DEPARTMENT OF SURGERY. 
287 
Operation .—The instruments necessary for the operation 
are : eye speculum, probe, scissors, dissecting forceps, spatula, 
needles, sutures and several sharp-pointed knives. When we 
have but slight adhesions, a local anaesthetic is all that is neces¬ 
sary, but when they are extensive and require careful dissection 
it is best to administer a general anaesthetic. When the lid ad¬ 
heres to the ball, the operator should first attempt to separate 
them with a probe or spatula, but if the adhesions are too firm 
they must be dissected apart and a rubber shield placed between 
the lid and eyeball and left in place until the parts have healed. 
When the eyelid is distorted it must be shaped as near normal 
as possible by surgical means. If it becomes necessary to clean 
the parts, the shield must be removed during the intervals of 
cleaning, and thoroughly washed before replacing it. The eye 
must be covered with gauze or cotton and bandaged or covered 
with a hood. 
When the eyelids are united to one another and not to the ball 
the operation is very simple and with careful attention the results 
are generally good. In such cases the lids are separated with 
a knife, making the incision as long as necessary to make the 
palpebral opening as long as its fellow. The condition of these 
new formed edges will depend much upon the care that they re¬ 
ceive. The conjunctiva may be dissected from the lids for a 
short distance along the edges and sutured over the new formed 
edges, but this is not always necessary and in some cases not ad¬ 
visable, because the sutures increase the danger of infection and 
cause irritation. Very good results follow careful dressing 
without sutures. Aseptic dressings of gauze placed between 
the edges and covered with cotton and properly bandaged is 
generally all that is necessary. 
SURGICAL ITEMS. 
In the Journal of the American Medical A ssociation^ June 
15, 1901, we notice an editorial on the increase of fatal cases of 
tetanus in large cities resulting from wounds inflicted by explo¬ 
sives used in celebrating the Fourth of July, in which is men¬ 
tioned that “ According to Wells, 27 boys ranging from 10 to 
17 died from Fourth of July wounds in Chicago last year. * * * 
The period of incubation varied from five to eleven days after 
the accident” ; and it recommends that such wounds be treated 
surgically and a prophylactic dose of tetanus antitoxin admin¬ 
istered. (5CC.) The editorial also refers to the success that vet¬ 
erinarians have had with this antitoxin as a prophylactic meas- 
