DESCRIPTION 
OF THF 
ORTHOPEDIC APPARATUS 
EMPLOYED IN THE 
TREATMENT OF DEFORMITIES AND DEFICIENCIES 
OF THE HUMAN BODY, 
WITH 
DIRECTIONS FOR TAKING MEASUREMENTS FOR THEIR 
APPLICATION. 
SIXTH EDITION* 
BY 
D. W. KOLBE & SON, 
Manufacturers of Surgical Instruments, 
Mechanists to the Philadelphia Orthopaedic Hospital, 
and 
Instrument Makers to the Pennsylvania Hospital. 
No. IB SOUTH NINTH-STREET. 
1207 ARCH STREET. 
PHILADELPHIA: 
COLLINS, PRINTER, 705 JAYNE STREET. 
1879. Entered according to act of Congress, in the year 1871, 
BY D. W. KOLB£, 
in the Office of the Librarian of Congress, at Washington. TWO MEDALS AND DIPLOMAS 
Awarded to D. W. KOLBE, 
By the U. S. CENTENNIAL COMMISSION, 
ON 
SURGICAL INSTRUMENTS, 
For the following reasons, viz:- 
For superior quality and workmanship: 
ON 
ORTHOPEDIC INSTRUMENTS, 
viz:- 
For the most practically constructed and best finished Orthopedic 
Instruments, combining durability and adaptability: 
AND ON 
ARTIFICIAL LEGS AND ARMS, 
viz:- 
For superior workmanship, quality, and fitness for purpose of limbs. PREFACE TO THE FIRST EDITION. 
Having been frequently consulted by physicians and others living at a distance, as 
to the mode of taking measurements for the construction of mechanical contrivances 
for the treatment of deformities and deficiencies of the body, I have been induced to 
prepare this catalogue, which contains accurate directions in these particulars, so that 
blunders cannot possibly occur if these directions are properly followed. 
The forms of instruments described are of the most approved kinds, and embrace 
the most recent advances ami discoveries in mechanical therapeutics, as exhibited in 
the latest and most elaborate works on this subject. They are sanctioned by the 
large mass of practising surgeons, as shown in Prof. Gross' System of Surgery, and 
in Dr. Wales' Mechanical Therapeutics, in which works fuller accounts of these 
apparatus may be found. 
I am prepared to furnish, besides the above-described apparatus, any form of sur- 
gical appliance or modification of apparatus that may be ordered by the surgeon. 
D. W. KOLBE. INTRODUCTION. 
Six years have elapsed since I issued the first edition of my pamphlet 
on Orthopaedic Apparatus, and the success it has met with has embold- 
ened me again to present it in an enlarged and revised form. 
My connection with the invention and improvement of mechanical 
appliances for the treatment of deformities and deficiencies of the human 
body for nearly thirty-five years, both in this country and in Europe, 
has given me an aggregate of experience second to none engaged in 
the pursuit of this practical art. The result of this experience has 
been the development of many new principles in mechanical thera- 
peutics, and the invention of improved and new apparatus, among 
which I may mention my apparatus for club-foot, which, by all odds, 
takes the highest rank in the esteem of the profession. The great 
advantages possessed by this instrument over all others have led many 
persons to appropriate my invention and to claim the merit of its dis- 
covery. In order to sustain my claims I will present as succinctly as 
possible the facts upon which they are based, and trace the origin and 
perfection of my apparatus. 
It was in 1781 that Scarpa devised the first shoe with a steel plate for 
the relief of club-foot, and his was the principal method of treatment 
until Stromeyer introduced the operation of the division of the tendo- 
Achillis in 1831. 
This operation, requiring as it did appliances to maintain the positions 
designed and perfect the cure of the deformities for which it was insti- 
tuted, may be said to have imparted new energy to, if it was not even 
the initial or starting-point of, the present scientific system of mechanical 
therapeutics. 
I began to study the manufacture of surgical instruments and ortho- 
paedic appliances in 1837, at Marburg University (founded 1521). 1 
soon learned that, in order to make good and useful instruments, I must 
be acquainted with operations, and that the construction of suitable 
appliances necessitated an anatomical knowledge of those parts, at least, 
most frequently affected by deformities. In 1842, I acted more fully 
upon previously formed resolutions by witnessing, at Cologne, a number 
of operations for the relief of deformities in general, and of club-foot in 
( 5 ) 6 
particular, for which latter a modification of Stromeyer's instrument was 
used in the after-treatment, it being considered the most perfect appa- 
ratus at that time. It was, however, incapable of holding the foot in the 
required position without causing pain, and often became the cause of 
unfavorable results. After various experiments I succeeded, in 1843, 
at Brussels, Belgium, in making the first important improvement in the 
foot-piece, which corresponded with the medio-tarsal articulation ; and 
this I adapted to the apparatus of Dr. Martin, while in Paris during 
1844, '45, and '46, it being the one in general use at that time through- 
out France; in fact, my entire time, while in Paris, was devoted to 
the manufacture of instruments and apparatus, while I did not neg- 
lect the advantages offered by surgical clinics. In a word, I studied 
the science in its adaptation to cases, and became identified with its 
progress in the principal cities on the continent. When I came to this 
city, in 1847, I found that I had wisely directed my attention previously, 
and that there was a demand for such instruments and appliances as 
I was able to furnish. This fact, together with the indorsement of 
our eminent surgeons (whom I shall ever hold in grateful remembrance), 
induced me to devote every energy to the development of both the 
science and the art of those parts of my business which had already 
engrossed so much of my attention and study; and I think I may add 
that if I have given more time than others to the perfection of apparatus 
for the relief of deformities, it has been associated with a modest esti- 
mation of my ability to do so. The number of cases placed under my 
care for the mechanical part of the after-treatment of club-foot enabled 
me, through the practical experience gained, to so simplify and improve 
my apparatus that it became, even in 1855, well represented in works 
on surgery, and favorably received by the medical profession throughout 
the land. 
In 1867, the Philadelphia Orthopaedic Hospital was established, and 
I was appointed its mechanist. The large number and the great variety 
of cases which have already been successfully treated at this hospital, 
are additional evidence that I have made many improvements in appa- 
ratus for the mechanical treatment of deformity. Various plans of 
treatment of club-foot and construction of apparatus have been sug- 
gested from time to time, but have never met with success, because their 
inventors were lacking both in experience and mechanical skill, so that 
they are more certain to disappoint than to give satisfaction to the 
practitioner who may be induced to rely upon them. 
The following directions for the application of my articulated club- 
foot shoe, as shown in Fig. 9, page 9, will be of use to those desiring 
success in the treatment of cases. 7 
In infants affected with equino-varus, and when the surgeon intends 
not to divide the tendons, the foot is manipulated into as nearly the 
normal position, as the contracted tendons and the displaced tarsus 
will allow without being provocative of inflammation : in this position it 
is firmly held, while a bandage, extending up the-leg, is carefully applied, 
so that the entire foot is covered and protected from the apparatus, 
which, after being adjusted, should then be applied. As this apparatus 
simulates the natural motions of the foot, and is intended to retain the 
position produced by the manipulations, it should be adapted to this 
purpose by its regulating screws. 
In placing the foot in the shoe, see that the sole is in perfect appo- 
sition with the sole of the shoe, and the heel well back, the latter pre- 
caution being one of the most important and essential of the directions 
to be observed; still holding the foot firmly, lace the gaiter, and buckle 
the straps around the leg and thigh, in order that those bands, which 
have connected with them the lateral bars, may be properly adjusted. 
The heel is held in the desired position by the regulating screw at the 
ankle-joint, and should equalize the pressure of the gaiter lacing over 
the instep. The foot is turned outward by the screw concealed at the 
bottom of the heel; the steel frame on the side and front part of the 
shoe which resists the inversion of the foot, should fit well over the 
great toe, and it is sometimes necessary to adjust it, which can easily 
be done, as it is made of annealed steel which permits its being bent. 
When this direction is well complied with, it is not important to lace 
the front part of the shoe. 
As it is necessary that the patient should wear the shoe constantly, 
it should be removed and reapplied twice daily for the first week, after 
which once daily is sufficient; and the foot should be manipulated and 
bathed at each removal of the apparatus. After a period of from three 
to six weeks, an ordinary stocking may take the place of the bandage, 
and the continuation of the treatment be intrusted to the parents or nurse. 
