Sulphetrone

What It Is Achieving In Treatment Of Leprosy

INTERESTING things about leprosy— one of the oldest diseases known to mankind —were told in a broadcast .ddress in New Zealand, on November 26, y Dr. C. J. Austin, medical superintend nt of the Makogai Leprosarium, Fiji.

The disease was rampant in Europe in be Middle Ages; there was little, if any, reatment of individual cases; yet it be ame extinct there. The doctor said this lay have been due to the ruthless isola- Lon of lepers, and to the fact that so irge a part of the population (including lost of the sick and neglected lepers) died i the Black Plague of the fourteenth sntury.

Chaulmoogra oil had been used against iprosy in India and SE Asia for Gent ries, but it came into use by Europeans nly in recent times. It has rather violent ;action in some people and it is of little se against advanced cases. However, it as effective in a large proportion of irly cases.

There is a very strong resemblance be veen leprosy and tuberculosis; but one ifference is that, while some animals can mtract TB (and thus be used for re larch against the disease) no animal will mtract leprosy. This fact led to the scovery of the new drug—sulphetrone— dw being used against leprosy. Here is r. Austin’s story:— “In 1942 certain drugs known as sul mes were found effective in the tuber ilosis of guinea pigs, as well as in sterl ing cultures of the tubercule bacillus, hey proved much less useful, however, in jman tuberculosis, as well as being ghly toxic, producing severe anaemia id other changes.

“In an attempt to reduce this toxicity, number of similar drugs were produced ithin a short while, and as early as 1943 vourable results in leprosy were re tried. The drugs were, however, in very iort supply owing to more urgent needs the time, and the post-war dollar situa m still further delayed our chances of ying them out. It was just over two ars ago that we obtained our first sup y of sulnhetrone—a sulphone derivative epared in England.

“In my Annual Report for 1948 —only r o months after starting sulphetrone satment —l was able to refer to its out mding and rapid effect in clearing long mding ulceration in leprosy. But I had couple this tribute with a warning re rding the drug’s marked toxicity, cessitating frequent blood examinations d the utmost care in assessing the in

fidual dosage.

‘At the time we had only sufficient sul etrone for about 60 patients, so I had cided to give it to the most severe of r cases, on the ground that it might ill represent their only chance of im- Dvement. It was not, therefore, a fair al for a drug already known to be fie, and it is not surprising that more an half of the patients had to be taken the treatment during the first month. ‘Only 14 of these 60 advanced cases re able to maintain the moderate dose 3.0 grams daily for the two months the first trial. A number of those who d been unable to stand the drug at first re able, after a short rest and a course iron and liver treatment, to resume it smaller doses. ‘ln spite, however, of this evidence of irked toxicity, and in spite of the con sent broken treatment and small dos e, 27 of these 60 patients became com itely free of ulceration within the two mths, and 20 more were recorded as ich improved from that point of view. ‘When it is realised that these were

ulcerations of long standing which had successfully resisted all previous forms of

treatment—including Chaulmoogra oil .

hitherto the only recognised treatment for ieprosy—as well as Penicillin and the Sulpha drugs, it is evident that the introduction of the sulphones represents the arpafpst advance in lenrosv trpatmpnt Ss yet been'made. lePr ° Sy treatment tha t • .

The difficulty in assessing progress up to date is that the clearing of these sores has deprived us of one of our best indications of improvement. We no longer have any ulcerations of this type, which

by their rapid healing can give such striking evidence of improvement.

< Itt „

Unfortunately the healing of these ® ore ? nc s m^ an that . le^ os ? £ al f mg them has been cured. No patient ™V et . beco ™ e ell S lb Jf discharge from IMakogai as the result of sulphone treat ment, for we have a probationary period of two years after a patient has been found free from leprotic activity before he can be discharged.

“That this policy is fully justified is shown by a recent case in which I my self found a candidate for discharge to

be harbouring leprosy bacilli on the actual day on which the Discharge Board was considering my own report that he had been free from leprotic activity for the previous two years. It’s a good thing we lay no claim to infallibility!

“There is no doubt in my own mind, however, that the improvement under sulphone treatment—so dramatically shown by the rapid healing of open sores —is steadily continuing, though less ob viously and perhaps much more slowly, in the great majority of our patients who can stand the treatment. Most of them

look and feel much better, and from the bacteriological point of view, they show fewer bacilli on the whole, and such bacilli as can be found appear to be de generating.

“Time will tell whether this improve ment can go on to complete cure, and in any case such a result cannot be a rapid one.”

The Rev. F. Kemp and Miss Eileen Davis, both members of the Methodist Overseas Mission in Papua, were married in NSW recently.