COMMENT

This patient was first treated 16 months before his death for sudden blindness. At that time he showed papilledema, cardiomegaly, and hepatomegaly. From the subsequent history, it seems most probable that the patient's ocular symptoms and findings were caused by a grade 4 hypertensive retinopathy, although a superimposed uremic retinopathy at that time cannot be excluded by the history. The cardiomegaly was undoubtedly secondary to a grade 3 essential hypertension. The hepatomegaly could have been due to cardiac decompensation, but the history of the first admission is not suggestive of myocardial failure. The history suggests the possibility of portal cirrhosis (which is not established or denied in the pathological report).

The second admission revealed the typical story of cardiac decompensation secondary to hypertensive cardiovascular disease and renal insufficiency arising from arterial and arteriolar nephrosclerosis. The patient's erythrocyte count and hemoglobin level were compatible with his azotemic state. The leukocytosis with