Ambroise Paré IV: The early history of artificial limbs (from ...

One of the earliest written references to prosthetics is found in a book published in France in 1579. That year, French surgeon Ambroise Paré (1510–1590) published his complete works, part of which described some of the artificial limbs he fitted on his amputees. As a military surgeon, Paré had removed many a soldier's shattered arm or leg, and he eventually began designing and building artificial limbs to help the men who had been maimed.

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Ambroise Paré was the official royal surgeon to four successive kings, and earned his position by practicing medicine on the battlefield, attempting to save, or at least treat, wounded soldiers. As a doctor, he was most disturbed by the reaction of some of the people whom he had saved. He found that some soldiers took their own lives rather than live without limbs, or with terrible wounds. To try to combat this problem, Paré began crafting artificial limbs. This was not new. There is evidence for the use of prostheses from the times of the ancient Egyptians. Prostheses were developed for function, cosmetic appearance and a psycho-spiritual sense of wholeness. Amputation was often feared more than death in some cultures. It was believed that it not only affected the amputee on earth, but also in the afterlife. The ablated limbs were buried and then disinterred and reburied at the time of the amputee’s death so the amputee could be whole for eternal life. One of the earliest examples comes from the 18th dynasty of ancient Egypt in the reign of Amenhotep II in the fifteenth century B.C. A mummy in the Cairo Museum has clearly had the great toe of the right foot amputated and replaced with a prosthesis manufactured from leather and wood. The first true rehabilitation aids that could be recognised as prostheses were made during the civilisations of Greece and Rome. During this period, prostheses for battle and hiding deformity were heavy, crude devices made of available materials—wood, metal and leather. Records of ancient prosthesis can be found all over the world. Legend holds that Roman general Marcus Sergius wore an iron replacement hand during the Second Punic War. During the European mediaeval period, armoured knights used iron prosthetics to conceal lost limbs. Some pirates actually did wear crudely fashioned hooks and peg legs.

Paré's limbs were something different. He wanted them to be functional, not just stop-gap solutions. He was an accomplished anatomist, and so when he designed limbs, he attempted to make them work the way biological limbs worked. When he designed legs, he gave them a mechanical knee that could be locked when standing and bent at will. He drew up preliminary sketches of an arm that could be bent with a pulley that mimicked arm muscles. Paré had the idea to use the progress in robotics that occurred in his period to create prostheses that worked with the mechanical devices invented for robotic toys or clocks. In China, King-his Tse, invented in the 500 b. C. a flying magpie of wood and bamboo, and a wooden horse able to jump. Around year 200 B.C., Philo of Byzantium, inventor of the repetitive catapult, constructed an aquatic robot. In 206 B.C., the first Han Emperor found the Chin Shih Hueng Ti's treasure. It included a mechanical toy orchestra that moved independently. In old Greece, Archytas of Tarento (referenced in English as Archytas of Tarentum, and in some references in Spanish as Architas de Tarento), philosopher, mathematician and contemporary politician of Plato, considered the father of mechanical engineering and precursory of the robotics, invented the screw and the pulley, among other many devices. The materials used for the construction of robots were wood (parts with form), iron (fixed structure, supports, hinges), copper (which is mouldable and allowed the construction of thinner parts), leather (cables, footwear) and fabrics. The first models used the application of direct force to make movements, facilitated with sets of pulleys, gears and handles. In this phase the robots were replicas of the human being that made a series of simple movements. The machines began assuming tasks of aid to the man and ended up repelling their conception of the world and animated beings. The mechanics affected the study of nature, spreading to the anatomy science; of which agreed models with that conception were elaborated, such as “De Humani Corporis Fabrica” (On the workings of the human body) from Andreas Vesalius (1514–1564) who conceived the man as a complex mechanical structure.

His stand-out design was a mechanical hand. It was a hand that was operated by multiple catches and springs, which simulated the joints of a biological hand. His ‘Le Petit Lorrain’, a mechanical hand operated by catches and springs, was worn by a French Army captain in battle. When he showed his design to colleagues it was such a sensation that they worked up a prototype, and in 1551, a movable prosthesis was worn into battle by a French army captain. The captain claimed it worked so well that he was able to grip and release the reins of his horse.

