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61
Drugs and preparations in the treatment and prevention of
tuberculosis
During the year two methods of dealing with tuberculosis were
brought prominently before the public; first, prevention by means of
BCG vaccination (as reported briefly on p. 5 of my report for 1948),
and secondly, treatment by means of the drug streptomycin. With
regard to BCG vaccination there is little new to report except that a
Ministry of Health sponsored scheme of limited size has now started.
With regard to streptomycin much public confusion has been caused
by incorrect or exaggerated reports in the press and therefore it may be
helpful to quote from a leaflet on the drug recently issued by the
National Association for the Prevention of Tuberculosis. Streptomycin
"is a powerful drug which was reported in America in the year 1944.
It is made from an extract of a mould which grows in the soil. People
imagine that streptomycin can produce successful results in a large
number of cases of tuberculosis. This is quite incorrect. Streptomycin
is certainly useful in the treatment of tuberculosis, but it is by no
means an absolute and infallible cure for all cases. In fact, streptomycin
can only be used successfully for a relatively small number of
patients suffering from this disease.
One severe, and usually fatal form of tuberculosis is that known
as tuberculous meningitis — a condition affecting the covering of the
brain. Before streptomycin was discovered, tuberculous meningitis
was nearly always fatal. But streptomycin, given properly and under
very careful conditions, can cure tuberculous meningitis in a number
of cases — though not in all.
Unfortunately, streptomycin is a very powerful drug and may injure
certain nerve cells and fibres. It may indeed cause serious damage to
the nerves which control the muscular balance. Newer forms of
streptomycin may not be quite so dangerous in this respect and, in
time, we may be able to avoid these dangerous effects altogether. Yet
the risk remains.
There is another unexpected and serious result which streptomycin
may have when given to a tuberculous patient. Some of the germs
of tuberculosis inside the patient's body may become what is called
"resistant" to streptomycin—that is, they may be quite unaffected
by it, indeed they may continue to grow in large numbers even while
the patient is receiving the drug. So that the patient becomes entirely
"proof" against streptomycin and the drug will be no good whatever.
If a serious moment should come in that patient's illness, he will be
deprived of streptomycin at the critical time. It might have been
much better for such a patient to "save up" streptomycin for a particular
crisis or dangerous stage in his illness, when no other drug
would do him so much good. Streptomycin should be used at the right
moment or not at all. Worse than that. Such a patient may infect
other healthy people with the "resistant" strains of the tuberculosis
germs. So that more and more people may develop a form of the disease
in which streptomycin would be valueless.