Disorders of metabolism: an account of five cases: presented for the Wightman Prize in Clinical Medicine
Wilson, C. W. M.
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The cases for this essay have been chosen to illustrate conditions in which medical research is now particularly interested. They are all cases to which, in the early stages, successful treatment can be rapidly and effectively applied. This treatment which consists essentially of endocrine substitution therapy alleviates the clinical features although it does not cure the disease. The advances which have led to the use of this therapy have been too recent to allow the prognosis of conditions treated in this way to be known exactly, or the ultimate progress of pathological complications in these diseases to be understood fully.In the cases described the signs and symptoms caused by the original disease are made more complex by the presence of clinical features produced by a condition which is commonly supposed to complicate the initial disease. In the discussions of the cases the treatment is considered in relation to its influence on the production of these complications; an attempt is made to determine the reason why such complications occur and their relation to the initial disease. It is only by such a study that rational and effective prophylactic therapy can be applied in the future.Medical teaching in Edinburgh stresses the value of accurate diagnosis and rational therapy but it does not stress to the same extent the fact that a careful clinical study of the patient may bring to light facts which if applied in clinical research may result in advances in medical knowledge. These cases. have presented complicated clinical problems; it has been the object in the discussions to try to elucidate these problems. When this has successfully been done the ultimate prognosis for patients who suffer from metabolic diseases which. previously were fatal in the acute stages, will be improved because the complications now associated associated with the late stages of the disease will be understood and subject to therapeutic control.