Tumačenje nastajanja naglašenog skvrčavanja trahomskih ožiljaka

Abstract

Formation of copious scars in severe« oases of trachoma was viewed as a sing of superchronic nature of the disease bringing about a deep infiltration. A similar process is peculiar to pemphigus of the conjunctiva as well as to corrosions of the conjunctiva by Chemical action of alkalis. There is, hovvever, a feature common to ali the three kinds of lesions of the conjunctiva, ,a characteristic which has so farmot been accounted for satisfactorily, i. e. the subsequent strongly marked cicatricial

retraction occurring mainly in severe cases of trachoma owing to copious formation of scars. Such strongly marked cicatrization in trachoma cannot be regarded simply as a consequence of the destruction of a large number of plasmatic cells, still lees as being caused directly by a softening of follicules. The copiousness of scar formation as well as the subsequent pronounced cicatricial retraction can only be conditioned, in our opinion, by the epithelioneurotrope property or capacity of the trachoma virus.

The specific mode of the action itself would be identical with a lesion of vasomotor, trophical, and sensitive nerve-fibres respectively, thus impairing the process of adequate regular resorption. At the same time, account has to be taken of the fact that the functioning of regular resorption bears a relation both to the newly fbrmed conjunctival tissue and to the inflammatory cell-infiltration as well.

The occurrence of these manifestations in pemphigus of the conjunctiva is in ali probability due to virologic properties of the agent; if so, then the virus here in question must have about the same capacity as the one of trachoma, i. e. the power of deep penetratrion with consequent lesions of nerve-fibres (vasomotor, trophical, and sensitive respectivelly.

The claim of several laryngologists (Treer, Gušić) that in cases of oesophagus lesions caused by Chemical action of alkalis, the formationn of copious scars and subsequent strong cicatricial shrinkage bring about a contiuned secondary inflammation goes to show, at any rate, points of remarkable similarity in this process and that of trachoma and pemphigus.

The established presence of nerve-trunk lesions, as demonstraded by Guši'ć, around scalds caused by alkalis, can be taken as additional evidence in support of our thesis. In this case, however,  it is not the neurotrope action of any virus that is responsifole for the trouble but rather the direct lesion caused by alkalis in a state of diffusion. At the same tima, we vvould like to stress the point that in the other two diseases, viz. trachoma and pemphigus of the conjonctiva, the neurotrope efect of their respective viruses vvould be limited and vvould only go as far as the adherent ganglia, or those belonging to the affected fibres.

Owing to difficulties encountered in making histological preparation and their colouring — after the method of Bielschowsky-Gros — our practical experience and the knovvledge gained conceming the state of nerve-fibres in trachoma is rather limited. Likevvise, we are only in possession od Komatnzaki ’s (1938) data regarding the reaction of nerve-fibres in cicatrized cases of trachoma; they give evidence of a process of great pathological changes in the fibres ending in their complete disappearance. The Figures 4—9 clearly show the gradual disappearance of the affected nerve-fibres, in cases of florid trachoma, observed in the subepithelial and subtarsal zones. This reveals most adequately alterations in normal resorption of pathologic substratum in trachoma, including the newly formed copious conjunctival tissue. Moreover, this lesion could vvell account for ulterior phatological changes, which come about in the copious cicatricial tissue, especially for their marked retractility.

Our recent investigations, vvhich are still in progress, tend to bear sufficient evidence in support of our allegation that, in florid trahoma, the nerve-fibres (vasomotor. t rophical and sensitive respectively) become strongly affected and their functioning considerably impaired in consequence, as they do in the case of pannus as regards the sensitive sphere of the comea (Jean Sedan, Ema Zitting).

Thus, the explanation of the phenomena of copious cicatrization and marked retractile cicatrices in severe cases of trachoma vvould seem to lie — in the author’s opinion — in the epithelioneurotrope properties of the trachoma virus.