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Journal Subscription Rates to be Increased
AMERICAN JOURNAL OF OPHTHALMOLOGY Published Monthly by the Ophthalmic Publishing Company EDITORIAL STAFF S. RODMAN IRVINE
DERRICK VAIL, Editor-in-Chief
9730 Wilshire Boulevard, Beverly Hills, California
700 North Michigan Avenue, Chicago 11
WILLIAM H. CRISP, Consulting Editor
JAMES E. LEBENSOHN
1276 Emerson Street, Denver 3
4010 West Madison Street, Chicago 24
LAWRENCE T. POST, Consulting Editor
DONALD J. LYLE
640 South Kingshighway, Saint Louis 10
601 Union Trust Building, Cincinnati 2
WILLIAM L. BENEDICT
WILLIAM A. MANN
FREDERICK C. CORDES
JOHN V. V. NICHOLS
SIR STEWART DUKE-ELDER
ALGERNON B. REESE
The Mayo Clinic, Rochester, Minnesota
30 North Michigan Avenue, Chicago 2 1414 Drummond Street, Montreal
384 Post Street, San Francisco 8
73 East Seventy-first Street, New York 21
63 Harley Street, London, W.l
PHILLIPS THYGESON
EDWIN B. DUNPHY
87 North 6th Street San Jose, California
243 Charles Street, Boston 14
F. HERBERT HAESSLER
M. URIBE TRONCOSO
PARKER HEATH
ALAN C. WOODS
561 North 15th Street, Milwaukee 3
500 West End Avenue, New York 24
Johns Hopkins Hospital, Baltimore 5
243 Charles Street, Boston 14
KATHERINE FERGUSON CHALKLEY, Manuscript Editor
Lake Geneva, Wisconsin
Directors: WILLIAM L. BENEDICT, President; FREDERICK C. CORDES, Vice-President; WILLIAM A. MANN, Secretary and Treasurer; WILLIAM H. CRISP, LAWRENCE T. POST, DERRICK VAIL.
Address original papers, other scientific communications including correspondence, also books for review to Dr. Derrick Vail, 700 North Michigan Avenue, Chicago 11, Illinois; Society Proceedings to Mrs. Katherine F. Chalkley, Lake Geneva, Wisconsin. Manuscripts should be original copies, typed in double space, with wide margins. Exchange copies of medical journals should be sent to Dr. F. Herbert Haessler, 561 North 15th Street, Milwaukee 3, Wisconsin. Subscriptions, application for single copies, notices of changes of address, and communications with reference to advertising should be addressed to the Manager of Subscriptions and Advertising, 664 North Michigan Avenue, Chicago 11, Illinois. Copy of advertisements must be sent to the manager by the 15th of the month preceding its appearance. Change of address notice should be received not later than the 15th of the month prior to the issue for which the change is to go into effect. Both old and new addresses should be given. Author's proofs should be corrected and returned within forty-eight hours to the Manuscript Editor, Mrs. Katherine F. Chalkley, Lake Geneva, Wisconsin. Twenty-five reprints of each article will be sup plied to the author without charge. Additional reprints may be obtained from the printer, the George Banta Publishing Company, 450-458 Ahnaip Street, Menasha, Wisconsin, if ordered at the time proofs are returned. But reprints to contain colored plates must be ordered when the article is accepted. JOURNAL TO
SUBSCRIPTION RATES BE INCREASED
T h e Board of Directors of the Ophthalmic Publishing Company reluctantly announces a slight increase in subscription rates for the
In the past seven years, printing costs have quadrupled and overhead expenses have increased correspondingly, due to inflation ary trends and the increase in size and con tent of the JOURNAL.
During the same period, t h e circulation of the JOURNAL has doubled, and this has effective with the October issue. made it possible to maintain the subscription Since the establishment of the current rate unaltered u p t o t h e present time. series of the JOURNAL in 1918, the subscrip A recent increase in printing a n d paper tion price has remained at $10.00 per an costs of about eight percent has precipitated num for domestic subscriptions, through a decision t o increase the rates rather than the vicissitudes of wars and economic u p reduce the size of the magazine o r in any heavals.
AMERICAN
JOURNAL
OF OPHTHALMOLOGY,
1188
EDITORIALS way impair the standards being maintained by the editor-in-chief and his editorial board. It should be emphasized that the AMERI CAN JOURNAL OF OPHTHALMOLOGY is
not
a profit-making venture but is published as a service to the profession—a service which can be perpetuated on its present high plane only if it is possible to meet increased ex penses. The new subscription rates will be $12.00 a year for domestic, and $14.00 a year for foreign subscriptions. William A. Mann.
