SURGICAL COMPLICATIONS AND SEQUELS OF FEVERS. 45 



abscess around the membranous urethra. Three fistulte were 

 caused by necrosis of the pelvic bones or sacrum, and nine by- 

 gangrenous ulcers, whii-h sloughed not onl}' externally, but in 

 five, certainly communicated with the rectum, and probably 

 did so in others. Except two cases of 21 and 22 years of age, 

 they all occurred (when the age is stated) from 39 to 74 years 

 of age, later in life than most of the other sequels. They 

 arose from the third to th'e seventh week, that is, during dis- 

 tinct convalescence, and to this is probabl}^ due the fact tliat 

 10 recovered and 2 died, one from the peri-urethral abscess, 

 the other from hemorrhage upon sloughing into tlie rectum. 



The question of treatment of gangrene is, after all, the most 

 important in a practical point of view, and is divided naturally 

 into the preventive and remedial. The general supporting 

 treatment of the disease is, of course, the most important 

 preventive. Next, a careful and repeated examination of the 

 body, especially the parts most likely to be attacked. If gan- 

 grene is specifically threatened, stimulation of the circulation, 

 both at the centre and at the threatened spot, is imperative. 

 To stimulate the centre, alcohol in liberal doses is the best 

 remedy, and two extremely instructive cases are given by 

 Stokes.^ In one, "the surface was cold, and tlie pulse imper- 

 ceptible. From the middle of the calf of each leg downwards 

 over both feet, the surface was black, the skin hanging in loose 

 wrinkles, giving an appearance as if the i)atient had on a pair 

 of black socks." Sixteen ounces of brandj^ in the first eight 

 hours saved his life. Digitalis might also possibly be used 

 with advantage. The peripheral circulation must be stimulated 

 bj' such means as will assist the threatened circulation by 

 inducing alternate dilatation and contraction of the arterioles. 

 Permanently wrapping up the part in cotton, and other similar 

 means, will but assist permanent vascular dilatation and stasis. 



' On Fever, Pliila., 1876, p. 205. 