In children old enough to walk, and whose feet have been brought 
into the normal position, it is advisable to use, during the day only, an 
additional and less complicated shoe, which, from its confining the foot 
in the required position, without the necessity of adjustment, while at 
the same time it allows the natural movements of locomotion, it is called 
the walking shoe (see Figs. 11, 12, 13, 14, pp. 9, 10). This shoe should 
be worn until the foot has become sufficiently strong to retain the natu- 
ral position without the aid of support. The advantages derived from 
having shoes for both night and day use may be thus stated:- 
1st. They are less expensive eventually. 
2d. They are more comfortable to the patient. 
3d. They are more effectual in establishing a cure. 8 
The last is due to the fact that the one which is most likely to be 
interfered with is worn at night, while that worn during the day cannot 
be disarranged. 
The walking shoe should not be confounded with the ordinary weak- 
ankle supporter furnished by some makers, for, although it is similar in 
appearance, in construction and application it is very different. 
Immediately after the division of the tendons in those cases requir- 
ing it, the foot should be brought into as nearly as possible the normal 
position, and the directions previously given carried out, great care 
being observed in the application of both bandage and apparatus to 
avoid excoriation. Three or four hours after the operation it will be 
well to loosen the apparatus, but not enough to allow the foot to resume 
its deformed position. The next day both the apparatus and bandage 
should be entirely removed, so as to bathe and examine the foot; and 
in reapplying them, cotton or some soft material should be interposed 
so as to prevent pressure for too long a time on any given spot. 
In from four to six days the inflammation will have sufficiently sub- 
sided to allow manipulations at every removal of the apparatus during 
the treatment. Tenotomy is advisable in most of the cases not corrected 
up to two years of age, and from that to twenty years of age and more, 
should be performed not only as an adjunct to the treatment, but as a 
proceeding upon which a cure can alone be promised. To this general 
rule for tenotomy, some paralytic cases will, of course, form exceptions. 
Sometimes cases of long standing are presented for treatment; they 
may have walked with their deformity, or have had operations frequently 
performed without success; in these the tarsal malformations are firm and 
the overlying tissues thickened and shortened, and even after tenotomy 
is performed, the strength of the surgeon will be found insufficient to 
break up the adhesions, stretch the parts, or restore the foot to its normal 
position, and yet without this it would be useless to attempt a cure. In 
such cases my club-foot stretcher (see Fig. 15, page 10) is to be used. 
Success in very severe cases has attended its use in the Philadelphia 
Orthopaedic Hospital, where the custom is to place the patient under the 
influence of an anaesthetic, perform tenotomy, and then apply the 
stretcher; the articulated shoe (Fig 10, page 9) is then put on, and the 
treatment conducted as before described, and if the stretcher is used 
from time to time, it will be found that in two or three weeks the walk- 
ing shoe may be worn. 
By permission of the Board of Surgeons of the Philadelphia Ortho- 
paedic Hospital, I have added, for illustration to the various appliances, 
a number of wood-cuts, accurate copies of photographs of some of the 
extreme deformities treated at that charity. 
D. W. KOLBE. Fig- 1. 
Fig. 2. 
Talipes varus. 
Talipes valgus. 
Fig. 3. 
Normal foot. 
Fig 4. 
Fig. 5. 
Talipes equinus. 
Talipes calcaneus. 
9 10 
APPARATUS FOR DEFORMITIES OF THE LOWER 
EXTREMITIES. 
Talipes varus, valgus, and equinus. 
Apparatus for Club-Foot» 
Fig. 6. 
GUIDE FOR MEASUREMENTS. 
B A. Circumference at the middle of thigh. 
K L. Circumference below the knee. 
G F. Circumference above the ankle. 
I H. Circumference over instep and heel. 
C D. Length from middle of thigh to centre 
of knee-joint. 
D E. Length from centre of knee-joint to sole 
of foot. 
To give a correct idea of the deformity, 
place the foot on a sheet of paper and 
draw a line around it, to obtain its con- 
tour, as shown in Figs. 7 and 8. It will 
be found in children from two years of 
age upwards, who have been unsuccess- 
fully treated, that, for want of support 
from the heel, the muscular power of the 
knee has been impaired, causing the knee 
to bend backward and inward. This fact 
should be mentioned in ordering, as the 
apparatus can be constructed to remedy 
this defect. 
Fig. 7. 
Fig. 8. 
Varus. 
Valgus. 
State age and sex of the patient; also whether tenotomy has been, or 
will be, resorted to. 11 
Fig. 9. 
Fig. 10. 
Kolbe's articulated club-foot shoe for 
the correction of talipes varus, valgus, 
and equinus, either in connection with 
tenotomy or by manipulation alone. 
It is preferable in children from a few 
Weeks to three years of age. 
Kolbg's articulated club-foot shoe Tor 
the correction of talipes varus, valgus, 
and equinus. It is preferable in pa- 
tients from three years of age and up- 
wards, and intended for night use in 
particular. 
Fig. 11. 
Fig. 12. 
KolbS's walking shoe for the after- 
treatment of club-foot, with support for 
the knee-joint. It is preferable in cases 
where the knee bends backward and 
inward. 
Kolbe's walking shoe for the after- 
treatment of club-foot. It is preferable 
when the knee-joint is perfect. 12 
Fig. 14. 
Kolbe's walking shoe for the after- 
treatment of club-foot. It is preferable 
in cases where paralysis of the exten- 
sors is marked, or the contraction of the 
tendo Achillis has not been entirely 
overcome. 
Kolba's walking shoe for the after- 
treatment of club-foot, showing the po- 
sition for application. The lateral bars 
should not be brought in position until 
the shoe is laced and the strap fastened 
over the instep. 
Fig 15. 
Kolbe's club-foot stretcher. 
Fig. 15 illustrates Kolbe's club-foot stretcher. It consists of a foot- 
board in which are imbedded three regulating screws; its mechanical 
action is fully illustrated by the wood-cut. It can be used for the right 
or left foot by simply changing the screws to which the straps are 
attached from the one side to the other. The cushion, which acts as a 
counter-lever at the heel, simply needs to be screwed to the opposite 
side. 
When the foot is thus placed in proper position, the surgeon has 
entire control over it, and can manipulate it with facility. 13 
Calcaneal Club-Foot. 
GUIDE FOR MEASUREMENTS. 
Fig. 16. 
Circumference above the knee. _4_ 
Circumference below the knee. 
Length from middle of thigh to centre of knee, from 
centre of knee to sole of foot. 
In taking the measurements of the foot, let it 
rest lightly on a sheet of paper, and draw a line 
around it. Take the circumference immediately 
above the ankle, around the heel and instep, over 
the instep, and around the toes. 
State age and sex of the patient. 
This apparatus resembles somewhat the one 
described on page 9, Fig. 11, used in the after- 
treatment for Talipes varus, valgus, and equinus. 
It differs from it, however, in possessing a spiral 
or India-rubber spring attached between two cir- 
cular arms stretching across from one lateral bar 
to the other, one above, and the other below the 
centre of the ankle-joint. By the action of the 
spring the elongation of the tendo Achillis is 
overcome. The sole of the shoe is provided 
with a steel plate sufficiently strong to maintain 
the normal position of the plantar arch. 
Talipes calcaneus. 
Fig. 17. 
Figs. 
18. < 
19. < 
20. < 
21. - 
Application of Kolla's 
apparatus for Talipes 
calcaneus. 
Four different forms of tenotomy knives. 14 
Fig. 22. 
Fig. 23. 
Result after the division of tendons 
and fascia with walking shoe applied. 
(From photograph.) 
Double inverted club-foot. (From 
photograph.) 
Fig. 24. 
Fig. 25. 
Double inverted club-foot and club- 
hand. (From photograph.) 
Result after the division of tendons 
and fascia with apparatus applied. 
(From photograph.) 15 
Apparatus for Bunions. 
Fig. 26. 
GUIDE FOR MEASUREMENTS. 
Circumference over the instep. 
Outline of the foot obtained by placing it on 
a sheet of paper and drawing a line around 
it. See Fig. 7, page 8. 
Biggs' Apparatus. 
Figs. 27 and 28 illustrate a more simple mode of treatment for the 
relief of bunions. A soft cup-shaped pad of thick leather or felt, with an 
Fig. 27. 
Fig. 28. 
opening in the centre, is placed directly ovei* the 
bunion, the toe is straightened, and while held in 
that position a long narrow strip of adhesive plaster 
is turned around the extreme end of the toe, from 
which point it is thrown crosswise tightly over the 
pad and fastened around the foot, as shown in the 
drawing. The pad prevents the bunion from irradiating, and forms a 
part of a lever to hold the toe in the normal position; a shoe or boot 
may be worn with comfort, but it should be sufficiently large to prevent 
the toes from being forced together. Renewal of the adhesive plaster 
from time to time will secure a satisfactory result. 16 
Apparatus for Genu valgum, or Knock-Knee. 
