successful worker in years past for this journal. His that the operation should be done under strict aseptic connection with the medical publishing business in precautions; in other words, the subject to be vaccinated, general, and with the REVIEW in particular, was inter rupted for several years, but he now returns to his old love and means to devote body and soul to it, alto gether, and more than ever. as well as the vaccinator, should be surgically clean, i. e., aseptic. If this was insisted on in every case, vac cination would not be looked upon, by the laity and even some physicians, as a simple and innocuous procedure. We know even of instances where physicians have given their patients vaccine points with the instruction to vaccinate themselves. This is unpardon able. Mr. Dreyer is a thorough bred business man and be ing such, is naturally of a peace-loving disposition. We are sure, that his affiliation with the REVIEW will Of as much importance, or even more, than the surgi. have a softening influence on the warlike spirit for cal cleanliness of patient and vaccinator is the quality which our editorial columns have become noted. We of the lymph, which should be prepared by, or under hope that the suavity of his ways will by transfert be the direction of, men who have had a thorough bacteri communicated to the fighting editor and that the white-ological training and should be tested as to its purity winged dove of peace will permeate our future edito. and efficacy before it is used. rials. In other words: If our neighbors let us alone, do not throw stones over our fence, and do not encroach on our front steps or backyard, we shall cultivate good companion- and comradeship with our contemporaries. We mean to bury the hatchet and are now trying the art of twirling artistic rings out of a pipe of peace, specially bought for this purpose. We shall respect the corns of others as long as ours are not trod upon. Mr. Chambers, who is not only the father of the RE VIEW, but has, for fifteen years, steered its ship safely through the breakers and shallows that beset medical journalism, retires to quieter fields of business. While severing his business connection with the REVIEW, the old editor and associates, he takes with him our best wishes for good health, success and prosperity. In future all matter intended for the REVIEW, either literary or otherwise, should be addressed to O. H. Dreyer, Publisher, 112 N. 4th Street, Room 25, St. Louis, Mo. L. T. RIESMEYER, M.D. The Necessity of a Reform in Vaccination. Reports of serious complications following vaccination have been numerous during the recent epidemic of small-pox and this is hardly to be wondered at when one considers the careless way in which vaccine points are occasionally handled. Let us hope that in the majority of instances these complications were due to a neglect on the part of patients in taking the necessary precaution for preventing infections. It is a well established fact that even the slightest operation should be made under precautions which will almost exclude the possibility of an infection and, owing to the occurrence of said accidents, it is very pertinent to ask: Can the present method of vaccinating be im. proved? In order to deprive vaccination from any danger due to a complicating infection it is, of course, necessary is The most scientific, and therefore the safest method of preserving vaccine virus is by drawing it into aseptic "If liquid vaccine can be had in an aseptic condition or can be made aseptic we may carry our points with us in a vial containing a suitable antiseptic fluid, take them out with a disinfected hand, and when we use them them into the liquid vaccine and scarify the disinarms." Dr. Fuetterer announces that he is at present, by experiment and practice, trying to answer the following questions: "1. Which is the best way to disinfect these points and how may they be kept in an aseptic condition? "2. How should aseptic vaccine be kept and carried around for practical use? "3. How can septic vaccine be made aseptic and kept without impairing its properties as an effective vaccine medium? "The last point must be well considered, since a vaccine that has been found to be aseptic once may not always be so and even if it is, it can easily be contami. nated by opening the bottle for use. It would certainly be safer if a disinfecting agent was added that would not only destroy the germs already contained in the vaccine fluid, but also those entering later." We hope that Dr. Fuetterer will be successful in an swering these questions satisfactorily, as vaccination could thereby be simplified, especially where many in. dividuals are to be subjected to that process. For the present we would consider the method indicated by us as answering the purpose completely, especially as we doubt the probability of finding a disinfecting agent which would not destroy the efficacy of the virus. The ivory points are readily sterilized by heat and may be kept free from germs, by wrapping each individual point, with sterilized hands, in sterilized cotton, protected by sterilized rubber tissue or a similar envelope. While we can not see why it should be impossible to keep vaccine virus on ivory points in an aseptic condition if the necessary precautions are taken, results of a bacteriological examination of vaccine points from different sources made by Dr. Fuetterer, are of interest. The points were, as fresh as they could beh ad, in packages which remained unopened until the