SURGICAL COMPLICATIONS AJND SEQULLS OF FEVEKS. 31 



IV, GANGRENE. 



The cases of gangrene maj' be divided into two classes: A, 

 those from pressure ; and B, cases of spontaneous gangrene. 



A. Those from pressui'e^ or the ordinary bedsores, are not 

 peculiar to the continued fevers, as is well known, but arise 

 from any prolonged debilitating disease or accident. They are 

 more common, therefore, in typhoid fever than in typhus, on 

 account of its greater duration. But they not infrequently 

 follow typhus, if it be prolonged by any complication. The only 

 points in addition to the greater danger of pyifimia, to which I 

 desire to call attention, are as follows : — 



First, as pointed out by Nelaton,^ Blandin,* and others, if 

 they penetrate deeply they may destroy the ligaments uniting 

 the sacrum and coccyx, and so penetrate into the spinal canal 

 and set up meningitis, etc. This complication, I believe, arises 

 much more frequently from bed-sores, whatever their cause, 

 than is generally known. Recently I have had two instances : 

 one arising from a bedsore following confinement, the specimen 

 which I show 3'ou, and which I owe to the courtesy of Dr. 

 Schell, my colleague at St. Mary's Hospital ; and the other 

 in a boy who injured his knee and died some weeks after 

 from tetanus induced probably by this complication. T have 

 found 6 cases of tetanus recorded ; 4 following typhoid and 

 2 typhus. Four of them were females. In one it was clearly 

 caused by a bedsore.' Four of them died, but the two women 

 who recovered had had menstrual irregularities, which proba- 

 bly caused the alleged tetanus.* 



' Path. Chir., Paris. 1844, i. 256-7. 



2 Anat. Top., 2nie ed. p. 437. See also Charcot, Mai. du Syst. Nerveux, 

 2ine ed., i. 89-90. 



" Maclagan's. 



■• De Laurlere (see Bibl.) reports also a case of hydrophobia, which 

 became ataxic, following a quotidian fever. He had been bitten by a 



