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CHEMOTHERAPY OF STREPTOCOCCAL INFECTIONS
1536 the kidney which is concerned in their elimination. While this hypothesis is as yet unsubstantiated it is of interest that Kellett finds2 a sharp fall in the complement in a small series of cases of acute Bright’s disease, suggesting that an extensive antigen-antibody reaction has taken place. No comparable fall was found in a control series, including cases of chronic nephritis. The whole subject of experimental nephritis and so-called " nephropathy " has recently been ably reviewed by H. Horn.4 His comment upon the production of nephritis by parenteral injections of proteins and nephrotoxins is as follows :-
" Repeated parenteral injections of protein have been shown to produce marked glomerular and tubular changes and occasionally to result in the reactivation of the mesenchymal elements of the interstitial tissue. The results with isonephrotoxins and autonephrotoxins have been inconclusive. With heteronephrotoxins, on the other hand, marked abnormalities of the renal structural units have been obtained, their distribution and intensity varying with the dose of the injected material. The significance, however, of the hemolytic factor which seems to be common to all serums employed in these experiments has not been definitely shown.... In spite of this, the pictures described indicate that the presence of a state of hypersensitivity is largely responsible for the appearance of the more widespread changes and seems to substantiate further the contention that tissue allergy is essential for the production of a diffuse non-suppurative renal lesion." CHEMOTHERAPY OF STREPTOCOCCAL INFECTIONS
A greater variety of infections are also being treated. While the haemolytic streptococcus is still the outstanding organism of proven susceptibility, experimental evidence justifies the adoption of this treatment in meningococcal meningitis, although clinical reports on its effect are still scanty, and in mouse infections there has been experimental success with bacteria of the enteric group and with the pneumococcus. According to Branham and Rosenthalthe combined use of sulphanilamide and serum is more effective than either alone in pneumococcal We also and meningococcal infections in mice. noted last week a paper by Dees and Colston of Baltimore, describing a degree of success in the treatment of gonorrhoea with sulphanilamide that has evidently impressed and perhaps surprised these authors themselves. There are thus three genera of bacteria-streptococcus, bacterium, and neisseriawhich include one or more species susceptible to the action of these drugs, and it is not unlikely that others will be included shortly. The Council on Pharmacy and Chemistry of the American Medical Association has now published a report7 briefly setting forth the steps by which the present position has been reached and approving sulphanilamide "for inclusion in New and Nonofficial Remedies as a therapeutic agent for the treatment of infections by hemolytic streptococci of Lancefield’s serologic group A." This report also adopts " sulfanilamide " as the non-proprietary name for p-aminobenzenesulphonamide, and deplores the coining of a variety of proprietary names for it. The Council finally announces its intention to "proceed with determining the acceptability of the various brands that have been submitted." This is likely to be no small task, and if the scope of the inquiry comes to embrace other related compounds it will strain the resources of the greatest medical organisation of the world to their utmost. That there is no official organisation in this country capable of conducting such an inquiry on the scale which may shortly be necessary makes us dependent on the work of individual observers ; but they can at all events claim a very large measure of success in advancing this research within the past year.