examination commenced. Of seventy-five points thus examined the following kinds of micro-organisms were found: of the College of Physicians and Surgeons, we have to say, that after reading carefully said editorial,we are at a loss of comprehending how anyone can decipher the same as an insult, unless it be in consequence of some mys. terious illusion, hallucination or delusion in some occult convolution of his cerebrum and we would advise that the mental faculties of such a person be subjected to a very careful analysis by some of our expert psychiaters. We are confident that the latter would find the case of "Fox and Grapes" a situs inversus, caused by a corresponding causative disarrangement of the particular groups of ganglionic cells of said occult brain center. To the insinuation of the Fortnightly that our editorials are penned in the interest of one or more colleges we have to state that, unlike the editor of the Fortnightly, the editor of this journal has no connection whatever with any medical college and is absolutely free from any college restraint and thereby enabled to "1. A bacillus, which I was unable to obtain in pure wield his pen in the interest of truth and justice. cultures found in one point only. "2. Yellow sarcina from a great number of the points. This kind of sarcina is commonly found in the Examining Station at the City Hospital for atmospheric air and is of a saprophytic character. "3. Pathogenic micro-organisms: Staphylococcus aureus, so commonly found as the cause of purulent inflammation, in about fifty five points. Supposed Cases of Insanity. Among the many laudable reform efforts of our effici ent and energetic Health Commissioner, Dr. Starkloff, "4. Staphylococcus albus in about the same number we would particularly point out the establishment of an of points as the staph. aureus. examining station for supposed victims of insanity. "5. Staphylococcus citreus was found only in a few Heretofore these unfortunates had to be examined in a points. hurry at the City Dispensary. The examination neces"6. The streptococcus of erysipelas and phlegmonous sary in some cases to determine the sanity of patients inflammations was found in ten points." No Insult Nor Untruthful Statements. Our esteemed contemporary, the editor of the Medical Fortnightly, in an editorial styled "Fox and Grapes" calls our article of May 25, 1895, entitled "College of Physicians and Surgeons," "an untruthful statement" and "a gratuitious insult to both the recent board of trustees and the late faculty of the St. Louis College of Physicians and Surgeons." As to the first accusation we have to register the fact that the untruthfulness of statements (to use the lan guage of the Fortnightly) is entirely on its own (the Fortnightly's) side. The proposition to the Beaumont Hospital Medical College, referred to in our editorial, was made to Dr. Lutz by Judge Henry D. Laughlin, as President of the Board of Trustees of the St. Louis College of Physicians and Surgeons. Although the Board of Trustees denied that such an offer had been made, Dr. Lutz made the above statement to the full Board of Trustees in the presence of the entire faculty of the Beaumont Hospital Medical College and he was borne out in every essential by Judge Laughlin, the President of the Board of Trustees. As to the second accusation, that our editorial is an insult to the recent Board of Trustees and the late faculty requires much more time and caution then can be bestowed upon them by the City Dispensary physicians, and the cantemplated innovation of detaining such individuals at a separate station at the City Hospital until they have been satisfactorily examined, before turning them over to the insane asylum, is most commendable and will be endorsed by every member of the St. Louis medical profession. A Board of Health Circular on The Health Commissioner of Brooklyn, N. Y., Dr. Z. T. Emery, has drawn up the following circular for the guidance of the laity in respect of the questions of household sanitation that are constantly arising in every large city: THE PREVENTION OF CONSUMPTION. Consumption is a dangerous, infectious, communicable disease and can be prevented by simple and easy means of cleanliness on the part of those affected and those having the care of them. It is transmitted, in the vast majority of cases, from the sick to the healthy by means of the sputum or expectoration of those afflicted with the disease. It should be remembered that the dangerous element is the expectoration of consumptives, An examination, made on Thursday under the influence of chloroform, revealed a unilateral laceration of the cervix, which was rather hard. The body of the uterus was enlarged about one half. The adnexa and pelvic contents on the left side seemed to be normal. On the right side, however, an oblong mass, about the size of a hen's egg, could be outlined at the horn of the uterus. It extended posteriorly into the cul-de sac and filled up the fossa entirely. It was very firm, appearing to the sense of touch to be fibrous in character. and that if this is destroyed before it becomes dry, little various occasions, doubtless being the formations of danger is to be feared. The expectoration should be false membrane in the uterus. There was also a slight received if the patient is confined to the house, into discharge of blood and mucous. cups containing carbolic acid (1 part of the acid to 20 of water), or if the patient is up and about, on pieces of cloth which should be saved and burned at the