A piece of steel in the ciliary body located by means of Roentgen's x-rays : extraction with the elctro-magnet and preservation of good vision after two similar operative procedures, without the use of the rays, had been unsuccessful / by G. E. de Schweinitz.

  • George Edmund de Schweinitz
Date:
[1897]
Catalogue details

Licence: Public Domain Mark

Credit: A piece of steel in the ciliary body located by means of Roentgen's x-rays : extraction with the elctro-magnet and preservation of good vision after two similar operative procedures, without the use of the rays, had been unsuccessful / by G. E. de Schweinitz. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    lower and inner quadrant of the eye. The patient was immediately taken to a neighboring hospital, where an electro-magnet was twice introduced through the wound of entrance, without, however, removing the foreign body. The physician in charge of the operation stated that he thought he had moved the body, but that his magnet was not strong enough to withdraw it. The patient, by the advice of Dr. John Fay, then came to Philadelphia with the hope of obtaining relief. Examination: Vision of R. E., 6/6, full accommodative power, prac- tically normal fundus, H. equals 1 D. Vision of L. E., 5/60, with diffi- culty. The pupil was dilated widely, probably from the effects of atro- pine, the tension was diminished, the bulbar and tarsal conjunctivae were flushed, and a small bead of vitreous protruded from a linear wound 3 mm. in length, situated 2 centimetre from the corneal border, downward and inward, between the insertion of the internal and inferior rectus. Ophthalmoscopic examination was unsatisfactory, on account of the haze in the vitreous, which prevented accurate observation of the details of the fundus. As far as could be made out, however, these included a vertically oval disk, enormously distended and tortuous veins, a patch of white tissue upon the nasal side of the disk, a fringe of hemorrhage downward and outward from the papilla, and far forward in the upper portion of the eyeground an indistinct spot of dark color, vaguely resembling a blood-clot, but very difficult to study. The lower half of the vitreous was filled with large blood-clots, through which could be seen dimly the rent in the coats of the eye. The next day, January 14th, an electro-magnet was introduced twice, unsuccessfully, through the wound of entrance. Thinking that the small, dark spot in the upper portion of the eye might indicate the position of the foreign body, the fine, straight point of a Hirschberg magnet was inserted through a small wound made for this purpose in the upper ciliary region. Once a bystander thought he heard the click of metal on metal, but on withdrawal of the point no foreign body was attached. The incision was small—not much larger than was necessary to admit the point of the electro-magnet; therefore it is possible that the foreign body could not have passed between the lips of the wound without being detached from the magnet. I am inclined to think, however, even if the point of the instrument did touch the piece of steel, that the magnetic attraction was not sufficiently strong to dislodge it, because the mouth of the wound was carefully watched by Dr. Veasey and its sides separated by small retractors. Further operative interference at that time was not deemed justifiable. No immediate reaction followed this operation. The boy was kept under observation for ten days, seven of which he spent in the hospital. Small doses of calomel and iodide of sodium were administered and mydriasis was maintained with atropine. This treatment was instituted in the hope that some absorption of the vitreous exudations and blood- clots would take place and enable a more perfect ophthalmoscopic examination to be made. In this hope I was disappointed, because the vitreous haze deepened, and on the seventh day the signs of beginning cyclitis were well marked. In the meantime, however, and as soon as possible, through the kind- ness of Dr. Max J. Stern, an excellent skiagraph was obtained, which is herewith exhibited, chiefly interesting because, in spite of the fact that the current gave out and the exposure was only four minutes, the
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