Publications and Papers by Alan J Hawk
Clinical Oorthopaedics and Related Research, 2021
physician in the US Army Medical Corps, had a simple mission: lead the medical section of the U.S... more physician in the US Army Medical Corps, had a simple mission: lead the medical section of the U.S. Army Engineer Battalion in Nicaragua, created in response to a congressional mandate for a survey of a proposed Transocean canal. The canal was a proposed companion for the recently completed Panama Canal. Just before 10:30 am, Maj. Hawley's mission suddenly changed. A powerful earthquake had just destroyed Managua, the capital and largest city of Nicaragua, in less than 6 seconds, and in the process killed approximately 1000 people. Virtually every building in Managua was leveled to the ground and the city's municipal water and sewage systems were also destroyed. After receiving a cable from Washington DC, Lt. Col. Daniel Sultan (1885-1947), Battalion Commander, organized a relief train with supplies en route to Managua [1]. The train's supplies were desperately needed. Major fires burning in the city would ultimately last into the next day. All the hospitals in the city had collapsed and any medical equipment buried in the ruins needed to be recovered as soon as possible. On board the relief train, Maj. Hawley had nothing to deal with a disaster on the scale he faced upon his arrival in Managua. As a Battalion Linden Lane,
Clinical Orthopaedics and Related Research®, 2016
Clin Orthop Relat Res, 2019
During the first half of the 20th century, surgeons generally treated fractures with external spl... more During the first half of the 20th century, surgeons generally treated fractures with external splints, plaster casts, or by painstakingly assembling the bone fragments at surgery, and holding them together with screws, plates, or wires.
But at the Surgical Congress in Berlin, Germany in 1940, German surgeon Gerhard Küntscher (1900-1972) proposed inserting a stainless steel, hollow rod into the intramedullary cavity to stabilize the damaged limb (Fig. (Fig.1),1), an approach he based on his preliminary results while experimenting with animals [1, 5, 6].
The attendees of the congress soundly dismissed and ridiculed Küntscher and his surgical concept [1, 4, 6], suggesting he stood as an outsider among the German surgeons inside the Nazi regime [7].
While his German colleagues rejected the technique, one surgeon attending the conference, Lorenz Böhler (1885-1973) managed to smuggle an example of the nail back into his native Vienna [1, 4, 6], a dangerous endeavor considering the heavy restrictions Germany placed on information flow in times of war [4]. Böhler performed the technique in Vienna, where it eventually was accepted; it later spread throughout Nazi-annexed and neutral Europe [2].
Clinical Orthopaedics & Related Research, 2022
While on a trip to Europe in 1890, Major John Shaw Billings (1838-1913), Curator of the Army Medi... more While on a trip to Europe in 1890, Major John Shaw Billings (1838-1913), Curator of the Army Medical Museum, made a peculiar purchase from noted French anatomist and model maker Jules Talrich (1826-1904): a collection of 20 plaster casts of female pelvises “showing either narrowing or flattening, rachitic or non-rachitic, symmetrical or non-symmetrical; mostly scoliotic” [6].
His purchase was strange because none of the characteristics represented by this collection were under the purview of a military surgeon. Scoliosis and rickets would be disqualifying conditions for any man interested in the Army, and women could not serve. Despite having the commonality of scoliosis, these models depicted the pelvis, the hip portion of the femur, and only the bottom two or three lumbar vertebrae—not more of the curved spine as one might expect
Clinical Orthopaedics & Related Research, 2020
Two American inmates of a Japanese POW Camp in Burma created a prosthesis for fellow POW Cpl. Ber... more Two American inmates of a Japanese POW Camp in Burma created a prosthesis for fellow POW Cpl. Bert Jones in 1942. Cpl. Jones’ leg was amputated after developing
a tropical ulcer due to the unsanitary conditions in the camp. The two POWs fashioned the leg of the prosthesis from the remains of a leather belt and metal folding chair
using only a pocketknife. The leg was constructed in secret for fear that the Japanese Guards would discover and confiscate their tools and equipment before completion.
Clin Orthop Relat Res, 2021
Robert Liston (1794-1847) held a (well-earned) reputation as the fastest surgeon of his time. One... more Robert Liston (1794-1847) held a (well-earned) reputation as the fastest surgeon of his time. One contemporary recalled of Liston: “It is told that when he amputated, the gleam of his knife was followed so instantaneously by the sound of the bone being sawn as to make the two actions appear almost simultaneous” [7]. Before each of his procedures, he told the observing medical students, “Now gentlemen, time me” [6]. In at least one instance, the amputation took less than 30 seconds.
He is better known, perhaps apocryphally, for accidently amputating a patient’s testicle in addition to his leg [1]. Another time, he allegedly performed a procedure with 300% mortality. Let me explain: A spectator dropped dead at the shock of being slashed with the surgical knife, an assistant succumbed to infection after part of his hand had been cut off as well, and of course, the patient who developed postoperative gangrene [3].
