R C Z / D ~ / ~ ~

3 October 1449

QRIGINAL : m%LISH

WORLD HEALTH O W I Z B T I O N

FEGfONAL C W l T E E FOR THE EASTERN MEDXTFJEUlUq

NOTE: ON PENICILLIN THEUPY IN S ~ L I S '

Experience with penici l l in in the treatment of ayphilis now extends over a

riod of more than six years . Numerous ar t i c les on various phases of this experience

w been published in the American, Br i t i sh , French, Polish and other national medical

brature. A bibliography giving a part ial list of thosc publications is appended,

In general the following defini te statcm~nts concarning tho prosent status

pmicil; l in therapy f o r syphilfs can be mado:++

CryatdUno p d c i l l i n G in aqueous solution administered in appropriate time-

Bage schedules will curo a t least 90% of patients with early infoctf ous syphilf a,

ample sehedulo: 40,000 Oxford u n i t s every 3 hours day and night fo r 60 fnjactfons or

Repository preparations such as p e n i c i l l i n G in oil and booswax (haml~sQ

mula) or more preferably aqueous procaine ponic i l l in or procaine penici l l in in oil

th 2% aluminium monostearate w i l l a l so give a high curs rate in early infectious

phi118 at least as good as aqueous ponic i l l in G, when ndminist~red in appropriate

m-dosage achedulea. Procdne Pen ic i l l i n G in o i l and 25 Alurmtrdum Monostearate is

w the drug of choice in treatment of syphilis and gonorrhea, Simple schedule:

4,000 Oxford U n i t s (2cc) of Procaine Penicillin G in oil with monostearate dai ly

berg 24, hours) for 6 to ti days.

bepared by Piortimer S, Falk, M.D., M.S.P.H., ad h s WHO I'encreal Disease Consultant btern Moditerrmean Region, at the request of Sir Aly Tawfick Shousha, Pasha, Regional rector, for the Regional C d t t e c mcoting, Genova 12 Octobor 1949.

For more elaborate information on developments re la t ing to penici l l in in ayphilis Ler t o bibliographical notea propared by t h o VD Section and the reports of the firat second aaseion of the WHO Expert C d t t e e on Venoreal Disoases 8 end 15).

3 1 n prenatal, syphilis gcn lc i l l i n treatment, utilizing e i the r of the suggested

schedulos, w i l l a f ford a healthy infmt in more than 95% of cases, no matter which

trimester during pregnancy the mother i s treated.

4 American s ta t i s t i cs based on signif icant ly large series of patients indlcab

that so-called combined treatment schedules utilizing penicillin, arsenicals and/or

bismuth have n o d v a n t a ~ e s over penicillin alone (when administered in propor the-

dosage schedule),

5. In early congenital syphilis (up to two years) aqueoua crystalline p d c i l l f

G has given excellent results. There is reason t o balicvo that repository penici l l in

preparations are equally effective. (Sanple schedule: h total of 200,000 W o r d

units per kilogram of body weight a v i d e d i n t o 120 equal doses administered every

3 hours (15 days),

6. It is desirable t o follow the progress of penicillin-treated early smhi l i~

with quantitative serologfc t e a t s f o r syphilis n t monthly f n t e r v d a for at least the

first posbtreatment yem. The blood serologic tosts f o r syphi l i s become gradually

roduced in quantitative titre aver e period of months & t a r treatment. I n general

t he rate of serologic reversal varies d i r e c t l y with length o f tine the pat len t has

been infected.

7 f t i s known t h a t penicillin i s of value in other stages of syphi l is , v i a ,

l a t e n t sypMli s, various f oms of tertiary ayphi l i s, late c o n g e n i t a l syphf 11 a, new*

syphilis and cnrdiovascular syphilis. Bowavcr, a discussion of pen ic i l l in therapy

f o r these conditions would necessarily have t o include many qualifications to be

scientifically accurate. The reader is, therefors, referred to the appended reference

list for articles concerning penicillin therepy in those phas~s of syphilis.

