Manual for medical and dental officers of the Royal Air Force / Air Ministry.

Date:
1938
Catalogue details

Licence: Public Domain Mark

Credit: Manual for medical and dental officers of the Royal Air Force / Air Ministry. Source: Wellcome Collection.

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    each half-hour is measured and the specific gravity taken. A normal person should, during this test, pass approximately two pints of urine in three to four hours ; if less than one-and- a-half pints is passed, there is probably a renal defect. The case should then be investigated further. In warm climates or during hot weather, due allowance must be made for sweating. 4. The great value of these tests lies in the detection of vascular and interstitial changes in the kidneys. Chronic toxic conditions at any early stage may have a distinct, if moderate, effect on the urea metabolism. Thus in chronic alcoholics, before permanent lesions are apparent, the water excretion is often found to be abnormal. This, along with evidence of physical inefficiency, is an early sign of more damage to follow, unless the cause is removed. It is difficult to be sure, without the patient’s admission, as to the exact toxin at work, but the complete examination eliminates many causes. Moreover, the results of the test are apparent to the patient, who is readily convinced of the damage done. By informing him that the present lesion is probably temporary and will become normal, if the excesses are stopped, the average patient sees reason, and is rendered more efficient. Further tests performed at intervals of a month or so show whether the case is likely to recover, and to what degree. 5. Although the newer renal tests are of great value, the older tests must not be ignored. Thus, cases of renal tuberculosis have been met with where full efficiency tests have revealed a defective renal excretion, but the urine had not been examined for the tubercle bacillus. Cases of slight albuminuria have been from time to time encountered, also, in which a detailed examination has revealed either the ova of Schistosoma hematobium or the Bacillus tuberculosis to be the cause of the trouble. In some cases the condition had been overlooked for a considerable period of time. For this reason micro- scopical and cultural examinations are performed on all urines, and the deposit is always stained for the tubercle bacillus. 6. The following case illustrates the importance of investi- gating the cause of all instances of albuminuria. The patient was born in Bareilly, India, in 1901, and came to England in 1903. He went to South Africa (Orange Free State and Natal) in 1906, and remained there until September, 1914, when he returned to the United Kingdom. He had not been out of the United Kingdom since that date, or in other words, for nine years. The man claimed to have enjoyed perfect health at all times. He appeared before the Central Medical Board in April, 1923, to be tested for fitness to become a non-commis- sioned officer pilot, but was rejected on account of albuminuria. ig f..- a 4] a? See ah