Introduction - Uppsala Monitoring Centre

1947 December 6 th
1948 January 17 th
One hundred and eighteen patient with tuberculous meningitis.
1. General toxic disturbances: somnolence and clouding of the mind
may be caused by the drug. Deafness in 15 of patients.
2. Cutaneous reactions: transient erythema with fever.
3. Meningeal reactions: stiff neck, pain on each injection, severe
convulsions with opisthotonos (Debré, 1947).
Reaction most frequently encountered is disturbance of
equilibrium which is uncomfortable, but not usually dangerous;
deafness–usually in patients with meningitis, mild irritation of the
kidneys (Riggins and Hinshaw, 1947).
Review
The vestibular disturbance is dose dependent–at a dose of 1 Gm
daily fewer than 30% will have symptoms but at 2 Gm daily this
increases to at least 90%. Including erythematous rash, fever,
eosinophilia and abnormal urinary elements (Feldman & Hinshaw,
1948).
1948 April George Orwell, author of ‘Animal Farm’ and ‘Nineteen Eighty Four’
His Doctor: ‘He was given 1g of Streptomycin daily and appeared
to be making some clinical response, but after a few weeks he
developed a severe allergic reaction with dermatitis and stomatitis.
He wrote an excellent description of this in his notebook, he could
not receive any more of this drug.’
George Orwell: ‘I forget them; it is worth writing down the
secondary symptoms produced by streptomycin when I was treated
with it last year. Streptomycin was then almost a new drug & had
never been used at that hospital before. The symptoms in my case
were quite different from those described in the American medical
journal in which we read the subject up beforehand.
At first, though the streptomycin seemed to produce an almost
immediate improvement in my health, there were no secondary
symptoms, except that a sort of discoloration appeared at the base of
my fingers & toe nails. Then my face became noticeably redder & the
skin had a tendency to flake off, & a sort of rash appeared all over my
body, especially down my back. There was no itching associated with
this. After about 3 weeks I got a severe sore throat, which did not go
away & was not affected by sucking penicillin lozenges. It was very
painful to swallow & I had to have a special diet for some weeks. There
was now ulceration with blisters in my throat & in the insides of my