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November 2, 2020

¶ 1 Leave a comment on paragraph 1 0 SURGICAL CASES, BY CLEMENT HAWKINS, ESQ.

¶ 2 Leave a comment on paragraph 2 0 341

¶ 3 Leave a comment on paragraph 3 1 against the prevailing epidemic, the primary object having been to restore the equilibrium of the circulation, and, consequently, the natural temperature of the body, upon the loss of which, in varying degrees, many of the most prominent symptoms of the disease may be said to depend. My experience has, of course, bean very limited, because the disease has never visited this town epidemically; and the only opportunities I have had of observing its peculiarities, or of testing the mode of treatment which I have employed, have been in cases which have been imported into the town from other infected districts, or in a few isolated instances occurring sporadically, while it has existed epidemically in other localities. I do not pretend to affirm that they have all been cases of the true Asiatic disease; but they have for the most part closely resembled it, in some of its most prominent features, and have all, to the number of eighteen, without a single exception, yielded to the mode of treatment which I have adopted for their relief.

¶ 4 Leave a comment on paragraph 4 1 Setting aside the ordinary well-marked symptoms of the premonitory diarrhoea, there can be little doubt that in the fully- developed disease internal congestion, in various degrees of in- tensity, constitutes one of the most significant features of this complaint. The coldness of the extremities, and the feeble and almost imperceptible pulse, clearly indicate an oppression at the centre of the circulating system, and this without reference to any previous drain of the fluids of the body ; for it happens in many cases that there have been no excessive evacuations to account for the prostration of the vital powers observed. Upon what this congestive condition of internal organs depends, whether upon the absorption of some morbid poison into the system, or upon some peculiar disturbance of the electrical condition of the atmosphere, it is impossible to say; but it is certain that it always exists in varying degrees in different cases, and has indeed been proved to have existed by post-mortem examination of those who have died from the disease, by which it has been found, that the whole of the spinal and ganglionic nervous system must have been so completely under congestion during life as necessarily to have occasioned great interruption to the functions of organs under the influence of these portions of the nervous system.

¶ 5 Leave a comment on paragraph 5 1 Modern opinion leans to the belief, that the curative means to be employed in this disease should be essentially of an eliminative character, and the good effects which have been recently observed from the use of repeated doses of castor-oil would tend to strengthen this opinion. The mode of treatment adopted in the foregoing cases is partly founded upon this hypothesis, but mainly upon the fact, that it possesses the power of relieving the congestion of internal organs, and consequently of restoring and preserving the natural temperature of the body, a point of great importance in all cases of poisoning, from whatever cause arising.

¶ 6 Leave a comment on paragraph 6 1 It has been clearly proved by physiological experiment that the maintenance of temperature alone is capable of exerting a direct and remarkable influence in preventing the ill effects of poison upon the animal economy, a circumstance particularly alluded to by M. Brown Sequard, of whose observations on the subject an interesting digest is afforded in the pages of the Leader newspaper of October 1, 1853, which partially tending as they do to explain the effects produced in the foregoing cases, I shall take the liberty of transcribing.

¶ 7 Leave a comment on paragraph 7 1 “It has long been known that sudden lowering of the temperature to a certain degree causes death in all mammalia. It is also known that in cases of poisoning there is a remarkable lowering of the temperature. Connecting these facts with the known diminution of temperature resulting from wounds, from diarrhoea, from cholera, etc., it occurred to this celebrated physiologist that diminution of temperature was in all these cases the proximate cause of death. He tested this hypothesis by experiment, and in the 1st volume of “ Les Memoires de la Societe de Biologie,” p. 102, will be found a communication he addressed to the Society in July, 1849. We give briefly his results. He found that a dose of poison, which would under ordinary circumstances destroy an animal, was ineffectual if the animal’s normal temperature could be maintained. Thus, a dose given to an animal kept in an atmosphere of from 8 to 10 degrees Centigrade (46 to 50 degs. Fahrenheit), destroyed it in periods varying from 4 to 48 hours.

¶ 8 Leave a comment on paragraph 8 0 “But a similar dose, given to a similar animal whose temperature was maintained by keeping it in an atmosphere of 28 to 30 degs. Centigrade (82 to 86 degs. Fahrenheit), did not take effect. The animal survived.

