prickling sensation when he rested his stump on the floor, 
it should not receive any weight at its end. An artificial leg 
was applied, as in ordinary cases of leg amputation, to take the 
weight of the body upon its walls and the thigh, so as to suspend 
and relieve the end of the stump. The Captain entertained the 
plea of tenderness as valid; but being very greatly annoyed by the 
weight and irritation of the apparatus, he sent for a surgeon of 
this city, who, upon examining the stump and appliance, imme- 
diately transferred him to me. I found his stump admirably 
well formed and healthy, except a little prickling sensation pro- 
duced by hard pressure. 
After ten days of preliminary treatment, during which a case- 
ment and foot 'were fitted, and trials made, the prickling had 
entirely subsided, the natural sensation of the heel was restored, 
and the patient went out walking without inconvenience. The 
senation of prickling is no unusual complaint for persons to make 12 
who have suffered an injury of the tissues of the heel or foot, when 
they have so far recovered as to begin to exercise the part. 
It is a mere temporary sensation which exercise soon converts 
into a normal one. The objections to Syme’s operation—tender- 
ness, unsoundness and unreliableness as a basis of support, after 
the stump has become well healed—are entire gratuities without 
cause. 
The practice of Mr. Syme (original method) to exsect 
the indurated tissue, the most depending and most ser- 
viceable feature of the tibia, thereby exposing the cancellated 
structure, and also to remove the malleoli through their base on 
a level with its articular surface, is unphilosophical and inexpe- 
dient. The increased vascularity of the cancelli must necessarily 
conduce to protract the tenderness of the face of the stump. Some 
surgeons strive to enlarge the base of support afforded by the 
tibio-tarsal surface by sawing the malleoli off, at a line transverse 
with the end of the tibia; but the practice is entirely gratuitous, 
and in some respects prejudicial. 
The inter-malleolar space is the only true and all-sufficient 
base of support; any additional surface is superfluous ; and by 
increasing the periphery of the end renders it unduly large for the 
adaptation of symmetrical apparatus. The articular surface 
should not be molested. The malleoli should be exsected with the 
saw, at a beveling angle of some forty degrees. The most ser- 
viceable and best proportioned stump is thus composed. With 
the dense ivory structure, the cancellated and medullary tissues 
all preserved, other matters being equal, we may rationally antic- 
ipate the best results. The modified variety of Baudens, the 
dorsal flap, or that of Roux, lateral flap, will never be chosen va- 
rieties, but adopted as dernier resort only. Even when the opera- 
tion is thus modified, the stump is eminently superior for utility, 
and the entire pressure upon its face, to any amputation of the leg. 
I have had two cases of the bilateral-flaps variety, made for 
want of plantar tissue, and cicatrized over the end of the stump, 
and one of the dorsal variety, upon each of which the patients 
bore their entire weight, with an artificial foot, with the utmost 
comfort. 
“ The following wood-cuts, of reduced size, taken from sim- 
ilar illustrations in the Monthly Journal, February, 1850, of Mr. 
Syme’s mode, give a more correct idea of the line of incision than 
can any verbal description. It will be seen that they differ very 
materially from those given in text-books. 13 
“Accidents.—The principal precaution to be observed is in the 
dissection on the posterior part of the os calcis, in order not to 
wound the posterior tibial artery, and thus deprive the flap of 
its nourishment.” 
This operation is perfected by beveling off1 the malleoli, which 
favors a perfect symmetry of the part constituting the ankle of 
the mechanical appliance. 
The cut represents the stump of Syme’s operation, which ena- 
bles the subject to take his support on its end, the same as on the 
natural heel. 
The compensative apparatus I have been the first to originate 
and apply in the United States; nor am I aware of any like 
legitimate treatment abroad. 
With it I have invariably made the face of the 
stump the basis of entire support, and with no inter- 
vening substance, other than one or two thicknesses 
of soft flannel cloth. The apparatus is composed of 
a light semi-cylindrical wooden case for the leg, re- 
ceiving the bulbous end of the stump in a concavity, 
at its lower end, fitted snugly to the posterior half 
of the parietes of the stump and leg for two-thirds of 
its length, while its base is entirely supported. Wide 
leather bands lace up over the anterior half of the 
leg, to keep it in situ. 
The case is strengthened with strong hickory pins, so dove- 
tailed as to prevent its splitting or yielding to the weight of the 
body. To the leg and stump case an artificial foot, of natural 
size and shape, is attached by a strong ginglymus ankle-joint, on a 
line nearly parallel with that of its mate. An artificial tendo-achillis 
passes up from the heel, through an inclosed groove into the calf 
of the casement, where it is strongly inserted. It preserves the 
Resulting Stump, 
Photographed. 14 
foot at a right angle with the leg part, when the weight of the 
body passes over and forward upon the ball and toe-piece of the foot. 
The latter is made to hug the ground, the same as the toes of the 
natural foot, by a strong lever and rubber spring. When the heel 
strikes the ground, the anterior part of the foot is depressed, but 
elevated sufficiently by rubber flexor springs, when the weight is 
off, to prevent tripping. The apparatus is covered with green 
rawhide, dried and contracted on, and coated with a neat flesh- 
colored enamel. It may be dressed with stocking, shoe or boot, 
at pleasure, the same as its fellow. 
With its application the patient is, to all appearance and for 
usefulness, restored to a normal condition. 
I repeat: The great and important feature of the Syme oper- 
ation at the ankle-joint is the natural, philosophical basis of 
support which the method retains, and the opportunity it affords, 
by a sufficient shortness, for the adaptation of a compensating 
artificial foot, and a ginglymus aiikle-joint in a proper place. 
The main and defensive feature of M. Pikigoff’s modification 
is the increased length of stump, created by the excision of the 
tibia and calcaneum, and the annexation of a greater or less por- 
tion of the latter to the former, for the service of the “poor man,” 
with the application of a “ bucket ” or “ boot.” 
Every physiological anatomist must readily perceive that the 
increased length of the stump, by an adventitious portion of the 
os calcis, will, in the ratio of its increased length, necessarily 
impair it for the application of legitimate mechanical appliance. 
Statistics furnish abundant evidence that it possesses no supe- 
rior advantage as relates to mortality, sloughings, necrosis, or other 
untoward events, over the Syme method; nor even as a reliable 
basis of support/ only to secure the benefits of an os-pegleg—the 
similitude of the wooden relic of barbarity. 
Science having for its true object practical and humane use, it 
becomes unwise for men to exercise their brains for unscientific 
purposes. 
The special interests of the subject of an amputation of the 
inferior extremity are the matters of importance—“ and how the 
patient may most fitly use the rest of his leg by walking on an 
artificial leg.” ISTo artificial leg has, nor can be constructed and 
adapted to any stump of the leg, having its parietes for support 
with such perfect favor, as that which I originated and adapt for 
ankle-joint amputations. The same apparatus, modified, may be 15 
applied to the Pirigoff modification, but the result is far less satis- 
factory. 
I never have a patient of a Syme amputation make use of a 
cane, nor walk in any other than the most natural gait. There is 
one condition of the ankle-joint in which the Pirigoff method may 
be adopted for the very great benefit of the patient, viz.: Where 
caries, necrosis, or injury of the tarsal end of the tibia, pre- 
clude the possibility of the Syme method, and would render the 
Pirigoff method a valuable alternative to an amputation of the 
leg at its lower third. In any such event, to excise the diseased 
tibia, and a sufficient amount of the calcaneum, and annex to the 
tibia to compensate its loss by excision, would be an additional 
fact to surgical improvement—a worthy expedient—but only as 
an alternative to the leg amputation. It would make the leg of 
normal length, and alike serviceable as a Syme case for the adap- 
tation of a befitting apparatus. 
