Recent Advances in Oto-Rhino-Laryngology, with Special Reference to Penicillin Therapy

I HE advent of chemotherapy has forced physicians and surgeons to change their views on the prognosis and treatment of many injuries and diseases. The greatly improved results following the introduction of the sulphonamides has been further advanced by the discovery and use of penicillin. Previously, surgery's main ftunction in many cases of infection was to provide drainiage, leaving the defences of the bodv to deal with the infecting organisms. Now the defences can be greatly supplemented by chemotherapy. This short communication is mainly concernedl with penicillin. I shall not deal with the history, chemistry, pharmacology, or bacteriology of penicillin, but will devote my remarks mainly to the methods of administration and the accepted and proved uses. It canrot be too often repeated that for penicilliin to be of any use, the infecting organism must be susceptible. bacteriological examination should be carried out as soon as possible, but this does not mean to say that the commencement of treatment with penicillin need be delayed until reports are received. If the examination proves the infection to be due to a non-penicillin-sensitive organism, penicillin therapy should be discontinued and otlier appropriate measures substituted. Ad-nministration of peniicillinl mnay be by the system-ic, initra-thecal, or local routes. For systemic use, the penicillin salt is dissolved in sterile, re-distilled water. For intra-thecal use, the pure cr-ystallinie penicillin slhould be used. For local use, the followinig preparationis are, in common use :-creams anid ointnmelnts, powders, lozenges, sprays, and drops. 'I'he Cremor Penicillini (B.P.) rather than the Cremor Penicillini Sterilisatus (B.P.) should be prescribed for the patient's own use, because it contains 1 per cent. chlorocresol. This prevents penicilliniase-producilng organisms growiing in it. If pyocyaneus infection complicates the picture, 2 per cent. phenoxetol may be ad(le(d to the cream. Only eniough cream to last a week should be prescribed at one timne. Sprays anid drops are use(l in strengths of 1,000 to 2,000 units or more per c.c. in sterile (listille(i water or sterile normal saline. Ihese lose their potency in five or six (lays, sO only small quantites should be prescribed. The dropper or spray should be boiled frequently. Powders are prepared by mixing a sterile sulphonamide or lactose with calcium penicillin in strengths of 500 to 10,000 units per gramme. The dry powder retains its potency for about six months. THE EAR Staphylococcal and streptococcal infections of the skin of the pinna may be treated …