¶ 9 Leave a comment on paragraph 9 0 “ Not only did diminution of temperature in these cases appear the proximate cause of death, temperature being the only condition which was varied in the experiments, but M. Brown

¶ 10 Leave a comment on paragraph 10 1 Sequard proved it another way. It had been repeatedly shown by Majendie, Breschet, and others, that animals entirely covered with coatings of oil or varnish, which prevented transpiration, were invariably killed, poisoned as it was supposed by the substance eliminated from the blood, which could no longer pass away through the skin. Now M. Brown Sequard performed this experiment, varying the condition of temperature, and he found that when kept in an atmosphere of 82 degs. Fahrenheit they invariably survived.

¶ 11 Leave a comment on paragraph 11 0 “ These experiments demonstrate the fact, that the diminution of temperature resulting, from poisons, and many other disturbances of the system, is the proximate cause of death.”

¶ 12 Leave a comment on paragraph 12 0 SURGICAL CASES IN THE PRACTICE

¶ 13 Leave a comment on paragraph 13 0 OF

¶ 14 Leave a comment on paragraph 14 0 CLEMENT HAWKINS, Esq., F.R.C.S.

0. ¶ 15 Leave a comment on paragraph 15 0
1. Case 1. —COMPOUND FRACTURE OF LEG IN EIGHTH MONTH OF PREGNANCY—RECOVERY.

¶ 16 Leave a comment on paragraph 16 0 I was requested to attend Mrs. J., aged 36, Feb. 22nd. She had received a compound fracture of the right leg at its lower third. The fracture was very oblique; the tibia protruding nearly an inch; the haemorrhage had been considerable, but had ceased when I saw her. The bones were adjusted without much difficulty, two leg splints and a fracture-box were applied, the wound being dressed lightly with lint, and cold evaporating lotion applied.

¶ 17 Leave a comment on paragraph 17 1 Feb. 28.—The wound was dressed; suppuration had commenced; there was a slight blush about it; simple dressing was applied.

¶ 18 Leave a comment on paragraph 18 0 March 10.—The wound had firmly healed; two straight pieces of board were substituted for common leg-splints.

¶ 19 Leave a comment on paragraph 19 0 Five weeks from the receipt of the accident the bones had firmly united. April 2, I delivered her of a healthy female child, and, on the 14th, she left her bed quite recovered.’

0. ¶ 20 Leave a comment on paragraph 20 0
1. Case 2. —DISEASE OF ANKLE-JOINT DURING PREGNANCY-AMPUTATION OF LEG IN SIXTH MONTH —RECOVERY—DELIVERY,

¶ 21 Leave a comment on paragraph 21 1 March 15.—I removed the left leg below the knee from a woman aged 32, who was in the sixth month of utero-gestation. When eight years of age she was severely burnt, and had been in feeble health since, but had never had any severe illness; she has had one child at the full time, and has not suffered uterine disease.

¶ 22 Leave a comment on paragraph 22 1 In December she got very wet, and was seized with pain and swelling of the left instep, for which she was treated. An abscess formed on the fibular side of the. limb, which was opened; pain of the most severe character preventing rest ensued, and when she came under my care (about three weeks since,) I found the ankle-joint in a state of extension fixed, an opening at the external malleolus, through which a probe passed upwards for an inch; the internal ankle was swollen, as also its anterior aspect; the pulse was quick; the countenance anxious and sharp, and expressive of great suffering. She informed me she was nearly six months pregnant, and felt the motions of the child. Opium, poultices, and other means calculated to lessen the irritation were used; the pain increased, and she implored me to remove her limb.

¶ 23 Leave a comment on paragraph 23 0 March 14.—I requested my friend, Mr. Fowler, to see her, who, together with Mr. Skey, sanctioned the amputation.

¶ 24 Leave a comment on paragraph 24 0 March 15th.—I removed the limb at the usual place, below the knee, the patient being under the influence of chloroform, little blood was lost, ligatures were applied to all the vessels, (arteries and veins) which bled.

¶ 25 Leave a comment on paragraph 25 0 Everything went on well till the 19th, when she was seized suddenly with shivering and vomiting, followed by pain in the groin; an absorbent gland enlarged; but, under the use. of calomel and opium, and stimulants, subsided, and at the end of three weeks the stump was healed. On the 4th July she was safely delivered of a fine healthy child, and is now quite well.

¶ 26 Leave a comment on paragraph 26 0 I will not trespass further on your space, than to state the examination of the amputated limb. Discovered a great extent of disease, ulceration of cartilage, and pieces of detached bone loose in the joint, etc.

¶ 27 Leave a comment on paragraph 27 0 Cheltenham, Sept. 6, 1854.