The following is the expression of a Committee of the Medical 
Members of the Sanitary Commission on the subject of amputa- 
tions of the foot and ankle, viz.: 
“ Of the amputations through the tarsus, or at the ankle-joint, 
preference should be given to Syme’s operation, as affording a 
minimum mortality, with a stump best adapted to an artificial 
limb. An artificial limb may be applied to a Syme’s stump, 
which both relieves deformity and renders the patient’s gait free 
from the slightest halt.” 
Signed, 
Stephen Smith, M. D., Chairman. 
Valentine Mott, M. D. 
Gurdon Buck, M. D. 
John Watson, M. D. 
Alfred C. Post, M. D. 
Willard Parker, M. D. 
Ernest Krackowizer, M. D. 
W. II. Van Buren, M. D. 
The same sentiments as above expressed are entertained by 
the lirst surgeons of this city and country. 
The operation is performed by surgeons who are familiar 
with the minute anatomy of the foot and ankle, and the work of 
the operation with as great facility and ease as any amputation 
of the inferior extremity. 
The numerous operations I have witnessed have been per- 
formed in a brief space of time, with precision, and invariable 16 
success, though the diseased condition of some rendered the pros- 
pects of success very unfavorable, and taxed the skill of the sur- 
geon to secure sufficient healthy tissue for flaps to cover the end 
of the stump. 
The reported failures in military practice were no greater than 
it were rational to expect, and should not influence surgery in civil 
practice. 
The healing is often primary. I know of several cases that 
have been cicatrized in thirty days’ time; and in sixty days were 
traveling, the same as with natural feet, without canes, or halt in 
their gait. 
FINAL RESULTS. 
ILLUSTRATED WITH CUTS. 
These cuts, engraved from photographs, represent the case of 
Kate Riley, described in the letter of Dr. Stephen Smith. The 
graceful appearance of the apparatus when dressed, and the fact 
of her having performed the duties of hospital nurse for many 
years, are the best of testimony to its ingenuity and utility. 
syme’s operation with apparatus. 
APPEARANCE WHEN DRESSED. 17 
THE INTRODUCTION OF SYME’s OPERATION INTO AMERICA, AND ITS 
FIRST TREATMENT WITH SURGICAL APPARATUS. 
Dr. J. M. Carnociian to Dr. J. Simons, U. S. 
A., President of the Board for the Examin- 
ation of Artificial Limbs for Soldiers and 
Sailors, and Medical Director, Richmond 
Va.: ’ 
14 East 16th St., N. Y., April 15th, 1865. 
My Dear Doctor: 
Dr. Hudson has just recalled to me a fact, 
which I very willingly confirm, that he is the 
first to have given attention to the mechanical 
means suited to meet the conditions of the lower 
limb, after amputation through the ankle-joint, 
known now as Syme’s operation. Having been 
a pupil of Mr. Syme, on a more recent visit to 
Edinburgh, Syme was, at that time, engaged in 
introducing this operation, and soon after my 
return to this country, about 1852 or ’3,1 intro- 
duced the ankle-joint operation, I believe, for 
the first time here. Dr. Hudson, in 1854, ad- 
justed one of his pieces of mechanism on one 
of my patients much to my satisfaction. I 
make this statement, wishing to render justice 
to Dr. Hudson, believing, as I do, that he 
merits much credit for the various ingenious 
improvements he has added to mechanical surgery. 
Believe me, dear Doctor, 
Very truly yours, 
J. M. CARNOCHAN, 
Professor of Surgery, &c. &c. 
To Dr. J. Simons, U. S. A. &c. 
LETTER. 
FROM PHOTOGRAPHS OF STOMP AN D 
ARTIFICIAL FOOT. 
THE SECOND PLACE OF ELECTION 
Is in the continuity of the leg, at the junction of its lower and 
middle thirds; by measure, nine or ten inches from the lower edge 
of the patella. 
With well-formed and cicatrized bilateral flaps, the muscular 
insertions and powers being retained, the most serviceable stump 
of the leg is secured. 
With such a stump of the leg, and appropriate apparatus, ad- 
justed to its parietes—angles and crest—in a manner to distribute 18 
the weight of the body equally over its entire surface, in locomo- 
tion, the final success is secondary only to the sequelae of the 
ankle-joint amputation. 
THE THHJD PLACE 
To be elected for the amputation is at the junction of the middle 
and upper thirds, at a point three and a half or four inches from 
the lower edge of the patella. That is the highest part at which 
an amputation can be safely made, to have the artificial leg ap- 
plied with a stump socket, and to retain therewith the use of the 
natural knee-joint. Such a length of stump, when well composed, 
and treated with the application of apparatus, does very satisfac- 
tory service. The use of the natural knee-joint is thereby secured 
to the patient, who appreciates its inestimable value. As a matter 
/qf course, when amputation is required to be performed above the 
lower third, every available part of the middle thikd of the leg 
will be sjacredly retained ! 
The foregoing cuts represent a 
model stump of the leg, and the 
artificial leg for an amputation be- 
low the knee. 
THE FOURTH PLACE OF INCISION 
is at the extreme upper third of the 
leg. 
This place secures only a very 
short stump, which, when flexed at 
a right angle with the thigh, makes a valuable knee support for 19 
the application of a leg, with an exceedingly useful artificial knee 
joint. 
But the humane principles of modern surgeons have decreed 
this part to be no longer, as formerly, “ the place of election /” 
only to be accepted when disease or injury imperatively require it. 
Even where occasion occurs for an amputation at the upper third 
of the leg, it is no longer necessarily associated with the subse- 
quent use of a “ peg legfor in the great advancement of opera- 
tive surgery, therapeutic agencies have kept 
equal pace. Instead of the uncouth and 
cumbersome stick appended to the flexed 
knee, a very philosophically constructed 
limb is prescribed and adapted, which per- 
sonates the natural leg in form, length and 
joints, and in movements, utility and com- 
fort. 
In amputations of the leg, in proximity 
to the knee joint, the stump should be flexed 
at once at a right angle with the thigh, to 
anticipate the result of any affection of the 
knee joint which may subsequently arise. 
I have had to contend with several very bad 
cases, in the adaptation of limbs, because 
the surgeon neglected to flex the stump, 
which resulted in a complete anchylosis of 
the knee joint, with the stump in an extend- 
ed position. The face of such a stump be- 
ing intolerant of support presents an unfa- 
vorable condition of limb for the best of 
THE ACCOMPANYING CUT REPRESENTS THE KNEE-SUPPORTING ARTIFI- 
CIAL LEG. 
AMPUTATION THROUGH THE KNEE-JOINT. 
This operation may wisely be regarded one of the greatest and 
most humane improvements of modern surgery, when the benefit 
of the patient is taken into account. It is greater, in fact, than 
the very great one of Mr. Syme at the ankle-joint. For when we 
consider the comparative disability, from an amputation in the 20 
continuity of the thigh, and that from a leg amputation in the 
continuity, the importance of the knee-joint amputation, as an 
alternative for the former assumes its true magnitude. 
Amputation of the knee-joint is vastly superior to one of the 
thigh in the facilities afforded for the practical application of ap- 
paratus and its subsequent reliable use. With credit to conserva- 
tive surgery, many eminent surgeons have revived, with modifica- 
tions and improvements, the ancient operation of disarticulation 
of the knee-joint. They have attained a success which fully 
demonstrates its safety, vdiile subsequent treatment, with improved 
and appropriate artificial limbs, determines its superior utility and 
beneficence. When the condyles of the femur are vTell provided 
with a long anterior or posterior flap, firmly united w7ith corre- 
sponding short flaps, with or without the retention of the patella, 
the base of support which they present is pre-eminently superior to 
any possibly to be gained by a thigh stump from its walls and 
parts beneath the os ischium. The fitness of the articular sur- 
faces, when clothed with a long anterior or posterior flap, or even 
with anterior and posterior flaps united and cicatrized over the 
face of the condyles, for such mechanical pressure as is experienced 
from the weight of the body, in the application of the artificial 
limb, must at once impress the anatomist and physiologist as 
natural and rational. 
