Diasone in the Treatment of Pulmonary Tuberculosis

¹ The medical service of Sea View Hospital, Staten Island, N. Y.

1) A concept of chemotherapeutic cure in tuberculosis is entertained whereby sputum alteration becomes the major criterion of change.

2) Cases benignly resolving or inevitably progressive and those complicated by extra-pulmonary tuberculosis or other diseases were eliminated from this study in order to fairly evaluate the usefulness of diasone.

3) One hundred and six patients were selected for the study. Ninety-three per cent of these were classified as predominantly caseous-pneumonic. According to other classifications, they are recorded as 64 per cent far-advanced, 33 per cent moderately advanced; 75 per cent were positive over six months before institution of therapy; 75 per cent had sputa in the high Gaffky range.

4) Therapy was discontinued in four of the 106 patients because of marked toxicity. There were skin lesions in each of these cases; one terminated fatally. Other signs and symptoms of toxicity were frequently encountered but these were relatively mild and transitory.

5) Results after four months of therapy — 102 patients. Evidence of conversion in 20 patients (19.6%); sputum appreciably reduced (See text,"sputum" under heading of "results" for definition of "reduction") in 15 patients (14.7%). The conversions and reductions occurred at a higher rate in the moderately advanced or minimal, predominantly productive groups and in those positive less than six months before institution of therapy.

6) The combined conversion and reduction rate was 34.3 per cent.

7) Results after six months of therapy — 41 patients. Evidence of conversion in eight patients, appreciable reduction in 19. Total combined tabulation of the entire 102 patient series indicates sputum conversion in nine patients (8.8%), appreciable reduction in 21 (20.6%).

8) The chest x-ray demonstrated no significant change in one-half of the series. There was clearing and reduction in cavity size in one-fifth of the series; new lesions and increased cavity size were noted in one-fifth; new cavities appeared in two patients. Among the conversions there was clearing in one-third of the patients and no change in two-thirds. One conversion presented a persistently visible cavity. Diasone did not prevent spreads. Emphasis is placed upon the relative unimportance of the x-ray in evaluating chemotherapy since considerable lag between "sterilization" and visible healing changes is anticipated.

9) A 50 patient control series manifested 12 per cent spontaneous conversion and four per cent reduction rates.

10) The unusually high percentage of relapses at six months after an excellent start at four months suggests interference with the proliferation of the tubercle bacillus at that time and reflects the probability of early "open healing." It also introduces the concept of "drug fastness."

11) With chemical control of the tubercle bacillus the usual criteria of arrest will have to undergo considerable modification.

12) Because of the evidence of early weak activity, diasone should not be abandoned but a new approach should be considered.