32 THE TONER LECTURES. 



Secondly, large bedsores, as in two eases reported b}- Chenu 

 in the Crimea,' may greatly hinder free motion of the legs and 

 trunk by the extensive cicatrices. 



Thirdly, the treatment first proposed, I believe, by Brown- 

 Sequard, of ice poultices for fifteen minutes, followed b}' hot 

 flaxseed poultices for two to three hours, often stimulates the 

 most indolent bedsores to heal with surprising rai)idity. During 

 and since the civil war I have repeatedly and successfully tried 

 this plan of treatment. 



Sometimes gangrene results from the slighest pressure, as in 

 a case reported by Stokes,' in which there were thirtj'^ such 

 spots ; two or three new ones appearing every morning, at 

 points of such trifling pressure, as where the mammae leaned 

 on the arm, or one leg on another, and a black hand appearing 

 where the face had rested on the hand. Strange to say, the 

 woman recovered after a month's abdominal decubitus. For 

 such cases Liebermeister recommends an almost continuous 

 and complete bath, the body resting and reclining on sponges. 



B. But the cases of so-called spontaneous gangrene, though 

 less frequent, are of far greater interest from a surgical point 

 of view. They vary greatly in frequency. Thus, neither 

 Flint nor Trousseau ever saw a case ; Nelaton does not name 

 fever as a cause of gangrene ; Murchison, though he has seen a 

 few, does not cite a single English post-mortem. Yet Estlan- 

 der reports 34 eases, and I have collected in all 113 cases. 

 The frequency varies in proportion to the severity of the case 

 and of the epidemic, and especially to the preceding conditions 

 as to bodily nourishment, mental depression, and general mode 

 of life. In former wars especially, from the time of Thucydides 

 to that of Nnpoleon, fierce epidemics, especially of typhus, have 



healthy dog three months before. R. Reid (Pathol, and Treat, of 

 Fpver, Trans. Queen's Coll. Phys. Ireland, iii. 41) alludes to the simi- 

 larity of hydrophobia and the excitable stasfc of fever. 



' Rapport, pp. 520, 524. ^ Qu Fever, Phila., 1876, p. 210. 