Fig. 29. 
GUIDE FOR MEASUREMENTS. 
-+• Circumference of upper third of thigh. 
-+• Circumference above knee. 
-b Diameter of knee. 
-t- Circumference below knee. 
Length from upper third of thigh to centre of 
knee; from centre of knee to sole of foot. 
In taking tne measure of the foot, let it rest 
lightly on a sheet of paper, and draw a line 
around it, as illustrated in Fig. 7, page 8. 
Take the circumference immediately above the 
ankle, around the heel and instep, over the in- 
step, and around the toes. It is also desirable 
to have the outlines of the inner side of the 
knee-joint, which can be obtained as directed 
on page 33, angular curvature. The age and 
sex of the patient should be given. 
Knock-knee is an inward inclination of one 
or both knees, caused by a relaxed and elon- 
gated condition of the internal lateral ligament 
of the knee-joint, and increased by the superin- 
cumbent weight of the body. To relieve this 
deformity, numerous mechanical contrivances 
have been constructed and employed. The one 
represented in Fig. 30 is the simplest and most 
convenient for the patient to wear, while its 
efficacy is none the less. It consists of a plain 
shoe, to which two lateral steel bars, reaching 
to the upper third of the thigh, are attached, and 
connected with calf and thigh bands; and it is 
provided with joints corresponding with the 
natural articulations, to allow locomotion. The 
knee is confined in its normal position by a well- 
padded cap. 
Fig. 30. 
KolbS's apparatus for 
knock-knee. 17 
Fig. 31. 
Fig. 32. 
Result of mechanical treatment. 
(From photograph.) 
Knock-knee. (From photograph.) 
Fi<r. 34. 
Fig. 33. 
Knee bending backward. (From pho- 
tograph.) 
Result of mechanical treatment. 
(From photograph.) 18 
Apparatus for Genu extrorsum, or Bow-Legs 
Fig. 35. 
GUIDE FOR MEASUREMENTS. 
-I- Circumference of upper third of thigh. 
-»- Circumference above kuee. 
-Diameter of knee. 
-t- Circumference below the knee. 
-t- Circumference. 
The length to be taken on the inner side of the 
limb, from the upper part of thigh to the cen- 
tre of knee, from the centre of knee to sole of 
foot. 
The curvature of the outside of the leg should be given, which can be 
obtained as directed on page 33, angular curvature. The age and sex 
of the patient should also be stated. 
In taking measure for the shoe, see page 14. 
If the deformity is very marked, a photograph 
showing the form of the lower extremity will 
be advantageous. 
As bow-legs is a deviation in the opposite 
direction to that of knock-knee, whether it re- 
sults from elongation of the external ligaments 
of the knee, or by curvature of the leg bones, 
the mechanical appliance for it illustrated in 
Fig. 36 is constructed upon the same princi- 
ple as that described on page 14, Fig. 30, with 
the difference that, in addition, a steel plate 
well padded is attached to the external lateral 
bar, and regulated by means of screws, while 
at the same time provision is made, by the con- 
tinuation of the leather padding, to correct 
anterior curvature of the tibia. 
Fig. 36. 
Kolbe's apparatus for 
bow-leg. 19 
Apparatus for Anterior and Lateral Curvature 
of the Leg. 
Fig. 37. 
Fig- 38. 
(Guide for 
measurements, 
see page 16, 
Fig. 35. 
Apparatus for anterior curvature of 
the leg. Adaptable only in slight cases 
of this deformity. 
Bigg's apparatus for lateral curvature 
of the leg. As the patient's locomotion 
is impaired by the application of this 
apparatus, it is not recommendable. 
Fig. 39. 
Fig. 40. 
Bow-legs. (From photograph.) 
Result of mechanical treatment. 
(From photograph.) 20 
Apparatus for the Ankle. 
Fig. 41. 
MEASUREMENTS. 
Circumference immediately 
below the knee. 
Length from centre of knee 
to sole ot foot. 
State the age and sex of pa- 
tient. 
Mention to which side the 
foot is inclined. 
The measure of the foot 
should be given as di- 
rected on page 14. 
Kolba's apparatus for weak ankles, 
The construction of the above apparatus is similar to that of the 
appliances already described. It is an excellent support in sprains, 
and in dislocation of long standing, where the deformity is very marked. 
A plaster cast of the foot will be of advantage in making the apparatus. 
Fig. 42. 
In measuring for Fig. 42, give 
the circumference of limb 
below the knee, at the calf 
.nd ankle, around the heel, 
over the instep, at the toes, 
and length of foot. 
State whether the splint is to 
be applied to the inner or 
outer side; also whether 
for right or left leg. 
The above is an illustration of a wire splint useful in the treatment 
of dislocations and sprains of the ankle-joint. It forms also a light 
and easy splint for the treatment of fractures of the leg. 
Fig. 43 shows Boisnot's apparatus for dislocation of the ankle-joint, 
resections, &c. This apparatus explains itself, and is applicable where 
a continuous line of support is desired from below the knee. Exercise 
may be taken, and dressings applied without removal of the instrument. 
Fig. 44 represents Kolbe's extension apparatus for dislocations of the 
ankle-joint. The apparatus is similar in construction to that shown in 
Fig. 41 for weak ankle, with the addition of two extension screws con- 
nected with the lateral stems, and also a regulating screw at the ankle- 
joint, by which talipes equinus is prevented. 21 
Fig. 43. 
Fig. 44. 
(For measure- 
ments for these 
appliances, 
see page 18, 
Fig. 41.) 
Boisnot's extension apparatus for disloca- 
tion of the ankle-joint, resections, &c. 
Kolbe's extension apparatus for dis- 
locations of the ankle-joint. 
Apparatus for Anchylosis of the Knee-Joint. 
Guide fob Measurements.-Circumference of limb at D C, B A, L H, and K I. 
Length from E to F, and F toG. The measure for 
shoe to be taken as directed on page 14. 
Fig. 45. 
Fig. 46. 
Fig. 46 shows the application of Kolbe's apparatus for anchylosis of the knee- 
joint. At the suggestion of Prof. Pancoast this apparatus has been modified so 
as to extend to the foot, thereby giving the patient additional comfort and sup- 
port, and greatly, facilitating walking. 22 
Fig. 47. 
Fig. 48. 
False anchylosis of knee-joint. 
(From photograph.) 
Result after forcible breaking up of ad- 
hesions and division of hamstring tendons, 
with apparatus. (From photograph.) 
Apparatus for Fracture of the Patella. 
Fig. 49. 
Fig. 50.' 
Boisnot's apparatus. 
(See "Transactions of the American Medi- 
cal Association," 1S65.) 
Measurements : Circumference of 
thigh. 
Circumference of leg. 
State age and sex of patient. 23 
Fig. 51. 
Fig. 52. 
Levis' apparatus. 
Hartshorne's apparatus. 
Dr. Levis' apparatus (Fig. 51) consists of a strap padded where it 
lies above the patella. This strap is continued down the leg on each 
side, and is buckled to a padded stirrup-like strap, which gives a fixed 
point for extension from the sole of the foot. There is also a broad 
pad which rests behind the knee. Through a ring attached to this pad 
the first strap passes, and thus has its direction changed. The lower 
fragment of the fractured patella, having no force to displace it, is 
retained in position merely by a strip of adhesive plaster. 
The apparatus is complete in itself, requiring no splints, and is adapt- 
able to limbs of any size. 
It is claimed that with this apparatus a patient can be well treated 
while walking about on crutches. 
Measurements : Circumference above knee, and length from knee to 
sole of foot. 
Dr. Hartshorne's apparatus (Fig. 52) consists of a light tin case, 
fitting to the limb behind, lacing in front of the thigh and the leg, and 
provided with straps (elastic or not, according to circumstances), which 
are to be applied as usual across the joint, above and below the patella, 
and drawn obliquely, to be fastened and tightened by means of a wedge, 
screw, or hooks. 
Measurements: Circumference of thigh and leg. 
State age and sex of patient. 24 
Fig. 53. 
Lansdale's apparatus. 
Dr. Lansdale's apparatus for the treatment of fracture of the patella 
consists of-1. A splint of one-inch pine board, concave at each end to 
receive the thigh and calf, six inches wide and eighteen inches long. 
