SULFANILAMIDE — SPINK 485 



and the wound contaminated by dirt and microorganisms, there was 

 a gi-eat danger of infections occurring in the injured tissues. To pre- 

 vent these infections, these surgeons have placed pure sulfanilamide 

 crystals in the wounds with the results that the incidence of infec- 

 tions following compound fractures has been considerably reduced. 



The question is often raised, How does sulfanilamide work? The 

 answer is still shrouded in some mystery, but we can say that the 

 drug acts directly upon the microorganisms interfering with their 

 metabolism. They fail to reproduce as rapidly, and those remaining 

 are injured so that the defense mechanism of the body can cope with 

 and kill them. As a matter of fact, there is some evidence that 

 sulfanilamide may actually kill small numbers of organisms. 



Thus far, we have extolled the virtues of sulfanilamide. It must 

 be emphasized again and again that sulfanilamide and its related 

 compounds are potentially dangerous drugs. Their administration 

 to patients may result in serious toxic reactions. Under no circum- 

 stances should any individual take any of these drugs unless they are 

 prescribed by a physician. The physician, in turn, must be prepared 

 to observe the patient closely, and withdraw the drug when toxic 

 signs and symptoms manifest themselves. Shortly after sulfanil- 

 amide had been accepted by the medical profession of this country, 

 a number of human lives were sacrificed following the ingestion of a 

 preparation known as Elixir of Sulfanilamide. It was discovered 

 that the cause of these deaths was not due to sulfanilamide, but to 

 a constituent of the Elixir, diethylene glycol. In order to prohibit 

 the hasty marketing of new drugs with a repetition of another 

 tragedy. Congress revised the Federal Food and Drug Act. At the 

 present time, new chemotherapeutic agents are made available for 

 the medical profession only after they have been thoroughly investi- 

 gated as to their toxic properties and therapeutic value. 



I would like to discuss now the toxic reactions that are caused by 

 sulfanilamide in the human being. It is well that the patient, the rela- 

 tives, and physician should have some knowledge of these manifesta- 

 tions. Some of these are more serious than others. Certain of these 

 may cause the patient and those caring for him some alarm, but may not 

 be a contraindication to a continuation of therapy. The first group of 

 toxic manifestations are related to the central nervous system. They 

 are dizziness, headache, mental depression, giddiness, nausea and 

 vomiting, convulsions, and psychoses. Usually, we do not consider the 

 first four serious enough to warrant withdrawal of the drug when the 

 patient is kept in bed. However, the exhibition of dizziness and gid- 

 diness may be of serious moment in ambulatory patients who endeavor 

 to carry on their daily work, particularly in those individuals oper- 

 ating motor vehicles, or engaged in dangerous occupations. Bed- 