first op portunity. This precaution is as necessary for the consumptive as for those about him, as many cases would get well if they would avoid reinfecting themselves. Consumptives should not spit on the sidewalks, or in places of public congregation. Cases of consumption should be reported to the Health Department, not with a view of quarantining or otherwise interfering with them, but that the department may place in their hands Upon opening the abdomen this morning, at the hos simple instructions to prevent their communicating the pital, the mass detected at the examination immediately disease to those around them and to assist in their own presented itself after the median incision had been recovery. Apartments which have been occupied by made. It was adherent to the adjacent pelvic strucconsumptives should not be occupied by others until tures, and separated from the general abdominal cavity they have been renovated. They should be cleaned, by a membrane which had spread itself across from the scrubbed, whitewashed, painted or papered, as the case broad ligament. The mass was very readily removed may be, before they are again occupied. Bedding, by tying it off at the proximal end close to the uterus. clothing, carpets, rugs, etc., used by consumptives An examination of the specimen shows a very beautishould be disinfected, preferably by the Health Depart ful, well preserved six weeks' fetus lying in the fimbriated extremity of the distended Fallopian tube. The tube itself had not ruptured entirely, but a rupture had occurred in the muscular walls. The distension had been confined between the two layers of the broad ligament and had occurred in a downward direction, filling in the pelvic fossa and extending into the cul-de sac. ment. MEDICAL SOCIETIES Proceedings of the St. Louis Medical W. H. FUCHS, M.D., EDITOR. Stated meeting, Saturday evening, May 18, 1895; the Vice-President, F. R. FRY, M.D., in the chair. DR. L. H. LAIDLEY presented a specimen of "ExtraUterine Pregnancy" obtained this morning at 10 o'clock by celiotomy. The patient, Mrs. B., 36 years of age, was first seen by speaker on Thursday afternoon, in consultation with Dr. Klemm. The cavity was flushed with hot, sterilized water and packed with iodoform gauze. The patient is doing very well. The diagnosis in this case was rendered somewhat obscure by the absence of all the usual symptoms of pregnancy. The only symptom of significance was the periodical discharge of false membranes from the cavity of the uterus. DR. J. H. MCINTYRE considered the course pursued by Dr. Laidley as the only correct one. The earlier the operation is done the better it is for the patient and the easier for the operator. The old idea of waiting for the development of further symptoms must be considered dangerous conservatism and should be relegated to the past. Nothing but well-directed surgery will give a woman a real chance for life under such circum. itances. The discussion of "Paranoia" was taken up as a special order of scientific business. DR. LUDWIG BREMER, being invited by the Chair, addressed the Society upon the subject. Patient had one miscarriage prior to the birth of her two children, the youngest of which was twelve months, and which was deriving all its nourishment at the breast. Six weeks ago she had her normal period of menstruation, followed, two weeks later, by right ab. dominal pain of a bearing down character, and as severe as at normal labor. These pains have been continu DR. BREMER'S REMARKS ON PARANOIA. ously present during the past month and were only partially relieved by the exhibition of opiates. She was DR. BREMER said that he reluctantly consented to under this influence when first seen by speaker, though speak on a subject which, though he had given it consuffering considerably in spite of it. Attempts had siderable attention of late, owing to his connection as been made at various times by the attending physician an expert with the Duestrow case, he could not, on the to introduce the uterine sound for diagnostic purposes, spur of the moment, treat it in a manner as it should be but the attempts failed. Shreds were discharged on treated. Speaker considered it very unfortunate that such a wrote a paper on the subject in 1865. He described a name as "paranoia" should be brought before a jury, a primary chronic form of paranoia, a disease which is of body of professional men, before the public, or before an individual character, which starts out with an erronewspaper men particularly. There must be something neous central idea, as it were, around which others clus irritating and exasperating in the very sound of the ter and are logically fitted in, there being no flaw in the word "paranoia," since it is not generally known as to reasoning process, only the premises being wrong. For its meaning and not having been heard very much. a time paranoia was looked upon as an essentially Such was his opinion, also, when the diagnosis of para chronic disease, arising in middle aged persons who had noia had been reached in the case of Duestrow. Never otherwise no serious individual defect. It was suptheless, there was no other name for the particular dis- posed to start out with one delusion, was chronic from ease, which the experts, who were employed for the de the beginning and in its course and development, and fense in this lamentable case, had diagnosed. never ended in dementia, as do the various forms of The word "paranoia" is from the Greek, being de affective insanities. These were