Cortisone, allergy and rheumatic fever.

Among the infective diseases of man in which allergy is thought to play an important part, rheumatic fever is outstanding. It is associated with a haemolytic streptococcal infection of 3 to 4 weeks' duration, high antitoxin levels, and marked sensitivity to streptococcal allergens. The tissues do not show the " pyogenic response" commonly associated with haemolytic streptococci, but a widespread inflammation of connective tissue, which is characterized by marked oedema and collagen degeneration, and is similar to that seen in many naturally-occurring and experimentally-produced diseases associated with sensitization to various antigens, with ascorbic acid deficiency, and often with endocrine disturbance. It is irrelevant to the problem of infective allergy to discuss differences between such conditions. We are concerned with the broad analogy; diseases which resemble each other in some ways, may do so in others, so that what we learn of one may have an application in another. On this basis, we have taken certain features of rheumatic fever and studied what we think may be comparable features in the guinea-pig. We have, for convenience, selected tuberculous allergy (not streptococcal allergy); ascorbic acid deficiency-since it occurs both in the active stage of rheumatic fever and during convalescence; cortisone and ACTH,. for obvious reasons; thyroxine, because we have a hunch that the thyroid has something to do with rheumatic fever, know that it has something to do with the adrenal cortex, believe that it has something to do with allergy, and suspect that it has something to do with ascorbic acid metabolism.