PENICILLIN THERAPY ALONE IN NEUROSYPHILIS: AN ANALYSIS OF CLINICAL RESULTS

Abstract

161 cases of neurosyphilis were treated with penicillin alone from November, 1943, to July, 1945. The results, as measured clinically and by blood and spinal fluid change, showed that penicillin is an active therapeutic agent. The greatest effect on symptoms and signs occurred in the mental breaks, the incoordination, tremors and speech defects of paresis and in the lightning pains of tabes. Fixed pupils, absent reflexes and other signs of destructive lesions did not improve. Spinal fluid abnormalities were particularly responsive to penicillin. The effect on asymptomatic cases was greatest and on paretics least. Blood responses are less than spinal fluid responses. Penicillin is the tirst choice for the first treatment of neurosyphilis. This statement may be qualified for severe paretics. In these, failure to improve promptly indicates further treatment, either more penicillin or fever. Dose schedules are discussed in the light of the various factors involved including the changing character of penicillin. Adequate clinical and spinal fluid follow-up is essential.