2. A muslin bag six inches square, filled with sawdust and sewed up, 
and tacked to the middle of the splint, to afford a firm support to the 
knee-joint and keep it in an easy position of slight flexion. 3. Two 
iron bows to button on each side of the splint near its extremities, and 
having a female screw in the middle to receive two thumbscrews, each 
operating on a semilunar pad backed with iron. 4. Across each ex- 
tremity of the splint should be tacked a piece of bandage or strong tape 
(not represented above); these are to be brought 
up and tied over the thumbscrews, to prevent the 
pads from riding up over the patella when the 
screws are tightened. 
Measurements: Circumference of thigh and leg. 
State age and sex of patient. 
Fig. 54 illustrates Kolb6's apparatus for support- 
ing fracture of the patella with ligamentous union. 
This apparatus may be safely used in cases where 
the fragments of the bone are separated from half 
an inch to an inch. 
Measurements: Circumference of thigh and leg. 
State age and sex of patient, and whether it is 
the right or left leg. 
Fig. 54. 
Kolbe's apparatus. 25 
Apparatus for Coxalgia, or Hip Disease. 
Fig. 55 is intended as a guide for measurement for the apparatus for 
hip-joint disease. 
Fig. 55. 
G F. Circumference of body. 
A B. Length from centre of hip-joint to 
middle of patella. 
B C. From patella to sole of foot. 
D E. Length of sound limb. 
Circumference above and below the knee. 
State which limb is affected, the age and sex of the patient. Also 
a sketch or outline of the position in which the patient holds his limb 
is desirable. 
If the apparatus in Fig. 62 or Fig. 64 is selected, it is necessary to 
send the measurement of the foot, as a shoe must be attached to the 
apparatus. The measurement for a shoe should be taken as directed 
on page 14. 
Figs. 56 and 5T illustrate the wire splint and the mode of its appli- 
cation in hip disease. This splint is intended as a substitute for the 
carved splint. For measurements, see Fig. 55. 
Figs. 58 and 59 illustrate a modification of Davis' extension splint for 
coxalgia, and the mode of its application by means of adhesive plaster 
and roller bandage. For measurements, see Fig. 55. 
Fig. 60 illustrates an extension apparatus for coxalgia, devised by 
Dr. S. W. Gross. It can be applied by means of adhesive plaster or a 
gaiter, as shown in the drawing. For measurements, see Fig. 55. 26 
Fig. 60. 
Fig. 59. 
Fig. 58 
Fig. 57. 
Fig. 56. 27 
Figs. Cl and 62 illustrate an extension apparatus for coxalgia, and 
the mode of its application, devised by Prof. J. Pancoast. No adhesive 
plaster is used. For measurements, see Fig. 55, page 23. 
Figs. 63 and 64 illustrate an extension apparatus for coxalgia, and 
the mode of its application, devised by Prof. D. H. Agnew. No ad- 
hesive plaster is used. For measurements, see Fig. 55, page 23. 
Fig. 61. 
Fig. 62. 
Fig. 63. 
Fig. 64. 28 
Apparatus for Ununited Fracture, Resections, and 
Dislocation of Hip-Joint. 
Fig. 67. 
Fracture below 
the knee. 
Fracture above 
the knee. 
1 igs. 65 and 66 exhibit tne apparatus of 
Prof. H. H. Smith for the treatment of ununited 
fracture. 
A similar apparatus is also an excellent sup- 
port in resection of the thigh and leg. 
Fig. 67 illustrates Kolbe's apparatus for dislocation of the hip-joint, 
ununited fracture of the neck of the femur, and resection at the upper 
part of the thigh. 
Guide for measurement, see Fig. 69, page 28; and to point out the 
seat of fracture or excision of the bone, see Fig. 68, page 27. 
For ununited fracture or excision of the bone below the knee, take cir- 
cumference at O, N, M, K, and I; the length from R to L, and L to H. 
For ununited fracture above the knee, upper part of the thigh, neck 
of the femur, or dislocation of the hip-joint, take circumference at M, 
K, I, G, and C, D ; length from R to L, L to F, and F to D. 
The length from R, sole of foot, to the perineum a little above the 
line H, should also be given. 
In measuring for shoe, see page 14. 
State which limb is affected, the age and sex of the patient. 29 
Fig. 68, a drawing of the bones of the thigh, leg, foot, and a portion 
of the pelvis (in their normal state), is inserted in order to mark the seat 
of fracture or excision of the bone, which is necessary, in addition to the 
measurement, for the construction of the apparatus. 
Fig. 68. 
Acetabulum. 
Fsi> ur. 
Patella. 
Tibia. 
Fibula. 
The astragalus. 
Os cal cis. 
The three cunei- 
form bones. 
Cuboid bone. 
The metatarsus. 
L, M, N, the pha- 
langes. 30 
Fig. 69. 
Circumference. 
Length. 
A. Armpit. 
B. Armpit. 
C. Waist. 
D Waist. 
£. Hip-joint. 
F. Hip-joint. 
G. Upper part of 
thigh. 
H. Upper part of 
thigh. 
I. Middle of 
thigh. 
K. Above knee. 
L. Centre of 
knee. 
M. Below knee. 
N. Cait 
O. Above ankle. 
Sole of foot. 31 
Apparatus for Paralysis. 
Fig. 70 represents Kolbe's apparatus for paralysis of both limbs. It 
consists of lateral leg-stems, carried on the inner side as high as the 
perineum; on the outer, to the pelvic band or to the armpit, as the case 
may require. Joints are placed at the hip, knee, and ankle, and are 
secured to the body by the pelvic, thigh, and leg bands. If the patient 
has not sufficient strength to maintain the erect position, the apparatus, 
is provided with a contrivance to lock the knee, and, if necessary, also 
the hip-joint. In some cases it is preferable to attach elastic straps to 
the back of the pelvic band, running downward over the posterior sur- 
face of the thigh, to the back part of the thigh-band, which will give the 
hip-joint an artificial muscular extension to hold the patient in an erect 
position, while it will allow a more free motion in walking. When the 
patient is lying down or sitting, the joints may be relaxed or unlocked, 
to permit free flexion. 
Fig. 72 represents Kolbe's apparatus for paralysis of one limb. Its 
construction is the same as that shown in Fig. 70. 
Both these apparatuses should only be employed in cases where the 
patient has lost its entire control over the hip-joint. 
Figs. 73, 74, and 75 illustrate Kolbe's apparatus with spring joints, 
by which the patient is enabled to flex the knee in walking; the de- 
ficiency of the musculai' power being supplied by the elasticity of the 
joints. Either of these apparatuses is applicable, in fact preferable, in 
cases where the patient has but slight control over the hip-joint. Fig. 75 
represents the last modification. 
Fig. 76 illustrates Kolbe's apparatus for one or both limbs, with 
spring lock at the knee-joint. This apparatus is principally applied in 
cases where the entire control of the knee and ankle-joint is lost. 
GUIDE FOR MEASUREMENTS. 
(See Fig. 69, page 28.) 
R L. Length from sole of foot to centre of knee. 
L F. Length from centre of knee-joint to hip. 
F B. Length from hip-joint to under the arm. 
M. Circumference below the knee. 
K. Circumference above the knee. 
I. Circumference of middle of thigh. 
C D. Circumference around the waist. 
A B. Circumference under the arm, if requisite. 
Measure for shoe as directed on page 14. 
State the age and sex of the patient. 32 
Fig. 70. 
Fig. 71. 
Fig. 72. 
Apparatus for para- 
lysis of both limbs, 
with the pelvic band. 
Paralysis with apparatus. 
(From photograph.) 
Apparatus for pa- 
ralysis of one limb, 
with pelvic band. 
Fig. 73. 
Fig. 74. 
Apparatus for paralysis for one or 
both limbs, with spring joints at the 
knee-joint. 
Apparatus for paralysis for one or 
both limbs, with spring joints at the 
knee and ankle-joint. 33 
Fig. 75. 
Fig. 75. 
Apparatus for paralysis for one or 
both limbs, with elastic extension at 
knee and ankle-joint. 
Apparatus for paralysis for one cz 
both limbs, with spring lock at the 
kn^e-joint. 
Fig. 77. 
Fig. 78. 
Partial paralysis of both limbs, with 
contraction of legs and feet, and mal- 
formation of tarsal bones. (From pho- 
tograph. ) 
Result after the division of tendons, 
with apparatus applied. (From pho- 
tograph.) 34 
APPARATUS FOR DEFORMITIES OF THE TRUNK. 
CURVATURES OF THE SPINE. 
Apparatus for Lateral Curvature of the Spine. 
Fig. 79. 
In ordering an apparatus for lat- 
eral curvature of the spine, the fol- 
lowing measurements are necessary. 
(See guide for measurements, Fig. 69, p. 28.) 
A B. 
C D. 
