PART I. CLINICAL. 



S. HOLTH. 



1 he pupil must be considered abnormally small when its diameter is 

 less than 2 mm. by diffuse daylight, the eyes looking at a distant object. 

 A pupil of 1.5 mm. or less under the same conditions is in a pathologic 

 contraction, miosis {ueiato = I diminish); the spelling "Myosis" is wrong 

 (J. Hirschberg). This marked contraction of the pupil, most frequently 

 appearing after a local application of eserine or pilocarpine, is a well 

 known characteristic also of certain intoxications (especially of opium or 

 morphia); it appears in several diseases of the brain or the spinal cord, 

 and is seen — mostly unilaterally — in paralysis of the cervical sympa- 

 thetic nerve. 



These conditions are excluded in the three cases of congenital extre- 

 mely contracted pupils observed by me, and which I will describe below. 

 Congenital miosis must be extremely rare; during 30 years I have only 

 seen these three cases. I searched for a long time in vain in ophthalmolo- 

 gical literature, for instance in the numerous volumes of Graefe-Saemisch 

 "Handbuch der gesamten Augenheilkunde", and even in L. Bach's mono- 

 graphy "Die Pupillenlehre" of 1908. It is not mentioned in "Encyclopédie 

 Française d'Ophtalmologie" (Paris 1903 — 1910), at any rate not in the places 

 where it might be expected to be found. X. Galezowski (Lit. 2, p. 286) saw- 

 four cases of "myosis", without an\- disease in the optic nerve; there was 

 nearly always at the same time a contraction of the accomodation muscle. 

 Galezowski gave no information as to whether the cases were congenital, 

 nor do True and \'alude when they say (Lit. 3, T. I, p. 475) that the pupil 

 may be a point with a comparatively weak effect of mydriatics. — "il s'agit 

 alors de spasme ou de rigidité". This last h3'pothesis agrees more with 

 a contraction of the pupil acquired at a later age, than with a congenital 

 state. In "The American Encyclopedia and Dictionary of Ophthalmology", 

 in 18 volumes (Chicago 1914 — 1921) nothing is found under the heading 



