Biomedical Ephemera, or: A Frog for Your Boils

"PHAGEDENIC CONDITION OF GUNSHOT WOUND"

When invasive organisms were introduced to the body via gunshot wounds, a "phagedenic condition" ("eating-sloughing") can occur. It was treated the same way as all other ulcers developing wet gangrene - amputation. 

Charles F. Barnum, Private in Co. E, of the 187th Regiment of Pennsylvania Volunteers, was shot in the Battle of Petersburg, VA, and was photographed and illustrated when his ulcer extended 6.5 inches from his ankle. The amputation was performed just below the tubercule of the tibia, and healed fully. No prosthetic was recorded before discharge.

Photograph from National Museum of Health Archives. Contributed Photograph 1183.

Gunshot wound of the forearm, leading to gangrene and amputation.

Cpl. William Brown was struck at the battle of Petersburg, VA, on March 31, 1865. His wound began to heal, but ultimately developed gangrene, and was amputated before the gangrene spread.

Gangrene following a gunshot laceration of the femoral artery

Dry gangrene is caused by acute or chronic loss of blood flow to the distal part of a limb, and is most often seen these days in those with poorly-controlled diabetes and in life-long smokers. However, it can also occur if the limb suddenly loses circulation, such as in a thrombosis (blood clot), or a lacerated artery, as is seen here.

With no circulation, tissues begin to die immediately, and spreads outwards until the point where bloodflow is adequate to keep tissue alive (in this case, probably around the point of laceration). Assuming no bacterial infection took hold above the gangrenous area, and the healthy tissue sealed itself off successfully, the end result without surgery would be the drying up and falling off of the necrotic tissue, in a process known as autoamputation.

However, the number of confounding factors in possible autoamputation scenarios is vast, and surgical intervention is called for whenever possible.

An American Text-Book of Surgery. Edited by J. William White and William W. Keen, 1894.

Left: Pathological bone loss from gunshot wound. 2.5 inches lost. Ends of bones partially healed and injured bone reabsorbed due to significant delay in reaching surgical hospital (one fortnight on the battlefront after gunshot - external splinting and sanitation only). Right: Inlay sliver fixation graft in same case. Held in place with kangaroo sutures. Engaging both ends of ulnar fragment.

Orthopedic and Reconstruction Surgery, Industrial and Civilian. Fred H. Albee, 1919.

Gunshot Fracture of Right Humerus, with Lodgement of the Missile

This was a standard round that ricocheted into the upper extremity of a soldier. The highly reduced velocity created an effect similar to what was often found when soldiers were hit with shrapnel balls. It did not go through the bone, but was deflected as the bone absorbed the remaining force, and lodged firmly in the soft tissue. Case recovered well, with no need for amputation or bone resection.

Gunshot Roentgenograms: A Series of Roentgenograms Taken in Constantinople during the Turko-Balkan War 1912-1913, Illustrating Some Gunshot Wounds in the Turkish Army. Clyde S. Ford, 1915.

Gunshot Fracture of the Tibia and Fibula

The larger bone fragments and much of the shrapnel ball have been removed and the wound is beginning to heal here. You can see the callous tissue in the x-ray indicating the initial stages of the repair process.

Gunshot Roentgenograms: A Series of Roentgenograms Taken in Constantinople during the Turko-Balkan War 1912-1913, Illustrating Some Gunshot Wounds in the Turkish Army. Clyde S. Ford, 1915.

Fragments of the core and mantle of a Mauser in the hand.

Wounds in War: The Mechanism of Their Production and Their Treatment. Col. W. F. Stevenson R.A.M.C., 1910.

1863. Private Milton E. Wallen, Co. C, 1st Kentucky Cavalry.

Private Wallen was wounded by a Minie ball while in prison. His arm was amputated and was beginning to heal well, but after a week he began to develop hospital gangrene in the amputated stump.

Hospital gangrene was very common back in the days before antiseptic practices. As opposed to the conditions considered to be forms of gangrene today (gas, dry, wet), "hospital gangrene" was largely caused by Clostridium spp., and was quickly fatal. As Clostridium are bacteria that thrive in the lower GI tract, hospitals with poor sanitation (and consequently widespread fecal contamination) have far higher rates of hospital gangrene death.

1944. A young surgeon and his assistants perform emergency surgery on an injured soldier. One man is dripping ether onto a makeshift gauze mask for anesthesia.

1864. Confederate Soldier Thomas Maynard. Gunshot wound of the back. Treated and recovered at Seldon's Battery under the care of Dr. B.B. Breed. 

Carte de visite format courtesy of the Otis Archives; modified version available on Wikimedia Commons.

Pvt. Rist H. Cutler, 36th Regiment, WI Volunteers.

Gun ball lodged in knee, initially had leg amputated at knee joint. Patient was healthy upon admission, but wound was not healing. It wasn't gangrenous upon admission, but ulcer was not granulating. 

Wound became infected after admission, leg was re-amputated above knee joint, at time of photograph, wound was cicatriced around edges, but granulating and healing well. 

Representative Herbert C. Dreger, shot to death on South Murray street. His funeral was widely attended...by KKK members in full uniform.

And no one batted an eye.