little or no special advantage over his less fortunate brethren. Neither to the broad sunlight nor to the diligent quest of the dark room is one of the most important parts of the eye revealed. I refer to what is known as the ciliary body. I pause here to say that a misconception is liable to grow out of the use of this

term.

The ciliary body, as we assume to name it, is composed of the ciliary processes, the ciliary muscle and the ciliary portion of the iris. These structures are greatly unlike each other in form and function. They agree chiefly, first, in their common proximity to each other; secondly, in having largely common sources of supply of blood and nerves; and thirdly, in having a tendency to become alike and simultaneously implicated in states of inflammation.

Perhaps I should in justice also admit that in the all-important work of accommodation these parts are the principal agents, and are in common, though by no means equally, concerned. But while the ciliary body as a whole is a myth, yet we may allow the term to stand if we hold it strictly to this anatomical interpretation.

It can be seen at a glance that we have here grouped under this designation, the ciliary body, a part of the eye the diseases of which, if they rise in importance equal to the importance of the function and anatomical relations of the structures they invade, must hold no mean place in the domain of ophthalmologic pathology.

Removed as the parts are from immediate observation, we are unable to differentiate between the probable varying pathological conditions that are incident to the tissues of which the parts are composed.

Another peculiar fact is worthy of notice just here, and that is that notwithstanding the close relationship sustained by the various structures of the eye, inflammatory states readily become circumscribed, and so are limited in their results. This is extremely fortunate, otherwise we should have with each attack of inflammation of the ciliary body either glaucoma or panophthalmitis. And since these results do sometimes follow, the subject is full of interest to the investigator.

Stretching backward from the ciliary body, and in direct anatomical relation to it, especially through the ciliary processes, we have the well-known choroid coat, characterized by its great vascularity.

From the ciliary body downward and forward we have stretching the iris with a predominant nervous endowment. We may say then that the ciliary body partaking of both these tissues is characterized by both vascular and nervous morbid modifications, hy peræmia, congestion and suppuration from the former, and neuralgia from the latter. And these conditions represent to us about all we know of the morbid anatomy of the part.

But as to the etiology of cyclitis, we may advance somewhat further in our knowledge. In the first place, cyclitis may be primary, thus originating de novo in the ciliary body, in which case it has been my experience to find it caused by traumatic injury. It is, however, more commonly secondary, and consequent upon a previous choroiditis or a previous iritis. And this latter, whether commencing in the body and extending to the iris, or commencing in the iris and extending to the body, either being antecedent or consequent, constitutes the immediate subject of this paper, namely, irido-cyclitis.

When the ciliary body is involved in a condition of inflammation, we have chiefly, 1st, loss of accommodation; 2d, impaired sight; 3d, generally severe pain; 4th, great tenderness of the eyeball over the ciliary region; and 5th, if the parts go on to suppuration we have deposit of pus in the anterior chamber (hypopion).

Now if the choroid is involved, we have in addition to the foregoing, 1st, ophthalmoscopic changes in that structure; 2d, probably turbid vitreous, and 3d, increased tension of the eyeball.

If the iris is involved, we have sensible modifications, 1st, of its shape, the ciliary margin being drawn back, thus making the anterior chamber abnormally deep, and 2d, impaired mobility.

Three classes of traumatic injuries are productive of cyclitis and its concomitants, namely: 1st, blows upon the ciliary region of the eyeball; 2d, penetrating wounds that reach into the ciliary body; and 3d, foreign bodies that penetrate either chamber or the vitreous body.

When from any cause whatever we have symptoms such as we have named, pointing unmistakably to cyclitis, especially when we have this symptom, great tenderness to pressure over the ciliary region, we have cause for the gravest apprehension, and should exercise the greatest care over such cases.

To any form of iritis cyclitic complications add great gravity, and we may safely affirm that, when we have a well-recognized case of irido-cyclitis, we have in hand conditions not second in importance to any disease with which the eye may be affected.

But it is well to bear in mind that pains referable to the ciliary body, with great tenderness of the parts, are not always indicative of cyclitis. Asthenopia is quite frequently the cause of severe ciliary irritation. Frontal cephalalgias also often produce great soreness of the eyeballs. These conditions are generally easily distinguishable from true irido-cyclitis by their variableness, the pain and tenderness soon passing wholly away, or are greatly modified by rest.

