DEPARTMENT OF SURGERY. 
483 
when this is done in the early stage of either of these conditions ; 
and, when it is a secondary condition, it is usually confined to 
the superficial layers of the cornea ( pannits tennis ) ; but if due 
to a trachomatous condition it generally invades the proper sub¬ 
stance of the cornea (Review, Vo/. XXV., No. j, p. 208 ), and in 
such cases the layers involved become very thick {panmts cras- 
sus ), sometimes involving the entire cornea, which becomes so 
thick that the iris cannot be seeu. If the pannus is the result 
of a trachomatous process, it seldom terminates without ulcer¬ 
ation ; but if due to hypernutrition, the newly formed blood 
vessels in the connective tissue are sometimes obliterated by 
absorption. As pannus is generally a secondary condition, the 
treatment necessarily must be directed to the primary cause ; 
and that removed, either by surgical means or otherwise ; but 
when the vascularity remains after the cause is removed, then 
the treatment must be direct to the condition itself. 
The treatment adopted in such cases, should be either one of 
the following : 
( a ) A reduction of the blood supply to the newly formed 
tissue, or: 
( b ) Increased absorption of newly formed tissues. 
The latter ( b ) is generally not very successful, although 
various methods have been recommended for this purpose ; such 
as infusions that will cause inflammation of the conjunctiva ; or, 
the insufflation of powdered remedies to cause inflammation and 
increase absorption ; these methods of treatment, however, have 
never given very good satisfaction, but are the only substitutes 
for surgical intervention. 
Most cases of pannus, when allowed to run their course with¬ 
out treatment, terminate in ulceration of the cornea {suppurative 
keratitis ), especially in severe extensive vascularity; therefore, 
when the condition is such that the indications point to such 
an unfavorable termination, the only course of treatment to 
select is surgical intervention which will reduce the blood sup¬ 
ply to the cornea. 
There are several methods of operating for vascularity of 
the cornea, and we shall mention one besides the operation in 
question ( peritomy ) which has been considered a good substi¬ 
tute for periotomy. The procedure was introduced into the list 
of ocular operations by Kenneth Scott, and according to his 
method of operating for vascularity, the blood vessels are cut 
one by one until all have been divided. In order to accomplish 
this, it is necessary to use a magnifying glass ; for without the 
