By Deborah Conn

The American Orthotic & Prosthetic Association (AOPA) turns 90 this year, and it’s the perfect occasion to look back at the rich past of the O&P industry in this country. The history of this profession is a long one, filled with ingenious innovators, dedicated humanitarians and savvy business owners.

Products have taken unimaginable leaps—from limbs made of barrel staves to technological wonders that practically think for themselves. In this issue and the next, the O&P Almanac takes a look at some of the highlights of O&P over the last century and a half. In this part, we cover the years from the Civil War to World War II.

It all started…
It’s logical, if tragic, that wars have been the powerful engine driving the prosthetics industry. The Civil War caused between 60,000 and 70,000 amputations. A Confederate soldier, James Edward Hanger, is popularly believed to be the first amputee in that war, when a cannonball ricocheted around a barn to where he was sleeping.

Hanger was captured and treated by a Union surgeon, but he was unhappy with the artificial leg he received. An engineer by training, Hanger created a better prosthesis, with a hinged knee and foot, from barrel staves, rubber, wood and metal. Hanger’s device received a lot of attention, and he began selling the device to other amputees during and after the war. Hanger patented his prosthesis and established the J.E. Hanger Co., in 1861, the first prosthetic company in the United States, in Richmond, Va. Today, the Hanger Orthopedic Group is one of the largest O&P companies in the world.

Another early, and innovative, company was founded by A.A. Marks in New York City, in 1853. According to Donald Schurr and Thomas Cook, authors of the book Orthotics and Prosthetics, Marks improved prosthetic feet in 1860 by using hard rubber instead of wood. The company sold wooden socket limbs by mail for $75 to $150. By 1890, Marks was touting its 10,000-square-foot facility as the largest artificial limb “manu-factory” in the world.

In 1885, Albert Winkley patented a new kind of prosthesis. Winkley, who had lost his foot in a farm accident, was a customer of the Hanger Co. in Chicago. “Albert tried a number of artificial legs and was not happy with them,” says Greg Gruman, CP, president of Winkley Orthotics and Prosthetics, now headquartered in Golden Valley, Minn.  

“He tried to eliminate the friction between the socket and the stump by wrapping a piece of leather around the residual limb. It allowed the limb to move independently from the prosthesis, eliminating friction and shear forces around the residual limb,” explains Gruman.

Winkley called his device the slip socket, and it was so well received that he established the Winkley Artificial Limb Co. in Minneapolis in 1888.

Lowell Jepson became Winkley’s business partner, and in 1892, the company demonstrated its invention at the annual Grand Army of the Republic convention, held in Minneapolis that year.

“That was a big jump for the company,” says Gruman. “After that, we attended a number of expositions, steadily winning best-in-show awards for the next 10 or 12 years. We had the chance to reach a lot of Civil War veterans, and Mississippi and Alabama awarded us contracts to provide every amputee veteran with an artificial limb.”

It was not uncommon for O&P companies to spring up after the Civil War—and disappear soon after. “There were 12 companies in Minneapolis that started in the 1890s and failed within a few years,” says Gruman. “It took more than just being an amputee to create a successful business.”

Upper-extremity limbs
Lower-limb amputees were receiving most of the attention at this time. Al Pike, CP, with the VA Medical Center in Minneapolis, notes that one exception was D.W. Dorrance, who invented a better arm prosthesis in 1909 after losing his limb in an industrial accident. Dorrance’s device featured a split hook that could be opened with a strap across the back. He founded the D.W. Dorrance Co. in 1912 in San Jose, Cal., and his hook design remained the standard for decades.

Another upper-limb manufacturer was A.J. Hosmer, who had developed such components as wrists, elbows, hinges and cable parts after an amputation from an industrial accident in 1943. The two companies merged in 1969 as the Hosmer Dorrance Co., which is today a subsidiary of the Fillauer Companies, Inc., in Chattanooga, Tenn.

Fillauer got its own start in 1914, when George Fillauer, a German immigrant, opened a pharmacy in Chattanooga. According to Karl Fillauer, CPO, FAAOP, and CEO of the Fillauer Companies, George located the pharmacy across the street from the hospital and by the 1920s was fitting appliances.

“In the early 1930s Granddad hired a German mechanic to manufacture braces,” says Fillauer. “They began fitting custom-made corsets, trusses and back braces. Then Granddad added on to the pharmacy, building a shop that did orthotics. He then became a distributor for Minneapolis Artificial Limb and expanded into prosthetics.

“My grandfather was very entrepreneurial and creative. He patented several trusses and back braces in the late 1930s.”

Today, still owned by the family, the Fillauer Companies encompasses Fillauer LLC, Hosmer, Motion Control, Center for Orthotics Design and Centri.

Carving legs from willow wood
In 1905, a railroad brakeman named William Arbogast lost both his legs—one above and one below the knee—when a train ran over them. He survived, says his great-granddaughter, Lisa Arbogast, only because he crawled to a nearby wooden shack and set it ablaze, hoping to catch someone’s attention.

Dissatisfied with the artificial limbs he was using, Arbogast began carving legs from the willow trees that grew all over his property in Five Points, Ohio. He established a prosthetic manufacturing company in 1907, aptly named Ohio Willow Wood, that moved to Mt. Sterling in 1913, where it remains today.

