Civil War Washington

CASE 526.—Private H. C. Frazer, Co. A, 40th New York, while cutting wood, on June 20, 1862, accidentally struck the left knee. He entered Ascension Hospital,, Washington, July 4th, whence Acting Assistant Surgeon J. W. Bulkley reported that the cut ran obliquely across the outside of the joint and had nearly healed when the patient was admitted. About ten or eleven days afterwards, however, the leg and joint became greatly swollen and inflamed, the skin rapidly assuming a bright red color. This was attended with excessive pain in the joint upon motion. Ice, cold irrigations, and tincture of iodine were applied, and salines, small doses of tartar emetic, and sweet spirits of nitre were administered. Bandages were applied from the foot to the knee joint with good effect. On July 20th, a small incision was made inside the ligamentum patella and gave exit to a large amount of sanious and highly offensive pus. About July 27th, the pus was noticed to be accumulating in the joint and burrowing above it in the muscles of the thigh. The bandage was still used, and cold, alternated with warm, applications were continued. Quinine and tincture of iron was now given, and beef tea and brandy punch freely. About the beginning of August an incision, made in the calf of the leg, gave exit to still more offensive pus. After August 5th the patient was slowly sinking. A small blackish discoloration was then seen on the inside of the leg, midway between the knee and the ankle; the foot, which from the first had remained œdematous, was puffed and pitting on pressure. On August 13th the black spot was noticed to be rapidly increasing and was recognized as gangrene, when a lotion of nitric acid was applied. On the following day, the necessity of amputation becoming manifest, two doses of one-half grain of morphia each were administered, after which the limb was removed about six inches below the trochanters by the antero-posterior flap method. The operation was performed by Surgeon J. C. Dorr, U. S. V., assisted by others, the patient being under the influence of chloroform, and losing but a slight amount of blood. Dead and disorganized tissues were found in the flaps and dissected out, after which the lips of the wound were closed by silver sutures and adhesive plaster. Stimulants were freely given, but the patient sank rapidly, and died at 5 P. M. on the same day. An examination showed that the soft parts were extensively disorganized nearly to the trochanters; also that the original wound had communicated with the knee joint.