Sulfanilamide Survey

Only since February 1935 has the drug sulfanilamide been known. In the past three years it has proven so useful as a treatment for "coccus" infections (streptococcus, gonococcus, meningococcus) and there has been so much to learn about its effects that practically every issue of every medical journal has referred to it. Several months ago, following the deaths of two score Southerners who had taken an "elixir" of sulfanilamide & diethylene glycol (TIME, Dec. 20, et ante), the Journal of the American Medical Association published a survey of sulfanilamide's uses and dangers. But so many new discoveries have occurred that the New England Journal of Medicine had Dr. Maurice A. Schnitker of Harvard's Peter Bent Brigham Hospital make a new survey, which it published last fortnight. Its prime points:

Effects. Sulfanilamide inhibits the growth of certain germs, perhaps injuring them "in such a way as to permit them to be [destroyed] by the white blood cells." It also seems to strengthen the resistance of the body toward germs and to inhibit the production of toxins by germs.

Uses. Sulfanilamide has cured septicemia, erysipelas, meningitis, scarlet fever, otitismedia (earinflammation). It has cured some cases of tonsillitis, peritonitis, osteomyelitis. It has cured gonorrhea in people who have been infected for some time, but "first infections . . respond poorly if at all." It is a good antiseptic against infections of the kidneys and bladder.

Toxicity. "Untoward reactions, even death, may result from the administration of sulfanilamide. . . . The toxic effects are more commonly the results of its indiscriminate use, but may occur from an idiosyncrasy. . . . Fifteen per cent of patients cannot take large doses, and 10% are unable to tolerate it at all. Patients in bed tolerate larger doses than do those who are ambulatory. Patients exposed to sunlight are more apt than are others to develop a skin rash." The rash may resemble measles, scarlet fever or hives, and break out on the face, trunk or extremities. Slight poisoning by sulfanilamide causes headache, vomiting, dizziness, breathlessness. A person dying from an overdose of sulfanilamide becomes blue, has pains in abdomen and chest, gasps. His heart beats fast; his hands & feet tingle; he has diarrhea.

No other drugs should be used with sulfanilamide, "except sodium bicarbonate. . . . Any preparation which produces a watery stool such as magnesium sulfate [Epsom salts] and other cathartics may aggravate the deleterious effects of sulfanilamide. Hydrochloric acid and coal tar derivatives may act similarly. . . . The colon should be kept free from food residues by a cleansing enema before treatment is started, and a low-residue diet . . . containing few eggs should be given."

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