Death Penalty
To work, and two months later regained his normal weight, and the patient is still working four years later and apparently in normal health.
Abstract
to work, and two months later regained his normal weight. Tke spleen became impalpable after six months, but the liver was still enlarged 4 cm. below the costal margin. Two years later the liver was just palpable below the costal margin. At nio time did the ascites recur, and the patient is still working four years later and apparently in normal health. Case 2.-A married woman aged 52 was admitted to hospital in September, 1953. complaining of intermittent abdominal swelling for three years, associated with flatulence, borborygmi, and colicky pain. Fourmonths bcfore admission these symptoms incr-eased and were accompanied by swelling of the lower limbs, lassitude, anor-exia, and the loss of I stone (6.4 kg.) in weight. She was emaciated and had moderate ascites and some pitting ocdema of the ankles. The liver was 7 cm. below the costal margin and had a firm, slightly i-rregular bor-der. The Wassermann and Khan reactions wer-e positive on two occasions. Her husband was suffering from cardiovascular syphilis and her daughterlf-om congeniital syphilis. There was no history of alcoholism, jaundice, or previous antisyphilitic treatment. Biochemical tests: thymol turbidity, 10 units; ser-um alkaline phosphatase, 56 KingArmstr-ong units; and serum bilirubin, 1.5 nig. per 100 ml. Needle aspiration biopsy cf the liver showed per-iportal fibrosis with infiltration of the connective tissue bands wit h iymphocytes, histiocytes, and occasional plasma cells. Antisyphilitic therapy was started with procaine penicillin and potassium iodide. There was an immediate and dramatic response; afterthr-ee weeks the ascites had almost disappeared and the patient waS fit ellough to go home. Out-patient treatmiient with courses of intr-amuscular injections of penicillin and bismuth continued until April, 1955. She received a total of 40 mega units of peniicillin andi 1) g. of bismuth. After one year's treatment she had put oii flesh andt svas easily managing her former work of weaver in a cotton mill. The liver and spleen were still palpable, although the for-mer was smaller. Liver function tests had improved: thymol tur-bidity, 4.5 units; serum alkaline phosphatase, 29.3 King-Armstrong units; and serum bilirubin, 0.7 mg. per100 ml. Good progress was maintained until May, 1955, when she developed an acute staphylococcal br-onchopneumonia and died 18 hours afteradmission. At necropsy the liver was coar-sely granular and weighed 1. 150 g. The histological picture was that of portal cirrhosis.. Thcre was no evidenice of syphilitic disease in the otheror-gans.