The experimental induction of localised skeletal tuberculous lesions and their accessibility to streptomycin.

There has been prolonged disagreement and confusion over the penetration of antituberculous antibiotics and chemotherapeutic agents into skeletal tuberculous lesions. Surgical extirpation has been recommended by many workers on the supposition that drugs are unable to gain access to skeletal tuberculous abscess and necrotic bone (Wilkinson 1950, 1955, 1969; Orell 1951 : Hodgson and Stock 1956; Kondo and Yamada 1957; Hodgson, Stock, Fang and Ong 1960). On the other hand, encouraging results of successful treatment of skeletal tuberculosis by modern anti-tuberculous drugs without routine operation have been reported by many workers more recently (Konstam and Konstam 1958; Konstam and Blesovsky 1962; American Thoracic Society 1963 ; Konstam 1963 ; Chofnas, Surrett and Severn 1964 ; Friedman 1966; Dickson 1967; Tuli, Srivastava, Varma and Sinha l967a and b; Tuli 1969; Tuli and Kumar 1971). In the human disease many uncontrolled variables such as the site, duration, extent ofthe disease, pathological structure ofthe lesion, age and nutritional state ofthe patient, sensitivity of the organism and previous treatment make the evaluation of penetration of various anti-tuberculous agents extremely difficult and undependable. Fell#{228}nder, Hiertonn and Wallmark (1952), Katayama, Itami, Oya, Tanaka and Maruno (1954) and Hever and Risko (1960) tried to determine the concentration of streptomycin in tuberculous material from human skeletal tuberculous lesions but found the results to vary widely from patient to patient. To resolve the controversy regarding the power of penetration of the anti-tuberculous drugs an experiment was prepared to promote chronic localised skeletal tuberculous lesions in