Treatment for Gangrene?

[J. Donaldson]

I am in the process of doing some dissertation research and the letters of a member of the 2nd Iowa Cavalry have raised a peripheral question for me. Byron McClain mentions being shot in late July of 1864 during a cavalry raid into Mississippi. While in the hospital he related to his parents the some of his wounds were healing fine, while others had turned gangrenous. He says that the doctor "burned out" the gangrenous wounds to treat them. How would this have been done? How common was this treatment? Whatever the treatment was, it did not work, as Mr. McClain died in the hospital at Jefferson Barracks on August 26, 1864.

Thanks in advance for any of your comments.

[Hank Trent]

Re: Treatment for Gangrene?

He's probably talking about applying the actual cautery to the affected area. See http://books.google.com/books?pg=PA4...ES&output=html

Hank Trent
hanktrent@voyager.net

[J. Donaldson]

Re: Treatment for Gangrene?

That very well may fit the bill. Unfortunately for Mr. McClain, his wounds never healed properly and he bled to death on the morning of the 26th. I would imagine that they kept reopening and then finally hemorraged.

[Bill Woodhams]

Re: Treatment for Gangrene?

There were many different treatments surprisingly for gangrene. My favorite was maggots.

[Cyclesmith]

I am in the process of doing some dissertation research and the letters of a member of the 2nd Iowa Cavalry have raised a peripheral question for me. Byron McClain mentions being shot in late July of 1864 during a cavalry raid into Mississippi. While in the hospital he related to his parents the some of his wounds were healing fine, while others had turned gangrenous. He says that the doctor "burned out" the gangrenous wounds to treat them. How would this have been done? How common was this treatment? Whatever the treatment was, it did not work, as Mr. McClain died in the hospital at Jefferson Barracks on August 26, 1864.

Thanks in advance for any of your comments.

Well I am not a doctor… but I did stay at a Holiday Inn Express!!


When I was in college I did a paper on gangrene and as a result I have a little knowledge about the treatment that may shed some light on your questions.

There are basically 3 types of gangrene… dry, moist, and gas. Civil War doctors really didn’t discern the difference between them and often lumped them all together and treated them the same. But in this case I think it’s relatively clear that you are dealing with a case of “Moist” gangrene. Gangrene is definined as the death of tissue as a result of lack of blood flow. Dry gangrene is a slow process that is usually caused by internal blockages like clots and such, which results in the areas cellular death. Moist gangrene is a rapid death of tissue that is caused by the sudden loss of blood flow to an area … such as a bullet wound or other physical damage. In either case the treatment is the same… the removal of the dead tissue and the healing of the wound area (or restore blood flow). Most Civil War doctors would simply amputate the infected limb in order to get rid of the gangrene and start with a fresh wound in order to treat. Due to the volume of gangrenous wounds in field hospitals and such this was the most effective and timely treatment to prevent the spread of the gangrene.

However, amputation is not always a necessity or possible… even during the Civil War. Effective treatments were available. The evidence here is that Mr. McCain’s doctors attempted to treat the gangrene, perhaps in order to save the limb. Or the gangrene may have been in an area that could not be amputated... like a torso. To treat gangrene is a 2 step process…. Removal of the infected/dead tissue and then the healing of the open wound. Even today gangrene is rarely treated with antibiotics alone… removal of the dead tissue is required. This removal is called “debridement”… and is a surgical process. During the Civil War the “sloughing” tissue would be clipped out and the wound would be manually cleaned as well as possible. Then chemicals would often be used to further clean the wound out. Bromine, Nitric Acid, Creosote, and other costive chemicals were wildly used for this. During this time the wound would be kept open and then chemicals would be packed in the wound until it was “cleaned”… sometime this process could easily take days or even much longer is the gangrene was aggressive and difficult to get rid of… or if the areas blood supply was severely damaged. And the whole treatment may have had to been repeated a number of times to achieve success. Bromine was very popular for this purpose of “cleaning”, and is a very corrosive and toxic chemical… and it effects could easily be described as “burning out” a wound. It would be impossible for a wound to heal in the presence of a chemical as corrosive as bromine… and it is easy to see how a patient could die from blood loss during this treatment. This would be my interpretation of what happened. It would have been a painful and agonizing ordeal.


