ANTIBIOTICS AS CHEMOTHERAPEUTIC AGENTS 295 



failure may have been due to the small amount of streptomycin ad- 

 ministered. 



Salmonella as well as E. coli infections lend themselves readily to 

 treatment with streptomycin. A patient with a colony count of 23 mil- 

 lion Salmonella in the stool gave a negative stool after 4 days' oral 

 therapy with i gm. streptomycin daily, the number of E. coli was re- 

 duced simultaneously to about 1,000} S. jaecalis disappeared and the 

 Clostridia were reduced from 75,000 to 8,000. P. tularensis is one of the 

 most sensitive organisms in vitro to the bactericidal action of strepto- 

 mycin. Parenteral administration of relatively low doses proved suc- 

 cessful in human tularemia. One patient who began to receive strepto- 

 mycin on the eighth day of the disease was sent home as cured on the 

 seventeenth day. In another case with perisplenitis and generalized 

 infection of the peritoneal cavity, the peritoneal fluid was noninfective 

 on the sixth day after treatment, whereas usually such fluid is infective 

 for at least nine months. Seven patients who had received strepto- 

 mycin all responded promptly. 



In a study of 34 tuberculous patients treated with streptomycin for 

 nine months, streptomycin exerted a limited suppressive effect, es- 

 pecially on some of the more unusual types of pulmonary and extra- 

 pulmonary tuberculosis. The reproduction of M. tuberculosis may 

 have been temporarily inhibited by the treatment} there was no evi- 

 dence, however, of rapidly effective bactericidal action. It was sug- 

 gested that studies be made of early pulmonary tuberculosis, tubercu- 

 losis of the genito-urinary tract, suppurative tuberculous lymphadenitis, 

 and early miliary and extensive hematogenous forms of tuberculosis 

 (429). 



In a recent summary (494a) of a thousand cases treated with strepto- 

 mycin, the following results were recorded: In urinary tract infections 

 (409 cases), the over-all recovery rate was 42 per cent. Of 100 cases of 

 H. infiien'zae meningitis, recovery was obtained in 79 per cent; the 

 17 fatal cases received treatment too late. Of 14 cases of meningitis 

 caused by other gram-negative organisms, 4 died. In 91 bacteremia 

 cases, 49 recovered, 12 improved, 26 died} again, the fatal cases were 

 treated too late. Striking results were seen in tularemia (^G'}^ recoveries 



