The paucity of the literature prevents our answering the question whether a complicating nephritis affects to any great extent the prog nosis of an individual case of hereditary syphilis. So much is cer tain; with the subsidence of the general symptoms thc pathological alter tions in the urine may also disappear. But it is equally possible that there may develop a typieal contraeted kidney, with plentiful clear urine, of low specific gravity, small percentage of albumin, and very few casts.
Therapeutic measures are directed to the cause. Especially to be recommended are gluteal injections of corrosive sublimate, as advised by Immerwol 0.2 c.c. (3 drops) of a solution of sublimate 0.1 am. Mgr.). sodium chloride 0.2 Gm. (3 gr.), aquw destill. 10. c.c. (4 dr.) given once a week. This treatment is to be interrupted only if the symp toms of renal disease are increased under the medication. The child is to be fed on the same principles as any patient with congenital syphilis.
4. Contracted Kidney Granular atrophy occurs congenitally in a very- few eases (Arnold, Westphal, Baginsky). The transition in infancy from an acute neph ritis to the eontracting kidney is not very frequent, but it has been shown to occur in the ease of the nephritis of syphilis. Heredity
certainly has a decided influence in the causation of contracted kidney in infancy. This was especially noticeable in the observation of Hellen dall upon a brother and sister of one half and two years respectively', who died of contracted kidney. The mother also suffered from the same condition, and it was shown that the origin of the trouble in the latter coincided with the fmtal life of the children.
The clinical manifestations are often very- insignificant. The quan tity of urine is large and the specific gravity is low. Repeated examina tions may albumin and a few casts (hyaline), but since they are frequently absent for considerable periods, the differential diag nosis from diabetes insipidus may be difficult. Cardiac hypertrophy and accentuation of the second aortic sound sometimes assist in the diagnosis.
The course may- be exceedingly chronic. A secondary contracting kidney is always a point of lowered resistance from which, if its powers are taxed, there may proceed symptoms of insufficiency. Therapeutics are of little avail. Even a rigorous milk diet continued beyond the period of infancy must be considered injurious in nephritis.