E F. 
Points of circumferential measure- 
ments of the body. 
- Distances between the highest and 
lowest body measures, extend- 
ing from the armpits or axillas 
to the points of the hips. 
A C. 
B D. 
In addition to the above measure- 
ments, state to which side the body 
inclines (right or left), the age and 
sex of the patient. 
Showing the deformity. 
Fig. 80. 
Fig. 81. 
Application of apparatus 
Application of apparatus. 35 
r ig. 80 represents Kolbe's apparatus 
for lateral curvature. It consists of a 
steel frame well padded with leather or 
other appropriate material. The power 
is applied by means of screws and ratchet 
centres. 
Figs. 81 and 82 illustrate the construc- 
tion of another form of Kolbe's appara- 
tus. It consists of a steel frame, padded 
as in the former case. The power is ap- 
plied by means of free centres and elastic 
or inelastic straps. It serves a double 
purpose for young ladies, for, while sup- 
porting the lateral curvature, it also 
takes the place of the ordinary corsets. 
This apparatus is preferable for both male and female. 
Fig. 82. 
Apparatus for Antero-Posterior or Angular Curvature 
(Pott's Disease). 
In ordering an apparatus for angular curva- 
ture of the spine, the following measurements 
are necessary. 
Fig. 83. 
A B. 
C D. 
E F. 
(See guide for measurements, Fig. 69, page 28.) 
Circumferential measures. 
A C. 
B D. 
Distances between the highest and. lowest body- 
measures, extending from the armpits or 
axillas to the points of the hips. 
Length from mark 1, horizontal line E F, to the 
centre of curvature, on perpendicular line. 
In all cases of this deformity it will be neces- 
sary to take the outline of the dorsal protu- 
berance, which may be readily obtained by 
placing the patient in a horizontal position on 
his face, and then applying a strip of sheet-lead, 
lead wire, or pasteboard cut edgewise, along 
the median line over the apex of curvature, and extending from 1 to 7 
on the perpendicular line. This will give a curved outline, which may 
then be marked off on a sheet of paper. The age and sex of the patient 
will also be required. 
Showing the deformity. 36 
r igs. 84 and 85 represent Kolbe's apparatus for antero-posterior or 
angular curvature. It consists of a light steel frame, well padded. The 
bearings or points of support are established on the hips by the pelvic 
belt, from which runs, on either side of the spine, a support provided 
with soft cushions, and connected by means of straps with the lateral 
crutch-shaped support, which is intended only to steady the support on 
the back. This apparatus fully provides for the necessary rest of the 
spine sought by confining the patient to the bed. 
Fig. 84. 
Fig. 85. 
Apparatus for children and adult 
male patients. 
Apparatus for adult female patients. 
Fig. 86. 
Fig. 87. 
Application of apparatus. 
Fig. 87 shows the old form of a spinal supporter. It consists also of 
a light steel frame well padded, which takes its support on the pelvis, 
and supports the upper part of the body by axillary crutches. It is an 
imperfect support, and cannot be relied on. 37 
Apparatus for Cervical Curvature. 
Fig. 88 shows Kolbe's modification of an apparatus for cervical curva- 
ture, and Fig. 89 illustrates the mode in which it is applied. 
In ordering the above appa- 
ratus, the person will be guided 
by the same measurements as 
are given on page 33, angular 
curvature, with the addition of 
the distance from the line E F 
to the top of the head, mark 
1 to 8. 
This instrument may also be 
employed in slight cases of wry- 
neck. It is similar in construc- 
tion to the apparatus employed 
for the treatment of angular curvature in the 
dorsal region; the cephalic lever is movable, and 
in slight cases of distortion it may be detached 
from the body of the apparatus during the time 
the patient walks abroad. 
Fig. 88. 
Fig. 89. 
APPARATUS FOR DEFORMITIES OF THE HEAD 
AND NECK. 
WRY-NECK. 
Figs. 90 and 91 show Kolbe's apparatus for wry-neck, and Fig. 92 an 
apparatus for the same purpose, modified and improved 
Fig. 90. 
Fig. 91. 
Fig. 92. 
Apparatus for 
wry-neck. 
Showing the mode of appli- 
cation of the apparatus. 
Showing the application of the 
apparatus modified by Kolbe. 38 
Fig. 93. 
Fig. 94. 
Fig. 93 shows Kolbe's apparatus for 
wry-neck, as last improved. 
Fig. 94 illustrates the mode of sup- 
porting the head, which also is appli- 
cable in cases of cervical curvature. 
The above forms of apparatus for wry-neck take their bearings or 
point of counter-extension upon the pelvis, instead of the shoulders, as 
in the ordinary collar apparatus, and they are therefore stable, without 
the slightest tendency to become displaced. The rotative force applied 
to the head by the two cephalic levers admits of graduation by means 
of ratchet centres, as seen in the cuts. 
In ordering an apparatus of the sort, the measurements given on 
page 35 will be required. A sketch or 
photograph showing the extent of con- 
traction will be desirable, and assist 
greatly in making 
a well-fitting ap- 
paratus. 
Figs. 95 and 96 
show the applica- 
tion of shoulder- 
braces- It will be 
simply necessary, 
in ordering these, 
to mention the age 
and sex of the pa- 
tient. 
Fig. 95. 
Fig. 93. 39 
APPARATUS FOR DEFORMITIES OF THE UPPER 
EXTREMITIES. 
FRACTURES. 
Apparatus for Fracture of the Clavicle. 
The apparatus represented in Figs. 97 and 98 (front and back views) 
is that devised by Dr. Boisnot. It consists of a leather forearm tray, 
A, lacing and made to fit the 
parts well. To the upper and 
outei* part of this tray a stout 
piece of leather is attached, 
freely movable; this part is 
again extended by the addi- 
tion of two yards of stout 
webbing, C C, which, after 
coursing around the chest in 
the manner shown in the cut, 
is finally attached to the tray 
by the buckle D, thence to 
sound shoulder for sling. 
In ordering this apparatus 
no measurements are required, but simply the age and sex of the patient. 
Figs- 99 and 100 show the apparatus of Dr. Levis. It consists of a 
short, firm pad in the axilla, by which the shoulder is held from the 
side and over which, as a fulcrum, the elbow is drawn to the side. To 
Fig. 97. 
Fig. 98. 
Front view. 
Back view. 
Fig. 99. 
Fig. 100. 40 
the front and back of the axillary pad are fastened straps, which pas-, 
directly upwards, and are buckled to a wide main supporting band, 
which passes from the shoulder across the upper part of the back, and 
over the shoulder of the sound side, and terminates on the front of the 
chest. To the front end of the wide supporting band is suspended a 
sling, by which the elbow is supported. On the back of the sling, at a 
short distance above the point of the elbow, a strap is attached, which 
passes obliquely across the back, and, coming in front, is buckled to the 
main supporting band. The extra buckle, which will be noticed at 
the front end of the wide band, comes into use when the apparatus is 
reversed for the opposite shoulder. 
Fig. 101. 
Fig. 102. 
Front view. 
Back view. 
Pigs. 101 and 102 illustrate the apparatus for fracture of the clavicle 
as designed by Dr. Edward Hartshorne. This differs from the preceding 
in having a compress placed upon the lower and inner margin of the 
scapula of the injured side. 
In ordering this apparatus, no measurement is required. State the 
age and sex of the patient. 
Fig. 103 shows Kolbe's modification of one of Stromeyer's splints for 
anchylosis of the elbow. Other 
forms of the apparatus are made, 
in which the regulating screw is 
so placed as not to materially 
interfere with the patient's cloth- 
ing. In measuring for this ap- 
paratus, give the circumference 
of the arm above and below the 
elbow, and also the length from 
the wrist to the elbow, and from 
the elbow to the armpit. 
Fig. 103. 41 
Fig. 104. 
Paralysis of the extensors of the hand. 
Figs. 105 and 106 illustrate Kolbe's modification of Duchenne and 
Delacroix's apparatus for paralysis of the extensors of the hand. 
Fig. 105. 
Apparatus applied on the back of the hand. 
Fig. 106. 
Apparatus applied on the palm of the hand. 
Fig 107. 
Apparatus devised by Dr. S. W. Gross, to overcome, by elastic extension, 
contraction and false anchylosis of the wrist-joint. 
In measuring for these apparatuses, give the circumference of the arm 
below the elbow, and the length from the wrist to the elbow. Place 
the arm and hand on a sheet of paper and draw a line around them, to 
obtain their contour. 42 
Fig. 108 shows Kolbe's ap- 
paratus for resections at the 
shoulder-joint and in the con- 
tinuity of the humerus. In 
ordering this apparatus, mark 
the seat of the resection; give 
the circumference of the shoul- 
der, and of the chest just under 
the armpits; the distance from 
the armpit to the elbow. State 
whether it is the right or left 
arm for which the apparatus is 
intended. 
