Dr. Fleischner reported a case of re-infected syphilis. Recent observers deny that a patient having been cured of one attack can be re-infected. However, there are four such cases on record. The patient in question had been treated four years ago by the doctor. The roseola had developed after two weeks and the usual symptoms were noticeable. The patient became better. One year later he presented himself with papules, some tuberculous syphilides, shin-bone pains and intense headache, leaving thus no chance for doubt. Persistent treatment was pushed for six months, and the disease succumbed to the treatment. Five weeks ago he presented himself with a chancre. This was indurated, solitary, one-fifth of an inch in breadth, one-third of an inch in length, and oblong. It was excavated, became papular, broke down in the center, had a hard, well-defined edge, and after healing left the typical hard induration of a chancre. Therefore, it was not a late broken-down gumma or a profuse ulceration. After waiting a few days, the roseola appeared. This was not simply a blush, neither was it the late roseola, which is diffuse, but was in every particular the small papular syphilide of the second stage. Treatment was begun and the roseola is now fading. Here is, then, an undoubted case of re-infection of syphilis, which is not to be confused with a late manifestation.

The question for discussion, "The Treatment for Constipation," was then taken up. Dr. L. W. Bacon, Jr., opened the discussion. He divided constipation into three classes-first, acute constipation in patients otherwise well; second, relative constipation—that is, where other conditions require action of the bowels; third, chronic constipation.

To treat the first, a simple remedy is all that is necessary Frequently no medicine is needed. There are some advantages to be derived from compounding drugs which act on different parts of the intestinal tract, and, therefore, these combinations are desirable. The second class can be illustrated in the administration of morphia, which, by drying up the secretions, causes constipation. To prevent this, we combine with the morphia. some mild purge and give in divided doses. of the same class occurs in typhoid fever. logical reason why the administration of purgatives, in case of constipation in typhoid fever, should lead to intestinal hæmorrhage. The doctor cited a case of typhoid fever where Rochelle salts preceded by one-fourth grain doses of calomel were given with good results. Unfortunately, perforation occurred and, therefore, this treatment could not be carried out. But although

Another illustration
There is no physio-

it is considered unsafe to administer a purge in typhoid fever, Dr. Bacon thought it rational treatment.

Cascara sagrada is indicated for chronic constipation, the only objection being the long time which the patient must be under observation. Proper treatment consists in good diet, good hygienic surroundings, massage of abdomen, horse-back riding, and rolling a heavy cannon-ball up and down the colon. The use of drugs is not always desirable, but when employed a combination in which the principal ingredient is strychnine is frequently used.

Dr. Russell stated that he used magnesium sulphate when a loose, watery and easy evacuation was desired. He did not use purgatives in typhoid fever, except in the very early stages. Enemata are useful when the obstructions were low down in the gut. Strychnine is the first drug to be used in chronic constipation in doses of one-thirtieth to one-sixtieth grains t. i. d. Belladonna is also sometimes used. Cascara is not to be compared with these two drugs. The resin of podyphillum rubbed up with lactose acts most acceptably.

Dr. Fleischner gives mercurial preparations with chalk in daily doses. The doctor thought that typhoid fever patients ought to have a purge at first, but it should be a mild one, and after that no medication is desirable. Obstruction in this disease is low down, therefore is not a constipation of intestinal tract, and a glycerine suppository or a warm water enema is all that is needed.

Dr. Hotchkiss gives one ounce of cream with three ounces of water to infants, which is followed in about fifty hours with a painful movement, but stools are not pasty, nor do they have a bad odor.

Dr. Eliot gives sugar and water, syrup of sweet orange, sometimes cod-liver oil and syrup of lactophosphate of lime. For constipation in the mother, give aloes, the child being affected also through the milk. May give mercury. For habitual constipation, Dr. Eliot says diet alone is not satisfactory. Two factors are to be recognized; first, habit; second, deficient secretion. A patient after being told he must have a movement, will often help it along. To increase secretions, give single drugs, or one or two in small repeated doses. Aloes is most useful; cascara has done well, but is disagreeable to take.

Dr. Bacon, in a general résumé, then closed the discussion. The committee on location of a society house reported several desirable sites, but after some discussion the matter was tabled. Meeting then adjourned.

HOSPITAL AND CLINIC NOTES, ETC.

In view of the fact that acetanilid* is being so extensively and successfully used in surgical dressings in the place of iodoform, it is well to report cases where its use has been followed by untoward effects. It has been used most extensively in the New Haven Dispensary with excellent results for the past nine months, and since October 1st has been used exclusively in the New Haven Hospital with similar results. The following presents the only exception in the dispensary service: a child twenty days old was operated upon November 2d for phimosis, with adhesion of the mucous membrane to the glands. Local anesthesia was produced by ethyl chloride. The mucous membrane, which had been somewhat excoriated in breaking up the adhesions, was dressed with acetanilid. The following morning the child was found in a stupor, the extremities cold and blue, the respirations very rapid and the face cyanosed, but the pulse strong.