S . There is evidence t h a t the incidence of late syphilitic nanifestations will

be extremely low in the patients trectc2 f o r c u r l y syphjlis with penicillin. Part ial l

indicat ive of th i s is the d l percentage (less than 1%) of a b n o m l spinal fluids

found after one, two, three and four years in pat ien ts who have recefved adequate

ge'nicillin therapy,

9. It is importcnt t o emphasize that in addition to the efficacy afforded by

penicillin therapy it has the additional ndvmtage of an extremely l o w toxicity in

omparison wi th arsenicals and heavy metals and from the public health vieupoint the

percentage of patients completing treatment i s increased fron an evernge of 10-30% (routine accepted courses of ar senical-bismuth therapy) t o practically 100%.

REF3RENCE LIST

ENICILLIN IN FARLY SYPHILIS

Arnold, R C. and Nicholson, F. P.

Tmatarent Failures vs Reinfeceom f o 1 1 0 ~ ~ Penfcillfn Therapy in Early syphilis, Recent A h . Study Ven. DL a, Symposim, Ven. Es. Educ. Inst. P USPB, Raleigh, N, Carolina, 1948. p.107*

Blackwood, J.Q., Soott, V. and Clark, E.G.

of early sfphtlis with sodium pniciPLfn. A pralbdnar~r =port wlth comgal-ison of resrilts w i t h 4,800,000 u n i t s , administered in seven and a half days, w i t h smallor dosages. Arch; Ihm*Sgph., 57, 6: 1028, (JW) 19481

Chargin, L., Sobel, N., h i n , C.R. and IEosenthal, T.

The Treatment of %rly 5yghi l is w i t h 300,0QO u 5 t s of Crystalline Penic i l l in C. in Peanut CK1 and Beeswax (POB) for 16 consecutive days. brch,f3erarata Bt w h . , 1948. ( b s s )

Council on Pharmacy and Chemistry, kmerlMed.As~., WhiUs Stu* Section National Inst i tub of EEaalth, US Public Health Service.

The Status of Penic i l l in in the Tmatnrent of mhj.lis. J.hr+med,Asal , L36t 873 ( h r ) 1948.

Heller, J.R., Bmm, R.firm and Price, E.Y.

Rapid' Tmatmnt of Early SyphiUs ; Progrcss Report, December 19117. JmVe3nerbMs.Infam., 29: 103 ( ~ p r ) 1948.

Penicillin Therapy of Garly Syphilis, iwr.J15ypha, 311 41-44 (Jan) 1947

Kitchen, D. K. , Thorns, E.W. and Rein, C. R.

Serum Concentrations Folhw%ng f i v e Treatment Schedules w i t h Procaine Perdcillin in Oil with A l u m i n i u m Uonoabayata. (In Press).

Penicillin in Syphilis, Rev.medFranc., 281 19-21 (Feb) 1947.

The Treatment of Q-phiUs w i t h Penicil l in, W t . J.vener.Dis., 24, l t 11-15, (br) 1948.

Mahoney, J. F. , Amold, R. C, and Harris, A*

Penicillin Treatment of Early grPhilis; h l i d n a r y Report. hierr J. Publ. Hlth,, 33e l387 (hc) 1943,

l@/296/49

&honey, J.Fb, Arnold, &C., Stemnor, B.L., Harr ls , A. and Z w a l l y , U.R.

Moore, 3,&, Whomy, J.F., Schwarts, We, Stemberg, TI and wood,

Rider, R.V.

Report of, the Central S t ~ t i s M c a l Wtr 111 limmphoua Penicillin vs Cryata l lhe %nicillfn G; 111. Aqueous Penic i l l in va Ponici llin-M1-Beesvrax. Recent bdv. StuQ Van. ms. mposium. pen. Bs. Edw . Inat* & USPHS, Raleigh, M, Carolfm, 1948. p.99.

Schuch, A, G. and Alexander L. 3.

