Leg Amputation in a Four-Year-Old—Reactions of the Child, her Family, and the Staff

Ruth, four years and two months old, made a dramatic entrance into our hospital. She was brought to the emergency room with a high fever in a toxic, but alert condition. While being examined petechiae (small hemorrhages under the skin) broke out all over the child's body, and particularly severely over the lower extremities. She had a stiff neck, pain in the ankles and hips. The illness was diagnosed as meningococcemia (blood poisoning due to bacteria meningococcus). She was immediately started on sulfa drugs by intravenous medication. In spite of therapy, nine hours after her arrival on the Division for Contagious Diseases, the child had a temperature of 42°, blood pressure of 0/0, and seemed moribund. This condition lasted for about four hours, then the blood pressure slowly returned. When it appeared that this child had very little chance for survival a dramatic change for improvement began, which continued.

During the next few days the lesions on her legs and buttocks became larger and darker, and gangrene set in. The need to amputate seemed imminent. On the ninth hospital day it was still difficult to predict the fate of the legs, but it was decided to wait until gangrene or infection would force the issue.

During this whole period the child was fed by nasal tube or intravenously. Sixteen days after the onset of illness, arteriograms were done under general anesthesia to determine the extent of circulation