ACTH and Cortisone Therapy of Rheumatic Fever and Rheumatic Carditis

The Rebound Phenomenon in Acute Rheumatic Fever

“…Several writers have implied that the rebound is a feature of hormone therapy. That a rebound may be seen after salicylate treatment has been emphasized by Massell (1950Massell ( , 1953, Fischel, Frank and Ragan (1952), Stollerman (1953), Illingworth et al (1954), Kuttner (1954) and McEwen (1954), and Still (1927) wrote: 'I have several times observed that . .…”

“…Massell (1950Massell ( , 1953 described the rebound in salicylate-treated cases as 'an occasionally observed phenomenon'. Done, Ely, Ainger, Seely and Kelley (1955) reported on 21 children treated with salicylates in varying amounts and for varying periods of time but until 444 the sedimentation rate had been normal for at least a week.…”

“…According to Bunim, Kuttner, Baldwin and McEwen (1952), the rebound usually subsides within 20 days. Massell (1950), writing about rebounds in salicylatetreated cases, said that the fever subsided in three or four days. Dorfman, Smull, Bergenstal, Howard, Muller, Oleson and Senz (1951) found the intensity and duration of the rebound to be highly variable.…”

“…It seems likely that most workers give further treatment if the rebound persists for longer than a specified period or if the rebound includes clinical features of appreciable intensity. Massell (1950) and McEwen (1954) suggested giving small doses of salicylates for a short time after the end of the main course of treatment to reduce the incidence of the rebound. Graham (1955) felt that salicylates were more suitable than hormones for the control of the rebound.…”