In short, he was remembered as the stereotypical cocky early 19th century surgeon who would not be above proclaiming a procedure a success despite leaving the patient dead on the table. However, Liston’s approach to amputation, and more importantly, to pain management, had a positive motive. His need for speed derived from empathy for his patients rather than from his ego.
Clin Orthop Relat Res. , 2019
At the beginning of WWII, physicians had no means of determining the quality of nerve conduction ... more At the beginning of WWII, physicians had no means of determining the quality of nerve conduction for a soldier sustaining a gunshot wound to the upper or lower extremity. Part of the decision of whether to try to salvage the limb depended on whether any large nerves were degenerating, had degenerated, or were regenerating. At that time, the only way a surgeon could determine whether a nerve had been severed was by using a galvanic-faradic nerve stimulator to see whether the muscle twitched. Something more-precise was needed.
The Committee on Medical Research of the Office of Scientific Research and Development contracted researchers at Northwestern University to develop a better understanding of muscle and nerve damage resulting from trauma. One of the neurologists at Northwestern, LTJG James G. Golseth MD, USN-MC at Percy Jones General Hospital in Battle Creek, MI, USA, collaborated with engineer James A. Fizzell BS to develop a constant current impulse stimulator to measure the current flowing through a nerve, called an electromyograph (EMG) [7].
Clin Orthop Relat Res., 2018
Benjamin Tredwell Jr. (1735-1830) possessed a set of amputation knives (Fig. (Fig.1)1) that rese... more Benjamin Tredwell Jr. (1735-1830) possessed a set of amputation knives (Fig. (Fig.1)1) that resembled tools rather than surgical instruments. The sickle-shaped blades, with the cutting edge on the concave or inside of the curve [3], have an unpolished surface due to being sharpened many times with a grinding wheel. The smaller knife was likely designed to amputate a finger, a larger knife made to amputate an arm or leg, and the largest such knife was used to amputate from the thigh. Amputations of the period were performed using a circular stroke, rather than creating flaps for the residual limb. An assistant pulled up the skin proximally while the surgeon cut through the dermis and subcutaneous tissue.
J Trauma Acute Care Surg, 2018
BACKGROUND: Just over 200 years ago, surgeons were puzzled that the use of the tourniquet to cont... more BACKGROUND: Just over 200 years ago, surgeons were puzzled that the use of the tourniquet to control hemorrhage as common sense during surgery was a relatively recent development. Within the last 20 years, much progress has been made to controlling hemorrhage in the prehospital context. Then, as now, it was surprising that progress on something that appeared obvious had occurred only recently , begging the question how controlling blood loss was common sense in a surgical context, but not for emergency treatment. METHODS: This article is a historical survey of the evolution of the medical understanding of hemorrhage along with technological response. RESULTS: The danger of blood loss had historically been consistently underestimated as physicians looked at other explanations for symptoms of how the human body responded to trauma. As the danger from hemorrhage became apparent, even obvious, responsibility for hemorrhage control was delegated down from the surgeon to the paramedic and eventually to individual service members and civilian bystanders with training to " stop the bleed. " CONCLUSION: Hippocratic medicine assumed that blood diffused centrifugally into periphery through arteries. William Harvey's observation in 1615 that blood ran through a closed circulatory system gradually transformed conventional wisdom about blood loss, leading to the development of the tourniquet about a century later by Jean-Louis Petit, which made amputation of limbs survivable. However , physicians were cautious about their application during the First World War over concerns over effects on patient recovery. Hemorrhage had generally been seen as symptom to be managed until the patient would be seen by a surgeon who would stop the bleeding. More thorough collection and analysis of data related to case histories of soldiers wounded during the Vietnam Conflict transformed how surgeons understood the importance to hemorrhage leading to development of the doctrine of Tactical Combat Casualty Care in the late 1990s. (J Trauma Acute Care Surg. 2018;85: S13–S17.
Clinical Orthopedics and Related Research, 2017
George Tiemann & Co also had a reputation for creating innovative surgical instruments. One such ... more George Tiemann & Co also had a reputation for creating innovative surgical instruments. One such instrument was an amputation saw with a pistol grip handle, designed by Edward Pfarre, an instrument maker and partner in the company. Many of the smaller surgical kits included a backsaw with the Pfarre handle.
This design was marketed under a variety of names after the Civil War until it became widely identified as ‘‘Satterlee’s Saw’’. The curious thing about the Satterlee Saw was that it was neither designed by Satterlee nor specified by him. The saw, marketed by Tiemann as ‘‘Pfarre’s Amputating Saw’’ in 1872, was described as ‘‘Satterlee’s Capital Saw’’ 5 years later.
