Civil War Washington

In February, 1863, a number of cases of hospital gangrene occurred at the Douglas Hospital, Washington, D. C., and were observed by Assistant Surgeon William Thomson, U. S. A., who, in a special report to the Surgeon General, gives the following interesting account of the pathology and treatment of the cases. In several instances later information has been added to the cases cited by Dr. Thomson.

"On the 26th of December, 1862, about two hundred wounded from the battle of Fredericksburg were received into the Douglas Hospital.

"CASE I.—Sergeant Otto Kosack, Co. K, 2d Maryland, who had been struck by a shell, December 13, 1862, which made it necessary to amputate his left leg at the middle. The operation was done ten minutes after the injury. He was received here on tin- 25th of December. The stump closed by granulation, a small portion of the tibia having been removed by exfoliation. The cicatrization had been almost complete, when, a few days previous to the 17th, the still open wound commenced to slough. He was anaemic, very pallid, haggard, and with an expression of great depression in his features ; his pulse was very feeble and rapid ; he had been feeling very badly for several days, and complained of a burning pain in the stump. -On the outer side of the tibia there was an ulcer one inch in diameter, covered with a yellowish-gray pultaceous slough, and a serous and very fetid discharge ; the edges were thickened and everted, and an areola of purple livid congestion extended for half an inch from the margin, which was undermined. This sore was at once treated with pure nitric acid, applied both to the ulcer and to the areola ; the ulcer was dressed with an antiseptic solution of creasote, and citrate of iron and quinine, with stimulants and nutrients, were freely given. On the 18th the sloughing had extended to the border of yesterday s livid areola, but was now more superficial, and the areola, which had likewise invaded the surrounding skin, was more florid. The ulcer was now two inches in diameter. As there was some doubt as to its specific character, the patient was not removed from the ward until the 23d, when he was transferred, with several others, to a small ward prepared in the brick building, and completely isolated from the other wounded men. The iron and quinine were found to disturb his stomach and destroy his appetite, and was replaced by a mixture of nitromuriatic acid and tincture of opium. March 3d: The sore was now perfectly healthy and was granulating rapidly. [The patient was discharged June 15, 1864, and was a pensioner in 1882. A plaster cast of the stump is preserved in the Army Medical Museum and is numbered 6706 of the Sunjicul Section. ]

"This was a mild case, treated in its iucipieucy with nitric acid most thoroughly. The ulceration had not extended so deeply, nor so far beneath the margin of the skin, as to make it almost impossible to reach every portion of the diseased surface. There was no scorbutis. The gums were firm and hard. The patient was very pallid, his heart feeble, and his pupils dilated. The mucous membranes were very pale, and the expression of the face haggard and anxious. He recovered rapidly with a good stump, and was seen, several months after, walking with great ease on an artificial leg.