The mother claimed that during the night there had been some hemorrhage. Upon examination, there was found a slight oozing of blood from a small branch of the dorsal vein. This was checked, and brandy in water, five drops in a teaspoonful, was given every hour. The child had revived by night, and the next day there were to be seen no ill effects from the hemorrhage, which was supposed to have been the cause of the trouble. Acetanilid was dusted upon the gland again that evening, the first time since the operation. The following morning the child was again found to be very much cyanosed. Upon the removal of the dressing and administration of brandy, the same as before, the child revived by evening. It is interesting to note that upon both occasions, though there was distinct cyanosis, the heart's action. was apparently unaffected.

In connection with this, the following case, reported by Dr. R. C. Rosenberger in the Philadelphia Polyclinic, November 9th, 1895, is of interest:

An Italian child, sixteen days old, came under observation, suffering from hemorrhage of umbilicus. The child also had a cough, which made the hemorrhage worse during the paroxysms

* For a résumé of the subject see Squibb's Ephemeris of Materia Medica and Pharmacy, January, 1895, p. 1583; also The Anti-bacterial Action of Acetanilid, by L. Frothingham, M. D. V., and J. H. Pratt, Am. Journal of Med. Sciences, August, 1895, p. 146.

of coughing. A powder consisting of boric acid and acetanilid, of each two drams, was given, to apply locally twice daily. Three days afterward, the child was brought in, with the face. distinctly cyanotic; the lips, ears, finger tips and toes bluish; the hands and feet cold; the breathing bordering on stertor. The powder was discontinued; strychnine sulphate one-three-hundredth of a grain and ten drops of brandy were given four times daily in a teaspoonful of water. The parents were directed to bring the child back in forty-eight hours, at which time the cyanosis had disappeared, the hands and feet were warm, and the child was a great deal brighter. The hemorrhage had not recurred.

*

Miss Henry, who was recently appointed Superintendent of Nurses at the New Haven Hospital, is an English lady of considerable experience both abroad and in this country.

Her early training as a nurse was begun at the Royal Infirmary, in Liverpool, where she afterwards became head nurse. After finishing her service at the above-named place, she accepted a position as night superintendent of nurses at the Western Infirmary, of Glasgow, Scotland, where, after sixteen months, she became day superintendent. The need of rest brought her to this country early in 1894. She soon after accepted the superintendency of nurses, temporarily, at St. John's Hospital, of Brooklyn, N. Y. Finishing at this institution, she was requested to organize a training school and hospital at Kingston, N. Y., and after a year of successful work she resigned her position, to take the superintendency of nurses at this institution.

Miss Henry is ably assisted by Miss Stephens, who was trained at the Bishop's Memorial Hospital, in Pittsfield, Mass., and has been head nurse in that institution for some time.

A vacancy at the New Haven Hospital caused by the expiration of service of Dr. F. N. Sperry, has been filled by John W. Durkee, M.D., of Sandusky, Ohio. Dr. Durkee spent two years at Ann Arbor, and two at the College of Physicians and Surgeons of New York. The present house staff at the Hospital is as follows: Dr. W. J. Sheehan, Yale '95, Senior House Surgeon; Dr. Phelps, P. and S. '95, Senior House Physician; Dr. J. H. J. Flynn, Yale '95, Junior House Surgeon; Dr. Durkee, P. and S. '95, Junior House Physician.

During the month of October twenty-seven operations were performed at the New Haven Hospital.

cers.

ITEMS OF INTEREST.

The annual meeting of the board of managers of the New Haven Dispensary was held Tuesday evening, November 12th. The Secretary, Dr. Swain, read the reports of the different offiThey showed that eleven thousand five hundred and eight patients had been treated this last year, including people from all parts of the world. This is an increase over last year of seven hundred and sixty-two, and five times the number of patients in 1888. There were fifteen thousand one hundred and seventy three prescriptions put up at a total cost of $642.18, making the cost of each prescription $0.0427. There are now twenty-two men on the dispensary staff.

Mr. J. Edward Heaton was elected to the board of managers in the place of Eli Whitney, deceased. With this exception the board remains the same for the ensuing year.

Dr. Frederick Holme Wiggin has been re-appointed visiting gynecologist to the New York City Hospital (B. I.) by the Commissioners of Charities and Corrections.

In the report of the proceedings of the Connecticut State Medical Association an error was made in reference to the death-rate of typhoid fever treated at the Hartford Hospital by a system of hydrotherapy under the care of Dr. J. B. Hall. The facts are these: Eighty-two cases were treated, with seventy-eight recoveries and four deaths, making their death-rate four and threetenths per cent.

*

Graduation exercises of the Connecticut Training School for Nurses will be held in the Chapel of the New Haven Hospital December 12th, 1895. Nineteen nurses will be graduated.