1c:I[419806,["/_next/static/chunks/bb923814e1f4d2e9.js","/_next/static/chunks/dd3ee9f5b7716ca6.js","/_next/static/chunks/4204a0ae82542ca8.js","/_next/static/chunks/1270dead247da766.js","/_next/static/chunks/6e1aa89a642f40be.js","/_next/static/chunks/2d7aa753e81324a8.js","/_next/static/chunks/8ffd0b71567920d8.js","/_next/static/chunks/67ea6dfd21f16c5f.js","/_next/static/chunks/24eb4379f68013fd.js","/_next/static/chunks/b8cd775ffdf935bd.js","/_next/static/chunks/983103cd9eb7b428.js","/_next/static/chunks/263f2cdcb9aa2341.js","/_next/static/chunks/294b9525248c8e5f.js"],"default"] 1d:T426,PATIENTS with rheumatoid arthritis, acute rheumatic fever, certain other diseases with articular complications and certain nonrheumatic diseases have been improved markedly and promptly, but usually temporarily, by intramuscular injections of cortisone or ACTH. Cortisone is the hormone of the adrenal cortex previously known as compound E (17-hydroxy-11-dehydrocorticosterone). ACTH is the pituitary adrenal corticotropic hormone which stimulates responsive adrenal glands to produce cortisone or a cortisone-like steroid such as compound F. Our preliminary results have been reported.¹Herein are presented further experiences with these hormones. Because they are still scarce and because our experience with them is still limited, this report, like our preceding one, is presented as a study in clinical physiology and not as a report on clinical therapeutics.

STUDIES WHICH LED TO OUR USE OF THESE HORMONES

In 1925 the weakness, fatigue and low blood pressure common among patients with rheumatoid arthritis (which we then called "chronic1e:T427,UNTIL recently inadequate supplies of the adrenal cortex hormone 17-hydroxy-11-dehydrocorticosterone¹(formerly known as "compound E" and hereinafter called "cortisone") and pituitary adrenocorticotropic hormone (hereinafter called "ACTH") have limited studies of the effects of these substances in man when administered in amounts sufficient to have pronounced physiologic activity. With the development and improvement of methods for partial synthesis of cortisone and for the separation of larger amounts of ACTH from the pituitary glands of animals, adequate amounts of both materials became available for trial in certain diseases of human beings. A great impetus was given to their production by recent observations concerning their favorable influence on the course of a common chronic disease (rheumatoid arthritis) as well as in a common acute disease with serious chronic sequelae (acute rheumatic fever).²In the short time since these observations were made, increasing amounts of these hormones have become available and, although1f:T446,The antirheumatic effects of the adrenal cortical hormone, cortisone, and of the pituitary adrenocorticotropic hormone (ACTH; corticotropin) have been demonstrated by many investigators within the past year. These beneficial effects may be produced especially on rheumatoid arthritis and acute rheumatic fever but also on several other articular conditions such as the acute arthritis of gout, the arthritis of disseminated lupus erythematosus, of psoriasis, of ulcerative colitis and to a limited extent on the arthritis of tuberculosis and in certain cases of primary osteoarthritis. In general the relief lasts only during the period of hormonal administration.

GENERAL RESULTS IN RHEUMATOID ARTHRITIS

Varying degrees of improvement have been obtained in practically all cases of active rheumatoid arthritis, rheumatoid spondylitis and Still's disease (juvenile rheumatoid arthritis) in which cortisone and pituitary adrenocorticotropic hormone have been used. Most patients, even those with severe but reversible disease, have promptly obtained decided relief. Other patients whose

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