Streptomycin in the Treatment of Tuberculosis in Humans

Walsh McDermott and Changing Conceptions of Tuberculosis Antibiotic Therapy

“…Their 1947 studies 15,17 complemented the findings of more influential experiments funded by the U.S. National Institutes of Health and the American Trudeau Society and larger clinical trials performed by the British Medical Research Council from 1946 to 1948. 18,19 The larger studies clearly supported the therapeutic value of streptomycin and advanced the randomized control trial design, but looking at the contributions of McDermott’s group offers a more nuanced understanding of the evolution of TB chemotherapy: It reveals how clinician–researchers shifted their focus from the biology of the host to that of the bacilli.…”

“…12,13 McDermott “expressed the opinion that streptomycin exerts a definite action on the tuberculous process,” basing his claim on a small set of pulmonary TB subjects who experienced a complete remission or significant reduction in the size of cavities after at least two months of therapy. 14 His group’s case reports of TB patients receiving the drug from 1946 to 1947 affirmed this “unprecedented ability” 15 : Previously, patients who suffered from rare forms of meningeal or miliary TB typically died within a few weeks; when treated with streptomycin, however, they survived for several months. Patients with pulmonary TB, the form responsible for the majority of deaths, typically experienced a “prompt improvement of symptoms” and complete remission for at least several weeks of receiving streptomycin.…”

“…McDermott’s group speculated that any effective TB chemotherapy would need to suppress the bacilli over a prolonged period to facilitate the immune system’s contribution to producing a cure. Indeed, the prevailing goal of antimicrobial therapy in 1947 was “to establish control of an infection for a sufficiently long period to afford opportunity for the host to mobilize mechanisms for permanent control.” 15 After contemplating “both the nature of tuberculous lesions and the poorly understood variables of the host–parasite relationship,” McDermott’s group concluded that “the ideal procedure in the chemotherapy of tuberculosis would be to administer the drug for many months.” 17 This focus on how to facilitate the host’s response guided further research into the drug regimen.…”

Tubercles of the Choroid

“…Often these scars were so small that they could not be located unless each choroidal tubercle had been accurately mapped in its earlier stages. McDermott, Muschenheim, Hadley, Bunn and Gorman (1947) noted the disappearance of these lesions in two out of 13 cases of miliary tuberculosis. Debre (1952) considered that small choroidal tubercles may disappear completely.…”

A Study of Ten Children after Treatment with Streptomycin for Tuberculous Meningitis

“…' Later publications (Alperin and Toomey, 1948;American Trudeau Society, 1947 andApplebaum and Halkin, 1947;Bunn, 1948;Cathie, 1949;Choremis, 1948;Debr etal., 1948;Decourt, 1948;Dolivo and Rossi, 1948;Dowling, 1949;Dubois, 1948;'Lancet,' 1948a and1948b;McDermott, 1947;Mann, 1948;Medical Research Council, 1948;Mordasini, 1948;Nau, and Wenzler, 1948;and Rubie and Mohun, 1949) produce an over-all i on that when tuberculous meningitis is treated with sutptomycin most paints die, and that of the minority who survive a considerable number are deaf or paralysed, and others are mentally abnormaL Smith et aL (1948), and linoln and Kirmse (1949) on the contrary, point out that recovered cases have not been left badly crippled either physically or mentaly.…”