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This report supplements our observations recorded in The Journal in the fall of 1944.1 In general, our enlarged experience has tended to confirm the initial impression that sodium penicillin given by intramuscular injection is very satisfactory treatment for the syphilitic pregnant woman to prevent congenital infection of the fetus and that it may rapidly become the treatment of choice in this condition. Considerable progress has also been made in arriving at a satisfactory regimen for the infant infected with syphilis. The latter problem has seemed considerably more complex to work out than has been the treatment of syphilis in the adult with penicillin, largely because of the severity of the disease frequently encountered in the newborn in contradistinction to the adult, and because of the theoretical dangers inherent in the injudicious use of a rapidly spirillicidal drug under such circumstances. This study is still in progress and much is

THE PENICILLIN Syphilis Group at the University of Pennsylvania has treated 746 patients with penicillin since Nov. 11, 1943. Of these, 283 had neurosyphilis. The average period of observation is 357 days, the longest period of observation being 719 days. One hundred and nineteen had been observed from 120 to 364 days, 55 for 365 to 599 days and 23 for 600 days and over. Thanks to the follow-up workers of the Institute for the Control of Syphilis, 97.7 per cent of these patients have been kept track of and returned for periodic observation and treatment. The material is classified by diagnosis and initial spinal fluid findings in table 1. The patients with negative spinal fluids at the outset showed symptoms against which response could be measured. POINTS DESERVING EMPHASIS IN THIS MATERIAL In order to be considered for penicillin treatment, the patient must have presented some

Recent writings convey the impression that pregnant syphilitic women tolerate arsenical therapy well.1 In fact, the fear of serious reaction to the intravenous treatment of these patients with the arsphenamines has become so remote that some authorities recommend this prophylactic procedure for the unborn child, even "on suspicion" that the prospective mother may be diseased.2 McCord,3 who has apparently never seen a serious treatment reaction or death in the medical supervision of more than 2,000 syphilitic pregnant women, remarks that "such therapy seems to be safe for the mother." The Cooperative Clinical Group, with Cole4 as spokesman, feels that, regardless of antecedent therapy, in order to insure the birth of a healthy child it is desirable to treat intensively throughout each pregnancy every woman who has ever had syphilis, whether the serologic tests of the blood for syphilis are positive or negative or the infection is

Since the report of the joint County Medical Society Health Service survey, conducted three years ago in Philadelphia,1 an active effort has been made to elicit the interest of the private physician in the treatment of venereal disease. The apparent success of the plan is the subject for this discussion.Any plan for the control of the venereal diseases which does not take into full account the medical resources of the body of the profession cannot be successful, except in part. This was recognized in the "preamble" of the purposes of the venereal disease control program as they might affect the private physician,2 set forth in the 1936 Washington conference and in numerous other statements made at that time and since both local and nationwide in their scope, California,3 Kansas,4 Michigan,5 Ohio,6 Alabama,7 North Carolina,8 Delaware,9 Illinois,10 Connecticut11 and

The treatment of the pregnant syphilitic woman and of the congenitally syphilitic infant with weekly injections of neoarsphenamine or mapharsen supplemented by a bismuth preparation, although eminently satisfactory from the standpoint of both preventive and curative medicine, still has several aspects in which improvement may be expected. These facts have led us to try penicillin in the treatment of these conditions with the hope that it might be possible to eliminate some of the deficiencies in present day therapy.Included among the factors in the prevention and treatment of congenital syphilis which we would like to see improved by the discovery and application of new drugs and new technics, the following may be mentioned:Arsenotherapy is relatively toxic. Although, generally speaking, arsenicals are well tolerated and safe to use in the average case,1 reactions do occur which interfere with treatment or at times preclude their use entirely, and

The United States, following its well known predilection, is on the edge if not actually near the crest of a wave of legislative enactment in a newly discovered though very old public health field, that of venereal disease control. It therefore behooves the physician who wishes to understand, influence and cooperate to be informed on many as yet little appreciated aspects of the problem. THE LAW IN ENACTMENT AND IMPLICATION Law on the question of the transmission of infectious disease rests fundamentally on police powers conveyed by the legal enactments establishing state boards of health and supported by favorable decisions in the courts on issues involving quarantine and the protection of the public against the dissemination of infection. On this broad legal base rests a structure of local ordinances varied occasionally by legislative supplements from higher sources, so to speak, as in more sweeping types of laws governing groups such

