The diminution of the excretory function of the kidney leads - if pronounced, already at the beginning of the disease, otherwise in the later stages - to uremia. The latter manifests itself when present in a minor degree, by slight headaches, nausea sometimes accompanied by vomiting and general unneasiness. When the excretory function is lacking in a higher degree, it leads to loss of consciousness and also convulsions. The arterial blood pressure - usually high in nephritics - frequently shows a further increase; although in rare instances the reverse takes place (bad prognosis).

The diet will consist of milk and gruels and fruit juices, 5 to 7 ounces every 2-3 hours. When vomiting exists or when loss of consciousness be present, rectal alimentation must be resorted to. Notwithstanding the existence of edema, a 5-6% glucose solution can be given by the Murphy Drip through the rectum in quantities of one to two quarts daily. By this means it is occasionally possible to stimulate the kidneys to better work, in such a manner that the obnoxious substances are ultimately removed, - leading to a return of consciousness. As soon as patient is able to take food, the same diet is employed as in acute nephritis. Provided there is a further improvement alimentation is gradually increased and the rules laid down in chronic kidney disease observed.

Dropsy

Dropsy (general edematous swelling, anasarca, ascites; pleuritic exudations) frequently appears in acute nephritis and is almost always encountered at one time or another, during the chronic stage of renal affections. This complication requires special treatment and diet. An exclusive milk diet (l 1/2 - 2 1/2 quarts daily) is frequently found beneficial, the urine becoming more abundant, showing less albumen, and the swellings gradually disappearing. The general nutrition, however, cannot improve on this insufficient alimentation. For this reason this regime, while useful for a short period of time, cannot be employed indefinitely.

Widal and Strauss have conclusively shown that chloride of sodium retention which is frequently met with in nephritis leads to edema. This discovery gave origin to a new mode of diet appropriate for these cases, namely the salt-free diet. Restriction of fluids and of chloride of sodium is most important. The diet consists of bread, milk, eggs, arrowroot, rice, vegetables; everything prepared without salt. Fish, poultry or meat may be added, and milk (if not desired) entirely omitted from the bill-of-fare. The quantity of meat should however, not exceed 1/4 of a pound a day. Fruits should be given in considerable quantities, while spices and meat soups, likewise alcoholic beverages, should be entirely forbidden. The salt-free diet regime has been generally accepted and is employed with great benefit.

Another mode of dietary regime for dropsy has been suggested by Kakowski.1 This eminent clinician gives his patients 3-5 pounds of squash daily divided into 3 portions, prepared with milk or cream or rice soup and butter. The squash is prepared as follows:

Raw squash, in quantities of 3-5 pounds, is cut into small pieces and placed into a pot, a small quantity of water, enough to cover the bottom, is added and the whole mass stirred. The pot is now left boiling over a low fire for two hours, and the contents are frequently stirred. The squash mush is then mixed with some butter and milk-soup (usually rice soup) and is ready for use. Instead of water the squash may be prepared with cream, which gives it a better flavor and makes it more nutritious.

Kakowski had excellent results from this exclusive squash regime. He considers the squash as the best natural diuretic, increasing the secretory function of the kidney without having any slight irritative effect on this organ.

1 A. Kakowski: "Die Kürbisbehandlung der Odeme." Zeitschr. i. phys. und diätetische Therapie, Juni and Juli, 1914, Bd. xviii, h. 6, 7.

In conjunction with Dr. N. Stadtmüller I have employed squash and also musk melons, watermelons and cucumbers in cases of dropsy. While we did not see as striking results as described by Kakowski, we, nevertheless, had the impression that this group of fruits (cucur-bitæ) acts beneficially on the kidney function and deserves recommendation. The squash we gave as prescribed by Kakowski. Musk and watermelons, we employed raw (about 2 pounds daily), taken in conjunction with a salt-free diet. The cucumbers were given as a vegetable, boiled in milk, about a pound daily, also in conjunction with a salt-free diet.

Squash, melons and cucumbers may be administered with advantage not only in cases of dropsy, but in all instances of kidney derangement. The beneficial action of the cucurbitaceæ may be explained by their richness in potassium salts while containing but little chloride of sodium, and also by their mild aperient qualities.