F • CLINICAL ASPECTS OF SPINAL CORD INJURIES
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for eight to ten days or even longer in special cases, but should not be continued for more
than 19 days. In cases where a course of antibiotics does not clear the urine, it is very
worth while to start a short course of Furadantin and the urine may become crystal
clear. During my weekly consultant visits to the Duchess of Gloucester House, the
hostel for paraplegics, who are employed in the surrounding industries, I always inspect
the urines of the residents and on occasions a short Furadantin course of 6-8 days is
prescribed, if a urine is found to be cloudy and containing mucus and sediment in a
resident, who is known to have recurrent though sub-clinical urinary infections, and within
a few days the urine becomes crystal clear. Side effects of Furadantin are, as a rule,
insignificant and consist mainly of a sickly feeling. A few patients who are allergic to the
drug may develop raised temperature with lung involvement. Moreover, polyneuropathy
was observed in patients who had been treated with doses of 200-400 mg daily for longer
periods (Spencer, 1962; Rubinstein, 1962).
With the discoveries of Sulphanilamide and its many derivatives and, in particular,
the antibiotics, a new era in the treatment of the infection of the urinary tract began and
our facilities for a more specific treatment of the various types of micro-organisms have
vastly increased. Of the sulphonamides, sulphadiazine and sulphamezathine proved in
pyelitis more suitable than the less soluble sulphathiazole. A well tolerated and readily
soluble sulphonamide
is gantrisin (sulphonamide-isoxasole, Hoffmann-La Roche)
which neither crystallizes nor has harmful effects on the renale tubules. Whereas the
sulphonamides were used in the treatment of both Gram-positive and Gram-negative
organisms, with the introduction of penicillin for wider clinical use during the war,
attempts were made to treat urinary infections with penicillin. Since 1944, I treated
acute urinary infections with three hourly intramuscular injections of 30-50,000 units of
penicillin up to a total of 3,000,000 units and found it effective not only against Gram-
positive organisms but also against atypical coli of the paracolon group. With the discovery
of streptomycin and broad spectrum antibiotics as well as nitrofurantoin (furadantin),
penicillin became somewhat forgotten in the treatment of urinary infections. However,
in the late 19505 resistance of Gram-negative organisms became more and more apparent
at Stoke Mandeville. Milner (1963) of the Pathology Department, in identifying separately
members of the Paracolon group, showed that most of the organisms previously called
Paracolon bacilli were Providence and most of the strains of Providence were resistant
to the antibiotics available at that time. My colleagues Colley & Frankel (1964) carried
out systematic studies on 32 paraplegic patients with Providence urinary infections. Of
the 30 strains of Providence, the majority (23) were isolated as biotype 21 and 7 were
of biotype 27. The sensitivity of these Providence strains was determined against the
following antibiotics: pencillin (Penicillin G), ampicillin (Penbritin), methicillin (Cel-
benin), cloxacillin (Orbenin), phenothicillin (Broxil), propicillin (Brocillin), tetracycline,
streptomycin, nitrofurantoin, colymycin, trimethoprim and kanamycin. Nearly all
strains were sensitive to penicillin and ampicillin, all strains were sensitive to kanamycin
and trimethroprim but only few were sensitive to the other antibiotics. Pencillin G was
found very effective in the treatment of Providence urinary infection. Of the 32 patients
treated with Penicillin G 1,000,000 units 6 hourly for 6 to 10 days, Providence was
eliminated in 30 patients but it recurred in 5 patients after 4 weeks. Two of these patients
