Good News from the West

From the sunbaked wastes of Arizona's Navajo Reservation came dramatic news about the new TB drug, isoniazid (TIME, March 3). The report was carefully evaluated in the gleaming tower of Manhattan's New York Hospital-Cornell Medical Center. Then, last week, Cornell's Dr. Ralph Tompsett got up in London's cavernous, dingy Central Hall and passed the news to 400-odd experts gathered for a British Empire conference on TB. Sum of the findings: isoniazid is the only drug that belongs in the same class with streptomycin for effectiveness against tuberculosis. In most respects it is as good as streptomycin; in some ways, better.

In the great majority of cases, tuberculosis attacks the lungs. Isoniazid* was first given to such patients a year ago, and enthusiastic reports of good results broke out during the winter. But TB of the lungs is an unpredictable disease; of two patients with chest X rays which look alike, one may die quickly while the other gets better for no apparent reason. It might take years, and thousands of cases, to prove the value of a drug in these circumstances.

Human Test Tube. Less common but deadlier forms of tuberculosis are meningeal, in which the bacilli attack the covering of the brain and spinal cord, and miliary, in which they spread throughout the system. Untreated, both meningeal and miliary tuberculosis commonly kill within two or three months, and about one-third of the victims get only temporary help from streptomycin. To researchers, a patient with miliary TB is like a human test tube. The course of his disease is so predictable that they can tell just what a drug is doing for him.

As soon as they knew that isoniazid was safe, the Cornell researchers turned to the Navajos of Arizona to give it a thorough test. With their high susceptibility to TB and wretched living standards, the Indians provide a tragically large number of miliary and meningeal cases. Often, one patient has both forms. The Navajos were eager to help medical research fight the white man's disease which has killed more of them than white man's bullets ever did. Their Tribal Council put up $10,000 toward the project.

Hungry for the Bottle. The first Navajo to be treated with isoniazid was a seven-month-old baby girl named Patty. When her parents brought her to Dr. Charles M. Clark at Western Navajo Hospital in Tuba City, Patty was a wizened starveling of 9 lbs., with miliary TB. Her temperature was 103DEG and she had to be fed by tube. After 17 days of treatment with isoniazid, her temperature dropped to normal and she began taking the bottle hungrily. Now Patty weighs 16 lbs. and her TB seems to have been arrested.

A 17-year-old Navajo girl named Jean Smith was Dr. Clark's next miliary case. She weighed 79 lbs., had an agonizing, rattling cough and had trouble breathing. Moreover, says Dr. Clark, the X ray of her lungs "looked like a snowstorm." Under treatment with isoniazid she soon got rid of her fever, cough and shortness of breath. Jean has eaten her way up to 114 lbs.

Almost as heartening are the early results in tuberculous meningitis. Dr. Clark has treated several cases which had relapsed after courses of streptomycin. After 80 days of streptomycin, eight-year-old Elsie still had a fever; she had TB germs in her spinal fluid; she was mentally clouded and suffering spasms. Within a month, isoniazid changed all that, and not long after, Dr. Clark was able to take Elsie to the circus.

Another patient who went to the circus instead of a cemetery is Little Joe, also eight. Within ten days, isoniazid ended his unbearable headache and loosened his stiff spine and neck. Now Little Joe is the life of the men's ward at Winslow Indian Sanatorium, first up in the morning and (complain the tired oldsters) the last to turn in at night.

Questions. As Dr. Tompsett was careful to point out in London, bacilli can still be found in most patients with TB of the lungs after months of isoniazid treatment. So there is no reason to believe that the drug can really wipe out the disease. Nobody knows how long the drug can be given at a stretch, or how soon its effects may wear off after it is withdrawn.

Finally, there is the frightening fact that tubercle bacilli, by changing their nature, may learn to live with isoniazid, producing "resistant strains." But there is reason to believe that these can be kept to a minimum by giving isoniazid along with another anti-TB drug.

Near-final answers to most of these problems should be in by year's end. Meanwhile, the patient Navajo patients and the Bureau of Indian Affairs have helped Dr. Clark and the Cornell researchers to prove isoniazid's worth. It is the second truly great weapon for chemical warfare against TB.

*The hydrazide of isonicotinic acid, marketed under such names as Rimifon, Nydrazid, Pyricidin, Dinacrin. A related drug is trade-named Marsilid.

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