12 THE TONER LECTURES. 



rations subsequently done b}- Dr. Gurdon Buck, of New York,* 

 to remedy the frightful deformity which had been produced. 

 It is but proper to say that the man was reported to have 

 talien about 3ij of various mercurials during his preceding 

 illness ; but from the facts I have stated, as well as his scanty 

 history, I think it tolerably clear that the fever and not the 

 mercury caused the necrosis. Mercury or syphilis complicated 

 two or three of the other cases I have tabulated, but they were 

 not, apparently at least, the cause of the trouble. 



Mr, Salter'' has pointed out the relation of alveolar necrosis 

 to the eruptive fevers, especially scarlet fever, and believes 

 that as these structures are dermal in character they partake 

 with the skin in tlie eruptive mlscliief While this relation 

 remains undisturbed, yet I do not think the necrosis exists as 

 a specific sequel of these fevers only. Of the 12 cases cited, T 

 occurred as follows: one at 16, one at 12, and five at 10 years 

 of age and under, that is, during the period of dental develop- 

 ment and growth. That such cases are more frequent in the 

 exanthemata is natural when we consider the relative infre- 

 quency of the continued fevers under 15 yeai's of age. 



The period at which these diseases of the bones arise varies 

 greatly. Of 47 cases 10 arose in the first two weeks, 27 in 

 from three to six weeks, and the remaining 10 followed often 

 months after the fever. The earlier cases include probably, 

 most of those from clots, and the later ones those arising from 

 enfeebled nutrition, whose effects especially in structures which 

 vary so slowly as the bones may readily extend over such long 

 periods. 



Especially does this enfeebled nutrition show itself in case 

 where too early strain is put upon the parts and justifies the 

 remark of Aitken that '^no man can be considered fit for work 



' See Bibliocr. 



* Holmes's Sjst. Surgery, 1st ed., vol. iv.- p. 50. 



