PENICILLIN IN SUPPURATIVE DISEASE OF THE LUNGS DUE TO STREPTOCOCCUS HEMOLYTICUS*

SINCE penicillin has been employed clinically only since 1941 and, until comparatively recently, has not been available in sufficient quantity to permit the study of a large series of cases, the amount of literature concerning its clinical use in suppurative diseases of the lungs is necessarily limited. There is now sufficient evidence, however, to justify its employment in pneumonia, suppurative pneumonitis, lung abscess and empyema when due to an organism or organisms susceptible to the antibiotic action of penicillin. Although a definite decrease of empyema has occurred since the use of the sulfonamides, there is a limited group of sulfonamide resistant cases who develop empyema during the course of their treatment. Then, too, em-pyema may already have been present when sulfonamide was started. Tillett, Cambier and McCormack 3 found bacteria retained viability in the pleural space after sulfadiazine was injected intrapleurally. They also demonstrated the cure of empyema without rib resection when penicillin was placed directly into the empyemic cavity. Blake and Craige4 report the successful use of penicillin in three cases of suppurative disease of the lung, due to staphylococcus in two cases and Streptococcus hemolyticus in the third. Penicillin was used successfully in sulfonamide-resistant pneumonia by Bennett and Parkes.5 They state that the results'obtained in their cases represent a new phase in the treatment of empyema. Here, again, thoraco-tomy was obviated. When penicillin is injected intravenously or intramuscularly, it does not penetrate in significant amounts into walled-off collections of pus such as may be found in thoracic empyema or an abscess cavity. Conversely, peni-cillin injected directly into an abscess does not escape rapidly.1'