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Objective: To explore the impact of medical interventions on reducing the prevalence of mental retardation (MR) in the United States over the last 50 years., Design: We reviewed the medical literature and other data from 1950 to 2000 to construct estimates of the general and condition-specific prevalence of MR in the United States over time. We further explored the existing literature to document historically important influences on condition-specific prevalence, including the year that an effective intervention was introduced, the likelihood of success of the intervention, and the availability of such interventions nationwide. Specific conditions included congenital syphilis, Rh hemolytic disease of the newborn, measles, Haemophilus influenzae type B meningitis, congenital hypothyroidism, phenylketonuria, and congenital rubella syndrome., Setting: Twentieth-century North America., Participants: Children with MR or 1 of the 7 specific conditions listed earlier., Main Outcome Measures: Case-specific and general prevalence of MR from 1950 to 2000., Results: The prevalence of MR caused by a number of specific medical conditions has decreased sharply over the last 50 years. However, the incidence of each of these conditions is relatively low, and cases of MR due to these conditions represent, at most, 16.5% of the total number of cases of MR in 1950., Conclusion: Although specific medical interventions have prevented thousands of cases of MR, their contribution to the overall prevalence of MR is relatively small.

Despite decades of experience with congenital syphilis, problems still arise in case definition, diagnostic evaluation, treatment, and follow-up. We reviewed all 50 cases of early congenital syphilis reported to the State of Texas in 1982. A large proportion of the infants were premature (39%), of low birth weight (38%), and symptomatic at birth (62%). Because of these findings, we believe that possible cases of asymptomatic congenital syphilis in Texas may be under-reported. Laboratory and/or roentgenographic findings were important to confirm the diagnosis of congenital syphilis. Over half of the asymptomatic infants had positive results of cerebrospinal fluid VDRLs. After diagnosis, the treatment of infants with penicillin varied considerably. While all 47 living infants were treated with penicillin, 21 different regimens were used. We urge all physicians to perform complete diagnostic evaluations on suspected infants consisting of a quantitative serum test for syphilis, serum IgM levels, a cerebrospinal fluid VDRL, roentgenographs of the long bones, and dark-field microscopy where indicated. Additionally, infants and their families need appropriate follow-up after treatment.

Treponemicidal levels of penicillin in the CSF were not obtained following intramuscular (IM) injections of 600,000 IU of penicillin G procaine along with 2% aluminum monostearate (PAM). Treponemicidal levels of penicillin in the CSF were achieved in 31 patients by probenecid, 500 mg/6 hr by mouth, with penicillin G, 500,000 IU by IM injection, and by probenecid every six hours by mouth and IM injections of penicillin G procaine once a day in two of three patients following injections of 600,000 IU, in four of five following 1.2 million IU, and in three (now all nine) following 2.4 million IU.