SURGICAL COMPLICATIONS AND SEQUELS OF FEVERS. 9 



the external sandbag or splint. If the effusion threaten to 

 produce dislocation, it may well be a question whether aspira- 

 tion would not afford a safe and efficient means of prophylaxis. 



II. DISEASES OP THE BONES. 



A popular name for necrosis is " fever sore," but, as Nathan 

 Smith long since pointed out, more because it caused fever than 

 because it was caused by fever. That it does follow fever and 

 is caused by it is certainly true, but it is not a very frequent 

 though a very important sequel. I have collected thus far 50 

 cases of necrosis proper following continued fevers, but among 

 these are 19 reported by one single author — Whately — the his- 

 tories of which are exceedingly brief and unsatisfactory. He 

 states, indeed, that he has seen 30 cases — an incredible state- 

 ment, I think, in view of the fact that from all other sources, 

 after an extended search, I can only gather 31 more. " Fever" 

 with him, however, may include a A'ery wide range. One 

 element of unavoidable uncertainty in the history is seen at 

 once. The osseus disease usually falls under the eye of the 

 surgeon at a period distinctly subsequent to the fever, and, 

 knowing nothing personally as to the previous medical history, 

 he must depend upon the statemeiit of the patient — often a 

 most unreliable means of information. 



Two causes for such necroses and other forms of disease, 

 such as periostitis and caries, are to be found : first, thrombosis, 

 or in some cases possibl}^ embolism ; and secondly, absolute 

 inanition or want of nutrition. 



The role assigned of late to the marrow together witli tlie 

 spleen as a source of the red corpuscles, would seem to be 

 confirmed by the similarity of the changes observed by Ponfick' 



' Ueber die sympathischen Krankh. des Knochonmarks bei inneren 

 Krankh. Virchow's Arcliiv, Ivi 534. Cf. also Anatom. Studieu Uber 

 den Feb. Recurrens, Vircli. Archiv, 1871, Ix. 153. 

 41 



