Unravelling the ‘Tangled Web’: Chemotherapy for Tuberculosis in Britain, 1940–70The William Bynum Prize Essay

Abstract

Abstract:The introduction and assimilation of chemotherapy to treat pulmonary tuberculosis (TB) during the mid-twentieth century appears at first sight to be a success story dominated by the use of streptomycin in a series of randomised clinical trials run under the auspices of the Medical Research Council (MRC). However, what this standard rhetoric overlooks is the complexity of TB chemotherapy, and the relationship between this and two other ways of treating the disease, bed rest and thoracic surgery. During the late 1940s and 1950s, these three treatment strands overlapped one another, and determining best practice from a plethora of prescribing choices was a difficult task. This article focuses on the clinical decision-making underpinning the evolution of successful treatment for TB using drugs alone. Fears over the risk of streptomycin-resistant organisms entering the community meant that, initially, the clinical application of streptomycin was limited. Combining it with other drugs lessened this risk, but even so the potential of chemotherapy as a curative option for TB was not immediately apparent. The MRC ran a series of clinical trials in the post-war period but not all of their recommendations were adopted by clinicians in the field. Rather, a range of different determinants, including the timing of trials, the time taken for results to emerge, and whether these results 'fitted' with individual experience all influenced the translation of trial results into clinical practice.

Increasing incidence of tuberculosis diagnosed by surgery: a single centre analysis in low-incidence country

“…If all previously mentioned methods (including image guided biopsies) fail then definitive diagnosis can be obtained by surgical methods. The introduction of effective AAT in the 1950s superseded surgery as primary TB treatment (11). The need for surgery became limited to the treatment of TB complications and to diagnose uncertain lesions or otherwise unrecognized disease (12).…”

“…Surgery has been a unique tool of TB management for several decades. However, with introduction of antituberculous therapy (ATT) the role of surgery became limited to the treatment of TB complications and diagnoses of uncertain lesions or otherwise unrecognized disease (7)(8)(9)(10)(11).…”

Infrastructure-building for Public Health : The World Health Organization and Tuberculosis Control in South Korea, 1945-1963

“…In developing countries that could not afford to build sanatoria, vaccinations were the only feasible method of systematic control [ 55 ]. But in the mid-1950s, WHO carried out a series of pilot programs and clinical trials in Kenya and India, in search for an effective, simple, and affordable alternative to the expensive streptomycin ( Valier, 2010 ; McMillen, 2015: 119-137 ; Amrith, 2006: 149-160 ; Leeming-Latham, 2015: 156-176 ). In 1959, WHO presented the outcomes of a study that promised all three.…”