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Follow-up studies were performed on the first 32 patients to undergo mitral valve replacement with the glutaraldehyde-preserved porcine heterograft premounted on a semirigid stent at the Stanford Medical Center. There was one operative death among the 23 patients who had isolated mitral valve replacement and two operative deaths among the remaining 9 patients who had additional valve surgery or coronary artery grafting. During the follow-up period of 483 months, or 17 ± 5 months per patient, there were three late deaths, two thromboembolic events within the first postoperative month in patients in atrial fibrillation, and one reoperation. A pannus of tissue formed on the atrial side of an otherwise normal heterograft necessitated the one reoperation because of inflow obstruction. Functional improvement from preoperative Class III or IV to postoperative Class I or II was noted in 24 of the 29 survivors of the operation, an 83 per cent improvement rate. Catheterization in the 5 unimproved patients, performed 6 ± 3 months after operation, showed advanced left ventricular disease and normal heterograft function in 4 and mitral restenosis in the fifth. Catheterization in 5 clinically improved patients 17 ± 4 months after operation showed normal heterograft and normal regurgitation. The mean gradient across the ten mitral heterografts averaged 5.7 ± 2 mm. Hg. ventricular function. Angiography in these 10 patients showed no significant mitral Normal heterograft histology was noted in four recovered valves at 4, 4, 18, and 29 months.

The loss of all the distal portion of the fingers on both hands with the forming of a pannus of skin over the stumps furnished the interesting clinical condition reported in this paper. The partial restoration of four digits on one hand and one on the other, allowing independent use of each hand with an increase of function, was obtained by plastic operations.

Pannus was present in all stages of trachoma throughout a series of 31 cases. The biomicroscopic picture of the normal and pathologic limbus is described; that of trachomatous pannus being quite characteristic and useful for differential diagnosis. From the Department of Ophthalmology, State University of Iowa Hospital and College of Medicine. Read before the Colorado Congress of Ophthalmology at Denver, June 22, 1933.

The etiology of rheumatoid arthritis has remained obscure in spite of considerable investigation. The difficulty of its elucidation is increased by the fact that no experimental animal has yet been found in which it is possible to reproduce the disease or in which a strictly comparable disease has occurred spontaneously. Until comparatively recent, all attempts to produce arthritis in animals by the injection of microorganisms, either directly into joints, into the blood stream or by the establishment of foci elsewhere, have led to the development of joint disease which bears only slight resemblance to the typical changes of rheumatoid arthritis. The animal arthritis produced by bacteria is an acute process, usually markedly purulent, which may go on to a chronic state in which the late stages of the inflammatory process suggest, to a certain extent, the pathological changes found in rheumatoid arthritis, but the animal disease lacks many of the outstanding features of the human, particularly the phenomenon of recurrences, and also destruction of cartilage under a granulation tissue pannus. Recently there have appeared reports of spontaneous arthritis occurring in rats and mice, which have given new impetus to attempts to find an animal disease which resembles more closely rheumatoid arthritis and also to investi

In a paper read before the Section on Ophthalmology of the New York Academy of Medicine, on Feb. 20, 1911, I 1 recommended circumcorneal transplantation of mucous membrane from the mouth as a curative measure in diseases of the eye. Since then, I have performed this operation in a large number of cases, not only for trachomatous pannus, but also for scrofulous pannus, for torpid and dystrophic processes of the cornea, the character of which is often obscure, and also for herpes. An excellent field for grafting is presented by burns of the conjunctiva and cornea. In analyzing the curative effect of a graft on a diseased cornea, it seems to me that the important point is the improved nutrition of the cornea, diseased mucous membrane of the eye being removed and replaced by healthy mucous membrane from the mouth. However, not only will the nutrition of the cornea

Before the treatment of trachoma is reviewed a few general facts regarding the disease itself will be briefly stated. Trachoma is contagious, and therefore its secretions can readily infect, either directly or indirectly, the conjunctivae of many persons. Its cause is still unknown ; therefore, the diagnosis rests on the clinical symptoms appearing at any stage of the disease. In its early stages it may be devoid of acute manifestations, but there may be superimposed or mixed infections, demonstrable by bacteriologic examination. The primary pathologic sign of trachoma is papillary hypertrophy of the tarsal conjunctiva, manifest mainly on the upper lid, although both lids are usually involved. According to most authorities, trachoma results in cicatrization of the conjunctiva and atrophy of the tarsus, producing deformities of the lid. In the hypertrophic or the cicatrizatial stage of the disease, there is frequently corneal vascularization or pannus, causing deterioration of vision or even

The cases successfully treated with a conjunctival flap included ulcer, perforation of the cornea, and inveterate pannus. The advantages of this treatment are rapid healing and prompt relief from pain. Read at the annual meeting of the American Ophthalmological Society, Quebec, June 27, 1927.

