Notes on the Electro-Magnet in Ophthalmology, 
with a Report of Nine Cases. 
WM. ELLERY BRIGGS, M. D. 
BY 
Sacramento, Cal. 
SACRAMENTO, CAEIEORNIA : 
Reprinted from the Occidental Medical Times, August, rBBg. Reprinted from the Occidental Medical Times, August, 1889. 
NOTES ON THE ELECTRO-MAGNET IN OPHTHALMOLOGY, 
WITH A REPORT OF NINE CASES. 
Wm. ELivERY Briggs, M. D., Sacramento, Cal. 
Read before the Sacramento Society for Medical Improvement. 
No recent advance in ophthalmic surgery surpasses in its bene- 
ficial results the use of the electro-magnet in those cases in which 
it is applicable. It is essentially a conservative procedure, often 
enabling the operator to save an eye that previous to Hirschberg’s 
success in perfecting this instrument would have been enucleated, 
or have remained a dreaded source of sympathetic ophthalmia. 
I believe that the magnet is used far less frequently than its un- 
doubted value demands. Practically, an error in the diagnosis of 
a penetrating foreign body is very rare, and even should the ope- 
rator fail to remove the extraneous substance the eye is not neces- 
sarily left in a much worse condition. With proper care and 
under antiseptic precautions there is, as a rule, but slight inflam- 
matory reaction following the introduction of the magnet, and the 
visual acuteness is not materially lessened. Should no foreign 
body be present, but little damage has been done, while if one 
remaiji, the indications for a more radical operation will soon be 
manifest. 
When we consider the aggregate number of suitable cases oc- 
curring, the reported operations are certainly meagre; and from 
this may in part arise the lack of a more general appreciation of 
this invaluable instrument. For this reason I have concluded to 
publish the following cases upon which I have operated during the 
past eight years. Case I was reported to the California State 
Medical Society (Transactions 1881-82), and was the first case 
reported on the Pacific Coast. Cases 11, 111 and IV were reported 
to the same Society (Transactions 1883-84). The remaining 
ones are now published for the first time. I regret that I have not 
preserved the records of two unsuccessful cases not included in the 
following; 
Case I.—M. A , blacksmith, residing in a neighboring town, 
while at work, felt that something had struck his right eye. A physi- 
cian who saw the case was unable to recognize the presence of a for- 
eign body. After four days, during which time the eye had been 2 
intensely painful, the patient came to Sacramento. Upon examina- 
tion I found a small wound in the cornea, below the centre and in 
the middle line, with a black speck in the iris near the pupil. The 
pain was sufficient to prevent sleep, and there was considerable in- 
flammatory exudation upon the iris and in the anterior chamber. 
An incision was made in the cornea, with a Grade’s cataract knife, 
near the lower border, the point of the electro-magnet was passed 
into the anterior chamber towards the foreign body, which was at- 
tracted, attaching itself to the magnet and being withdrawn with 
it. It was a piece of steel more than two mm. in length. Eserine 
was instilled, and a compress and bandage applied. The following 
day atropine was used. Three days later the patient returned 
home with perfect vision. 
Case II—J. M , blacksmith, while working, felt that some- 
thing had penetrated his left eye. When seen a few hours after 
the injury the eye was injected, freely lachrymating, with vision 
little above the perception of light. The corneal wound, injured 
iris and lens, could be readily seen, but the foreign body was not 
detected. There had been free hemorrhage into the vitreous. 
From the nature of the wound a foreign body was believed to have 
lodged within the eye. A point of the electro-magnet was accord- 
ingly introduced into the vitreous through an incision made in the 
conjunctiva and sclerotic between the external and inferior recti 
muscles. It was held in position a few seconds, and upon with- 
drawal a small fragment of steel was found to be attached. 
Atropine was instilled, and a compress and bandage applied. The 
inflammation which followed was slight, and in four weeks the eye 
was free from irritation. Traumatic cataract remained, but with a 
fair visual field. . 
Case III—F. W was injured in the ciliary region of the 
left eye. The eye contained a large quantity of blood, and no 
foreign body could be seen. The wound was slightly enlarged 
backwards and a point of the magnet introduced but failed to at- 
tract the foreign body, and after two unsuccessful attempts at ex- 
traction the eye was enucleated. A piece of steel was found, 
firmly impacted in the sclerotic at the fundus. 
