Diseases of the kidneys and of the spleen, hemorrhagic diseases / by H. Senator and M. Litten ; edited, with additions by James B. Herrick ; authorized translation from the German, under the editorial supervison of Alfred Stengel.

  • Hermann Senator
Date:
1905
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of the kidneys and of the spleen, hemorrhagic diseases / by H. Senator and M. Litten ; edited, with additions by James B. Herrick ; authorized translation from the German, under the editorial supervison of Alfred Stengel. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    cular system in all patients. He is a careless physician who neglects to do this when seeing a patient for the first time. It is the family doctor who, having examined his patient on other occasions and having found him sound, is most liable to neglect urinalysis or care- ful physical examination when, later, this patient comes to him with what seems to be a slight ailment. It is well to keep in mind the various manifestations of chronic uremia discussed under that heading; the trifling complaint may be one of the stigmata of chronic uremic intoxication. Often these complaints are of such a nature as to lead the patient to consult the specialist or to be sent to him by the family doctor. We need not mention them all here, as it would be merely a repetition of what has been said elsewhere, but one should not forget that ano- rexia, nausea, vomiting, and diarrhea may mean uremia, and so may pru- ritus, cramps in the muscles, as in the calves of the legs ; dizziness, tinni- tus, blurring of vision and other ocular disturbances be uremic, as may headache. We should always think of the kidney as the possible cause of an obstinate headache in one in middle life who has heretofore been free from it. Careful attention to the subjective history will often arouse our suspicions as to the renal origin of symptoms, and lead us to examine more critically the heart, vessels, retina, urine, and save us from an exasperating, if not serious, error in diagnosis.—Ed.] PROGNOSIS. The prognosis of fully developed contracted kidney, so far as recovery is concerned, is altogether unfavorable; as regards life, on the other hand, it is not quite so hopeless, although far from favorable. It depends, in the first place, on the condition of the vascular system and the power of the heart; for so long as there are no disturbances in these organs, the patient's condition may remain comparatively good for a number of years, and he may even enjoy a certain measure of comfort and be able to follow some light occupation. The case is quite different, however, so soon as compensation is disturbed or hemorrhages, particu- larly cerebral hemorrhages, make their appearance. Even if the patient recovers from one or more of such accidents, his days are nevertheless numbered. [This statement is in general true, yet occasionally, even after cerebral or other hemorrhage in nephritis, the patient will, with care, manage to live with a fair degree of comfort for some months or even years.—Ed.] There is one danger to which an individual with pronounced contracted kidney is always exposed—namely, uremia—aiKi it is impossible to predict with certainty whether it will or will not occur. All that can be said is that it is more likely to occur after excesses of any kind, whether bodily or mental, than in the absence of such excesses. But so long as the condition of contracted kidney is not fully developed, and the heart and blood-vessels particularly are not involved, or at least show no signs of being diseased by the presence of increased arterial tension, there is always hope that the morbid process may become arrested or, that functional recovery, at least, may take place. The outlook is, of course, better if the disease is recognized early, and 19
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