My experience in the treatment of many such cases, wdien 
contrasted with that in the treatment of a far greater number of 
thigh amputations, affords me the strongest evidence of the vast 
superiority of the condyles of the femur over the walls of the 
thigh for support and for locomotion. 
The exhibition of two cases of disarticulation of the knee to 
the Board of U. S. Surgeons, commissioned to examine and ap- 
prove artificial limbs and surgical apparatus, had the effect to 
conquer their pre-established prejudice to that operation and to 
create a lively interest in its favor. With a well-adjusted thigh 
-piece arranged to fit the condyles and fossa, and with trunnion 
bolts to attach the leg and compose an artificial knee-joint, with- 
out elongating the thigh beyond its fellow, the patient is very 
perfectly compensated in his loss. The retention of the entire 
thigh for leverage is thus secured, and proves an inestimable 
advantage. 
Of the varieties of flap the long anterior has presented the 
best results. It affords a smooth surface to the base, where pres- 21 
sure is in excess, and to the anterior angle which is the point of 
application of the lever power for the propulsion of the leg for- 
ward in taking the step. The posterior angle, less subject to pres- 
sure and irritation, is the location suitable for the cicatrix. 
The retention of the patella, so long regarded as an essential 
and conservative feature in this operation, is of indifferent expe- 
diency. When it is retained in situ it affords a graceful contour 
and smooth surface to the stump, and some addition to the base 
of support. But in a majority of cases the patella is retracted 
upon the anterior aspect of the thigh. In the operation the con- 
dyles of the femur should 
not be unnecessarily ex- 
cised. It has been fairly 
demonstrated that the ar- 
ticular surface of the 
condyles affords a more 
ready and reliable sup- 
port than cancellated 
tissue, and that it inter- 
poses no obstacle to a 
union of the various tis- 
sues, nor to healthy cica- 
trization. 
To exsect the epi- 
physes of the condyles, 
on a level with the supe- 
rior surface of the inter- 
condyloid fossa, to en- 
large the basis of sup- 
port, is altogether a 
gratuity, if not prejudi- 
cial. It is a gratuity as 
respects the base of sup- 
port, and the adaptation 
of an artificial limb, which affords concavo-convex surfaces corre- 
sponding to those of the condyles, and may prove pernicious by 
injury to the tissues, and their consequent protracted tenderness. 
The above cut illustrates knee-joint amputation with 
artificial leg applied. 
THIGH AMPUTATION. 
While this operation inflicts a greater degree of disability than 
any other of the inferior extremity, yet, with suitable means, the 22 
impairment can be largely compensated, and the subject is able to 
re-engage in ordinary pursuits. 
Much of the ability of one who has suf- 
fered a thigh amputation depends not only 
upon the place of the operation, its success- 
ful issue, a well-arranged and adapted arti- 
ficial limb, but also upon his energy and 
spirit of enterprise. 
The choice of place for the incision is at 
the junction of its lower and middle third, 
measuring a length of ten inches from the 
trochanter major, or from the perineum. 
The most perfect stump is composed by the 
bilateral or the circular operation, or a modi- 
fied variety, the union of the two—care 
being exercised so as not to have the angle 
extend up upon the anterior aspect of the 
stump, but mostly upon the posterior. The 
artificial leg should represent the general 
formation and functions of the natural leg, 
and be so applied as to yield full obedience 
to the retained powers of the stump. 
The disparity in manner of locomotion, 
between those wearing artificial limbs, is not 
always occasioned by the greater or less phy- 
sical advantage they possess ; neither by the 
quality of the artificial limb they use. Some 
men are natural acrobats, can readily and leu for thigh stump. 
perfectly balance. Others are easily trained to a graceful and easy 
movement, have precision and enterprise. But others are timid, 
irresolute, despairing, and lacking those happy faculties, which 
generally insure the more creditable performance and greater use- 
fulness. 
SANITARY AD VICE. 
When the stump of a thigh or leg has long been kept in a 
flexed position, and the flexor muscles are morbidly contracted, a 
continuous and persevering effort should be practiced to extend 
the stump till the patient regains a natural command of it, and 
the movements of the joints are entirely free. When the parts of 
the stump at its middle, or below, are larger in circumference than 23 
at the upper, they should be gently bandaged, and the bandage be 
renewed every night and morning, to reduce it to a tapering form 
for the better adjustment of the socket of the artificial leg, and 
also to compact the soft tissues when they are loose and flabby. 
To quicken circulation, to restore healthy tone, to relieve 
irritability or torpidity, cold and flaccid conditions of the stump, 
resort should be made to frictions with the hand or flannel, stimu- 
lating lotions, cold affusions, in connection with a flannel roller. 
SURGICAL SPLINT FOR UNUNITED FRACTURE OF 
FEMUR. 
(Extract from Hamilton on Fractions and Dislocations.) 
“ As a means of combining immobility with compression and 
healthy exercise, the apparatus immobile, in many of its forms, is 
peculiarly adapted. Dr. E. D. Hudson, of Hew York, has 
applied in similar cases an apparatus of his own construction, 
made of willow, and secured in place by leather straps. In case 
the purpose of the apparatus is to encourage bony union, no 
motion is allowed at the knee-joint.” 
This splint was originally furnished a middle-aged lady for an 
oblique fracture of the lower third of the femur, of which the 
parts had failed to reunite. After an unsuccessful resort had been 
had to the introduction of setons, DiefFenbach’s plugs, and other 
expedients, to excite an action of the opposing surfaces and 
surrounding tissues favorable to a reunion, it became desir- 
able to furnish the patient a means of exercise in walking. 
The limb was shortened by overlapping of the fractured part, 
one and a half inches, sufficient to allow the introduction 
of an inclined plane under the heel. A bolt passing at right 
angle through this inclined plane, connecting the splint to the 
latter, served as the lower point of support afforded by the splint; 
while the thigh socket, fitted to the parietes of the thigh, above 
the fractured part, and extending up beneath the glutei mus- 
cles and perineum, constituted the superior point of support. The 
primary object in this case was to keep the fractured parts in situ 
—to oppose the threatened protrusion of the superior fragment; 
while the final object was to compact the limb in the semi-cylindri- 
cal and immobile splint, and with a short splint over the anterior 
fractured parts, the whole limb being kept in place by strong 
leather bands, to effect a reunion. The action of the splint was 24 
every way satisfactory, to enable her to have the desired exercise 
and retain the fractured parts in 
apposition. What its ultimate 
effect was 1 am unable to report, 
as the lady went off to a remote 
part of the country. I anticipated 
a reunion of the fractured parts 
if the use of the apparatus should 
be carefully persisted in. When 
the limb is not shortened, the in- 
clined plane is dispensed with, and 
steel straps pass down under the 
foot, and constitute the lower 
point of support. Knee and ankle- 
joints are appended to the splint 
when desirable. 
Fig-1 
Fig.'i 
EXCISIONS OF THE TIBIA. 
A modified form of the splint 
for ununited fractures I have ar- 
ranged and applied to cases of 
excision of the tibia with the 
happiest effect. 
Several cases of excision of three to four inches of the tibia, 
while the fibula and the leg were of the normal length, have been 
restored to usefulness and locomotion without the aid of a cane by 
the adaptation of this modified appliance. The points (Tapjoui were 
established in the sole of the shoe and at parts above the excision, 
while the semi-cylindrical case and leather bands kept the supe- 
rior and inferior parts of the leg in their relative positions. 
