SURGICAL COMPLICATIONS AND SEQUELS OF FEVERS. 41 



gi'ene is pi'onouuced, since it does not progress with any 

 gradually growing thrombus. For the same reason it less 

 frequently returns in the stump after an amputation. Its area 

 also is usuall}^ much less than those cases in which a throm- 

 bus exists, rarely extending in the leg beyond the foot or ankle; 

 and it rarely involves surrounding parts to a large extent, if it 

 occur in the nose, ear, genitals, etc. Sometimes, however, it 

 may extend more widely, as in a case of typhus and starvation, 

 mentioned by Lj^ons,^ in which the patient walked to the work- 

 house, and on baring his chest the whole of the right side was 

 " a dark, olive-green, jell3'-like, tremulous mass." The abdomi- 

 nal wall is somtimes similarly involved. The probably irregu- 

 lar area in which the stasis of the blood will take place in this 

 form, also accounts for the great irregularity generally seen in 

 the line of demarcation ; whereas, if a clot exists, it is apt to 

 be fairly even. This sudden history is usually followed by a 

 speedily decided issue. Death follows quickly, or reaction and 

 recovery set in within a sliort time, instead of hanging in the 

 balance for months. 



The results of spontaneous gangrene vary much according 

 to its situation and extent. In the extremities, if life be saved, 

 the result is usuall}'^ an amputation, either by nature or by the 

 surgeon. In the nose, it may perforate the septum or destroy 

 the entire organ to a greater or less extent. During some 

 civil, as well as military, epidemics of typhus, this seems to 

 have been a favorite spot for its beginning, so that the disease 

 was popularly known early in this century as the " Blue Nose" f 

 and inspired terror whenever it appeared. In 1834, Mauthner 

 says, it was an extremely common result, seen in all the 

 military hospitals, and "all hope was gone as soon as this 

 dreadful symptom was seen." Another not infrequent form is 



' On Fever, p. 191. 



2 See Mauthner, Kraft, Gutbcrlet, Wendelstadt, and Barker and 

 Cheyne. i. 232. 

 43 