its distinctive features. rived from "para," beside, and "nous" the mind; one Then came another investigator, Westphal, who was who is beside himself, crazy, insane. It was employed the successor of Griesinger as director of the psychiatric by Plato, who meant by it insanity generally. In 1818 division of the Charite in Berlin, and professor of a German psychiater, by the name of Seinroth, de- psychiatry in the Berlin University, who held, that scribed a disease under this name, which pretty well there was not only a chronic form of paranoia, in which covers the present acceptation of the term. Speaker the characteristic is that all ideas of the persons are had read Heinroth, and had there found some cases logical conclusions, but that there are acute cases. This which would come under this head to-day, although, of is a form which, modern German authors say, develops, course, psychiatry was very much more mixed at that as a rule, on degenerate soil, in young people between time than it is to-day; and it is a very mixed science twenty and thirty years, who are not very bright to now and in a very unsettled condition, like everything start with. It ends in recovery or dementia. To the that pertains to the mind. first category belong certain founders of religious creeds, social reformers, political innovators, inventors, in all of whom the idea of greatness and, together with it, that of persecution, develops gradually and systematically. The French, under the leadership of Esquirol, called this disease monomania, but that name has now been abandoned, and for good reasons. Monomania involves the idea of there being one delusion, one erroneous idea, whereas the other ideas are correct and connected. There is one form which is now pretty generally rec. Esquirol himself said that the very fact that one idea ognized by modern authors, which is called hallucinais wrong and that that erroneous idea can not be cor- tory paranoia, in contra distinction to the primary rected by a process of reasoning and remains a wrong chronic form. It may be either acute or chronic, and idea, is evidence that the mind is unsound on general usually starts out with an illusion or with hallucinations principles; in fact, the theory of there being one fixed upon which are built erroneous ideas. Persons afflicted delusion and the other portions of the mental faculty with this form of paranoia usually have perverted senbeing in tact has been abandoned generally. Wherever sations-anomalies of the sense of touch-for instance, there is one predominating erroneous and false idea a creeping or crawling sensation of the skin. In the there are others, and such a person is insane generally. endeavor and desire, in this form of paranoia, to reason Griesinger, an author who has been frequently quoted, out the symptoms such an individual will come to the also alludes to the disease and describes some instances conclusion that it is the influence of electricity, for inin which the diagnosis of paranoia might be made to stance, manipulated from a distance by some person, day. But he mixes up a variety of diseases. For in persons or society that are trying to work a trick or stance, under the head of monomania he relates cases punish him. The peculiarity of this form, that everywhich nowadays would certainly be classed as paretic thing that does happen happens from a distance, has dementia (softening of the brain), in which there is also led the Germans to call it fern wirkungs wahn. Fola delirium grandeur, ideas of self-exaltation, etc. Gries. lowing the delusions of sensation, or occurring simul inger describes this disease, which he calls "Partielle taneously with them, are hallucinations of hearing. Verruchtheit"-partial craziness-as one which arises There may be indistinct voices at first, which gradually without any hallucinations, and in which there are cer become distinct, are usually of a threatening character, tain erroneous ideas upon which is built a superstructure uttered by imaginary enemies of the patient, and the of other ideas, provided all the component ideas are accusations usually relate to the past life of the individlogical. But he maintained that partial craziness was ual. Sometimes, however, they are at variance with always the sequel of one of the forms of the so called the patient's former habits. In the Duestrow case, affective insanities (melancholia or monomania). This these accusations were of an extremely vile character, idea he revoked, however, on his death bed, in 1868. all of them relating to perverted sexuality. They were such as only an extremely diseased mind could conceive, and which an ordinary normal individual would shudder to pronounce. The founder of the doctrine, that paranoia is a pri mary disease, a disease with the symptoms as we under stand them to-day, is Snell, a German psychiater, who Hallucinations of sight, taste and smell may, and elementary subjects. It would, therefore, be impossi. usually do, follow in typical cases. ble that such an individual should, through the reading or imagination, concoct a form of insanity like this, which is a typical case of sub-acute paranoia. Besides, the trouble was characteristically progressive; it has been closely watched and one idea after the other has followed in rather rapid succession. Though this whole train of hallucinations and delu sions the patient imagines he is the victim of the trick ery and machinations of invisible enemies. This in cites him to cast about for plans of defense. From now on