With a tape line measure the distance from the point of shoulder to the point of elbow of the sound arm, also the distance from the armpit to the bend of elbow (indicated by dotted lines in Cut Z 7). Measure the distance from the point of the shoulder to the point of the elbow of amputated arm, also the distance from the armpit to the bend of elbow. Give the circumference of each arm at points two inches apart, beginning close to the body. These circumferences are represented by dotted lines A, B, C, D, E, and F of sound arm, and the dotted lines A, B, C, D, E, F, G, and H in the diagram of the stump (Cut Z 5). Then give the circumference of the hand at the base of the thumb, the circumference of the palm at the base of the fingers, the circumference of the thumb at the first joint, represented by dotted lines G, H, and I (Cut Z 5).

If one arm is amputated in or above the elbow, the diagrams and measurements of the sound arm called for by Cuts Z 5 and Z 6 are required, and only one diagram of the stump, together with circumferences at places two inches apart, the distance from point of the shoulder to the point of the stump and from armpit to the point of the stump are also required.

If both arms are amputated above the elbow, diagrams of each stump, and the distances from the point of each shoulder to the point of each stump, and from armpit to the point of each stump are required, also the circumferences of each taken at points two inches apart.

If both arms are amputated below the elbows, the diagrams and measurements may be taken as suggested by Cuts Z 6 and Z 8.

All amputations in the shoulders, elbows, or wrists, or in the hands, leave extremities that are bony, more or less sensitive, requiring very exact fitting. Such stumps should be reproduced in plaster.

Answers to the following questions should be attached to the blank and forwarded with every order: Name of patient? Post-office address? Occupation? Age? Cause of amputation? When was amputation performed? Which arm amputated? Has the patient worn an artificial arm? If so, whose make? Name of party ordering? His address? Is the arm to be made and fitted from measurements in the absence of the wearer? To what address shall it be shipped?

Plaster casts of arm stumps are only required in amputations in the wrists, elbows, shoulders, and in the hands, and in other cases when there are peculiarities that cannot be clearly indicated by the diagrams. A dentist, wax flower maker, or plaster statuette maker is familiar with the manipulation of plaster, and if one is available he should be employed for the purpose. The operation, however, of taking a plaster cast is not difficult, and can be done by almost any person.

The simplest method is as follows: Remove all clothing, shave away all hair, or stick it down with glue, paste, thick plaster, or thick soap. Then place about two quarts of plaster of Paris in a basin containing one quart of water, stir it up thoroughly, so that the plaster will become pasty. Then spread it upon the stump, until it is entirely covered with at least one-half an inch in thickness. The stump should be kept very quiet until the plaster has become hard, at which time it can be withdrawn, and the plaster will form a mold of the stump. This can be sent to us, or, if preferred, the inside can be greased and filled up with slaked plaster of Paris, which, when hard, can be taken from the mold.

If the end of the stump is large, or if there are prominences on the stump, it will be necessary to make the mold in two parts, so that they can be separated when hard, and the stump removed. The simplest way is to spread a little slaked plaster on the table, lay the stump upon it, pressing it down until it sinks half way into the plaster (see Cut Z 9). Then lay pieces of thin, wet paper all over the exposed surfaces of the plaster. Then pour and spread plaster on the top of the stump (Cut Z 10). Let the plaster run down the sides on the paper. The stump should be covered with at least one-half inch in thickness. When it has become thoroughly hard, the piece of paper will permit the plaster to separate and the stump can be withdrawn. The mold thus produced can be sent to us, or, if preferred, a plaster facsimile of stump can be made from it, by first spreading oil or grease in the mold, then placing the two parts together, tying them by a string; then mix plaster of Paris to about the thickness of cream and pour it inside the mold. When this has become hard, the mold can be separated and the cast withdrawn.

ARMS FITTED FROM MEASUREMENTS

Artificial arms can, as a rule, be fitted from measurements and diagrams, while the wearers remain at home. The same reasons that are given for fitting artificial legs from measurements apply to arms. The guarantees that we give protect the ordering party in the strongest possible way. Should an arm fail to fit acceptably, when made from measurements, it may be assumed that the stump has changed, or that there are peculiarities about the stump which have not been made known. No matter what conditions may be responsible for such misfit, the arm can be returned, with particulars, and all the needed alterations or reconstructions will be made by us without charge, or, if the wearer desires, he can at that time call upon us and have the arm refitted and readjusted directly to his stump. It will thus be seen that the conditions under which fittings are made from measurements are entirely in the interest of the wearer. As a rule, fitting from measurements results in saving the party expense, annoyance, and loss of time in traveling.