192 FRANKLIN C. McLEAN 



Epstein reports remarkable results. In his cases, diuresis, with corre- 

 sponding reduction in the amount of edema, followed very shortly after 

 the diet was inaugurated, and within a few weeks edema was absent, 

 the urinary protein diminished or disappeared, the renal excretory func- 

 tion improved, and the composition of the blood became approximately 

 normal. In one severe case, in which the output of urinary protein had 

 been as high as 41.2 grams in 24 hours, edema disappeared completely 

 and permanently, as well as every trace of the original renal disturbance 

 after six months of treatment. The patient, a young man of 23, was 

 later drafted into the army, and shortly after discharge was accepted by a 

 life insurance company as a desirable policy holder. Favorable results 

 following the Epstein method of treatment have also been reported by 

 Allbutt, MacLean and DeWesselow, Box, and Symes. 



Epstein calls attention to the fact that chronic parenchymatous 

 nephritis is often associated with pregnancy, and states that it is neces- 

 sary to inquire closely into the relation of the process to reproduction, 

 including lactation. He also states that some cases are associated with a 

 certain degree of myxedema, and that although such cases may closely 

 resemble, the pure form of parenchymatous nephritis ultimate cure is 

 not attained until the use of thyroid extract is instituted. 



Epstein has used the same dietary measures in cases of chronic diffuse 

 nephritis, and in the mixed type of chronic nephrosis with superimposed 

 diffuse nephritis, with favorable results, as far as albuminuria, edema 

 and blood proteins and lipoids are concerned, but without any influence 

 on the course of the nephritis, or upon the impairment of renal excretory 

 function. He concludes that in such cases, in the absence of marked 

 accumulation of nitrogenous waste products in the blood, high protein 

 diet may be used with advantage. If, however, the blood shows extreme 

 retention of these substances, proteins in the diet must be restricted. In 

 such cases the diet should consist largely of carbohydrates until the excess 

 of nitrogenous waste products in the blood is eliminated. Restriction of 

 salt and water is usually also necessary. The amount of fat which should 

 be given with the food must be judged by the lipoid content of the blood. 



Drug Therapy. Digitalis. In cases of heart failure with edema the 

 effect of digitalis is usually marked, and in most cases no other diuretic 

 is needed. Digitalis is also of great benefit in cases of nephritis in which 

 edema occurs as the result of heart failure. In such cases the indications 

 for administration of the drug is the same as in uncomplicated heart 

 failure. 



Diuretics. The diuretics of the theobromin group are often of value 

 in the treatment of edema of heart failure, and may be used to supple*- 

 ment the use of digitalis. Diuretin, or theobromin-sodium-salicylate, in 

 doses of 1.0 gram four times daily may prove effective. If no effect is 

 produced within four to five days further administration is useless. 



