SURGICAL COMPLICATIONS AND SEQUELS OF FEVERS. 33 



decimated armies and often displayed a most frightful tendency 

 to gangrene. But of late, whether in civil or military practice, 

 if we may judge from the scanty gleanings 1 have been ahle to 

 obtain from the journals and the experience in our own civil 

 war as well as in the late European wars, the condition of the 

 sick has been so ameliorated that gangrene is happily a rare 

 complication. 



The history of the extraordinary series of cases reported hy 

 Estlander, well illustrates these predisposing causes. In Fin- 

 land, a financial crisis and a series of bad harvests from 18G2, 

 were followed in 1865-7 b}^ sporadic cases of fever, mainly 

 typhoid ; but from the thrifty habits of the people and govern- 

 mental support, the epidemic was at first neither severe nor 

 extensive. Then came the cold and rainy summer of 186Y, 

 followed by a very bad harvest. That winter, typhus raged in 

 almost ever}'^ household, so that often the well were not numer- 

 ous enough to nurse the sick. The death-rate rose from 2.74 

 per cent, to 7.69 per cent. Instead of an annual increase in 

 the population of over 15,000, it deci'eased, in 1868, nearly 

 94,000; and this in a population of less than 2,000,000. Of 

 105 doctors, 30 sickened and 8 died. Up to 1868 not a case 

 of gangrene occurred, but in the first seven months of that 

 year 28 cases occurred. Then came the bountiful harvest of 

 1868, and by August the epidemic had almost disappeared. 

 Yet the lingering effects of the previous want were seen in six 

 later cases of gangrene. But such an experience is altogether 

 exceptional. From other writers I have rarely obtained more 

 than two or three cases. 



Estlander's 34 cases were all, except one, from typhus ; but 

 of the remaining 79 cases, 43 followed typhoid, 22 typhus. 

 The influence of age is not very marked, as is seen in the fact 

 that of 67 cases, 8 occurred before 15, 27 from 15 to 25, and 

 32 after 25 years of age. But sex, as usual, has a marked 

 3 



