Anaphylactic death is more likely to follow injection into a vein than into a muscle, and is less likely the more slowly the drug is absorbed, so that repository penicillins are safer than penicillin in water solution given by injection. Skin allergies, furthermore, are known to have a complex basis, often including emotional factors.

Europe lagged behind the United States in the exclusive use of penicillin, with reservations lingering there which, as we will see, were not altogether unjustified. In the Soviet Union arsphenamines and bismuth were still being used as adjuncts to penicillin treatment, at least until recently.

Even earlier, in 1929, Alexander Fleming had noticed that a soluble product of a Penicillin mold which he called penicillin had valuable "antiseptic" properties and seemed entirely harmless to man. This fact did not bear fruit until 1940 1941, when, partly under the stress of war, Chain, Florey, and their associates in England were able to show how to produce penicillin in usable quantities.

The modern era of so called chemotherapy dates from the announcement of Salvarsan Ehrlich's No. 606 as a specific for syphilis. Ehrlich had won a Nobel Prize (with Metchnikoff) two years before for his studies of immunity. In 1909 his young Japanese assistant, Sahachiro Hata, who had learned how to work with syphilis in rabbits, retested two of Ehrlich's organic arsenical compounds ("arsphenamines"), numbered 418 and 606; earlier tests by another assistant had shown promise for the first but not for the second.

Of all drugs used for VD before Ehrlich's time, only mercury for syphilis and silver nitrate to prevent gonococcal blindness in newborn babies can now be thought to have had any value. Of these, the second, introduced in the early 1880s by the Leipzig obstetrician Karl Siegmund Franz Crede following the work of Noeggerath, is still in use today.

An ounce of prevention, says grandma, is worth a pound of cure. Few people take her seriously. Unless we are singed by the fire before being snatched to safety, we are not likely to know that anything has been prevented; and mass prevention seems anonymous or impertinent and elicits no gratitude.

As for the minor venereal diseases, the recognition of lymphogranuloma venereum is based first on clinical signs and confirmed by a group of laboratory tests. Ordinary cultures show nothing useful: the LGV agent grows like a virus, best in the yolk sac of fertile hens' eggs.

The problem of diagnosing gonorrhea is different and in some ways tougher. The part played by medical ignorance or lack of interest, and by technical carelessness or incompetence, is much the same for both diseases. But syphilis can be diagnosed if it is suspected and if the patient can be induced to stay around for the necessary brief interval.

The FTA ABS test is almost as specific as the TPI test and may be even more sensitive, especially in early syphilis. Nevertheless it appears that some blood specimens which are reagin-positive and FTA ABS negative still prove to be positive by the TPI test, so that they cannot be called BFP's; and oddly enough, the Reiter test is also still found useful in some of these cases.

The virulent spirochete tests would probably replace all others if they were easier to do, and they would be easier, for example, if virulent spirochetes could be cultured. But they still have a few drawbacks, and it is possible that reagin type tests would continue to be needed in any event.