some cases, it may be advisable to resort to puncture of the tube-sac through the vagina. This method is available in small cyst-like tumors that are within easy reach. These sometimes remain unfilled after a single puncture, and the case proceeds to recovery. In other instances, repeated puncture becomes necessary, unless drainage is provided and antiseptic irrigations employed.

The question of removal of the appendages by abdominal section for various conditions that may be classed as inflammatory remnants, brings us into a field of great importance, and where, notwithstanding all that has been written and said of late, there is still room for much discussion. That the operation is a justifiable procedure in certain junctures-that it has a fieldcannot be gainsaid. The principal and all-important question is to decide its applicability to each particular case. Are there no other means of cure? Shall the operation be done now, or shall there be further delay? These points are often thrust at the gynecological surgeon for decision, after other difficult problems have been disposed of and the way finally cleared for a judgment upon them. It is not here that a mere knowledge of the technique of the operation will avail, nor the courage to do it; but that rare combination of tact and skill which can only be found in a matured surgical judgment, is required for the exigency. Dr. Parvin, in a recent review (American Journal of Medical Sciences, February, 1888, p. 155), says: "A pressing question of the hour is, When is pelvic peritonitis a mere consequence usually of disease of tubes or ovaries, to be treated medically, and when is extirpation of the uterine appendages necessary? The latter question is not to be determined by the experience of one individual, no matter how great that is, but by that of numerous members of the profession, who shall wisely observe and carefully record not only immediate, but remote, results from the removal of the uterine appendages."

That the operation has been done when it ought not to have been done, is probably true. I have no doubt it is equally true that it has been left undone when it ought to have been done.

There are yet many opinions and many methods concerning the earlier conduct of these cases; but, given a tube distended with pus, no matter what its origin, if, after a reasonable trial of minor measures, it still renders existence miserable, torturing the patient and jeopardizing her life, there is, I affirm, no rational mode of relief excepting through the avenue of excision. I would not make haste to extirpate every swollen tube; I would exhaust other means first, and then, if need be, cut them out to save life or relieve grievous bodily suffering.

With the abdomen once open, various other questions are presented that must be decided, and that quickly. Shall the tube-sac be simply punctured and only the contents withdrawn? Shall the tube and ovary on one side only be removed? Shall the appendages on both sides be extirpated? Shall adhesions be broken up and the organs left? The operation may be complicated with other and new-found conditions, such as fibromata, metric, parametric, and peritoneal residues, cancerous and tubercular diseases, etc. If removal of a tube becomes impossible by reason of many and strong adhesions or friability of the tissues, we may then content ourselves with incision of the sac, sewing its edges to the abdominal wound, and drainage; or the abdominal opening may be sutured, and drainage through the vagina employed, according to Martin.

It

If the disease is wholly confined to one side, the other tube and ovary being perfectly healthy, then extirpation may be limited to the diseased side. Great circumspection will often be required to determine this question, as it frequently becomes a cause of regret, if subsequent mischief arises in the organs left behind, that they were not included in the first operation. has been urged that the appendages should be saved on one side, unless there be very marked evidences of disease, lest the woman be sterilized by the operation. It is a burning question with me whether a woman who has had sufficient pelvic disease to warrant the unilateral extirpation of the appendages, should ever again be subjected to the dangers of pregnancy and parturition. In cases of doubt, I should lean to the side of total extirpation.

The decision might, with propriety, be left with the parties in greatest interest in each case, upon a full explanation beforehand.

It does not come within the province of this paper to treat upon the technique of the operation.

Many other details concerning the management of the residues of pelvic inflammations merit careful consideration, but this paper has already reached the limits which are proper in this paper.

In the foregoing, I have sought to underscore the following points, viz. :

1. The importance of early attention to even the soi-disant minor pelvic inflammations.

2. The suggestion of a simpler classification of pelvic inflammations.

3. The influence inflammatory remnants exert upon the health of women.

4. The great value, inter alia, of support and pressure in their management.

5. The thorough trial of all intermediate therapeusis before, 6. The final resort to surgical relief by abdominal section. 284 FRANKLIN STREET, June, 1888.

