EDEMA 191 



four, and eight o'clock. No other liquids or solids are given during the 

 day or night for a pjeriod of from four to seven days. This regime 

 furnishes 800 c.c. of fluid, 32 O. of protein, 300 calories, and 1.3 O. 

 of sodium chlorid. A regime so deficient in nourishment cannot of course 

 be continued for more than a limited period. Occasionally even more 

 stringent limitation of intake is made for a few days, down to 300 or 

 400 c.c. of milk per day. It is customary. to prescribe a gradual return 

 in the course of the second week to a more permanent diet, which will 

 probably be of restricted but adequate fluid caloric and protein content 

 and of low salt content. With a patient resting in bed the ordeal is 

 usually easily borne, and the results generally justify the procedure. 

 Edema often disappears rapidly, and convalescence is materially 

 shortened. 



Epsteins Dietetic Therapy of Nephritis with Edema. After analyz- 

 ing the blood serum and edematous fluid from patients with certain forms 

 of nephritis, especially the form known as chronic parenchymatous 

 nephritis (nephrosis) Epstein (6) concluded that the cause of edema, in 

 this type of nephritis at least, is "the decreased osmotic pressure of the 

 blood resulting from the diminution of the protein content of the blood- 

 serum, a condition directly due to the steady loss of large quantities of 

 albumin in the urine." According to him, "the altered condition of the 

 blood-serum (and the consequent reduced osmotic pressure) favors the ab- 

 sorption and retention of fluid by the tissues. Hence the great edema and 

 oliguria." The increased lipoid content in the blood in chronic parenchy- 

 matous nephritis, according to Epstein, "indicates a state of impaired 

 nutrition, and constitutes an additional disturbing factor in the physico- 

 chemical state of the blood." . 



On this basis, Epstein states that the indications for treatment are: 

 "first, to increase the protein content of the blood, and thus to restore its 

 osmotic power ; second, to remove the excessive lipoids." To effect this 

 result he finds it necessary to give a diet which is rich in proteins and poor 

 in fats. Starchy foods are limited in order to promote the maximum 

 assimilation of proteins and to lessen the production and retention of 

 water. 



An example of the diet used by Epstein is as follows : 



per diem 



Water 240 c.c. 



Milk (skimmed) 360 c.c. 



Coffee 180 c.c. 



Broth 220 c.c. 



Egg white from 8 eggs 



Cracker 1 



Matzoths 1 



Veal chop 1 



Chicken 2 oz. 



Vegetables (5% carbohydrates) 250 grams 



Vegetables ( 10% carbohydrates) 100 grama 



Orange 1 



