One thing that has not been touched upon is the matter of controlling syphilis. We are supposed to keep as professional secrets the names of those who suffer with syphilis, but I believe that cases of this disease should be reported with the same care as scarlet fever or any other contagious disease. We should use our discretion, however. Some patients are intelligent, and have sufficient regard for their fellowmen not to spread the disease; but others have not, and I think that these cases should be reported. I know of two women in Hartford, both of whom have the disease. Both have children, and are sleeping with them. One is a public prostitute, and is in the active stage of syphilis. I saw her twice, and she then went to another physician-so you cannot follow these cases up. Such cases we should be compelled to report.

DR. OLIVER C. SMITH (Hartford): In a recent meeting of the county society at Hartford, Dr. Robert N. Willson of Philadelphia stated on good authority that 50 per cent. of the male population suffer from Neisserian infection, and that one million and a half women are sick from that cause. If that is true the study of this disease is as important as that of tuberculosis; and it is true that, for some reason, the profession, as well as the laity, are inclined to treat it lightly. It is a very serious problem, and I am glad that Dr. Nadler has touched upon it. I believe that the place for such patients is in the hospital, in bed on their backs. They have no right to go about disseminating the disease. We are remiss in allowing them to do so when in the active stage of the infection. A good many will go into the hospital, if it is impressed upon them how important it is to do so, for their own sakes, as well as for others of the community and their families. They are taught in the hospital to treat the disease themselves, and about the importance of asepsis and cleanliness, as they cannot be when receiving treatment promiscuously.

In the case of students, this is especially important. We should try to educate the communities in which we practice concerning the great importance of these two terrible infections. If we do this conscientiously, there will be less spread of the evils, and we shall do our duty as we have not done it in the past.

DR. RIENZI ROBINSON (Danielson): I should like to ask the author of the paper whether he would prefer mercurial treatment of the tertiary manifestations of syphilis to the iodide. I remember a case of syphilitic iritis in which the anterior chamber was filled with pus. I gave 150 grains of iodide of potash for ten days, 100 grains for the next ten days, and 75 grains for the ten days following, the result being a clearing up of the infection; and I should like to ask whether he would have treated the case with mercury, rather than with the iodide.

DR. CHARLES S. STERN (Hartford): Dr. McDonnell's method is good, and is the one generally used. In Dr. Keyes' book, he says the treatment that his father used is still used with good effect, and is as thorough and satisfactory as the injection treatment.

I wish to speak about one other point in Dr. Nadler's paper. He mentioned the Wasserman reaction as being of considerable diagnostic importance, but I do not believe it has the same standing among physicians at present as it had a year ago. Either positive or negative, it is not to be depended upon.

DR. P. DUNCAN LITTLEJOHN (New Haven): I should like to thank Dr. Nadler for his interesting paper. I was glad to hear Dr. Smith dwell upon the prophylaxis in the manner that he did. I thoroughly agree that gonorrhoeal patients are better off in the hospital, though you cannot keep syphilitic patients there. Unfortunately, we do have a good many cases of gonorrhoea among the students in this town. A number of those who have treated them agree with me that it is difficult to treat them without sending them to the hospital; but, unfortunately, they are not allowed to go to the infirmary of the university, so that there is only the public hospital left. It is sometimes difficult to convince a university man that he should go anywhere else than to Yale Infirmary, but the rules of the university do not allow the infirmary to take gonorrhoeal patients.

DR. ALFRED G. NADLER (New Haven): With reference to the Wasserman reaction, I would say that it is not considered so valuable now as formerly. I think that I mentioned in my paper that even negative reactions do not indicate a cure of the disease.

I should treat the iritis with intramuscular injections of calomel, and give potassium iodide.

I did not enter into the sociological question at all.

Chancre should be excised, when convenient. It may be located where it can be conveniently removed; and in that case, its removal will take away a host of infecting agents that are a great danger to the system.

Regarding the question of making an early diagnosis, I think that the spirochata can be readily discovered under the microscope with the so-called dark-ground illumination, or by staining with pelikan.

A Consideration of the Anatomy and Clinical Importance of the Subdeltoid Bursa.

PAUL P. SWETT, M.D., HARTFORD, CONN.

During the past few years great strides have been made in our understanding of that class of conditions commonly referred to as periarthritis of the shoulder. These advances involve so many considerations that it becomes necessary for us to entirely reform our conceptions regarding these disabilities. Codman (1), whose work along these lines has been so complete and so extensive, says that lesions of the subdeltoid bursa are more common than any others in the shoulder joint and that more cases seek hospital relief for subacromial bursitis than for all other lesions of the shoulder joint, including tuberculosis and fractures. Prior to the enlightening work of Codman (2), Finney (3), Baer (4), and Painter (5), all these cases were grouped as periarthritis, or fibrous ankylosis. If one doubts their great frequency of occurrence, one needs only to recollect that many of them are suffering under such diagnoses as neuritis, muscular rheumatism, circumflex paralysis, contusion of the shoulder, fibrous ankylosis, periarthritis, gout,

etc.

Anatomy:

The subdeltoid bursa is a large "sac which intervenes between the acromion process and deltoid above, and the upper aspect of the capsule of the shoulder joint below. It facilitates the play of the upper end of the humerus with its capsule on the under aspect of the acromion process and deltoid. x X X In some cases it is divided into two or more chambers or loculi" (Cunningham). When this occurs, the parts are referred to as the subacromial bursa and the subdeltoid bursa respectively. For practical purposes, however, it is not essen