Toxicity of M & B 693

SIR,-It was interesting to see in Dr. J. H. Crawford's paper (Journal, March 25, p. 608) that even in the presence of tuberculosis M & B 693 exercised a favourable, if not decisive, influence on the course of pneumococcal pneumonia. I would like to record my own experiences with sulphonamide in pulmonary tuberculosis. A woman of 45, who has had the disease for about ten years with occasional exacerbations, and whose lungs are now both heavily involved, recently developed a continued pyrexia with profuse sputum, night sweats, and rapid wasting. Her husband appealed to me to make a special effort to prevent what looked like the inevitable outcome, and I decided to try out the new chemotherapy-I had seen no reference to its use in the literature. Accordingly she took one 72-grain tablet four times a day for one week. The effect was immediate. Her temperature began to fall at once, and by the end of the week was normal. She was now feeling a little uncomfortable from the side-effects of the drug, so that it was stopped for a week. At the end of this time her temperature, which had originally been in the region of 100° to 101° F., had risen again to 990 to 1000 F. Again the drug was started at the same dosage, and the effect was the same. This time we have continued for a fortnight, and at the beginning of the second week her temperature fell to 970 F., where it remained. This is the stage we are at now, and I have again stopped the exhibition of the drug for a week. Next week I propose to give her M & B 693 to see if that will help at all. During this time her sputum has decreased in volume to about half, but I cannot say that her lung .sounds are in any way improved. It has generally been accepted that some of the later symptoms of advanced tuberculosis are due to secondary invading organisms and not to the tubercle bacillus itself, and so what I think must have happened, in the absence of bacteriological proof, is that I have disposed of a lot of these by chemotherapy. It is too much to hope that the effect can be anything but temporary, but if ever she seems likely to be overwhelmed in this way again I shall look to chemotherapy to help her to come back to the best sort of health which she can expect.-I am, etc., Essex, March 27. W. H. M. WILSON.