The Ethics of Medical Homicide and MutilationO'Malley, Austin
Religion
The Ethics of Medical Homicide and Mutilation
O'Malley, Austin
Medical ethics
Both subacute and chronic parenchymatous nephritis show clinically
much albumin, many casts, marked edema (except in very emaciated
cases), absence of high blood-pressure, and the heart is not
enlarged. This condition is caused commonly by chronic tuberculosis,
syphilis, sepsis, and malignant tumors. With these clinical symptoms
and the history, we may differentiate the nephritis of pregnancy
from Bright's disease. Again, acute intestinal nephritis or
glomerulonephritis has urinary findings like the nephritides just
described, and there may be edema. The heart and the blood-vessels
are normal. The cause is usually a pus microörganism, and there
may be anemia from the sepsis. In subacute glomerulonephritis, or
intestinal nephritis, the urinary findings are marked (much albumin
and many casts), anemia is rather constant, the blood-pressure
gradually goes up to 180 or 200, edema may be marked or absent. The
cause is usually a pus microörganism. Chronic glomerulonephritis
shows much epithelium and many casts (sometimes in showers), the
blood-pressure is high, the heart is usually somewhat enlarged,
there is polyuria and some blood, edema is common (but there are
dry cases), albuminuric retinitis is rare, and anemia is marked
and secondary. It may be difficult to find the cause of this
chronic glomerulonephritis, but there is, as a rule, a history of
tonsillitis, septic rheumatism, endocarditis, a true influenza, or
the like infection. Primary arteriosclerotic contracted kidney shows
hypertension and secondary circulatory disturbance. The urinary
findings are comparatively slight and transient, and there is little
or no anemia. The development is insidious, and the etiology is not
known.
There is evidence of late to find a septic cause for most of the
nephritides, such as infectious fevers, pyorrhea of the teeth,
and like bacterial intoxications; in pregnancy the nephritis may
be toxemic from sources that are not bacterial. It is extremely
difficult, and not seldom impossible, to make any differentiation, as
has been said. When the child is viable, whether the uterus should be
emptied or not must be decided for the individual case; no general
rule can be set down to cover all conditions.
One of the kidneys may be dislocated during pregnancy--usually the
right kidney. If a floating kidney becomes twisted on its pedicle,
abortion may be a consequence. The torsion may compress the renal
blood-vessels and bring on acute hydronephrosis with high fever,
great abdominal tenderness, and a peritonic facial expression.
Pyelitis of the renal pelvis is not seldom met in pregnancy. The
gonococcus, colon bacillus, or some other pyogenic bacterium gets a
nidus after pressure and lowered power of resistance. This condition
is sometimes mistaken for appendicitis.
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