Penic i l l in Treatment o f &rly SyghilS a, J.Amer.md,hss., 130: 696-698 (2.0 Mar) 1946.

B Comp~rison of 'Treatwnt Reanlts UtiUzing GryatalUn~ Penicillin G in th; Treatment of Patfonts with Early @philist Injoctiona Zwery TWO Hoyrs vs InJactions Zvexy Throe Holu's, Recent idv. Stu@ Van.Ma. ~posiurn. Ven. Es. Educ. Inst. 5r rfiPHS, Raleigh, P, Carolina, 1948, p+ 335,

S c o t t , V.

Procaine Fcnic i l l ln in Syphil is. Recent Adv. Study Ven. Ms. Sympasium~ Venn Dis r Educ. Inst. & USBIES, W i g h , Pf. Carolina, 1949, p.335-

Wth, LC., KauParan, W.H. and Sohafer, JIG+

Treatment o f Early hcq~ired ~ M U s with 800,000 u n i t s cf Sodium Penici lUn. Arch, Dem. mL, Chicago, 55s 644&9, (Wy) 1947.

Eerste vaorluapigo msdedeoling o w r de systematischa bafiandoling van syphilis met penicilline. Ned.Tijdschr.Gene;;sk., glt 1445, 1947.

Sbemborg, T.H. and Leifar, iV,

Pen ic i l l i n tm.Smnt cf early syphi3A.a. J,2mr.med.bss., 133s 1-5, (4 $an) 1947.

Panicillin Tmatmnt of Early Syphil is. h r . J. U d . , . 5 a &7, ( ~ o v ) 1948,

A Comparison of the Cmul;atf w F a i l m Rahs of awn Different Schedules of Rapid Treabent of Early SypWUs ~ 5 t h Penici l l in Llone or Penic i l l in C m b b d with Other b a s l Recent Adv. Study Van. Us4 Qmpodm. Van. Dis,Educ. Inst. & DSW, Raleigh, Na CaroUm, 337, 1948.

Thms, E.W., Lyons, R. fl., Rumnab, M. J., Rein, C. R. and Kitchen, D. K.

Newer Repository i 'cnicil l in Products. J.imer. med.bss. , 137: 1517, (21 Aug) 1948.

Thomas, d.W. , Zandy, S. and Cooper, C.

Rapid eeatruent of Early Syphilis with Penicill in in Beaswax and Oil. J.vener,Dis.Znform., 2 8 8 19, 1947.

Turner, T. B.

Pen i c i lUn w i t h Venereal Disease Control Program. J* SOC. Hyg., 34 i 205, 1948,

US Public Ekalth %rvice

Recent Advances in the St* ef Vensm;.aL Mseases. Ven.Dis,Educ.Inst. & USPHS, Raleigh, N. Cmolina, 1948,

The Pract ical Lpp3kation of Penici l l in in &ha treatlnsnt of Syphilis. J.Amnr.m~d,:Somen~s- Ass,, 2t 425 (Oct) 1947*

Webster, Bmse o t al.

Syphilis: Treatmat. Cornell Confer. on lbrapy, NY, 6694 , 1947. kcmill ,zn Co, Brit.J.lkrm.Syph., 60, 9 : 314, (Sopt] 1948,

Zwijndregt, H.1i. , Stoenbergen, ~3. P. van and Stam, I:. C. M.

De systemati sche behandeling van primaire c t secundair~ syphilis m e t genlcillinl-. on met penlei l l ino cn bismuth, alsmedo enige boschouwingen o w r dc indef ing m n brbahandeldan. Ned* TiJdschr. Genessk. 928 3828, 1 9 4 .

REFERENCE LIST

PENICJLLIN f N PRENATAL AND INFANTILE SYPHILIS

Prevention crf Hereditary Syphilis by Peniaillin ( ~ a p r k n t i o n de If hhrido-grphilis p& la p e n i c l l l h ) * Clinlque, 42: 3 (5-20 an) 1947.

bun, H.C.S., Barton, R.L, andBauer, T.J.

