Two objects must here be aimed at: to diminish the loss of albumen, and the production of effete excretory products. It has been erroneously thought that, because albumen is lost by the kidney, there must be an excess of albumen in the diet to compensate for this loss; but it is forgotten that while the albumen is lost by the blood the urea is retained, and that as in the digestion of albumen, urea is the final product, an excess of albumen in the food will, when the kidneys do not excrete all the urea, lead to a dangerous accumulation of poisonous products in the blood, with probably uraemic poisoning, coma, and death as the result. The indications therefore are to give such nutritious food as will maintain the strength without increasing nitrogenous refuse in the blood.

Milk Diet

It has been found that the best food in severe cases of Bright's disease is milk, and if it is well borne the happiest results have been obtained from an exclusive milk diet. It is quite remarkable how beneficial the result often is when a rigid milk diet has been maintained. The amount of urine has increased, the albumen passed has diminished, the amount of urea excreted has been augmented, the dropsy has disappeared, and the improvement in strength and the general well-being have been most marked. The milk should be taken as fresh as possible, and in small quantities at short intervals, namely, about six ounces every hour during the day, one glass on getting up and another on going to bed - about from three to four quarts a day in all. If the milk is disliked and produces a disagreeable taste in the mouth, it can be mixed with a little lime water or aerated waters, or a small amount of alkaline water can be taken after the glass of milk. If the milk treatment is tolerated by the patient, it should be continued either till there is a complete disappearance of albumen from the urine, or the amount of it is very much reduced. This period varies in different cases, but usually after six to eight weeks of milk diet, there is such a marked improvement in the condition of the patient, and such a striking amelioration of symptoms, that he may be allowed to gradually return to a mixed diet. If there should afterwards be a return of the dropsy and albuminuria the milk diet should be again enforced.

Some patients have been known to live on milk for years, and have certainly suffered less discomfort, and have lived longer, than if they had attempted to live on an ordinary diet. On leaving off the milk diet the return to an ordinary regimen should be by cautious and slow degrees. A little arrowroot should first be mixed with the milk, then rice and tapioca, milk puddings should be added, and finally a little fish, chicken, and cooked vegetable may be ventured on. Daily examinations of the urine should be made to see what influence the change of diet has on the excretion of the albumen, and if any particular articles of diet exercise a malign influence. If the albumen does not reappear, a light nutritious dietary can then be established.