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Observations of the basic principles of wound healing can contribute to patient comfort, early return to a normal state, and a more pleasant appearance of the wound. A treatment for keloid overgrowth of a scar and a simple technique for rapid but careful closure of the skin are also presented.

IN 1938, an anatomic and pathologic study of the lymphatic spread of carcinoma of the breast was started at the Presbyterian Hospital as a corollary to the work already done by Gilchrist and David on the lymphatic spread of carcinoma of the bowel. Surgical specimens removed by radical mastectomy were washed completely free of blood, fixed in 10 per cent formaldehyde solution for twenty-four hours, and then dehydrated in varying strengths of alcohol from 50 per cent to absolute. The specimens were then cleared in oil of wintergreen. From such cleared specimens all the lymph nodes were removed, their location marked on an appropriate diagram of the thoracic wall and each of the lymph nodes sectioned and examined microscopically. From 1938 through 1942, a total of 87 surgical specimens of carcinoma of the breast were studied in this fashion. These were removed by fifteen different surgeons on the hospital staff,

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.

THE PATIENT who must have a permanent ileostomy has been materially benefited by the technic of Dragstedt and his associates,1 who covered the terminal ileum with a split thickness of skin, thus providing a greater length of bowel externally and facilitating the collection of fecal material into a suitable container.The inherent tendency, however, of both the bowel and a split thickness graft to contract may, over a period of time, result in a marked shortening of the ileostomy. In 1 patient for whom we made such an ileostomy, the original 3½ inches (9 cm.) of skincovered ileum over a period of eighteen months contracted to the point that only ¼ inch (0.6 cm.) of skin remained and the mucosal edges of the bowel were in contact with the skin of the abdomen. This occurred in spite of a primary take of the graft. There would undoubtedly be less

Under ordinary conditions musculofascial cross-grafts made between pairs of rabbits of the same strain and species elicited classical host-homograft tissue interactions. When the cross-grafting was done 7 to 10 days after exchange transfusions leading to introduction of about 40 per cent of foreign blood, the classical host-homograft reaction failed to develop. In its stead there was an harmonious interaction characterized by abundant vascularization of each graft, with minimal stromal replacement and without a trace of inflammation. This reaction resembled a common type previously described in cross-grafts made between postparabiotic twins but lacked some conspicuous features of the reaction of an animal to grafts of its own tissues.

Twenty-five pairs of male rabbits of the same variety and strain were joined together in aural parabiosis for 13 to 15 days and then separated from one another. Thirteen pairs of the separated parabiotic twins were surgically united for a second period of parabiosis, less successful than the first due to deficient healing and spontaneous separation of tissue in 5 to 15 days at the site of anastomosis. Within 6 to 90 days after spontaneous or surgical separation of all parabionts, the postparabiotic twins which had been united to one another were cross-grafted with musculofascial transplants. 2 weeks later, the animals were sacrificed and microscopic studies made of the organs and sites of transplantation. These studies disclosed that either one or two periods of parabiosis resulted in the same persistent modification of classical host-homograft interactions. This modification was characterized by the replacement of the customary basic or sensitized homologous incompatibility reactions by a reaction more easily interpreted as one of host-graft tolerance or indifference. The intense inflammatory aspects of the usual host-homograft interactions were absent. Penetration of the musculofascial graft by vascularized mesenchyme derived from the host was retarded. When it occurred, the vascularizing reaction was abnormal and unaccompanied by the customary proliferative, resorptive, and repairative activities of admixed cells of the host and the graft. These observations provide another means which may be useful in seeking conditions for increasing the probability of successful homografting between members of a genetically impure species.