Prenatal Syphilis: f t e Preventf on by Uee of Feniotllin tn Treatment of Pre gnmt Women with Early Infeatf ous 3yphilis. Arch.Deratat. & Syph., 56: 349 (Sept) 1W7.

k k e r , L.P. An Evaluation of the Penici l l in . Treatmen* in Early Congenitd. Syphilis. J.Pediat., 328 51&521 (Hay) 1948. 4 refs. Abstr, World Med. 4, 5 : 526 (1833) (Xw) 1948.

B a r n e t t , C+W., and had, J.M.

Syphilis in Pregnancy,

Cote, H.N., Ayres, S, et al,

U s e of Penic i l l in in the Treatment of Syphil is in Pxe w c y . Aroh-&mat. & Syph., 45, 3~255-265, 1946.

Congenital Syphi l i s in an Infant Trea ted with Penloillin. bnoe t , 22 432 (6 O a t ) 1945.

Croaa, R.G.

Repeated abortions, miscarriages and stil3.birtha t Val- o f Anti-wphilitic ~ r e a h e n t . Lancet, 2 r 754, 1946.

Dabauens, A*

Penicillin in ambulatory therapy in infants and childmn with report of cases, Rev, chilana de pdia t . , 172 752-779, 1947,

Frevention of Syphilis in Newborn (use of P e n i c ~ l i n ) . Texas S t a t e J.lded., 42: 372-374, (0ct) 1946,

Penic i l l in treatment of infantile syphi l i s HZ k d = J . , 450 558-560, 1947.

Goodwin, Y.S. and Farber, M,S.

T b Necessity f o r Treatment of Pre @ant wphl-litio W w n during every Pregnancry, h e r - J..Syph*,-32: 5 ( a p t ) 1948.

page 2

PaniciUh i n Auvention of Frenaterl Syphilis. J . h r a e d . 8 8 ~ 0 ~ . 130; 688 (16 Mar) 1946.

Green, H.J. and Ilobby, G*L*

Transmisssion of Penicillin through human plaoenta r A Prelitrdnary Repvrt . Roc. Soc . exp, Biol . NY . , 57: 282, 1944.

Heyman, A. and Yampolslgl, J1

TreaWlrt of fnfantne Congenital Syphilis with Pen ic i l l h4 Amr.J,Dis.Child., 7l: 506, 1946.

H i l l , Jr., A.J,,.Platou, R.V. and Kometani, J,T.

Odseous.congenital syphilis: Effects of penici l l in an rate of baling. .J. Pediat.St.Lwis, 30, 5 : 547-563,. 1947..

H l l 1 , A.J., Plst~U, R I V ~ , Ingraham, N.R., Goodwin, M.S., Wilkinson, E.E., Hansen, A.E. and Heyman, A*

Early ~owenital Syphilis. J.&r.med.Assoc., 133, I t 10-16, 19474

Hutton, A.M. and Parks, J.

The transmisdon & penicillin tbrough the placenta; P -1- Report. Amer.J.Obplt* & Gynec., 49; 663, 1945,

Ingram, Jr,, C.H.

Syphilis in Pregnancy Treated by Penioillin, AmerrJ, Obst. & @Zie~r, 53: 881 ( ~ a y ) 19474

Penicillin in the Treatment b f the Syphilitic Infant. J.Bmer.med.4haoc., ' ~ 0 : 694, 1946.

PenicUlln Treatment of theh Syphil i t ic kegpant Woman. J.Atner.md.Assoc., 130: 683 (16 Mar) 1946.

fngraham, Jr., X.R., Rose, E.K., Beerman,.W., Wamaack, V.S., Stokes, d. and wb'rgy, P.

