The discovery of the effect of adrenocorticosteroids in altering the manifestations of many clinical disorders was, in common with many other important medical discoveries, a clinical observation without an adequate theoretical framework for predicting the observed effects. Much of the subsequent investigation of the action of adrenocorticosteroids has followed the same pragmatic pattern. In addition, increasing attention has been focused on mechanisms of action of these steroids, although a clear metabolic basis for understanding their action is still not available.
In the study of the role of corticosteroids in the management of severe infections, pragmatic clinical observations have necessarily provided much of the available information. Unfortunately, most of these observations have not been controlled. The need for critical and carefully controlled investigation of the role of corticosteroids in the management of infectious diseases is perhaps best displayed by citing the numerous important arguments supporting the use of corticosteroids in the