CHAPTER LXXXIII 

 CHEMOTHERAPY OF BACTERIAL DISEASES' 



JOHN A. KOLMER 



University of Pennsylvania and Research Institute for Cutaneous Medicine, Philadelphia 



"Chemotherapy" may be defined as the prevention and treatment of disease by 

 chemical disinfection or inhibition of the parasitic causes without marked or serious 

 toxic effects. It usually conveys the idea of specific therapy, and properly so, but its 

 practical applications are by no means limited to the treatment of syphilis, malaria, 

 and a few other infectious diseases, as popular impressions would indicate. It is true 

 that most advance has been made in the treatment of these as well as in relapsing 

 fever, frambesia tropica, trypanosomiasis, leishmaniasis, schistosomiasis, amebic and 

 other protozoan and metazoan infestations, but some real progress has been made 

 also in the important field of bacterial diseases and especially when chemotherapy is 

 employed for the treatment of local as well as of systemic infections. In other words, 

 the local disinfection of tissues by chemical agents properly belongs to this new field 

 of therapeutic science and greatly broadens the field of application and usefulness. 



It is true, however, that some of the original theories of chemotherapy have begun 

 to show themselves inadequate for our expanding knowledge of the processes con- 

 cerned and require reconstruction, though without either hasty or wholesale rejection 

 of those principles which served Ehrlich and other early workers so well. But the 

 original idea of chemotherapy, tending to shift the focus of attention from the in- 

 fected host to the invading parasites by producing chemical agents capable of direct 

 destruction of organisms without the co-operation of the host, has been questioned 

 and especially in relation to the disinfection of the tissues in generalized infections, 

 although this simple mechanism may, and probably does, hold good to a large degree 

 for the disinfection of the tissues by local or topical application of parasiticidal agents, 



PARASITOTROPISM, ORGANOTROPISM, AND THE CHEMOTHERAPEUTIC INDEX 



A special and selective affinity of the chemical agent for the parasite designated as 

 "parasitotropism" is the predominant thought in modern chemotherapy. "Organo- 

 tropism" refers to the affinity and effects of the agent for the blood, lymph, and fixed 

 tissues of the body, and the relation between the two is expressed as the "chemo- 

 therapeutic index." In other words, parasitotropism refers to the toxicity of the 

 chemical agent for the parasites, and organotropism to thetoxicityfor the body cells; 

 the aim of chemotherapeutic research is to discover compounds with a maximum of 



Maximal tolerated dose per kilogram . . , 



-.,. ■ — ] — - — -. 3 Tm = Cnemotnerapeutic mdex. 



Mmimal curative dose per kilogram ^ 



' A fuller discussion of this subject with complete bibliography will be found in Kolmer, J. A.: 

 Principles and Practice of Chemotherapy with Special Reference to the Treatment of Syphilis. Phila- 

 delphia: W. B. Saunders Co., 1927. 



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