Among 2,700 babies born in a maternity hospital there were 71 (2.6%) cases of eye sepsis, mostly mild. Forty-four of these cases were screened for inclusions of TRIC agent. Four certain positives and a further four very suggestive cases were found-an incidence of 18% of the cases of eye sepsis investigated. The true incidence is probably somewhat higher.Follow-up showed that even minimal and transitory eye sepsis from TRIC infection in the neonate can lead to permanent scarring of the conjunctiva and cornea, with or without pannus.

For the eyes of laboratory animals, B. monocytogenes possesses a remarkable infectivity, most severe for guinea pigs, less so for rabbits and monkeys. The severe type of reaction, as it occurs experimentally in guinea pigs, consists of an acute conjunctivitis, exudate, and turbidity and vascularity of the cornea. Pathologically, the infection is characterized by a massive infiltration of the conjunctiva and cornea with monocytes, and by the appearance of congested capillaries which give the appearance of pannus in the cornea. Although the infection remains localized in the inoculated eye, a study of the circulating blood revealed occasional instances of a distinct mononucleosis which did not, however, parallel the clinical symptoms. Animals recovered from an eye infection, exhibited some local resistance to subsequent reinfection with the organism. From the Bacteriological Laboratories of the Oscar Johnson Institute, Washington University, School of Medicine. Conducted under a grant from the Commonwealth Fund of New York City.

Solution of epinephrine hydrochloride in a concentration of 1: 1,000 has been used as a vasoconstrictor for the past forty years. In the practice of ophthalmology this preparation is of more or less therapeutic value for its vasoconstrictive action in cases of scleritis, episcleritis, various forms of conjunctivitis, keratitis (including ulcer), iritis, iridocyclitis, prolapse of the iris, glaucoma and pannus and occasionally in cases of a few other ocular conditions. Recently the 1 per cent strength was introduced for oral administration in cases of asthma, and about two and one-half years ago I began some clinical experimental studies with it in the field of ophthalmology, using two different preparations.1The two preparations acted equally well, and so far as these experiments were concerned there did not seem to be any difference in the results. The first phase of the problem concerning the 1 per

Experiments in the therapeutic use of pepsin made in the Ophthalmic Clinic of the John Casimir University of Lwow, Poland, directed by Professor A. Bednarski, are here reported. The trials were made in lid diseases due to cicatrices in trachomatous pannus and in turbidity of the vitreous. In pannus and deforming infiltration of the tarsus it was found a helpful remedy. In diseases of the vitreous the benefit was less certain. First presented to the meeting of Polish Oculists in 1924.

say 2 weeks later, the ulcer wouild inflame again, and we would be compelled to cover the cornea again, as has happened. Even 2-3 months later we have seen a weak relapse with a small hypopyon for a few days. As far as our observations go, the interval of at least 6 months has to be kept. It is surprising, how willingly our patients wait, till the set term is over. The re-opening is a simple procedure. We lift the conjunctiva somewhere on the cornea, make a hole in it through which we introduce the scissors and cut away the flap all around inside the limbus. The parts grown together are detached as a pseudopterygium by iris-spatula and keratome. One has to take care not to leave a thin capsular layer on the cornea. The eye is dressed for 1 to 3 days. Encouraged by the satisfactory results, recently we have begun to extend considerably the sphere of application of the total hooding, t.e., to all acute and chronic keratitic processes unhealed or not healing well, such as ulcerated and degenerated pannus, ulcus destruens, herpes corneae, kerato-mycosis, neuroparalytic ketatitis. Once we applied it to an enormous exophthalmos in Graves' disease with excellent result. Thus the total conjunctival hooding of the cornea became at my clinic an increasingly employed proceeding for keratitic processes and it is my firm conviction that we can save eyes by it, that would be otherwise inevitably lost. /

