SURGICAL COMPLICATIONS AND SEQUELS OF FEVERS. 47 



amputations in the foot. Before demarcation was established, 

 5 out of 8 died ; after demarcation, 12 out of 22, a mortality, 

 respectively, of 63 and 55 per cent. As a rule, therefore, wait 

 for the line of demarcation, but amputate soon after its appear- 

 ance ; but if danger of septic poisoning, or of speedy exhaus- 

 tion should appear, amputate at once, at or aboA-e the probable 

 limitation of the disease, which, if tiie femoral be free, will not 

 be, in the majority of cases, above the tubercle of the tibia; 

 but if the femoral be involved, amputation would probably be 

 more dangerous than the expectant treatment. As dead parts 

 slough, they should be removed to prevent septic poisoning. 

 Fortunately there is but little danger of hemorrhage, either 

 primary or secondarj-, in the thrombotic cases, since the 

 arteries are all plugged securely. 



Of course, the ordinaiy treatment of the gangrenous ulcers 

 and abscesses, especiall}' of the perineum and genitals, should 

 be pursued, but I would especially urge the importance of free 

 incision, especially in abscesses in the Aicinity of the anus, and 

 the use of detergent and stimulating washes in the vagina in 

 case of sloughing of the labia, in order to prevent in both cases 

 the establishment of fistulse. 



V. H^MATOMATA. 



The muscular sj'stem suffers, in typhus and typhoid fevers, 

 in common with almost every other tissue of the body, 

 undergoing a peculiar form of degeneration, resulting some- 

 times in rupture and the formation of hsematomata. These, 

 although not so strictl}' surgical as some of the other diseases 

 noted, yet, as their proper surgical treatment is so important, 

 I shall notice briefl}'. 



Apparentl}^, tlie first published case was observed b}^ that 

 shrewd surgeon Yelpeau, in 1819, in the post-mortem exami- 

 nation of a soldier at Tunis. " Rupture of the muscles of the 



