Introduction - Uppsala Monitoring Centre

stimulation and in the majority of cases response returned in varying
degrees over a period of two years and 89% had mild decrease in
vestibular function at the end of six weeks. These were followed up
and at one year 25 patients had negative responses, at 2 years 5
patients and at three years 3 patients had no response to caloric
tests, but in the older group (over 45 years) in a small percentage
there was never a return to normal. Those over 45 years of age
suffered more than younger patients. These figures give a
percentage of 68% for diagnosis by caloric stimulation of vestibular
dysfunction compared with 65% for clinical diagnosis in the MRC
study. In 215 patients taking the lower dose of 1gm per day for 110
days the figures at the end of treatment was 18 negative responses
(complete loss of response to caloric stimulation), two had negative
responses after one year and none had negative responses after
three years (Chase, 1951). In the MRC study neither the
streptomycin group nor the control group knew that they were in a
clinical trial (Crofton, 2006) and therefore it would have been
unacceptable to have carried out tests which did not have a direct
connection with their treatment. However this would not have
prevented them from monitoring the streptomycin group for their
vestibular function and hearing. Neither the MRC nor the National
Archives could find copies of the protocol and the safety results
(MRC, 2009).
1949 Nausea and vomiting occurred in 17(35%) of 49 patients, but this
could be prevented by ‘Benadryl’, an antihistamine with
anticholinergic properties (Bignall & Crofton, 1949).
1951 During trials at the Brompton hospital in the above study 76 patients
were treated with streptomycin and of these 14% on 2G daily had
giddiness with an average time to onset of 45 days, whilst of those
on 1G daily 7% complained of giddiness and the time to onset was
halved at 22 days (Bignall et al., 1951).
1953 Patients developing hypersensitivity could be desensitized and so
continue with treatment, but this did not come in time to save George
Orwell (Crofton, 1953).
1961 A review of 3,148 patients found 7 cases of hearing impairment; all
were older than 40 years and had normal renal function. The dosage
used was 1G either daily or twice weekly, plus para-aminosalicylic
acid (PAS) 3 G twice or four times a day. Isoniazid (INAH) at a
dosage of 100 or 150 mgm twice daily. They quoted other papers
giving incidences of vestibular damage: 12%, 20%, 24%, 21%, 14%.