The conclusions which may be drawn from the results of the experiments here presented are: 1. The cornea of the rabbit is highly sensitive to the action of various injected bacteria. The lesions vary from insignificant, transient changes to severe, destructive panophthalmitis, with fine gradations from the mildest to the violent form of inflammation. Moreover, animals that receive the same organisms show like changes. 2. The varying degree of inflammatory reaction is related to the pathogenicity of the special culture employed; as, for example, is shown by the reactions to Type I pneumococci and to Bacterium granulosis. It is evident that when a microorganism having a certain degree of virulence is used, a lesion of localized vasculonebulous keratitis resembling pannus tenuis or vasculosus of human trachoma can be induced. Thus Bacterium granulosis, Bacillus xerosis, Hemophilus influenzae, Pneumococcus Type II, Streptococcus viridans, and gonococcus can cause the pannus-like corneal changes in the rabbit. Of these organisms, however, only Bacterium granulosis induces early, uncomplicated and enduring keratitic lesions; the others cause first, diffuse keratitis with suppurative lesions; then, as a residual effect, transient, localized, vasculonebulous changes in the cornea. These changes, in contradistinction to the granulosis lesions, are, therefore delayed, complicated, and transient. When, on the other hand, the invasiveness and infecting power of the organisms are low, as is the case with the filtrable, Gram-negative bacillus and the small, Gram-negative bacilli ultimately derived from cases of folliculosis, no marked effect is produced by their intracorneal inoculation. If the pathogenicity of bacteria is high (as shown by Pneumococcus Type I, hemolytic streptococcus, and the remaining bacteria), intracorneal inoculation of the microorganisms leads to serious suppurative or destructive changes. 3. The results of experiments with monkeys indicate that while pannus is not a sequel of experimental trachomatous conjunctivitis, a lesion resembling it follows intracorneal inoculation of Bacterium granulosis. 4. One can infer from these results, therefore, that the stimulus necessary to produce corneal changes in animals, similar to those of trachomatous pannus, is an agent having a definite but extremely low power of invasiveness and infectivity.

Mycoplasma hyorhinis arthritis, induced in young Yorkshire swine, can be considered as a three-stage process. The first 3 weeks of the disease were characterized by a severe polyserositis and mild synovitis. In the second stage, mononuclear cell infiltration of the synovium and other tissues was apparent. In the final stage, beginning about 3 months after inoculation, lymphocytic aggregates had become nodular, synovial hypertrophy was pronounced, and bone and cartilage destruction by pannus was common. Continued activity was apparent to Day 224.

This article does not lend itself to abstracting, as the substance of it is a comprehensive review of the entire subject. In discussing the difficulties in making an early diagnosis of trachoma, the author states that the slitlamp has been the means of advancing the date of earliest, correct, differential diagnosis and that pannus indisputably belongs in the picture of true trachoma. Presented in part at the Academy of Ophthalmology and Oto-Laryngology in Montreal, Canada, September 21, 1932, under the title, "Recent developments in trachoma investigations." From the Department of Ophthalmology, Washington University, St. Louis, Missouri.

The infrequency of serious cartilage destruction in the joints of children makes it probable that the majority will recover with antibiotic and constitutional treatment alone, especially if a joint biopsy is performed. Synovectomy for children should therefore be reserved for those whose knees remain swollen and warm, even after antibiotic therapy, or whose range of movement does not show signs of returning. Exploration of such joints may show that pannus is wholly or partly covering the cartilage and that it is soft and pitted. Removal of the pannus allows better nutrition of the cartilage. The number of children who require arthrodesis in the future should be very small. Adults who respond well to antibiotic and constitutional treatment may also recover without surgery, except biopsy, but for patients with more severe disease the need for an alternative to arthrodesis exists. The choice between synovectomy–better called joint clearance –can often only be made after the joint has been opened. The choice between the two operations has always been fully discussed with the patient before the operation. The results enumerated in this paper suggest that arthrodesis may only need to be performed for patients with severe disease, often involving the bony articular surfaces, and that joints may recover function even when there has been partial destruction of cartilage.

A resumeof results obtained by leading students of trachoma in experimental inoculation of M. rhesus monkeys with B. granulosis is given. Four of five monkeys in which folliculosis was produced by the author yielded B. granulosis. The disease differs from human trachoma mainly in the absence of pannus. The author concludes that etiologic relationship of this organism to human trachoma can never be established by monkey experimentation. From the Departments of Ophthalmology and Bacteriology. University of Colorado School of Medicine.