a new phase in the development of the disease be comes noticeable. The patient imagines that he, too, The great trouble in arriving at an understanding, can work the electric trick, that he can transmit sensa even among experts and men who know something tions, thoughts, odors, etc., and retaliate on general about paranoia, is, that the limits of paranoia are not principles. In order to accomplish this he makes some well defined. There is a classical form, the one generimaginary discovery, invents some system, or exerts ally described and accepted as paranoias, and a number some peculiar or supernatural influence over the minds of his enemies. This constitutes the period of self-exaltation, of grandeur, and it is at this time that the in dividual writes essays and treatises, being expositions of his imaginary inventions or discoveries. Of course, they know very little of the subject, as a rule, and the substance of their writings is often the queerest nonsense and composed of erroneous ideas. The essays of the particular individual in question are, of course, ridiculous, as he is an absolutely illiterate man, one who can not write connectedly, in spite of the fact that he had an opportunity to get a good education. In spite of this there is a chain of reasoning, a logic, in all that the patient says or writes. It is, however, not the logical connection between the different delu sions, but rather the logical origin and sequence of their reasoning, as to the explanation of their perverted senses of touch, hearing, sight, etc.; it is the manner in which they explain the phenomena that brings in the logical part of the reasoning. In a measure, it is a rea soning mania. Not that high degree of reasoning which the primary chronic paranoiac has, of the political, religious or litiginous variety, but that form which par takes more of the character of a bland delirium in which, however, the hallucinations become systematized, although they are systematized only in a feeble way. This might be called the telepathic variety of paranoia, the variety which depends and rests upou the delusion of the effect of distance (Fernwirkungs wahn). This is the kind of paranoia that exists in Duestrow's case. He imagines he can transmit electricity; he is hypnotized and hypnotizes others at a distance; he hears messages through the telephone and transmits them in the same manner; bad odors are transmitted to him and he punishes his adversaries by an invention which enables him to transmit bad odors; finally, he is rewarded by being appointed assistant surgeon general. of varieties, and the acute and sub acute forms. An evidence of the extent to which paranoia has entered the field of psychiatry 18 found in the fact that an alcoholic and cocaine paranoia is described in the books. Speaker had seen a number of cocaine paranoiacs and they correspond, in a measure, to the picture just drawn. It is, however, a very difficult matter to describe a mental disease of this character, especially when this is done before a body of medical men who are not especially trained in this direction, or who have not had plenty of opportunity to observe these cases, since it is a rather metaphysical subject. DR. BORCK.-Can these cases be cured? DR. RREMER said that the chronic form, which develops gradually and is called by some a simple hypertrophy of character; the classical form-never gets well, but does not end in dementia. A cure in this form is impossible, although there may be a temporary suppression of the delusions. In fact, when these individuals are confined in an asylum they feel secure and the delirium of persecution is temporarily suppressed. The acute form, however, which sets in suddenly and arises in the young, may result in recovery, although a state of mental weakness remains which may pass into dementia. The sub acute form is more or less curable, but, also, may pass into dementia and is then incurable. DR. I. N. LOVE asked Dr. Bremer, whether it is not exceptional for a paranoiac to be otherwise than absolutely harmless. DR. BREMER said that there are a great many harm. less paranoiacs and that very few commit murder. It depends somewhat on the individuals, as they may be come dangerous under certain conditions. DR. F. R. FRY said that Dr. Bremer had given a very good exposition of paranoia as we find it in the literature of to-day. The Doctor did not tell us exactly how he stood individually on the so-called, sub-divisions of paranoia; whether, for instance, he would accept such terms as alcoholic and cocaine paranoia as proper. The speaker did not believe in their use. Neurologists understand pretty well what another neurologist means by the use of this kind of language, but the profession Of course, there is a very powerful motive to sham in a case like this, where the man is under indictment for a horrible crime, and it probably looks somewhat suspicious when these symptoms are related before a jury. A pertinent question is, who will get up such a system, or think of that particular form of insanity to coach generally does not. It leads to a confusion about the him, as has been charged by the prosecution. In the opinion of the speaker, it is inconceivable. The individual is of feeble mind, never conversed much in his life, and whenever he did say anything it was about term paranoia, which is not necessary if we will only be careful to keep out these little side issues. This variation in nomenclature has prevented the profession from understanding the position of the ex |