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Sulfanilamide for Trachoma
EDITORIALS method of action of adrenalin after the primary constriction is over. Mecholyl must—like suprarenin—be administered cautiously; not like adrenalin because of danger both locally and systemically, but only because of the systemic reaction and possible heart stoppage. This is true es pecially when injected in cases of asthma or bronchial allergy, and the administra tor is warned to have atropine always ready for injection should the drug act alarmingly; not exactly a pleasant thought. However, the drug is reported efficacious where other local treatment has failed and is therefore worthy of a trial. Equally important may be the second drug described; namely, prostigmine. This, according to the author, is more potent than pilocarpine and eserine in chronic simple glaucoma in that it is ef fectual where these have failed. Further more it seems to act well in combination with mecholyl. The need for additional armamentaria for the control of glaucoma is so urgent that these promising drugs should cer tainly be given a trial. But even the best drugs provide only symptomatic treat ment and the study of the fundamental glaucomatous condition must be con tinued unremittingly because this dis ease of middle and late life obviously is becoming more frequent as the life span lengthens. Lawrence T. Post. SULFANILAMIDE FOR TRACHOMA This drug, sometimes called prontosil album, or white prontosil, has come into prominence as a remedy to combat vari ous diseases. Infections due to strepto coccus of different varieties, pneumococcus, staphylococcus and gonococcus, are all indications for its use. Reports on its beneficial effects now occupy an impor
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tant place in current medical literature. It seems to have a wide and important antibacterial action within the body. Whether trachoma is caused by bacteria, or whether it is due to a virus, may not be settled; but sulfanilamide has been used for trachoma with rather striking benefit. In our lack of knowledge of the cause and pathology of trachoma, it is worthy of trial. At the San Francisco meeting of the Section on Ophthalmology of the Ameri can Medical Association, some of those present testified to the beneficial influence it seems to exert in trachoma. Favorable reports have been received of its use for trachoma among the Indians in different parts of this country. Since hearing of it, several ophthalmologists have tried the drug on trachoma patients and found it beneficial. Its efficacy has been especially apparent in the checking and clearing up of corneal lesions. In the Lancet for October 29th, Dr. Kirk, of Khartoum, Africa, and two col leagues give their experience with sul fanilamide in 25 cases of trachoma among the natives of Central Africa. In all the cases but one there was improvement of the eye conditions. In three cases with less than one month of previous treat ment there was rapid improvement in two and slower improvement in the third. Among eight cases that had previously been under treatment "for months," six showed rapid improvement, one slow im provement, and one improved at first and then suffered a relapse. Four cases that gave history of previous treatment for years, and eight that gave no history of previous treatment, all improved under sulfanilamide. Where trachoma was com plicated with vernal conjunctivitis (spring catarrh), the results were not so good. The drug was given in tablets, one-half gram each, three times a day for seven days; and then an intermission of seven
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EDITORIALS
days. In one case there was no inter mission, and it improved rapidly. Sulfanilamide, like other new drugs of known power, must be used with caution. Great value in combating the disease for which it is used may be offset by danger of very undesirable or even fatal effects. This has been illustrated by the danger of dinitrophenol causing cataract. Intermis sions in treatment have been used to guard against possible dangers of sulfanilamide. It belongs to a class of drugs that sometimes damage the blood-making organs, and cause death by leucopenia (agranulocytosis). This is sometimes, perhaps, caused by the original disease, but sometimes probably from the effect of the drug. If used long, blood counts should be made from time to time; and if the leucocytes fall below the normal number, the drug must be stopped. It now seems we may have in sulfanilamide a drug that may cure a disease that has been known for thousands of years as a most important cause of blindness. It should be tried, with proper precau tions, in every case of trachoma that is surely recognized and that may be prop erly watched and controlled. Can it cure ? Is the cure permanent? How is the drug best used? What must be done to guard against its dangers? A large number of eye physicians and general practitioners may be properly expected to seek the answers for these questions. Edward Jackson. HYPERTENSIVE RETINITIS Much of the language of ophthalmol ogy dates back to remote antiquity. The name "cataract" was given to something which was assumed to fall across the sight. "Glaucoma" was the term applied to a condition of blindness associated with a green (or blue-gray) shimmer in the pupil. These and other expressions were
of Greek origin, because Greek physi cians had laid the foundation for medical knowledge as it was still accepted and applied through the period of the Roman Empire and the centuries of the Renais sance, with its revival of classic learning and its dim groping for new scientific facts. Our study of the ocular background in the living subject is about three fourths of a century old. Its terminology is partly antiquated and is often confusing. The term "retinitis," implying an inflamma tion of the retina, is attached to a number of conditions in which the retina is cer tainly not "inflamed," and in which the changes are of a degenerative character. To the presence of an excess of circula tory fluid in the nerve-head we often apply the peculiarly idiomatic title of "choked disc," and those who prefer a more international terminology substitute for this the term "papilledema," whose Greek origin would seem to imply a wat ery swelling of a protruding structure, whereas the normal optic disc represents rather a depression than a protrusion as related to the general fundus level. The exact significance of retinal changes is often veiled in mystery. Par ticularly is this true as regards the rela tionship between retinal vascular changes and disturbances of the general vascular system. What essential distinctions are there between diabetic disturbances of the retina and those encountered in asso ciation with nephritis? How far can we interpret the grave systemic implications of general vascular hypertension, or of renal degeneration, on the basis of our ophthalmoscopic findings ? It is interesting to recall the origin of the expression "albuminuric retinitis," still more or less generally used for a group of changes of which the most strik ing feature is a star-shaped pattern in the macular region. Before the invention of