THE treatment of trachoma with aureomycin is still far from satisfactory, in spite of favourable reports from such authorities as Braley and Sanders (1949), Boase (1950), Duke-Elder, Ainslie, and Boase (1950), and Tanaka (1951). The drug had been given a fair trial here, but the results have been uncertain in pannus as well as in the lid condition. Similarly disappointing results were reported by Van Tien (1951), Andrade (1951), Sakon, Kohn, and Raphael (1951), Shah (1951), and Sarkies (1951). Mere amelioration of symptoms cannot be taken as a criterion except in acute cases, which are usually encountered after experimental inoculation, or in cases complicated by some secondary infection. Since trachoma alone is a chronic disease, the lid condition as well as the pannus has been given due consideration. Good results were obtained by Kamel (1951) and by Sakon, Kohn, and Raphael (1951) with sulphacetamide, though their results with aureomycin were disappointing. Present Investigations Better results were noted when these drugs were supplemented with grattage, as shown by the statistics given below. Two groups of cases were studied

Noguchi's 1 principal argument for Bacterium granulosis as the etiologic agent of trachoma was based on evidence obtained from inoculation of the conjunctiva of a monkey with pure cultures of this bacterium. A chronic granular conjunctivitis was induced which resembled the human disease and which appeared to have the characteristics of trachomatous infection in monkeys. But experimental trachoma differs from trachoma in man in several important respects : Pannus does not occur and, though mild cicatricial changes have been reported, there are none of the severe degenerative and cicatricial lesions which are of such importance in diagnosis. This lack of definite diagnostic criteria has prevented ophthalmologists who have observed the disease due to Bacterium granulosis from agreeing as to whether the condition is true trachoma or a type of follicular conjunctivitis. Olitsky, Syverton and Tyler, 2 at the Rockefeller Institute for Medical Research, and Bengtson, 3 at the National Institute

Among the various changes of the cornea in trachoma united under the general name of pannus or interpreted as sequels of it there is one form of damage of the cornea which is of great interest. It is characterized by the appearance of pale yellowish spots which are situated mainly in the center of the cornea. Among all the authors of textbooks and manuals, only Fuchs 1 has mentioned these lesions. He wrote about changes in pannus of long standing in the form of "small, intensely white spots in the region of the pupil." The appearance of those spots, which "closely adhere to the thin vessels of the pannus, resemble leaden incrustations. The spots lie superficially and can be removed by scraping." These changes were described in detail by Calderaro 2 from the Corinesno clinics. According to Calderaro, these lesions are rather rare and were observed in only 0.1

There are a few landmarks of clinical observation to be mentioned in considering the part played by the gonococcus in hot climates where trachoma is common or perhaps universal. The first was the recognition by Muller, in 1898, that the infiltration of the superficial layers of the cornea by trachomatous granulation tissue, or pannus, is a means of defense against damage of the cornea by ulceration caused by gonococcic conjunctivitis. The second was the observation made by Morax, in 1901, that there is no such condition as acute trachoma, and that acute signs occurring in a trachomatous subject are the result of a superimposed infection with gonococci or other known bacteria. It is probable, moreover, that the presence of trachomatous conjunctivitis predisposes the membrane to infection by gonococci, or, in other words, that the trachomatous conjunctiva provides an excellent culture medium for these organisms. It is to

This method evolved from modifications of tarsectomy has something in common with the old operation of peritomy for pannus, and yields very favorable results as here reported.

In February 1938 Dr. Fred Loe, of Rosebud, S. D., notified us of his successful treatment of trachoma in Indian subjects with sulfanilamide, the details of which he has recently published. 1 Favorable results were also reported by Lian. 2 After obtaining marked improvement with this treatment in certain isolated cases and rapid cure in 2 cases of experimental trachoma in baboons, we decided to test the drug on a series of persons with previously untreated active follicular trachoma in whom corneal progress could be followed by means of the slit lamp and the corneal microscope. Accordingly, we selected 14 Apache Indian children with active follicular trachoma, 12 to be treated and 2 to be kept untreated as controls. All children had pannus and exhibited corneal activity, as evidenced by dilated pannus vessels, subepithelial infiltrates and fluorescein-staining punctate epithelial lesions. Typical epithelial cell inclusions, characteristic of active trachoma, were demonstrated

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The report of a case of trachoma experimentally induced in a human subject who had previously been inoculated with Bacterium granulosis several times, in an attempt to test its pathogenicity for the human conjunctiva, with negative results. The case here reported ran a typical course, developed pannus, was positive for Prowazek-Halberstaedter bodies, and resisted treatment. From the laboratories of the Pasteur Institute of Tunis and the Department of Ophthalmology, College of Medicine, State University of Iowa.