Treatment of the gtchtlitf e Pre gnmt Tomar1 with Penicillin h MT-$eeswqt A chparison w i t h results obtalned using aqueous &dhm penici l l in. J,Vener.Di's.Infom., 281 155, b u g ) 1947

Penicirlin in t h ~ %&rnrun and Treatment of Congenital Syphiris; %D& vn Exprienae wlth the Treatment of Fourteen m i a n t W-n with E a r l y m f s and Nine

~ ~ 5 t h Congenital S y p ~ i e r . J,Bmer.med.Assoa., 126s 408, (14 -1 m.

Trbgi-e sa Rcpbrhan Treatment cf Congenital E$phl.lis with PonicUlLn. b e r j , A l . s , ChLZd., 73: 125 an) 1947.

Loe Ping Kim

The. Tre:l:;nont cf' Cangcn5tal SyphUia w i t h Penic i l l in , ,N<ei.,Tijdaehr.Ger.eeslc,, 91, 31: 2913-2916, 1947.

The Treatment of a p h i l i s wi tkPen ic f l l i n . Brlt.J.Vener.Dis., 24: 3 - 1 5 > (Idarch) 1948, 12 ~ f p . AhstrcP!~Wld M~d.9 4, 3: 305-306, 1074 (apt) 1948.

'?rat~m-l.ent o mbt~ t . a t c~ io de la a i f i l i s conghita, con : i i R c ~ ~ i s t a Espanola de PedZatria, 3, 2 : 241-253, lJ)47,

Trsatmnl; cl Congenital and of Acquired Sypllilis in Infantcs andv in Children by Penj.ci?!lin. ArctiODemat. & Sygh., 53: 625, 194&

Ragf b T~eztment of Prenatal Syphilis, h e r . 3, Syph*, 3 l t 1, an) 194'7.

Conge~i?.zJ. *?hi ! ; - 1 Snemzture Twins treated with Peni~tll Cn . &ledcTimcc. 73r 130 (May) 1W5.

EfTe.5-L [ f i7ar~tc , i17b I, the T ' r e a h n t of InfantLle Congenital. SyphL! i sa Arne,-, J,Dis - Ch31d. 72: 655-648, 1946.

Plat.+~u, Fl*V*,'IIill9 A y J v , kgraham, N,R.) Goodwin, M.S., Wilkinsm, E.E.. and Har.,gen, X.S.

"ni<ill.?il ii Treatment ~f Znf ~ ~ - t : I l c Congenital 5yphSlis. d ,Am:r,rnzd,, dssoc , , 127: 582: (10. M,W) 1945,

Rosc, E*K,, G p r ~ P. and Jngxs.ham, Jr. N.R,

Ferric i~: tke Treatment - of .:;he Pjrphilitic Irif ant: A Progress h p r j ~ t . J . Tediat., 29: 557, 1946.

Rose, E-K-, Gj&&y, P, an^ Sngra?hxlil, N.Kg

Shepp~, W.M.

The Place of Penicillin in the Treatment of Syphilis. The West V i r g h i a k d . J* , 42, 92 237-224, 1946.

The Diagnosis and Treatment of Congenital SyphKLie, J*Iowa Med.Soc., 37: 1613 ( ~ p ~ i l ) 1947.

Control of Syphilis in Pregnant Women under the Care of the General Practitioner. d.Amer.med.Assoc., 129% 500403, (13 Qct) 1945-

Spiser, M., Flaum, G., Moon-Adms, D. and Thorns, E.W.

Penfcillin Therapy for Qphi l i s in Pregnancy, d,Vener, Dis.Infonn. 28, 6r 108-1.19 (June) 194'7.

T h e Results of Penic i l l in Theram for SypMis in Pregnancy. NY &dm, 3: 17 (20 Aug) 1W7.

Speiser, M. and Thomas, E.W.

Regarding the unusual effect of penicill in therapy upon the Uterus* J.Vener.Dis.Inform., 27: 20, 1946.

Treatment of Congenital Syphilis with Penicillin. Ned,Tijdschr,Gencesk, 28; 1872-1877, 1947.

Tucker, H.A.

