age.

Incision, as in Bassini's method, along the inguinal canal and as far as the upper segment of the scrotum. As a rule, the testicle is easily drawn out and separated from the adhesions; next, the spermatic cord is dissected out, sometimes it stretches very readily, in others a circular incision must first be made through its coverings or the muscle fibers must be divided; after this has been done it can be stretched without much difficulty. A canal destined for the testicle is now made in the scrotum by means of a pair of forceps, or with the finger; a thread, with two large needles, is drawn through the substance of the testicle; the scrotum is pierced at its root with needles so that the raphe comes to lie between the two transfixing needles. By drawing the threads together the testicle is pulled down into the scrotum and comes to lie at the fundus. The threads are then tied together over a Marly roll.

The spermatic cord is fixed at the inguinal ring, and the entrance into the scrotum by means of circular sutures, which prevent the retraction of the testicle by the spermatic cord. The inguinal ring is closed with interrupted sutures, and the skin around is closed next. The testicular suture is removed on the 10-14th day, or it is allowed to remain until it cuts through of its own accord.

Results observed at end of some time: In four of the patients operated upon, who were re-examined at the end of a year, the testicle remained in its new position, at the root of the scrotum; in the remaining four patients who were re-ex

The cases complicated by hernia were operated upon as follows:

As the testicle and the spermatic cord are brought out the hernial sac will follow, as a rule; it is dissected free from the spermatic cord, tied off at its root, divided and the stump buried in the wound. In some of the cases it was fixed accordind to Kocher. The inguinal ring is closed in all cases with an interrupted suture, except the point where the spermatic cord is situated. In the cases with incarcerated hernia the coil of small intestine which had twined around the spermatic cord could be liberated without difficulty after incision of the inguinal canal. The intestinal coil was then replaced in the abdominal cavity and the testicle was brought down into the scrotum according to the customary method. The outcome was entirely satisfactory.

As has been seen, the testicle was fixed in the scrotal fundus according to the method employed by Schuller, Czerny and Riedel, with a slight modification of the suture technique. The spermatic cord was attached to the inguinal ring and the upper portion of the scrotum, the testicle being thus retained in the lower segment. The skin wound was closed by means of Michel's clamps in the majority of the

cases.

The post-operative course was favorable in all the cases. The indications for the operation were positive in all these patients; ten suffered from hernia, two from hydrocele of the testicle and the spermatic cord, one from tumor of the

Venous pulsation.

5. Abnormal stippling or pigmentary changes at or about the macula, not to be accounted for by other causes.

The prognosis is not the brightest, but several important things may be said of it:

1. We know nothing about what changes or modifications in the disease are wrought by presbyopia, which, as it lessens the intraocular pressure, switching plus astigmatic axes to 180, etc., may bring lessening of the choking. Massage of the globes of the eyes does not seem of much avail. Gould is going to try the effect of long-continued instillations of weak eserin solutions.

2. Most patients require nothing more than abstention from reading, writing, etc., to secure comparative comfort and happiness.

The recognition of the inobviable commands of fate and limits of circumstances is infinitely better than the fright and horror of a fatality, whose nature is unknown, and beyond forecast of how, when or where it will strike.

4. On the part of the patient the recognition makes definite and orderly the direction of the life, whereas at present how many thousands are wandering from doctor to doctor, from sanitarium to sanitarium, now filled with hope, then in the misery of despair, never well and never dying. With this knowledge the plagued patient may learn the essence of all lifewisdom-to make a friend of fate-i, e., to learn the uses of his limitations and to stop banging his head against the walls of destiny.

5. On the part of the profession it would be far better to know the real source of the suffering of so many patients, now dubbed by a dozen silly words -"toxemia," "neurasthenia," "hysteria," “invalidism," "breakdown," "neuropathic

diathesis," etc. Those physicians may be checked who are deluding these victims throughout their pitiful lives, knowing medicine cannot cure, but knowing as well that the patient can pay well for the delusion that medicine will cure. On the part of the conscientious physician or oculist it is better to know what is the cause of the nagging mystery, to know at least that it is not due to improper glasses, muscle imbalance.

