The first use of streptomycin was reported in 1947 by Videla , who described five patients with plague in Argentina. All of them survived, with two being discharged promptly after therapy, and three having more prolonged hospital courses. Also in 1947, with reports being published in 1948, patients in Palestine and India were treated with streptomycin [13, 43-48]. In Palestine, Haddad and Valero  treated three severely ill patients who had failed to respond to sulphonamide, with the result that all survived. In India, Sokhey and Wagle  reported that only four of 118 bubonic plague patients treated with streptomycin, or 3%, died. These authors updated this experience in 1953 to include 148 patients, of whom only six, or 4%, died . In addition to the lower mortality rate with streptomycin therapy, the authors noted faster defervescence of patients treated with streptomycin, with an average of 50 h, as compared with 85–89 h for those treated with sulphadiazine or sulphamerazine . One of the authors, Wagle , an astute investigator, performed quantitative blood cultures to show that three of the fatal cases treated with streptomycin had high-grade bacteraemia. Wagle called this condition severe septicaemic plague, indicating that the patients were probably already in septic shock that was not amenable to reversal with antibiotic therapy. Also in India, Karamchandi and Rao  described five patients treated with streptomycin. They all survived, despite the fact that they were all moribund, and the condition of three of them had worsened while they were receiving sulphathiazole during the preceding day. Having been semiconscious or comatose before treatment, these patients were observed to regain consciousness, with marked improvement, within 36 h after the start of streptomycin treatment. These authors updated their experience in the following year to include 15 moribund plague patients treated with streptomycin, of whom 3, or 20%, died . These physicians were impressed with both the efficacy of the drug and its superiority to sulphonamides, because all of their patients were moribund, and three of the survivors had failed to respond to sulphadiazine. Furthermore, all three deaths occurred in patients who had presented after the third day of illness, with death occurring during the first day of treatment, whereas five survivors described in 1948 all presented for treatment after only 1 day or 2 days of illness . In another report from India, Datt Gupta related that seven of 24 plague patients treated with streptomycin, or 29%, died . This relatively high mortality rate was explained by the study design, whereby only severe cases were selected to receive streptomycin. Furthermore, two of the deaths occurred within 12 h after admission, indicating that the patients probably had advanced disease before treatment . Thus, 1947 was a watershed year: all bubonic plague patients fortunate to receive streptomycin within the first 2 days of symptoms survived, whereas deaths were reported only in some ‘moribund’ cases who had symptoms for at least 3 days or had failed to respond to sulphonamides . For pneumonic plague, in which sulphonamides had failed to save any lives among eight patients in 1941 , streptomycin therapy in 1948 in Madagascar was reported to give recovery in one patient , and in 1949 to give recovery in another two patients .