The treatment fulfils two indications, viz : allows of the form- 
ation of intervening osseous tissue, while it enables the patient to 
engage freely in his accustomed avocation and locomotion. 
SPLINT AVITH STEEL 
STRAPS. 
SPLINT WITH IN- 
CLINED PLANE. 
THIGHS AND LEGS SHORTENED BY FRACTURES AND EXCISIONS 
TREATMENT OF CONTINUED. 
During the late war, many cases of extensive fracture of the 
thigh and leg were produced by gun-shots, in which, by the cred- 
itable effort of surgeons, the limbs were saved, but in a condition 
of great shortness and distortion. 25 
Very many cases of such a character have been assigned to 
me for compensative treatment, by special orders of the Surgeon 
General United States Army. 
They have resulted very creditably in naturalness of length 
and appearance and locomotion. 
The following cuts and history of two cases illustrate many 
others which I have successfully treated. 
Case 1st. J. F., Private Co. F., 127th N. Y. Infantry, wounded 
in his right thigh by a musket ball, in S. C., November, 1864. 
The femur was shortened seven inches, and seriously disfigured. 
The soft tissues were very much damaged and wasted by ab- 
scesses, the motion of the knee-joint limited, the foot rigidly ex- 
tended, arch increased, the whole limb suffering extreme debility 
and partial paralysis. 
To the foot, leg, and thigh, both lengthening and supporting 
appliance were adapted, which, in full dress, personated his well 
foot and limb ; and on it he walked with great naturalness and 26 
comfort. Six months after the apparatus was furnished, he 
reported himself as walking ordinarily without the aid of a cane, 
with scarcely any halting gait, and performing the duties of a 
watchman, which required much activity. 
Case 2d. J. J., Private Co. I, Yth N. Y. Heavy Artillery, was 
wounded in the upper third of the right thigh, by a minie-ball, at 
Cold Harbor, Va., June 3d, 1864; was taken prisoner; seven 
inches of the shaft of the femur were excised from and beneath 
the great trochanter, the second day after injury. His foot 
became rigidly extended, its arch very greatly increased, on the 
one part by morbid contractions, and on the other by partial paral- 
ysis. In September, 1865, I furnished extending and supporting 
apparatus to his foot and leg; a concave splint, with oscillatory 
joint, to support the injured and debilitated parts of the thigh. 
The success was very perfect, enabling him to walk on rough 
ground, in the woods and over fields on hunting excursions. 
MORBUS COXARIUS (OR HIP DISEASE) AND CONGENITAL DISLOCATIONS. 
The number of those on whom the disease and injury have 
wrought their baneful results demand an appliance which shall 
alleviate their irremediable deformities, and enable the sufferer to 
use and exercise the deformed limb in a manner likely to conduce 
to health, ease and beauty of dress. 
Some fifteen years ago I undertook, for the first time, the 
treatment of such a case, the applicant being a young lady, and 
with a success which has continued to the present time a rich 
reward by its utility and improvement of her general health; 
since which time the apparatus has been so modified and improved 
as to be applicable alike to men and women, and proved gratifying 
to all to whom it has been adjusted. It is light, strong, and dura- 
ble, and when applied gives the patient the appearance, in dress, 
length of limb, and action of the foot, of being whole, and enables 
him to wTalk a great distance without fatigue. 
Numerous cases have been presented for my advice and treat- 
ment. One young man of this city, whose limb was shortened 
six inches, who had been burdened with a heavy cork-boot, which, 
by its weight and dragging movement, greatly impaired his health 
and grace of action, says that no consideration would induce him 
to part with the artificial foot and its salutary effects. One young 
lady, with her limb shortened eight inches by congenital disloca- 27 
tion and lack of growth, now passes with her schoolmates as being 
apparently whole. There are many similar interesting cases to 
whom I am permitted to refer those who may desire such appli- 
ance, and to inform themselves of it by seeing its application and 
action. 
EXPLANATION OF CUT. 
The deformed limb below the knee is inserted in a light 
case, accurately fitted to the shape of the leg and ankle. It is 
retained by soft leather bands, laced in 
front. 
The foot rests on an inclined plane so as 
to reduce the anterior-posterior distance from 
toe to heel. A calf-skin boot or gaiter, full 
at the instep, may then be drawn over the 
whole, and pants of the usual shape and 
size can be worn, and will entirely conceal 
the deformity. All parts are properly pad- 
ded. The artificial foot corresponds in size 
with the foot of the other leg. The artificial 
ankle-joint obviates the excessive limping 
and physical strain experienced in the use 
of cork boots and stirrups. It also allows 
the patient to gain the natural length of 
step. 
APPARATUS FOR EXCISIONS. 
The possibility of compensating the osseous structure, powers, 
and functions of the arm, that have suffered by excision, and re- 
storing it to usefulness, had not been entertained by surgeons in 
this country prior to the war—neither has it been in Europe. 
Even previous to 1862—when I was first incited by the applica- 
tion of a volunteer soldier, with nearly five inches of his arm and 
fore-arm resected, to study up an apparatus which should restore 
his arm to usefulness—a supporting splint was all that had been 
expected. 
The apparatus which I furnished him—and a like case soon 
after—so far restored the fore-arm to the exercise of its normal 
powers as to enable the patient to carry a dumb-bell of many 
pounds weight, with the arm and fore-arm extended at a right 28 
angle with the body, and thence by flexion to his head, and to 
engage with his accustomed usefulness in his usual vocation as a 
farmer. 
EXSECTION OF THE ELBOW. 
EXSECTION' OF THE ELBOW TREATED. 
The successful issue of the case being reported to the Surgeon- 
General of the United States army, special orders were given for 
apparatus to be furnished for other cases—of excision of the head 
and shaft of the humerus, of the entire humerus, etc. Their treat- 
ment was followed by the detailing of a Board of Surgeons to ex- 
amine the merits of the apparatus. The apparatus presented—its 
artistic beauty, the scientific and anatomic principles observed in 
its construction and adaptation, the physiological functions which 
it supplies either in whole or part, and its great practical success 
—secured for it an extended consideration. It received the high- 
est personal encomiums of the members of the Board, and was 
deemed of such importance as to merit a separate commission. 
This commission applies to all cases of resection—of the humerus 
—ulna and radius—as well as of the joints. 
I have been the first to propose to the profession the treatment 
of resections of the elbow and shoulder with compensative appa- 
ratus. One hundred and thirty cases in military and civil practice 
have been successfully treated during the past three years. To 
supply lost leverage, to give rigidity to the muscles, to restore the 29 
functions of flexion, extension, pronation, and supination—im- 
paired by wounds of the muscles or motor nerves—and leave the 
arm in a condition favorable to the reproduction of bone, and 
possible reunion, are the objects sought and obtained by this ap- 
paratus. It is destined to, work a great change in the operative 
surgery of the superior extremity. With its introduction, the 
only objection to resection—uselessness of the mutilated arm—is 
obviated. This operation will be almost exclusively substituted 
for amputation. 
A more extended treatise on resections, and their treatment 
with apparatus, is contained in a Monograph—“ Remarks on Ex- 
sections, with Cases and Plates, by E. D. Hudson, M. I)., Hew 
York.” The above monograph contains descriptions of ten selected 
cases of resections, including resections of the shoulder and elbow- 
joints, resection of the entire humerus and heads of the ulna and 
radius, resection of the upper, middle, and lower thirds of the 
humerus, and resection of the ulna and radius. 
