Penicillin in Subacute Bacterial Endocarditis

IN the autumn of 1944 a small committee was formed in Belfast to investigate the clinical applications of penicillin, and for various research projects special supplies of penicillin were received from the Medical Research Council of Great Britain. In February, 1945, the committee agreed to accept responsibility in Northern Ireland for a thorough clinical trial of penicillin in subacute bacterial endocarditis. This trial was organised by the Medical Research Council on a nation-wide basis, and University centres in England, Scotland, and Wales also took part. In each of several groups of such centres a different daily dosage was allotted and, in the case of Belfast, this dose was fixed at 250,000 units. Relatively large quantities of penicillin were therefore required and used, and it was necessary to insist on adequate bacteriological confirmation of diagnosis, and on a careful and prolonged clinical and laboratory control of the progress of the disease during and after treatment. The preliminary results from all centres were recently reviewed by Christie (1946). The Belfast Committee is greatly indebted to successive Penicillin Officers attached to the Royal Victoria Hospital, Drs. L. Leitch, R. J. L. Wilson and B. T. Smyth, for their interest in the special investigation and treatment of these cases in that hospital. The report below has been prepared for the Committee by Dr. Wilson and Dr. Smyth, and is of such general interest that its publication is most desirable.