Penicil l in S y p h i l o t h e r a ~ administered prior to pregnancy. A Study of 111 pregnancies during which a d d l t l m d anti- s y p h i l i t i c treatment urns dthheld. h e r . J. Syph, , 33 a 1, (Jan) 1949.

Tucker, H.A.

Penicillin syphilotherapy during pmgnancy: A Study of 144 pregnancies during which penic i l l in was given. for early maternal syphi l i s . In Press.

E a r l y Congenital Wphil is : Diagnostio Criteria and Penicillin Theraw. J.Med.Assoc. Gec~gia , 34: 200 ( ~ o t ) 1945.

Penicillin in the Trcztnaent of Copgenital SyphUis. Texas State 3.Mede, 41: 401 (bo) 1945.

Wdtz , J.HIE, and W i l q , M.M.

Transmission of Penic i l l in to pmvlable fetus - Sign42ioance in prenatal mhilis. J.Amer*me d.Assoc* 131: 969.970. (20 July) 1946,

... r jol tz , J.H.E, and Zinte l , Hcb.

Pansmiss ion of p n i c i l l i n to runmiobic fluid and f a t d blood in the hum=. Arner.J.Obst, & Gynec, 50: 338, 1945.

Yampolsw, J. and Heyman, Am

P e r A c i l l k ~ in the Treatment of Syphilis in Children. J4 Amer .mod.Assoc., 132: 368, 1946.

N m r concapts L? management in children (especially use of m i c i l l l ~ ) M. Clin. N m Am r . , 31: 636446 (w) '1947.

E d i t o r i a l - Bri t i sh Medical Jaurmal, 4516: 160, 1947.

Penicillin f o r Congenital ??yphilis.

P e n i c i l l i n in tho Treatmnt of Syphilis.

ComcjZ .on Pharmacy and Chemi~try to the iincr.f!ed,Assoc. & Q p h i l i s St~z* Sectizn. Na t ioncd Institute of Health, US PlahIic Service.

The Status oi" Pen ic i l l i n In Treatment of Syphilis. J ,her.md,Assoc. , 136: 879479, (27 Mar) 1948.

De Jong, 3*5.

Res'dts of Penici l l in Treatment in Congenital Sypl-dlia. Maandschr . Kind~rgenee sk. 16: 161-166, (MW) 1948. 7 refs .

REFFJBHCE LIST

PmICILLIN IN ~ S ~ I L I S

Crawford, G.M.

MedScal Progress: Syphilis t N e w England J,Med., 236: 2mj 1947.

Curtfa, A&,, Hms, S.Fm and Nortun, D.H.

MamaypMlist Evaluation After Two Paws of Treatment with Pa%piJ3in Alone- and w i t h a Cmbfnation of PtmicilUn and -re. &or.J.Syph., 322 $48, 194&

Signifioancts of Spinal Fluid F i n a g e in Neurosyphilfs. Bmer.J.Med.,-5t 709, 1948,

Dattner, B.

Heuraaypbifis and the Latest Metho& of batanent, Med, C1in.N .her. , 32 t 107, 1948.

Dattner, B,

Treatment of Neurosyphilia with Penic i l l in Alone. Amer . J. Syph . , 32 I 399, 1948.

Dattner, B., Eaufman, 3, and Thomas, E.W.

Penicillin In Qe Treatment of.Heurosyphil5.8. Arch.of Neurol. & Psych,, 582 426, 1947.

Delay, J., Weyfus-Moreau and Stevenin, L, Action de la p8nicillirie d a n ~ une* paralyse gdn6rale juvenile. Ann.Msd.Psychol., 104 t 152, 1946.

G m n , G.D;,-Stakes, J.H., Steiger, R.P;, Shele , W.H., Beaman, N. Inpaham, N.R,, Jr., Gyb;rgy, P., Rose, E., Lentz, J.W. Omstein, A. and Scott, D.