Hope that helps… if you do find out the some sort of flame or hot iron or something was used, please post the info. I would be interested in seeing it. Not a treatment that I have heard of before.

Todd Reynolds

[Hank Trent]

Re: Treatment for Gangrene?

Bromine was very popular for this purpose of “cleaning”, and is a very corrosive and toxic chemical… and it effects could easily be described as “burning out” a wound. It would be impossible for a wound to heal in the presence of a chemical as corrosive as bromine… and it is easy to see how a patient could die from blood loss during this treatment. This would be my interpretation of what happened.

I wondered if it could be referring to use of a potential cautery (the caustic medicines you're referring to) rather than the actual cautery. The only reason I leaned toward the actual cautery was that it's closer to literally "burning out," but you're certainly right that the same phrase could apply to a caustic chemical. There's really no way of knowing, without finding information on the specific hospital and the doctors' preferred treatment there.

Hope that helps… if you do find out the some sort of flame or hot iron or something was used, please post the info. I would be interested in seeing it. Not a treatment that I have heard of before.

Uh, read the link in my post above. The actual cautery was an often-mentioned medical instrument in the period.

Edited to add, I just tried the link again to make sure it worked, and today it didn't. It worked for me when I posted it. Go figure. If anyone else is having trouble getting it to work now, go to http://books.google.com/advanced_print_search?ie=UTF-8 and search for gangrene cautery limited by date to whatever you want, 1850-1865, or whatever, and you can take your pick of hits, mostly surgical manuals, reports of treatment, etc.

Hank Trent
hanktrent@voyager.net

[J. Donaldson]

Re: Treatment for Gangrene?

McClain was suffering the effects of a shotgun blast while foraging with a small party in Mississippi. For your perusal:

“Six of us conclu[d]ed we would not starve so we started with out leave while we were out we were ambushed and Shafer and myself were shot none of the rest being hurt. Shafer has one buck shot in his head and three in his side just above the hip. he’s not very badly hurt it did not injure his skull any. I have one in my right hand one in my right shoulder two through the hide in my head the rest of 16 or 18 are put in in my left hand arm and shoulder. Thare are no bones broken or injured that I know of. I am getting along finely and will be all right sooner that I at first thought I would. . . . It was a lot of Old Citizens which ambushed us."

Frank McClain letter to parents dated July 29th, 1864, Gayose (?) Hospital

He was transferred to Jefferson Barracks, and died there on August 26th. There is a letter from his parents written the day that he died trying to arrange his transportation to Keokuk or for convalescent leave back home to Wilton.

[hiplainsyank]

Re: Treatment for Gangrene?

Of the Civil War era treatments, would the maggots have been the most effective? A la Gladiator? Were they used much at all? Not a scientist, I am curious.

[Hank Trent]

Re: Treatment for Gangrene?

Of the Civil War era treatments, would the maggots have been the most effective? A la Gladiator? Were they used much at all? Not a scientist, I am curious.

Well, first, were they actually used as a "treatment"? Maybe Bill Woodham, who introduced the topic, can provide his research on that.

The closest I've found is the observation that wounds in which maggots appeared healed faster than those in which they didn't, as reported in the testimony at Henry Wirz's trial in 1865.

However, here a surgeon reported how to prevent flies and the "effects of maggots." There are many other references to maggots being a bad thing, with various attempts to kill or remove them.

So while some surgeons observed that wounds infested with maggots healed faster, others were attempting to rid wounds of maggots. I've not found anything to indicate they were deliberately introduced or encouraged as a treatment, but I'm curious what Bill Woodhams has found.

Hank Trent
hanktrent@voyager.net