DANGEROUS DRUGS

his capacity. If lung involvement is bilateral, surgical collapse methods may not be practicable, and in such cases they feel that "Sulphetrone" therapy may sometimes be justified with the limited objective of arresting disease in one lung (where it is recent and Infiltrative ) to permit surgical attack on the more extensively diseased opposite lung; this was achieved in four cases in their series. The type of patient who seems to them most likely to benefit is the one with an early infiltrative lesion; this is based on their general experience, though they have had unexplained failures in certain cases. Thetr general attitude to the drug is guarded but favourable. D. G. Madigan' describes the use of "Sulphetrone" therapy in seventy cases of tuberculosis affecting diffollrent organs. In general no beneficial effect was detected in acute infections, such as acute miliary tuberculosis and tuberculous meningitis, but a patient with chronic miliary tuberculosis recovered. On the other hand, improvement was observed in chronic lesions. In 12 out of 17 cases of acute pulmonary fibra-caseous disease, and in 13 out of 22 chronic cases, improvement was noted. Benefit was derived in all of four cases of primary pulmonary tuberculosis and in six: out of eight cases of strictly exudative lesions. In the chronic hrematogenous group all of four patients improved, and in the productive pulmonary infiltrative group three out of four patients improved. Madigan considers that in general all exudative phases of infiltrative disease were halted and reversed by the administration of "Sulphetrone". He emphastzes the need for long-continued courses and for routine laboratory control and sums up with the opinion that "Sulphetrone" is "useful as an adjuvant with definite objectives in view". The same general conclusion was reached by M. G. Clay and A. C. Clay, of Aberdeen,' from the treatment of 44 patients. Their results briefly were that improvement was noted in 22 cases; nine patients improved considerably, seven moderately and six slightly, the improvement not being dramatic. Toxic sideeffects were observed in six patients; these effects disappeared on withdrawal of the drug. The necessity is expressed for facilities for estimating blood "Sulphetrone" levels and for carrying out blood counts. The final conclusion of the Clays is that at best "Sulphetrone" can be regarded as only an adjuvant and not in any way as a specific for tuberculosis. This is probably the essence of the opinions of all the investigators, though they are not all quite so cautious. No mention has been made here of the details of other coincidental treatment which is described in the several reports, but all the investigators have taken this into consideration. The unpredictable course of tuberculous infections and the impossibility of arranging satisfactory controls are thoroughly realized, so that dogmatic conclusions are as yet quite unwarranted. However, all investigators obtained generally encouraging results, while not claiming cures, and it seems that at least further trials of "Sulphetrone" are desirable, with the object of finding it a place, if warranted, in the treatment of selected cases of tuberculosis.