Civil War Washington

CASE 112.—Private F. Binder, Co. G, 131st Pa.; age 27; was admitted Dec. 30, 1862, with gangrene of both feet after typhoid fever. About eight weeks prior to admission he was attacked with chills and fever, but the disease afterwards assumed the character of typhoid fever. The condition of his feet was supposed to be due to frost-bite while sick in camp. On Jan. 7, 1863, the skin of both feet was reported as blue from the toes to above the ankles, where was an irregular border of redness; below the malleoli the parts were cold and a pin could be inserted without being felt. Lines of demarcation were formed on the 9th just above the malleoli; at this time the patient's appetite was improving and his tongue looking well, but his skin was slightly yellow and he complained of much pain, which he referred to his feet. On the 22d his bowels became loose, there having been five stools during the day, and next day the tongue was somewhat dry. He slept well at night and had no night-sweats, but he lost flesh and continued to suffer from pain in the feet. The right foot separated at the ankle-joint on the 26th, the stump having bled quite freely. Next day both legs were amputated by "Le Noir's" operation, after which the patient reacted fairly and rested well. On the 30th the stumps looked badly and discharged a grayish pus, while vomiting, hiccough and extreme depression were developed. Death took place February 2. Post-mortem examination twenty-four hours after death: There were clots in all the arteries of the stumps except the right anterior tibial. On pressing the medulla of the left tibia a yellowish liquid exuded from the vascular foramina in the compact substance of the bone. The brain was healthy. The right lung weighed thirty-three ounces and three-quarters; in its lower lobe was a circumscribed, light-colored, consolidated mass and numerous light-colored points, about the size of pinheads, surrounded by irregular areas of congestion; a portion of this lobe was in the state of gray hepatization. The left lung weighed eighteen ounces and a quarter; on the posterior surface of its lower lobe and in the substance of the upper lobe were a number of discolored spots beneath which the lung-tissue was infiltrated with serum. The heart was pale and contained a small fibrinous clot in the right ventricle. The liver was pale and firm; the gall-bladder small; the spleen weighed seven ounces and a half and was very soft; the pancreas was of a grayish color; both kidneys were small and light-colored. The stomach was large, its mucous membrane slightly softened; the upper part of the jejunum was slate-colored; the whole of the ileum congested and its valvulæ conniventes indistinct; Peyer's patches were slightly thickened and some of them congested. The large intestine was congested.—Ass't Surg. George M. McGill, U. S. A., Lincoln Hospital, Washington, D. C.