A man exposed to mustard gas in action suffered burns of the face and severe conjunctivitis. The corneas became steamy followed by opacity of the left. Four years afterwards there was photophobia, conjunctival hyperemia, pannus and epiphora.

Phonocardiography was used to detect “stenosis” of a Starr-Edwards extended cloth-covered mitral valve prosthesis (series 6300). An abbreviated interval from aortic closure to the mitral valve opening click suggested a large mitral valve gradient which was confirmed by cardiac catheterization and abolished by replacement of the valve. Because there was no formation of thrombus or pannus or regurgitation, the “stenosis” was considered to be due to the excessively small orifice of the valve in this series.

Nothing original is claimed for what I have to say. I merely beg to submit to your judgment my preference for a method of treatment, as it has developed by personal experience during years of labor in one of the most common fields of ophthalmology. With your permission, I will introduce and exemplify my remarks by the report of a case, the only one I shall report. Dec. 6, 1890, Mrs. F. W. C., of Boston, came to me with chronic trachoma. Both eyelids turned in, lashes irregularly scattered over the rounded free margin, many on the inner edge. Pannus over the whole cornea. V., 20-200. The inner surface of the lids showing an irregular network of cicatrices with projecting islets of swollen mucous membrane between the fiber tracts (xerosis glabra). Palpebral fissure narrowed. Constant lacrymation, some mucous discharge, incessant irritation. Daily touchings with the sulphate of copper crystal did

ACID phosphatase and cathepsin are two of the hydrolytic enzymes shown by de Duve1 to be present in the lysosomal fraction of liver, and similar particles have been shown in many other tissues2. Increases in lysosomal enzymes have been shown to be present in cases of rapid tissue breakdown3,4. The synovial tissue in a rheumatoid arthritic patient may proliferate rapidly, forming many villi. and can extend as the so-called pannus tissue growing over the articular cartilage. When this pannus tissue forms, erosion of the cartilage takes place. An increase in enzymes of the lysosomal type might therefore be expected in rheumatoid tissue.

To the growing list of diseases in which sulfapyridine may be found of use we should like to add trachoma. In two cases, herewith reported, we have observed astonishing improvement in the chronic form of the disease when treated with sulfapyridine. REPORT OF CASES Case 1.— F. F., a white youth aged 15, first seen by us March 11, 1939, had been under treatment for trachoma elsewhere for about one year. Examination showed both corneas markedly opaque. There were no clear areas on either cornea. Vision in both eyes was fingers at 1 foot. Pannus was markedly developed on both corneas. The under surfaces of both upper lids were covered with follicles. The Wassermann and Kahn reactions of the blood were negative. The patient was hospitalized and massive doses of sulfanilamide were given. During the period of hospitalization, covering one month, about 1,000 grains (65 Gm.) of sulfanilamide was given.

Inoculation of approximately 1 × 108 yeast phase C. albicans into the supra-patellar bursae of rabbits produced an interesting septic synovitis. Effusions began to develop in the second week after inoculation, and were maximal in the third and fourth week, subsiding to a chronic synovial pannus with cartilage destruction and repair by 8 weeks. Synovial fluid cultures became negative at the time of maximal purulent effusion. Although marked delayed sensitivity skin reactions developed during the course of the arthritis, inoculation of the opposite knee when skin sensitivity was present failed to accelerate the experimental arthritis.

The earliest changes in a joint affected by rheumatoid arthritis are in the peripheral crypts near to the attachments of the capsule to bone. Progressive inflammation and proliferation of the synovium is followed by its extension over the articular cartilage as a pannus, or by invasion of the bone near to the capsular attachments where it is not covered by articular cartilage. It is this invasion of bone which gives the typical erosions seen on radiographs and may lead to juxtarticular collapse. At the same stage ligaments may become elongated or may rupture. In recent years an increasing number of early synovectomies have been performed in an attempt to prevent this synovial invasion. Pain is relieved and recurrence is relatively rare, but the operation is not likely to be successful once radiological evidence of bone erosion has developed. Operations on metacarpo-phalangeal joints have shown that the earliest synovial proliferation and bone erosions are commonly under the collateral ligaments, with eros...

