ART. I.-Abstract of Proceedings of the Buffalo Medical Association. TUESDAY EVENING, August 6th, 1867.

The meeting was called to order at the usual hour by the Vice President, Dr. J. R. Lothrop. Members present-Drs. Lothrop, Strong, Wetmore, Abbott, Wyckoff, Gould, Nichell, Little, Potter, Lockwood, Jansen, Cronyn, Congar, Gay, Smith and Johnson.

The minutes of the last meeting were read and approved. Drs. M. G. Potter and A. E. Mackay, were elected members of the Association.

The following gentlemen made application for membership:Drs. C. F. A. Nichell, Conrad Diehl and B. H. Daggett.

Dissertations on designated subjects being in order, Dr. P. H. Strong presented the following dissertation:

Typhoid Fever-Is it Arrestable? The Affirmative Presented. Mr. President and gentlemen of the Association:

The subject of Typhoid Fever, (so called) has filled a large place in the medical mind, and a large space in medical literature, and that for many years. Some of the best talent of the profession, especially during the present century, has been engaged in exploring the field, and in making record of its explorations and deducVOL. 7, NO. 2-6.

tions, insomuch that it may almost seem a trite and well nigh exhausted theme, to dwell upon which, may be thought, if not presumptuous, at least profitless.

I have selected it as the theme for the evening, not to make an historical resumé of discarded or received theories and opinions upon it, not to describe its symptoms, nor to enter at length upon either its etiology, therapeutics or pathology. The subject, thus considered, is altogether too vast, and already too well elaborated to make it either necessary or excusable in this presence, and in our brief interviews to give the natural history of the subject. What I have proposed to myself is more a work of reconciliation, than au ght else; by which I mean, to reconcile medicine with itself.

Fever, in the abstract, as to its nature and essence, has for centuries been an open question. The day has not yet dawned when we can fully solve the problem as to many of its types and forms. But it has seemed to me for years that the time has fully come when the typhoid affection, (which designation I prefer to that of typhoid fever,) should be eliminated from the category of opprobria medicorum, at least so far as pertains to its proximate cause, the order and relation of its essential and multiform phenomena, and its indications for treatment.

The tendency of the medical mind of the present day, it seems to me, is more and more strongly to the conviction that every form and phase of disease, howsoever insidious and occult, is the product of some lesion of structure. Not that we can always, with our present means of investigation, trace to its ultimate source and fix the exact point of departure from the normal state, either by unaided or aided sense. But the tendency is with ever increasing strength, not to rest short of just that goal. Even insanity instead of being regarded merely as a functional phenomenon, as formerly, is found to be in most cases, and believed to be in all, traceable to lesions of brain structure as its causa sina qua. non. Pyæmia, or any other form of blood poisoning, whether its assaults may be made upon the mysterious organization of the nerves and nerve centres, upon the hardly less intangible structure of the secernents and absorbents, or a combined assault upon both, cannot be allowed to be an exception to the rule. Change and modification of structure probably always exists, and must

always be sought, if we would profitably study or successfully treat disease.

But, not to dwell upon generalities, what is the truth in regard to this point, as pertaining to the typhoid affection? According to Louis' post mortem investigations, while other lesions of various organs and tissues were not wanting-such as the mesenteric and mesocolic glands and the spleen, the mucous membrane of the cœcum and colon, of the stomach, pharynx and oesophagus, of the bronchial membrane, and the pulmonary structure, of the brain and its meninges, etc., etc. Yet all of these were ever varying in kind and degree, existing in some cases and non-existing in others, but originating consecutively or secondarily in all. While the elliptical patches of Peyer were in varying stages of disease in every case, without exception. This disease varied in intensity and in extent of disorganization from a point nearest the ileo-cœcal valve, where was uniformly found its maximum, upward one, two, three, four feet or more of the ileum. Near its lower terminus were found often more or less of sloughing of the glandular structures and of sub-mucus tissues, sometimes the unsloughed deposits of what is called the typhoid material in these parts; next, ulceration of the mucous membrane covering the patches; higher up, or in the direction of diminishing severity, softening and thickening of the patches from one to three lines in depth, and from a few lines to as many inches in surface measure; higher still, yet immediately contiguous, were found lesser stages of softening and thickening, merging to the simple stage of incipient inflammation. (I owe an apology for this very imperfect and almost unintelligible description of a pathological condition, to do justice to which, would require as many pages as my limits will allow me to devote lines.) These unique structural disorganizations and lesions were found so uniformly, (varying only in number and in degree as the history of the case was more or less protracted,) as to deserve and receive from Louis the designation of the "Anatomical Characteristic."