Fig. 109 shows Kolbe's ap- 
paratus for resection of the 
forearm. It will be necessary, 
in ordering this apparatus, to 
give the circumference of the arm at the armpit, above 
the elbow, below the elbow, and at the wrist. State 
also the length from the wrist to the elbow-joint, from the elbow-joint to 
the armpit, and whether' it is the right or left arm. 
Fig. 108. 
Apparatus for Resections. 
Fig. 109. 
Fig. 110. 
Fig. 111. 
Resection of the humerus. 
(From photograph.) 
Apparatus applied. 
(From photograph.) 43 
Abdominal Supporter and Trusses. 
Fig. 112. 
Fig. 112 illustrates the application of an 
elastic abdominal supporter in pregnancy 
and large tumors of this region. In or- 
dering this bandage, simply give the cir- 
cumference of the abdomen in the directions 
of the lines AB, AC, and A D. 
We keep on hand a large assortment of 
other forms of abdominal and uterine sup- 
porters, and manufacture to order any pat- 
tern which may be desired by the surgeon. 
Fig. 113 shows the plain French pattern truss, which is in many cases 
preferable to the more complicated truss.. A large assortment of other 
trusses and suspensory bandages is kept constantly on hand. 
In taking measurement for such an instrument, give the circumference 
of the body at the point where the hernia protrudes-that is, on a level 
with the inguinal, crural, ventral, or umbilical apertures; and also men- 
tion if the hernia is on the right or left side, or both. 
Fig. 113. 
Fig. 114. 
Fig. 114 shows a spring truss for prolapsus ani, or falling of the 
body. In ordering the instrument, give the circumference of the body 
above the hips, and the distance from the front central point of this line, 
over the perineum, to the centre of the back part of the line. 44 
Fig. 115. 
Elastic Stockings. 
A combination of vulcanized rubber, web- 
bing, silk, or cotton, used in the treatment of 
varicose veins, ulcers, and swelling of the legs. 
In measuring for stockings for the entire leg, 
give the circumference at the points shown in 
the illustration. For parts of the leg, as fol- 
lows :- 
Ankle Stocking.-Circumferences from T up to E. 
Leg Stocking.-Circumferences from T up to C. 
Stocking for above the Knee.-Circumferences from 
T up to A. 
For the Knee-Cap (only).-Circumferences from C 
up to A. 
In all cases the length should be given from 
the sole of the foot to the point to which the 
stocking is to extend. 
Fig. 116. 
Apparatus for Shortened Limbs. 
GUIDE FOR MEASUREMENTS. 
Circumference above knee. 
Circumference below knee. 
Circumference around ankle. • 
Circumference around instep. 
Length from patella to sole of foot. 
The difference in length between sound and defective 
limb. 
Place the foot on a sheet of paper and draw a line 
around it, to obtain its contour. 
State which limb, the age and sex of the patient. 
Artificial foot with sup- 
port above and below the 
knee. 45 
Apparatus for Shortened Limbs. 
Fig. 117. 
Fig. 118. 
Artificial foot with support 
below the knee. 
Cork shoe with support to 
tiie ankle-joint. 
Figs. 116 and 117 illustrate Kolbe's apparatus to supply the deficiency 
of a shortened limb, caused by hip-joint disease, resection, &c. A boot or 
laced shoe is worn over the natural and artificial foot, which conceals 
the deformity. 
Fig. 118 illustrates an apparatus, less expensive, for the deficiency of 
a shortened limb. It consists of a shoe provided with 
cork between the sole and shoe, to which is attached a 
support, to guard against spraining the ankle, which is 
more or less unavoidable by the use of a high cork shoe 
alone. 
Fig. 119 represents a wooden pin, or "box-leg." It 
consists of a wooden frame widely grooved below, to 
accommodate the knee, and of four lateral side-pieces; 
the external, slightly curved backward, reaches from the 
knee to the crest of the ilium, and the internal half-way 
up to the thigh. From the bottom of the socket a pin 
projects, and makes up the interval between the knee 
and the ground. 
Fig. 119. 46 
ARTIFICIAL LIMBS 
Invented and Manufactured by 
D. W. KOLBE. 
Approved and commissioned fry the Surgeon-General of the U. S. Army. 
In addition to the public in general, they are furnished to officers, 
soldiers, and sailors of the Army and Navy of the United States, under 
an act of Congress approved June 17 and 30, 1870, and bond has been 
given, according to the requirements of the act, for the faithful perform- 
ance of our duty to those who may favor us with their patronage. 
As a guarantee to our patrons of our capability to give entire satis- 
faction I need only to call attention to the fact that I have made a 
specialty of this branch of the art for the last thirty-three years. Ten 
years were spent in the most celebrated workshops of Germany, Belgium, 
and Paris, and twenty-three years in the United States. In this period 
we have gained the confidence and patronage of the leading surgeons 
in this country, who have testified their appreciation of oui' efforts by 
permitting their names as reference, and referring to us in terms of 
commendation in their works on surgical science. 
These warm testimonials to our labors have rendered it entirely use- 
less for us to follow the now antiquated and absurd custom of presenting 
any array of testimonials from the wearers of our limbs as to their effi- 
ciency. This question has been definitely settled by the appointment of 
boards of surgeons by the army authorities, and by civil practitioners, 
whose decisions as to the relative merits of our limbs have been suffi- 
ciently gratifying and encouraging to lead us to believe that those 
needing them will be influenced in their choice by professional experts 
who have devoted years to the study of this branch of mechanical sur- 
gery. We simply ask, therefore, those who desire artificial appliances 
-limbs, apparatus for deformities, &c.-to call at our store and examine 
the limbs themselves. The comparison can then be made between our 
work and that of other manufacturers. We regard this rather to be the 
crucial test of superiority than general impressions of uninformed persons. 
I propose to present first the cuts of our limbs for amputation above 
the knee and below the knee. 
In Fig. 120 is shown the complete limb for amputation above the 
knee. It is the best appliance that has as yet been devised for supply- 
ing the loss of the natural member. Its action is in perfect imitation 
of the functions of the natural limb, and this is effected in the most 
simple manner, as shown in Fig. 122. 47 
Fig. 120. 
Fig. 121. 
Fig. 122. 
Kolbe's limb for ampu- 
tation above the knee. 
Kolbe's limb for amputa- 
tion below the knee. 
Vertical section of perfect 
limb. 
As is usual, the framework is of willow wood, which is selected for 
its tenacity, strength, and fine grain, and is covered with rawhide (spe- 
cially prepared for that purpose); its external appearance is of a flesh- 
color, waterproof enamelled; the thigh-piece, or bucket, fitting the thigh 
accurately, and extending up to the ischium and perineum, which sus- 
tains a part of the weight of the body, the balance being diffused over 
the outer surface of the thigh. Its walls are opened by oblong slits or 
fenestne, which permit a due amount of ventilation, and at the same 
time allow the secretions of the part to escape. The thigh-piece is 
strongly articulated at the knee to the leg-piece by a steel bolt, which 
permits antero-posterior motion only. From the inner surface of the 
lower third of the bucket a wooden pin, I K, projects, to which are 
attached two strong cords made of twisted linen thread. One of these, 
i E, being inserted into the heel, represents the tendo Achillis ; it sup- 
ports the weight of the body by preventing the foot being bent at any 
greater angle than a right angle. The other' cord, K D, is inserted into 
the middle ot the posterior surface of the leg, and is accessory to the 
former, an arrangement by which the limb is rendered so exceedingly 
strong that the weight of the strongest man cannot injure its stability. 
The cord marked G G is a spring which is intended to give the leg a 
slight impulse forward in taking a step; it is the analogue of the ex- 
tensor quadriceps of the natural limb. 48 
Fig. 123 shows the mechanism of the ankle-joint. It is somewhat 
peculiar, combining all the strength of a ginglymoid joint with lateral 
motion. The inferior surface of the leg and 
the corresponding surface of the foot are pro- 
vided each with a hemispherical depression, 
which, when conjoined, form a hollow sphere; 
in the interior of this sphere the globular en- 
largement seated at the centre of the steel 
ankle-bolt works, the extremities of the bolt 
passing through the lateral metal straps in 
holes a little larger than their diameter; these 
extremities are sustained by two pieces of 
India-rubber, which permit the amount of 
lateral motion desirable in the ankle. F F, in 
Fig. 122, indicate the position of a cord at- 
tached to a horizontal spring fastened to the 
sole of the foot, and intended to bring the foot 
again to a rectangular position with the leg after it has been extended; 
it is the analogue of the tibialis anticus. h a mark the metatarso- 
pharyngeal joint; it is a simple tenon and mortise joint, firmly bolted 
together, and under the control of a spring which brings the toes straight 
with the foot after they have been extended by the weight of the body. 