FOREIGN-PROTEIN T H E R A P Y I N OPHTHALMOLOGY I'll rack thee with old cramps; Fill all thy bones with aches; make thee roar, That beasts shall tremble at thy din. —Tempest, Act I., Scene 2. Grey-Edwards was probably the first to administer bacterial products in the treat ment of ocular disease in 1908. Since his report on the use of staphylococcic vaccine in the treatment of hypopyon ulcer, literally hundreds of compounds have been suggested for nonspecific, shock or foreign-protein therapy. The striking therapeutic effects of the adrenocortical hormones in ocular inflam mation have led many authorities to suggest that the beneficial actions which follow the "nonspecific response" are due mainly to stimulation of the adrenal cortex in a de fense reaction of the body to a noxious stimulus. It is, therefore, of interest to clarify the status of foreign-protein therapy in oph thalmic disease since, if the action is directly attributable to adrenocortical stimulation, this method of therapy should be abandoned if more potent and specific effects may be obtained by administering ACTH or corti sone. The continued use of foreign-protein therapy in ophthalmology can be justified only if it has or causes desirable effects
1189
not related to the actions of the adreno cortical hormones. Bennett and Beeson, in a recent com prehensive review, point out that the com mon denominator of all of the substances used as foreign proteins is bacterial pyro gens. Pyrogens are heat stable, complex polysaccharides formed wherever bacteria are grown. Gram-negative rods are the most potent producers. Compounds not con taminated by bacteria in any stage of their preparation do not cause fever and are of no value in eliciting the nonspecific response. Different bacteria produce different pyro gens and this variation may be the basis of the clinical popularity of certain vaccines for the treatment of specific clinical condi tions. There is little question but that bacterial pyrogens stimulate the adrenal cortex to the secretion of its characteristic steroid hor mones. This stimulatory action is mediated through the pituitary gland and ACTH, but whether it occurs because of a reduced titer of the cortical hormone in the body fluids or because of a release of epinephrine is not known. At any rate administration of bacterial pyrogens causes depletion of the adrenal ascorbic acid, depletion of sudanophilic sub stance, decrease in concentration of chol esterol, and increase in glandular weight— all evidences of adrenal stimulation. The quantity of cortical hormone released is proportionate to the degree of malaise and fever which in turn is proportionate to the dosage of the bacterial pyrogen and the activity of the reticulo-endothelial system in removing it from the circulation. Adrenalectomized animals are extremely sensitive to the noxious effects of bacterial pyrogens and are killed by doses which are much too small to have any action in the intact animal. Cortisone induces an atrophy and depres sion of function in the adrenal cortex with transient effects similar to those of hypoadrenalism. Sprague points out that it is
DERRICK VAIL, Editor-in-Chief
9730 Wilshire Boulevard, Beverly Hills, California
700 North Michigan Avenue, Chicago 11
WILLIAM H. CRISP, Consulting Editor
JAMES E. LEBENSOHN
1276 Emerson Street, Denver 3
4010 West Madison Street, Chicago 24
LAWRENCE T. POST, Consulting Editor
DONALD J. LYLE
640 South Kingshighway, Saint Louis 10
601 Union Trust Building, Cincinnati 2
WILLIAM L. BENEDICT
WILLIAM A. MANN
FREDERICK C. CORDES
JOHN V. V. NICHOLS
SIR STEWART DUKE-ELDER
ALGERNON B. REESE
The Mayo Clinic, Rochester, Minnesota
30 North Michigan Avenue, Chicago 2 1414 Drummond Street, Montreal
384 Post Street, San Francisco 8
73 East Seventy-first Street, New York 21
63 Harley Street, London, W.l
PHILLIPS THYGESON
EDWIN B. DUNPHY
87 North 6th Street San Jose, California
243 Charles Street, Boston 14
F. HERBERT HAESSLER
M. URIBE TRONCOSO
PARKER HEATH
ALAN C. WOODS
561 North 15th Street, Milwaukee 3
500 West End Avenue, New York 24
Johns Hopkins Hospital, Baltimore 5
243 Charles Street, Boston 14
KATHERINE FERGUSON CHALKLEY, Manuscript Editor
Lake Geneva, Wisconsin
Directors: WILLIAM L. BENEDICT, President; FREDERICK C. CORDES, Vice-President; WILLIAM A. MANN, Secretary and Treasurer; WILLIAM H. CRISP, LAWRENCE T. POST, DERRICK VAIL.
