Introduction This paper is a cooperative report of the clinical, spinal fluid, and serologic findings in a group of 1,086 patients with general paresis (dementia paralytica) treated with penicillin with or without fever therapy at eight different hospitals. A detailed account of the formation and function of this cooperative clinical study has been given previously as an introduction to the presentation of the group experience in treatment of asymptomatic central nervous system syphilis.1 Shortly after the effectiveness of penicillin in the treatment of early syphilis was reported, various investigators began to study the efficacy of this new antibiotic in the treatment of central nervous system syphilis. These investigations were supported in part by grants from the Office of Scientific Research and Development, the National Institutes of Health, and the Division of Venereal Disease, U. S. Public Health Service. The findings of the individual investigators have provided much of the

Paresis strikes most frequently during life's most productive years. It is seen approximately three times as frequently in males as females, and over twice as frequently in whites as in Negroes. The usual incubation period is 10 to 24 years after infection. The simple dementing type of psychosis is more frequent than all other types combined. In the absence of previous treatment the spinal fluid complement fixation reaction is always positive and the spinal fluid cell count is almost always elevated. The blood serologic test may, rarely, be negative.

1.1. A report is given of the long-term results of therapy of latent syphilis with “adequate” arsenobismuth therapy in terms of clinical and serologic response.2.2. The prison milieu of treatment made possible close and careful serologic and clinical follow-up. Thus, a 10 per cent sample was given complete posttreatment examination at a time averaging about 14 years after treatment.3.3. To provide a control group against which to assess the significance of the so-called abnormal neurologic findings, reflex and pupillary examinations were performed by the same physicians, utilizing identical examination techniques, on a group of 847 nonsyphilitic prisoners in the same institution.4.4. The minimum rate of progression to neurosyphilis in the group “adequately” treated for latency was 0.3 per cent.5.5. The proportion of patients in the sample showing clinical evidence of possible neurosyphilis or cardiovascular syphilis was small. Of 255 for whom complete records are available, out of the final 277 examined, only 36 showed any tendon reflex abnormalities, and only 19 showed pupillary abnormalities of any kind. In none of these patients could a diagnosis of neurosyphilis be made unequivocally, and it appears that the abnormalities reported are of the same order as found in a nonsyphilitic group of comparable status.6.6. In this same group, only 11 findings in 10 patients suggestive of cardiovascular syphilis were found; and, of these, only one with aortic aneurysm had evidence permitting an unequivocal diagnosis of cardiovascular syphilis.7.7. “Adequate” arsenotherapy, given according to the standards utilized at Sing Sing prison for treatment of latent syphilis, results in a high degree of success in prevention of the development of neurosyphilis or cardiovascular syphilis.

The pattern of seroreversal, as measured by the New York State complement fixation test following “curative” treatment for latent syphilis, is shown and discussed with respect to a prison population experience involving 2,820 patients.

During the past several years, the Venereal Disease Program, in cooperation with a number of well-known clinics and hospitals throughout the country, has conducted a study to determine the effectiveness of penicillin in the treatment of asymptomatic neurosyphilis. A preceding report1has shown that factors such as age, race, sex, previous treatment, and re-treatment status have little or no relationship to clinical prognosis in penicillin-treated asymptomatic central nervous system (CNS) syphilis. The present report deals with the pretreatment and post-treatment status of the patient group in terms of results of blood and spinal fluid examinations. This study consists of 765 patients with asymptomatic neurosyphilis, whose histories were selected from the records of eight cooperating clinics in accordance with the following criteria: (1) reactive spinal fluid, i.e., abnormalities in the spinal fluid test for syphilis, colloidal test, total protein, or cell count, or