Daniel Sousa and amputee history

[dirty_diana]

Posting about Agent Carter with the permission of the mod.

Recently a tumblr user posed a question about the nature of Sousa's injury/prosthesis in the AC tag, which sent me into a bit of a google spiral trying to figure out what the options would have been. Trying to match Enver Gjokaj's performance to what the technology would have been at that time, our conclusions were best summarised by yalumesse as

So we can pretty much say that, if he has a prosthetic*, it’s got to be a socket type that starts somewhere on his thigh, has a knee joint, can take some weight but is stiff and can’t bend easily, but does bend, and he doesn’t need to use his hands to manually bend/lock it. He doesn’t absolutely need the crutch to move in emergencies, but probably can’t go without it too long without getting exhausted/causing more or long-term damage to himself. Sound right?

You can read our meandering chain of logic/research here. One source about the progress of prosthetic knee hydraulics I read but didn't explicitly credit is here, which adds that balance would also have been an issue.

We don't go into it much but it seems like a lot of the engineering progress was spurred by complaints and protests about lack of quality care and prosthesis availability that the veteran amputees were making in 1945-ish, which is an interesting read on Sousa's sometimes jaded tone.

Then lilacsigil directed me to the life and times of Douglas Bader, who flew fighter planes for the RAF in WWII after his double amputation a few years before. About whom wikipedia says

It was thought that Bader's success as a fighter pilot was partly because of his having no legs; pilots pulling high "g-forces" in combat turns often "blacked out" as the flow of blood from the brain drained to other parts of the body, usually the legs. As Bader had no legs he could remain conscious longer, and thus had an advantage over more able-bodied opponents.

Linking in case of interest and/or desire to correct our understanding of medical history. :)

Comments

[sholio]

Speaking as someone who's just started writing this character, this is absolutely fascinating and very useful; thank you!

Yeah, I've been watching the way Sousa (or, well, Gjokaj-as-Sousa) moves, since I have a leg-related disability myself and that kind of thing is interesting to me. One thing that I had noticed is that, while I think he does pretty well with it, the way he moves is a lot less ... graceful, naturalized I guess, than most people IRL who actually have amputations or other mobility-impairment disabilities. (For contrast, look at how Jim Byrnes -- of Highlander and Wiseguy, who has a double above-the-knee amputation and walks with two prostheses and a cane -- moves around on his shows.) Obviously the out-of-universe explanation is that Gjokaj actually has two perfectly functional legs and isn't used to it, but it also makes sense to me in-universe because he's probably only had a couple of years to relearn how to move around and the prosthetics would be pretty clunky as well. It's also headcanon for me, I guess, that he's suffering from the after-effects of poor surgical care and really nothing in the way of physical therapy, considering the state of medical care at the time and the fact that he got his primary care in a war theatre.

... anyway, I am ridiculously fascinated by this stuff, so thanks for the links. :D

[dirty_diana]

Obviously the out-of-universe explanation is that Gjokaj actually has two perfectly functional legs and isn't used to it, but it also makes sense to me in-universe because he's probably only had a couple of years to relearn how to move around and the prosthetics would be pretty clunky as well.

Yep, while Gjokaj definitely appears to have put some thought into it, it's still impossible for it to be a perfect impression. (And of course there's the question of why they didn't hire an actual amputee/pwd even though I appreciate his effort.) But the Watsonian explanations are enough to make it reasonably believable. The technology just wasn't all that far along yet. And that's a good point that it's still new to him. He's portrayed as still holding onto *some* grief for his old body, which would potentially be another barrier to really perfecting use of the new one.

You're welcome! I had no idea that I was going to find it interesting but apparently I do. Would love to see lots of Sousa fic that takes it into consideration.

