No abstract

Penicillin has made the specific treatment of cardiovascular syphilis easy to give and easy to take and has all but abolished dangerous treatment reactions. Just as the curative therapy of acute syphilis with penicillin is simple and feasible, so is the prophylactic treatment of cardiovascular syphilis in individuals with latent syphilis and uncomplicated syphilitic aortitis simple and feasible. In spite of the fact that the effectiveness of such treatment has not been conclusively established, the prospects seem bright that the incidence of cardiovascular syphilis will decrease sharply in the immediate future. Cardiovascular syphilis may be treated, with or without preliminary bismuth and iodide "preparation," by the administration of 4.8 to 6 million units of penicillin in a period of 8 to 10 days. Larger doses and longer periods of treatment have been employed. Experience thus far does not indicate that penicillin therapy of established complications of syphilitic aortitis will be any more successful than was therapy of the pre-penicillin era.

No abstract

The inability of patients to provide a history and to cooperate in physical or technological examinations makes the diagnostic and therapeutic management of physical disease in psychotic and especially in elderly psychotic patients very difficult. There needs to be a disproportionate dependence upon laboratory and radiologic information in diagnosis of physical disease in such patients. Observations by personnel on the psychiatric wards are essential to identification of probable physical illness. An experience with 1800 patients on a medical service now approved for Medicare and Medicaid in a state psychiatric hospital clearly shows the impossibility of applying the norms of care set for a general hospital in such a setting. Additionally, the clinician is faced with ethical considerations of which actions are justifiable and which are not in the search for a diagnosis. The Professional Standards Review Organization, judicial verdicts requiring care for the mentally ill equal to that of other citizens, and the hazards of professional liability do not permit these considerations to be taken lightly. An organization that has responsibility for the mentally ill might well address itself to finding answers to these questions.