Address original papers, other scientific communications including correspondence, also books for review to Dr. Derrick Vail, 700 North Michigan Avenue, Chicago 11, Illinois; Society Proceedings to Mrs. Katherine F. Chalkley, Lake Geneva, Wisconsin. Manuscripts should be original copies, typed in double space, with wide margins. Exchange copies of medical journals should be sent to Dr. F. Herbert Haessler, 561 North 15th Street, Milwaukee 3, Wisconsin. Subscriptions, application for single copies, notices of changes of address, and communications with reference to advertising should be addressed to the Manager of Subscriptions and Advertising, 664 North Michigan Avenue, Chicago 11, Illinois. Copy of advertisements must be sent to the manager by the 15th of the month preceding its appearance. Change of address notice should be received not later than the 15th of the month prior to the issue for which the change is to go into effect. Both old and new addresses should be given. Author's proofs should be corrected and returned within forty-eight hours to the Manuscript Editor, Mrs. Katherine F. Chalkley, Lake Geneva, Wisconsin. Twenty-five reprints of each article will be sup plied to the author without charge. Additional reprints may be obtained from the printer, the George Banta Publishing Company, 450-458 Ahnaip Street, Menasha, Wisconsin, if ordered at the time proofs are returned. But reprints to contain colored plates must be ordered when the article is accepted. JOURNAL TO
SUBSCRIPTION RATES BE INCREASED
T h e Board of Directors of the Ophthalmic Publishing Company reluctantly announces a slight increase in subscription rates for the
In the past seven years, printing costs have quadrupled and overhead expenses have increased correspondingly, due to inflation ary trends and the increase in size and con tent of the JOURNAL.
During the same period, t h e circulation of the JOURNAL has doubled, and this has effective with the October issue. made it possible to maintain the subscription Since the establishment of the current rate unaltered u p t o t h e present time. series of the JOURNAL in 1918, the subscrip A recent increase in printing a n d paper tion price has remained at $10.00 per an costs of about eight percent has precipitated num for domestic subscriptions, through a decision t o increase the rates rather than the vicissitudes of wars and economic u p reduce the size of the magazine o r in any heavals.
AMERICAN
JOURNAL
OF OPHTHALMOLOGY,
1188
EDITORIALS way impair the standards being maintained by the editor-in-chief and his editorial board. It should be emphasized that the AMERI CAN JOURNAL OF OPHTHALMOLOGY is
not
a profit-making venture but is published as a service to the profession—a service which can be perpetuated on its present high plane only if it is possible to meet increased ex penses. The new subscription rates will be $12.00 a year for domestic, and $14.00 a year for foreign subscriptions. William A. Mann.
FOREIGN-PROTEIN T H E R A P Y I N OPHTHALMOLOGY I'll rack thee with old cramps; Fill all thy bones with aches; make thee roar, That beasts shall tremble at thy din. —Tempest, Act I., Scene 2. Grey-Edwards was probably the first to administer bacterial products in the treat ment of ocular disease in 1908. Since his report on the use of staphylococcic vaccine in the treatment of hypopyon ulcer, literally hundreds of compounds have been suggested for nonspecific, shock or foreign-protein therapy. The striking therapeutic effects of the adrenocortical hormones in ocular inflam mation have led many authorities to suggest that the beneficial actions which follow the "nonspecific response" are due mainly to stimulation of the adrenal cortex in a de fense reaction of the body to a noxious stimulus. It is, therefore, of interest to clarify the status of foreign-protein therapy in oph thalmic disease since, if the action is directly attributable to adrenocortical stimulation, this method of therapy should be abandoned if more potent and specific effects may be obtained by administering ACTH or corti sone. The continued use of foreign-protein therapy in ophthalmology can be justified only if it has or causes desirable effects
1189
not related to the actions of the adreno cortical hormones. Bennett and Beeson, in a recent com prehensive review, point out that the com mon denominator of all of the substances used as foreign proteins is bacterial pyro gens. Pyrogens are heat stable, complex polysaccharides formed wherever bacteria are grown. Gram-negative rods are the most potent producers. Compounds not con taminated by bacteria in any stage of their preparation do not cause fever and are of no value in eliciting the nonspecific response. Different bacteria produce different pyro gens and this variation may be the basis of the clinical popularity of certain vaccines for the treatment of specific clinical condi tions. There is little question but that bacterial pyrogens stimulate the adrenal cortex to the secretion of its characteristic steroid hor mones. This stimulatory action is mediated through the pituitary gland and ACTH, but whether it occurs because of a reduced titer of the cortical hormone in the body fluids or because of a release of epinephrine is not known. At any rate administration of bacterial pyrogens causes depletion of the adrenal ascorbic acid, depletion of sudanophilic sub stance, decrease in concentration of chol esterol, and increase in glandular weight— all evidences of adrenal stimulation. The quantity of cortical hormone released is proportionate to the degree of malaise and fever which in turn is proportionate to the dosage of the bacterial pyrogen and the activity of the reticulo-endothelial system in removing it from the circulation. Adrenalectomized animals are extremely sensitive to the noxious effects of bacterial pyrogens and are killed by doses which are much too small to have any action in the intact animal. Cortisone induces an atrophy and depres sion of function in the adrenal cortex with transient effects similar to those of hypoadrenalism. Sprague points out that it is