Fig. 123. 
Fig. 124. 
Fig. 125. 
Artificial limbs applied. 
(From photograph.) 
Amputation through knee and leg. 
(From photograph.) 49 
The artificial leg, Fig. 121, for amputation below the knee, is con- 
structed in the same substantial manner as above described. No arti- 
ficial means are needed for the antero-posterior motion of the knee-joint. 
We shall now present, by way of illustration, selected from a large 
number, the drawings of two cases in which our limbs were used with 
perfect success. 
Fig. 124 shows a patient with both legs removed, one through the 
knee and the other below. The stumps were of peculiar form and un- 
usually tender, being surrounded with cicatrices caused by sloughing. 
Fig. 125 is the patient with the limbs applied. 
Fig. 126 shows a young man who had both legs cut off below the 
knee, and who for fifteen years crawled along on knee-pads, in conse- 
quence of which the knees were deformed and contracted, the stumps 
had undergone sloughing, leaving the end of the bones projecting and 
barely covered with skin, as represented in the cut. 
Fig. 127 shows the patient with the limbs applied. 
The success in both these cases was as complete as it was surprising, 
and left nothing desirable that art could supply. 
For further confirmation of the perfect adaptability and superiority 
of our limbs, I shall quote an extract from Wales's Mechanical Thera- 
peutics, a work the reputation of which is thoroughly established in the 
Fig. 126. 
Fig. 127. 
Amputation through both legs. 
(From photograph.) 
Artificial limbs applied. 
(From photograph.) 50 
medical profession. He says that "Kolbe, of Philadelphia, has devised 
a leg in many respects superior to that of others. It possesses slight 
lateral motion at the ankle, enough to relieve the strain upon the thigh- 
sheath when the person steps upon an irregular or an inclinal surface; 
while, at the same time, it does not render the walking unstable, as it 
must do if too great an amount of motion is given to the ankle. The 
external finish and strength of the limb give it rank with the best auto- 
matic appliances now offered for the patronage of the maimed, and one 
great recommendation it possesses is that it may be adapted to every 
form or length of stump. Its mechanism is so simple that the wearer 
Fig. 128. 
Fig. 129. 
Circum. 
close 
to body. 
Circum. 
close 
to body. 
From body to end of thigh stump on inside. 
do. 2 inch- 
do. 2 inch. 
do. 4 inch. 
do. 4 inch- 
Length from body to knee support 
do. 6 inch- 
do. 6 inch. 
do. 8 inch... 
do. 8 inch. 
do. 10 inch. 
do. 10 inch- 
close to 
knee. 
Lat dia. knee- 
Circum. 
1 in. from knee 
do. 2 inch do ... 
do. calf do 
Length from knee to floor, standing erect. 
do. 6 inch do. 
do 8 inch do- 
do. 10 inch do 51 
of the limb can in general be his own repairer, snoulcl any portion of it 
give out or need overhauling, and this is no small advantage to persons 
residing at a distance from the manufacturer. 
DIRECTIONS FOR MEASURING FOR ARTIFICIAL LEG. 
Fig. 128 is intended for measuring the stump above the knee and below the knee. 
Fig. 129, for measuring stump in amputation at or immediately below the knee. 
Fig. 130, for measuring sound limb in flexed position when amputation is performed above the knee. 
Fig. 131, for measuring sound limb in either amputation. 
1. In measuring, draw the tape moderately tight. 
2 The limb should be bare, and the patient must stand erect, with the hips level, while the mea- 
sures in Fig. 131 are taken. 
3. The patient must be seated while those 
in Fig. 130 are taken, and bear no weight 
on the foot. 
4. For amputation below the knee, when 
the patient cannot visit the manufactory, 
it is desirable to have a plaster cast of the 
end of the stump to about six inches above 
the knee-joint. 
5. State age and sex of patient; which 
leg amputated; whether well healed and 
joint flexible ; weight of the patient; occu- 
pation ; and whether a false limb has been 
worn before. 
6. For size of foot, let it rest on a sheet 
ef paper and draw a pencil-mark around 
it, to obtain its contour. 
Fig. 131. 
Circumference! 
close to body. J 
2 inches from. 
Length from body to floor on inside. 
4 inches from... 
C inches from... 
S inches from.... 
Fig. 130. 
13 inches from... 
1 inch above 
patella. 
Lateral dia. of! 
knee joint. J 
Cir. 1 inch be- 
low patella. 
Length from lower edge of patella 
to floor, standing. 
2 inches below . 
At calf...., 
At ankle,small- 
est part. 
Circnm instep. 
toe joints. > 
instep. 
toe jntg. 
Length ft. 
Length of foot. 52 
Fig. 132. 
Figs. 132, 133, 134, and 135 
illustrate Kolbe's artificial foot, 
used after Syme's, Chopart's, 
Iley's, and Pirogoff's operations. 
The perfection attained in the 
construction of this peculiar ar- 
tificial substitute has overcome 
the numberless objections made 
against the above-named opera- 
tions. It as fully supplies the 
important necessity of comfort 
in locomotion, etc., as can be 
expected of any other artificial 
limb when amputation is per- 
formed anterior to the insertion 
of the flexors of the foot. 
In many cases the artificial 
foot as represented in Fig. 134 
is preferable. 
Fig. 133. 
Artificial foot with sup- 
port below the knee. 
Artificial foot with 
shoe applied. 
Fig. 134. 
Fig. 135 
Fig. 136. 
Artificial foot without support 
taken from the knee. 
Artificial foot with 
shoe applied. 
GUIDE FOR MEASUREMENTS. 
Length from lower edge of patella to end of stump. 
Circumference below knee. 
A plaster cast extending a little above the ankle, 
showing the deformity, should be taken. Also the 
length of the sound limb from the lower edge of the patella to the sole 
of the foot, and the outline of the foot, should be given. 
Stump. 53 
DESCRIPTION OF KOLBE'S ARTIFICIAL HAND AND ARM 
FOR AMPUTATION AT THE SHOULDER, ABOVE AND BELOW THE ELBOW, 
AND AT THE WRIST. 
Approved and commissioned by the Surgeon-Genera? s Circular Order, May 13, 1865, and 
f urnished (by special contract, Jan. 28, 1867) to the maimed of the State of Georgia. 
This is the only combination of the dress and stump arm yet invented, 
and will be found to combine, in an unusual degree, the advantages of 
both. The arm and hand together form a 
perfect imitation of the natural limb, while its 
usefulness in daily occupation is unequalled. 
The following drawings are intended to 
illustrate the outward form and the mechan- 
ism of motion of the artificial arm. It can 
be adapted to stumps of any length. 
Fig. 137 shows the arm complete for an 
amputation above the elbow. It performs 
the various functions of the upper extremity, 
as flexion, extension of the elbow, moving 
and grasping of the fingers. 
Fig. 138 represents an arm for amputation below the elbow and at 
the wrist-joint; its motions are the same as in the previous case. This 
arm is of great service in farming, driving 
horses, and for laboring men in general, as 
I have so modified the connection of the 
hand with the forearm that the former may 
be removed at pleasure, and various useful 
contrivances substituted, such as a chisel, 
screwdriver, knife, fork, or spoon, etc., or 
indeed any tool or implement which the 
wearer may find useful in his daily occupation. 
Fig. 139 shows the hand detached, and Fig. 140 the hand replaced by 
Fig. 137. 
Fig. 138. 
Fig. 139. 
Fig. 140. 54 
a pair of nippers. The form of the arm is made of leather (specially 
prepared), and mounted with steel strips. The socket receiving the 
stump has an agreeably soft feeling, and can be applied to the most 
tender stumps. The application of power is provided for, in the con- 
struction of these limbs, by the following mechanism : A traction-cord, 
consisting partly of webbing and partly of a well-tempered slip of steel, 
is attached above by the webbing to the shoulder from the arm opposite 
that which the artificial substitute is intended to replace, and below 
hooks on, by the end of the metallic portion of the cord which runs 
about the forearm, to a short vertical steel slip running through a slit in 
the back of the margin of the wrist-plate; thus connecting it with the 
mechanical arrangements designed to move the fingers, which I shall 
briefly describe. 