Ophthalmia Neona- Rosa Ford (The torum. Hospital, February 29) discusses the modern treatment of ophthalmia neonatorum as follows:

1. In cases of ante-partum ophthalmia, when the child is born with the eyes already inflamed, do not apply Crédé's treatment. There is a tendency to think that if it is useful as a routine, much more is the method of value when inflammation is actually present. This is a mistake. The disease is already in its first stage, and silver nitrate solution will only do harm by increasing inflammation.

2. If Crédé's method has been neglected at birth, do not apply it on the first. sign of inflammation. It is then too late. 3. Never use silver nitrate solution stronger than 2 per cent. Mistakes are so often made, and the results are so disastrous, that it is well to emphasize the caution that a solution labeled 10 per cent. is five times as strong as one labeled 10 grains to the ounce (2 per cent.).

but firm pressure on the eyeball, and also holding the two thumbs constantly paralle! to each other, the lids should be separated as far as possible. Maintain this position steadily until the child moves the eye, as it is sure to do sooner or later, so that the cornea comes for a brief moment into full view. The other method is by metal retractors, which should only be used as a last resort.

5. Protargol must be prepared with cold water. The best method is to dust the powder on to as large a surface as possible of the required amount of distilled water, and leave without stirring. It will dissolve in about half an hour. The solution does not keep well unless preserved in an amber-colored bottle in a cool, dark place. A convenient form for the practitioner who does not often use it is the soloid of I gr. or 4 grs.

6. If the inflammation is limited to one eye it is in all probability a result of a congenital duct obstruction. The case should be referred to an ophthalmic surgeon. Recognized early, these cases can be cured rapidly and easily, but if allowed to persist for some months treatment is often difficult and tedious.

7. The percentage of cases of ophthalmia neonatorum due to the gonococcus has been estimated at 60 per cent. (Sydney Stephenson).

8. With regard to prognosis, De Schweinitz's opinion is valuable. He states that if an eye is seen while the cornea is still clear, except in diphtheritic or inherently malignant types, or in cases of malnutrition, a complete cure should be looked for. It has been estimated that 66 per cent. of the cases of ophthalmia neonatorum recover with unimpaired sight.

9. Protargol must not be used for too long. It undoubtedly stains the conjunctiva (Snell, de Schweinitz).

Prophylaxis.-(1) Wipe the eyelids clean with a damp swab immediately after birth, (2) drop protargol 10 per cent. into each conjunctival sac as soon as possible after birth.

Treatment. (1) Cleanse the conjunctival sac every half hour with a warm solution of borax (3ij. ad. Oj.); (2) foment the eyes with squares of gauze wrung out of a hot solution of the same Do not kind. Change every half hour. cover the gauze with anything else; (3) drop protargol 10 per cent. into the conjunctival sac every hour; (4) once a day instil protargol 20 per cent., keeping the solution in the conjunctival sac for two minutes.

If the cornea becomes hazy, instil atropin (grs. ij. ad. 3j.) three times a day, and continue all the other measures.

In hyper-acute cases and in relapses, treat as above until the tense swelling is reduced and the secretion free, then make a single alteration; instead of instilling the 20 per cent. protargol paint the whole of the palpebral conjunctiva with 2 per cent. silver nitrate solution once a day. After a minute wash off any excess of fluid with sterilized salt solution.

The possibility of injury to the infant's eyes can hardly weigh as a serious contraindication to the employment of obstetrical forceps, but the possibility of such injury should always be borne in mind by those who attend women in confinement. After prolonged or difficult labors, whether spontaneous or instrumental, any marks of violence to the eyes or ocular adnexa of the baby, or even in the absence of such marks, a searching examination not only of the external ocular structures, but the deeper parts of the eye, is urgently demanded for the sake of the future ocular welfare of the infant.