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 IX.—George Zilch (Zuelch). Sergeant, Co. K, 7th New York, aged 25 years, had his left leg amputated at its upper third for a bullet wound received at Fredericksburg, December 13, 1862. He was admitted to Douglas Hospital December 26th, and placed in ward No. 5. The stump had closed slowly by granulation until there remained an ulcer as large as a half dime on its face. April 14, 1863, this ulcer was inflamed around its edges and covered with a white pultaceous slough; there was no constitutional disturbance, and the patient was allowed to remain on his crutches. The ulcer was cauterized with nitric acid and dressed with solution sodre chlorinatse. 18th : The ulceration and areola are both enlarged, and the slough, yet very tough, is thicker. Acid was again used locally. 21st: He is feverish and inclined to nausea; his pulse 120, skin hot. and tongue thickly coated. The ulcer is extending in depth, and he was removed to the gangrene ward. 22d: The solution of bromine was applied to the sore after cleansing the surface as much as possible of the tenacious slough. His general condition was unfavorable, and there was a tendency to diarrhœa and perspiration. Internally he took muriatic acid, with extra diet and stimulants. 24th: Bromine was again applied to the surface and used in the form of vapor. The ulcer was now three inches in diameter, irregularly circular in form, with ragged, everted, and thickened edges, and surrounded by a purple areola. The slough was one inch in thickness, and resisted the action of the bromine. 26th: The sore is looking better; it has been disinfected since the first application of bromine, and the constitutional symptoms are better. 27th : A pointing in oil was made to-day by Surgeon Brinton's direction, which would be pronounced a good representation of hospital gangrene. 28th: The slough is much thinner to-day, and the granulations are showing the thin gray covering. 29th: The sore is much better, is becoming covered with granulations, and has lost almost entirely its specific appearance. There is no constitutional disturbance, no fever, no headache, the tongue is cleaning oft , and there is a return of the appetite. The bromine vapor was discontinued, and sol. sod. chlorinat. substituted. 30th : The livid areola has been changing daily in hue under the bromine treatment, has now entirely disappeared, and the sore is perfectly healthy. May 6th: He is still improving, and is taking tonics and nutrients. 20th: The sore is reduced to half its original size and is now cicatrizing rapidly. 24th: There is now a surface as large as a penny unhealed; health is very good; he is about the ward on crutches, and is no longer considered an interesting case. This man steadily improved; recovered with a good stump, and was finally sent to New York to be mustered out of service. He was discharged May 8, 1863, and died July 2, 1878, of valvular disease of the heart and cardiac asthma.

We have in this case another instance in which the acid, locally used, proved useless, and in which the solution of bromine caused an immediate improvement. It was found necessary to apply the caustic solution to the ulcer three times, owing to the thickness of the slough, which was too closely attached to be removed by spatula or forceps. Its action here seemed to correct the fetor at once, to check the molecular death, and to change the hue of the areola, by causing a more healthy action in the capillaries. The gnawing burning pain was relieved, and the patient was able to sleep in comfort. The absorption of the virus produced in the ulcer was prevented by its destruction, and the nervous system quickly regained its tone.