The examination of one specimen of urine does not give much information, especially if it should be found to contain no abnormal elements. Fairly accurate data may be gathered from the mixed night and morning urine; most accurate data from the twenty-four hour specimen. To be of any real value there should be frequent examinations of the day's excretion.
In measuring the day's output a good rule is as follows: begin to collect urine after the first morning's micturition and collect all including the first quantity passed the next morning. It is best to examine the centrifugated urine for casts even though no albumin be present. It is useless to look for casts in an alkaline urine.
Casts are not infrequently found in chemically normal urine from a middle-aged patient. Other things being normal, the finding has no significance. The kidneys must be carefully tested functionally.
Blood pressure readings should always be taken with the patient in the same posture at every estimation. At the first examination it is advisable to take readings from both brachial arteries. Let the patient sit comfortably and relax all muscles.
Differentiate as soon as possible between the uncompensated heart caused by valvular disease and that caused by arteriosclerosis. There is a difference in prognosis. Both give the same symptoms, and are treated similarly until compensation returns; thereafter the management of the two forms is different.
Aortic incompetence that comes on late in life is generally the result of curling of the free margins of the valves caused by syphilitic arteriosclerosis. Prognosis is grave because of the fact that the heart muscle also is the seat of degenerative changes and compensatory hypertrophy is established with difficulty.
When laying down a regime for a patient, consider his disposition, and individualize the treatment. Remember that exercise is an essential feature of the hygiene of the patient's life but do not forget to be explicit about the amount and character of the permissible exercise.
In the prophylaxis of arteriosclerosis, a rational mode of living is the all-important factor. As a rule, the less meat one eats, the less is the liability of arterial degeneration as age advances. The exceptions to this rule are many, and probably depend upon the character of the "vital rubber" with which the individual begins life.
The diet in well-marked cases of arteriosclerosis should be carefully selected with regard to its nutritive and non-irritating character. Animal proteins should be sparingly used. Milk should have an important place in the dietary.
No drug relieves the pain of uncomplicated aneurysm as surely as iodide of potassium.