SURGICAL COMPLICATIONS AND SEQUELS OF FEVERS. 11 



Hartraanu' has shown, experimentally, that obliteration of the 



nutritious artery causes necrosis of the inner lamella of bone 



a strong point it must be admitted in favor of Whately's theory 

 that after fever the result is not ordinary necrosis but a central 

 necrosis of the inner lamella which he limits to the tibia. 

 Blocking of the veins is evidently not so dangerous in bones 

 as blocking of the arteries, since the collateral venous circu- 

 lation especially towards the extremities is abundant, while the 

 collateral arterial circulation is scant3\ 



I have found 69 cases of diseases of bone following continued 

 fevers. Of these, 50 were cases of necrosis, 12 of caries, 3 of 

 periostitis, and 4 of indeterminate or doubtful nature. Three 

 cases of necrosis following typhoid and smallpox I have ex- 

 cluded. Typhoid, as usual, claims the larger share, for of 41 

 cases 31 followed typhoid and only 4 followed typhus. Males 

 also are in the preponderance, counting 38, to 14 females. Age 

 has not a very marked influence, as 19 were under 20 j^ears, 11 

 from 20 to 30, 11 from 30 to 40, and 5 over 40. Scarcely any 

 region of the bod}'^ escapes ; 22 cases involved the head, 7 the 

 trunk, 6 the upper extremities, and 42 the lower, a result 

 strikingly in accord with the cases of arthritis and gangrene. 

 In the head I have found 1 2 cases of necrosis of the alveoli and 

 jaws. Among these perhaps the most remarkable, altliough 

 somewhat doubtful, case is the one I saw in a soldier at 

 Frederick, Maryland, in 1862, in which, after typhoid fever 

 followed by pneumonia, the entire right upper jaw with a part 

 of the palate bono and the intermaxillary bone necrosed and 

 separated. The case is remarkable, both from its being a 

 striking example of the limitation of disease by the embryonic 

 development,^ and also from the extraordinary series of ope- 



' Nekrose herbei^efubrt durch Verstopfung des Foram. nutrit. Yirch. 

 Archiv, viii. 114. 



2 H. Allen, Studies in the Facial Region, Phila., 1875, has sijecially 

 called attention to this point. 



