Not a single exact clinically experi mental basis found in all the literature for the exclusion of dark meats in chronic nephritis, but only hypothetical affirma tions over the greater content of irri tating products (especially nitrogenous extractives) for the kidneys in brown meat. In a personal case a patient with chronic parenchymatous nephritis who took 'I, pound of poultry daily for five days excreted the same amount of ni trogen and a trifle more albumin than be did in the next five days, in which, in stead of the poultry, be took an equiva lent amount of nitrogen in beef.
In many cases also a restriction of the amount of fluids to 42 or 50 ounces can be of great advantage. This treatment is peculiarly applicable to those cases with cardiac asthma and dilation of the heart. Patients with interstitial ne phritis suffer no diminution in the elimi nation of the important metabolic prod ucts by the restriction of liquids to litres. Von Noorden (Verhandl. d. Cong. f. innere Mod., p. 3S6, '99).
Indication for milk diet. The prevail ing custom to put the patient on a strict or partial milk diet has been strongly condemned by von Noorden, Lancereaux, and others, the second named holding that it is only advisable in desquamative nephritis, and not in the interstitial variety.
Great care should be taken to deter mine whether the albuminuria is func tional or due to a kidney lesion, which can only be ascertained by a prolonged and careful investigation of the patient's antecedents and habits. If it be con cluded that there is a chronic nephritis, the medication must assume a depurative character, as no medicines are capable of curing the disease. Milk is very valu able in such cases. In functional cases, however, the cause may be nervous, gastro-hepatie, gouty, or due to gravel, rapid growth, or menstrual disorder, and here treatment should be directed to the cause. As a result of neglect, such transient albuminuria may become per manent, owing to chronic injury of the renal epithelium. In these cases milk may be largely used or not, as may seem best in regard to the general health and nutrition, and its digestibility in indi vidual instances. Marboux (Lyon Mad., Feb. 11, 19011).
Indications for milk diet. In cases of functional albuminuria, as in the early stage of gout or in lithiasis, at the time of puberty, menstrual or digestive albu minuria, an exclusive milk diet evokes no other result than great weakness and sometimes an intense degree of anemia, without causing a disappearance of the albumin. The same eases improved
under a mixed diet in combination with some water cure. It is necessary to de termine the source of the albuminuria. If a chronic nephritis of whatever origin is present, the nutrition of the patient must be the first consideration. Here milk is at once a medicine and a food. If simple alhuminuria with no renal ele ments in the sediment is noted, if it is dependent upon some nervous, gastro hepatic, or gouty factor, or if a calculus is the cause. the cause must be treated, since the albumin may eventually have a deleterious effect upon the epithelium of the kidney. In such cases a mixed diet containing milk is to be advised. Victor Scheiber (Wiener med. Blatter, Mar. S and 15, 1900).
Patients with chronic nephritis seem to thrive best on a mixed meat diet, neither the white nor the dark meat of fowls appearing to be injurious. A. Pabst (Berliner kiln. Woch., June Is, 1P00).
Carefully regulated habits in regard to dress, exercise. and diet, and a change to a warmer, drier. and more equable climate, are necessary in eases that are convalescent from the very serious forms of nephritis, in which the renal paren chyma, by the persistence, at intervals, of a slight albuminuria, is shown to have been somewhat damaged.
In acute nephritis in children, rest in bed and strict milk diet: from one to two scarified cuppings on each side of the spine, with mustard plasters; every two hours 2 drachms of benzonaph thol and 2 drachms of milk-sugar in an effusion of cherry-stalk; morning and evening cold boiled-water enema; once or twice a week julep and scammony; dry friction of the body, and asepsis of the mouth. Perier (Jour. de Med., Apr. 29, '94).
When acute or subacute attack ap pears, more or less long sojourn in bed. patient lying between blankets. Warm climate, but not on or near the sea. Brushing of skin, but no baths, lest patient take cold. Moderate exercise or massage. Pregnancy contraindicated; sexual sobriety important. Milk the food and medicine par excellence; 2 quarts daily need not be exceeded. When marked improvement, vegetarian diet. Purgatives and diuretics only remedies needed, and caffeine subcutane ously if heart show sign of failure. Sapelier (Bull. Gin. de Then, Nov. 30, '94).