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subject with sulphapyridine. The treatment of a condition such
as pulmonary tuberculosis presents so many problems that the results
of investigations carried out on a limited number of cases cannot,
according to Bradford Hill, be put forward as definitely significant.
It is felt that the results of our observations are not altogether
discouraging and, moreover, they open a number of avenues for
further work.
One of the main problems has been the difficulty patients have
experienced in taking sulphapyridine. We have tried the effects
of 2 gms. per day, four days a week, over prolonged periods, even
up to six months, on advanced and moderately advanced cases.
These doses are, of course, low judged by ordinary standards, and
are referable to the cases on whom it has been tried. The efficacy
of the dose should be tested by estimations of free and total sulphapyridine
in the sputum, and a concentration of less than 2 mgms. per
cent. of free sulphapyridine should be regarded as unsatisfactory.
Short periods of treatment appear valueless. A decrease in the
number of secondary invading organisms should not be expected,
particularly when a number of patients are together in one ward.
The results may be summarised:—Cases of moderate or slight
severity treated with the drug have shown a higher rate of recovery
although the mortality rate has been very similar in both treated
and control groups.
Tubercle bacilli disappeared more frequently in the treated
group, but, contrary to our expectations, pyogenic organisms were
not affected in either group.
The estimation of sulphapyridine in the sputum has offered a
guide to the efficacy of the treatment, and where the concentration
is high there has been a corresponding improvement in the condition
of the patient. Patients severely affected with the disease showed
no improvement.
Accommodation for Treatment of Tuberculosis in Children.
The lack of facilities for treating cases of pulmonary tuberculosis
in children continues to be a source of great anxiety, and it is to be
hoped that this matter will soon be overcome.
Accommodation for Advanced Cases.
This continues to be a very urgent problem as facilities for
dealing with such cases have become more difficult than ever before.