66 



THE TONER LECTURES. 



and where indeed does the same rule not hold good ? — ^^is, that 

 time and trouble must be taken, and that no patient, suffering 

 from a continued fever, and especially from typhoid, should 

 escape frequent, minute, complete, physical examinations, in 

 which every pai't of the body from head to foot should 

 be questioned. Especially should the physical condition of 

 the larynx, the bell}', the legs, and the toes, and in children, 

 the hip-joint, be exactly ascertained. This shonld be done 

 at least .every second day, and that too, not only in severe, 

 but in mild cases, and not only during the fever, but especially 

 in early convalescence, for it is in just such mild and con- 

 valescent cases that the wariness of the doctor is the patient's 

 surest reliance. Particularly should attention be paid to hoarse- 

 ness or even the slightest change in the voice, and the larynx 

 be examined at once with the greatest care from day to day, 

 by the eye, the finger, and the laryngoscope, lest sudden 

 CBdema or the more insidious and more fatal necrosis of 

 the cartilages be impending. The eye should seize upon 

 an}' hindered movements, even without discomfort, and no 

 complaint of pain should fall upon a deaf ear, especially if it 

 be in the throat, the belly-wall, the buttock, the hip-joint, the 

 legs, or the toes. True, it may mean nothing. It may be 

 the vagary of a wandering mind. But it may also be, as we 

 have seen, the herald of the gravest dangers whose attack may 

 be entirely repelled or their force broken by heeding this timely 

 warning. 



8. The prognosis is naturally unfavorable, yet not to the 

 extent w^e would suppose from the addition or sequence of 

 such serious disease. Of 383 cases in which tlie result is 

 named, 220 died and 163 recovered, a mortality of 57^ per cent. 



9. Still more clearly I think, after such a review, do we see 

 the powerful influence of mechanical causes as the proximate 

 factors in the production of such troubles, working in conjunc- 

 tion with the profoundly vitiated blood. With the exception, 



