GRAPHIC "Flesh Eating Bacteria" aka Hospital Gangrene from an Unusual Cause

lelliott19

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Public Domain. Pl. No. 1 of Dr. Jones' papers : Hospital gangrene : Case of W.J. Black. No. VII. New York Public Library. Link
Confederate Army surgeon, Dr. Joseph Jones, is generally credited with providing the first modern description of "necrotizing fasciitis." Back then it was called hospital gangrene; in the 1990s, the media popularized the name "flesh eating bacteria." Regardless of what it's called, it is a very aggressive necrotizing soft tissue infection, characterized by a rapid and progressive course. The image above illustrates an unusual case with an unusual cause. Private Whitfield J. Black (Company F, 21st Georgia) enlisted July 9, 1861 and served with his regiment in Trimble's brigade, Ewell's division at all the battles in Virginia and Maryland. But Pvt. Black didn't contract gangrene from the wound of a minié ball or shell or following an amputation surgery - he was infected by a pin prick while serving as a nurse in a Macon, Georgia hospital in 1864.

According to Dr. Joseph Jones
Has been acting as a nurse in this hospital for the past two months, since the conversion of this institution into a gangrene hospital. During this time has been inoculated with hospital gangrene twice. The first attack caused by the prick of a pin on the side of the hand, received in dressing a gangrenous wound. The prick of the pin became painful almost immediately; and in the course of two days the injury commenced to inflame, and the surface around assumed a purplish and bluish color. The disease spread from the centre of infection, and the slough presented a grayish and greenish color. The inflamed and gangrenous parts were freely cauterized with strong nitric acid. By this means the gangrene was arrested before the ulcer had exceeded one quarter of an inch in diameter.​

Whitfield Black returned to his nursing duties, dressing the gangrenous wounds of patients in the hospital. Unfortunately, the infection soon returned - this time much worse. It started as a blister, but soon caused such intense pain that Black complained that it "throbbed as if a bone was breaking loose." And it spread. Concentrated nitric acid was applied three times a day, but it did no good. Dr. Jones drew Black's gangrenous hand on October 3, 1864, just twelve days after the second attack commenced. It was decided that Black's recovery in the "poisoned atmosphere" of the hospital was unlikely and he was furloughed home to recover.
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[Joseph Jones Records, Manuscripts Collection 172, Manuscripts Department, Special Collections, Tulane University, New Orleans, Louisiana.] FindAGrave Memorial
Dr. Joseph Jones (6 September 1833 - 17 February 1896) of Liberty County, GA, was a chemist, clinical researcher, and medical doctor. Before the war, he was professor of chemistry at the Savannah Medical College and chair of chemistry at the Medical College of Georgia, Augusta. He enlisted as a Private in the cavalry, but was soon tapped by the medical department and assigned to the Confederate Hospital at Augusta. His interest in the relationship between environment and disease led him to document his cases in great detail. He submitted a number of reports to the Confederate Surgeon General, including a dissertation on Hospital Gangrene, in which the unusual case of Whitfield J Black was reported.
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"Investigations Upon the Nature, Causes, and Treatment of Hospital Gangrene, as it Prevailed in the Confederate Armies 1861-1865." Joseph Jones, M.D. Surgical Memoirs of the War of the Rebellion. New York, U.S. Sanitary Commission; 1870-71. Volume II, pp. 248-250. Link
 
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lelliott19

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Had it not been for Dr. Jones recording the details of this case and making Pvt. Black "famous," very little would be known about his life. He has no grave marker; no profile on ancestry; and no Find A Grave memorial.

Whitfield J Black, the man suffering from gangrene, was an illiterate farmer, residing in the Pool's Mill District of Troup County GA. He was married with six young children in the household. The family held real estate valued at $1000 and owned no slaves.
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Pvt. Black was admitted to Chimborazo Hospital, Richmond VA on May 4, 1863 (presumably for the hand wound described by Dr. Jones) and furloughed home May 27, 1863. There is no record in his file to indicate he was ever reviewed by a medical board and/or retired by surgeon's certificate.