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tant place in current medical literature. It seems to have a wide and important antibacterial action within the body. Whether trachoma is caused by bacteria, or whether it is due to a virus, may not be settled; but sulfanilamide has been used for trachoma with rather striking benefit. In our lack of knowledge of the cause and pathology of trachoma, it is worthy of trial. At the San Francisco meeting of the Section on Ophthalmology of the Ameri can Medical Association, some of those present testified to the beneficial influence it seems to exert in trachoma. Favorable reports have been received of its use for trachoma among the Indians in different parts of this country. Since hearing of it, several ophthalmologists have tried the drug on trachoma patients and found it beneficial. Its efficacy has been especially apparent in the checking and clearing up of corneal lesions. In the Lancet for October 29th, Dr. Kirk, of Khartoum, Africa, and two col leagues give their experience with sul fanilamide in 25 cases of trachoma among the natives of Central Africa. In all the cases but one there was improvement of the eye conditions. In three cases with less than one month of previous treat ment there was rapid improvement in two and slower improvement in the third. Among eight cases that had previously been under treatment "for months," six showed rapid improvement, one slow im provement, and one improved at first and then suffered a relapse. Four cases that gave history of previous treatment for years, and eight that gave no history of previous treatment, all improved under sulfanilamide. Where trachoma was com plicated with vernal conjunctivitis (spring catarrh), the results were not so good. The drug was given in tablets, one-half gram each, three times a day for seven days; and then an intermission of seven
316
EDITORIALS
days. In one case there was no inter mission, and it improved rapidly. Sulfanilamide, like other new drugs of known power, must be used with caution. Great value in combating the disease for which it is used may be offset by danger of very undesirable or even fatal effects. This has been illustrated by the danger of dinitrophenol causing cataract. Intermis sions in treatment have been used to guard against possible dangers of sulfanilamide. It belongs to a class of drugs that sometimes damage the blood-making organs, and cause death by leucopenia (agranulocytosis). This is sometimes, perhaps, caused by the original disease, but sometimes probably from the effect of the drug. If used long, blood counts should be made from time to time; and if the leucocytes fall below the normal number, the drug must be stopped. It now seems we may have in sulfanilamide a drug that may cure a disease that has been known for thousands of years as a most important cause of blindness. It should be tried, with proper precau tions, in every case of trachoma that is surely recognized and that may be prop erly watched and controlled. Can it cure ? Is the cure permanent? How is the drug best used? What must be done to guard against its dangers? A large number of eye physicians and general practitioners may be properly expected to seek the answers for these questions. Edward Jackson. HYPERTENSIVE RETINITIS Much of the language of ophthalmol ogy dates back to remote antiquity. The name "cataract" was given to something which was assumed to fall across the sight. "Glaucoma" was the term applied to a condition of blindness associated with a green (or blue-gray) shimmer in the pupil. These and other expressions were
of Greek origin, because Greek physi cians had laid the foundation for medical knowledge as it was still accepted and applied through the period of the Roman Empire and the centuries of the Renais sance, with its revival of classic learning and its dim groping for new scientific facts. Our study of the ocular background in the living subject is about three fourths of a century old. Its terminology is partly antiquated and is often confusing. The term "retinitis," implying an inflamma tion of the retina, is attached to a number of conditions in which the retina is cer tainly not "inflamed," and in which the changes are of a degenerative character. To the presence of an excess of circula tory fluid in the nerve-head we often apply the peculiarly idiomatic title of "choked disc," and those who prefer a more international terminology substitute for this the term "papilledema," whose Greek origin would seem to imply a wat ery swelling of a protruding structure, whereas the normal optic disc represents rather a depression than a protrusion as related to the general fundus level. The exact significance of retinal changes is often veiled in mystery. Par ticularly is this true as regards the rela tionship between retinal vascular changes and disturbances of the general vascular system. What essential distinctions are there between diabetic disturbances of the retina and those encountered in asso ciation with nephritis? How far can we interpret the grave systemic implications of general vascular hypertension, or of renal degeneration, on the basis of our ophthalmoscopic findings ? It is interesting to recall the origin of the expression "albuminuric retinitis," still more or less generally used for a group of changes of which the most strik ing feature is a star-shaped pattern in the macular region. Before the invention of