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 II.—L. D. Thurston, Private, Co. A, I6th New Hampshire, aged 42 years, was struck by a fragment of shell on December 13, 1862, at Fredericksburg, which caused a severe but superficial wound of the integuments on the outer side of the left thigh. When seen, February 17, 1863, there was a wound at the middle of the thigh, on its outer aspect, three and a half inches long by two and a half wide, exposing the muscular tissue slightly, the surface of which was glazed and dry. On the 10th of Februrary it had been found desirable to open an abscess three inches below the left greater trochanter. On the 13th this had assumed an unhealthy look, and when I saw it on the 17th the incision made by the lancet, half an inch in length, was surrounded by a border of sphacelus one inch in width, and by an areola of purple congestion, in which there seemed to have occurred a complete stasis of the circulation. There was no pus, but a discharge of very fetid dark-colored serum. There was no swelling, ulceration, or aversion of edges of the incision, which, although mortified, remained as sharp as when first made. There was profound nervous prostration, which was indicated by his rapid, feeble, and irritable pulse: by his sallow hue; his haggard and anxious expression of countenance; his weary and helpless decubitus and great mental despondency. He was treated internally with stimulants, the most condensed and nourishing food, and citrate of iron and quinine; nitric acid was applied locally, followed by a weak solution of creasote, three drops to the ounce of water, as an antiseptic dressing. The sphacelus extended in all directions rapidly, unchecked by this treatment, from which I hoped little, since it was impossible to bring the acid into contact with the diseased tissues, although it was injected into the incision. The constitutional symptoms also became more grave. On the night of the 20th there was quite a severe hæmorrhage from the incision, oozing slowly, and very difficult to restrain, since it was caused by the erosion of vessels at a distance from the small incision. There was now a circular patch of sphacelus surrounding this small incision, three inches in diameter. On February 23d he was removed to the ward in the brick building. The original wound, hitherto unaffected, now began to be black and offensive. The sphacelus extended from these two centres at the rate of one inch daily, preceded by the above-mentioned areola of purple stasis. No treatment, local or constitutional, produced the least effect. Stimulants were given in every possible form, until the stomach refused to retain them. Pure nitric acid was freely applied to the diseased surfaces with no benefit. He fell into a typhoid condition, with muttering delirium, subsultus tendinum, etc., and finally expired February 28th. The sphacelus then extended from the trochanter major to three inches above the outer condyle, and from the median line in front to a corresponding point behind. There had never been any ulceration, but the tissues seemed to perish en masse. The incision made by the lancet was yet plainly seen in the cen tre of any extensive surface of mortification. This man was 42 years old, had had chronic diarrhœa, and was in a feeble state of health when wounded. No benefit was observed from any treatment. He took in addition to the nutrients and tonics the acid mixture with tincture of opium. [A wet preparation of the thigh, exhibiting the ravages of hospital gangrene, is Specimen 1001 of the 8urgical Section, A. M. M.] * * *