SURGICitL COMPLICATIONS AND SEQUELS OF FEVERS. 57 



perhaps, of the almost constant muscular degeneration, and 

 its not infrequent subsequent haematomata, these surgical 

 results are not usually primar}^ but secondary processes ; not 

 dependent directly on the fever-poison, but its indirect and 

 often distant results ;• not constantly seen, but incidental, 

 indeed, often rare ; not parts of the fever, but its complications 

 and sequels. 



Pathologically all these results may be grouped into two 

 categories, viz.: 1. Those in "which a clot exists; 2. Tliose 

 without any clot. 



1. Those in which emboli of cardiac origin, or more fre- 

 quently local thrombi exist, are unquestionablj" most of the 

 cases of extensive gangrene and phlegmasia. In many other 

 cases in which such a clot is at present unsuspected, I believe 

 that more careful examination will reveal its presence in tlie 

 smaller vessels, and prove that if venous, it may be a cause 

 of oedema glottidis, and if arterial, of the local "necrobiotic 

 processes, which result in necrosis^of the bones, and probably 

 of the cartilages of the lar3^nx, and gangrene of the soft parts 

 with its abscesses, fistuloe, etc. 



2. Those in which no clot exists, and yet oedema glottidis, 



drops}', and dislocation of the hip, gangrene, ulcers, necroses, 



perichondritis, and other similar troubles occur. These are 



especially often ascribed to the fever-poison itself, acting 



locally and producing, for instance, the so called laryngo- 



typhus, the abscesses and ulcers in the skin and subcutaneous 



tissues etc., which are regarded as specific. While not denying 



this view outright, and especially in some cases, I feel still 



more strongly'' disposed to look upon them as allied disorders, 



the immediate results, as in the case of the pneumonia of 



fevers, of mechanical conditions, which produce a local stasis 



of the blood followed by a?dema, low forms of inflammation 



or gangrene. True, these results of fever are most frequent 



in severe cases and severe epidemics, in which the poison 

 44 



