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More than a century later,around 1912,the English aviator Marcel Desoutter began a trend toward lightness and durability with the in- troduction of aluminum as a prosthetic material. Although pure alu- minum was first extracted in 1827, it was so expensive to produce that it was used mostly in jewelry throughout much of the nineteenth century. But after a cheaper manufacturing method was invented in 1886, aluminum entered industrial use. Its use in aircraft began in 1897 when it was used to form the frame of an airship, and it contin- ued to play an important role in aviation.When Desoutter lost a leg in an airplane accident, he and his brother, an aeronautical engineer, designed the first prosthesis to use aluminum, combining strength with lightness.

While the needs of knightly warriors had provided initial moti- vation, and advances came from individual efforts like those of Marcel Desoutter, it took the massive scale of modern warfare to truly stimu- late prosthetic science. In the American CivilWar, the combination of enormous casualties with the state of nineteenth-century medical practice meant that amputations were common30,000 on the Union side alone. (On the Confederate side, General John Hood had his right leg amputated after he was shot at the battle of Chickamauga in 1863. He finished out the war with a wooden leg that allowed him to continue riding horseback.) When, in 1862, the federal govern- ment guaranteed prostheses for Union veterans who had lost limbs, the result was the growth of a business that by 1917 supported some 200 clinics.World War I also had its effect, albeit a relatively limited one in the United States, which was involved in the war only from 1917 to 1918. American soldiers suffered more than 4,000 amputa- tions, compared to nearly 10 times as many for British troops and a total of 100,000 for all the armies from European nationsa number that inspired the growth of prosthetic technology in Europe.

But after World War II, with its extensive casualties among all the combatants (including more than 45,000 amputees among U.S. troops), the need for the serious development of prostheses became widely recognized. Improvements proceeded faster, encouraged by government support. Now, although we do not have a major conflict

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