J.Jpn. Surg. Soc.. 54(11): 974-987, 1954

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Original article

STUDIES ON PENICILLIN TREATMENT, ESPECIALLY INTRACAVITARY INJECTION THERAPY OF PULMONARY GANGRENE

I have found intracavitary injection of penicillin to be most satisfactory for the treatment of pulmonary gangrene, as judged from the results on 65 cases in our clinic during the past 5 years. In order to discover the rationale of this treatment clinical, bacteriological and pathological studies were carried out with the following results.
1) The eｆfect of penicillin treatment seems to depend upon the penicillin content in the cavity, that is to say there is a relationship between the stage of disease and the method of administration of drug. As pathological changes are slight in early cases, the diffusion of penicillin into the cavity readily occurs even by intramuscular injection. However, with increasing changes of blood vessels (endarteritis) and bronchi (endo-, peribronchitis) resulting from the advancement of disease, the diffusion of penicillin becomes difficult not only by intramuscular but also by intratracheal injection. The intracavitary administration seems to be the only reliable method.
2) The penicillin sensivity of causative microorganisms found in the cavity are very complicated and they are classified into the following 3 groups:―(1)The penicillin sensitive group- dental spirocheta and B. fusiformis (2) The penicillin non-sensitive group― Bacillus and micrococcus (3) The intermediale group― B. ramosus, staphylococcus, streptococcus. Moreover, bacteriological examination of the sputum and pus in the cavity throughout the couse of penicillin treatment showed also the same results. So, the author has suggested that penicillin effect for such complicated mixed infections was obtained by obliterating the chain action of microorganisms, destroying the chief penicillin sensitive organism.
3) Pathological and histo-bacteriological studies showed tendency of good healing of penicillin-injected cavity, while no change could be seen in non-injected ones.
Based on these results, it is to be concluded that the healing mechanism of intracavitary injection therapy was due to the local action of penicillin.
(author's abstract)

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