Treatment.—A strict hygienic regime following an early appreciation of the disease will, to a considerable degree, prevent the advance of the cirrhotic process. Noxious substances that have an etiological influence must be removed as thoroughly as possible and avoided. Uric-acid formation must be reduced by dietetic supervision, alcohol must be in terdicted, and lead—when the causative factor—must be prevented from further poisoning the system by a change of occupation. The heart and blood-vessels are also preserved by the diminution of these irritants. The hygienic treatment embraces a regulation of all the habits of the body and the mode of living. The malady is incurable; therefore the pa tient himself must be treated, and not the malady. A suitable dietary must be formulated for each individual, and Saundby's rule furnishes a good work ing principle: "Eat very sparingly of butchers' meat; avoid malt liquors, spirits, and strong wines." An absolute milk diet may be necessary for short periods in the presence of gastric irri tability, but undue weakness will be the result of a continued restriction to milk alone.
Authors are by no means unanimous as to the best diet for patients with chronic Bright's disease. All the a priori reasons urged in favor of milk or any other particular diet were fallacious. The only way to attack the problem is carefully to observe the condition of the urine and the condition of the patient upon different diets.
1. Quantity of urine. Usually more urine was secreted upon farinaceous or milk diets than upon full diet.
2. Specific gravity. The diet had no certain influence on this, but, on the whole, it was lower on milk and fari naceous diets than on full diet.
3. The quantity of albumin passed. The figures showed that nearly always the albumin passed was more upon milk diet than upon farinaceous, and less upon full diet than upon either milk or farinaceous. Patients always best avoided loss of albumin by a full diet.
4. The quantity of urea passed. The influence of diet upon this was most un certain; often less urea was passed upon full diet than upon farinaceous, and less upon farinaceous than upon milk. Some times the reverse was true.
5. General condition of the patient. The cases distinctly showed that a full diet was not more liable to lead to uremia than any other; in fact, in one patient full diet appeared to ward off urmmia, and the patient ultimately re covered. The patients always felt and seemed much better and stronger on full diet, or on farinaceous diet with meat or eggs added, than on milk or farina ceous only. Hale White (Brit. Med. Jour., Apr. 29, '93).
Loss of albumin main point to be coun teracted. Loss not made up by increase of proteid food. Rich proteid diet may lead to retention of nitrogenous extract ives. Bence, (; ounces of meat, 13 ounces of bread, liberal allowance of vegetables and fruit, ounces sugar, 5 ounces fat a typical diet in chronic albuminuria. Milk mainly useful in acute cases when loss of appetite, or in addition to above mixed diet. Hirschfeld (Zeit. far Krank enpilege, May, '95).
A light, nourishing diet is, therefore, advisable. Lean meat may be allowed once daily in favorable cases, and vege tables, greens, fruits, and light, well cooked, farinaceous articles may also be partaken of. Tea, coffee, and cocoa may
be drunk. The use of the natural min eral waters aids in the renal circulation and keeps the kidneys flushed. As a rule, a mixed diet will be advantageous. The carbohydrate and nitrogenous ele ments (sugars and starches) should be used in moderate amounts, but fruits and pure fats are to be strongly recom mended.
Von Noorden announces that in cases of contracted kidney and the early stage of heart-weakness the elimination of the products of metabolism is not in fluenced to any extent by a reduction of the amount of fluid taken daily. Albumin does not seem to he materially changed either by an increase or de crease in the amount of liquid ingested. Moreover, in Bright's disease. the heart is failing, a diminution of the quantity of water proves beneficial. The reduction of the quantity of liquid is advised in the early stages. He has also noticed that after the ingestion of a large quantity of water in contracted kidney there is enlargement and weaken ing the heart. In the advanced stages. with a corresponding degree of arteriosclerosis with hypertrophy of the heart, restriction of liquid is impera tive. The average quantity of liquor advised is 2 pints. Professor Ewald confirms von Noorden.
The bath treatment was based on the assumption that the action of the skin had a certain connection with functions of the kidneys, and that by stimulating the former a disorder of the kidneys might be benefited.
J. Groedel (Practitioner, Dec., 1901) has never seen any curative re sults from the drinking of waters. His experience is that the bath treatment in eases of parenchymatous nephritis is contra-indicated. He divides eases of contracted kidneys into two groups. In the first group are those in whom the circulatory system is not greatly dis turbed. The second group consists of those who show an advanced degree of insufficiency of the heart, which is more or less distinctly dilated. In the first group of eases the Nanheim baths are suitable, but in the second group baths are contraindicated. It has been said that carbonic-acid saline baths always increase the blood-pressure, but this is not the fact, and it has been proved that in cases of arteriosclerosis we are able to regulate the baths in such a way as not to increase the blood-pressure, but rather to reduce it. If this is the case, these baths should also be beneficial in contracted kidney. The baths of Nauheim have the effect of reducing the blood-pressure for a longer period than the artificial baths. The more carbonic acid the bath contains, the more the temperature may be lowered, but not below 90° F. The baths seem to dilate the peripheral vessels, a con dition brought about by the irritation of the gas and the reduction of the blood-pressure: they lighten the work of the heart and lead to a saving of that organ, which gives it a chance of recovering strength, and this is still further promoted by the direct stimu lating and tonic effect of these baths. The increase in the diuresis is ascribed to the strengthening of the heart. Editorial (Phila. Med. dour.. Aug. 23. 1902).