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284 skin, the granulation tissue, "caro luxurians" of Virchow. The statements of Preuss respecting the microscopic appearances assert nothing which cannot be referred to the lymph follicles, and his remark that "often when such a granulation is seized with the scissors, a thick pulp issues from it as from a ruptured capsule," makes it probable that they are actually swollen lymph follicles. When now Preuss goes on to describe a proliferation of connective tissue and subsequent shrinkage as a metamorphosis of the granulations, it is certainly not to be doubted that such processes frequently occur upon the conjunctiva, but it is not probable that the lymph follicles alone experience this transformation.

The difficulty connected with the subject is that the various formations which are called conjunctival granulations may some of them have been originally anatomically identical, but by internal metamorphosis have come to be different, while others which seem similar were originally anatomically different. That this last often happens has been frequently shown in our discussion of conjunctival diseases.

Hemorrhages beneath the conjunctiva scleræ occur sometimes in consequence of injuries, sometimes from violent straining,—for instance, frequently during whooping-cough,—sometimes without any perceptible cause. They disappear spontaneously in a few days.

Œdema of the conjunctiva scleræ is generally only a symptom of some other disease. Acute conjunctival inflammation, severe iritis or choroiditis, inflammation of the orbital fat, etc., may be accompanied by excessive chemotic swelling. Often, however, without any apparent cause, there occur great swelling and hypersemia of the conjunctiva scleræ, which protrudes from the palpebral fissure as a tensely stretched dark-red tumor. In the course of one or two weeks, if the eye be kept quiet and protected from external irritation, this erysipelatous inflammation—if one wish to call it so—may disappear.

In the course of variola the characteristic pustules may develop upon the conjunctiva. After they are healed they generally leave pigmented spots.

The occurrence of lupus has already been mentioned on page 227.