Lisa Arbogast is now a graphic designer and human resources associate at Ohio Willow Wood and works with her father, Robert, who runs the company today. Her brother, Ryan, is a supervisor there. Like many O&P businesses, Ohio Willow Wood is a family concern that has spanned multiple generations.

The company added a knitting department in 1921. “That’s when we introduced Sterling Stump Socks,” says Lisa Arbogast. “The knit sock was an interface between the stump and the leg and it became the industry standard. This was a major contribution to the field.”

Willow wood, too, became standard for artificial limbs for many years. It was light and strong, with an even grain. “Early on, everyone used it,” says H. E. (Ted) Thranhardt, CPO(E). “Once it had been cut and cured for several years, it wouldn’t crack after you started carving it. And it was gorgeous.”

In the early 1930s, William Arbogast brought his two sons, Edwin and John, into the company. “The two brothers were quite innovative,” says Lisa Arbogast. “They introduced the first ankle joint to the industry. It helped simulate the motion of a human foot.”

Beginnings of Snell’s Limbs & Braces
One of the rare O&P entrepreneurs who was not an amputee himself was R.W. Snell of Memphis, known as “Pop” to his family. In the early 1900s, Snell had a variety of business interests. His grandson William C. (Clint) Snell, CPO, who is president of Snell’s Limbs and Braces, Inc., in Shreveport, La., explains, “Pop did fruit orchards and farming, manufactured walking canes and taught school.” Eventually R.W. got a job in Memphis with a surgical supply business that had an O&P office as a sideline.

“In 1911, Pop bought the P&O end of the business along with his three sons—my father, Jim, my uncle Ralph, and another uncle, William, who died soon after in an auto accident,” says Clint Snell.

R.W. Snell branched out from Memphis into Nashville and Little Rock, Ark., in 1935. Jim Snell ran the Little Rock office, and Ralph took on Nashville. Jim opened his own facility in Shreveport in 1938, and a nephew, Ed Snell, took over the Little Rock office in 1945. Today, there are three separate corporations run by Snell family members.

AOPA’s inception
The period between the Civil War and the end of World War II was fairly quiet in terms of technological breakthroughs. Nevertheless, one significant event does stand out: the founding in 1917 of what would become the American Orthotic & Prosthetic Association (AOPA).

The U.S. government anticipated that returning World War I soldiers would spike the need for orthotic and prosthetic services. The Council of National Defense met with artificial limb and brace manufacturers from around the country in Washington, D.C. to help prepare the industry, and the Artificial Limb Manufacturers and Brace Association (ALMBA) was born.

“The two specialties would have formed earlier into one organization,” says Al Pike, “but there was a split in those days. Orthotists perceived prosthetists as being the less professional branch. They considered prosthetists to be more like salesmen than professionals.”

Between the Great Wars
The O&P industry created opportunities beyond manufacturing and fitting limbs and braces. Knit-Rite, Inc., based in Kansas City, Mo., was founded in 1923 by a World War I amputee and prosthetist named Billy Isle. “My grandfather, Ted Smith, was his patient,” says Mark Smith, CP, now president of the company. “Ted had lost a leg in a childhood streetcar accident.”

The history of Knit-Rite goes back to 1906, when William Edgar Isle became manager of the Kansas City branch of the J.K. Rowley Co. of Chicago, an early O&P provider. Billy Isle, as he was known, went to Europe during World War I to work with amputee soldiers. He returned a year later and in 1920 purchased the Kansas City office from Rowley.

“In 1923, Billy bought a knitting machine and started making socks for patients,” says Smith. At first, Anna Coen Isle, Billy’s wife, knit the socks on the sun porch of their home. Interest grew, and she took to the road, traveling throughout the country in her car, selling socks.

By the 1930s, Knit-Rite was manufacturing such prosthetic components as feet, knees, joints and a variety of orthotic parts.

In 1935, Theodore Smith, Mark’s father, joined the company as an artificial limb salesman. Says Mark Smith, “Ted traveled around the country selling limbs and socks. He became a certified orthotist, a partner in 1945 and then president of the company in 1968.”

Another company, Becker Orthopedic, got its start in 1933. The firm was founded by Otto Becker, a German immigrant who came to the United States in 1929. Becker moved to Huntington, W.Va., from New York in the early 1930s, where he learned to make braces and artificial limbs from a man named William Jahnig. In 1933, Becker moved across town and opened his own patient care facility, the Otto K. Becker Co.
In 1941, he opened another office in Detroit, and in 1944, he moved everything to Detroit and renamed the business Becker Manufacturing Co. The company moved to Birmingham, Michigan in 1946 and became Becker Orthopedic Appliance Co.

“In the mid-1940s, my father decided to design component parts,” says his son, Rudolf B. Becker, III. “The company began to manufacture orthotic component parts and also provided what is now known as central fabrication for a number of other O&P facilities. But in the early years, most of the company’s revenues came from patient care.”

A turning point
Like the Civil War, World War II was a watershed for the O&P industry.  Next month, the Almanac looks at some of the companies that began after the war and an array of exciting developments in technology sparked by concern for returning soldiers.