To effect a cure of rheumatic fever, Coburn1 claims, one of two objectives must be realized. Either the immune response of the host must be modified so that the patient recovers promptly after his first attack or the capacity of the infected micro-organism to elaborate antigen must be inhibited by a chemotherapeutic agent. Since neither of these objectives has yet been realized, one is limited to the suppression of the inflammatory reaction. If salicylate therapy can modify the sterile inflammatory reaction which occurs during activity of the rheumatic process, one might expect this effect to inhibit the development of cardiac disease.
Evaluation of any form of therapy in rheumatic fever, Coburn states, is difficult because about 20 per cent of young adults may be expected to have a monocytic attack and recover spontaneously under symptomatic treatment. About 40 per cent of 43 young adults treated with daily doses of