A FATAL CASE OF SECONDARY SYPHILITIC NEPHRITIS: WITH REMARKS
Authors: A. J. Hall, J. M. Beattie
Journal: BMJ (1911)

THE[ case which forms the subject of this paper was admitted to the Sheffield Royal Hospital on May 12th, 1910.The history of his illness may be divided into two parts.For the first of these, relating to the beginning of his illness, our thanks are due to Dr. A. MePhedran, Physician to the Toronto Hospital, for the very complete record so promptly and courteously sent in reply to our inquiry.P., a chauffeur, aged 23, whilst on a visit to Canada in 'September, 1909, acquired a primary venereal infection.He was told that these were "soft sores."They healed comjpletely, but he continued to feel ill.What treatment, if any, he then had is unknown.On December lst, 1909, his throat began to be sore.On January 4th, 1910, the legs began to swell, followed by swelling of the scrotum, and on January 16th his hair began to fall out.The same day he was admitted to the Toronto Hospital, under Dr. McPhedran.His condition then was, briefly, as follows: Temperature, 1010 F.; enlargement of all the superfioial lymph glands; general oedema of the whole surface; deep serpiginous uloers on the fauces; a discrete macular rash; (?) mucous tuberole on the lower lip; urine 1014, albumen 0.2 per cent., no sugar, hyaline and granular casts abundant.Treatment consisted of: (1) Free purgation;(2) intra- muscular injections of mercury salicylate (1 grain) once a week; (3) potassium iodide, 5 grains thrice daily, increased by i5 grains per dose per week.On January 25th the oedema had almost disappeared, likewise the rash.He continued to im- prove, and on February 21st-that is to say, five weeks after admission-he left hospital against the advice of his physician.At that date the urine still contained 0.17 per cent. of albumen with a few hyaline and granular casts.He returned to England in Maroh, 1910.Soon after his ;arrival the dropsy returned, and he suffered from time to time from headache and vomiting.On May 12th, 1910, he was admitted to the Sheffield Royal Hospital, suffering from general oedema, anaemia, oliguria, vomiting, and headache.Urine, specific gravity 1012, much albumen and considerable blood, many casts.He stayed in hospital until his death, twelve weeks later, and though the severity of individual symptoms varied from time to time, he ;steadily got worse.Necropsy.A post-mortem examination was made by one of us (J.M. B.) -on August 10th, 1910.Naked-eye Appearances.-Thekidneys enlarged, the capsules strip easily, leaving a smooth surface, colour pale, stellate ,veins marked.The superficial cortex increased, being in the proportion to medulla of 1 to 1. On section a uniform yellowish colour, vascular markings obliterated; no amyloid -change, no pelvic dilatation; no cysts; tissue firm and oedema- tous.Vessels slightly thickened at places.The lungs: Slight pleurisy at left base.Heart: Recent pericarditis; left ventricle 'hypertrophied; pale and fatty.Liver friable; slight atheroma -of aorta; no gummata anywhere. Microscopical Examination.Kidney.-There are very extensive fibrotic changes both in the glomeruli and between the tubules.Gloneruli.-Thetuft in some of these appears to be hyper- trophied, shows marked lobulation, and the space between it * Read before the Yorkshire Branch, British Medical Association, -at Huddersfield, March, 1911.and Bowman's capsule is more evident than usual.The