Civil War Washington

CASE 76.—Private P. Brown, Co. A, 169th New York, aged 36 years, was wounded at Cold Harbor, June 3, 1864, and admitted to Harewood Hospital, Washington, five days afterwards. Surgeon R. B. Bontecou, U. S. V., reported: "Shot flesh wound of left leg. Patient furloughed July 29th." Assistant Surgeon M. F. Coggswell, U. S. V., in charge of the Albany Hospital, reported the following result of the case: "The patient was admitted August 1st, having a large ulcer, measuring six by five and a half inches, on the calf of the leg, the result of a gunshot wound. His general health was very poor, and he was anæmic and debilitated. Gangrene had appeared previous to his admission to this hospital, and the ulcer was indolent, foul, and unhealthy. Nitrate of silver was applied and solution of chlorinate of soda, also poultices of flaxseed-meal mingled with pulverized charcoal. This treatment was followed in twenty-four hours by a healthy discharge of pus and a general improvement of the ulcer. Beef-tea, milk-punch, and extra diet were ordered. On the 2d of August his tongue was red and dry, his appetite failed, and he manifested great uneasiness and appeared to labor under an impression of impending evil. That night (August 2d) the weather, which had been very hot and dry for several days, suddenly became damp and chilly, and on the morning of August 3d, at 4 o'clock, symptoms of trismus appeared, and were followed in two hours by a general spasm of all the voluntary muscles. The risus sardonicus was marked, and the patient was in great distress; deglutition was impossible. Beef-essence and milk-punch were administered by enemata, and half a grain of sulphate of morphia was injected hypodermically over the epigastrium. The latter acted so speedily and powerfully that in two hours all the muscles were relaxed. The patient's strength, however, was completely exhausted, and at 8 o'clock P. M. he expired, there being no recurrence of the tetanic symptoms. No general post-mortem was made; a local examination did not reveal anything. The trunk of the posterior tibial nerve was intact, but its muscular and cutaneous branches were involved."