These cases, viewed individ- 
ually and collectively, throw 
much light on the many ques- 
tions of expediency—the com- 
parative success and utility of 
different modes of incision, the 
retention of a single articular 
surface, &c.—involved in the 
subject of resection; while the 
application of apparatus, of 
recent suggestion, demanding 
the retention of every power 
and function of nerve and mus- 
cle, so far as is possible, sets 
aside the modes of operating 
formerly employed, which, 
seeking no such end, mutilated 
both, looking only to the suc- 
cessful removal of bone, speedy 
healing, and the formation of 
a false joint or intervention of anchylosis. 
The apparatus, or rather the system of apparatus—for each 
case demands an individual appliance, modified by the combina- 
tion of site, mode, and extent of operation, and the number ot 
CASE OF RESECTION OF THE SHOULDER-JOINT. 30 
functions retained or impaired—is not intended to act upon the 
injured arm as a passive object alone, but to facilitate the use of 
every power and the exercise and ultimate restoration of lost vigor 
and impaired functions. 
Where no vital nerves or important muscles have been severed, 
its usefulness is immeasurably augmented rather than obviated, as 
has been erroneously supposed. It retains the different parts at 
their natural distances from each other, supplies the place of the 
removed bone for leverage, holds the muscles within their proper 
limits, and augments their power by compressing them, as the 
pugilist bands his arm. A patient with resection at the elbow, 
when the insertions of the brachialis anticus, biceps, and triceps, 
have not been impaired, can pull forcibly and carry much weight 
in a vertical line, but with an apparatus he can in time raise heavy 
weights to the head, strike powerfully, and perform all that neces- 
sity requires with ease. Hence the superiority of its use to reli- 
ance on anchylosis or the formation of a false joint. 
The weight of the en- 
tire arm being suspend- 
ed by the apparatus, the 
injured, debilitated, and 
atrophied muscles of the 
shoulder are not only 
relieved of that burden, 
but are thickened up by 
the support afforded by 
the appliance. By ex- 
ercise they soon begin 
to gain tone and con- 
tractility, and to regain 
their natural strength. 
The truncated humerus 
is drawn upward to a 
greater or less extent in 
proximity to the glenoid 
cavity—in some instan- 
ces in juxtaposition with 
it, or the acromion pro- 
cess, where a false joint 
is formed by ligament- 
ous tissue of sufficient strength and motion, to permit, in process 
RESECTION OF SHOULDER WITH 
APPARATUS APPLIED. 
APPARATUS FOR RESEC- 
TION OF SHOULDER. 31 
of time, the disuse of the apparatus entirely or in part. By such 
treatment I feel assured that many cases of extreme excision of 
the humerus will eventually subject the patient to little or no 
inconvenience, except by the loss of length. In no instance should 
the arm or fore-arm be sacrificed by an amputation, except when 
the vital tissues have been destroyed by injury, or are involved in 
malignant disease. 
EXTENSOR APPARATUS FOR TIIE WRIST. 
The Extensor, Carpi Digitorum (see cut), is a light, sim- 
ple and efficient instrument, designed for the extension of the 
wrist and hand, in cases of paralysis of the extensor 
muscles of those parts, in the not infrequent occur- 
rence of what is termd “ wrist-drop,” which is occa- 
sioned by injuries to the nerves, by gun-shot wounds, 
operations of excision, or by lead poisoning and 
other forms of disease. Such cases I have often been 
required to witness, and furnish mechanical means 
to extend the hand, antagonize and alternate the 
action of the flexor muscles of the wrist, hand, and 
fingers. 
This little apparatus has proved every way effi- 
cacious. 
In its incipient use the action is representative. 
its therapeutic influence is to produce primary pas- 
sive action ; subsequently it serves to aid volition and 
a sanitary condition. Its levers, joints, stanchions, 
cords and rubber springs are very reliable aids, can 
be increased in power as occasion requires, to restore the hand to 
the exercise of its natural functions. 
In a number of such cases resulting from gun-shot injuries it 
has been applied with great benefit. 
EXTENSOR 
APPARATUS. 
ARTIFICIAL IIARDS AND ARMS. 
FOE AMPUTATIONS AND CONGENITAL DEFECTS. 
The hand and arm are new and successful imitations of the nat- 
ural ones; every joint and the contour of the fingers, wrist, and 
elbow being retained in their construction. They possess the 
functions of flexion and extension, for grasping and holding, and 32 
for every service which intelligence can expect in an artificial 
hand and arm. The 
many who have availed 
themselves of this beau- 
tiful and valuable de- 
vice are well pleased 
with it, not only for its 
perfect imitation of the 
natural hand in dress, 
but for its efficient 
service, especially in 
an amputation of the 
fore-arm. Plaster Paris casts of the unamputated hand and arm, 
and of the stump, are essential for governing the size and symme- 
try in the construction of the artificial ones. A very beautiful 
and serviceable hand is made for congenital malformations of 
hands and arms. 
HONORARY TESTIMONIAL TO THEIR MERIT. 
I have never presented these arms in competition for United 
States patronage. Their delicate mechanism and artistic finish 
render it impossible to furnish them at Government prices. 
My desire to supply apparatus of first-class workmanship and 
utility only, and my conviction of the secondary usefulness of even 
the best artificial arms, debarred me from the construction of an 
inferior article. Such, however, are made by others, and are of 
some practical utility. To the Board of United States Surgeons, 
convened in New York in 1864, in connection with other surgical 
apparatus presented for adoption by the Government, and for 
which I received commissions,! exhibited the artificial hand and arm 
as a scientific, ingenious, and artistic piece of mechanism, and to 
illustrate my interest in every department of mechanical surgery, 
and my ability to treat every form of mutilation in this as well as 
in its many other branches with perfected apparatus. It was 
carefully studied and admired, and received honorary mention in 
the Report of the Board to the Surgeon-General, as being a work 
of art for lightness, grace of action, naturalness of dress and util- 
ity, superior to all others. 33 
Expressions of the Profession. 
FROM THE LATE DR. VALENTINE MOTT. 
No. 1 Gramercy Park, N. Y., March 26, 1862. 
Bear Sir: I am gratified to find that you are giving your attention to what 
may properly be called Mechanical Surgery. As a regularly educated profes- 
sional man you can repair the mutilation which surgery has to make much 
more effectually than the mere mechanic. It will give me pleasure to take ad- 
vantage of your skill in the arrangement of surgical appliance. 
Yours, truly, 
VALENTINE MOTT, M. D., 
Emeritus Prof, of Surgery in the New York University, &c.; 
Surgeon to Bellevue and St. Vincent's Hospitals, &c. 
Dr. Hudson. 
New York, March 24, 1865. 
E. D. Hudson, M. D., the successor of Messrs. Palmer & Co. in the manu- 
facture and application of artificial limbs, I have known many years. Many of 
my patients have had the advantage of his skill, and he has given unfailing 
satisfaction. I believe him fully entitled to the confidence of the profession 
and the public. WILLARD PARKER, M. D., 
Prof. Surgery, College Physicians and Surgeons; 
Surgeon to Bellevue and New York Hospitals. 
14 East Sixteenth St., N. Y., March 27, 1865. 
Bear Sir : I am much gratified to learn that you still continue to devote 
your attention to the mechanical part of Surgery, which has for its aim the 
substitution and perfection of artificial limbs, to take the place of those on 
which disease has made the severe operation of removal necessary. Your edu- 
cation as a physician and surgeon enables you to carry out the indications 
which the peculiarities of individual cases must present, and thus the profes- 
sion, and patients who have been so unfortunate as to have required amputa- 
tion, will have the advantage of your mechanical ingenuity, as well as of your 
scientific acquirements. 
The perfection to which the artificial limbs you are now engaged in manu- 
facturing have been brought, and their recognized utility, place them among 
the valuable additions which intelligence and civilization have, in recent times, 
supplied for the amelioration and benefit of humanity. The professional com- 34 
munity will undoubtedly avail themselves of your capabilities in your special 
vocation, as I shall assuredly do when occasion requires. 
