1920 Journal of the American Medical Association (JAMA)  
Most cases of gummas of the kidney which have been recognized clinically have been cured by specific therapy. TREATMENT In kidney syphilis the treatment should be twofold, that is, directed toward the syphilis and toward the kidney condition. In the transient albuminuria occurring early in the course of syphilis, specifics and general treatment alone are indicated. Specifics, how¬ ever, must be administered with extreme caution in all nephritic conditions, the urine being examined for albumin
more » ... mined for albumin and casts, and the phenolsulphonephthalein test being performed at frequent intervals. In acute syphilitic nephritis, rest in bed is imper¬ ative. Diuretics, such as digitalis and potassium citrate, as well as cathartics, should be administered. Hot packs to promote diaphoresis should be applied, especially in severe cases. The diet should be nourish¬ ing, and consist largely of carbohydrates, while a strict milk diet is desirable in some cases. Mercury should be withheld until the urine is free from albumin or nearly so, while arsphenamin should be administered in doses not to exceed from 0.1 to 0.2 gm. at weekly intervals. Slight exacerbations follow¬ ing the injection of arsphenamin should be disre¬ garded and the dose repeated at the proper time. In chronic syphilitic nephritis, after the diagnosis has been established by the improvement of the con¬ dition under the administration of a small dose of arsphenamin, specifics should be pushed as intensively as possible, particularly the arsenicals, which are much better tolerated than the mercurials. The treatment of syphilitic amyloid kidney is symp¬ tomatic, although specifics may be administered, but with little hope of success. Large and increasing doses of potassium iodid, as well as arsphenamin and mercury, are indicated in gummas of the kidney. ABSTRACT OF DISCUSSION Dr. William H. Mercur, Pittsburgh: A few years ago Sir Rose Bradford, discussing a case of chronic nephritis, stated that when an unusually large amount of albumin was present in the urine it might be due to syphilis. Such patients do not usually show the customary clinical signs of being very ill. Dr. J. B. McElroy, Memphis, Tenn. : I have seen several of the cases described by Dr. Thompson, and there seems to be nothing specific, so far as the syphilis is concerned. They are the same cases which present the clinical syndrome which we recognize as degenerative nephro.pathies, nephroses, symp¬ toms which are characterized by the absence of high blood pressure, the occurrence of considerable edema, and a large quantity of albumin in the urine, with an absence of red blood cells. This syndrome is characteristic of degenerative nephropathies and occurs in other conditions as well as in syphilis. We must drop the terms parenchymatous, interstitial, etc., which occur in connection with nephritis. Insecticides.-Naphthylamin crystals are used to kill body lice by sprinkling them down a man's neck between his shirt and skin. Powdered sulphur, generally in the form of an ointment, is used against the itch mite. Mercurial oint¬ ment is used against the pubic louse by rubbing it in the affected part night and morning. Various solutions, such as 1:500 solution of mercury bichlorid and S per cent, phenol, are used to kill insects and liquor formaldehydi is used quite extensively in fly traps, although the gas formaldehyd is not an insecticide.-U. S. Nav. M. Bull., Jan¬ uary, 1920.
doi:10.1001/jama.1920.02620270024006 fatcat:ihrulcumzrb7raz563mp6khe64