now sees fresh developments in the of streptococcal and other bacterial infections, and the situation is becoming increasingly complex in two distinct ways. In the first place, the supremacy of sulphanilamide, which is the active derivative of the original Prontosil and has superseded it in therapeutics, is now being challenged by other related compounds, and on present information it seems scarcely possible to assess their relative merits even in streptococcal infections alone, while their wider potentialities, at least in the clinical field, are almost completely unknown. Dr. G. A. H. Buttle and his colleagues reported in our issue of June 5th some preliminary observations on two new compounds, diaminosulphone and dinitrosulphone, the A COMFORTABLE CURE OF THE OPIUM HABIT efficacy of which in relation to their toxicity is greater WHATEVER adjectives their exponents may have than that of sulphanilamide, at least in experimental applied to the various methods of treating opium infections in mice. Another compound, p-benzyladdiction, it is doubtful whether any but the lecithinaminobenzenesulphonamide, marketed in this diet method has been described as comfortable. country under the name of Proseptasine, entered the Wen-Chao Ma and his colleagues,8 who treated a therapeutic field some time ago with less experimental number of Chinese in this way and opium-smokers than that has in accumulated conwhich backing to it this found that, even when the applied epithet, nexion with sulphanilamide, and the results reported at remained home without restrictions, the patients by Dr. L. E. H. Whitby (p. 1517) in this issue are their lost desire for the in the course majority drug accordingly welcome as confirmation of its experi- of a few The both method, simple and days. being The chief mentally demonstrable efficacy. advantage of this compound is that it is decidedly less toxic inexpensive, was clearly worthy of further trial, and such has now been accorded it at the Carmichael than sulphanilamide, at least as measured by deterDiseases at Calcutta by R. N. Hospital for Tropical mining the maximum tolerated dose in animals. and 9 G. S. treated in all 200 patients Chopra.9 They on it have appeared in Favourable clinical reports in age from twenty to seventy years, 80 in varying and for France: Bloch-Michel, Conte, Durel,5 and 120 in the out-patient department, instance, treated 180 cases of erysipelas with excellent hospital 2 1 a morphine addict, and opium-smokers, being results. Let it not be supposed, however, that these the remainder opium by the mouth. Before taking are the only compounds related to sulphanilamide with which experimental and clinical research will starting on the special diet a careful history was taken and each patient had a thorough physical have shortly to deal: for other reports are already 6 appearing in which freshly synthesised compounds of Branham, S. E., and Rosenthal, S. M., Publ. Hlth Rep., this nature are mentioned as yielding promising Wash. May 28th, 1937. 7 J. Amer. med. Ass. May 29th, 1937, p. 1887. initial results. 8 Ma, W.-C., Ni, Y. Y., and Kao, H. C., Far-East. Ass. Med. Trans. (Ninth Congress) 1934, vol. ii, p. 381. Trop. 9 4 Arch. Path. 1937, 23, 121, 241. Chopra, R. N., and Chopra, G. S., Indian med. Gaz. May, 5
EVERY week
chemotherapy
Ann. Méd. January, 1937, p. 62.
1937, p. 265.
.
" Repeated parenteral injections of protein have been shown to produce marked glomerular and tubular changes and occasionally to result in the reactivation of the mesenchymal elements of the interstitial tissue. The results with isonephrotoxins and autonephrotoxins have been inconclusive. With heteronephrotoxins, on the other hand, marked abnormalities of the renal structural units have been obtained, their distribution and intensity varying with the dose of the injected material. The significance, however, of the hemolytic factor which seems to be common to all serums employed in these experiments has not been definitely shown.... In spite of this, the pictures described indicate that the presence of a state of hypersensitivity is largely responsible for the appearance of the more widespread changes and seems to substantiate further the contention that tissue allergy is essential for the production of a diffuse non-suppurative renal lesion." CHEMOTHERAPY OF STREPTOCOCCAL INFECTIONS
A greater variety of infections are also being treated. While the haemolytic streptococcus is still the outstanding organism of proven susceptibility, experimental evidence justifies the adoption of this treatment in meningococcal meningitis, although clinical reports on its effect are still scanty, and in mouse infections there has been experimental success with bacteria of the enteric group and with the pneumococcus. According to Branham and Rosenthalthe combined use of sulphanilamide and serum is more effective than either alone in pneumococcal We also and meningococcal infections in mice. noted last week a paper by Dees and Colston of Baltimore, describing a degree of success in the treatment of gonorrhoea with sulphanilamide that has evidently impressed and perhaps surprised these authors themselves. There are thus three genera of bacteria-streptococcus, bacterium, and neisseriawhich include one or more species susceptible to the action of these drugs, and it is not unlikely that others will be included shortly. The Council on Pharmacy and Chemistry of the American Medical Association has now published a report7 briefly setting forth the steps by which the present position has been reached and approving sulphanilamide "for inclusion in New and Nonofficial Remedies as a therapeutic agent for the treatment of infections by hemolytic streptococci of Lancefield’s serologic group A." This report also adopts " sulfanilamide " as the non-proprietary name for p-aminobenzenesulphonamide, and deplores the coining of a variety of proprietary names for it. The Council finally announces its intention to "proceed with determining the acceptability of the various brands that have been submitted." This is likely to be no small task, and if the scope of the inquiry comes to embrace other related compounds it will strain the resources of the greatest medical organisation of the world to their utmost. That there is no official organisation in this country capable of conducting such an inquiry on the scale which may shortly be necessary makes us dependent on the work of individual observers ; but they can at all events claim a very large measure of success in advancing this research within the past year.
