Sulphonamides and penicillin in the treatment of trachoma.

THERE has been considerable controversy as to whether or not sulphonamides have a specific effect on the, virus of trachoma. The answer to the question has importance not only for the correct treatment of the disease, but it also has importance as an aid in the classification of the group of morphologically indistinguishable viruses to which that of trachoma belongs. The extensive literature on the subject has been reviewed so often that it would only be -tedious if I were to do so again in this communication. Sufficient be it for me to say that of the numbers who have written on the subject a substantial nrajority has claimed a specific effect for sulphonamides upon the virus. Most of the protagonists of sulphonamides have -depended upon clinical observation. This in a disease whose end-point is so ill-defined, and in which the stage at which it ceases to be infectious is largely a matter of conjecture. Some have submitted sulphonamides to the more critical test of examining smears of conjunctival scrapings for the presence or absence of tht specific inclusion bodies before and after the course of treatment. The sulphonamide most extensively used has been sulphanilamide administered internally. Thygeson' claims that in cases in which specific inclusion bodies were found previous to the internal administration of sulphanilamide they could not be found afterwards. In this series of 31 cases of trachoma he found inclusion bodies in 16 (515 per cent.) before the commencement of sulphanilamide therapy. This is a high percentage of positives and is still the more remarkable in so much as 8 of the 16 cases are listed as being in either stage 3or stage 2-3. The percentage of positives in the series of54 cases of trachoma hereafter to be reported on was 33-3, and 53 per cent. of these were stage 1. Julianelle2 in a series of 602 cases found that 32 7 per cent showed the presence of specific cell inclusions, and in an analysis by him of forty-two reports from various countries in which a grand total of 5,777 patients was recorded the percentage of positives was 30 8. Thygeson reports that in all the 16 cases which were positive cell inclusions could not be found after so short a period as three days' treatment with sulphanilamide. In spite of this finding only 10 per cent. of the 16 cases are recorded as being " healed." He found that sulphanilamide therapy had no effect on secondary infection,