A circumscribed inflammation, arising often as the result of rheumatism, with infiltration and sero-fibrinous exudation in the external layer of the sclerotic (and in the deeper layer of the conjunctiva), often forming detached hard purplish lumps as large as a bean, between the cornea and the equator of the eyeball, and not movable with the conjunctiva, often extremely tender and accompanied by severe ciliary pains. They disappear after one or two months, leaving a greyish scar, and are apt to recur within the above limited area, but do not endanger the functions of the eye.

This not very common complaint lends itself to massage by its pathological-anatomical nature, and is also one to which Pagenstecher first applied such treatment with excellent results, which are all the more valuable since the other therapy (iodide of potassium, sodium salicylate, excision, scarification, scraping, etc.) was to the highest degree unsatisfactory. . His experience has since been confirmed by German, French, and other doctors.

In the deep form of scleritis (connected with the above by intermediate conditions), arising for the most part in tubercular, scrofulous, or syphilitic persons, Pagenstecher used massage. As we know, this form does not give rise to distinct, definitely circumscribed nodules, but larger, only slightly-raised (purplish) swellings. It is much more dangerous than the previous form, because to a larger or smaller extent it weakens the resistive power of the sclerotic to intra-ocular pressure, so that ectasia, true staphylo-mata (so-called ciliary-staphyloma), arise, or the entire front of the eyeball, and with it the sagittal axis of the eye, is lengthened, with the result that it is followed by complications in the cornea, iris, and uvea ; opacity of the cornea, synechias, occlusion of the pupil, cloudiness of the lens and vitreous humour, etc., finally entirely destroy the functions of the eye.

One must, however, carefully investigate each individual case and not order massage under all conditions as a routine treatment, even when no general contra-indications are present. Two colleagues in Stockholm, Dr. Nordenson and Dr. Widmark, have both massaged episcleritis and scleritis respectively, and each informs me independently that in certain cases of scleritis he has obtained remarkably good results (with 2 per cent precipitate ointment), but that in other cases quite uncomplicated in any way he has noticed the symptoms of irritation decidely increase and found himself compelled to stop all mechanical treatment. Even A. D. Mansfield, who also obtained cures by massage twice daily (yellow ointment) and anti-rheumatic treatment, has seen similar cases with too strong reaction.

Under all circumstances it is here, as always, a sine qua non for massage that there is no recent iritis present. Massage is done with yellow precipitate ointment. In many cases the external tenderness on pressure compels one, especially at first, to give very short and gentle treatments.* In any case, for this complaint, when only a sector of the eyeball is treated, one can make a rule of always using radiating massage.