Previous studies have established the fact that penicillin treatment of acute streptococcal pharyngitis results in a marked suppression of antibody formation (1,2,3). This is in contrast to the failure of penicillin treatment to alter the immune response in patients with pneumococcal pneumonia (4). It has been suggested that in the latter case, sufficient pneumococcal antigen is formed during the early phases of pneumonia to provide a maximal antigenic challenge before penicillin therapy is instituted (4). The capacity of penicillin to suppress the production of streptococcal antibodies suggests that in streptococcal infections the antigenic challenge may be presented more gradually. Under such circumstances, it would be expected that the effectiveness of penicillin in this regard would be related to the time of institution of therapy. Since no definitive information on this point has hitherto been obtained, the present study was designed to test this hypothesis. DESCRIPTION OF STUDYAll patients fulfilling the following criteria were included in the study: the presence of exudative pharyngitis, history of onset of symptoms less than 31 hours before admission, and subsequent isolation of group A streptococci from the initial throat culture. Patients with a past history of rheumatic fever or chorea were excluded. A throat culture and a serum specimen were obtained on each patient at the time of admission and on the fourteenth, twenty-first and twenty-eighth days from the onset of symptoms.

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Urban air pollution, when sufficiently severe, can cause death in humans; these deaths occur preponderantly among those with increased susceptibility. Pollution--carbon monoxide and oxidants in particular--is capable of aggravating preexisting chronic heart and lung diseases. Pollution and tobacco (especially cigarette) smoke act synergistically in a causative role in chronic bronchitis and in an aggravating role in emphysema. Susceptibility to the effects of urban air pollution varies widely, with the most susceptible being fetuses, the newborn, the elderly, the infirm, those with chronic heart and lung diseases, and those who smoke. The carbon monoxide standards for sea level are probably too lenient for an altitude of 1,500 m and above. Using a broad definition of health, which takes into account concepts such as quality of life and social and mental well-being, few metropolitan residents would deny that their health is compromised by air that is malodorous, that irritates mucous membranes, and that obscures beautiful scenery.

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