Action of Cortisone on Tissue Reactions

IT has already been shown in the two previous articles in this issue of the Journal that the clinical effects of cortisone and ACTH have excited much interest and a very extensive literature; the reports dealing with their effects upon the fundamental reactions of inflammation and repair, however, are as yet relatively few in number and there is still considerable disagreement over some of the more important problems. This is unfortunate and to some extent illogical, but it is only to be expected that agents which can exert an effect so dramatic upon many ocular diseases should be exploited clinically to the fullest possible extent at the earliest moment, even although the theoretical foundation for their action remains obscure. Only a few workers in ophthalmology have hitherto pursued their studies into the field of experimental pathology (Woods, 1950; Woods and Wood, 1950; Biegel, 1951; Leopold and others, 1951; Bourquin, 1951). Such investigations could well be of more than local importance, for the relative isolation of the eye and the facilities it provides for the study of the microscopical tissue-changes of disease, so readily discernible both in the living animal and in histological preparations, make this organ a unique sphere for investigation. In the papers which follow in this issue, some initial studies on the effect of cortisone on inflammatory processes as seen in the eye are therefore reported. In the present paper these are correlated with cognate work in the general literature on the action of ACTH and cortisone upon the inflammatory process, considering it in relation to the two essential components of the defensive and reparative reactions. The sub-divisions we have chosen represent some of the stages in these reactions, but the classification is not entirely satisfactory, because, owing to the lack of published experimental data, some details, such as the effect of cortisone on the margination and diapedesis of polymorphonuclears and phagocytosis, etc., have had to be omitted.