A fundamental principle of treatment in all like cases, acute or chronic, is to administer as much water as the patient can take, for water is the very best simple diuretic.

The next point is, restrict the quantity of proteid in the food. As a physiological axiom, I lay it down that animal proteid is a far more active stimulant than vegetable proteid; that 100 grams of animal proteid will pass through the kidneys in the form of urea in half the time the same quantity of vegetable proteid will take in leaving the organism. In other words, animal proteid is a far greater stimulant to destructive metabolism than vegetable proteid. Under the guidance of this fact, it appears to me, and experience bears me out, that a large part of the proteid of the food in such cases should be derived from the vegetable kingdom.

However, we must be guided by the idiosyncrasies of each patient. Some patients cannot tolerate too much vegetable proteid owing to the disturbance of the digestion and assimilating organs. Other patients cannot digest milk beyond a certain limited quantity; it would be inflicting great injury to compel such patients to ingest milk beyond a certain small quantity.

One point I must caution my readers against: that is, do not allow your patients suffering from kidney disease to take soups and broths made from animal stock, because these forms of food contain large quantities of meat extractions, which are great irritants to the epithelia of the kidneys. Beans, peas and other leguminous foods are difficult of digestion; therefore should be used as food by such patients in small quantity. The proteids of wheat, rye, barley, oats are highly nutritious and of easy digestion; to these I add rice, cornmeal, potatoes and the like. Eggs and milk constitute a good food, but too much albumin is not good, inasmuch as it makes urea in large quantity. Eggs made into pudding with rice or good cornstarch answer a very excellent purpose as an occasional diet. It is scientific to study how the food stuffs may be changed in various combinations to form toothsome dishes.

I have several times seen patients take with relish a dish made from a tablespoonful of minced raw beef dropped into a teacupful of milk in which half a teaspoonful of cornstarch was stirred, then slowly bring the milk to slight simmer, at this moment the minced

beef is dropped in and well mixed, remove from the fire, let stand in a warm place an hour, season to taste. This makes an excellent dish for one meal and should not be repeated the same day. A tablespoonful of fresh cream may be stirred in a tumbler of hot milk for drink at meals. Some patients can bear 3 to 4 pints of milk per diem; it is wise to remove part of the cream to avoid upsetting the digestion by too much fat. Fat, however, is a check on proteid metabolism; the former when properly used in the diet aids in nourishing the tissues, admitting of less proteid being taken in the food. I have often witnessed patients who were doing illy on proteid food immediately improve and begin to do very well when half the proteid was cut off and a liberal allowance of fat added. It is to be remembered that the albuminuria that is so prominently present in chronic kidney diseases can be modified and held in check only by wisely directing the diet; that increasing the amount of proteid in the food in these cases is the most unphysiological and, indeed, dangerous procedure, because the increase of albumin in the urine is indicative that the damaged kidneys are being more seriously damaged by the proteid in the food. In these cases we are bound to determine by trial and patient investigation how small amount of proteid the patient can live on and do well; that is, have less albumin in the urine, less prostration, less edoma, less restlessness, be more comfortable in general feelings, have better appetite, and more vigorous digestion and assimilation.

In nearly every case of chronic Bright's disease there is more or less damage to the heart; in consequence the circulation grows weak and defective, albumin increases in the urine, and anasarca augments. Such cases are treated by the allopaths with Digitalis, which, in my experience, is sure to further damage digestion and do the patient harm, while it is not sure it will benefit the circulation to any valuable degree. I most generally find Caffein, Convallaria, Collinsonia, Eupatorium purpura. Sometimes Strophanthus does excellently well in minute doses, strengthening the heart and aiding the absorbents and veins to remove the accumulated water. However, our main reliance in all such cases is in proper, careful feeding, nursing and hygiene.

Germain See is a strong advocate of almost exclusive milk diet

He has also

in all such cases; with his advice I am in accord. advised the use of Milk Sugar as a diuretic, which I have found to serve a valuable purpose in several cases. I have used Milk Sugar along with Queen of the Meadow, Smart Weed, Wahoo and Black Haw, in weak infusion. I order an ounce of either of the above medicaments infused in one quart of boiling water; two to three fl. ozs. of the tea is sweetened with Milk Sugar, the doses to be repeated every hour. In favorable cases a large flow of urine will take place and be kept up; during the twenty-four hours from 30 to 46 ozs. of urine can be obtained from the patient. During the time

it is wise to order liberal allowances of milk, either partly skimmed or whole, to be taken. Some patients can take 4 to 8 pints of milk and 6 to 8 ounces of good light bread buttered, and possibly a soft boiled egg or two during the day.

The more liquid food taken the better; the more the kidneys can be provoked to activity without stimulating their epithelia, the surer are good results to follow. It is wise to bear in mind that the epithelia of the kidneys are the essential parts of the organ, and through their normal functional activity are the nitrogenous wastes, water and other effete matters removed from the blood.

