Congenital Syphilis—Still a Shadow on the Land

The US Surgeon General, Thomas Parran, chose an ominous phrase—Shadow on the Land—as the title of his best-selling book about syphilis, published in 1937. It was not without reason. At the time, according to Parran, nearly 700 000 Americans were being treated for syphilis, constituting only a fraction of the approximately 1.7 million that he estimated needed treatment. At least 500 000 new infections occurred in the United States each year, Parran stated, including 60 000 cases of congenital syphilis. Cardiovascular syphilis claimed 40 000 lives each year. The arsenic-containing compound salvarsan, supplemented with mercury or bismuth, was the most effective treatment. Syphilis, Parran wrote, was "the most urgent public health problem in this country today."^(p52)