FIGURE 18.-This patient (figure 17) has very slight improvement in field and has an unchanged (Dattner-Thomas inactive) spinal fluid after a third course of 4,000,000 O.u.-total 6,400,000 O.u.

The findings indicate:

(1) Improvement of blood titer; reversal of CSF to normal, improvement in eye findings under repeated "low" dosage courses of penicillin intramuscularly. (2) Relapse (slight) in spinal fluid with such treatment (both first and second course).

(3) Relapse and extension of process (focal arachnoiditis, "island" type lesion?; retrobulbar neuritis?) after 2 courses of 1,200,000 O.u. each.

Focal lesions in the nervous system have long been known, depending on type and location, to resist systemic treatment and to progress independent of general serologic and clinical response. Penicillin produced both local aid general response at low dosage. Will it block local and general recurrence, and progression, at the higher dosage? What is a nonsignificant spinal fluid abnormality?

FIGURE 19.-The comparative lastingness of the good effect of penicillin here, remains to be determined. Retreatment at 2,400,000 O. u. should be considered

TABES DORSALIS WITH PRIMARY OPTIC ATROPHY

FIGURE 20.-Return of a tabetic grade III spinal fluid (primary optic atrophy) to normal with 2 courses of 1,200,000 O. u. each

TABES DORSALIS-PRIMARY OPTIC ATROPHY-AORTITIS

CASE #44, R. S., W., M., age 52. Routine STS positive in 1936. 1936–1941, more than 30 As. and 60 Bi.

PENICILLIN 1,200,000 Oxford units (retreatment begun 157 days postpen).

9 CASES:

FIGURE 21.-Response of lightning pains; nonresponse of Charcot joints
TABES DORSALIS WITH LIGHTNING PAINS

2 tabetics with Charcot joints, no improvement on 3,000,000 O. u. and 3,600,000 O. u. and 1 developed a second Charcot joint.

Evaluation:
October 1944

FIGURE 22.-These results will for the moment bear comparison with those of fever therapy in paresis and taboparesis. The higher dosage seems the better

15 of 24 clinically improved-8 markedly (grade 3 and 4). 8 observed over 200 days, 6 improved. 8 Given 1,200,000 O. u., of whom 3 improved. 16 Given 2,400,000 O. u., of whom 11 improved.

FIGURE 23.—A striking clinical result, with serologic response, in taboparesis.

CENTRAL NERVOUS SYSTEM SYPHILIS-TABOPARESIS

Case #70, H.M., W., F., age 47. In 1942 noted trouble in walking which became progressively worse, confining patient to bed. In 1943 began to have flight of ideas, with garrulous, slurring speech. Paranoid ideas were noted in addition, in 1944.

Notes

Patient could not write or do housework. Had auditory hallucinations, personality changes, disorientation, tremor of tongue, hands and mouth, slurred speech. On second day of penicillin therapy had Herxheimer reaction with right-sided convulsions becoming generalized. After 24 hours, penicillin reinstituted at half-dose to total 1,200,000 units, without untoward effect. By 16th day, completely oriented, memory, speech, tremor improved, electroencephalogram improved. In 4 months patient tremor-free, speech and writing normal, well oriented, hallucination-free, and satisfactorily performing housework including marketing with points and driving car.

FIGURE 24.-Maintained improvement in spinal fluid in early taboparesis (meningovascular

neurosyphilis?)

EARLY TABOPARESIS

CASE #64, R. B., W., M., age 37. Questionable chancre 1925, routine STS 1942 positive, slight symptomatic changes. Received 22 mapharsen, 19 bismuth subsalicylate. Spinal fluid findings as below:

PENICILLIN 2,850,000 Oxford units-50,000 O. u. every 4 hours

Spinal fluid reduced to normal and maintained to 196th day.