58 THE TONER tECTURES. 



would be the most virulent, but it must also be remembered 

 that such epidemics and such cases are themselves, as a rule, 

 the result of exceptionally depressing pre-existing causes, 

 such as famine and war, want and sorrow. Even simple 

 inanition alone will produce identical results in many cases. 



But it is especially when we consider the position of the 

 troubles that this mechanical factor is apparent. Their 

 posterior position, as is seen in the laryngeal ulcers, the peri- 

 chondritis, the vaginal ulcers, the fistulse, and in the hsemato- 

 mata the posterior surface of the recti and adductors, is most 

 significant. Likewise is the fact that all such complications 

 as we have seen, are especially frequent in the lower extremi- 

 ties, that is, in parts mechanically unfavorable to a ready 

 return of the blood and eminently favorable, if not to throm- 

 bosis, at least to stasis. 



10. The treatment must be bold, but not rash; conservative, 

 but not timid. 



]S;-oTK. — After the portion on Diseases of the Joints was stereotyped. I 

 received a letter from Dr. V. P. Gibney, of the Hospital for Rnptured 

 and Crippled, New York City, giving the results in 860 cases of disease 

 of the joints. The following is the only case which followed any con- 

 tinned fever, and it is not tabulated with the others. 



" William H , fet. 12, presented himself at the out-door department 



of the Hospital for Ruptured and Crippled, May 2, 1876. His general 

 condition was good. The right hip was anchylosed with the thigh, abducted, 

 semiflexed, and rotated inward, the trochanter carried upward, and the 

 pelvis tilted to the right side. There was apparent shortening of the limb, 

 but the real shortening was not ascertained. The thigh was atrophied 

 three inches. Immense cicatrices of bedsores were found, one over each 

 posterior superior spine of the ilium, one over the right natis, and one 

 over each trochanter major, that over the right being the deeper, and 

 covered by a scab one and three-fourths by one and a half inches. 



" Prior to October, 1875, he was in perfect health, but was taken that 

 month with typhoid fever, and lay very ill for six weeks, during which 

 illness, the bedsores formed, and during convalescence the deformity at 

 the hip was observed. This history I obtained from the mother, who 

 was very intelligent. At the time I saw him, the disease was practically 

 arrested." 