Clinical Orthopedics and Related Research, 2018
In an effort to improve upon these prostheses, a multinational consortium known as the Groupe pou... more In an effort to improve upon these prostheses, a multinational consortium known as the Groupe pour l’utilisation et l’´etude des proth`eses articulaires (GUEPAR) formed at the Pavillon Ollier,Hˆopital Cochin in Paris, France and quickly settled on developing a hinged knee design, rather than a less constrained prosthesis. In order to more closely duplicate the motion of the joint, the group moved the pivot of the hinge joint closer to the knee’s natural axis of rotation, allowing for greater flexion. The prosthesis, made of chrome cobalt-molybdenum alloy, was manufactured with both straight stems and 7o valgus stems to match the alignment of the patient’s limbs.
The treatment of war wounds is an ancient art, constantly refined to reflect improvements in weap... more The treatment of war wounds is an ancient art, constantly refined to reflect improvements in weapons technology, transportation, antiseptic practices, and surgical techniques. Throughout most of the history of warfare, more soldiers died from disease than combat wounds, and misconceptions regarding the best timing and mode of treatment for injuries often resulted in more harm than good. Since the 19th century, mortality from war wounds steadily decreased as surgeons on all sides of conflicts developed systems for rapidly moving the wounded from the battlefield to frontline hospitals where surgical care is delivered. We review the most important trends in US and Western military trauma management over two centuries, including the shift from primary to delayed closure in wound management, refinement of amputation techniques, advances in evacuation philosophy and technology, the development of antiseptic practices, and the use of antibiotics. We also discuss how the lessons of history are reflected in contemporary US practices in Iraq and Afghanistan.
When his unit, the 2nd Surgical Hospital (MA), was established at An Khe in January 1966, MAJ Ric... more When his unit, the 2nd Surgical Hospital (MA), was established at An Khe in January 1966, MAJ Rich began collecting retrieved foreign bodies along with documentation of the wound. A museum displaying these objects was established at one end of the operating room Quonset hut. During Rich's tour of duty, there were 324 cases where the patient was wounded by a punji stick, representing 38% wounds because of hostile action
Journal of the South Carolina Medical Association (1975), May 1, 1991
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Publications and Papers by Alan J Hawk
But at the Surgical Congress in Berlin, Germany in 1940, German surgeon Gerhard Küntscher (1900-1972) proposed inserting a stainless steel, hollow rod into the intramedullary cavity to stabilize the damaged limb (Fig. (Fig.1),1), an approach he based on his preliminary results while experimenting with animals [1, 5, 6].
The attendees of the congress soundly dismissed and ridiculed Küntscher and his surgical concept [1, 4, 6], suggesting he stood as an outsider among the German surgeons inside the Nazi regime [7].
While his German colleagues rejected the technique, one surgeon attending the conference, Lorenz Böhler (1885-1973) managed to smuggle an example of the nail back into his native Vienna [1, 4, 6], a dangerous endeavor considering the heavy restrictions Germany placed on information flow in times of war [4]. Böhler performed the technique in Vienna, where it eventually was accepted; it later spread throughout Nazi-annexed and neutral Europe [2].
His purchase was strange because none of the characteristics represented by this collection were under the purview of a military surgeon. Scoliosis and rickets would be disqualifying conditions for any man interested in the Army, and women could not serve. Despite having the commonality of scoliosis, these models depicted the pelvis, the hip portion of the femur, and only the bottom two or three lumbar vertebrae—not more of the curved spine as one might expect
a tropical ulcer due to the unsanitary conditions in the camp. The two POWs fashioned the leg of the prosthesis from the remains of a leather belt and metal folding chair
using only a pocketknife. The leg was constructed in secret for fear that the Japanese Guards would discover and confiscate their tools and equipment before completion.
He is better known, perhaps apocryphally, for accidently amputating a patient’s testicle in addition to his leg [1]. Another time, he allegedly performed a procedure with 300% mortality. Let me explain: A spectator dropped dead at the shock of being slashed with the surgical knife, an assistant succumbed to infection after part of his hand had been cut off as well, and of course, the patient who developed postoperative gangrene [3].
In short, he was remembered as the stereotypical cocky early 19th century surgeon who would not be above proclaiming a procedure a success despite leaving the patient dead on the table. However, Liston’s approach to amputation, and more importantly, to pain management, had a positive motive. His need for speed derived from empathy for his patients rather than from his ego.
The Committee on Medical Research of the Office of Scientific Research and Development contracted researchers at Northwestern University to develop a better understanding of muscle and nerve damage resulting from trauma. One of the neurologists at Northwestern, LTJG James G. Golseth MD, USN-MC at Percy Jones General Hospital in Battle Creek, MI, USA, collaborated with engineer James A. Fizzell BS to develop a constant current impulse stimulator to measure the current flowing through a nerve, called an electromyograph (EMG) [7].
This design was marketed under a variety of names after the Civil War until it became widely identified as ‘‘Satterlee’s Saw’’. The curious thing about the Satterlee Saw was that it was neither designed by Satterlee nor specified by him. The saw, marketed by Tiemann as ‘‘Pfarre’s Amputating Saw’’ in 1872, was described as ‘‘Satterlee’s Capital Saw’’ 5 years later.