Subsequent refinements in medicine, surgery and prosthetic science greatly improved amputation surgery and the function of prostheses. People have used all sorts of artificial devices probably from the beginnings of human history to help them compensate for the loss of a limb. Thus in very ancient times, the first and simplest prosthesis may have been a forked tree that was used as a crutch to help someone walk whose leg may have been badly damaged or lost in an accident or to a disease. What began as a modified crutch with a wooden or leather cup and progressed through many metamorphoses has now developed into a highly sophisticated prosthetic limb made of space-age materials.

Such were the materials available to Ambroise Paré who invented both upper-limb and lower-limb prostheses.

Some people have lost limbs as a result of automobile accidents, military combat, or some people were born without limbs or have lost limbs due to illness. Approximately 2 million people in the United States have had an arm or leg amputated, and many wear prosthetic limbs. Prosthetics are devices designed to replace missing body parts or to help existing body parts function more effectively. There are currently prosthetic devices for:

• Arms
• Legs
• Eyes
• Hands
• Joints
• Teeth

Prosthetic devices have changed a lot over time thanks to advances in technology, materials, and design. Before the 20th century, many people could not afford professionally made prosthetics, so they created their own out of materials they had, such as a wooden chair or table leg. This is where the term “peg leg” comes from.

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Prosthetic Technological Advancements Timeline

Learn more about advances in prosthetics through the timeline of key developments below.

• 950–710 B.C. –The earliest-known prosthetic toe made from wood and leather was discovered in the 1800s attached to an Egyptian mummy.
• 600 B.C. – The Greville Chester toe, created by the Egyptians and discovered in 2000 near present-day Luxor, is made of cartonnage — a paper maché material made out of linen, glue, and plaster.
• 300 B.C. – The oldest known prosthetic leg — the Capua leg — was crafted by Romans from bronze and iron with a wooden core. It was once housed in the Royal College of Surgeons, but was destroyed during World War II bombings. A replica is now at the Science Museum in London.
• 476–1000 (Middle Ages) – Peg legs and hand hooks were common for those who could afford to have them fitted. Knights were often fitted with prostheses designed to hold a shield or fit in stirrups, but functionality was not a focus. An increasing number of tradesmen crafted prosthetics during this time. For example, those who made watches often used gears and springs to give limbs more detailed functionality.
• 1400s–1800s (The Renaissance) – Copper, iron, steel, and wood were the most common materials used for prosthetics during this period.
• 1863 – During the American Civil War, the U.S. started to see advancements in the field of prosthetics. The cosmetic rubber hand was introduced with fingers that could move and various attachments, such as brushes and hooks.
• 1945 – Following World War II, most limbs were made of a combination of wood and leather. While these materials provided the wearer with several benefits, the prosthetics were heavy, and leather can be difficult to keep clean, especially since it absorbs perspiration.
• 1970s–1990s – Plastics, polycarbonates, resins, and laminates were introduced as light, easy-to-clean alternatives to wood and leather models. Prosthetics also started being made from lightweight materials such as carbon fiber. Synthetic sockets were custom fitted for each patient to provide an individualized, comfortable, and hygienic fit.
• 2000-2014 – Prosthetic design has advanced to highly specialized prosthetics, including high-performance, lightweight running blades, responsive legs and feet for navigating varying terrain, and motorized hand prosthetics controlled by sensors and microprocessors.

Thanks to new technologies and the improvement of materials, prosthetics have come a long way since the first known wooden toe. Developments in technologies such as robotics, brain-computer interfaces, and 3-D printing have the potential to lead to future advancements the field of prosthetics.

During trials that began in 2011, researchers at the University of Pittsburgh have studied brain-computer interface technology, which uses surgically implanted electrodes to send signals from the brain to the prosthetic limb. Their research has allowed trial participants Jan Scheuermann and Tim Hemmes to control a prosthetic arm to reach for, grasp, and place objects.

For more information on prosthetics, please visit the UPMC Department of Physical Medicine and Rehabilitation webpage. If you or a loved one are interested in support for amputees, please visit the Amp Up! Support Group webpage.

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Physical Medicine and Rehabilitation

At UPMC, we strive to improve your function after injury or illness. We help people recover from functional, pain-related, and neurological conditions, with both inpatient and outpatient care available. We are dedicated to providing you with exceptional clinical care and focused on developing new technologies and treatments to help you achieve mobility and maintain independence. Find a provider near you.

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