When one is dealing with an infectious disease, demonstration of the causative agent is always desirable in order to establish the diagnosis. The necessity for demonstrating the organism varies inversely with the vividness of the clinical picture presented by the patient. A new-born syphilitic child is usually free of symptoms during the first few days or weeks of life.1 Hence, the demonstration of Spirochaeta pallida, were this possible, would be a valuable diagnostic aid.Obtaining material in which to demonstrate spirochetes from a living child suspected of having syphilis presents a problem which is often insurmountable. It is true that spirochetes have been shown to be present in the blood stream,2 the nasal secretion,3 the conjunctival secretion,4 syphilitic cutaneous lesions, the urine2c and in the meconium5 of syphilitic infants, but in most instances the infant in whom the causative micro-organism is found has manifest clinical

The avowed purposes of this study were to evaluate the effects of sodium penicillin in the treatment of early congenital syphilis, to find the best means for using this drug alone and to discover criteria by which results might be predicted. Observations incident to treatment of 252 infants in five cooperating university clinics have furnished a wealth of information toward these ends. The recent joint statement issued by the Committee on Medical Research, the United States Public Health Service and the Food and Drug Administration1 indicates that efforts to relate results quantitatively to various dosage schedules may be partially invalidated. There have been changes in the purity, potency and composition of commercial penicillin mixtures furnished to us since this study began. There have also been considerable variations in the actual amount of penicillin in individual vials labeled as containing 100,000 units.2 Though the extent to which these changes

This paper is a supplement to our observations on this same subject recorded about a year ago.1 Our increasing experience still leads us to feel that sodium penicillin given by intramuscular injection is a satisfactory treatment for infantile congenital syphilis. Considerable progress has been made toward arriving at a satisfactory regimen for the infant infected with syphilis. There is no denying the fact, however, that this problem has seemed considerably more complex to work out than has been the treatment of early syphilis in the adult, with penicillin, largely because of the relative severity of the disease frequently encountered in the newborn in contradistinction to that found in the adult and because of the theoretical dangers inherent in the injudicious use of a rapidly spirillicidal drug under such circumstances. Even though this study is still in progress and much is yet to be learned in the application of penicillin

HISTORY.— A Negro, aged 30, admitted to the Genito-Urinary Service of the Philadelphia General Hospital, Dec. 4, 1933, complained chiefly of acute urinary retention. Since birth he had never been able to retract the foreskin of the penis. Urine was expelled in a fine stream through a narrow opening in the prepuce. At each attempt at micturition, the urine flow being retarded not at the meatus but at the preputial orifice, there was a ballooning of the foreskin to form a sac, which had to be emptied by manual compression. For some months prior to admission, however, he had been unable to empty this preputial sac completely because of the presence of some hard substance, which he could easily feel in this structure with his fingers. This had increased rather rapidly in size until the sac had become swollen and hard, as though filled with stone. With the appearance of

In cases of neurosyphilis the response of the spinal fluid and blood are important objective criteria. Herein are summarized the observations on blood and spinal fluid of 89 cases of neurosyphilis treated from November 1943 to October 1944. This study continues work previously reported1 but is confined to cases treated at the University of Pennsylvania.Repeated examination, usually at two month intervals, were made of symptoms and signs and of the blood and spinal fluids. Cell counts were made immediately on fluid withdrawal; total protein was determined by the sulfosalicylic acid method of Kingsbury Clark. Kolmer quantitative Wassermann tests and colloidal mastic tests were run. The serologic tests on the blood were examined by a uniform series of technics, Kolmer, Eagle and Kline; for this report only the Kline quantitative titer results were used.Sodium penicillin in aqueous solution was given intramuscularly for eight days, every four or three

This is a brief preliminary note, as of Nov. 7, 1944, concerning 69 infants with manifest early congenital syphilis who have been treated with sodium penicillin by the university groups at Baltimore, Philadelphia, Galveston and New Orleans. Penicillin was administered intramuscularly in saline solution every three hours in sixty injections over a seven and one-half day period. Total dosages used ranged from 16,000 to 32,000 Oxford units per kilogram of body weight. No other antisyphilitic treatment was given.In 34 of these 69 infants reactions occurred during treatment. Nearly all of these reactions were mild, consisting of moderate fever beginning on the first or second day of treatment and seldom lasting longer than three days. One infant, forty-eight hours after treatment was begun, suddenly developed severe, nearly fatal collapse. Three infants died during or soon after treatment (twenty-four hours, seven days and nine days after penicillin was started); all of