The History of Gold Therapy for Tuberculosis

This is a historical study of the popularization of a medical therapy contrary to pertinent experimental findings. Presumably this circumstance reflects the desperation about tuberculosis: highly prevalent, highly fatal, and lacking any etiologically directed therapy. Gold compounds were introduced, based initially on the reputation of Robert Koch, who had found gold cyanide effective against M. tuberculosis in cultures, but not in experimentally infected animals. Treatment of pulmonary tuberculosis with these compounds was popularized, particularly by Danish physicians, in the mid-1920s, despite consistently negative experimental results, based on Paul Ehrlich's theories of antimicrobial drug effects. Difficulties in the design of interpretable clinical studies were soon recognized but also generally ignored, thus permitting data to be interpreted as favorable to antituberculous gold therapy. Eventually toxicity was considered to outweigh the alleged therapeutic benefit of all gold compounds. This resulted in their discard shortly before the introduction of streptomycin therapy.