Tuberculosis: The Chemotherapeutic Approaches

'[HE' term, chemotherapy of tuberculosis, implies a simplified concept which may have been compromised in the reader's mind by the experience of, successful chemotherapy in other fields. It is not a misplaced pedantry which leads clinicians to speak of the "management" of tuberculosis, but rather a work-a-day acquaintance and understanding of the many diverse pathological conditions involved. The mechanical changes have links in common with those found in typhoid fever, in schistosomiasis, in leprosy, and in syphilis. These basic facts were elicited fifty years or more ago by some of the most remarkable pathological studies ever reported, and there is a (langer which some see lurking in a certain neglect of these lessons by those of us whose businiess it is to stucdy the chemotherapy of tuberculosis, both experimentally and clinically. No other host-parasite relation has been the subject of such detailed enquiry at thc hands of the pathologists (Rich, 1944), bacteriologists, chemists (Wells and Long, 1932; Anderson, 1932), and others. Appreciation of the unusual pathology of this normally self-limiting chronic disease has emphasised the desirability of approaching the problem of elimination of the parasite on a broad front. It will be convenient for our present purpose first, to point the nature of the biochemical lesions which the observed pathological changes indicate, and from this basis, to review the present advances. Usually, by the time the disease is identified clinically it has established its characteristic pathology, the tubercle, and this is so even in tubercular meningitis (Rich and McCordock, 1933). The minimal clinical lesion visualised, for example, by X-ray shadows, represents destructive changes and reflects, as we shall see at least two 'biochemical lesions.'