Report of cases of hospital gangrene treated in Douglas Hospital, Washington, D.C / by William Thomson.

  • Thomson, William, Dr.
Date:
[1864?]
Catalogue details

Licence: Public Domain Mark

Credit: Report of cases of hospital gangrene treated in Douglas Hospital, Washington, D.C / by William Thomson. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    gangrene have been observed, occurring sporadical]j, and treated with success with bromine. Their clinical histories are very briefly offered for consideration, in addition to those already submitted. No other cases have occurred in this hospital. It will be observed that three of these four cases were fully treated with pure nitric acid without benefit, and that the four did yield eventually to the local application of bromine. Where that remedy has required heretofore several repetitions, it would now be used more energetically. The diseased surface would be thoroughly cleansed of all sloughs, by removing those portions dead, yet tenaciously adherent, with the forceps and scissors, and pure bromine would be freely used by means of a glass pipette or a syringe. A number of the cases reported I am now satisfied would have proved fatal but for this local treatment; and it will be a proud satisfaction to Surgeon Goldsmith to know that he has not only already been instrumental in preserving so many valuable lives, but that he has provided the military surgeon with a defence against one of the most deadly and obdurate of his antagonists. In conclusion, the writer regrets that circumstances do not permit him to render these clinical histories more acceptable to the critical reader. The report was made to the Surgeon General for the future use of the surgical historian of the war, and now meets the public eye in this crude form because it has been represented that further evidence as to the virtues of bromine might be of service in the exigencies of the coming campaign. Case X. Michael Flood, age 24, priv. Co. D, 33d N.Y. Yols., was struck by a minie ball at the battle of Chancellorsville, May 3d, 1863, which en- tered the right thigh anteriorly, comminuted the femur for four inches at the junction of the middle and upper third, and escaped posteriorly. He was admitted on the 8th of May. This man had been suffering from diar- rhoea, and was in a feeble condition. The usual profuse suppuration fol- lowed the injury, thus reducing his strength still further. The leg was lightly dressed, was supported by sand-bags, and extended by means of a brick attached to the limb by a band of adhesive plaster. On July 23d, the inner surface of the thigh, at its middle, was found red and inflamed oppo- site the seat of fracture, and in the centre of this diffused redness there was a spot very tender on pressure, slightly softened, and indicating an ap- proaching abscess. This was treated with a poultice. On the 24th, a small black spot of sphacelus was observed in the centre of this inflamed region, which was easily detached, and then revealed a sloughing condition of the connective tissue. No previous abrasion of the skin existed, nor any wound which would have permitted of inoculation ; nor was there any other case of gangrene then under treatment. The diarrhoea simultaneously increased, and the patient's condition became rapidly worse. The ulcer was treated with the solution of bromine and bromide of potassium. This was followed on the following day by pure nitric acid, with the apparent effect of adding to the rapid de'- struction of tissue. On the 2nh, the ulcer was in dimensions five by four inches, with irregular ragged edges, everted, thickened, and extensively un- dermined at the margins ; and, in a word, presented the characteristics of severe hospital gangrene. It was now thoroughly treated with pure bro-