(a) Chronic parenchymatous nephritis (face, pale and edematous, urine of moderately light specific gravity containing albumen and casts).

This forms a class of cases in which a great many practitioners prescribe a milk diet and keep it up indefinitely. While milk presents an ideal food for these patients and may be used with advantage for a week or two at a time, it should not form the only means of nourishment for a prolonged time. Although the kidneys are given more rest under this regime, the organism suffers from this onesided and at times insufficient alimentation. The anemia, here generally present, is enhanced and thus the conditions are unfavorable for the recuperation of any diseased organ. The consequence is that the kidney not withstanding its diminished activity, does not recover. A more liberal diet although requiring more strenuous work from the kidney creates a more healthful state of the individual and gives the affected organ a better chance for recovery.

The daily diet will therefore consist of the following:

Milk or kumyss, about a quart, gruel or porridge about one pint (given in two portions), 2-3 eggs (soft boiled, scrambled or poached), tender meat, preferably the white kinds (about 3-4 ounces), bread and butter; weak tea or weak coffee with sugar; fight vegetables and 11 fruits. Table salt should be avoided, and the dishes prepared if possible, without salt; seasoning substances, pepper, onion, mustard and the like, should likewise be avoided. Meat soups and broths should be forbidden. The amount of fluid including that contained in the food, should not be more than two quarts and a half in 24 hours.

Great variety in the selection and preparation of the foods is very desirable, for the appetite of the nephritic is usually poor and requires as much stimulation as possible. The patients should be encouraged to eat, and everything should be done to raise the nutritive state of the organism.

(6) Chronic interstitial nephritis (patient usually well nourished with a florid complexion and high strung temperament: urine pale, abundant in quantity, of a diminished specific gravity, with little albumen and but few casts and sufficient sodium chlorid excretion; the blood pressure is usually high).

This form of nephritis is frequently encountered in plethoric and stout individuals. Luxurious living, high tension in business or professional activities and diminished mental rest as well as lessened muscular exercises greatly contribute toward the development of interstitial nephritis. Tobacco and alcohol are here also contributory factors.

The dietary regime will be of a restricting type. Simple foods in moderate quantities with but scanty protein, should be given. Purin containing aliments, alcoholic beverages and spices should be prohibited. The physician will have to guard the patient against taking too large an amount of food. In fact reduction in the body weight is in this class of cases frequently beneficial. The daily ration may consist of white meat (chicken or fish) 3 iiiss, one or 2 eggs, some salt-free bread and butter, vegetables, fruits and 1-2 glassfuls of milk. Alcoholic beverages, coffee, meat broths should be forbidden: while alkaline mineral waters and a moderate quantity of weak tea may be given.

Occasionally it is advisable to institute one or two meat-free days weekly and also to prescribe a very small breakfast (1/2 roll and one cup of weak tea without milk). Provided the quantity of foods taken at the other two meals is not increased, this plan of alimentation will lead to a slight reduction in weight. Wherever the latter appears desirable, this regime can be applied with advantage.

(c) Congestive nephritis; (scanty urine of high specific gravity containing a small amount of albumen, without any or but very few casts).

Congestive nephritis is usually due to grave disturbances of the heart leading to diminished pressure in the renal arteries and increased pressure in the corresponding veins. The treatment must be directed toward improving the general circulatory system and the diet will be that adapted for the special heart lesion.

The main principle is to select a diet suitable for rest of the kidneys - as little protein as possible, no irritating substances, a small amount of fluid. Karell's diet is here appropriate for about 3-5 days. Later, especially if the condition improves, the diet is gradually and cautiously increased.