It has been established by previous inves­ tigators that common laboratory animals are refractory to trachoma and that only pri­ mates contract the disease. After the etiologic agent became available through cultiva­ tion in yolk sacs of embryonated eggs, ex­ perimental trachoma in monkeys with the organisms propagated in eggs was reported by Thygeson and associates. They reported that the experimental disease was not ac­ companied by pannus, cicatrization or major involvement of the upper tarsus and, in these respects, it differed sharply from human trachoma. Inclusion conjunctivitis in man has been considered to be different from trachoma clinically, in that it affects mainly the lower conjunctivas, does not cause pannus or con.junctival scars and has a tendency to run a more acute but shorter course. In addition, it is epidemiologically different from tracho­ ma in that it is associated with genital infec­ tion. The organisms of inclusion conjunctiv­ itis can be cultivated by similar egg tech­ niques. Again, experimental eye disease can be produced only in primates and is report­ ed to be generally more severe than trachoma. As in the case of experimental trachoma, no pannus or scars have been re­ ported.

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A study of cartilage removed from the knees of twenty patients with rheumatoid arthiritis was presented. Specimens from ten normal patients were obtained as controls. In all of the rheumatoid joints no pannus was observed grossly. Under the microscope, however, pannus cells resembling those of rheumatoid synovium were found growing across the articular surface and penetrating the superficial layers in six of the rheumatoid patients. Cartilage cells in the deeper layers showed a variety of changes. Some were surrounded by large moats containing fibrillar material, others accumulated fat in their cytoplasm, while others showed a remarkable elongation of their cell processes. In all cases cell degeneration and death were prominent features. A discussion of the possible significance of these findings was presented.

LYSOSOMAL enzymes are important mediators of the inflammatory process1. Soluble extracts of purified leucocyte lysosomes elicit cutaneous and joint inflammations2 and degrade the protein-mucopolysaccharide matrix of cartilage3. Activities of acid hydrolases are elevated significantly in inflamed tissues, including rheumatoid synovial membranes4–7. The hydrolytic degradation of cartilage protein-mucopolysaccharide, which underlies the inflammatory pannus of rheumatoid joints, may be provoked by lysosomal enzymes released from cells that are phagocytosing immune complexes within the pannus8,9.

In writing this paper I have made an attempt, inadequate though it is, to seek explanations for some of the more puzzling manifestations of ophthalmic infections caused by TRIC agents. We have in the past possibly taken too naive a view of these syndromes, regarding features such as follicles and pannus purely from the viewpoint of a simple inflammatory process, and without giving enough consideration to the immunological mechanisms that may contribute to their causation. A quotation fromWilson andMiles' textbook (37) is apposite: “It is probable, indeed, that an increased sensitivity, associated with an increased vigour of response, is of frequent, perhaps almost of constant, occurrence at one stage or another of every infective disease, and that this sensitization plays a part in pathogenesis, particularly in subacute or chronic infections.”

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Bullous keratopathy is a state of abnormal corneal epithelial hydration characterized clinically by corneal opacification and the presence of epithelial vacuoles and bullae. In its advanced form, a pannus develops. The stroma becomes vascularized and scarred and, finally, calcium may be deposited in the anterior portions of the stroma. There are probably many factors governing corneal turgescence, and their mechanism is complex. One of the most important factors controlling corneal hydration, and therefore corneal transparency, is the integrity of the corneal endothelium. When this layer is sufficiently damaged, the cornea becomes edematous, and if this edema persists for a sufficient length of time bullous keratopathy develops. The first changes seen in the pathogenesis of bullous keratopathy are in the endothelium. The cells of this layer, which are normally low and rectangular in shape, become flattened and attenuated. Later, their concentration is reduced and finally they may disappear. Figure 1 is

