Civil War Washington

CASE 659.—Private J. C. Coats, Co. I, 5th Vermont, aged 22 years, was wounded at Fredericksburg, December 13, 1862. He was conveyed to Harewood Hospital, Washington, and transferred to Satterlee, Philadelphia, December 23d. Acting Assistant Surgeon W. W. Keen, jr.​, from the latter hospital, described the wound as " an injury of the right tibia," and reported: "The man had been hit by a fragment of a shell, which struck his left shoe without seriously injuring the foot; it then glanced and struck the right tibia antero-internally in the lower third. On admission to the hospital there was a swelling, fluctuating but quite tense, at the point of the injury in the leg, which I opened by an incision about three-fourths of an inch long. About an ounce and a half of coagulated blood and some pus was evacuated, and poultices were ordered to be applied. The wound did well till January 1, 1863, when it began to enlarge and look very much like hospital gangrene. I suspected this the more from the prevalence of this disease at that time in the ward. The edges of the wound had become everted, its base rather ashy grey, and the discharge unhealthy, and a considerable circle of inflammation was around the opening. But the characteristic stinging pain being absent, I determined not to treat it as hospital gangrene but by the ordinary measures for inflammation. I ordered three compound cathartic pills to be taken and tincture of iodine to be applied locally, also a large poultice. On January 6th, the wound had increased to two and one-fourth inches in diameter, but was still entirely without the peculiar pain of hospital gangrene, when I ordered a mixture, consisting of half an ounce of hydrochloric acid, two ounces of laudanum, and one pint of water, to be used locally with lint. The acid wash was gradually diluted, and finally abandoned on January 25th. The patient being rather anæmic, I ordered two grains of quinine and four ounces of milk punch to be given daily. On January 30th another abscess was opened, and on February 9th yet another, each being preceded by severe pain, tenderness, and swelling. No doubt they as well as the original one were the result of severe local periostitis. They were readily subdued by cathartics and poultices, with morphia at night. No bone was at any time discharged, although considerable depression existed on the tibia from absorption of the tissue. On February 20th, the patient was transferred to Brattleboro', the wound having almost entirely healed and there being but little depression." The man entered the Marine Hospital at Burlington, and on March 8, 1864, was assigned to the Veteran Reserve Corps, and discharged July 13, 1865, and pensioned. Examining Surgeon A. P. Belden, of Whitehall, N. Y., reported the wound as being in an inflamed condition, and added that "it opens at any time the limb is much used in standing or walking. There is adhesion of the peroneus longus muscle and ligament, and inflammation produced partial anchylosis of the ankle joint." Examiner J. Lambert, of Salem, N. Y., August 10, 1878, reported that "the injured bone is necrosed for about three inches and demands an operation." The pensioner was paid September 4, 1880.