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

1. A study of the comparative incidence of the morphologic lesions found among ninety-two untreated syphilitic patients and thirty-two control patients examined at autopsy is presented. 2. The gross and microscopic findings on the individuals included in this study indicate that the lesions characteristic of syphilitic involvement in the Negro male are to be found for the most part in the cardiovascular system. For this reason, a detailed analysis of the cardiovascular abnormalities, including the relationship of clinical and autopsy findings, is included. 3. Linear striation of the thoracic aorta was found to be the most reliable gross sign of syphilitic aortitis, while thickening of the aorta wall and necrosis of the media were found to be pathognomonic of syphilitic aortitis in the microscopic examination. 4. In thirty-seven (41.6 per cent) of the eighty-seven syphilitic patients in whom the aorta was examined grossly and microscopically, there was no evidence of syphilitic aortitis by either examination, and in twenty-five (28.1 per cent) of the patients, aortitis was diagnosed by both gross and microscopic findings. 5. On the basis of the findings in this study, it is estimated that a Negro male with syphilis of more than ten years' duration for which he had received no treatment (or less than 12 units of routine treatment) and with sustained seropositivity prior to death would have, roughly, a 50-50 chance of demonstrating syphilitic cardiovascular involvement at autopsy. 6. The unusually high prevalence of cardiac hypertrophy in this study group is believed to be due to the presence of compensatory hypertrophy caused by hypertension and/or myocardial degeneration. 7. The similarity of the clinical signs and symptoms of syphilitic and arteriosclerotic aortitis reduces the efficiency of clinical methods in the detection of syphilitic aortitis. 8. The brain was examined in forty-six of the ninety-two syphilitic patients autopsied. The two patients showing clinical symptoms of central nervous system involvement (paresis and meningovascular syphilis) were among the group examined. The patient diagnosed with meningovascular syphilis showed microscopic cortical atrophy at autopsy, and both patients were found to have opacity of the pia-arachnoid and perivascular and meningeal cellular infiltration. 9. In the respiratory, digestive, hematopoietic, endocrine, urinary, and reproductive systems of the human body, the incidence of abnormalities among syphilitic patients was not significantly different from that among the control patients. 10. In twenty-eight (30.4 per cent) of the ninety-two syphilitic patients examined at autopsy, syphilitic involvement of the cardiovascular or the central nervous system was established as the primary cause of death. The distribution of the causes of death among the syphilitic patients, aside from syphilis itself, was not different from that in the nonsyphilitic group.

1.1. A study of the comparative incidence of the morphologic lesions found among ninety-two untreated syphilitic patients and thirty-two control patients examined at autopsy is presented.2.2. The gross and microscopic findings on the individuals included in this study indicate that the lesions characteristic of syphilitic involvement in the Negro male are to be found for the most part in the cardiovascular system. For this reason, a detailed analysis of the cardiovascular abnormalities, including the relationship of clinical and autopsy findings, is included.3.3. Linear striation of the thoracic aorta was found to be the most reliable gross sign of syphilitic aortitis, while thickening of the aorta wall and necrosis of the media were found to be pathognomonic of syphilitic aortitis in the microscopic examination.4.4. In thirty-seven (41.6 per cent) of the eighty-seven syphilitic patients in whom the aorta was examined grossly and microscopically, there was no evidence of syphilitic aortitis by either examination, and in twenty-five (28.1 per cent) of the patients, aortitis was diagnosed by both gross and microscopic findings.5.5. On the basis of the findings in this study, it is estimated that a Negro male with syphilis of more than ten years' duration for which he had received no treatment (or less than 12 units of routine treatment) and with sustained seropositivity prior to death would have, roughly, a 50-50 chance of demonstrating syphilitic cardiovascular involvement at autopsy.6.6. The unusually high prevalence of cardiac hypertrophy in this study group is believed to be due to the presence of compensatory hypertrophy caused by hypertension and/or myocardial degeneration.7.7. The similarity of the clinical signs and symptoms of syphilitic and arteriosclerotic aortitis reduces the efficiency of clinical methods in the detection of syphilitic aortitis.8.8. The brain was examined in forty-six of the ninety-two syphilitic patients autopsied. The two patients showing clinical symptoms of central nervous system involvement (paresis and meningovascular syphilis) were among the group examined. The patient diagnosed with meningovascular syphilis showed microscopic cortical atrophy at autopsy, and both patients were found to have opacity of the pia-arachnoid and perivascular and meningeal cellular infiltration.9.9. In the respiratory, digestive, hematopoietic, endocrine, urinary, and reproductive systems of the human body, the incidence of abnormalities among syphilitic patients was not significantly different from that among the control patients.10.10. In twenty-eight (30.4 per cent) of the ninety-two syphilitic patients examined at autopsy, syphilitic involvement of the cardiovascular or the central nervous system was established as the primary cause of death. The distribution of the causes of death among the syphilitic patients, aside from syphilis itself, was not different from that in the nonsyphilitic group.