intheso-called incurable condition ofxerosis secondary totrachoma. Sorsby (1948) andBrown(1941) reported goodresults from theuseofspecially prepared amniotic membranegrafts inconjunctival burns, butasconjunctiva wasattimes notavailable itwasdecided totransplant amniotic membrane. Asanexperimental measure a2-mm.piece of bulbar conjunctiva wasremoved, andapiece ofspecially prepared amniotic membrane ofsimilar size wasgrafted initsplace intwocases.Thegrafts didnottake, andthemembrane melted away, butsurprisingly enough there wasmarkedimprovement inthexerotic condition ineachcase.Itwas therefore decided toapply thesimple procedure oftissue therapy inxerosis. In1936Filatov first introduced tissue therapy inretinitis pigmentosa by theimplantation ofpieces ofplacenta beneath thesubconjunctiva, and reported acertain measure ofsuccess (Filatov andVerbitska, 1946). Filatov (1937) alsotried tissue therapy intrachomatous pannus. Implantations ofpreserved cadaver mucousmembrane fromthelipand conjunctiva ledtogratifying results. Implantations ofvarious tissues together withintramuscular injections ofcod-liver oilwereincluded among histherapeutic procedures, andhealsousedvegetable products suchas aloeleaves. Saint-Martin (1950) describes theuseofvegetable substances bysubcutaneous injection andofskinasimplant. Beneficial effects have also beenreported byOlontzeva andPokrovsky (1946). Intheseries here reported, 25cases havebeentreated bythis procedure andthere hasbeen markedimprovement inallofthem. Methods andMaterial

Simultaneous autologous and homologous musculofascial transplants were made in New Zealand white rabbits. The basic pattern of degeneration and granulation tissue organization of both types of transplant was essentially identical. The superposition of two reactions in the framework of organizing granulation tissue served to distinguish homologous from autologous transplants. One reaction to homologous transplants was predominantly characterized by lymphocytic infiltration and the other by angeitis. The principal locus of these reactions was in the musculofascial zone of the transplant, and from this zone the reactions spread to a variable degree through the fascia into the overlying pannus of granulation tissue. When single homologous transplants were made, the lymphocytic and mild angeitic forms of reaction predominated, becoming conspicuous at the end of 2 weeks. When multiple successive homologous transplants were made from the same donor to the same recipient, acute angeitis with thrombosis supervened and the lymphocytic reaction failed to develop or persist. Multiple successive autologous transplants, on the other hand, did not influence the type or degree of reaction to autologous transplants in the same animal. There was no evidence that autologous transplants had any influence upon the sequence of reactions to homologous transplants or that the presence of homologous transplants influenced the nature of the reaction to autologous transplants in the same animal. Until better methods are developed, methods of bio-assay of the type described, though lacking in quantitative precision, offer the best means for further analysis of factors which govern the incompatibility of tissues of one animal for those of another animal of the same species.

ANGEVINE1, in his study of the pituitary and adrenals of 20 human anencephalic fœtuses, noted that in practically every case the subcutaneous pannus of fat was unusually thick especially over the shoulders and thorax. This observation has been confirmed in a number of full-term or near full-term anencephalics which are now being studied. Jost2 has recently shown that fœtal thyroidectomy in the rabbit results in an increase in total fat (determined by ether–alcohol extraction), which does not occur if thyroxine is injected into the fœtus at the time of the thyroidectomy. This raises the possibility that the increase in fat in the human abnormality is due to a fœtal hormonal disturbance, and this view is supported by the knowledge that the pituitary of anencephalics is reduced in size and that secondary to this the adrenals are extremely small1. It is therefore possible that the hypofunction of the pituitary either directly, or indirectly by affecting other endocrine glands, determines the increase in fat found in the human anencephalic monster.

This preliminary report is concerned with the description of a disease of the conjunctiva and cornea of sheep, of natural occurrence, which results in the formation of a pannus, not unlike that in human trachoma.The farmer from whom I obtained my diseased sheep first noticed the non-purulent infection of the conjunctiva and nictitating membrane, evidenced by congestion, edema, epiphora, as fall weather and near-freezing temperatures prevailed. Examination by him of the large flock allowed about 200 infected animals to be isolated, 10% of which had marked vascularization of the cornea. Two weeks later, when I was asked to examine the flock, less than 1% were not infected. Probably 80% suffered clinical pannus formation, and 5% superficial ulcers at the tip of the pannus. Hypopyon ulcer was seen in only those that were so blinded as to be unable to prevent injury to the cornea in trying to graze and follow the flock. No perforation of the cornea was seen. A representative animal, moderately infected, was re...