Cortisone and ACTH: The Present Position in America

Special issue—before translational medicine: laboratory clinic relations lost in translation? Cortisone and the treatment of rheumatoid arthritis in Britain, 1950–1960

“…Doctors in Britain followed events across the Atlantic very closely (Editorial 1949c). In January 1950, John McNee, Regius Professor of Medicine at the University of Glasgow, reported on his recent 3-month stay and was obviously affected by the new mood, claiming that ‘something quite new and fundamental in medicine and therapeutics had been discovered, with far wider possibilities and implications far beyond the boundaries of the chronic rheumatic diseases’ (McNee 1950, p. 114). The other diseases he listed were: ‘acute rheumatic fever, chorea, gout, chronic ulcerative colitis, lupus erythematosus diffusa, scleroderma (with oesophageal involvement), asthma, lymphadenopathies (including lymphosarcoma and Hodgkin’s disease).’ On ‘compound E’ and ACTH, McNee reiterated the now familiar accounts of ‘rapid and intensely dramatic effects’ in patients with RA, observing that though the drug’s effects were like turning a tap on and off, many courses of treatment led to ‘lasting improvement over a number of months.’ However, there were side effects to consider.…”

Miliary Tuberculosis in a Case of Acute Disseminated Lupus Erythematosus Treated with A.C.T.H

“…and cortisone came reports from Hart and Rees (1950) and Michael et al (1950) that cortisone enhanced the evolution of tuberculosis even in those animals who possessed a high natural resistance to the disease. McNee (1950), commenting on the physiological responses to these steroids, stated that wounds showed no signs of healing and abscesses no signs of granulation-tissue formation in animals or patients to whom they were being adminis-MEDICAL JOURNAL tered, and warned that their effect on the granulationtissue barrier around an active tuberculous lesion might be disastrous.…”

Acrosclerosis

“…Diffuse true scleroderma, which is a somewhat similar disease to acrosclerosis, has already been shown to respond to cortisone (McNee, 1950). Should this prove to be the case in acrosclerosis, correct diagnosis would be essential, as no other treatment alters the course of the disease.…”