Penici l l in Therapy Alone in Neurosyphi1l.s . Ann.Int.Med., 25: 412, 1946.

Gilpin, S.F.

NeurosyphiliB, Xn Progress of Neurol. & Fsychiat. 2r 282, 1947.

Weatanent of Syphilis of the Central Iervouer System w i t h Penicillin. Amer,J.med,Sai., 213t 661, 1947.

Jones, MIL., and Perk, D,

The Early Results of P e n k i l l i n Treabent in General Paresis. ~,~iht.~ci :, 92: 414, 31946.

Kferland, RDR,, OtLawd+, P.A., and Undemood, Lodo

The Treatment of Neurosyphilfs with a Combination of Malaria and Penicillin, Amer,J,Syph., 321 470, 1948,

Koteen, H,, Doty, E.J., Webster, B,, and McDemtt, w,

Pen ic i l l in Therapy in Haurosyphilis. her.J.Syph., 3: 1, 1947.

The TYeatment of Neuroayphilis with P d e S l l i n . M J , 1: 922, 1948,

Merritt, H.H., Adams, R.D. , and Solomon, H.C.

Neurasyphilis, N e w Yark, Oxford University Press, 1946.

Njchol, W.D.

Pen ic i l l i n in Neurology. Brit.Med.J., (24 M a y ) 1947.

Penic i l l in in the Treatmsnt of Syphilis, Med. G l f n . Nort-h b ~ r f ca, 30 t 895,. 1946,

O'Leary, P A , , Brunsting, L0A.j and Ockerly, 0. Penicillin in the+Treatment of Neurosyphilis. ~ , & e r . ~ e d . ~ s s , , 130: 698, 1946,

Pmkhurst, G.E., and Bowaarl, R.W,

Treatment of0Newosyphilis at Hot Springs Medical Center, Arkansas. J. Vep.Dia. f nfom., 29 t 159, 1948.

Penicillin, Therapy in Neurology and Psychiatry; Med. Ann, District of Columbia, 151 488, 1946.

Reynolds, F.W., Mohr, D.F., and Moore, J.E.

Penicill in in the Treatment of N e ~ o s y p h f l i s , J,Amer.med.Ass,, 131: 1255, 1946.

Rose, A,S.

Pen ic i l l i n Treatment of Neurosyphilis, Connecticut S t a t e Mod. J,, 9 : 522, 1945,

Rose; A S . , and Solomon, H,C,

(a) Pen ic i l l i n in %he T r e a h n t of Neurosyphilis. J,Amer,med,Ass., 133: 5;1947. (b) Neurownlilitr , , a e r . J.Paychiat . , 103: 524, 1947.

Rose, ACE,, Trevett, L A , Hindla, J.A., Prout,.C,, and Solomon, H.C.

Psnici l l in Treatment of Neurosyphilis, AmerdApplr, 3 : 37 Wei

31% page 3

Scully, 3.P., Fdk, M.S,, a d Stokes, 3.H.

The Serologic Response in Penicillin-Treated Symptomatic Neurosyphilis. h e r J.Syph,, 32s 224, 1948.

Solomon, H. C , Pen ic i l l i n in Neurology & Psychiatry, Dig. Nrmrol. Psychiat., 14: 132, 1946.

Stern, J,E., and Campbell, K,M,

Ear ly Effects of Penicillin Treatsrent* of Dementia ParnZytica. Arch. Neurol,?sychiat ., 55 t 266, 1946.

Stokes, J.It,, Steiger, H.P., and Gammon, G.D.

Three Ysars,of Pen ic i l l i n Alone in #swosyphilis, Amer,J,Syph., 32: 28, 1948.

La penicillins en e l tratamiento de la neurosifilis, Prmsa Med. Argent,, 34: 240, 1947,

Tucker, H.A., and Robinson, R.C,

Eieurosyphilitic Pa t i en t s Treated with.Petzfcillin: Probable Herxheimer Reactions, J,Amer ,md,Ass., 132: 28l , 1946,