Chemotherapy of Tuberculosis: a Bacteriologist's Viewpoint

One of the most fruitful scientific methods for investigating the treatment of many conditions is the controlled clinical trial. Marc Daniels was a pioneer in the application of this procedure to the chemotherapy of pulmonary tuberculosis. He was responsible for the coordination of the first Medical Research Council co-operative studies in Britain. His scientific stature is demonstrated by the great care with which he collected his data, by his accuracy in the analysis of the results, and by his far-sighted judgment in their interpretation. It is fitting that many of the findings described in the present communication were obtained during the course of controlled clinical trials, carried out under the auspices of the Medical Research Council in the East African countries, and at the Tuberculosis Chemo- therapy Centre, Madras.-Before the discovery of antibacterial drugs for the treatment of tuberculosis therapeutic measures were mainly aimed at increasing the patient's resistance to the disease. These measures included rest for the patient and for the affected organ, good food, and an absence of emotional strain. However, with the increasing use of antibacterial drugs the aim in treatment has changed. The host and his immune response have become less important, while the reaction between the tubercle bacillus and the drug has come to dominate the scene. If we now wish to improve the results of treatment we attempt to use better drugs and to give them in the most efficient manner. It is my purpose to illustrate this change in attitude and to try to explain some of the more important bacteriological concepts involved.