cele.

The tray for the instruments is arranged as the operator may select.

In the operation for cystocele and rectocele I am not quite clear that catgut is always best. A few interrupted sutures of silkworm gut, that can be removed afterwards, are quite proper-silk not necessary. Silver wire, with or without the use of the split shot, is to be made use of in some instances, for in our earlier surgery we employed it successfully, and it is not to be forgotten or to be ignored.

Although this paper may seem somewhat like "carrying coals to Newcastle," yet I trust I have presented some few points, particularly in reference to cleansing the parts, wearing apparel for the operator and assistant, proper dressing of the patient, and the element of laundry work that may be the means of attracting attention to the economies of aseptic surgery.

28 Eagle Street.

THE USE OF A GIANT MAGNET IN THE REMOVAL OF A FRAGMENT OF IRON FROM THE EYE.-By J. ELLIOTT COLBURN, M. D., Chicago, Ill., Professor of Ophthalmology, Chicago Eye, Ear, Throat and Nose College.

The entrance of fragments of iron into the chambers or tunics of the eye is serious, particularly so if the structures have been much lacerated and the missile is obscured by its position or by the hæmorrhage resulting from the traumatism. The danger is greatly augmented if the chip is germ-laden and is not quickly removed.

Before the time of the Herschberg magnet a fragment of iron that could not be located by direct inspection, or by the aid of the ophthalmoscope, could only be removed by enucleating the eye that contained it. After the electro-magnet was brought into use the foreign body could frequently be removed through the wound of entrance, even though it could not be seen, or through another opening made near its location, providing it was not entangled too strongly in the tissues or in an exudate. With the advent of the X-ray to aid in determining the presence and location of a fragment of iron, and the giant magnet, devised by Haab, or one of its modifications, in nearly every case it can be removed and the eye be retained, at least until the tissues have had an opportunity to overcome, or succumb to, the bacteria which have been conveyed to its deeper structures.

The value of the eye for optical purposes will now be determined by the extent of the damage done to the cornea, lens, retina and humors. The danger from sympathetic disease will be determined by the location of the injury, the tis

sues involved, the degree and character of the infection, and the resistance of the structures.

The case I now present to you is that of an Italian, twenty-one years of age, a railroad track employe. At 8:30

a. m. he received a fragment from an iron maul in his right eye. (Fig. 1.) The wound of entrance was about the center of the upper quadrant of the cornea. The fragment passed downward and inward through the iris and lodged partially in the lens and partially in the iris.

At 2 o'clock

p. m., the body could be seen to occupy the position indicated in the drawing. The wound of entrance was small and had not allowed of much loss of aqueous.

The iris wound was

༡.
3

4

Fig. 1.

1. Corneal wound. 2. Iris wound.

3. Blood clot in anterior chamber. 4. Particle of iron seen through the pupil, located partially in lens and projecting into cavity of vitreous.

obscured by a small hæmorrhage which resembled a particle of rusty iron. It was mistaken for the foreign body. The fragment, however, could be seen through the dilated pupil held in the already clouded lens. It was easily located by its me

tallic luster.

Cocaine was instilled into the eye until there was a complete anesthesia of the cornea. The patient was seated on a stool in front of the magnet; the eyelids wide apart. The head was caused to approach the magnet so that the eye touched the tip of the magnet with the wound of the iris just opposite the portion of the cornea in contact with it. The current was gradually turned on, the iris seen to bulge for

ward, the eye to protrude more from its socket, and the bit of steel to rest against the cornea. The current was then turned off and the corneal wound brought into contact with the tip of the magnet when the foreign body was seen to spring out and attach itself to the tip. There was a small prolapse of the iris which was cut off. Atropia was instilled,

and the eye bandaged as for cataract extraction.

The wounds made and the location of the chip were favorable to the easy removal and speedy recovery of the tissues involved, providing infection was not a serious factor. The lens will be more or less slowly absorbed. The pupil will be blocked by the lens capsule, which may or may not require an operation at some future time, providing the recovery is not prevented by a general infection.

Fourteen days later. The recovery in this case has been uneventful, the tension of the eye has not been above normal, there has been no redness, pain or photophobia. The iris and lens alone show the evidence of injury. The lens has slowly swollen and is being absorbed. We can now consider our patient practically out of danger and allow him to leave the hospital to report on each clinic day. The atropine should be continued to keep the pupil slightly dilated.

The future usefulness of the eye will depend upon the density of the secondary cataract and the result of the needling, if that is required. A cataract glass will of course be required to correct the error of refraction caused by the loss of the lens.

34 Washington Street.

THE DIAGNOSIS AND TREATMENT OF HEREDITARY SYPHILIS.-By DR. N. FILATOV, late Professor in Imperial University of Moscow, Russia.

(Translation from Russian by G. B. Hassin, M. D., Chicago.)

The more recent the syphilis is, in both or one parent, the severer it affects the offspring (excluding only cases when the mother is affected during pregnancy; then the child very often remains healthy). In the most severe cases pregnancy does not continue to the end, but terminates in abortion or in still-birth; and here the foetus manifests undoubted evidences of syphilis. Syphilitic children are usually shortlived, dying during the first days or weeks after birth.

If the child is born at full term and seemingly healthy, it becomes sooner or later syphilitic, dependent on the period of the disease in the parents.

The first symptoms of syphilis occur in the child usually during the first weeks after birth, seldom from six to twelve weeks and almost never after three months. The majority of authors agree that the first appearance of hereditary syphilis may occur even many years after birth of the child, and the disease makes itself evident in such cases directly by symptoms of the tertiary stage (periostitis, gummous ulcers, etc.). This is the so-called syphilis congenita tarda in the strict sense of the word. But the symptoms during the first weeks of life being often developed indistinctly may be overlooked, and therefore it is possible that the majority of cases of late syphilis are nothing but relapses of the common heredWhatever it may be, it is true, that, with very few exceptions, hereditary syphilis manifests itself in the first three months of the child's life.

itary type.

In the majority of cases the disease begins with snuffles