Very truly yours, 
J. M. CARNOCHAN, M. D., 
Dr. E. D. Hudson. Prof, of Clin. Surg. N. Y. Med. Col.; 
Surg.-in-Chief to the State Emigrant Hospital, &c. 
No. 121 Tenth St., N. Y. March 27, 1865. 
The undersigned, from personal knowledge of Dr. E. D. Hudson’s skill and 
success in the adaptation of artificial substitutes for amputated limbs, takes 
pleasure in recommending him to the patronage of the profession, and of all 
who stand in need of his services. The high esteem enjoyed by Dr. H. hitherto 
in his professional relations, as well as his skill and experience acquired in the 
special department to which he devotes himself, entitle him to confidence and 
respect. GURDON BUCK, M. D., 
Surg. to N. Y. Hospital and St. Luke's Hospital. 
New York, March 26, 1865. 
My Dear Sir: I am gratified to know that you have formally adopted, as 
a specialty, the replacing of mutilated limbs, etc., by mechanical appliances. 
By bringing this duty to humanity properly within the pale of your profession, 
a step is gained in advance. It will give me pleasure to avail myself of your 
advice and assistance when occasion offers. Your entire success with the two 
cases of Syme’s amputation at the ankle-joint was equally gratifying to my 
patients and to myself. Most truly yours, 
WILLIAM II. VAN BUREN, M. I)., - 
Dr. E. D. Hudson. Surg. to New York Hospital, etc.; 
Prof, of Anatomy in New York University. 
From personal knowledge of your success in supplying useful artificial 
limbs, I cordially indorse the sentiments of Dr. Van Buren. 
JAMES R. WOOD, M. D., 
Surg. to Bellevue llosp. and Prof, of Surgery, etc. 
No. 4 East 17th Street, N. Y., Aug. 22, 1865. 
I have now for many years employed Dr. E. D. Hudson’s artificial limbs, 
and have had every reason to be well satisfied with their performance. In am- 
putations at the knee and ankle-joint his appliances are admirable, and I know 
of no superior artificial limb to that which he adapts to stumps made in the 
continuity of the leg. 
T. M. MARKOE, M. D., 
Surgeon to New York Hospital ; Prof. Adj. 
College Physicians and Surgeons. 35 
New York, August 21, 1865. 
My Bear Sir: I take pleasure in adding to the many expressions of ap- 
proval which you have already received from the profession. But I wish here to 
make particular mention of your specialty in the adaptation of an apparatus 
to supplant the clumsy shoe worn by patients who have suffered amputation at 
the ankle-joint, whether after the method of Syme or Pirigoff. From time to 
time I see the soldier on whom Pirigoff’s operation was performed in the field, 
and who still wears your apparatus much to his satisfaction. The two cases 
of Syme’s operation are also much gratified with their new feet, and walk 
without a halt. 
I have also examined, with no little interest, your apparatus for the excis- 
ion of the elbow-joint; I consider its introduction calculated to encourage 
surgeons in their efforts at conservative surgery of the upper extremities. 
In conclusion, permit me to express my satisfaction at the interest and 
kindness you have manifested in the patients sent you from the Central Park 
U. S. Hospital, during the period of my administration of that institution. 
Hoping you will continue as untiring in your well-directed efforts in Mechani- 
cal Surgery, and wishing every success, 
I am, sir, very respectfully, 
Your obedient servant, 
J. W. S. GOULEY, M. D., 
Demonstrator of Anatomy, University Medical 
College, N. Y., and Surgeon to Bellevue and 
St. Vincent's Hospitals, N. Y. 
To. E. D. Hudson, M. D., Clinton Hall, N. Y. 
I have been long acquainted with Dr. Hudson, and have for many years 
recommended my patients to him for artificial limbs. While in charge of the 
U. S. General Hospital in Central Park, organized for the reception of soldiers 
requiring artificial limbs, my opportunities forjudging of his skill were unu- 
sual. 
I do not hesitate to recommend all of his work; but I desire to call especial 
attention to his very ingenious mechanism for the support of limbs on which 
resections have been practiced. 
FRANK H. HAMILTON, M. D., 
Prof. Military Surgery, Bellevue Hospital. 
Medical College, New Yorle. 
64 Madison Avenue, N. Y., Aug. 22, 1865. 
New Yoke, August 25, 1865. 
Dr. E. D. Hudson. 
Dewr Sir : It gives me great pleasure to certify to the practical utility of 
the artificial limbs which you have applied to patients under my observation 
Your appliance to stumps in amputations at the ankle-joint, by Symers method, 36 
has, in my experience, been the perfection of usefulness. In the case of Kate 
Riley nothing could have been more satisfactory; not only could she walk 
without embarrassment, but no imperfection in her gait was perceptible. She 
performed her duties as nurse in Bellevue Hospital for several years, running 
up and down stairs, walking great distances, without her peculiar disability 
becoming known, either to her associates or to the Resident Medical Staff. 
While connected with the U. S. General Hospital at Central Park, I had 
abundant opportunities to study the results of the application of artificial 
limbs, and the uniform satisfaction which your appliances gave impressed me 
with their practical value. 
Yours, truly, STE PHEN SMITH, M. D., 
Surgeon Bellevue Hospital; Prof, of 
Principles Surgery, Bellevue Hosp. Med. Col., etc. 
New York, Aug. 24, 1865. 
Dr. E. D. Hudson,—Bear Sir: During two and a half years’ service at U. 
S. A. General Hospital, Central Park, New York, I have very frequently exam- 
ined the different mechanical appliances which you have furnished to the 
mutilated soldiers, and have been most favorably impressed with the skill, 
judgment and care with which they have been arranged; but I would espe- 
cially mention the excellency of your artificial foot for amputations at the 
ankle-joint, and your apparatus for resections of the elbow and shoulder-joints, 
also that for exsection in continuity of the humerus. I feel fully satisfied that 
by your ingenious mechanical treatment of resections of the upper extremities 
many limbs have been made exceedingly serviceable which otherwise would 
have remained comparatively useless; and that no artificial arms can perform 
the functions which these limbs do with the assistance of such apparatus. 
Very respectfully yours, S. TEATS, 
Late A. A. Surgeon U. S. A. 
UNITED STATES ARMY AND NAVY. 
FROM DR R. S. SATTERLEE, BRIG.-GEN. U. S. A., MEDICAL 
PURVEYOR, ETC. 
I have been for several years conversant with Dr. E. D. Hudson’s efforts in 
the cause of conservative surgery, and have seen his appliances for the benefit 
of not only those who have suffered the loss of legs and arms, but especially 
his apparatus for operations at the ankle after the manner of Professor Syme, 
and in restoring action in resection of joints; and I think the Medical Profes- 
sion and the public are under great obligations for his perseverance, and the 
degree of perfection to which he has brought his substitutes for nature in those 
cases. It gives me great pleasure to make this statement. 
R. S. SATTERLEE, M. D., 
Brig.-Gen. and Medical Purveyor U. S. A. 
Medical P dr ye yob's Office, 
New York, Aug. 24th, 1865. 37 
Office of the Chief Medical Officer, 
New York, January 28, 1867. 
While Medical Director of the Department of the East, I was in constant 
business relation with Dr. E. D. Hudson, Manufacturer of Artificial Limbs and 
of Mechanical Appliances, etc., for resections. 
In my whole intercourse then and since I was well satisfied with his entire 
ability and anxiety to do justice to the soldier and the Government. 
Being a medical man, he united professional skill with mechanical knowledge 
and gave great satisfaction. His mechanical appliances for resection were a 
specialty, and proved remarkably successful. 
WM. J. SLOAN, 
Surgeon U. S. Army ; 
Brig.-General, Chief Med. Officer, N. Y. City. 
