Patient 13/1949


Streptomycin was the first effective antibiotic drug treatment for tuberculosis. It was first brought to the UK in 1946 where the UK Medical Research Council's TB unit undertook trials to look at the effectiveness of combining Streptomycin with the traditional treatment of bed rest to bed rest alone; Streptomycin plus bed rest gave greater results. It was introduced as a treatment for tuberculosis in Stannington Sanatorium from 1947, however, it was not widely used and instead particular cases were singled out as suitable candidates for treatment. There were several problems arising from the use of Streptomycin that meant it could not be a cure-all treatment for everyone.


Patient 13/1949 was one of those to receive Streptomycin as a means of treating TB meningitis. This patient had been admitted to Newcastle General Hospital on 17th August 1948 with drowsiness and vomiting. Initial observations identified spinal stiffness, bilateral papilloedema (optic disc swelling) and drowsiness. She was diagnosed with TB meningitis and started on daily Streptomycin treatment both intramuscular and intrathecal, into the spinal canal to cerebrospinal fluid. She became less drowsy but the papilloedema persisted and by 6th September little improvement was noticeable with marked drowsiness, vomiting and headaches followed by incontinence, neck stiffness and finally unconsciousness; treatment was stopped on 15th September.


      AGE : 7


SEX: FEMALE


ADMISSION : 25th Jan 1949


DISCHARGE : 3rd May 1949


DIAGNOSIS: Healed TB Meningitis (Streptomycin Treatment)



A week after treatment had stopped the patient showed marked improvements so intrathecal injections were started again but under general anaesthetic. General improvement was noted but the papilloedema did not recede. In addition it was becoming more difficult to administer the intrathecal injection due to growing restlessness. A ventriculography, a radiograph of the ventricles of the brain with cerebral fluid replaced with air, was undertaken and following this a tube was inserted along the floor of the skull to the interpeduncular fossa and Streptomycin was injected along the tube on alternate days. Delirium was noted to occur for the first few days followed by steady improvement with the patient being described as rational and happy. By December 1948 she was able to get up, initially being ataxic but this improved slowly. In January 1949 her cerebrospinal fluid was still abnormal but was still showing great improvement. She was transferred to Stannington to continue her convalescence with the instruction of retuning her to Newcastle General Hospital if she developed headaches or vomiting for more than 48 hours.


This case clearly illustrates how Streptomycin was not always a simple cure. One noted side-effect in children is the possibility of irreversible auditory nerve damage. Contemporary studies also showed that toxic reactions to interthecal Streptomycin could occur sometimes with fatal consequences. The invasive methods of administering the drug meant that when it was first introduced some of the children in Stannington Sanatorium that were chosen to receive the treatment had to be discharged to a local hospital to receive it. Nonetheless, it still provided incredibly successful results and patient 13/1949 went on to be discharged as quiescent.


The years following the introduction of Streptomycin saw the development of several other drugs effective in the treatment in TB which helped to tackle problems of drug resistance. Instead combination therapy using multiple drugs became possible and their proper administration meant that the development of drug-resistant strains could be tackled. Owing to drug resistance and its difficult administration Streptomycin is no longer a first line drug but remains on the World Health Organisation's (WHO) list of essential medicines.