SULFANILAMIDE — SPINK 487 



that the patients died. Whether the temporary liver dysfunction that 

 the majority of patients have while taking sulfanilamide results in 

 any permanent damage will depend upon further investigation. 



One of the most common signs of sulfanilamide toxicity is anemia, 

 or the destruction of red blood cells in the circulating blood. This 

 usually happens after the drug has been taken for several days. In 

 the majority of cases, this destruction of cells is only of moderate 

 severity, but not infrequently there may be a sudden and precipitous 

 drop in the level of hemoglobin, endangering life if drug therapy is 

 not discontinued. This acute destruction of red blood cells is appar- 

 ently another expression of drug sensitivity, since the patients who 

 have exhibited this phenomenon may have the same reaction when an 

 initial dose of the drug is given several months after the first reaction. 



A more serious form of blood dyscrasia resulting from sulfanilamide 

 is a disturbance in the formation of the white blood cells. In common 

 Avith other toxic signs, this decrease in the number of circulating 

 leukocytes emerges after patients have ingested the drug for several 

 days. When the level of white blood cells does drop below normal, 

 sulfanilamide therapy should be suspended at once. One of the most 

 feared of all complications in this respect is agranulocytosis, wherein 

 there is a failure of the bone marrow to deliver leukocytes to the 

 circulating blood. This condition is highly fatal. 



Other toxic expressions of sulfanilamide have been encountered, but 

 they are less common. Among these is neuritis. Optic neuritis with 

 blindness has been recorded, as well as neuritis of the peripheral 

 nerves. I have dwelt at length on the toxicity of sulfanilamide for 

 the human organism in order to emphasize the inherent danger in the 

 injudicious use of the compound. I believe that you will agree with 

 me when I state again that self -medication is to be deprecated. 



As was anticipated, new derivatives of sulfanilamide have been 

 synthesized, and used in the therapy of certain infectious diseases. 

 In May 1938, Dr. L. E. H. Whitby of London announced that a new 

 derivative known as sulfapyridine was more effective than sulfanila- 

 mide in the treatment of infections due to the pneumococcus. The 

 most prevalent type of infection caused by this organism is pneu- 

 monia. It is also the etiological agent of a severe and fatal form 

 of meningitis. Although statistics for pneumococcal pneumonia have 

 shown a reduction in the mortality rate following the widespread use 

 of immune serum, there is still considerable room for improvement. 

 Sulfapyridine has proved to be an effective therapeutic agent for this 

 type of pneumonia. It is relatively easy to administer, and is less 

 costly than serum. This does not mean that the use of serum has 

 been abandoned. There is some evidence that in the more severe 

 cases of pneumonia, the combined employment of immune serum 