Medical Purveyor’s Office, 
Philadelphia, Jan. 29, 1867. 
While on duty as Medical Director Department of the East, at New York 
city, for about two and a half years, I gave many orders for artificial limbs 
and mechanical appliances upon Dr. E. D. Hudson. It was my practice always 
to examine personally the limbs and appliances before they were accepted, and 
I can therefore testify intelligently to the honesty and faithfulness with which 
the orders were filled. The artificial limbs and apparatuses for resections sup- 
plied by Dr. Hudson gave entire satisfaction, and I heartily concur in the opin- 
ion given by Gen. Sloan. 
C. McDOUGALL, 
Brig.-Gen. U. S. Army, Medical Purveyor. 
U. S. Naval Hospital, N. Y., 
Brooklyn, Aug. 25, 1865. 
Dear Sir: I have been much gratified with the result of your treatment of 
the numerous cases of mutilation sent you from this hospital. 
Your professional knowledge, with your mechanical skill, has enabled you 
to furnish the most perfect relief to each particular case; and the results must 
have been exceedingly gratifying to the recipients. 
I can, therefore, fully recommend you to all those who may have the misfor- 
tune to lose the use of their limbs by exsection or amputation, for the mitiga- 
tion of their afflictions, as far as human means can. 
Very respectfully, 
Your obedient servant, 
THOS. L. SMITH, 
Surgeon U. S. N, in charge af Naval Hospital. 
To E. D. Hudson, M. D., 
Clinton Hall, Astor Place, New Yorlc. 38 
COMMISSIONS FOR ARTIFICIAL LIMBS. 
the Surgeon- General of the United States Army. 
At the outset of the war, the American Medical Times proposed that the 
United States should make appropriations of money to furnish artificial limbs 
for soldiers who had lost their legs and arms in the service. Congress made 
appropriations, and referred the entire matter to the Surgeon-General of the 
United States Army. 
Three Boards of Surgeons were convened at different periods during the 
war, who patiently and deliberately examined every artificial limb which was 
presented for their investigation of its merits. The respective boards were 
composed of Dr. Valentine Mott, New York; Dr. R. S. Satterlee, U. S. Army, 
Medical Purveyor; Dr. Bache, U. S. Navy; Dr. Win. II. Van Buren, New 
York; Dr. Gross, Philadelphia; Dr. Warren, Boston; Dr. C. Mc- 
Dougall, U. S. Army, Medical Director; Dr. A. B. Clement, U. S. Army; Dr 
J. Simons, U. S. Army; Dr. Hewitt, New York. 
From some thirty varieties of limbs only eight were selected and recom- 
mended by the different boards, for the Commission of the Surgeon-General, 
to be furnished to soldiers. 
The following are the Commissions which my own apparatus received : 
Surgeon-General’s Office, 
Washington City, D. (7., May 13, 1865. 
Dr. E. D. Hudson, New York City. 
Sir: In accordance with the recommendation of a Board of Medical Offi- 
cers, recently convened in the city of New York, you are authorized to furnish 
to mutilated soldiers, upon the order of the Medical Director of a Department, 
Artificial Legs, of the approved pattern presented by you to the Board. 
By order of the Surgeon- General. 
Very respectfully your obd’t servant, 
W. C. SPENCER, 
Surg. U. S. Army. 
N. B.—This is the third commission granted by the United States to Dr. 
Hudson, who has furnished artificial legs to the Government during the war. 
Surgeon-General’s Office, 
Washington City, D. C.. May 13, 1865. 
Dr. E. D. Hudson, New York City. 
Sir: In accordance with the recommendation of a Board of Medical Offi- 
cers, recently convened in the city of New York, you are authorized to furnish 
to mutilated soldiers, upon the order of the Medical Director of a Department, 
Artificial Feet, of the approved pattern presented by you to the Board. 
By order of the Surgeon- General. 
Very respectfully your obed’t servant, 
W. C. SPENCER, 
Ass't. Surg. U. S. Army. 
N. B.—Dr. Hudson is the only one commissioned to apply Artificial Feet 
in cases of Syme’s Operation at the ankle-joint. 39 
Surgeon-General’s Office, 
Washington City, D. C., 
May 18, 1865. 
Dr. E. D. Hudson, New York City. 
Sir:—In accordance with the recommendation of a Board of Medical Offi- 
cers, recently convened in the city of New York, you are authorized to furnish 
to mutilated soldiers, upon the order of the Medical Director of a Department 
Apparatus for Resection of Elbow and Shoulder Joints, of the approved pattern 
presented by you to the Board. 
By Order of the Surgeon-General, 
Very respectfully your obed’t servant, 
W. C. SPENCER, 
Ass't Surg. U. S. Army. 
SPECIAL COMMISSIONS. 
Numerous cases of extreme mutilations of the femur by comminuted 
fractures; excisions, distortions, ununited fractures, destruction of muscular 
tissues, extensive shortness, partial anchylosis, excisions of the tibia—of tibia 
and fibula—fractures and distortions of the feet, partial paralysis of extensor 
and flexor muscles; excisions of carpal end of radius, paralysis of extensor 
muscles of the hand—have been assigned to me for special treatment with ap- 
paratus adapted to each individual case, by the special orders of the Surgeon- 
General of the United States Army. 
Their treatment with surgical apparatus—in a majority of cases impro- 
vised to fulfil indications—resulted very successfully. 
SOLDIERS AND SAILORS 
who have lost their limbs, or suffered resections of their limbs 
while in the service of the United States, and have not been fur- 
nished artificial limbs, or apparatus, by the United States, are 
entitled to the very best, free of expense to themselves, and also 
transportation to and from the place where the limbs are pro- 
vided. 
To obtain such limbs, apparatus and transportation, they must 
make application for the limb, or apparatus, and send— 
1. Their discharge paper; 2. Officer’s certificate and affidavit; 
and 3. The soldier’s own affidavit; which papers are delivered to 
the Medical Director of the Department of the East, who will 
issue an order to have the limb or apparatus furnished, and there- 
upon return the discharge paper, accompanied with transportation 
papers. The soldier, if he prefers, can make his application and 40 
send his papers to the Medical Director of the Department in 
which he resides. 
Special Cases of damaged limbs, as ununited fractures, short- 
ened legs by comminuted fractures, excisions, distortions, extensive 
lesions of muscles, injury of nerves, and partial paralyses, are fur- 
nished on application, with necessary papers, by reference to the 
Surgeon-General of the United States Army for his special con- 
sideration, and special order, with mechanical apparatus. 
Every application made to myself will be speedily attended to, 
and the entire wishes of the patient gratified. 
SANITARY CONDITION OF STUMPS, 
FOK THE APPLICATION OF ARTIFICIAL LIMBS. 
They should be entirely healed, the cicatrix strong and healthy. 
The joints retained should be free in their movements for normal 
extension and flexion. The contraction of flexor muscles of either 
the thigh or leg stumps, though often extreme, is readily over- 
come by a little persevering effort, except where the muscles have 
been much injured, and abnormal adhesions have occurred; which 
condition must be accommodated or modified, if it cannot be 
remedied. 
When chronic disease, debility, wasting, and laxity of tissues 
have occurred, either before or subsequent to the amputation, 
gentle and even bandaging of the entire stump should be prac- 
ticed and persevered in till the artificial limb has been applied— 
to not only compact and give tone to the soft parts, but to make 
the stump slightly and evenly tapering. 
Ablutions and affusions with cold water, night and morning, 
and friction with the hand, are valuable expedients to create a 
quickened and healthy condition. 
