The Purbis oration on some points in the diagnosis and treatment of granular kidney : delivered before the West Kent Medico-Chirurgical Society / by Samuel West, M.D. Oxon., F.R.C.P. Lond., consulting physician to St. Bartholomew's Hospital, etc.

  • West, Samuel
Date:
[1913?]
Catalogue details

Licence: In copyright

Credit: The Purbis oration on some points in the diagnosis and treatment of granular kidney : delivered before the West Kent Medico-Chirurgical Society / by Samuel West, M.D. Oxon., F.R.C.P. Lond., consulting physician to St. Bartholomew's Hospital, etc. Source: Wellcome Collection.

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    should be of studied moderation in all things, of such a sort as would tend to keep the physical health at the highest level. The risk at this stage is that the albuminuria which has been discovered should lead to its drastic treatment. The amount of albumin lost daily is too small to have of itself any effect upon the general health. Treatment has little or no effect in materially reducing its amount, still less in causing its disappearance, and drastic treatment by diet will injure the general health. Treat if need be, bnt do not over-treat. There is another risk by no means negligible— viz., that of alarming the patient so much as to convert him into a renal hypochondriac whereby there is added to the renal disease, which is bad enough in itself, a neurotic condition of no slight gravity. To dwell too much upon the gravity of the case in the early stages to the patient is there¬ fore undesirable, and, considering the long lease of life these early cases have, not warranted by facts. When symptoms arise they must be treated on general principles, bearing in mind especially the nature of the disease which underlies them. Thus if cardiac symptoms develop over-stimulation must be avoided because of the increased blood pressure this would cause. For this reason digitalis is of doubtful value, and caffeine is a better remedy. Vascular tension ought to be somewhat raised in granular kidney, and cannot be reduced much without detriment unless it be excessive. On the other hand, if the tension be low it must be raised, for with a low tension the patient is not so well, and will not be better until the tension has risen again. It is the tension that determines the use of digitalis. If the tension be raised it will do harm, but if low, and especially if associated with cardiac failure, digitalis is the best drug for the purpose. So soon, however, as the desired effect has been produced it should be suspended. Hcemorrhage may not be serious except when it affects the brain. Fortunately, cerebral haemor¬ rhage rarely develops without some warning, and if the warning be taken may be avoided. These