}S ■ THE TONER LECTURES. 



suffocation — this is tlie one great overshadowing clinical fact 

 wiiicli groups tliem all together whatever the form of the dis- 

 ease, or of the preceding fever. 



That simple asthenic oedema may arise just as oedema of the 

 lower extremities is not only probable, but has been positively 

 observed by Emmet and Buck. It has also been observed after 

 diarrhoea, bronchitis, and other diseases. But this is a much 

 rarer form than those cases in which it is secondary to erysipe- 

 las, o^ parotiti^s, or larjmgeal ulcers, often of small extent. I 

 cannot help suspecting also very strongly that more careful 

 future examinations will sliow in not a few cases that local 

 ven6us thrombosis has been the cause of the oedema. 



Tlie other two forms especially merge into each other. 

 Rokitanslcy believes that the ulcers are a peculiar form of 

 typhus, the so-called laryngo-typhus. Others, and I certainly 

 agree with them, do not believe that they are specific in their 

 origin, but belong " to the common cortege of septic diseases" 

 and other allied disorders in wliich the low grade of inflam- 

 mation readily runs into ulceration, and even into local gan- 

 grene. How much influence local stasis of the blood or even 

 clots in the vessels may have, has not been carefull}^ investi- 

 gated, but I believe them to be no unimportant factors. 



These ulcers are sometimes very common. Thus Griesinger 

 met with them in 31 out of 118 autopsies, Hoffmann in 28 out 

 of 250, and Louis believes that " if found on the bod}' of one 

 who has died of an aciite disease, they will establish with 

 nearly perfect certainty and without going any further, that 

 the affection is typhoid fever." At other times they are so 

 rare that in nearly 13,000 typhus cases at the London Fever 

 Hospital, Murchison records but 21 of lar3'ngitis, of whom 8 

 died ; and in tyjihoid he has only seen 3 or 4 cases. 



Where the cartilages are involved, Moritz-Haller, and others, 

 believe that it follows the ulceration which detroys the mucous 

 membrane and eats down to the cartilages, while Sestier has 