now sees fresh developments in the of streptococcal and other bacterial infections, and the situation is becoming increasingly complex in two distinct ways. In the first place, the supremacy of sulphanilamide, which is the active derivative of the original Prontosil and has superseded it in therapeutics, is now being challenged by other related compounds, and on present information it seems scarcely possible to assess their relative merits even in streptococcal infections alone, while their wider potentialities, at least in the clinical field, are almost completely unknown. Dr. G. A. H. Buttle and his colleagues reported in our issue of June 5th some preliminary observations on two new compounds, diaminosulphone and dinitrosulphone, the A COMFORTABLE CURE OF THE OPIUM HABIT efficacy of which in relation to their toxicity is greater WHATEVER adjectives their exponents may have than that of sulphanilamide, at least in experimental applied to the various methods of treating opium infections in mice. Another compound, p-benzyladdiction, it is doubtful whether any but the lecithinaminobenzenesulphonamide, marketed in this diet method has been described as comfortable. country under the name of Proseptasine, entered the Wen-Chao Ma and his colleagues,8 who treated a therapeutic field some time ago with less experimental number of Chinese in this way and opium-smokers than that has in accumulated conwhich backing to it this found that, even when the applied epithet, nexion with sulphanilamide, and the results reported at remained home without restrictions, the patients by Dr. L. E. H. Whitby (p. 1517) in this issue are their lost desire for the in the course majority drug accordingly welcome as confirmation of its experi- of a few The both method, simple and days. being The chief mentally demonstrable efficacy. advantage of this compound is that it is decidedly less toxic inexpensive, was clearly worthy of further trial, and such has now been accorded it at the Carmichael than sulphanilamide, at least as measured by deterDiseases at Calcutta by R. N. Hospital for Tropical mining the maximum tolerated dose in animals. and 9 G. S. treated in all 200 patients Chopra.9 They on it have appeared in Favourable clinical reports in age from twenty to seventy years, 80 in varying and for France: Bloch-Michel, Conte, Durel,5 and 120 in the out-patient department, instance, treated 180 cases of erysipelas with excellent hospital 2 1 a morphine addict, and opium-smokers, being results. Let it not be supposed, however, that these the remainder opium by the mouth. Before taking are the only compounds related to sulphanilamide with which experimental and clinical research will starting on the special diet a careful history was taken and each patient had a thorough physical have shortly to deal: for other reports are already 6 appearing in which freshly synthesised compounds of Branham, S. E., and Rosenthal, S. M., Publ. Hlth Rep., this nature are mentioned as yielding promising Wash. May 28th, 1937. 7 J. Amer. med. Ass. May 29th, 1937, p. 1887. initial results. 8 Ma, W.-C., Ni, Y. Y., and Kao, H. C., Far-East. Ass. Med. Trans. (Ninth Congress) 1934, vol. ii, p. 381. Trop. 9 4 Arch. Path. 1937, 23, 121, 241. Chopra, R. N., and Chopra, G. S., Indian med. Gaz. May, 5
EVERY week
chemotherapy
Ann. Méd. January, 1937, p. 62.
1937, p. 265.
.