482 AKNTJAL REPORT SMITHSONIAN INSTITUTION, 19 40 



extensively used in England and on the continent, it was never intro- 

 duced for general use in tliis country. Sulfanilamide has been the 

 drug of choice in the treatment of various diseases due to the hemoly- 

 tic streptococcus. In evaluating the results of sulfanilamide therapy 

 in this type of infection, it has been observed that the drug has 

 shortened the duration of the disease, prevented complications, and 

 reduced the mortality rate. Following are some of the streptococcal 

 infections for which sulfanilamide has been of value: Puerperal 

 fever, erysipelas and cellulitis, septicemia, scarlet fever, acute otitis 

 media, mastoiditis, meningitis, pneumonia, tonsillitis, and peritonitis. 



Puerperal fever is an invasion of the issues by streptococci occur- 

 ring in mothers at the time of childbirth or shortly thereafter. It is 

 a disease that has been viewed with alarm for many years by the 

 medical profession because it has such a high death rate; it is con- 

 tagious, often sweeping through a maternity hospital; and specific 

 therapy has been wanting. The investigations of Colebrook in Eng- 

 land, and others, have shown that sulfanilamide and its related com- 

 pounds have lowered the death rate, shortened the duration of the 

 disease, and prevented disabling complications. 



Erysipelas and cellulitis, which are streptococcal infections of the 

 skin and their deeper structures, have responded well to sulfanilamide 

 therapy, provided the drug is given early in the course of the disease. 

 These infections often kill patients because the streptococci invade 

 the blood stream. Sulfanilamide not only affects the local lesion, but 

 keeps the blood free of organisms. 



Septicemia, or the state wherein streptococci actually reproduce in 

 the circulating blood, has been one of the most feared of all infections. 

 The onset is sometimes insidious, but terminates in a fulminating and 

 often fatal infection. You probably all know of examples where an 

 individual had an innocent appearing lesion, such as a blister which 

 had ruptured, and then streptococci invaded the injured tissue, quickly 

 entered the blood stream, and death resulted. Treatment in most in- 

 stances has been ineffective. The mortality rate was over 75 percent. 

 Sulfanilamide therapy has cut this rate at least in half, and we may 

 expect even better results in the future. 



Scarlet fever, for the most part today, is a mild streptococcal in- 

 fection, but it may result in serious complications. Convalescent 

 human serum or potent antitoxin obtained from the serum of im- 

 munized horses are useful and often adequate in the treatment of scarlet 

 fever. It would appear that the early administration of sulfanilamide 

 may prevent the formation of metastatic bacterial complications. In 

 other words, antitoxin neutralizes the toxin elaborated by the strep- 

 tococcus, whereas sulfanilamide acts directly upon the organism. 

 Doctors Sako, Dwan, and Platou, working at the Minneapolis General 