Case IV —T. B was seen the evening of the injury. A 
wound in the centre of the corneal hemisphere was detected and a 
foreign body lodged in the iris near the pupil. The next day a 
corneal incision was made near the lower border, and a point of 
the magnet introduced into the anterior chamber. Before the mag- 
net had reached the foreign body it was seen to jump from its 
position and was withdrawn attached to the instrument. A com- 
press and bandage and cold water dressings were applied. The 
eye recovered with no untoward symptoms, and the patient was 
discharged in ten days with perfect vision. 3 
Case V—J. O , a blacksmith, was examined one hour 
after injury. I found a large wound of the right cornea, implicat- 
ing the external portion of the ciliary region and the border of the 
iris. The lens was dislocated downwards. So much blood had 
escaped into the vitreous that it was impossible to see the fundus, 
and no foreign body could be detected. .It was thought worth 
while to try to save the eye, and accordingly the electro-magnet 
was introduced through the wound made by the foreign body, but 
without success. Upon the second introduction the characteristic 
click was felt, and a large, irregular piece of steel was withdrawn, 
attached to the magnet. Atropine, cold applications and rest 
were ordered, and at the end of four weeks the patient was dis- 
charged, able to count fingers at fifteen feet. Later, however, the 
vision was lost from detachment of the retina. The eye has re- 
mained free from pain or irritability. 
Cases VI aiid VII.—These were two cases of unsuccessful 
attempts to extract steel from eyes in which there was every indi- 
cation of foreign bodies being present. In the first case I enucle- 
ated the eye, and found a small particle of steel in the fundus, at- 
tached to the sclerotic. In the second case the patient refused to 
have the eye enucleated, and soon after left Sacramento, so that I 
am unaware of the final result. 
Case VIII.—M. T , set. 26, machinist, was struck in the 
left eye with a chip of steel on January 18, 1889. According to 
his statement, several oculists who had examined him were uncer- 
tain whether or not a foreign body were in the eye. When he 
consulted me, four days after the injury, there was considerable 
photophobia, a moderate degree of pain, and some conjunctival 
and pericorneal injection. A small corneal wound, which had 
healed, just below and external to the centre, could be seen. Atro- 
pine revealed some posterior synechia, and quite extensive injury 
to the lower half of the lens. I was unable to satisfy myself that 
there was a foreign body present, and the patient consulted Dr. 
Barkan, of San Francisco, who kindly wrote me that he was pretty 
certain that the foreign body was in the vitreous, close to the injured 
lens. I did not, therefore, longer hesitate to operate. An incision, 
under cocaine anesthesia, was made through the conjunctiva and 
sclerotic posterior, to the ciliary region, about midway between 
the external and inferior rectus muscles, and the point of the magnet 
connected with 20 Leclanchfi cells was introduced. Upon with- 
drawing the instrument, I was gratified to see a piece of steel 
caught in the wound, whence it was removed with the forceps. 
It was a nearly straight and even splinter, a little more than 4 mm. 
in length and 1 mm. in thickness. There was scarcely any inflam- 
matory reaction, and the symptoms which previously existed 
rapidly subsided. The visual field was good, but the lens was be- 
coming cataractous, with vision reduced to 2W It was thought 4 
best not to extract the lens until some future time, and the patient 
returned to his work in Los Angeles about three weeks later. 
Case IX.—-M. V——, set 29, a stonecutter, while sharpening 
his tools on April 8, 1889, was struck in the left eye with a splinter 
of steel. His fellow workmen were unable to see a foreign body, 
and as there was no pain for several days he did not consult a 
physician until the 14th. He had noticed that vision was some- 
what less acute than usual, and the eye was slightly congested. 
The physician who first saw the patient, and who sent him to me, 
noticed a small, nearty square, perforation close to the pupillary 
border of the grey iris, which he very naturally mistook for a for- 
eign body. Upon close inspection a small scar was found about 
half way from the centre to the lower border of the cornea and 
the perforation of the iris above mentioned, which appeared black 
like the pupil, and for the same reason. Under atropine, an oph- 
thalmoscopic examination showed that a piece of steel had lodged 
in the vitreous apparently five or six mm. posterior to the lens. 
The injury to the lens was not extensive and vision was about 
14. The electro-magnet was introduced in the same position as 
in the previous case, and upon withdrawing the instrument after a 
second introduction a foreign body a little less than two mm. long 
and one mm. thick was seen attached to the point. Atropine, 
cold applications and rest were ordered, and strict antiseptic pre- 
cautions observed. In less than a week all irritation had subsided 
and the patient went to work with vision about the same as when 
first examined. 
