SURGICAL COMPLICATIONS AND SEQUELS OF FEVERS. 13 



or for general military service for three or four months after an 

 attack of severe typhoid fever." The following case illustrates 

 the wide-spread mischief that may follow in the osseous sj- stem 

 when put to tlie test by labor, months and even years after 

 such a fever. 



H. W., a remarkably stout, healthy lad of IG, w^as attacked 

 Dec. 17, 1871, with typhoid. He was delirious for four weeks, 

 was in bed four months, and first got out of doors in May, 

 1S72. Bedsores had formed, but they were kept in check by 

 incessant care. In the fall of 1872, not yet being strong, he 

 went to work at riveting in an iron works, which required him 

 to stand and use a ten pound hammer, the main strain being 

 naturally on the right arm and leg. His right arm soon began 

 to swell, and finally four fistulous sinuses formed. After the 

 removal or discharge of several pieces of bone, this arm 

 recovered in about a year. Returning then to the same 

 work, his health being still impaired, his right thigh began 

 to trouble him, broke out, and healed several times, dis- 

 charging sevei'al pieces of bone. He came under my care in 

 Jul}', 1875. He had then a scar and five open sinuses in the 

 thigh, all leading in the direction of the bone, and in one, just 

 above the knee, a fragment of dead bone an inch long was 

 found. This sinus and a second just below the patella, an ofl^- 

 shoot from it, threatened to invade the knee-joint. Meanwhile, 

 in the fall of 1874, not having done an^^ work on account of 

 his right leg, the left thigh broke out, and a sinus in the direc- 

 tion of the bone was established, but no dead bone was ever 

 actually found here. In January, 1875, an abscess also 

 appeared in the left arm, and after the discharge of some bone 

 finally healed. I enlarged all the existing sinuses in the right 

 thigh, removed the dead bone, and after treating the case care- 

 fully for four months all the sinuses liealed. A new one, 

 however, has appeared of late in the right thigh, but no dead 



