26 
FRANK S. BILLINGS. 
at once escape; the rupture is invariably of the external tissues 
at first, the augmented amount of fluid in the anterior chamber 
exercising a perfectly equal pressure against dccemetic membrane, 
preventing a rupture in that direction ; but when the abscess has 
been unusually extensive, the tissue forming its inner wall are too 
thin to resist this pressure, and a rupture soon follows with escape 
of the aqueous humor, and prolapsus of the lense followed by 
the utter destruction of the complicated organ. In the majority 
of cases this fatal termination does not occur, but from the rup¬ 
tured edges of the external walls and base of such an abscess the 
development of granulation tissue begins and extends across the 
cavity, completely filling it up and projecting to a considerable 
degree beyond the level of the surrounding tissues. Naturally the 
size and shape of this mass will vary with the size and shape of 
the original abscess and extent of the rupture. Such conditions 
have been illustrated in Figs. III. and IV. From these granula¬ 
tions the previously mentioned vascularization may be seen ex¬ 
tending in all directions towards the peripheries of the cornea* 
To one observing this disease for the first time, and before a com¬ 
plete examination of a severely complicated eye has been made, 
the most natural hypothesis would be that there must also be 
very extreme complications of the internal portion of the organ. 
He would find himself entirely mistaken, however ! Aside from 
an aedematous condition of the iris , the internal portions of the eye 
remain absolutely normal. Even the aqueous humor, while in¬ 
creased in quantity, remains as clear and pellucid as the clearest 
of distilled water, as I have tested in every case by the careful 
withdrawing of the same with a sterilized glass barreled syringe ; 
the most exact microscopical examination has failed to reveal the 
presence of a single leucoyte. 
Termination. —Singular to say, notwithstanding the apparent 
severity of the external lesions, with the exception of the rare 
cases in which complete rupture of the cornea with prolapsus of 
the lense occurs, there is, or better perhaps, has been, an absolute 
return to normality and complete reacquisition of sight. Where 
no rupture has occurred, or where there has been no accumulation 
of pus, the first step towards restoration is a decrease in the cali- 
