The Value of Chemotherapy with Sulphonamides in Some Common Zynotic Diseases

1. The results of treatment of a series of 224 cases of scarlet fever with sulphanilamide have been reviewed and compared with a concurrent series of 338 cases of scarlet fever treated without sulphanilamide. There is no evidence that the sulphanilamide had any beneficial effect in this disease whatever, either in the acute febrile stage or on the incidence of complications. 2. 54 cases of Erysipelas were treated with sulphanilamide with successful results. The toxaemia and the diffuse inflammation respond quickly to the drug. Attention is drawn to the fact that localised abscess formations are resistant to the effect of the drug. 3. 3 cases of Streptococcal empyema are described. In two cases treated with sulphanilamide by mouth aspiration was sufficient to cure the condition. In one case, treated with proseptasine, (benzyl sulphanilamide) the patient was benefited, but the pleural cavity required to be drained by the operation of rib resection. Sulphanilamide given early will tend to lessen the frequency of, or, even abolish, the need for operative interference other than aspiration, In 40 cases of puerperal infection excellent results have been obtained in some cases treated with prontosil rubrum and also in other cases treated with sulphanilamide. Cases of puerperal infection unaffected by large doses of both of those drugs have also been met with. Bacteriological investigation of the cases would probably have explained the variation in results. Where laboratory facilities are not available the use of the drugs in every severe case of puerperal infection is justifiable. 5. In 10 cases of Pyelitis due to infection with coliform bacilli rapid relief of symptoms disappearance of B. coli from urine was obtained with relatively small doses of sulphanilamide. This drug does not prevent relapses but can be conveniently combined with alkaline treatment. 6. Sulphanilamide had no curative effect on 6 faecal carriers of Bacillus para typhosus B. 7. 4 Cases of Meningococcal meningitis treated successfully with sulphanilamide or M. & B. 693 and meningococcal antitoxin are recorded. The impression was formed that the chemotherapy contributed to the success of the treatment. 8. 5 cases of Gonococcal ophthalmia neonatorum were treated with sulphanilamide with equivocal results. One case treated with M. & B. 693 was cured dramatically. 9. Uleron was used in the treatment of one case of Staphlococcal pyaemia without success. 10. 66 cases of pneumonia of various types were treated with M. & B. 693. The mortality rate in the treated cases was 7. 6% From 1935 to July 1938 the mortality rate in pneumonia patients in the hospital was 18% in 309 cases. Chemotherapy with M. & B. 693 is the best available treatment of pneumonia of all types. The M. & B. 693 is not invariably successful. The unsuccessful cases may be due to a highly resistant infecting organism or to a partially encysted infected area, e.g. lung abscess. The introduction of sulphonamide chemotherapy marks an important advance in the treatment of pneumonia, streptococcal diseases due to bacterial invasion of the body, such as erysipelas, puerperal sepsis and streptococcal empyema, and probably also in the treatment of meningococcal meningitis and gonococcal ophthalmia. The efficacy of the drugs by mouth simplifies treatment. Toxic symptoms are relatively few. Cyanosis which frequently develops during treatment is an excellent indication for caution as regards dosage. Patients being treated with the drug should be under supervision. Ambulant treatment is contra-indicated on account of the vertigo, tremor and nervousness which may be produced by the drug