[domarzione]

I don't know how useful a comparison it might be, but in the British tv series Foyle's War (available streaming on Netflix), Foyle, a police inspector in southern England during WWII has a sergeant, Paul Milner, who is available because he lost part of his leg at Trondheim. (His availability is part of the story of the first episode; Foyle approaches a despondent Milner in his hospital bed -- the leg is not all the war has cost him.) He gets around on a prosthesis with a limp but no crutch after the beginning, but is hampered in his work at times by his inability to drive and do things like climb ladders at all or stairs quickly.

[dirty_diana]

That's interesting! I will look for it. My short burst of research indicates that the US amputee veteran experience was partially due to some specifics of politics and Veteran Affairs kind of dropping the ball. So I'm not sure how much that part would also have applied to amputees who fought with other Allies but now I kind of want to look it up.

[domarzione]

You've obviously done more research than I have, but I would perhaps emphasize the state of adaptive technology (i.e., how sophisticated anyone could make fake limbs) over the government not doing enough. The welfare state was a different and much tinier thing back then with lower expectations placed upon it and private enterprise a much greater driving force in the first half of the 20th C.

Which is not to say that the gov't wasn't always buying the cheapest available option regardless of quality because, well, lowest bidder always wins.

(The history of adaptive tech is market-and-civilian-technology driven, not purely government driven. Governments make war and thus make wounded, but civilian demand for adaptive tech rose greatly in the post-war period, too -- more cars, more factories, more tractors, more power tools, better birth survival rates, etc. The VA was not the sole market, nor necessarily even the primary.

As an aside: the rate of permanently invalided soldiers rises as the advances in tactics and protective gear improve through the 20th C and beyond. It will always be behind the advances in weapons, but as casualty survivability increased, so did the need for adaptive tech. A limb blown off in WWII was much more likely to be fatal than it would be in Korea just a few years later because the Army changed the way MASH units were deployed -- pushing them much closer to the fighting and the wounded. The development of modern body armor further spiked the survival rate, which is why adaptive tech has leapfrogged since 2001 -- many of the wounded now would have been fatalities a short time ago, their torsos and heads as mangled as their limbs.)

[dirty_diana]

*nods* I wasn't trying to dismiss the technology aspect at all - that was my main area of curiousity/reading and it was obviously huge. I was just thinking about characterisation, since you kind of brought that up. I think that when an individual becomes disabled, their degree of bitterness/anger in that difficult beginning is often linked to how much help and fair treatment they perceive themselves to have gotten or not gotten.

So while there is a lot of universality in the experience of that strong, healthy young man who is suddenly an amputee, and as you mention wouldn't necessarily even have survived to live through these issues in earlier wars - I was just wondering about any non-transferable aspects in the problems of aftercare. And there might not have been any differences at all, I would just be curious to know either way. The show does touch on Sousa's frustration with society, as opposed to him strictly being frustrated with the missing leg.

Those are good points about the pace of improvements throughout history and combat. I think that I wouldn't argue with


(The history of adaptive tech is market-and-civilian-technology driven, not purely government driven. Governments make war and thus make wounded, but civilian demand for adaptive tech rose greatly in the post-war period, too -- more cars, more factories, more tractors, more power tools, better birth survival rates, etc. The VA was not the sole market, nor necessarily even the primary.

in general, but in the specific issue I was looking up - usability of knees in above-the-knee prosthetic legs - WWII was an overwhelming factor. After the protests the VA launched a push to organise the research and direct it in certain ways based on what the vets were saying were their biggest problems. Up until then that specific prosthesis hadn't reliably advanced much at all. The breakthroughs around knee bending/locking/unlocking that happened in the late 40s were veteran driven even if certainly other amputees and research motivation did exist.

When the National Academy of Sciences (NAS) initiated a research program in limb prosthetics in 1945 at the request of the Surgeon General of the Army, surveys of amputees indicated that the above-knee amputees felt that their greatest need was a knee lock that would prevent stumbling. This "finding" prompted a number of designs in the United States that used hydraulic systems to provide knee locking or braking on demand

[from source in post]