Search

Syphilis in the latent stage, as it exists in most pregnant women, is difficult to detect. This means that the disease must be suspected in every case, for a successful termination of pregnancy and a healthy child cannot be expected in the presence of an active or even a quiescent infection of this nature.

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

IN THE treatment of the infant with congenital syphilis, general experience to date has proved penicillin the most satisfactory therapeutic agent. Long term follow-up reports, however, have been lacking, and it is for this reason that our study, based on results in 60 infants1 followed over an average of two years, is presented. Previously, seemingly adequate antisyphilitic therapy in infancy has been followed by late relapses, the development of paresis or interstitial keratitis.A previous report2 discussed selection of cases, dosages, reactions, complications, deaths and immediate response to treatment. This report concerns itself more with long term observation of whether or not clinical or serologic relapses may take place in spite of initial clinical improvement and whether or not any other complications or sequelae of congenital syphilis may occur. RESULTS OF TREATMENT Table 1 shows an analysis of the age at onset of therapy in the 55 patients

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

IN THE year that has elapsed since our preliminary note,1 122 additional cases of manifest congenital syphilis in children under 2 years of age have been treated by the university groups at New Orleans, Philadelphia, Baltimore and Galveston. This brings the total number now suitable for analysis to 191. Among these are 84 Negro boys, 84 Negro girls, 10 white boys and 13 white girls. The mean age at start of treatment was 164 days, with range from 11 days to 23 months. Pretreatment studies have been adequate for all, and no therapy other than intramuscular injection of penicillin has been employed. Total dosages have ranged from 770 to 150,000 units per kilogram of body weight; the smaller of these represents the amount received by a moribund infant of 5 weeks who died during the first day of treatment. The smallest total dosage received by any infant who completed

In the year Jan. 1 to Dec. 31, 1934, at the Philadelphia General Hospital, where the incidence of syphilis among the pregnant women is 11.8 per cent, not one of the 1,517 babies discharged alive from the maternity division showed any clinical evidence diagnostic of congenital syphilis. Of the 126 stillborn infants and infants dying soon after birth in this hospital in the same period of time, 19 (15.1 per cent) were the offspring of syphilitic mothers, the death rate being 9.7 per cent among the syphilitic group (195 patients) as compared with 7.5 per cent among the infants in the obstetrical division at large (1,643 patients).It so happens that the majority of the syphilitic mothers who deliver their babies in this hospital have had insufficient treatment to insure the birth of healthy children, since it is unusual for a woman to report for prenatal supervision prior to the

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

Recently the opportunity has been afforded to review in considerable detail the results obtained in a study1 completed about five years ago in which was described a clinical method of approach to the often difficult problem of diagnosing congenital syphilis in the first few weeks of postnatal life. The restudy of this material seemed especially pertinent and essential in the light of the recent applications of advancing knowledge of the quantitative estimation of syphilis reagin in the infant's blood stream (Faber and Black,2 Christie3 and Davies4) and of the effect of infantile diseases or malnutritional states other than syphilis (Caffey,5 Aries6 and Evans7) and of antisyphilitic therapy administered to the mother prepartally (Caffey,8 Christie9 and Whitridge10) on the interpretation of the roentgenogram of the infant's long bones during the neonatal period. At the time of the original study the possibility

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