Regardless of his unofficial status, he managed to become officially attached to the Military Hospital at Atlanta GA on December 1, 1863. On March 1, 1864, Black was recorded as AWOL from Co F 21st Georgia. It appears that he remained in Georgia for the rest of the war - at least until October 7, 1864 when he was furloughed home to recover from his gangrenous condition. His fate afterwards is unknown.
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lelliott19

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During the Civil War, most patients who contracted hospital gangrene or "flesh eating bacteria" did so as a result of a serious wound or following amputation surgery. Those with compromised immune systems are at particular risk of developing necrotizing soft tissue infections but they can also occur in previously healthy patients - like Whitfield J. Black. Here's another version of Dr. Jones' drawing:
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[Public Domain. Wikimedia Commons. Drawing of gangrenous hand by Dr. Joseph Jones, 1864.]
According to The United States Library of Medicine, National Center for Biotechnology Information (NCBI) necrotizing soft tissue infections like hospital gangrene are most frequently caused by Group A beta-hemolytic streptococcus bacteria, but infections can involve multiple bacterial pathogens. Today, the keys to a successful outcome are early diagnosis, surgical debridement, fluid resuscitation, and administration of broad spectrum antibiotics, initiated as soon as the diagnosis is suspected.Source

Unfortunately, during the Civil War, there was no IV fluid replacement and antibiotics had not yet been discovered. About 45% of civil war soldiers who contracted an extensive necrotizing soft tissue infection died. If Whitfield J. Black survived, he was a very lucky man.
 
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Mrs. V

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Can I just say, “ow”?? Am I recalling correctly that one of the preventatives to hospital gangrene was doses of vitamin C, specifically lemons and lemonade?

My GGrandfather Samuel Webster lost part of a leg to gangrene. Farming accident. I remember hearing that they tried to soak his foot in kerosene to stop the infections..can’t imagine how painful that would have been. The story I have is that he had an artificial limb, and liked to come into the kitchen, sit in the big wood rocking chair and tell visitors, “My leg is hurting” and then proceed to take it off! Eventually he threw a clot and died, all directly related to the loss of his leg.
 

lelliott19

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It's a wonder that they didn't just take his hand off. It would certainly be the reasonable option considering how bad his case had become.
Agreed. Amputation was certainly fairly common in extensive and stubborn cases. The only problem was that the necrotizing infection sometimes attacked the site of the amputation after surgery. It was kind of a dammed if you do; dammed if you don't thing.
Am I recalling correctly that one of the preventatives to hospital gangrene was doses of vitamin C, specifically lemons and lemonade?
I think that was a theory promoted by Jane G. Swisshelm who served as a nurse in the Washington DC hospitals. Lemons and lemonade reduced scurvy. Scurvy debilitated many soldiers, especially prisoners, and contributed to the negative effects of other diseases and infections. So in a way, Swisshelm was right, but the effect of the lemons was likely indirect, rather than direct. I believe @connecticut yankee posted something about it in another thread.
I remember hearing that they tried to soak his foot in kerosene to stop the infections.
Oh wow. That must have been horrible! During the war, all kinds of terribly painful treatments were utilized: nitric acid, oil of turpentine, tincture of iodine, silver nitrate, injected bromide solution, etc. Here's a description of treatment in another case that clearly illustrates how painful the treatment could be:
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James N.

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This thread reminds me of a nightmare-inducing exhibit I remember seeing during the Civil War Centennial in 1961 in a downtown Richmond house near the Confederate Museum/White House that has no doubt been destroyed long ago by the cancerous growth of the hospital complex that has swallowed that entire neighborhood. The temporary exhibit was actually presented by the hospital and consisted mainly of period watercolors like these depicting various and horrible wounds, etc. suffered during the war by patients at Chimborazo and other wartime hospitals there.
 
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