Observations on the Influence of Cortisone on Tissue Response to Injury *

Since Hench and Kendall'"4 demonstrated the beneficial effect of ACTH and cortisone on rheumatoid arthritis and rheumatic fever, numerous reports on the influence of these drugs on tissue response to various injuries, and on granulation tissue have appeared. Systemically administered cortisone19'2and locally administered hog adrenal extract' depressed the formation of granulation tissue in wounds in the skin of rats and rabbits. The failure of granulation tissue to form in biopsy wounds" and decubitus ulcers' in patients being treated with cortisone has also been reported. Heilman" has shown that cortisone inhibits the proliferation of fibroblasts in tissue culture. It has been claimed that the administration of cortisone or ACTH depresses the response of connective tissue in healing traumatic wounds in man and in experimental animals. The influence of cortisone on allergic inflammation appears to be variable and dependent on the dosage, type of allergy, and the animal. Schwartzman, Schneierson, and Soffer" demonstrated that cortisone inhibits the Schwartzman phenomenon. Harris and Harris,' using large doses of cortisone in the rabbit and guinea pig, showed a suppression of the tuberculin reaction following infection with B.C.G. Sheldon, Cummings, and Evans," using smaller doses of cortisone in the guinea pig, did not demonstrate any suppression of the tuberculin reaction following infection with a virulent strain of M. tuberculosis. Cortisone-treated rabbits had little or no antibody response to horse serum, and no Arthus phenomenon could be elicited in them." Dougherty and Schneebeli,7 using adrenalectomized, cortisonetreated mice did not elicit an Arthus reaction. They also reported a decreased number of polymorphonuclear cells, lymphocytes, and macrophages in the smears of the inflammatory exudate in the cortisone-treated animals. When their results were statistically examined by the writer, it was noted that the control and experimental animals did not differ by more than three times the standard deviation. Schwartzman" reported that cortisone-treated mice and hamsters, in contrast to controls, showed a much higher mortality and shorter incubation period following inoculation with a strain of poliomyelitis virus. For some unknown reason, this did not occur when ACTH was used. Cortisone increased the mortality from tuberculosis