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With the discovery of antibiotics, among them streptomycin,
newer and more promising fields have been opened. More recently
some new synthetic chemical substances have been used in experimental
tuberculosis, including para-amino-salicylic acid (P.A.S.)
which is of low toxicity and may prove more effective than the
sulphone derivatives. The combination of P.A.S. and Streptomycin
promises favourable results.
The historical background of chemotherapy in general and of
tuberculosis in particular, has been summarised recently by Hart.
Gold, the sulphones, chaulmoogra oil, calciferol and streptomycin
are described in detail. Gold salts were shown to have an inhibitory
effect in vitro, but this was not confirmed clinically. Sulphones
exercise a deterrent effect on animals and on local application, but
toxic reactions (e.g. anaemia) render them undesirable. Chaulmoogra
oil was tried in view of the morphological and chemical
similarities of the bacillus of tuberculosis and that of leprosy, but
has not been successful. Large doses of calciferol help in lupus
vulgaris, but there is a danger of metastatic calcification. However,
a case treated with calciferol showed remarkable results.
Streptomycin gives the more promising results: toxic effects
(histamine-like responses, "venal irritation," eighth nerve deafness,
neuritis and dermatitis) are known but are unusual.
So much has been written in the medical and lay press on
streptomycin and so often hopes have been falsely raised, that
some reference must be made to the subject.
American workers, more particularly Hinshaw, Feldman and
their colleagues, have well summarised the situation to the present
time, and have demonstrated the effectiveness of streptomycin
in certain cases of tuberculosis, notably in miliary tuberculosis
where its beneficial effect on the clinical and pathological course
of the disease was marked. In pulmonary tuberculosis exudative
lesions are known to undergo some spontaneous resolution by simple
bed rest and hence, in this type of lesion, the part played by
streptomycin is not easy to assess. However, the work of several
American observers seems to indicate promising results in the
treatment of pulmonary tuberculosis where recent exudative
disease is the predominant feature. There is reason to believe
that streptomycin has some place in tuberculous pneumonia. In
extra-pulmonary lesions such as tuberculous lesions of the trachea
and larger bronchi, American workers report favourably on