SURGICAL COMPLICATIONS AND SEQUELS OF FEVERS. 55 



5. The period of development is not the initial period of the 

 fever, but first, from its height to its close, that is, the compli- 

 cations, especially gangrene and stenosis of tlie larynx ; and, 

 secondly and most freqiientlj^, during convalescence, that is, 

 the sequels. Of 240 cases, only 12 arose in the first week, 38 

 in the second, and 48 in the third, a total of 98. Jf we may 

 assume that convalescence, on the average, begins at the end 

 of the third week, then 142 occurred during convalescence, 

 when health is apparently in the near future. 



6. The lower half of the body is tlie especial seat of such 

 surgical troubles. Vv'itii the exception, of course, of the 

 laryngeal cases and parotitis, of 307 cases 216 occurred in the 

 pelvic region and legs, as agains.t 91 in all other parts of the 

 body. Moreover, the diseases attacking the upper half of the 

 bod}' are limited almost entirely to local gangrenes and caries 

 and necrosis, and they are usually far less severe in type and 

 more limited in extent than those in the lower half. Here, 

 whole limbs are blighted by gangrene, here occur most of the 

 dislocations, the hsematomata, the fistulas, here the severest 

 necroses and largest abscesses, and were we to add the long 

 catalogue of bedsores and phlegmasise, the preponderance of 

 the lower half of the body in importance would be still further 

 increased. 



T. The diagnosis is, in general, moderately eas}^ The 

 danger is not that difliiculty of diagnosis may obscure the case, 

 but that the diseases may be entirely overlooked. The}' occur 

 most frequently in parts of the body covered by the bedclothes, 

 parts whicli require time and trouble to expose and examine 

 in the routine of an ordinary visit. Moreover, the patient 

 is frequently so apathetic and insensible to pain, that he does 

 not complain, or, if he do so, it is ascribed to the ordinar}^ 

 pains so frequent in the belly and legs in such fevers, or 

 else to delirium itself. 



Hence the most important hint I can give in the diagnosis 



