[Reprinted from The Medical News, April 6, 1895.) 
TYPHOID FEVER AFTER DOUBLE AMPUTA- 
TION; RECOVERY. 
By JOHN R. ESPEY, M.D., 
DIVISION SURGEON U., P., D. * G. RAILWAY, TRINIDAD, COLORADO. 
D. M., twenty-eight years of age, an American, of 
Irish parentage, was a locomotive-fireman on a passen- 
ger-train, and was injured in a collision August 3, 1894. 
The accident occurred about 7 a.m., at a point eighty 
miles away, and I could not reach the scene of trouble 
until 1 p.m. Dr. Dayton, of Trinidad, accompanied me, 
as the telegram had stated that both legs were crushed. 
Upon our arrival we found the patient in a state of great 
shock, having lain for hours on an improvised bed on 
two car-seats. Both legs were crushed from a little above 
the middle of the leg to the foot. They had been but 
lightly wrapped by a physician, who did not have ap- 
pliances at hand to do more. In addition to this surgical 
care a hypodermic injection of morphin had been given. 
A sympathizing passenger had also poured the contents 
of two half-pint bottles of very common whisky down the 
man’s throat, which had thoroughly upset his stomach and 
materially added to his shock. We dressed his injuries 
aseptically, procuring boiled water from the engine. As 
the country was sparsely settled, without a suitable place 
to keep him, we concluded it was safer to move him to 
the St. Raphael Hospital in Trinidad, although we feared 
the eighty-mile ride before him. We placed him in a 
caboose, and with the engine and one trail car to lessen 
the jolting, we started for Trinidad. On the journey we 2 
combated shock with heat and hypodermic injections 
of strychnin, digitalis, and brandy. 
The patient was in extreme shock on reaching the 
hospital, but with increased facilities for combating this 
condition he rallied some during the night. Copious 
rectal injections of a hot saline solution were added to 
his treatment. On the morning of August 4th his tem- 
perature was 1020, and the pulse from 140 to 160 per 
minute. Notwithstanding that he had not more fully 
reacted from his shock, we deemed it best to amputate 
the right leg, as it was already dead and emitting a foul 
odor. I amputated at the junction of the upper and 
middle thirds at 10 a.m., assisted by Drs. Dayton and 
Thompson. Owing to extreme shock I amputated only 
the right leg, the left not being as yet a source of infec- 
tion. The same restoratives were continued until the 
next morning, August 5th, when, the patient having 
more fully rallied from his shock, I amputated the left 
leg at about the same point as the right. 
The patient reacted nicely from the second operation, 
and the left leg healed by primary union without further 
trouble. The right leg having been amputated while 
the patient was enduring considerable shock, the circu- 
lation was not so quickly reestablished, and it healed 
partly by primary union and a small part at one side 
by granulation, without any sloughing, however. The 
temperature gradually returned to normal by the end of 
ten days, and the man’s condition, although still one of 
considerable debility, was very satisfactory. 
On August 25th the temperature began to rise, and 
continued to rise steadily, with slight abatement in the 
morning, until on the evening of August 30th it reached 
104.8° This was not explainable from the condition of 
the stumps, which were healed, except a small point of 
granulation on the left, nor were there any chills. How- 
ever, the diagnostic symptoms of typhoid fever soon ap- 
peared, including the rose-spots, foul-smelling diarrhea, 3 
and meteorism. The fever pursued a typical but rather 
severe course, owing, perhaps, to the already debilitated 
state of the patient. 
On September 14th considerable ulceration was dis- 
covered on the right stump, which had not continued 
to heal since the onset of the fever, and the next day a 
bedsore appeared over the sacrum. Neither of these 
annoying symptoms continued to extend very seriously, 
as they were combated by strict cleanliness and turn- 
ing the patient. 
On September 18th all control of the sphincters was 
lost, and for the next nine days all evacuations from 
both bladder and bowels were involuntary and took place 
unconsciously. At the same time a low delirium set in, 
accompanied by a peculiar manner of holding the lower 
jaw to one side and with continual oscillations of it. 
The temperature, however, began to fall on the next 
day, September 19th, and on the morning of the 25th 
had declined to 99.5°, but in the afternoon, without 
apparent cause, the pulse ran up again to 136, the face 
became cyanotic, the breathing shallow, and it was 
thought dissolution was setting in. No antipyretics had 
at any time been used other than repeated sponge-baths. 
Indeed, the treatment had by this time become almost 
altogether supporting, and consisted of liquid nourish- 
ment, strychnin, strophanthus, and brandy. The brandy 
was during this attack of extreme depression increased 
to its highest limit during his illness, one tablespoonful 
being given every hour. The patient rallied, but the 
temperature rose to 104° the next day, September 26th, 
after which it fell continuously, reaching a morning nor- 
mal on September 30th, and being normal on the evening 
of October 2d, from which time convalescence was 
gradual but uninterrupted. 
The patient soon presented the bright-eyed appear- 
ance and developed the tremendous appetite, with rapid 
gain of flesh, so frequently observed in convalescents 4 
from typhoid fever. The slight bedsore and the ulcera- 
tion on the right stump healed rapidly, and the patient 
was discharged from the hospital in full health, with 
two good stumps and full use of both knee-joints. Being 
young and active, he was confident of being able to get 
about well on artificial limbs.