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Chemical Changes in Blood of Syphilitics. 211 



Bailey and MacKay 1 in a study of 25 cases of syphilis that 

 had developed toxic jaundice during arsphenamin treatment, found 

 values for blood sugar fairly normal, cholesterol very high when- 

 ever there were any signs of liver disturbance, and in the greatest 

 majority of cases, values for urea nitrogen ranging from 22 to 49 

 mg. per 100 c.c. of blood, twelve out of the twenty-five showing 

 figures above 30 mg. They observed similar increases in the uric 

 acid and creatinin of the blood. It is important to note that 

 although none of these cases showed any proteinurea before or 

 during treatment, they were distinctly nephritic, as proven by 

 these pathological figures and by the fact that they became 

 debilitated when placed on a high protein diet. 



The importance of studying the kidney function of syphilitics 

 before and during arsphenamin treatment has not been recognized 

 by syphilographers in general. Wechselmann, 2 early in the history 

 of arsphenamin therapy, emphasized the importance of kidney 

 insufficiency in syphilitics, and ascribed most of the fatalities to 

 this defect. Kolmer and Lucke, 3 in a recent histopathological 

 study, showed that even small (therapeutic) doses of arsphenamin 

 and neo-arsphenamin when injected repeatedly into the veins of 

 rabbits produced vascular and tubular changes in the kidneys, 

 characterized as "nephrosis." " Focal areas cf cellular degenera- 

 tions and necroses were frequently well marked, particularly 

 in the heart and liver." 



Scope and Method of Investigation. — The patients studied 

 were two cases of tertiary syphilis with optic atrophy. They were 

 kept in a ward on a hospital diet, low in proteins and fats and fairly 

 uniform from day to day. Their water intake was also controlled. 

 The blood specimens were always obtained three hours after a 

 special, constant breakfast. The analytical methods used were 

 those of Folin and Wu. 4 



1 Bailey, C. V. and MacKay, A. Toxic Jaundice in Patients under Anti- 

 syphilitic Treatment. Archiv. Int. Med., 1920, xxv, 628-647. 



2 Wechselmann, W. Uber die Pathogenese der Salvarsantodesfalle. Berlin, 

 19 13. Urban and Schwarzenberg. 



3 Kolmer, J. A., and Lucke, B. Summary of Experimental Studies on the 

 Histopathologic Changes Produced by Arsphenamin and Neo-arsphenamin. Archiv, 

 Der. and Syph., 1920, ii, 289-291; ibid., 192 1, iii, 483-580. 



4 Folin, O. and Wu, H. A System of Blood Analysis. Jour. Biol. Chem., 1919. 

 xxxviii, 81-109; and ibid., 1920, xli, 367-375. 