THE ELECTRO-MAĠNET IN REMOVAL OF STEEL FROM THE INTERIOR OF THE EYE.*

BY ALVIN A. HUBBELL, M. D.,

Professor of Diseases of the Eye, Ear and Throat, in the Medical Department of Niagara University, Buffalo, N. Y.

One of the most serious accidents that can befall the eye is the introduction of a foreign body into its interior. In some cases vision is at once destroyed, while in nearly all, inflammatory action rapidly develops, and if any sight were previously left, it soon becomes lost by this process. Such injuries are, moreover, extremely liable to cause sympathetic disease of the other eye, and thus lead to total blindness. Exceptional cases have been recorded, in which the presence of a foreign body in the eye has been tolerated for weeks, months, and even years,

* Read before the Western Branch of the New York State Medical Association, May 9, 1888.

without suffering, and sometimes with more or less preservation of vision; but these are so rare as practically to have no weight against the rule that the foreign body must be removed or the eye will be lost.

The kinds of foreign bodies which are driven into the eye are various, according to the occupation and circumstances, and they may lodge at almost any point. They may also produce any extent of injury, from one scarcely discernible to one causing a total destruction of the eye. Under all circumstances, their removal is most desirable, and even imperative, so far as the preservation of vision is concerned; yet, to attempt this, involves one of the most uncertain and difficult procedures in surgery. All sorts of forceps, hooks, curettes, scoops, etc., have been devised for the purpose, and when the foreign body is situated in the anterior part of the eye, where it can be seen by the operator, some of them may be used with occasional success. But when it is lodged in the vitreous cavity or posterior part of the ball, the difficulties are increased many-fold, and it is often necessary to remove the whole eye in order to avert sympathetic disease of the other eye and save the patient from hopeless blindness. This is especially true when any substance except steel or iron enters the eye. When, however, it is the latter, the chances for removal and recovery are greatly increased by the use of the permanent or electro-magnet.

Every one knows that the magnet has the power of attracting iron and steel; and it is the practical application of this principle that enables the operator of the present time to save many eyes that, treated by the old methods, would be lost.

The permanent magnet was suggested for the removal of steel from the eye many years ago.* But the credit of starting the impetus which has led to its more general use is due to Dr. W. A. McKeown,† of Belfast, Ireland, who, in 1874, recorded several cases which he had successfully treated. Various forms of the permanent magnet have been devised, but one of the best is that

It was suggested by Fabricius Hildanus, "Opera Observationum et Curationum," 1646; by Milhes, " Observations of Medicine and Surgery," 1745; by Morgagni, " De Sedibus et Causis Morborum," 1779; by Meyer," Mediz. Leitung vom Verein für Heilkunde in Preussen," No. 2, 1842; by Himley, "Die Krankheiten und Missbildungen des menschlichen Auges und deren Heilung," 1843 by White-Cooper, London "Lancet," 1859; and by Von Rothmund, in 1873, "Centralblatt für Augenheilkunde," 1880.

+"British Medical Journal," 1874.

of Dr. Greuning, of New York. This consists of several small cylinders joined together and armed at one extremity with a needle or point suitable for introduction into the eye.

The electro-magnet was first used by Hirschberg, * of Berlin, in 1875. His first instrument was of rude construction; but in 1877 a more perfect one was manufactured for him, which he fully described in 1881.

The electro-magnet, as used for extracting steel from the eye, consists essentially of a cylindrical core or nucleus of pure, soft iron, wound with several convolutions of insulated copper wire, which is connected with a galvanic cell or battery, and transmits the electric current for magnetizing the core. From one or both ends of the core are extended the points or needles to be introduced into the eye.

Several modifications of the electo-magnet have been presented to the profession, but the most important are those of Hirschberg, of Berlin; McHardy, of London; Snell, of Sheffield, and Bradford, of Boston. Hirschberg's seems to be the most bulky and clumsy, and McHardy's the lightest.

THE HUBBELL-PLUMB ELECTRO-MAGNET, ACTUAL SIZE. †

To this list I desire now to add another which had its origin at a time of emergency, and, as it appears to me, possesses sufficient merit to warrant me in calling the attention of the profession to it. It is shown in actual size in the accompanying cut, fig. I

* "Archives of Ophthalmology," Vol. X., 1881.

† For sale by Charles Pumb, Electrician, Buffalo, N. Y.