The Cultural Body

History of Prostheses

The earliest description of a limb prosthesis is found in Herodotus' The Histories written in 484 BCE. Herodotus tells of a Persian soldier, Hegesistratus, who was imprisoned by the enemy. In order to escape from the stocks, Hegesistratus cut off part of his own foot. He later wore a wooden replacement. The oldest known prosthesis, which was discovered in a tomb in Capua, Italy, was an artificial leg made out of copper and wood dating back to 300 BCE. Unfortunately the leg was destroyed by bombing during World War II. In the 15th and 16th centuries many prostheses were made from iron. They were created for soldiers by the same craftsmen who made their suits of armor. Ambroise Pare, a French army surgeon, contributed both to the practice of surgical amputation and to the design of limb prostheses.
102. Leg Prostheses 16th century This iron leg designed by Ambroise Pare was the first known to employ an articulated knee joint. Courtesy of John Martin Rare Book Room
103. Civil War Leg Prostheses circa 1865 Leg prostheses worn by Corporal David D. Cole for an amputation performed at the knee joint. Courtesy of the National Museum of Health and Medicine	Many innovations were made in the 19th century. Lighter-weight prostheses made from wood instead of metal gained popularity. In 1800, James Potts designed his famous wooden "Anglesey leg" which lifted the toe when bending the knee through the use of artificial tendons. In 1812 an arm prosthesis was developed which produced movement in the arm and hand using straps connected to the opposite shoulder. Interest in artificial limbs increased late in the century due to the large number of amputations during the American Civil War. That prosthesis technology advanced during this time was primarily due to two factors - the availability of government funding of prostheses for war veterans and the discovery of anesthetics such as chloroform and ether, which allowed longer surgeries during which more functional amputation stumps could be shaped. These more carefully designed stumps enabled prosthetists to improve the fit of their devices.
In response to the plight of World War II amputees, the National Academy of Sciences established the Artificial Limb Program in 1945. This agency promoted and coordinated scientific research with the goal of improving the design of prosthetic devices. Much emphasis was placed on investigating the movement of normal human limbs so that prostheses could be designed to appear as life-like as possible. Doctors and engineers worked together in many of these projects. Advances in biomechanical understanding, the development of new materials such as plastic, and the use of computer-aided design and manufacturing have all contributed to the creation of many new prosthetic devices.
104. Arm Prostheses circa 1903 Ordered by mail from the A.A. Marks Manual of Artificial Limbs, this device was used for a shoulder-joint amputation. It is held in place by straps around the body, and is capable of rotating above the elbow. The elbow flexion and extension are controlled by a flexion strap. A hook is used in place a hand for the "laboring man," since it is "the most desirable and useful implement." Courtesy of Donald Shurr, CPO, PT, Iowa City

	105. Hand Prostheses 16th century Iron hand designed by Ambroise Pare. Courtesy of John Martin Rare Book Room

The Recreated Body
As medical scientists continue to study the anatomical and molecular aspects of the human body, they have also developed means of altering and reconstructing the physical body. While replacing the physiological function of internal organs is a recent advance, the anatomical replacement of missing body parts has a long history. Evidence of the making of artificial eyes, ears, noses, and teeth recorded in illustrations has been found in archeological digs of tombs dating pre-2500 BCE.

The sheer quantity and complexity of medical implants and prosthetic devices have increased dramatically in recent years. Not only can the outside of an ear be reconstructed, but so can the working part of the ear, the cochlea, which transmits sound signals to the brain. From joints to breast implants, heart valves to artificial eyes, prostheses are available for many different parts of the body.

Quack practitioners have also long promoted the rebuilding of the human body. With false promises of medical expertise, they have sold health and beauty aids intended to "improve" the body. Advertised as "medical devices," they have been accepted by many buyers as legitimate, efficacious products.

Valauri, Augustus J., "The History and Development of Facial Prostheses," Advances in Ophthalmic, Plastic, and Reconstructive Surgery, 9(1992):243-60.

109. Face lift
Examples of before and after cosmetic surgery.
Reproduced by kind permission of the publisher. Richard B. Stark,
Aesthetic Plastic Surgery, Boston: Little, Brown and Company.

110. Rhinoplasty (nose job)
Examples of before and after cosmetic surgery.
Reproduced by kind permission of the publisher. Richard B. Stark,
Aesthetic Plastic Surgery, Boston: Little, Brown and Company.