Some practitioners place great stress on the importance of testing the urine every day to determine the quantity of albumin it contains. This may be of value, so far as knowing the fact that the urine contains albumin, and the average quantity. However, I know that we gain valuable information in knowing the quantity of urine the patient voids every day, and as the quantity increases the albumin is diminishing. I have also learned for years that it is wise to know the specific gravity also; experience has taught me that as the quantity of urine increases, and the specific gravity with it, the kidney disease is diminishing in serious intensity, and the epithelium of the convoluted tubules are regaining their physiological integrity. I have often seen deep engorgements of the kidneys caused by taking cold, accompanied by immense quantities of albumin in a very diminished secretion of urine. These cases improve rapidly by applying local heat over the loins, soaking the feet and legs in as hot water as can be borne, excit-. ing profuse perspiration by the vapor bath; or hot blocks placed around the body, abundance of infusion of Smart-weed, Lady Slip

per, Queen of the Meadow, and other hot potations of weak teas to excite and keep up free diuresis and sweat.

Our Eclectic fathers treated these cases with marked success. They frequently resorted to the alcohol vapor bath to produce sweat. The way this was usually accomplished was simple enough: a saucer half full of alcohol was placed on the floor under a canebottom chair in which the patient was seated, if able to sit up; his body up to his neck was enveloped in blankets and quilts, including the chair, the alcohol was fired, the combustion engendered immense quantities of hot vapor which was kept into the confined space by the blankets; the body was subjected to the action of the hot vapor for from 20 to 40 minutes, a profuse sweat was provoked; the patient was hurried to bed enveloped in the blankets, sweating was kept up by drinking considerable quantities of hot Smart-weed Tea. This sweating was kept up an hour longer in bed. It is not unusual for this treatment to "break up" a severe cold or an intense engorgement of the kidneys and restore equilibrium to the circulation,

Our fathers found pure Cream of Tartar the best aperient and an excellent diuretic. The medicament was administered in hot teas, in doses of 2 to 3 drachms, repeated at proper intervals, say two to four hours, according to the state of the bowels. As to being constipated, Cream of Tartar makes the urine alkaline, increases the quantity, bringing away with it large quantities of urea and other crystaline nitrogenous wastes, diminishes the quantity of albumin, and often acts well on the skin also. Under this system of treatment, and careful selection and adjustment of food, I have kept many old people alive for years and years. There is an old gentleman 78 years old, and an old lady 69 years old, sufferers from Bright's disease, who have been under my care, one eleven years, the lady eight years, both of whom would have died years ago, but are in enjoyment of comfortable health for them. Occasionally indiscretion of diet will work terrible retributive resultsfever, pain, oedema, suppression of urine, so as to reduce the usual quantity to less than half in 24 hours. By vigorous treatment on above mentioned lines, and cutting off almost all proteid food, eschewing animal albuminoids, serving skim milk, making them drink abundance of hot Smart-weed Teas well freighted with cream

and milk, keeping in bed between blankets; small doses of Strychnine and full doses of Convalaria; I have always succeeded in restoring them to a fair condition of health.

The condition of the heart and circulation in Bright's disease must be ever a matter of careful consideration, to prevent congestions, passive venous engorgements in the thorax and abdomen, to keep up carefully sufficient blood pressure in the renal arteries, on which physiological secretion of urine depends in a great measure, to which, and I believe, Convalaria contributes very considerably. It is a good heart tonic, a tonic to the kidneys, a trusty stimulant to the secretory elements of those organs without irritant influence on the epithelia.

In conclusion, I insist carefully selected and adjusted diet is the main treatment; without due regard to this all else must be unsuccessful. I am confident most of the drug treatment recommended from time to time has been either useless or worse, even harmful, and often dangerous to the patient's life. Attention to the state of the intestinal tract, to keep this soluble; due regard to the skin, to keep this active; to see to the urinary apparatus that it is brought to and kept in a state of physiological activity, by means that are not irritating to the kidney epithelia; that the liver be kept in physiological activity. As regards the liver, I here take opportunity to say there is a very close physiological intimacy between the hepatic and renal functions; that their relation is exceedingly important so that physiological equality and unanimity be maintained. Probably nearly all the urea is made in the liver; that many compounds of a nitrogenous nature undergo changes in the liver to fit them for elimination, and when the liver fails in this function these unchanged compounds are retained in the blood, producing in the organism the conditions favorable to producing the conditions prominent in Bright's disease; that the kidney disease is, in all probability, secondary to the preceding conditions.

Experience has taught me that many of the diseases of the liver are near kin to many renal diseases, especially those of the Bright's type; that both classes of diseases are treated very nearly alike successfully. Chionanthus has proven a very valuable medicament in many forms of Bright's disease of the kidneys, as well as in