The strip of Steel at the level of and upon the outer side of the elbow 
is articulated with the aid of a metal slide working for its whole length 
upon a tenon or projecting pin; the upper end of the slide is connected 
to the webbing or leather strap going to the shoulder: the object of this 
arrangement is to change the direction of the 
force when the arm is bent. The mechanical 
arrangement for moving the fingers is inclosed 
in a cavity hollowed in the substance of the 
hand, as shown in Fig. 141 It consists of a 
number of levers of different kinds, arranged 
in such a manner as to apply the force exer- 
cised by the traction-cord to the best mechanical advantage in moving 
the fingers. From the end of the long arm of the second lever a bar 
projects upwards to the extent of an inch and a half, and connected by 
a short coupling, by its proximate end, to an oblique bar fixed to the 
base of the thumb. A spiral spring runs along each side of the hand, 
and, acting upon each couple of fingers, keeps them in a position of 
approximation to the thumb. The fingers are connected with the hand 
by a transverse bolt; the index and middle fingers, and the ring and 
little fingers, are coupled together, possessing the first phalangeal joints. 
As the mechanism thus far described provides only for the extension 
of the first phalanges, an additional lever, working by an excentric, is 
placed in the first phalanges, and acts upon the second and third pha- 
langes. 
The entire mechanism of the hand and arm being of steel, it is not 
subject to the variations of the atmosphere, as is the case with catgut 
and similar substances so often employed by others. In warm weather 
these relax, and control of the hand and arm is almost entirely lost; 
while in wet weather these substances extract the moisture of the atmo- 
sphere and swell, thereby preventing free action of the parts. Owing 
Fig. 141. 55 
to these constant changes from atmospheric causes, these materials soon 
wear out, and the limb becomes more or less useless. By using steel 
(which is free from these objections), strength, lightness, durability, free- 
dom of motion, and non-liability to atmospheric changes are secured. 
The following is an extract from a report of a medical committee on 
the above described arm:- 
His Excellency Charles J. Jenlcins, Governor of Georgia: 
By a resolution of the General Assembly of the State of Georgia, 
entitled "A resolution for the relief of soldiers maimed in the State or 
Confederate States service, and now resident in this State," assented to 
November 29th, 1866, the undersigned were appointed a committee to 
make an examination into the professional merits of "the Kolbe arm," 
and to report the same to his Excellency the Governor. 
In pursuance of said resolution, the committee had the honor, on due 
deliberation, to present their report relating to "the Kolbe arm." 
With a conscientious recognition of the responsibility trustfully im- 
posed upon them, the undersigned committee have entered faithfully 
into the investigation of the structure, material, plan, and mechanism 
of "the Kolbe arm," as applicable to both humeral and cubital stumps, 
comparing it with other implements of a like character, and they further 
respectfully report that the limb under consideration possesses, by its 
lightness, strength, simplicity of construction, durability, and efficiency, 
many advantages over any others that they have examined. 
They would call particular attention to the distinguishing peculiarity 
of this arm, viz., that while it presents all the desirable qualities attach- 
ing to the best models of the ordinary "dress arm," it possesses the 
great advantage of a movable hand, which particular feature in its con- 
struction enables the wrist-end to be converted into a socket for the 
attachment of any and every variety of tool or instrument that the 
ingenuity of the mutilated person may devise for his convenience and 
nse. This advantage is illustrated in the hook furnished with each of 
the arms, to be applied, under the provision of the General Assembly's 
resolutions, in case the arm under consideration be adopted. 
Most respectfully submitted by the committee under resolution of the 
General Assembly of the State of Georgia. 
(Signed) HENRY CAMPBELL, M.D., Augusta, Ga. 
R. A. T. RIDLEY, M.D., Lagrange, Ga. 
THOS. S. POWELL, M.D., Atlanta, Ga. 
January 22,1867. 56 
Directions for Measuring Patients for Artificial Arm. 
will be used in cases where the amputation is above the elbow and shoulder-joint. 
Fig. 142 
Circumfei 
From5 to 6, length of stump 
ircumference. 
1. Length from the fold of the pectoralis ma- 
jor, where it forms the margin of the axilla, 
to the olecranon process of the ulna. 
2. From the olecranon process to the styloid 
process of the ulna. 
3. From the styloid process to the phalangeal 
extremity of the metacarpal bone of the 
little finger. 
Do. midway. 
Do. at wrist. 
The limbs, as represented in the figures, are in the proper positions 
for measuring. 
In measuring the circumference of the stump, the tape should be 
drawn only moderately tight. 
The perpendiculai- lines indicate the distance to be measured in order 
to get the length of the limb as well as the length of the stump. 
The cross-lines in the figure indicate where the circumferences are to 
be taken. The breadth across the shoulders, measuring on the back, 
must also be given; and in measuring from 1 to 2 the tape should be 
drawn on the inner side of the arm. 57 
State which limb is amputated, and whether the hand be large, me- 
dium, or small size. 
After taking the measure in amputation below the elbow, the arm 
should be laid on a sheet of paper (back down), and with a pencil, held 
perpendicularly, mark round it so as to give a correct profile of the 
shape of the stump and arm for a distance of five inches above the elbow. 
will be used in cases where the amputation is below the elbow and wrist. 
Fig. 143 
Circumferenct 
5 in. above 
elbow. 
Just above 
elbow. 
Just below 
elbow. 
3 inches below 
elbow. 
Circumference 
of wrist. 
End of stump. 
E 
Distance from the olecranon process to the 
end of the stump, D to E. 
Length from the olecranon process of the ulna, A, to the styloid process of the 
ulna, B. 
From the styloid process, B, to the phalangeal extremity of the metacarpal bone 
of the little finger, C. 58 
Fig. 144. 
Fig. 145. 
Fig 146. 
Bond's splints for fractured radius. 
Posterior angular splint for arm. 
Fig. 147. 
Fig. 148. 
Fig. 149. 
Lateral splints for legs and arms. 
Lateral angular splint for arm. 
Fig. 150. 
Fig. 151. 
Levis' splint for reducing dislocations of the 
phalanges. 
Stromeyer's splint for fractures 
or partial anchylosis of the 
arm or knee-joint. 59 
Fig. 152. 
Smith's anterior splint. 
Fig. 153. 
Fig. 154. 
Double inclined plane fracture-box. 
Fig. 155. 
Stand, weight, and pulley for mak- 
ing extension in fractures and joint 
affections of the lower extremity. 
Fracture-box. 
Fig. 156. 
Crutches of all sizes constantly on hand. 60 
In order to illustrate a greater variety of cases to which our artificial 
legs have been applied, we have added a number of wood-cuts to those 
already shown on pages 46 and 47. 
The difficulty in applying artificial support where double amputation has 
been performed, is at once apparent; but as it has been so successfully done, 
we have selected cases interesting both from their magnitude and their 
results. 
Fig. 157 represents a boy, aged 16, who has suffered double amputation 
of the thighs close to the body. He has crawled on his hands and body 
about Harrisburg, Pa. (his native city), for three years, during which time 
he attracted the attention of a sympathizing public. Lately, the Managers 
and Surgeons of the Philadelphia Orthopaedic Hospital (to which I am 
the mechanist) have been enabled (through the liberality of the State 
Legislature) to provide the means for the construction of the artificial 
limbs herewith shown in Fig. 158, and by which he is able to walk. To 
our knowledge, this is the only successful case on record in which artificial 
limbs have been applied where both knee-joints are required to be artificial. 
Fig. 157. 
Fig. 158. 
Amputation through both thighs 
close to the body. Result of rail- 
road accident. (From photo- 
graph.) 
Artificial limbs applied. 
(From photograph.) 61 
Fig. 159 shows a patient with double amputation ; one through the leg, 
and the other through the foot. 
Fig. IGO shows the patient with both limbs applied. 
Fig. 161 shows a young man who has suffered double amputation 
through both legs. 
Fig, 162 showing patient with limbs applied. 
Fig. 163 shows a patient with double amputation through both legs. 
Fig. 164 showing patient with limbs applied. 
Fig. 159. 
Fig. 160. 
Ampliation through the leg and foot. 
Result of frost-bite. (From photograph.) 
Artificial limbs applied. 
(From photograph.) 62 
Fig. 161. 
Fig. 162. 
Amputation through both legs. Re 
suit of frost-bite. (From photograph.) 
Artificial limbs applied. 
(From photograph.) 
Fig. 163. 
Fig. 164. 
Amputation through both 
legs. Result of railroad acci- 
dent. (From photograph.) 
Artificial limbs appl^^. 
(From photograph.)