Now the question is pertinent: What relation does this singular disease of these patches of glands bear to this affection? Opinions seem to differ upon this point. My time will only allow of my referring to those of Dr. Louis and Dr, Flint, the two highest authorities living or dead, as I regard them, upon this subject.

The question at issue is not so much one of fact, both agreeing as to the existence and the uniformity of the lesions, as of inference and deduction, or, as to what this lesion has to do with the disease under consideration. If I rightly understand Dr. Louis

he regards the incipient disease of the patches as the initial point of departure from health, the primary lesion; or, in a word, at once the beginning and the cause of the fever. If I rightly apprehend Dr. Flint, while he admits that the affection of the agminated glands is a general, perhaps even constant accompaniment, it is only an accompaniment of the fever. In brief, it is one of its symptoms or incidents.

Inasmuch as precisely upon this point will hinge most of what I shall have to offer you, gentlemen, this evening, and in order that no injustice shall be done to my eminent authority, it is only fair to quote his words, to which I would now invite your careful attention.

Alluding to case under analysis, Louis says: "They (the symp"toms) commenced at various periods of day, by chills or trem"bling, or both, headache, universal feeling of lassitude, anorexia, "thirst, some pains in abdomen, and, in the majority of cases "liquid dejections supervened during the first twenty-four hours. "Heat followed the chills, and then recurred several days. in suc"cession in nearly all the subjects—after which the skin was con"stantly more or less hot, and nearly always dry. These symp"toms presented nothing in them peculiar to any disease, and "showed that the affection had its seat in the abdomen, and they "successively became more and more violent. A little earlier or "later, at different periods of the disease, other symptoms began "relating to the cerebral and abdominal functions, to the organs "of sense," etc.

Again he says: "That in these cases, (alluding to cases in which was found the characteristic lesion of the ileum,) the ileum must "be considered as having been the principal seat of the disease, "and source of the principal and first changes in the system of the "patient. Again, in this case, as in the others, the first symptoms "can be attributed to the commencing disease in the ileum."

Again-"Between the symptoms and lesions of which we are "treating, the relation seems to me to be not less evident than

"that which is obtained between those two orders of facts, as they "take place in other affections-in pneumonia for example."

Again "I do not see how it is possible to doubt that the "period at which these lesions began was exactly the same as that "of the disease."

Again "Facts show that almost all (if not all) the symptoms "observed in typhoid fever, and especially those that may be "called characteristic, depend on the peculiar morbid change in "the ileum."

Of other coexisting lesions, he says: "Every time that there "were complications, and one could by the aid of the symptoms "discover the periods at which the different lesions commenced, "that of the patches of the ileum was evidently the first.— "And as in nearly all the cases which died, the first symptoms were "connected with a lesion in the intestinal canal, we must conclude "that the time at which the alteration of the elliptical patches "commenced was the same as that of the disease, and we must not "consider this lesion as one of the effects of the fever, but that it forms "the anatomical characteristic."

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So far on the general subject. I will now collate for you a few of his remarks upon the relation of some of the individual symptoms to the primary lesions. Of the extreme lassitude and debility which ushers in and attends the disease Louis says: "But to what cause shall we refer the extreme debility observed in the majority "of the cases? When it occurred at a late period of the disease we could to a certain extent, explain it by the condition of the 'organs, and the long disorder of the functions of the body, "although so great a prostration rarely occurs in the course of "other acute diseases. But in those cases in which there was "considerable debility from the commencement, (which was com"mon,) we could not give this explanation. We could not attrib"ute it to the diarrhoea which did not then exist, or was very "slight, nor to the abdominal pains, which were then not severe, nor to the cephalalgia which was generally dull, and the severest "attacks of which in other acute diseases do not produce like "diminution of strength, nor to any appreciable lesion of the "brain, for the reason already given, nor to the state of the mu"cous membrane of the stomach, which was healthy in many

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