An especially dangerous form of irido-cyclitis is to be found in cases like this. One eye has been lost, we mean the sight of it, by injury to the ball. This has been done either by direct injury to the ciliary body by a penetrating wound, or some foreign body has passed into the vitreous chamber, and lodging therein has set up a destructive inflammation.

Now sooner or later, following upon these accidents and the ruin they have caused, comes an inflammation of the other eyeball. This latter inflammation is generally an irido-cyclitis, and is better known as sympathetic ophthalmia.

This formidable inflammation is more easily prevented than cured, namely, by an early enucleation of the eye first affected.

I desire to close by giving you a case of special interest that came under my care some few months ago.

Edward H., æt. 19, four years ago, while riding in the cars, was struck in the face by a large stone that came crashing through the window, and filling his left eye with glass. Thirty or forty pieces were removed from the lids and conjunctival surfaces. The laceration and bleeding were considerable, and a mild traumatic inflammation ensued which kindly terminated in the course of a couple of weeks.

For a whole year after he experienced no trouble with the injured eye, but at the end of that time he began to have and continued to have for three years recurrent attacks of pain with all the symptoms peculiar to cyclitis. A few weeks would sometimes intervene with little disturbance of any sort, but use of the eye was sure to be followed by relapses lasting for weeks. During this time he was under care of three well-known oculists, who each gave the utmost attention to an examination of the case. Oblique illumination revealed, as indeed did a casual observation also, a hazy condition of the lower fourth of the cornea; there was in fact at this point an almost constant condition of pannus. At times of exacerbation there was impaired mobility of the iris; at other times the iris was normal.

My own observations lasted through several months, and were accompanied by complete failure to prevent the recurring attack.

A grand council of war was held consisting of doctors and specialists, and the latter were solidly arrayed against the proposition I had made of enucleating the offending organ. Yet no one could offer a reasonable explanation of the cause of the trouble, or promise certain relief in any other mode.

Briefly, then, my advice prevailed, and the eye was taken out some three months ago. Mark the result: The eye was no sooner out and turned upside down than a comparatively large piece of glass was found and distinctly seen lying loosely in the anterior chamber. It was about one centimetre long and two or three millimetres broad, irregular and jagged in form. During all this time it had completely hid itself behind the clouded part of the cornea. For one year it was carried there with impunity, and for three years after without setting up plastic or marked serous inflammation.

It had successfully escaped detection by its transparency in part and partly by the shield which the clouded part of the cornea threw over it. It is extremely doubtful if the glass could have been withdrawn with safety had it been discovered.

Suffice it to say, in conclusion, the patient in a few days recovered from the operation, and was thoroughly happy in being relieved of what seemed an age of suffering.

XXIV.

PLASTIC IRITIS.

BY W. A. PHILLIPS, M.D., CLEVELAND, O.

In

Of the various forms of disease attacking the human eye and imperilling its function, plastic iritis is one of the most common, and if neglected or badly treated is one of the most serious. fine, it may be emphatically said that none of the affections peculiar to the eye which may terminate in such a manner as permanently to impair the integrity of the organ, will so frequently result disastrously to vision if improperly managed, or, other things being equal, will so often terminate favorably if rightly treated. It is likely also that this affection is more frequently the occasion of error in diagnosis by physicians in general practice, than all other ocular diseases combined. The result is that a line of treatment is commonly adopted which directly increases the trouble by encouraging the inflammatory action, and thus hastening the complications peculiar to the disease. The reason why plastic iritis wrongly dealt with or neglected will almost invariably terminate more or less unfavorably, is not because of any peculiarity of the inflammation in respect of its severity or nature, but rather because of the anatomical relation which the iris sustains to the surrounding structures, namely, the lens, ciliary body and choroid. Thus it is to be borne in mind that the pupillary margin of the iris lies in immediate contact with the capsule of the lens, while at its periphery it is directly continuous with and substantially a part of the ciliary body and the choroid coat. Now, plastic inflammation is characterized by a