*A paper read at the South African Medical Congress, Johannesburg, September 1952. 1. ACTH and cortisone are of great value in the treatment of iridocyclitis, sympathetic ophthalmia, interstitial keratitis, episcleritis, phlyctenular kerato-conjunctivitis, rosacea, keratitis, spring catarrh, acute uveitis and choroiditis. 2. In chronic granulomatous uveitis, the effect of these hormones is not so spectacular and recurrences after cessation of treatment are frequent. 3. When employed to suppress the inflammatory reaction due to infection, their use should be accompanied by specific antibiotic or chemotherapeutic procedures to eliminate the basic underlying infection. 4. They have no effect in the usual degenerative diseases of the eye. There is a possibility, however, that they may be effective in ocular disease related to fibrinoid degeneration. 5. Experimental studies, using various ocular reactions as the indices, have shown that : i. Topical or parenteral cortisone and parenteral ACTH will : (a) Suppress various recognized ocular hypersensitivity reactions; (b) Suppress ocular reactions due to irritants; (c) Suppress inflammation due to infection; (d) Inhibit neo-vascularization of the cornea; (e) Reduce fibroplastic activity in the stroma of the cornea and regeneration of the corneal endothelium. ii. Cortisone and hydrocortisone will radically alter the pathogenesis of ocular tuberculosis, changing the picture in the immune-allergic rabbit from a restrained fibrotic process into a necrotizing, caseating, destructive lesion. 6. The mechanism of the therapeutic action of ACTH and cortisone in ocular disease is as yet undetermined. The present indications are that it is due to a direct action of the adrenocortical hormones on the mesenchymal fraction of the inflamed tissue.
1. Hydrocortisone has only been tried for 4 months in South Africa, but experience seems to indicate thar it will be exceedingly helpful in several conditions. 2. It is not a permanent cure for rheumatoid arthritis or osteo-arthritis, but it is capable of relieving pain and discomfort temporarily, thus allowing a programme of muscle and joint re-education to be instituted. 3. Intra-articular injections must be performed under strict aseptic precautions.
These diseases are of particular interest to maxillofacial surgeons and physicians because of their local and systemic manifestations and their ill-defined etiology, and more so, because they are either partially or completely refractory to most forms of treatment. It must be emphasized that in none of the cases in which a favourable response was obtained can it be regarded that this treatment has effected a final cure. However, these studies demonstrate that hydrocortisone is a valuable research tool in the field of oral and dental medicine.
1. A case is presented of a European boy of 13 with acute disseminated lupus erythematosus. 2. L. E. (lupus erythematosus) cells were demonstrated in bone marrow and peripheral blood-'specific diagnostic test'. 3. ACTH and cortisone induced rapid clinical improvement and remission of disease processes. 4. Prolonged therapy with oral cortisone in suppressive doses shows promise of maintaining full remission.