In Cases I and IV, the fragments of steel could be seen adherent 
to the irides near the pupillary border and the extraction might 
have been made with the forceps. In the first case, however, the 
splinter was in such close proximity to the anterior lens surface, 
that a slight depression, which might have been unavoidable in 
grasping it, would have put the eye in jeopardy by the production 
of traumatic cataract. The superiority of the magnet can readily 
be appreciated in such cases. 
Cases 11, V, VIII and IX, were typical ones, in which the great 
value of the magnet was practically demonstrated, as without its 
aid each of these eyes would have sooner or later required enuclea- 
tion. In Case V there was extensive injury to the ciliary region, 
iris and lens, and a considerable escape of vitreous, but the eye 
retained useful vision for three months. Since then it has not been 
a source of uneasiness, and cosmetically it is far superior to an 
artificial eye. Cases 11, VIII and IX have not been operated upon 
for cataracts which were produced by the passage of the splinters 5 
of steel through the lens, but the eyes present every prospect that 
an operation will restore useful vision to them. 
Cases 111, VI, VII, and two unreported cases, were unsuccess- 
ful, from the fact that the magnet could not extract the foreign 
bodies. 
The first four cases of the foregoing series were operated upon 
under ether; in the remaining ones the local anesthesia produced 
by a four per cent, cocaine hydrochlorate solution was found 
sufficient. During the past two years I have observed strict anti- 
septic precautions in this, as well as in most other operations upon 
the eye. I have found that less than 16 or 18 Leclanchfi cells do 
not develop the full power of my magnet. lat first used a Grenet 
cell as suggested by Hirschberg but found that the single fluid 
battery was far less satisfactory than the cell. The 
magnet was made under my instructions from the description 
of Hirschberg’s instrument, and is similar in its construction. 
The great majority of foreign bodies that lodge within the eye 
are splinters of steel. For this reason the electro-magnet has a 
larger scope of usefulness than would at first appear. When a 
piece of steel has lodged within the anterior chamber, or has pene- 
trated the iris or lens, it can usually be extracted with the forceps, 
but the electro-magnet offers a safer means of removing such 
bodies. The incision, which should be made through the cornea, 
near its border, where the foreign body can be most readily 
reached, need be no larger for the introduction of the point of the 
magnet than for the forceps. And the manipulation of the forceps 
necessary to grasp the particle will generally cause more injury to 
the delicate tissues than the introduction of the magnet point. It 
is rarely necessary to touch the fragment, as it will be attracted 
from some distance, unless it is firmly adherent to the tissues. 
When the steel is lodged in the vitreous chamber, and is 
beyond the reach of the forceps, the inestimable boon of an electro- 
magnet can be fully appreciated, If the surgeon is convinced 
from the appearance of the wound, from the direction whence the 
foreign body came, and from the internal injury to the eye, that 
something has lodged within the globe, I believe he is derelict in 
his duty to his patient if he does not attempt to extract it with 
the electro-magnet. If the foreign body can be seen in the vitre- 
ous chamber, there can then be no question of the necessity of 
prompt operation. Unless the wound made by the penetrating 6 
steel be in such a position as to enable the point of the magnet 
to be introduced without injury to the lens or iris, a new opening 
should be made posterior to the ciliary region, in the closest 
proximity to the probable location of the foreign body. 
Since having saved several eyes which, without the aid of the 
electro-magnet were destined to sure destruction, I have hesitated 
less to employ it than formerly. It produces but little inflamma- 
tion, and with care does not endanger the chances of the 
eye’s recovery, even if a foreign body be not found. It is almost 
the only hope of getting a splinter of steel out of the vitreous 
chamber—the cases in which we are so fortunate as to reach it 
with the forceps being very rare. In cases where the foreign 
body has injured the lens and penetrated the vitreous I have 
usually not removed the lens until some future time. This rule 
should not be followed when the lens can be extracted without 
complicating the operation; as, for instance, if the steel can be 
readily reached through a corneal incision, which would be re- 
quired to remove the lens, or in case the lens is so severely dam- 
aged that its substance, escaping into the anterior chamber, is a 
source of danger to the eye. 
From my experience I have arrived at the following conclusions: 
i. The electro-magnet is generally a safer instrument for the ex- 
traction of fragments of steel from the anterior chamber, from the 
iris, or from the anterior portion of the lens than the forceps. 
2. It is practically our only resource when the steel has pene- 
trated the vitreous chamber. 
3- It is safe to retain quite extensively injured eyes, if the offend- 
ing body be promptly removed and thorough asepsis observed. 
429Yz J street.