The mechanical stimulus of the socket and exercise of an 
artificial leg oftentimes relieve the stump of neuralgic pains, un- 
less the nerves are involved in cicatrices or disease. Diagrams are 
sent to patients for measurements. Patients can economize both 
time and expense by sending their measurements, which their 
physician can take, and a statement of their case, before they come 
for the adaptation, trying and completion of their limbs—AS 
EVERY LIMB AND* APPARATUS IS MADE TO ORDER. 41 
Testimonials of Patients. 
Certificates are so readily obtained from patients for even the most inferior 
articles, and such gross deception has been practiced in their use, that I am 
induced to give only a few cases as exponents of the general satisfaction af- 
forded by my treatment and apparatus, and its decided usefulness. 
CASES 
Illustrative of the Value of Ankle-joint Amputations. 
Case I.—J. E. A., Private Co. E., 8th N. Y. Cavalry. Wounded in the foot 
comminuting the tarsus, July, 1863. Amputation of the ankle-joint—Svme’s 
method—same day of injury, on the field. Oct. 18, 1863, transferred to Central 
Park U. S. General Hospital. Stump much swollen; tissues thickened, ulcer- 
ated, with indications of incipient necrosis. Appearances unfavorable. By 
good treatment the stump became healthy, though damaged some by abscesses. 
In January, 1864, I furnished apparatus for the case. The incipient use was 
satisfactory. Soon after he returned to the army associated with a sutler. He 
is now engaged as a clerk in the War Department, and informs me that in 
every appearance—standing, locomotion, dancing—he passes for a whole man. 
Can walk all day and feel no inconvenience. “ I can only say I have two good 
legs.” 
Case II.—P. C., Private 7th Mich. Yols. Suffered amputation of his 
ankle-joint. In October, 1866, I furnished him a foot. Incipient use very cred- 
itable, with entire weight on the end of his stump. At first trial he experienced 
a slight prickling, a temporary sensation. Nov. 11th, 1866, day after he returned 
home, he walked three miles with comfort; sensations all normal. The more 
he uses his foot the better, and feels every way whole and competent for his 
farming. 
Case III.—W. D., Private 6th Wisconsin Yols. Suffered amputation of 
the ankle-joint; Syme’s, modified by dorsal flap. Apparatus, adapted to Plas- 
ter Paris cast of stump, and sent by express, was applied 1st November, 1866. 
In December, after thirty days’ use, he wrote : “ The adaptation was perfect. I 
applied the foot—got up and walked with perfect ease and naturalness. I 
have traveled five miles continuously with it and experienced no fatigue. I 
am light-house keeper, and find it of inestimable value in going up and down 
stairs, of which I have much to do.” 
LEG AMPUTATIONS 
are the most common, and their compensation is uniformly successful and 
pleasing. 42 
Mr. P., civil engineer, has been in use of the artificial leg I furnished him 
fifteen years ago. Is in active duty, surveying out routes for railroads; traveling 
over hills and valleys ; climbing precipices, and performing the various fatig- 
uing duties of his profession. He never uses a cane. Residence, New York 
city. 
Mr. M., late soldier N. Y. Volunteers, lost his leg in the war. He is fur- 
nished an artificial leg by the Government. Has returned to his farm, is on his 
feet same as other farmers, from morning till night, in summer and winter. 
He stands in his lot apparently well, and ordinarily uses no cane. 
Of the Upper Third.—The following cases illustrate the value of the 
knee support, when the stump is flexed upon the thigh at a right angle, in 
conjunction with an apposite artificial leg, viz.: 
H. K. D., Farmer, Schuyler, N. F., lost his limb in the United States ser- 
vice ; informs me that he with his brother did all of the work on a dairy farm 
of 180 acres (except ten days of hired labor), milked fifteen cows, plowed, 
hoed, raked, and pitched hay, same as when he was whole; and in the winter 
loaded in the woods heavy logs, alone rolling them up, and drawing them to 
the saw-mill. He has worn the leg three years. 
M. Moses, Carpenter, Wisconsin, lost his leg at its upper third, in the United 
States service, and uses a knee-supporting artificial leg. He informs me 
that he works at his trade, as formerly, and frequently walks six and eight 
miles to his place of work. That he lifts as heavily as ever upon his limbs, 
upon which he is standing or walking much of Ills time. He has used his arti- 
ficial leg three years without repair. 
OF LEG AMPUTATIONS. 
Twelve consecutive cases, for which I have applied artificial limbs, the 
success has been invariably useful and pleasing. M. Conroy, who suffered 
amputation of his knee-joint eleven years ago, writes that he has used the 
artificial limb I furnished and adapted to the condyles of his stump ever since, 
and at continual hard work, with great command. 
Miss T. suffered an amputation of her leg, near the head of the tibia, in 
1859, for a complete anchylosis of the knee-joint. She writes: “I walk and 
work upon the limb you furnished me as I never expected to again. I am 
very happy in my new life. Use no cane, and walk as my companions do.” 
OF KNEE-JOINT AMPUTATIONS. 
C. L., 2d Lieut. Vet. Res. Corps, promoted from private, after the artificial 
limb was applied ; stump very bad, caused by extensive and almost fatal gan- 
grene—says: “ I have been on constant duty in Tennessee since April, 1864, 
one month after the artificial limb you furnished me was applied. I have 
walked long distances, have been able to ride horseback nearly if not quite as 
well as ever I could. The leg has more than given satisfaction. The leg is 
to-day as good as ever.” Has used his leg nearly three years. 
SINGLE THIGH AMPUTATIONS. 43 
Lieut. Neidhart says: “I am navigating with this walking machine of 
yours excellently well, and write you to-day only to express my gratification 
and thanks.” Oct. 25, ’66. 
H. C. D’W., First Sergt. U. S. Yet. Reserve Corps, walks nearly four miles 
within an hour. Since his limb was furnished has been in active U. S. service 
three years, and promoted from a private to first sergeant for his services. 
DOUBLE THIGH AMPUTATIONS. 
1. C. N. L., late Co. K, 1st Vermont Cavalry. One thigh amputated, and one 
knee-joint amputated, July —, 1863. Writes August 23, 1866: “I am doing 
finely with the pair of artificial legs, and the aid of canes. I keep improving. 
I find no difficulty in getting off or on railway cars, and steamboats; and in 
getting about quite independently. I suffer no irritation of my stumps; and 
after more than one year’s experience, and comparing my limbs with every 
other kind, I am satisfied with my selection. Bridport, Vt.” 
BOTH THIGHS AMPUTATED. 
C. G. R., at St. Luke’s Hospital, wounded in 
battle at Petersburgh, 1865. February 22d, ’66, 
writes to me that he can use his legs very well 
with the use of canes; get up and down stairs 
with a cane and railing; walk out of doors; 
and regards the limbs of great benefit for 
walking or sitting. To which Rev. Dr. Muhl- 
enburgh, Pastor and Superintendent, appended 
that the above statement was correct, that Dr. 
Hudson had done more for Mr. R. than he be- 
lieved possible. 
Mr. J. S. Sanford lost his legs in 1851, and 
was furnished a pair of artificial limbs by me ; 
one for the thigh, with an artificial knee-joint, 
and one for the leg amputation, which he is 
now using. He never uses but one cane, and 
about his ordinary business no cane. He is on 
his limbs most of the time as freight agent, and 
in other active duties. He goes up and down 
stairs with great facility, and is considered one 
of the most valuable of the men in the employ 
of the N. J. Central Railroad Co. 
[See Cut.] 
sanfoed’s case. To Ladies. 
Reference, and Special Information concerning the 
Artificial Limbs, and other Appliances, and Advice, will be 
furnished to any Lady who applies for them. 
Pamphlets are sent gratis. 
Ladies who apply for Limbs, or Apparatus, receive 
courteous and kind attention, and also every assistance 
desired to obtain pleasant and inexpensive homes when 
they visit the City.