Since the announcement by Hench and his collaborators at the Mayo Clinic that cortisone (17 -hydroxy -i i -dehydrocortico -sterone, Compound E) and ACTH (pituitary adenocorticotrophic hormone) can produce dramatic improvement in patients suffering from rheumatoid arthritis, the medical and lay press have shown a burst of interest in the treatment of this tragic and ancient disease. The general physician and endocrinologist, who in the past were often loath to admit cases to their beds,..now all seem keen 'to have a go.' It is therefore important that the problems arising from these new forms of treatment should be viewed with a proper sense of perspective. To do this a brief description of modem views on the aetiology, diagnosis and natural history of the disease is necessary. We must also reconsider our methods of assessing improvement and cure.
AetiologyThe cause of rheumatoid arthritis is unknown, though most workers agree that heredity and physical or emotional strain may be contributory factors. The disease is commoner in women than in men, in the poor than in the rich, in cold wet climates than in warm dry climates. We shall discuss not only these factors, but also the following suggested causes: focal sepsis, bacterial or virus infection, bacterial or virus sensitivity, vitamin deficiency, endocrinological factors and the general adaptation syndrome of Selye.Focal sepsis if always sought is not commonly found. Finding and clearing it rarely cures. It cannot therefore be regarded as a constant aetiological factor.The disease has many of the characteristics of a chronic infection, fever, malaise, wasting and, a
Summary
A new method is described for studying the modification by drugs of the oxidation‐reduction systems of the skin in man.
This consists in noting the changes produced in the decolorisation time of a standard intradermal wheal made with 2:6‐dichlorophenol indophenol indicator solutions.
The decolorisation time is significantly decreased by ascorbic acid and by glutathione, and increased by adrenocorticotrophic hormone and cortisone, when these agents are administered systemically.
The significance of the electrode potential (Eh) of the tissues in relation to these findings is discussed.
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